At the 2026 Unbreakable Health Retreat in Miami, Emily Kaplan hosted a discussion with general surgeon Dr. Patrick Larreategui, physician assistant educator Jen Garrett, and emergency physician Dr. Luke Palmisano about the role metabolic health can play inside—and outside—the traditional medical system. Drawing on their professional experiences in surgery, emergency medicine, and medical education, the panelists describe a health care system that can be remarkably effective at treating acute illness and injury while struggling to address the lifestyle and metabolic factors driving chronic disease.

The panel discusses how nutrition, exercise, sleep, and metabolic health can become a larger part of patient care, from teaching future clinicians to asking better questions to helping patients address the root, lifestyle causes that may contribute to repeated medical problems. The panelists also describe the obstacles they encounter within hospitals and medical training, including limited time, entrenched practices, and environments that can contradict the health advice clinicians are expected to give.

A recurring theme throughout the discussion is the potential for doctors, PAs, and coaches to work more closely together. The panel explores what each can contribute, where the current medical system leaves gaps, and how gyms and trained coaches may be able to provide the education, accountability, and day-to-day support that clinicians often do not have the time or structure to deliver.