Weight and Healthcare

Remember when I wrote about the FDA Averse Events Reporting System and how the drug companies are required to report adverse events? Novo Nordisk just got a warning from the FDA for…not doing that. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I’m very excited to announce the culmination of a project I’ve been working on for Project HEAL. They are an incredible organization that works to break down systemic, healthcare, and financial barriers to eating disorder healing. They already had a series of templates for insurance appeals and they reached out to me to create a blog post and templates to appeal weight-based denials and failure to accommodate. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1 we looked at the problematic justification used by the Colorado Legislature to pass legislation following massive lobbying from the weight loss industry and their astroturf “patient advocacy” groups.Today I am going to talk about the actual contents of the law and am grateful for input from an attorney with many years’ experience in health care law and regulation who was willing to provide thoughts but did want to note that they are not admitted to practice in Colorado. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

A bill in support of weight loss interventions, particularly GLP-1 diet drugs, has passed the Colorado state legislature and been signed into law. Very similar bills are being pushed by the weight loss industry (and their astroturf “patient-advocacy” groups, particularly the “Ob*sity Action Coalition”) in individual states and federally with the goal of increasing insurance coverage (and through that the market, and through that the profits) for weight loss drugs and other weight loss interventions.I’m going to go through the bill bit by bit as it relates to weight science, weight stigma, healthcare, and areas that suggest weight loss industry influence. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I got the following question from reader LouAnna who asked“I just saw that they are developing even more new weight loss drugs of the GLP1 type that (supposedly, of course) create even more lost weight. What ever happened to the claim that we just need to lose 5-10% ? Don’t these new weight loss drugs already claim that they exceed that? Will it never stop?”This is a great question and I’m happy to offer my thoughts. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we discussed a study that showed that malnutrition is very rarely studied in randomized controlled trials for GLP-1s. In part 2 we looked at the findings of research that studied nutritional deficiencies in GLP-1 users. Today we’ll talk about the implications of these findings, including what we know, what we don’t, and what we should. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1 we talked about a study that showed that most randomized controlled trials for GLP-1s failed to assess nutrition/possible nutrition deficits. Today I’m going to summarize some research that did look at these possible issues in people using GLP-1s. In Part 3 I’ll talk about the implications of all of this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I subscribe to a borderline ridiculous number of medical publications from which I receive an absolutely ridiculous number of emails. One headline caught my eye “GLP-1s Bringing Back Scurvy?” Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received the following reader question:My name is Mary and I’m a family doc (you can use my first name if you print this.) I wouldn’t say that I’m fully onboard with being weight inclusive but I’ve been reading your work and I can’t deny that what you are writing makes sense and is grounded in research (some of which I had never heard of in any of my training.) I have been thinking about what you wrote when you said how important it is that we ask our patients questions instead of making assumptions. I will admit to making assumptions about diet and exercise with patients who are what you would call higher weight. Thank you for helping me see that, but I’m having difficulty with what to do instead and how to ask the questions and I thought others might be as well. Is this something you would be interested in writing about?Thanks for the introspection, the open-mindedness, and the great question, I’m happy to write about this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1 we looked into the authors and methodology of the study The Acute Inflammatory Effects of Weight Stigma: An Experimental Pilot Study which was published in August, 2025. In part 2 we’ll look at the results. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

A new study in this vein has come out that looks at the link between weight stigma and inflammation. The study is called The Acute Inflammatory Effects of Weight Stigma: An Experimental Pilot Study and it was published in August, 2025. In part 1 we’ll look at the study authors and the methodology, and in part 2 we’ll look at the results. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we discussed the issues with the decades-long practice of healthcare providers prescribing behavior-based weight loss not based on the evidence (which shows that the vast majority of patients will lose weight short-term and then regain it long-term) but on the belief/hope that every one of their patients will experience the very rare “Best Case Scenario” of significant, sustained weight loss. Today we’re going to talk about how the new GLP-1 weight loss drugs are taking this problem to new lows. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

When it comes to recommending weight loss, healthcare has always had what I call a Best Case Scenario Problem. I think the best way for patients to protect ourselves from this is to understand it so that we can spot it when it’s happening so in Part 1 I’ll examine how this works (in the past and currently) around behavior-based interventions and then in part 2 we’ll look at how GLP-1s are driving an increase in this problem and creating even more harm and what we can do if this problem happens to us. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I’ve had a bunch of requests to write about this so here you go! Novo Nordisk has a long and sordid history of misdeeds, many of which I’ve written about previously. Now they have a new one to add to the list. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In Part 1 we started discussing the “Million Pound Challenge” created by Toby Cosgrove and Dr. Michael Roizen in which they are “challenging” an unknown number of people to collectively lose one million pounds. In part 2 we’ll discuss the program itself. (If you haven’t read part 1, I recommend it to fully understand part 2.) As always I’ll indent the quotes from the website so that you can avoid harmful weight stigma if you choose. They explain the program as a 3-step process:Step 1: Enroll Your OrgRegister your health system. Get access to a variety of resources in the Million Pound Challenge Tool Kit for your entire team.Step 2: Your Staff, Your WayEmployees can use the tools provided, join their own programs, work with providers—whatever works. Your organization decides how to structure participation.Step 3: Track ProgressThe only requirement? Track results with a monthly check with your Challenge coordinator. Watch as individual effort becomes collective momentum toward one million pounds.This is where they make things incredibly clear - literally the only requirement is to track weight loss. This isn’t about health metrics, there is no way to make this program weight neutral or to focus on health - weight loss is the only metric and tracking it is the only thing the program requires.And when they blithely say “whatever works” let’s be clear that a century of research finds that, unless their goal is to create weight cycling, nothing does. So there is no common intervention and all they are tracking is weight loss. Right. And how is weight loss tracked? Per the FAQs (emphasis mine)“Your Challenge ambassador must log your team’s results monthly with your assigned Challenge Coordinator—this is the only requirement. Individual weights remain completely private. Only aggregate organizational totals are posted on the community leaderboard so you can see how your organization compares nationally.”Um, they aren’t private if you have to share them with your company’s challenge ambassador (and I have serious concerns that someone who would sign up for that job may be the last person that a coworker would want to tell their weight.) Workplace programs (or any programs) that include a weight loss component have significant risks to physical and mental health, including through eating disorders. But programs that compel people to compete solely on the basis of weight loss, as this one does, can actually encourage participation in dangerous behaviors in order to create weight loss.Measure your organization’s progress, celebrate your success stories, and recognize your top-performing teams. Join leaders at quarterly events, Chamber Summit, Aspen Ideas Festival, and HLTH to keep momentum strong.Do. Not. Do. This. Another huge issue with this, and all workplace/organization weight-loss challenges, besides the issues with disordered eating and eating disorders and weight cycling, is that it can single out people who aren’t participating or “achieving” in ways that create a hostile work environment for them. It can mean that those who have chosen an evidence-based weight-neutral path (either due to a history of eating disorders or other reasons) have to choose between their physical and mental health and being seen as “not a team player.” It can lead to organizations under valuing employees who, due to many reasons including disability, chronic illness, and more, cannot participate in the initiative at all (or in ways that make them “top-performing”) which can lead them to being seen by subordinates, peers, and bosses as a “drag” on the team or having less value to the organization. This is not surprising from someone like program co-founder Toby Cosgrove who once gleefully told the New York Times magazine that he didn’t want to hire higher-weight people (as the CEO of the Cleveland Clinic,) but let’s not follow in those bigoted footsteps.After 12 months, we’ll have collectively proven what we’ve known all along—that sustainable health outcomes are achievable. Winners celebrated at HLTH 2026. Every organization recognized for leading the revolution.There is so much wrong with this that I scarcely know where to begin. As I said in part 1, “prove” is a very strong word so I expect robust research and lots of it (spoiler alert - I’m going to be disappointed again, but in no way surprised, again.) These two doctors should know better than to suggest that anything about “sustainable health outcomes” can be “proven” by a random “challenge” that only lasts a year has no common intervention, and only measures weight loss. This does not have the ring of sound science. The truth is, we can’t even be sure how many of the participants would get thin enough that program co-founder Toby Cosgrove would think they deserved to be employed.I don’t want to spend too much time analyzing the deck chairs on this titanic

Reader Shannon Roosma-Goldstein, MPH, BSN, RN, NPD-BC recently reached out to me because a professional healthcare organization she belongs to had sent her an email encouraging her, as a member, to participate with the organization in the “Million Pound Challenge.”In Part 1 we’ll look at the basic issues with the challenge and who is behind it. In part 2 we’ll look at the details of the program, and in part 3 we’ll talk about what you can do if your workplace announces a program like this, including with sample letters written by Shannon that you can use as a template. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Behavior-based interventions (sometimes under the auspices of lifestyle medicine) can be evidence-based, health-supporting, and weight-neutral. Unfortunately, when it comes to recommending behavior-based interventions to higher-weight people, there are common mistakes that providers make. We’ll talk about the mistakes and then what patients and providers can do to avoid and/or navigate them. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we started looking at a study called Weight Regain after cessation of medication for weight management systemic review and meta-analysis by West et al. and in part 2 we looked at the findings. Today I thought it would be helpful to look at how the media is covering this study so we can see how these findings translate. If you haven’t read part 2 (or, at least, the summary) then I recommend starting there. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1 we began discussing Weight Regain after cessation of medication for weight management systemic review and meta-analysis by West et al. Today we’ll discuss the findings. This is a long one so I’ve got a summary and then a deeper dive. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I’ve received well over a hundred questions about this new study, all asking roughly the same thing - what does this mean?In Part 1 we’ll talk about the study authors and methodologyPart 2 we’ll talk about the findingsPart 3 we’ll talk about how the media is covering the studyThe study we are looking at is called Weight Regain after cessation of medication for weight management systematic review and meta-analysis by West et al. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I was recently advocating for a patient who needed an emergency head CT to rule out some potentially serious complications. (Luckily she was fine and her symptoms had the least concerning diagnosis.) Of course, I have her permission to write about this.A content note, this post is going to include medical weight stigma.After the imaging was done and the report completed the doctor came into the room to tell her that everything on the CT looked “great”.The next day, the results were released to her MyChart and she had an unpleasant experience that I’ve heard from many other patients.The first line of the “impression” section was “Significantly limited evaluation due to body habitus.” That was also the first line of the “findings” section. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we looked at the basics of the newly approved Wegovy pill for weight loss. In part 2 we began looking at the trial that was used for approval (Oral Semaglutide at a Dose of 25 mg in Adults with Overw*ight or Ob*sity.) Today we’ll look at the findings of that trial. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1 we looked at what Novo Nordisk’s page said about the new Wegovy Pill for weight loss. Today we’ll look at the trial. Now, Novo didn’t link to the trial (or even mention the name or the authors) on the webpage. They did say twice that it was a 64 week trial. That threw me off for a minute because it was actually written up as a 71 week trial, but we’ll get to that. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Wow did I get a lot of requests to write about this! We’ll start with some basic information today and then break down the actual trial data in the rest of this series. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received the following question from reader Rebecca:This is my first New Years away from dieting and while I am happier (and healthier, though I know that’s complicated) than ever. Still I am struggling with New Years Resolution season, do you have any tips for making non-diet resolutions that focus on my health?I’m happy to help, you are definitely not alone in trying to navigate this time of year in weight-neutral, non-diet ways! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we talked about a trial of semaglutide for knee osteoarthritis. In part 2 we compared that trial to a trial that used metformin. Today we’re going to talk about research around behavioral (non-pharmacotherapy) weight-neutral interventions. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we looked at a study of the effect of semaglutide 2.4mg (Wegovy) on knee osteoarthritis. Today we’ll look at two studies that consider the effect of metformin and compare that with the semaglutide study. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I've received a number of questions about GLP1s and knee pain/osteoarthritis and in this series we’ll look at what the research says.In part 1 we’ll look at the trial for semaglutide and knee osteoarthritis.In part 2 we’ll look at 2 studies that consider the effects of metformin on knee osteoarthritis.In part 3 we’ll look at a study of a weight-neutral intervention Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received a question from reader Brit who said “I see you and other people talking and writing about the weight-inclusive and weight-centric (and sometimes weight-neutral and weight-loss paradigm). I think I know what they mean but could you give a quick explanation?I’m happy to Brit, sometimes it’s good to go back to basics! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1 we began discussing the article “Implications of a New Ob*sity Definition Among the All of Us Cohort” by Fourman et al. This is a study that took the recommendations of the (heavily financially entangled with the weight loss industry) Lancet Commission around increasing the methods by which “ob*sity” can be “diagnosed” (the massive issues with which I wrote about here,) and applied it to the All of Us population. So what did they find? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I previously wrote about a Lancet Commission that published what I would describe as an opinion piece that they attempted to disguise as legitimate science. In it, they manipulated multiple research processes in order to create the largest possible market for the weight loss industry (in which the authors had massive financial entanglements) by wildly expanding the ways that someone might be “diagnosed” as “ob*se.” You can read about the whole sordid affair here. This has been a longtime goal of the weight loss industry and this group of financially entangled authors made it real, at least in their article.Now another group of authors have shown the reality if these ideas are applied in the real world. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Today I’m taking a break from talking about weight and healthcare to write about navigating so much of the nonsense that happens during the holiday season. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Today will be the first post in a short series discussing attempts to “calculate” the (supposed) “costs” of “ob*sity.”Before we get into any of this I want to say unequivocally that anytime we try to calculate the cost of a group of people, including and especially, to support a call for their eradication, we are going down a very bad, very wrong road. So while I will be discussing the specific issues with these calculations, please always remember that the calculations shouldn’t be undertaken in the first place. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1 we looked at the basics and early research around GLP-1s for weight loss and muscle loss. In part 2 we looked at recent research around the newest GLP-1 weight loss drugs, tirzepatide (Zepbound) and semaglutide (Wegovy).In this final part of the series we are going to talk about the justifications/excuses/spin that are happening around the loss of lean muscle mass on GLP-1s. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1 we looked at an early study of GLP1 drugs and muscle loss. Today we’ll look at two more recent studies, one for Eli Lilly’s drug tirzepatide and one for Novo Nordisk’s drug semaglutide. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

As GLP-1 drugs get heavily marketed for weight loss, we know that when people stop taking the drugs they experience rapid weight regain. We also know that, while the claim is that if people stay on the drugs forever they’ll maintain the weight loss, there isn’t any research proving that and that in the longest study of these drugs for weight loss (4 years) they lost 89.5% of the sample.There is another aspect that I think is not being discussed nearly enough and that is the subject of how much of the weight that is lost is coming from what is known as lean body mass. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Several months ago I was asked to complete an interview over email for online publication The Quo. I was recently told that the writer fell ill and that the piece won’t be published. The interview was, essentially, a quick guide to the issues with diet drugs and surgeries for children so I thought I would publish the answers here. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I write a lot here about the fallacy of blaming health issues on body size. Today I want to talk about the tendency to credit weight loss for physical, psychological, and social benefits. For example, someone will (at least short term) lose weight and offer a testimonial about how much better they feel, how much more they are doing in the world etc. Or a study will determine that Health Related Quality of Life (HRQoL) has improved after weight loss.Just like a weight-centric healthcare system (and world) tends to completely uncritically blame weight for health issues, it also completely uncritically credits weight loss for health, life, and HRQoL improvements. Today I want to take a critical look at this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I last wrote about the Ob*sity Action Coalition (OAC) in 2022 and you can read about their history in that post here. It’s time for an update. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I got the following question from reader Katrina:“You spoke to my doctoral program recently and in the Q&A you said something about poking holes into people’s thinking where better ideas could fall in. In the past I’ve talked to my doctor about research. I love the research posts you make but I know my doctor isn’t going to read or listen to something that long (he really should he just won’t!) Do you have some quick questions I could ask to poke some holes in his thinking that better ideas could fall into?”Sure Katrina, here are my top 5 quick questions for when a doctor (or friend or family member or article etc.) makes claims that being higher-weight causes health issues and/or that weight loss is a treatment or cure. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

One of the things I’m seeing with the rise of GLP-1 weight loss drugs is other companies trying to use these drugs as a profit center. Today we’ll look at a drug that is seeking approval to help those who take GLP-1s avoid some of the adverse events. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I write a lot here about the specific lies, obfuscations, and shenanigans done by the weight loss industry. But there are two overarching lies that I think may do the most harm in weight and healthcare sometimes consciously and sometimes subconsciously - as part of the unstated background of decisions around purchasing, care, and accommodation. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

After I posted the final part of my 3-part series on GLP-1s and kidney function, I got a question from reader Liza:“I appreciate how you always talk about how the authors get money from the drug company, I think it’s important to know. As I read this newsletter [GLP-1 and Kidney Function Part 3] I was wondering if it is possible to calculate how much the drug company themself would make?”This is an interesting question. I think it’s tough to figure out because (at least here in the US) discount cards and insurance companies and PBMs and discount pharmacies et al. mean that people (even people in the same family!) can pay vastly different amounts for the same drugs.I do think it’s possible to at least come up with an estimate of the highest possible amount of gross profit. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 and 2 we explored the document “Person-Centered Conversations: Weight Management and Type 2 Diabetes” that was put out by the Association of Diabetes Care and Education Specialists (ADCES) as a “framework” document. Reader Emily wrote in to ask if I would analyze it as she has recently been told to use it in her work as a diabetes educator. In Part 1 we looked at the basics, in part 2 the conversation recommendations. Today we’re going to look at what they are calling “Continuing the conversation” Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we started to explore the document “Person-Centered Conversations: Weight Management and Type 2 Diabetes” that was put out by the Association of Diabetes Care and Education Specialists (ADCES) as a “framework” document based on a request from reader Emily who is a diabetes educator who was recently told to use this document in the care of her higher-weight clients. Today we’re going to look at their specific recommendations for these conversations. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I recently got this question from reader Emily:I work as a diabetes educator and the place where I work just sent this document to everyone and told us that we should use it when talking to “o-word” patients. It doesn’t seem right to me at all can you do some analysis so I can push back?Thanks for asking Emily, I will do my best. The document she is referring to is called “Person-Centered Conversations: Weight Management and Type 2 Diabetes” and was put out by the Association of Diabetes Care and Education Specialists (ADCES) as a “framework” document. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe