Weight and Healthcare

Today I am thrilled to bring you the first of a two-part series about creating safe fitness spaces that I had the honor of co-writing with Leslie Jordan Garcia. You may remember Leslie from her 5 Questions With… feature, and you may know her as the incredible passionate multi-certified Anti-diet Ed Recovery, wellness practitioner, and fitness professional behind Liberati Wellness! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 of this series, Dr. Zed Zha shared a patient story of the harm that can happen when assumptions are made about the relationships between weight and inflammation. In parts 2 and 3, Dr. Zha examined common beliefs around inflammation, weight, and weight loss. In the final installment of this series, I’ll look at two possible confounding variables that may be at the root of associations between weight and inflammation. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 Dr. Zed Zha discussed a patient experience that elucidated the issues that happen when assumptions are made about the relationships between weight and health. In part 2 she began a discussion of four conditions that must be met to rigorously prove the theorem that weight loss lowers inflammation - “weight ↓ → inflammation ↓”. In part 3 of this 4-part series, she’ll discuss the third and fourth conditions. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In November I responded to readers’ questions about a paper that was being teased to the media suggesting a new definition for “ob*sity.” The paper is now out, and it’s even worse than I thought. I’ve had a lot of requests to write about it and there is a ton of media on it right now (though, sadly, not a ton of any kind of critical/investigative journalism.)As regular readers know, I am in the middle of a four-part series with Dr. Zed Zha about weight and inflammation. I’m pausing that today to give an overview of the issues with this article from the initial analysis that I’ve completed. After the final two pieces of the inflammation series are published, I’ll have a deep dive into the massive conflicts of interest and methodological issues with this paper. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1, Dr. Zed Zha (M.D. and Fellow of the American Academy of Family Physicians) discussed a patient experience that illuminated the need to look beyond simple assumptions about weight and inflammation. In part 2 she will begin a deep dive into the research around weight, weight loss, and inflammation. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In discussions around weight and health, the concept of “inflammation” almost always arises. This is a complex discussion and so I am thrilled and honored to share a four-part series in which Zed Zha, MD, FAAFP (Fellow of the American Academy of Family Physicians) and I explore assumptions around weight, weight loss, and inflammation.Here now, Part 1 - Patient Story - as told by Dr. Zha Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

On Saturday I posted a piece helping patients navigate weight stigma in healthcare, today I want to offer some support to healthcare providers to avoid creating weight stigma. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Higher-weight people too often find themselves in healthcare situations where they are being treated poorly/unequally because of weight stigma. These situations are, sadly, too numerous to count and in some cases need to be addressed in very specific ways. In many cases though, there are some standard responses that higher-weight patients and/or those advocating for them can use to try to get appropriate care. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This came up in our monthly subscriber Ask Me Anything. When I break down research I often talk about using absolute risk reduction and statistical significance to determine the efficacy of an intervention. Another number that helps determine efficacy is the Number Needed to Treat (NNT). This number helps us understand how many patients need to be treated with an intervention in order to avoid a single negative outcome. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

You can’t win if you don’t play.That’s what the PowerBall ad said. I could pay $2 for a ticket and possibly win a $20 million jackpot. Of course, I have a 99.9999997 percent chance of losing which may be why my stats teacher used to say that the lottery was a tax on people who didn’t pay attention in her class.So why am I going on about the lottery in a newsletter about the intersections of weight science, weight stigma, and healthcare?Because I hear a similar type of “logic” all the time from the weight loss industry, lay people, even doctors. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I got the following question from reader Naomi“Thanks for the information on the CDC growth charts. I wonder if you could talk about how to understand them. My pediatrician said that my child is more than 120 percent of the 95th percentile. What the h e double hockey sticks does that even mean? Help!” I’m happy to try to explain. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Today we’re going to talk about a new study called whose goal was to assess the “relationship of cardiorespiratory fitness (CRF) and Body Mass Index (BMI) on both cardiovascular disease (CVD) and all- cause mortality risk” by Nathan R Weeldreyer, Jeison C De Guzman, Craig Paterson, Jason D Allen, Glenn A Gaesser, and Siddhartha S Angadi. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

There are many ways that weight stigma occurs in healthcare. One that is harmful on multiple levels happens when higher-weight people are blamed for the ways in which healthcare fails them. This occurs when a patient is blamed for being “too big” for something they need. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I’ve now had eleven different doctors ask me about this article, so let’s talk about it! Here is one of the emails:“I’m an MD and I just read this article in Medscape about “clinical ob*sity.” Should I be worried? I feel like I should be worried. I understand it hasn’t happened yet, but it seems like one of those things that will happen all at once without any chance to pushback. Any ideas on how to handle this?” Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Regular readers may know that while speaking and writing are my primary work, I’m also a Board Certified Patient Advocate and I sometimes work directly with patients, typically in emergency or complex medical situations. Recently I was advocating for a patient at a cardiology appointment (who has given me permission to share this.) I was waiting outside the treatment room while my patient got settled, near the area where the scale that is used for weigh-ins was located. In this practice each cardiologist has a nurse and the nurse is responsible for getting weight as well as actual vital signs. As I was standing there a nurse brought a patient over and asked them to step on the scale. The patient made an “Ugh” noise and the nurse laughed and said “I know, weighing in is the worst. I postponed my last appointment by two weeks so that I could lose five pounds first.”At that exact moment I was called into my patient’s treatment room and so I switched my focus 100% to the patient but I am reaching out to start a dialog about this at the practice. So, what went wrong, and what go be done better? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received the following question from reader Jin,I’m a pharmacist and one of the things I’ve learned from following you over the years is the importance of language. I wanted to ask you about language like “anti-ob*sity” medication and “ob*sity treatment.” I notice that you still use terms like weight loss drugs and I imagine that is on purpose. I’d love to understand more about this. Feel free to make it a Substack post if you’d like.Thanks for noticing and thanks for asking Jin! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received the following question from reader Alina:I’m a family med doctor and I’ve started seeing lots of publications, even research, using the terms “person with ob*sity” and “person with overw*ight.” I took some CME [Continuing Medical Education] where they said that it was for weight stigma reduction. I’m not sure why, but it just doesn’t feel right at all (Does person with overw*ight even make sense?) I would love to see a newsletter about this.Thanks for asking Alina, your feeling that something’s not right here is spot on. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

There are many aspects of weight stigma within the healthcare system that harm higher-weight people. There is an issue that isn't often discussed that underpins many of the harms that the healthcare system does to higher-weight people.Research. Or a lack thereof. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we discussed a New York Times article about so-called “Ob*sity First Medicine” (OFM) which suggests that higher weight people with health issues should be targeted for weight loss treatment (in this case specifically the new GLP-1 diet drugs) treating them differently than thinner people with the same symptoms/presentations/diagnoses.Today we’re going to look at an opinion piece in WaPo that discusses the same phenomenon. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Many of you reached out to me about two articles. One in the New York Times by Gina Kolata about so-called “Ob*sity First Medicine” - OFM (you may remember Kolata from a different article I wrote about that essentially lobbied for insurance coverage for weight loss drugs and failed to disclose that each person interviewed was on the payroll of the drug companies.) Another an opinion piece in the Washington Post by Leana S. Wen. We’ll discuss the NYT article in part 1, along with some general issues and the WaPo article in Part 2. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received a reader question from Annilyn who said:“My doctor just suggested that I try the AspireAssist to lose weight. I didn’t want to Google it because I think it will be really triggering but based on what he described, I just don’t think this thing can be real, can it? Will you write about it?”I’m happy to write about this weight loss device Annilyn, and mostly I’m happy because it seems to be off the market, but we’ll get to that. I think it’s worth looking at the history and research around this thing as an example of what happens in a “thin my any means necessary” healthcare culture. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part one we looked at a lawsuit being brought by Jaclyn Bjorklund against Novo Nordisk (maker of Semaglutide - brand names Ozempic/Rybelsus/Wegovy) and Eli Lilly (maker of Tirzepatide - brand names Mounjaro/Zepbound) for the severe gastrointestinal side effects she experienced after taking Ozempic and then Mounjaro for type 2 diabetes. At the end I made the point that, for some people, the negative side effects don’t end when they stop taking the medications and for others, the damage has been done. That brings us to Juanita Gantt. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received requests from a number of you to write about this situation. Jaclyn Bjorklund, a 44 year old woman from Louisiana is suing both Novo Nordisk and Eli Lilly.Content note: this piece will include details of severe gastrointestinal symptoms and conditions. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the final part of the series about the study “Eating disorder risk during behavioral weight management in adults with overw*ight or ob*sity: A systematic review with meta-analysis” by Jebeile et al, 2023. In part 1 we talked about overarching issues with the science, in part 2 we talked about general issues with this specific study, and in part 3 we’ll discuss the specific claims made. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we discussed the overarching issues with “Eating disorder risk during behavioral weight management in adults with overw*ight or ob*sity: A systematic review with meta-analysis” by Jebeile et al, 2023. Today we’ll begin to dig into the specific issues with this study.Content note: in this piece I’ll be talking about eating disorders, including specific behaviors, and weight loss methods that include eating disorder behaviors. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

The study we’re looking at in this series is “Eating disorder risk during behavioral weight management in adults with overw*ight or ob*sity: A systematic review with meta-analysis” by Jebeile et al, 2023In Part 1 we’ll look at overarching issues and in parts 2 and 3 we’ll dig into the specifics of the study. For this section I reached out to Deb Burgard, PhD and Fellow of the Academy of Eating Disorders for her thoughts and I’m super grateful for her contributions. 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!I recently wrote about an NBC News article that included a quote from Tom Hildebrandt, PsyD who runs the Hildebrandt Lab at Mount Sinai in New York, which houses Mount Sinai’s Center of Excellence in Eating and Weight Disorders.I promised that I would write a separate article about their troubling conceptualization of higher-weight as an eating disorder, and this is that article. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we started exploring the concerning new CDC-Recognized Family Healthy Weight Programs and the issues with their requirement that “Family Healthy Weight Programs (FHWPs) are safe, effective treatments for childhood ob*sity.*”Today we’ll talk about the requirement that these programs be “Appropriate for childhood ob*sity” Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I wrote earlier about the disastrous American Academy of Pediatrics Guidelines, written predominantly by people who were either taking money from the weight loss industry or personally/through their employers selling weight loss to kids.I also did a deep dive on the serious issues with their recommendations of intensive behavioral interventions starting at 2 years old, diet drugs at 12, and weight loss surgeries at 13 as well as questionable claims around potential harm and eating disorders risk. Recently I also answered a reader question about how BMI works with kids.Unfortunately the stakes have been raised significantly as their recommendations around weight-focused interventions starting when kids are still in diapers have been given a huge boost in the form of what are called “CDC-Recognized Family Healthy Weight Programs.”I’ll be writing more about this, including analyzing specific curricula (some of which I’ve already obtained,) but I want to start with the basics. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I got this question from reader Mina:I was in a discussion about weight-neutral health and now I feel a bit confused. I practice what I always thought was weight-neutral health and I was chatting with a friend who does the same. She mentioned Intuitive Eating and I said that I knew a lot of people that worked great for, but that it didn’t work for me and before I could finish she said that in order to be weight-neutral health it has to have intuitive eating and joyful movement. That can’t be right, can it? Can you write about this please?Thanks Mina. Yes, I can write about it. No, I don’t think what your friend said is correct. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we looked at the major issues with the ways that children are labeled “overw*ight” and “ob*se”. In part 2 we’ll look at more of the nuances. Again, Deb Burgard, PhD, FAED was incredibly helpful in putting together this piece. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I got the following question from reader Lynn:“I know that they use BMI for kids and I know that it’s different than what they do for adults, but I don’t understand how. Maybe you could write a newsletter about it?”Indeed I can Lynn, thanks for the suggestion! This gets a bit complex, so it’s going to be a two-part series. In part 1 we’ll look at the basics. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

As updated COVID vaccines and this year's flu vaccines roll out, I got a request from several readers to post about the need for longer needles for higher-weight people’s vaccinations. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

While progress toward weight-neutrality is absolutely being made, our healthcare is predominantly based in the weight-centric paradigm. This paradigm currently considers simply existing in a higher-weight body to be a disease and weight loss to be the cure. (Now, there is no shame in having a disease, it’s just that simply existing in a larger body does not qualify.) One of the most dangerous harms within this paradigm is the hypothetical future thin person fallacy. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Eil Lilly has recently announced that they are going to sell their weight loss drug, Zepbound, directly to consumers who can’t get insurance coverage and don’t qualify for other cost-lowering programs. They are going to do that through their private pharmacy Lilly Direct.The subject of whether drug companies should have their own pharmacies is a topic for another day.I’ve previously done deep dives into the research and claims made about these weight loss medications. I do not think they are going to live up to the hype and I think people aren’t getting appropriate informed consent around these drugs.Still, I believe in bodily autonomy and I think that people who choose to take these medications deserve a safe experience.What I want to talk about today is the catch of Lilly’s direct drug discount. That catch is the delivery system. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I got this question from reader Jenn:I was hate watching a workshop about “ob*sity” treatment and one of the people on the panel said that “ob*sity” isn’t a disease unless it impacts someone’s health. I don’t understand how that works?Thanks for the question Jenn. You don’t understand how it works because it doesn’t work. This is fully ludicrous and I’ve seen them make the claim in real time as well. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1, by reader request, I began a discussion of the NBC news article “Weight loss drugs like Wegovy may trigger eating disorders in some patients, doctors warn”. Today we'll complete that discussion. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Many of you asked me to write about the NBC News Article “Weight loss drugs like Wegovy may trigger eating disorders in some patients, doctors warn” by Liz Szabo, Marina Kopf and Akshay Syal, M.D. 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!I received this question from reader Louise:I see you and other people talk about the weight loss industry, but what does that mean? Is it just drug companies and places like weight watchers? Do doctors who recommend weight loss count? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we talked about a Medscape Today article that reader Antoni sent me about weight stigma in healthcare called “Weight Stigma is Bad Medicine.” The author, Mengyi (Zed) Zha, MD made important points about weight stigma, some of which aren’t often aren’t made. So there’s a lot of good in the article, which I appreciate.What Dr. Zha has written is brave (and she will undoubtedly get criticism from those who implicit or explicit anti-fat bias drives their thoughts about and interactions with higher-weight people.) I’m beyond grateful that she wrote this articleThat doesn’t mean I’m not going to push farther, though, because there is more to the journey here to reduce the harm done to higher-weight people by the healthcare system and the providers within it.So there are some issues with the article that I want to discuss. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Reader Antoni sent me the following question.I saw this article posted on LinkedIn (Weight Stigma is Bad Medicine by Mengyi (Zed) Zha, MD in MedPageToday). I feel like the author made good points but it still doesn’t feel quite right to me. What do you think? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we started looking at a company called PrescribeFit that is focused on getting referrals from orthopedics office of higher-weight patients with musculoskeletal (MSK) issues. We looked at the scientific basis they are using as well as their promises around efficacy. Today, we’ll look at what they have available for providers. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This came up in our monthly subscriber Ask Me Anything and then from another email from reader Julie who wrote:“I hurt my knee playing soccer. After a lot of of imaging I was told it wasn’t surgical. I asked for a referral to physical therapy and my ortho referred me to PrescribeFit. I assumed it was physical therapy but it seems like it’s some kind of online diet thing. Can you tell me what’s going on?”I can try! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Many of you have reached out asking me to write about Brandi Mallory and Mandisa Hundley’s deaths. Today is the day I’m going to do that. I want to start by saying that their deaths, regardless of cause, are a tragedy and my heart goes out to them and their families, friends, and loved ones. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I got the following question from reader Kyrie:I started having pain in my knee after I jumped out of a truck and twisted it. I went to my regular doctor and he referred me to an orthopedist. He (the orthopedist) told me that the only thing that could possibly help was to lose weight. I asked the question that I learned from you “what would you recommend for a thin patient in this situation?” The orthopedist said “I don’t have to talk to thin patients about knee pain.” Obviously that’s a complete lie, but what can I do as a patient when a doctor just says something like that? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Reader Kellisa sent me the following question:I appreciate all the different things you write about, but some of my favorite newsletters are where you show how people and studies are paid for by the diet industry. I know this was a while ago, but I just found the newsletter you wrote about where you figured out that the person behind that “bill of rights” was actually a lobbyist for Novo Nordisk and I decided to ask this question. How do you find this stuff out? Are there any tips you can give to help someone like me “follow the money” as they say? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

As I discuss the issues of GLP-1 agonist and GLP-1/GIP co-agonist weight loss drugs Semaglutide (Ozempic/Wegovy) and Tirzepatide (Mounjaro/Zepbound)I’ve been increasingly hearing from people who are engaged in practices with these drugs that are not remotely evidence based. 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!Reader Shauna asked “I just saw an article about the Body Roundness Index, is that as silly as I think it is?”The Body Roundness Index seems to be the weight loss industry’s response to finally having to (at least begin to) admit that the Body Mass Index (BMI) is nonsense. The BMI is a ratio of weight and height that has been used to pathologize bodies based on their size alone and has its basis in racism. I talked about that in depth in this piece.Earlier this year the AMA, which takes hundreds of thousands of dollars in donations from the weight loss industry, tried a little sleight of hand with this, admitting that there are serious issues with the BMI (which has been used as a justification for the much of the weight loss paradigm) but instead of acknowledging that simply pathologizing bodies based on shared size is an idea lacking scientific basis and merit that has done incredible harm, they instead said that we just needed more and different ways to pathologize bodies based on shared size.That brings us to the study Shauna sent me: “Body Roundness Index and All-Cause Mortality Among US Adults” published in JAMA (the Journal of the American Medical Association.)The authors reported no conflicts of interest, even though one of the authors, Qiushi Lin, MD, PhD, literally works for Sanofi Aventis which just had its weight loss drug preliminarily rejected by an FDA panel.Where the BMI is used to pathologize bodies based on weight and height, the The Body Roundness Index (BRI) uses height and waist circumference.The specific calculation they used is “364.2 − 365.5 × √(1 − [waist circumference in centimeters / 2π]2 / [0.5 × height in meters]2)”The use of mathematical formulas tends to lend these concepts an heir of scientific validity that they do not deserve. They explain that “Due to the lack of a reference range, BRI was categorized into 5 groups according to the 20th, 40th, 60th, and 80th quantiles to explore the association with all-cause mortality.”They find a “U-shaped association between BRI and all-cause mortality. Our findings provide compelling evidence for the application of BRI as a noninvasive and easy to obtain screening tool for estimation of mortality risk and identification of high-risk individuals, a novel concept that could be incorporated into public health practice pending consistent validation in other independent studies.”By this they mean that those at the lower and higher ends of this scale have higher all-cause mortality. As I’ve talked about before, one of the cornerstones of research methods is that correlation does not imply causation. The U-shaped association they found might be a valid correlation. The mistake happens if the assumption is that the BRI is the REASON for the increased risk and, when it comes to weight and health (particularly those of higher-weight people) that’s what typically happens. That’s what I think the problem is going to be. In our culture, there is a tendency to jump at any perceived “proof,” no matter how shoddy, that being higher weight causes health issues/is a health issue. What these researchers have found is an unexplained correlation between being at lower and higher weights and higher rates of all-cause mortality. What they absolutely have not found is that being at lower and higher weight CAUSES higher rates of all cause mortality. They don’t ever claim that they’ve found causation but then they conclude “a novel concept that could be incorporated into public health practice pending consistent validation in other independent studies” and not, for example, that causal mechanism(s) should be identified prior to foisting this formula on the public, it gives me the sense that they are jumping the gun here. I’m not going to do a deep dive into the methodology here because the concept is so deeply flawed at its base.I’ll start with those at lower BRI range. Their BRI could be due to extreme illness (including everything from cancer, to substance use disorders, to eating disorders and more )that are the actual reason for increased all cause mortality. What they may have found is that those in the lower BRI categories are more likely to be very ill which means their findings would not extrapolate to those at the lower end of the weight spectrum who are not experiencing illness. When it comes to higher-weight people, we know that experiences of weight stigma, weight cycling, and healthcare inequalities are all associated with increased all-cause mortality. People with a higher BRI are more likely to have these experiences. Not only did these study authors fail to control for these, they failed to even mention them. Without controlling for these possible confounding variables, what their findings may indicate is just that they’ve found even more evidence that experiences of weight stigma, weight cycling, and healthcare inequalities

This came up in our monthly Subscriber Ask Me Anything discussion and it’s something I get asked about a lot – how can you advocate for a fat* friend/family member in a healthcare appointment? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

The co-opting of concepts from weight-neutral health community to sell weight loss (or obfuscate the harm it causes) is rampant. We’ve talked about this with the concept of weight stigma and fake anti weight stigma events, PR campaigns, and marketing. In today’s edition of “words mean things” we’re going to talk about the co-option of the concept of weight-neutral. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe