Weight and Healthcare

In my recent quick guide to creating a size-inclusive office, I mentioned troncoconical blood pressure cuffs and I heard from a number of people in healthcare who said that they had never heard of them so I thought I’d write a follow-up piece. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we talked about the research (or lack thereof) around the ways in which GLP-1 drugs, taken in large doses for weight loss, might impact the absorption of other medications. Today, we’re going to hear from someone who was personally impacted by the issue. I received the following information from Jennifer Jonsson who gave me permission to publish it and use her name. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

One of the questions I’ve been getting a lot is about how the new GLP-1 weight loss drugs (Novo’s Semaglutide Wegovy) and GLP-1/GIP co-agonist weight loss drugs (Lilly’s Tirzepatide/Zepbound) can interfere with the absorption of other medications. In part 1 we’ll look at the information around this and in part 2 we’ll have a personal story of someone who experienced it. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Let’s start today with what P-hacking is, and then we can talk about why we needed to talk about it in the first place. Please note this is an overview, there are many more layers and complications to this, these are the basics. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1 I talked about the WaPo/Examination piece “As ob*sity rises, Big Food and dietitians push 'anti-diet' advice…General Mills warns of “food shaming"; dietitian influencers promote junk foods and discourage weight loss efforts.” I discussed my experience with being interviewed, as well as some basics about the piece. Today I’m going to talk about their methodology, such as it is. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

The headline ran “As ob*sity rises, Big Food and dietitians push 'anti-diet' advice…General Mills warns of “food shaming"; dietitian influencers promote junk foods and discourage weight loss efforts.” (As is my policy, I don’t link to studies or articles that contain weight stigma, but I give enough information to Google.)Why am I calling it a hit piece? For two reasons, first because I know that the authors had every opportunity to provide a more balanced story, and second, because of their… let’s call it methodology.In this piece, I’ll talk about my experience with one of the authors. In part 2 I’ll examine their methodology. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we examined the massively misleading opening claim of the abstract of the new study “Long-term weight loss effects of semaglutide in obesity without diabetes in the SELECT trial” by Ryan et al, published in the journal naturemedicine, and we looked at the magnitude of the conflicts of the authors. Today I’ll dig into the rest of the study. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

As you might imagine, I subscribe to a large number of medical publications and in the last couple of days I’ve been receiving updates from them falling all over themselves to breathlessly claim that weight loss was maintained for 4 years on Semaglutide 2.4mg (aka Wegovy) in the SELECT trial.The ways in which these claims are misleading are egregious and anti-science. In part 1 I’ll look at the initial claims and the people making them, in part 2 I’ll do a deeper analysis of the study. 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!During the Q&A at a recent talk at a medical conference a healthcare provider at the end said “there is so much to do, what would you suggest is a good place to start?”There are plenty of places to start, but one that jumps to mind is in creating an accommodating office. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we talked about the long-standing, evidence-free phenomenon of “jump-starting” weight loss using some kind of short-term extreme food/caloric restriction. Today we have another version straight from the doctor's office. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received the following question from reader Deena:I love when you talk about the funding and other conflicts of interest of the people who write studies. It seems obvious that you don’t think disclosures are adequate, so I’m just wondering - what do you think that disclosures should include?Deena is exactly right, I do not think that disclosures as they are currently done are anywhere near adequate. So today I’ll talk about what I wish research disclosures included. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part one we looked at the staggering conflicts of interest and issues with the efficacy in the Semaglutide 2.4 (Wegovy) cardiovascular trial (Semaglutide and Cardiovascular Outcomes in Ob*sity* without Diabetes DOI: 10.1056/NEJMoa2307563) especially as compared to the deeply misleading claims in Novo Nordisk’s “company announcement” publicity stunt prior to publication.Today we’re going to dig deeper into the data, what there is of it, anyway. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Today we’re going to talk about common advice that has long been a pet peeve of mine. It is advice that I, myself, have been given and that I’ve heard from countless people. It happens when someone (a fitness professional, a doctor, whomever) tells a higher-weight person that they should not lift weights/lift heavy weights/strength train etc. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In their zeal to medicalize and pathologize higher-weight bodies for profit, the weight loss industry (and the advocacy groups they fund, and the elements of healthcare they influence) have worked hard to claim that “ob*sity” is a disease and then manipulate the definitions of ob*sity to their best interest. Let’s look at some: Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Moving forward I’m going to be writing about efforts on a number of fronts that are trying to recommend weight loss and, in particular, weight loss drugs to older adults. Much of this is part of the weight loss industry’s holy grail of getting their drugs approved by Medicare, so I wanted to provide some basics around this today. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Every single day I hear from people who have had terrible experiences with healthcare providers. I often write about issues with overt weight stigma and the weight-loss paradigm in working higher-weight with patients/clients. Today I’d like to discuss things that often get said in front of these patients, but not to them. These things can cause significant harm, including damaging the relationship between the provider and the patient, making the patient less likely to be open and honest, and driving patient disengagement from care. 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!This is the final in a three-part series about Tirzepatide (Brand name Mounjaro for Type 2 diabetes and Zepbound for Weight Loss.) In part one we discussed the basics of the drug, in part 2 we discussed the authors of this study and finally, in part three we’ll finish discussing the most recent study on Zepbound - SURMOUNT -4.(the text in italics is from the study itself.)SURMOUNT-4 was designed to find out what happens when higher-weight people (without type 2 diabetes) go on the drug for a while and then go off of it. The study was divided into two periods In the first 36 weeks all of the participants took Tirzepatide. Then there was a 52-week period during which subjects were randomly assigned to receive either tirzepatide, or a placebo.The basic findings, per the study:After 36 weeks of open-label maximum tolerated dose of tirzepatide (10 or 15 mg), adults (n = 670) with obesity or overweight (without diabetes) experienced a mean weight reduction of 20.9%. From randomization (at week 36), those switched to placebo experienced a 14% weight regain and those continuing tirzepatide experienced an additional 5.5% weight reduction during the 52-week double-blind period.Here's a graph that shows the average results:Some things to note:First, the graph clearly shows that people who go off the drug rapidly start regaining the weight they lost, and their weight was trending up when follow-up ended, suggesting that the weight regain will continue (as we’ve seen in about a century of research and in the history of weight loss drugs.) In addition to being exposed to the side effects of these drugs (some of which can be fatal) these people will also be subjected to the risks that come from weight cycling which include everything from increased risk of type 2 diabetes and hypertension to increased cardiovascular disease and overall mortality. This is important since there are any number of reasons why someone would have to go off the drug, from side effects, to expense, to availability.For those who remained on the drug, weight loss slowed considerably and by the end, had started to rise slightly, which means that the claim that weight loss will be permanent as long as people stay on the drug is not supported by the evidence.Let’s go beyond average results and get into some specifics - 783 participants were enrolled in the initial 36-week study in which all participants took Tirzepatide, but 113 discontinued the study drug before the 36-week stage even ended, most commonly due to an adverse event or participant withdrawal. So a little over 14% didn’t even make it 9 months on the drug, and that’s including the fact that the drug was started at a minimal 2.5mg dose and then increased by 2.5 mg every 4 weeks until a maximum tolerated dose of 10 or 15 mg was achieved.300 participants (89.5%) receiving tirzepatide at 88 weeks maintained at least 80% of the weight loss during the lead-in periodDid you catch that? First, 10.5% of the group who were still taking the drug during the one-year follow-up had already gained back more than 20% of the weight they lost in the first 36 weeks- again even though they were Still. Taking. The. Drug. As for the rest, they could well have been regaining the weight because of the way the study defined “maintaining.” For the purposes of this study, “maintaining” weight loss doesn’t mean that people lost weight and kept it off (as the word would be used in any reasonable context.) For this study, “maintained” just meant that they were regaining the lost weight slowly enough that by 52 weeks these participants hadn’t regained 20% of the weight that they lost in the first 32 weeks…yet. (This is one of those examples of words having different meanings in weight loss research.)Let’s take a look at side effects:A total of 81.0% of participants reported at least 1 treatment-emergent adverse event during the tirzepatide lead-in treatment period, with the most frequent events being gastrointestinal (nausea [35.5%], diarrhea, [21.1%], constipation [20.7%], and vomiting [16.3%]… [During the follow up period] Gastrointestinal events were more common in the tirzepatide group than in the placebo group (diarrhea, 10.7% vs 4.8%; nausea, 8.1% vs 2.7%; and vomiting, 5.7% vs 1.2%)Of course, the trial wasn’t long enough to determine long-term impacts. They also say :A significantly greater percentage of participants continuing tirzepatide vs placebo met the weight reduction thresholds of at least 5% (97.3% vs 70.3%), at least 10% (92.1% vs 46.2%), at least 15% (84.1% vs 25.9%), and at least 20% (69.5% vs 12.6%) from week 0 to week 88Let’s say the above another way: 2.7% of people who took Tirzepatide for 88 weeks, opening themselves up to side effects and unknown long-term consequences failed to lose even 5% of their body weight, 7.9% failed to lose even 10%, 15.9% failed to lose 15% and 30.

In part one I gave a summary of the drug Tirzepatide. Today we’re going to begin a look into the most recent study of Tirzepatide for weight loss under the brand name Zepbound - the SURMOUNT – 4 trial. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Zepbound (one of the brand names for Tirzepatide) is a newly approved “weight loss medication” (more on that in a moment) delivered by weekly injection. Today we’ll talk about the basics of the drug, and over the next two parts we’ll do a deep dive into the latest research. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Reader Patty asked:”I’m confused, it seems like these new weight loss drugs have some dangerous side effects, but they are FDA approved so doesn’t that mean they are safe?”Thanks for the great question, Patty! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

On the days when I need some hope and good news, I think about Medical Students for Size Inclusivity. In their own words “We are a community of medical students raising awareness about the harms of weight discrimination in the healthcare system. We believe all people, regardless of their weight, body shape, and size, deserve equitable medical treatment and the right to pursue health".They do incredible work, including the GLP-1 Agonist informed consent project that I’ve linked to here before.The fact that these incredible people are the future of medicine gives me more hope than I can say.Today in our “5 questions with…” series we have 5 questions with three amazing MSSI members! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Reader Barabara asked:”I’ve tried to look into the “science” Awaken 180 claims to rely on, but there’s not much to go on from their website. Similarly, I’ve tried to find out more about the founder, Paige Lopez, but only the basics seem to be available. Awaken 180 has quite a bit of traction in New England, and they have linked up with professional athletes, as well, which has broadened the appeal. Have you looked into Awaken 180, or would you be willing to do some digging? I would love to have some concrete feedback to help my clients assess all this, but I’m swinging in the dark. “Thanks for asking Barbara, let’s get into this! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Reader Lindsay sent this question in, and it’s one I hear a lot from healthcare practitioners in the Q&As after my talks:If I’m practicing patient-centered care, doesn’t that mean that if a patient’s goal is weight loss then I need to offer them weight management interventions?This is a tricky question, and I’m not going to make a yes/no pronouncement, but here are some things to think about... Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Content note: Many of you requested this piece and I think it’s important to talk about, but I also want to let you know that today’s piece might be a tough read. It discusses the lack of care for, and harm done to, higher-weight patients by Bellevue Hospital’s weight loss surgery program. Please take care of yourself.An expose by the New York Times has revealed that New York’s famed Bellevue Hospital is churning patients through its weight loss surgery program: Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received the following request from reader Anisha:I like the in-depth reviews you have of the studies for Wegovy, but I’m talking to a lot of friends and family about this and it would help to have something that’s easier to read. If you are open to writing it you would have my thanks!You got it Anisha! This is a quick guide to Wegovy/Ozempic for weight loss. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

BMI-Based denials of care are about holding healthcare hostage for a weight loss ransom. A ransom that most people won’t be able to pay. Today I’m talking about resources that can be used to fight BMI-based denials for lumbar spinal surgery. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Happy 2024! I am ready for another year of writing about the intersections of weight science, weight stigma, and healthcare and I’m glad you are here reading! This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!I received the following question from reader Lisa:I notice that when you write about things that can hurt larger people’s health you usually mention weight cycling, weight stigma, and healthcare inequalities. I’ve read your posts for the first two – is there a post that describes the third one?Thanks for asking Lisa, I’ve been meaning to write this and you’ve given me the perfect gentle push! For the record the piece for the harm of weight cycling is here and the one on the harm of weight stigma is here.The idea of healthcare inequalities is difficult to quantify because it’s such a vast category. In terms of a definition, the one I’m going to use here is any way in which higher-weight people’s healthcare experiences differ from those of thin people to the detriment of higher-weight people.It’s always important to remember that when we discuss these inequalities we are clear that they don’t impact everyone equally, as people’s weight becomes higher their experience of inequality typically increases as well and, utilizing Kimberlé Crenshaw’s framework of intersectionality, those who have multiple marginalized identities will also face greater inequality in their individual marginalizations and at the intersections of them.Finally, I want to point out that thin people can face healthcare disparities as well based on things like marginalized identities and socioeconomic status. The comparisons I’m drawing here are about the typical experience of thin people and are not meant to indicate that thin people never face issues in accessing healthcare, just that as a group thin people are not systematically marginalized within the healthcare system because of their size.I also want to be clear that this is not an exhaustive list and I welcome you to add other examples in the comment section. I’m going to divide these up into groups to help give this conversation some structure.Practitioner BiasThis includes a lot of different things. Before I get into it, I want to point out that providers aren’t necessarily bad actors who just hate fat people (though, sadly, some absolutely are.) Many are simply a product of a healthcare system (including healthcare education) that is deeply rooted in weight stigma. Regardless of how they got to this place, these practitioners are responsible for the harm that they do.Some practitioners are operating out of implicit bias, which is to say that the bias is subconscious. Others are operating from explicit bias, they are fully aware of their negative beliefs and stereotypes about higher-weight people and they are working with higher-weight patients based on those beliefs and feelings. This can lead to a lot of negative impacts. Some examples:There is the classic (and far too prevalent) example of a practitioner who offers ethical, evidence-based treatments to thin patients for health issues, but sends higher-weight patients with the same symptoms/diagnoses/complaints away with a diet.There’s the “Occam’s razor” mistake. Occam’s Razor states “plurality should not be posited without necessity.” Said another way, when choosing between theories, the simplest one is usually correct. This gets applied to the care of higher-weight patients when providers don’t address individual health issues/symptoms/diagnoses/complaints for fat patients because they assume weight loss will solve them all (and/or they want to see what weight loss solves before attempting the ethical, evidence-based treatments that thin people would typically get for the same issues/symptoms/diagnoses/complaints.)Some practitioners assume that fat patients are lying if what they are telling the provider doesn’t match up with the provider’s stereotypes of people their size. These practitioners base decisions and recommendations on their stereotypes rather than what the patient is telling them.There are practitioners who, consciously or subconsciously, are reluctant to touch fat patients or manipulate their bodies which can impact everything from examinations to post-operative care.There are practitioners who think it’s worth risking fat people’s lives and quality of life in attempts to make them thin. Some of these practitioners take this further by deciding that they know better than fat people and so try to manipulate/trick/bully fat people into weight loss interventions (including dangerous drugs and surgeries) by almost any means necessary including intentionally failing to give a thorough informed consent conversation – blowing patients off with phrases like “all drugs have side effects” or “it’s nothing to worry about” rather than being honest about the risks and/or making threats about the patient’s health and life expectancy that are not supp

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Part one of this was published on December 13, but this piece was pre-empted when the USPSTF put forth dangerous dieting recommendations for children (remember that the public comment period ends January 16.) In the past I’ve written pieces specifically about issues and mistakes that are made with terminology that is used…let’s call it differently in weight science as well as common statistics mistakes and mishaps. In part 1 I offered some additional terminology troubles today in part two we’re discussing statistics shenanigans. Using a percentage that seems high without proper context:In one example of this, early in the COVID-19 pandemic I saw a news report claiming that so-called “ob*sity”* was a risk factor for severe COVID because, in a particular city, 25% of severe negative outcomes were in people who are classified as “ob*se.” At first, that might seem like a large number, but that doesn’t justify calling being higher-weight a risk factor. In order to even begin to be able to draw conclusions from this, we have to at least know the total number of so-called ob*se people who live in the city - otherwise we have no way to know if 25% is higher or lower than the total percentage of this population. I looked it up and that number was 38%. Several things are issues here.First, if I were trying to draw conclusions from this (and I wouldn’t, more on that in a moment) I would conclude that being higher-weight is protective, since 38% of the community is higher-weight, but only 25% of the people with severe outcomes were. (Said another way, people who weren’t “ob*se” were 62% of the overall population but 75% of the severe outcomes.) That’s the main statistical issue here. You can’t use a percentage like this without contextualizing it.Moreover, I wouldn’t draw conclusions from this at all. First, because “ob*sity” is simply a ratio of weight and height. Making assumptions that since a group of people have some physical characteristic in common (like, in this case, height-weight ratio) then that physical characteristic is the reason for the difference in outcomes is on extremely shaky ground, scientifically speaking. In this example, since there are many other factors that can impact this result (including the fact that higher-weight people are at the mercy of a healthcare system in which practitioner weight bias is rampant and, even if that’s not an issue, the tools, best practices, pharmacotherapies and more, that are used are typically developed for thin bodies/excluding fat bodies) we don’t know what number of those severe outcomes were due to healthcare inequalities or other factors.Relative vs Absolute RiskNovo Nordisk recently used this one in their manipulative press release about the possible cardiovascular benefits of Wegovy. Relative Risk Reduction is the percentage decrease of risk in the group who received an intervention vs the group that didn’t receive the intervention. This number can be helpful to determine differences in outcomes between groups, but it’s not that helpful in determining individual risk. For that you need Absolute Risk Reduction.Absolute Risk Reduction is the actual difference in risk between the group that got the intervention and the group that didn’t. This helps us understand the likelihood that a given individual will benefit from an intervention.Relative risk reduction can often be a much larger number than absolute risk reduction and those who are trying to manipulate statistics (and those who don’t know about this - like reporters quoting a Novo Nordisk press release) can use relative risk reduction to make people believe a treatment has a greater effect than it actually does.Let’s use a super simplified example. Let’s say that 200 people who have Condition X are enrolled in a study to see if Medication Y reduces death from Condition X. 100 of them are given the medication (the intervention group) and 100 are not (the control group). At the end of the observation period, 1 person in the intervention group dies and 2 people in the control group die. The relative risk reduction (percent risk of death in the intervention group divided by percent risk of death in the control group, in this case .01 divided by .02) is 0.5 or 50%. That seems like a lot – a company with incredibly poor ethics might issue a press release saying that their drug reduced death by 50% without mentioning absolute risk.Absolute risk is calculated by subtracting the percentage of risk reduction in the intervention group from the percentage of risk reduction in the control group, or 2%-1% which is a 1% reduction. A much smaller number that more accurately predicts individual experience.So when a weight loss company gives a percentage of risk reduction, it’s important to ask if it is relative or absolute risk reduction they are talking about.For example, in the Novo Nordisk press r

In the past I’ve written pieces specifically about issues and mistakes that are made with terminology that is used…let’s call it differently in weight science as well as common statistics mistakes and mishaps. Today I’m offering an update on terminology as part 1 and in part 2 we’ll talk about the statistics. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I have written before about the various types of weight stigma that can impact healthcare including implicit weight stigma and bias (wherein people have negative beliefs and stereotypes about fat people and are acting on them unconsciously) and explicit bias (wherein people are fully aware that they have negative beliefs and stereotypes about fat people and are acting on them). Today we have a doctor who seemed to be going out of their way to demonstrate textbook explicit bias. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the second part of a series answering a reader’s question about weight loss industry “big think” strategies within healthcare. In part 1 we discussed how the weight loss industry strategically created a market by turning simply existing on the higher end of the weight spectrum into a so-called “disease diagnosis. “In part 2 we’ll talk about how they are relentlessly working to expand that market. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Today I’ll be taking a break from research breakdowns and such to talk about navigating nonsense that happens during the holiday season. Reader Anna asked:It seems like I can’t put a bite of food in my mouth from November to January without somebody saying something - my mom, the people at my work. I’m looking forward to seeing my family but also dreading it. A little help, maybe?I’m so sorry about this and I’m happy to offer some thoughts. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I have written plenty about the sorry state of weight science – an area of science wherein research that would get a freshman flunked out of their intro to research methods class gets published in peer-reviewed academic journals (some of which are actually owned and operated by the weight loss industry!)Today I’m offering three things that, if they were required of all weight loss studies, would instantly create massive improvement in the information that could be gleaned from these studies by healthcare practitioners, the media, and the public at large. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I’ve written quite a lot about BMI-based procedure denials for higher-weight patients. These denials typically amount to a patient having their healthcare held hostage for a weight loss ransom that they are very unlikely to be able to pay.I have a collection of resources to fight gender-affirming surgery denials and now I have another study to add to that collection. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we discussed the types and rates of side effects for Wegovy. Today we’re going to discuss the claim that reader Connie’s doctor made that the weight loss drug Wegovy “has been around forever and is safe.” Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received the following question from reader Connie: “My doctor is pushing me to take Wegovy. I told him I’m not interested in weight loss medication but the kept pushing so I said that I was worried about the side effects. He said they are ‘nothing to worry about’ and that ‘all drugs have side effects’ and that ‘besides, this drug has been around forever and is safe.’ I didn’t know what to say to that, can you help?” Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part one we talked a bit about who was behind Ob*sityWeek and the money involved. Today we’re going to look at how this plays out. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Ob*sityWeek* (OW) is over, but the onslaught of uncritical media articles promoting its contents has just begun. In Part 1 we’ll discuss what OW is (and who is behind it.) In part 2 we’ll discuss some of this year’s happenings. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Today I was using cooking spray (for non-diet ease of use purposes!) and I had a flashback to a doctor’s appointment before I learned the truth about the failure rate of weight loss. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

A reader sent me the marketing email for a heart health seminar that perfectly demonstrates many of the issues that we see with weight science, weight stigma, healthcare, and pharmaceutical industry money. I want to acknowledge that the people who put this together may have been well-intentioned, but that doesn’t erase the harm. 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 J’Alice:I recently heard somebody say that ob*sity* is an addiction just like alcohol or gambling, but that sounds wrong to me. Can you explain?Thanks for the question J’Alice! You’re right, it’s wrong. Let’s dig into this a bit: Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you appreciate the content here, please consider supporting the newsletter by subscribing and/or sharing!This is another in the series of research breakdowns I completed as part of a project with Weight Inclusive Nutrition and Dietetics (WIND) to create a comprehensive response to the horrible AAP guidelines.The study is Association of pediatric ob*sity* treatment, including a dietary component, with change in depression and anxiety: a systematic review and meta-analysis 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!The idea that people can gain “clinically meaningful health benefits” by losing 5-10% of their body weight is ubiquitous and ridiculous. Sometimes it is recommended as a way to improve general health, to reduce cardiometabolic risk factors, or to improve a specific health condition. I wrote about this, and a study that tested it, here. Today I want to look at the sheer folly of the basic math and logic of this because this 5-10% weight loss idea doesn’t just defy research, it defies logic and math. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received a request to write about an article titled “Graphic and grisly beverage warning labels stressing sugar content dangers could curb ob*sity*, study finds.”The study found no such thing. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Our current medical view of weight and health is deeply muddied by weight loss industry involvement. I created this list of questions as a guide to interrogation. It can be used by or with healthcare practitioners, or by anyone who wants to take a critical look at our current weight and health paradigm. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received this question from reader Jeremy: “I’m in healthcare and I was recently in a training that was talking about O-word as a chronic disease (eye-roll) and then they used the term lifelong relapsing remitting obesity but didn’t elaborate what it meant, can you help?”Thanks for asking Jeremy, let's get into it! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I've written previously about the serious issues with the field of so-called “ob*sity* medicine.” Today I’d like to talk about what could be. What if there was a field of medicine dedicated to providing better care to fat* patients rather than dedicated to making us thin? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Thanks to everyone who sent me this article from Medical News Today and asked me to write about it! I’ll discuss the study, but I’m also going talk about the article because it’s a great demonstration of how even articles that appear to question weight stigma can still be deeply rooted in weight stigma. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Healthcare practitioners have a long history of blaming and shaming fat patients for the failure of intentional weight loss. While fat activists and weight-neutral healthcare practitioners have been talking about this for literally decades, we are starting to hear pushback against this from, what seems at the outset, an unlikely source – the weight loss industry.Suddenly they seem to be falling all over themselves to admit the failure of intentional weight loss.While that seems like a step in the right direction, it’s their next step that is so dangerous and insidious. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I have permission to share the story of a patient I advocate for. She is fat and has Type 2 Diabetes (T2D). Her latest A1C test was 7.1%. This is .1% over her goal and up from her previous test. Her doctor told her that she didn’t need to adjust meds but should “do her best to eat less sweets and carbohydrates.”This is incredibly common advice (perhaps especially with fat patients for whom many healthcare practitioners seem to always be trying to find a reason to prescribe food restriction, but I hear it from thin patients as well.) Unfortunately, it is also problematic advice on a number of levels. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe