Weight and Healthcare

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

I received the following question from reader Ximena: “I appreciate how you always look to find out how much money different doctors have taken from pharmaceutical companies but I’m wondering, is there any proof that these payments actually influence doctors?”This is a great question, and there is research about this... Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This series is part of the work I did with WIND (Weight Inclusive Nutrition and Dietetics) to create a comprehensive response to the disastrous American Academy of Pediatrics (AAP) guidelines for higher-weight children. I was part of the team that analyzed the research that, the AAP claims, supports their recommendations, and I’ll be publishing my breakdowns here as well.Today’s study is The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012 by Chang S-H, Stoll CRT, Song J, Varela JE, Eagon CJ, Colditz GA Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Embroiled in lawsuits and investigations across multiple countries about the dangerous side effects of their weight loss drug Wegovy (which I interrupted writing about to write about this,) Novo Nordisk put out a press release today with the headline “Semaglutide 2.4 mg reduces the risk of major adverse cardiovascular events by 20% in adults with overw*ight or ob*sity in the SELECT trial.”Normally I would be releasing a detailed breakdown of the study results. The problem is, the SELECT trial is not peer-reviewed or published in any way. I would love to dig into the comparator groups, the statistical analysis, and the outcomes, but I can’t. Nobody can. Novo Nordisk pushed out a press release with their claimed top-line result and then moved on with their day. This company, which has been sanctioned for its questionable and deceptive marketing tactics in the US and the UK, wants us to take their word for it.I’m obviously not going to do that... Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I was recently asked for an interview by a reporter who was writing about Novo Nordisk’s new weight loss drug.I sent a long answer via email and then we did a 30 minute phone call. The quote that appeared in the article didn’t come from my email interview or the phone interview, but rather from a piece I had written here, so I thought I would share the full email interview that I sent (I asked the reporter for the recording and/or transcription of our call and they declined.) I want to note that this isn’t comprehensive, more of a 101. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

As a fat patient who often exercises my right of informed refusal when it comes to recommendations of weight loss, I have had to correct my chart multiple times when the healthcare provider who recommended the weight loss labeled me as “non-compliant.” I’ll tell you how I handle it, but first I want to dig into the whole concept of “compliance” and weight loss recommendations. I refuse weight loss recommendations whether they are behavior-based, pharmacotherapy, or surgical, but in this post I’m going to focus on behavioral interventions. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This series is part of the work I’m doing with Weight Inclusive Nutrition and Dietetics (WIND) to create a comprehensive response to the disastrous American Academy of Pediatrics (AAP) guidelines for higher-weight children. I’m part of the team that is analyzing the research that, the AAP claims, supports their recommendations, and I’ll be publishing my breakdowns here as well.Today’s study is Laparoscopic sleeve gastrectomy in children younger than 14 years: refuting the concernsAayed Alqahtani, MD, FRCSC, FACS, Mohamed Elahmedi, MBBS, and Awadh R. Al Qahtani, MD, MSc, FRCSC Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received this question from an anonymous reader who is an RN, and it’s a question I’ve received in various shapes and forms from a number of providers:I feel like I’m surrounded by weight stigma all day long - negative body talk in front of (sometimes to and at!) patients, diet talk amongst the staff (sometimes also in front of patients) jokes at high weight patient’s expense behind the scenes …you get the idea. I want to say something but I’m not clear how. Do you have any ideas on what to say to a colleague who is engaging in weight stigma, especially in front of the patients?This is a great question, a common question, and a tricky question. The approach to these conversations can be impacted by power and privilege imbalances, the cultures of the people involved or the workplace in general, the relationships between the people involved and more.That said, I think that there are a few main options (with plenty of variations). In this piece I’ll look at different options for dealing with colleagues more or less directly, with the understanding that sometimes the best option may be utilizing HR or the chain of command to file a report/get assistance. 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!I’ve previously written a series about fat people and joint health, including joint pain, osteoarthritis, and resources to fight BMI-based joint surgery denials. I’ve added a new resource to the list thanks to Dr. Greg Dodell who let me know about this new study.Before I get into this particular study, I want to offer a reminder that even if higher-weight people didn’t have the same outcomes as thin people:1. That wouldn’t mean that the patient’s weight is the problem. There are any number of confounding variables (including the impact of weight cycling on the patient, practitioner weight bias impacting the procedure, structural weight stigma impacting the procedure - including tools, best practices, and other medical equipment being developed for thin bodies and often to the exclusion of fat bodies - and the impact of patients trying to lose weight prior to surgery and going into the surgery undernourished.) 2. That wouldn’t make weight loss the correct next step. First of all, because it’s highly unlikely to work and second of all because it’s possible that the weight loss attempt, even if it is successful in the short term, could negatively impact surgical outcomes as this study shows. 3. That shouldn’t automatically be a reason for denying the surgery. The idea that fat people only deserve healthcare if they have the same outcomes as thinner people is based in weight-stigma. It also means that the ways that the healthcare system fails to support and accommodate fat people then gets taken out on fat people, then subsequently used to justify more exclusion of fat people from care. Fat people getting a surgery to reduce pain or improve quality of life is a worthy goal, even if there might be more complications or different outcomes. If there is actually a higher risk for higher-weight people (and that would require good, unbiased research to detect) then, first and foremost, we should get better at performing surgeries and after care on fat patients and, in the meantime, the risk should be communicated accurately to the patient and then the patient should be allowed to make the choice. I want to note that that would require systemic change to the way that surgeons’ performance/statistics are judged so that they aren’t encouraged to cherry pick the easiest cases and deny care to those who might be (or whom they perceive might be) at greater risk for complications.With all of that said, let’s look at this study - Differential Impact of Body Mass Index in Hip Arthroscopy: Ob*sity Does Not Impact Outcomes., by Suri et al published in The Ochsner Journal.This study reviewed the medical records of 459 patients who had undergone hip arthroscopy at a single facility from 2008 to 2016. They divided the patients into BMI-based weight categories of “underweight,” “normal weight,” “overweight.” and “ob*se.” (Note that the entire idea of categorizing people by BMI is unscientific and harmful.) Then they looked at their rates of improvement at 1 and 2 years after surgery.They utilized three metrics:The Harris Hip Score (HHS) which considers pain, function, absence of deformity, and and range of motion, the physical component score from the 12-Item Short Form Survey (PCS-12) and the mental component score from the 12-Item Short Form Survey (MCS-12).They found thatAt 1 and 2 years postoperatively, all cohorts experienced statistically significant improvements in the HHS and PCS-12. At 3 years postoperatively, statistically significant improvements were seen in the HHS for all cohorts; in the PCS-12 for the normal weight, overweight, and ob*se cohorts; and in the MCS-12 for the normal weight cohort. Intercohort differences were not statistically significant at 1, 2, or 3 years postoperatively.They concluded:In our population, BMI did not have statistically significant effects on patient outcome scores following hip arthroscopy. All patient cohorts showed postoperative improvements, and differences between BMI cohorts were not statistically significant at any postoperative time point.Statistical significance is a measure of how likely it is that the effect was due to the intervention or rather than by chance, there is a more detailed explanation here.Interestingly, in follow up three years after surgery (which was the longest follow-up) the “ob*se” group had the highest overall score on all three instruments, followed by the “overweight” group, then the “normal weight” group, with the the “underweight” group showing the lowest overall improvement:There are limitations to this study including the small sample size, the single facility, the relatively short follow-up, and the lack of information about re-surgery rates.Still, this finding is important because, as the study authors point out, “the goals of hip arthroscopy are to alleviate symptoms, improve hip function, and de

Noom has announced the start of Noom Med, a division focused on selling diet drugs. If this sounds familiar, it’s because Weight Watchers just did the exact same thing. Let's talk about this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we started discussing the study “Working toward eradicating weight stigma by combating pathologization: A qualitative pilot study using direct contact and narrative medicine” by Rachel Fox, Kelly Park, Rowan Hildebrand-Chupp, and Anne T. Vo.We discussed the issues with existing weight stigma research and the approach that this study is taking. Today we’ll take a look at the study and its findings. Again, thank you so much to Rachel Fox for reviewing this before it was published! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I was thrilled to learn of a study by Rachel Fox, Kelly Park, Rowan Hildebrand-Chupp, and Anne T. Vo called “Working toward eradicating weight stigma by combating pathologization: A qualitative pilot study using direct contact and narrative medicine.”The study explains why research that seeks to end weight stigma cannot come from a pathologization of fatness. Thanks to Rachel Fox for reviewing my draft prior to publication! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

There is about a century of research showing that the most common outcome will be that people lose weight short-term and then regain it long-term as their bodies adjust to food restriction and change physiologically in order to become weight maintaining, weight regaining machines. Then there is deeply flawed research (often funded and/or conducted by the weight loss industry) that uses a number of methods to try to obfuscate the abject failure of these weight loss interventions.In all of this, there is a question that is almost never even asked, certainly not by the weight loss industry:Are the people following these weight loss interventions getting enough actual nutrition? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Two columns in the New York Times by "The Ethicist" (one where someone wants to comment on their friend's weight and behaviors and another where someone is concerned about the safety of weight loss drugs) show what happens when weight stigma meets staggering hypocrisy. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Wow, did a lot of you write to me about this one. Someone wrote in to the New York Times column “The Ethicist” to ask if they should “intervene” because their friend, who specifically asked them not to talk to her about her weight, is fat and, in their perception, has health issues (which of course the letter writer blamed on her weight.)So obviously the answer was “you should stop monitoring your friend’s body size and thinking and writing about her in shame-drenched ways, respect her wishes, and work on your own weight stigma.” Right?Wrong. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I often get asked by practitioners what they can do to become better providers and advocates for their higher-weight clients. I conceptualize this as a four-step progression. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1 I talked about Beachbody’s supposed rebrand to “Bodi” to focus on health. I signed up for the 14-day free trial to check it out myself. I was holding out hope that perhaps they really were moving away from their weight loss focus, but all of those hopes evaporated after two minutes of scrolling the site. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I recently got a question from reader Marisol asking “I have food and bee allergies, so I carry epipens. I just came across your writing about vaccine needles and it made me wonder about the needle on my epipen, should I be worried?”Let's talk about it. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I’ve been contacted by a number of people wanting to know if I think that Beachbody’s rebrand to “BODi” really represents a commitment to weight-neutral fitness. I was hopeful at the start but, unfortunately that does not seem to be the case. It seems like they are, at best, paradigm-straddling and, more likely, co-opting the ideas of focusing on health and not size, but maintaining a platform of weight stigma and weight loss that will allow them to keep the diet culture dollars rolling in. Let's talk about it... Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

A tweet from a PhD Psychologist was brought to my attention and gives us a perfect example of what not to do if you don't want to harm fat people. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Recently during Q&A after a talk about how to deal with weight stigma at the doctor’s office, one of the participants asked if I had any ideas for what to do when they were so sick of experiencing fatphobia from healthcare providers that they just wanted to not go.This is, unfortunately, a too-common situation. Here are some tips and techniques that can help you get the care that you deserve. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I don’t do a lot of guest posts here, but as I was reading Rachel Fox’s excellent piece “An Open Letter to the Well-Intentioned Medical Students Who Want to Do a Capstone Project on Weight Stigma and Email Me Asking For Advice” I knew I wanted to share it here. I reached out to Rachel who kindly agreed. 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!Recently I was made aware of something that was happening with the National Eating Disorders Association (NEDA) helpline. For the past twenty years, NEDA has run a helpline providing support to tens of thousands of people a year via text, chat, and phone. That helpline was recently replaced with an AI-driven chatbot. Investigating this I learned that it happened around a labor action. As Vice reported, sourcing Abbie Harper’s piece on LaborNotes, a group of four paid helpline staff, including Harper, decided to unionize because “they felt overwhelmed and understaffed.”Harper explains:“We asked for adequate staffing and ongoing training to keep up with our changing and growing Helpline, and opportunities for promotion to grow within NEDA. We didn’t even ask for more money. When NEDA refused, we filed for an election with the National Labor Relations Board and won on March 17. Then, four days after our election results were certified, all four of us were told we were being let go and replaced by a chatbot.”For their part, NEDA claims that this was a “long-anticipated change” which, if true, means that for a long time NEDA thought it was a good idea to replace six paid staffers, supervisors, and up to 200 volunteers supporting people whose lives and health can be in serious peril, with an AI chatbot. I think that would have been an astonishingly bad idea even if this wasn’t about union-busting.But it gets worse. Before I get into it, a bit of background. The National Eating Disorders Association (NEDA) has a long history of either ignoring higher-weight people (as well as others with marginalized identities) or treating us poorly. (NEDA tends to focus their attention on thin, white, cis girls and young women to the exclusion of others.) For a brief time, they brought on Chevese Turner, founder of the Binge Eating Disorder Association, and it looked like they might be turning things around in terms of intersectional work. During this time I was asked to become an official ambassador. Then Chevese was summarily fired without explanation, and I publicly left the organization. Since then, NEDA has faced a significant amount of controversy for their actions around higher-weight people. Recently they were one of the only eating disorders organizations that failed to clearly denounce the disastrous American Academy of Pediatrics Guidelines for higher-weight youth.I’m writing about this here because NEDA has significant funding (we’ll get to that in a moment) spending, per their 2021 filing, over $800,000 a year on digital and social media support, and they have a tendency to delete or bury criticism, so it’s easy to be unaware of this.Activist Sharon Maxwell decided to test the bot. Her experiences were chilling to anyone who is knowledgeable about the intersections of weight, health, and eating disorders. I have viewed the screenshots of the chat transcripts. Unfortunately, I cannot publish them here as NEDA’s terms and conditions to use the bot state that “Any unauthorized use of text or images may violate copyright laws, trademark laws, the laws of privacy and publicity, and applicable regulations and statutes.” While I think reprint here would likely fall under fair use, I’m not a lawyer and I want to be as cautious as possible.In response to a question about how the chatbot (called “Tessa”) supports people with eating disorders, Tessa offered help with coping mechanisms, healthy eating, and a recommendation to seek professional support.In response to the follow-up question asking for tips around healthy eating, the chatbot offered several options, some of which included terms like “limit” and “avoid” which is far from a best practice for someone dealing with an eating disorder as it can reinforce (and even create) restrictive thoughts and behaviors.Maxwell asked about eating the right foods to lose weight. This was a clear test for the bot. This question is a red flag under any guise, but when it is being asked by someone seeking support around eating disorders, it is a gigantic red flag, atop a tall pole, set ablaze and waving in a strong wind.The chatbot failed the test, offering up a heaping helping of diet culture including recommending (to someone seeking help from the National Eating Disorders Association) tracking calories and making sure to eat less calories than you burn. Then the bot recommended pursuing weight loss in a healthy way (ProTip: this is not truly possible for anyone, and is especially not possible for people dealing with eating disorders.) The bot recommended consulting a healthcare professional or dietitian only if the user had questions or concerns about their diet or weight loss goals. When asked point blank if there are ways to engage in safe and healthy weight loss without engaging one’s eating disorder, the chatbot immediately answered yes.That is a dangerous ans

Today we are breaking down Novo Nordisk's 2-year study of their weight loss drug, Wegovy. I want to thank Deb Burgard for her help with this piece. She is quoted and was kind enough to review and give feedback on the piece and I am incredibly grateful! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

The public comment period has opened for the US Preventative Services Task Force’s massively ill-advised draft research plan “Weight Loss to Prevent Ob*sity*-Related Morbidity and Mortality in Adults: Interventions”Here is the link to the plan text.Here is the link to comment (you can also go to the link above and click “leave a comment” in the last line of the yellow box at the top of the page)We have until June 14th to comment, please feel free to use anything I’ve written here for your comments. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Today I’m looking into “New insights about how to make an intervention in children and adolescents with metabolic syndrome: diet, exercise vs. changes in body composition. A systematic review of RCT by Albert Pérez E, Mateu Olivares V, Martínez-Espinosa RM, Molina Vila MD, Reig García-Galbis MThis is one of the studies cited by the disastrous American Academy of Pediatrics guidelines. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Jenny Craig has announced that they are shutting down. While I’m deeply sorry for the stress and unemployment it will cause for the employees who really believed they were helping people (because Jenny Craig told them they were,) as far as the program itself, I say good riddance to bad rubbish. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

The entire idea of “ob*sity”* is problematic. It’s a made-up concept to pathologize bodies based on shared size rather than shared symptomology. It uses Body Mass Index (BMI) which is a math equation created with a racist basis. If your weight in pounds times 703 divided by your height in inches squared is 30 or more, you are “diagnosed” with “ob*sity.” This does not have the ring of sound science, but it gets worse.In this episode we're talking about the many issues with the "classes of "ob*sity" and how to solve them. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

A very common issue for higher-weight people who are trying to access healthcare is healthcare providers (HCPs) who want to focus on weight and weight loss. Today I’ll give some tips that I’ve learned both from personal experience and as a patient advocate for navigating what I call Provider Weight Distraction. In this episode we look at options to get weight-neutral healthcare, even from HCPs dealing with PWD. 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!One of the ways that the diet industry is trying to squash the weight-neutral health and fat liberation movements is by using their money, clout, and enmeshment in the healthcare system to re-brand themselves as weight stigma experts, including at conferences, panels, and other events. This can be done by large weight loss industry representatives like the Ob*sity* Action Coalition or by individuals.It is imperative that we do not let this happen, because their goal is to co-opt the concept of eradicating weight stigma and use it to sell weight-loss interventions that risk the health and lives of higher-weight people (which, in turn, increases weight stigma by perpetuating the idea that being fat is so terrible that it’s worth risking fat people’s lives and quality of life in attempts to make them thin.) So, here are four major red flags that an event that claims to be about ending weight stigma may actually be about co-opting anti-weight-stigma work to sell dangerous, expensive “treatments” for fat people.There are no (fat-positive) fat people speakingThere is absolutely no excuse for this, but that doesn’t mean we don’t hear them. I think my personal [least] favorite is “we are looking for experts rather than lived experience.” This is wrong in every way I can think of. First of all, lived experience of stigma gives one expertise that cannot be gained in any other way. Beyond that, unless by “experts” they mean “thin people” then there is literally no type of expert that does not include fat people. Doctors, academics, researchers, statisticians, whatever they are looking for, they could find a fat expert. The idea that someone is either an expert in weight stigma or a fat person is weight stigma. Bottom line: If there are no fat-positive fat people speaking at an event, then this isn’t truly an anti-weight-stigma event. I will say that I have consulted with people in situations where they were speaking at such an event as a harm reduction tool after they tried to get a fat speaker booked and failed, but this shouldn’t be happening.Representatives from the weight loss industry are speakingThey could be representing the weight loss industry directly, through one of their programs (like Novo Nordisk’s absolutely ridiculous “It’s Bigger Than Me” campaign,) or through an astroturf organization like the “Ob*sity Action Coalition.”This is also why in the first category I specifically said “fat-positive fat people.” Fat people are allowed to want to eradicate fatness in themselves, including as a way for them to try to escape weight stigma, but that doesn’t make it an anti-weight-stigma view, especially if they are representing the weight-loss industry or claiming to represent all fat people. (To me, as someone who is both fat and queer, it would be similar to an anti-homophobia panel with a bunch of straight people and one gay panelist who was undergoing so-called “conversion therapy” to become an ex-gay and was representing the interests of the companies selling the therapy.)They are using stigmatizing terminologyIf they are using terms and/or aligning with concepts like “ob*sity,” “person with ob*sity” or “ob*sity epidemic then they are perpetuating stigma. The idea of pathologizing body sizes is, first and foremost, rooted in racism, weight supremacy, and anti-Blackness and I highly recommend reading Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness to understand more about that. Concepts like “overw*ight” and “ob*sity” were created to pathologize bodies based on shared size rather than shared symptomology or cardiometabolic profile. This has been largely architected and perpetuated by the weight loss industry. And while there is absolutely no shame in having a disease, simply existing in a higher-weight body doesn’t qualify, and the diet industry’s insistence that it does - and especially their use of “anti-weight-stigma” platforms to try to forward that message - harms and kills fat people. They want to find a way to make fat people thin and stop future fat people from existingWeight stigma is so ubiquitous in our culture, that someone can publicly espouse the notion (in various nomenclature) that the world would be better without fat people in it, and still be considered (and booked!) as an expert on ending weight stigma. It is impossible to fight a “war on ob*sity” without waging war against fat people, and wars, inevitably, have casualties.You cannot be invested in pathologizing and eradicating fatness and also be effective at reducing the stigma against fat people, they are mutually exclusive.There are some people who produce research about weight stigma whose results can be helpful from a harm reduction perspective , even though they, themselves, and their research a

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In my work around weight science and healthcare, I see a lot of confusion about, and misuse of, statistics. Today I thought I would point out the three of the most common issues that I experience.Sure, intentional weight loss fails 95% of the time, you just have to keep trying until you’re in the 5%.I know not everyone took statistics, but I did, so let me assure you that this isn’t how statistics work on the most basic level (remember that this is the “logic” that many people use when playing the lottery.) in fact, weight loss is worse than the lottery in this respect because repeated attempts can actually have decreasing odds of success. The body responds to weight loss attempts by changing physiologically to become a weight-gaining, weight-maintaining machine, which it continues to do even after the diet ends. This can make repeated attempts even less likely to result in significant, long-term weight loss. Moreover, many people regain more than they lost, meaning that if they (or their healthcare provider) had a specific weight/BMI in mind, they may end up farther from it than they started. Not to mention that “failure” (being clear that the diet failed the patient, and not the other way around) is not benign. Weight cycling (losing weight and then gaining it back) is linked to significant harm, including health issues that get blamed on being higher weight.But It’s Statistically SignificantIn the most simplified explanation, if a study result is “statistically significant,” it means that it’s more likely that the result was caused by the study intervention than by chance. So participants could have lost an average of one pound, but if it’s determined that it’s more likely that the one pound loss was due to the weight loss intervention being studied than by chance, then that one-pound loss is statistically significant.There are a couple of ways that this goes wrong.Sometimes people either think that “statistically significant” means “important” (or they hope that other people will think that’s what it means,) so they’ll say that a result in a study was “statistically significant” without mentioning that the actual effect (the amount of weight loss, for example) was very small (one might even say…insignificant.)Something else that happens with weight science is that the conclusion of a study (which is often the only part that is not behind a paywall) will state that participants lost “a significant amount of weight” when what they really mean is that they lost a small amount of weight, but that the weight loss was statistically significant. Whether accidentally or on purpose, due to the colloquial meaning of significant this misleads people (including healthcare practitioners) to believe that the intervention was far more successful than it actually was. So the conclusion might say that subjects lost a significant amount of weight when, if you get behind the paywall and dig into the study, you’ll find that they lost 2.9% of their body weight (and often, had already started regaining it when the study ended.)Percent increase of complication risk vs percent of complication riskMany healthcare procedures have risks of complications. Typically (and, again, this is a simplified explanation) the decision to treat is based on the benefits of the treatment versus the risk of the procedure. The same procedure may have a different risk of complications for people with different circumstances. For example, people with hemophilia can have a higher risk of bleeding during surgery and a higher risk of poor wound healing and infection immediately following surgery than those who do not have hemophilia.To be clear, I’m not suggesting that higher risk justifies denial of care, and I’m giving the most simplified possible view of this in the service of just explaining the statistical issue. It gets very complicated in everything from the methodology of the research used to determine the risk of complications to the structures of privilege and oppression that lead some people’s lives to be valued more highly than others. Complication risk is often used as the “justification” for BMI-based healthcare denials (wherein healthcare is held hostage for a weight loss ransom and I wrote about that in more detail here. )I recently encountered an example of the issues with confusing these when I received an email from a patient who was facing a BMI-based denial of surgery. The surgeon insisted that there was a 100% complication rate for the procedure for people with a BMI over 40. That wasn’t my understanding and it didn’t strike me as likely, so I did some digging. It turns out that there was absolutely no research to back the 100% complication claim, but there was some research that showed that for people with a BMI over 40 the risk of complications increased by 100%.Herein lies the issue. A 100% increase in the

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In part 1 we talked about a request that has been submitted for the World Health Organization (WHO) to add diet drugs (specifically GLP1 agonists like Novo Nordisk’s Saxenda and Wegovy) to their list of “essential medicines.” We discussed who was making this request and the justification that they were using. In part 2 we took a deeper dive into the research that they used to try to support this request, and in this final installment, we will look at the research around efficacy, harm, and cost-effectiveness.First I’ll offer a summary for each issue and then I’ll give a breakdowns of the research that they cite. Just a quick reminder that this request is asking the World Health Organization (WHO) to add these drugs to their list of “essential medications” globally.Before we get into the sections, I want to mention two overarching issues that are found throughout the entirety of this request and the studies that are used to support it.First, in general, a belief has been fomented (predominantly by those in the weight loss industry) that being higher-weight is so terrible then it’s worth “throwing anything at the problem.” This leads to acceptance of poor, short-term, and/or incomplete data as “good enough” to foist recommendations onto higher-weight people, which means that part of weight stigma in healthcare is that higher-weight people are afforded less right to ethical, evidence-based medicine than thinner people.Second, is clinging to correlation (without any mechanism of causation) when it comes to weight, health, and health outcomes, including the abject failure to consider confounding variables. So throughout these studies “being higher-weight is associated with [health issue(s)]” stated uncritically in support of weight loss interventions. There is an utter failure to explore the idea that the reason for the outcome differences is not weight itself but, instead, exposure to weight stigma, weight cycling (which these medications actually perpetuate by their own admission,) and healthcare inequalities. Issues with research supporting effectiveness, harms, and benefitsStudy Duration:This is the main issue. While there was one study that went up to 106 weeks, the vast majority of the studies are between 14 and 56 weeks. We know that these drugs can have significant, even life-threatening side effects (earning them the FDA’s strongest warning.) 14-56 weeks is not not nearly enough time to capture the danger of long-term effects, or to capture long-term trends around weight loss/weight regain.Study PopulationMany of the studies included have small samples. Many have study populations are overwhelmingly white, which is a huge issue when making a global recommendations.Small effect and overlapMany of the studies show only a bit of weight loss (often 15lbs or less) and often there was overlap in weight lost between the treatment group and the placebo group. Even using the “ob*sity” construct that this request is based on, for many people, this amount of weight loss wouldn’t even change their “class” of “ob*sity.”Failure to capture adverse eventsMuch of the research they use to support their claims of safety didn’t actually capture individual adverse events or serious adverse events. Often they only captured subjects who reported leaving treatment due to side effects.Issues with research supporting cost effectivenessThe cost-effectiveness analyses they cite are based on Quality Adjusted Life Years (QALYs). This is a measurement of the effectiveness of a medical intervention to lengthen and/or improve patients’ lives.The calculation for this is [Years of Life * Utility Value = #QALY]So if a treatment gives someone 3 extra years of life with a Health-Related Quality of Life (HRQL) score of 0.7, then the treatment is said to generate 2.1 [3 x 0.7] QALYs.This is a complicated and problematic concept that deserves its own post sometime in the future, but looking just at this request I think it’s important to note that they are working on two main unproven assumptions:1. That being higher weight causes lower health-related quality of life and/or shorter life span (rather than any lower HRQL being related to experiences that higher-weight people have including weight stigma, weight cycling, healthcare inequalities et al.) 2. That this treatment induces weight loss and/or health benefits that increase the life span and/or health-related quality of life of those who take it.I don’t believe either of these assumptions are proven by the material cited in the request to the WHO. Specifically, it’s very possible that it’s not living in a higher-weight body, but rather the experiences that higher-weight people are more likely to have (weight stigma, weight cycling, healthcare inequalities) that impact their HRQL.Further, the short-term efficacy data available (and Novo Nordisk’s own admission about high