Weight and Healthcare

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 The problem is, the SELECT trial is not peer-reviewed or published in any way.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

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 to their list of “essential medicines.” We discussed who was making this request and the justification that they were using. Today we’re going to take a deeper dive into the research that they used to try to support this request, and in part three will look at the research around harm and “efficacy,” as well as “cost effectiveness.” (I was originally going to write this in two parts, but I realized that it was just ridiculously long, and there is time before the WHO meets about this, so I’ve decided to break it into three parts.)Just a reminder that I don’t hyperlink to studies or articles that come from a place of weight stigma, though I do provide enough information that someone could google them.In their ”Summary statement of the proposal for inclusion” they say“The use of GLP-1 RAs in the treatment of ob*sity has been well studied and meta-analyses of various GLP-1 RAs have demonstrated that this class of medications can lead to clinically significant weight loss. Compared to control groups, GLP-1 RAs were found to lead to more significant weight loss with a mean difference of approximately 7.1 kg as well as an improvement in glycemic control, with low concern for hypoglycemia[3].”The single paper they cite to back this up (Iqbal et al. Effect of glucagon-like peptide-1 receptor agonists on body weight in adults with ob*sity without diabetes mellitus-a systematic review and meta-analysis of randomized control trials, 2022) looked at weight loss on these drugs among “ob*se” adults without type 2 diabetes (so hypoglycemia would have been unlikely anyway.) It included 12 trials with a total of 11,459 participants. 80% of the participants were white, 10% were Black or African Americans and 5% were Asians. It is concerning that they are making a global recommendation based on a study population that is overwhelmingly white. There is also the issue of follow-up. Some of the trials were as short as 14 weeks and the longest trial included was only 3 years. The average weight loss was 15.6 lbs more in the group taking the drugs than in control, but some subjects on the drugs lost as little as 5.5 lbs. Those on the drugs also experienced vomiting, nausea, dyspepsia (indigestion,) diarrhea, constipation and abdominal pain as common side effects. There is no way to know how much of this (short-term) weight loss is due to experiencing these common side effects. These drugs also have significant (possibly life-threatening) side effects and the short-term follow-up included here is not likely long enough to capture those. Also, remember that the recommendation is for people to take these drugs for the rest of their lives (since, if they don’t, their weight shoots right back up and they lose cardiometabolic benefits,) and they are making that recommendation (globally) on just 14 weeks to 3 years of data.The authors of this study cite no conflicts of interest. Per LinkedIn, someone with the same name as the lead author is a product specialist at Novo Nordisk but I imagine that must be a coincidence or surely it would have been listed as a COI. The article was published in “Ob*sity Reviews” which is an official journal of the “World Ob*sity Federation” (WOF). The WOF took over $5.3 Million dollars from Novo Nordisk (whose weight loss drugs are covered by this recommendation) over three years. Their “members” include the Ob*sity Action Coalition (whose chief funder is Novo Nordisk.) Their current President has taken money to speak on behalf of Novo Nordisk and their past president is John Wilding who was implicated in the recent Novo Nordisk scandal for not disclosing his financial ties to Novo Nordisk while praising their weight loss drugs in the media.There are more issues with this meta-analysis but I’ll just stop there and say that I don’t think there is any way that 14 weeks to 3 years of data on 11,459 people who are mostly white justifies a global recommendation of these drugs as “essential.”Under “Treatment details (requirements for diagnosis, treatment and monitoring)”Here again they say “Ob*sity, a preventable disease” but offer no citation or support for this narrative that has been largely architected and marketed by the weight loss industry. They continue:“When used in supplement to life style modifications, including a decrease in caloric intake and an increase in exercise, liraglutide is indicated for adults with ob*sity (BMI >30.00) or overweight (BMI >27.00) with a weight-related comorbidity”I just want to note here that this indication (which wasn’t created by those who wrote the recommendation to the WHO) predicates risk on body size and simple correlation. These drugs have very unpleasant common side effects and other, possibly life-threatening, side effects. So the

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!There are a number of different ways that bias can impact the healthcare that higher-weight patients receive. This includes provider bias and structural bias (when the healthcare system is created for thin bodies and/or to the specific exclusion of fat bodies.) Today I want to talk about what happens when these two types of bias intersect. It’s a perfect storm that both supports and increases this bias. It doesn’t have to be this way, and there is a simple first step (though it’s certainly not the only step,) that healthcare providers can take to interrupt it. Let’s look at some real-world examples (shared anonymously with permission):A fat patient arrives for a mammogram. They receive a gown but it doesn’t fit, they ask for a larger gown and the tech says “If you’re too big for that one I can give you a second one and you can wear both.”A fat patient needs an MRI. They get on the table, and it begins to move. But the patient’s hips catch on the sides. The tech stops the table, and says “Your hips are too wide for the MRI, we wont’ be able to do the scan.”A patient goes to the pharmacist to get Plan B for pregnancy prevention. The pharmacist asks the patient’s weight and then says “Your weight is too high for this pill to be effective.”A fat patient calls 911 because they have symptoms of a stroke. The paramedics arrive and say “you are too wide to fit on our gurney, we’re calling a special ambulance to transport you.”A fat patient gets a report back on a CT scan and it says that conclusions could not be drawn because of the “patient’s body habitus.”A fat, pregnant patient arrives at an Ob/Gyn practice for their first pre-natal visit. The receptionist says “You are too heavy for our tables so we can’t accept you as a patient.”A fat patient points out to the receptionist that all of the chairs in the waiting room are too small for them, the receptionist says “I’m so sorry but if you don’t fit in the chairs you’ll need to stand.”A fat patient is at the doctor for their annual pap smear. The gynecologist says “I’m sorry but you are too heavy for our largest speculum, if you want to make another appointment and bring your own, we can proceed.”A fat patient has injured their knee and sought care in the ER. The doctor says that “there is nothing he can do to help, you’ll need to get an MRI and see an orthopedist and you should keep the knee immobilized and not put any weight on it or you could cause catastrophic injury. Unfortunately, your knee is too big for the immobilization braces we have, and your weight is too high for the crutches. We can let you use a wheelchair to get to your car but then you’re on your own.”A fat patient has come to the ER for chest pains. An EKG has shown arrhythmias and blood tests show elevated troponin. The nurse explains that the patient is being admitted but says “I apologize but you are too heavy for our ER beds, we are waiting on a bariatric bed to be brought down.”Again, these are all true stories that have happened to higher-weight patients and there are a LOT of things wrong here that negatively impact patient care. But did you notice the one thing that all of these scenarios had in common? The one thing that, had providers done it differently, could have immediately reduced the weight stigma being experienced by the patient (even though many other steps are necessary to actually solve the problem)?Feel free to take a minute to think about it, or read on for the answer.The one thing that each of these scenarios have in common is that healthcare providers blamed the patient’s body for the lack of accommodation. This is a common way that we see both implicit and explicit bias surface and intersect with structural weight stigma. The patient is already experiencing structural weight stigma that is impacting their care, the added stigma of being blamed for the healthcare systems’ failure to accommodate them adds insult to injury and adds harm.Solving weight stigma can be difficult and involve a lot of action from a lot of different people, but this one can be solved by each individual provider at the point of care. The patient isn’t “too big,” “too wide,” “too heavy,” etc. The equipment is too small. The patient is never the problem. Healthcare should be accessible to everyone and, if it’s not, then that’s a failure of healthcare, not a failure of the patient for existing in a body with needs that were completely predictable.One way to think about this is “Did the decisionmaker here not know that fat patients existed, or did they just not care if fat patients got the same care as thinner ones?” Either way it’s an absolute failure of the healthcare system, not the patient.It’s entirely possible that the lack of accommodation is not the fault of the provider who is currently working with the patient, but they can still be the one to apologize and make it clear t

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 how Novo Nordisk got suspended from The Association of the British Pharmaceutical Industry for their shady marketing practices. Today, we’re going to talk about an investigation by The Observer that found what so many of us have been saying for a looooong time - that Novo Nordisk had paid millions to prominent ob*sity “charities,” NHS trusts, universities and other bodies as well healthcare professionals who publicly praised the drug (typically without disclosure of their funding) and who advised NICE (The National Institute for Health and Care Excellence) on their reviewing of Novo’s weight loss drug to decide whether or not it should be made available.The Observer article by Shanti Das and Jon Ungoes-Thomas “‘Orchestrated PR campaign’: how skinny jab drug firm sought to shape ob*sity debate” (Note: per my policy I’m not linking to it because it still comes from a place of weight stigma) found that in three years, Novo Nordisk had shelled out £21,700,000 (about $26,415,301.50 USD) over 3,500 transactions which were separate from their research and development spending.The Observer found:“The payments include donations, event sponsorship, grants and other fees to prominent ob*sity charities, NHS trusts, royal colleges, GP surgeries, healthcare education providers and universities - on top of £28m spent by the company on research and development. A further £4m in payments such as consulting and lecture fees went to health professionals, including experts on ob*sity. The business has also provided financial support for the running of the all-party parliamentary group on ob*sity - a cross party group of MPs and members of the Lords that lobbies the government on health policy.”I’ve written before about how major papers like the New York Times are writing articles that are, essentially, lobbying for Novo Nordisk’s priorities where every expert quoted is on Novo’s payroll with no disclosure. One question I get asked a lot is “how is that legal?” First I’ll point out that legal and ethical are two different things. Beyond that, there is a tendency to believe that doctors and academics are somehow immune to industry influence (or to the ways that their promotion of the weight loss paradigm will support their careers) such that reporters and others (including those on the pharma industry’s payroll) claim that disclosing these conflicts of interest isn’t important.An excellent example of the ways in which those who are seen as “impartial” experts in academia are, in fact, on the payroll of these companies and actively shilling for them is Professor John Wilding. Professor Wilding is at Liverpool University, where he leads clinical research on “ob*sity.” He also serves as president of the “World Ob*sity Federation” (an astroturf organization similar to the Ob*sity Action Coalition) which took more than £4.3M over three years, per The Observer. Somehow, this did not make its way onto his conflicts of interest statement. Meanwhile, he was quoted extensively in the media recommending Novo’s drug Wegovy. Jason Halford, who is the Head of the School of Psychology at the University of Leeds, told an audience of millions on BBC that Wegovy is “one of the most powerful pharmaceutical tools” for treating “ob*sity.” He did not disclose that he is also the president of the European Association for the Study of Ob*sity (EASO), another astroturf organization (which is to say, an organization that claims to advocate for marginalized people but, in reality, is predominantly funded by and acting as a lobbying arm of, the pharmaceutical/weight loss surgery industry.) The Observer found that the EASO received more than three-quarters of its income (more than £3.65m) from Novo Nordisk. He was also a previous member of Novo Nordisk’s UK advisory board.I’m glad Novo Nordisk’s lack of ethics are getting wider coverage (though, as I pointed out in part 1, people in fat liberation and weight-neutral health advocates like Mikey Mercedes, Louise Adams, Asher Larmie, myself and others have been talking about this for some time,) but I don’t expect it to stop them until we can put enough pressure on them to force them to stop. This is a company that orchestrated aggressive price gouging on insulin, proving beyond a doubt that they will kill people for money. And as pressure in the US is forcing Novo to lower the price of insulin, they seem to have a lot of eggs in the Wegovy basket. Prior to launch, they promised their shareholders the “fastest ever” post FDA-approval launch and that they would double their “ob*sity” sales by 2025. In fact, The Observer found that Novo Nordisk’s sales on their new “ob*sity treatments” rose 84% in 2022 to $2.4B – a figure Novo projects will “grow significantly” in 2023.And what will they do to grow this figure significantly this year? I think their behavior makes it

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!If you have read this newsletter for any period of time, you’ve read my accounts of how pharmaceutical company Novo Nordisk has been using extremely shady marketing practices (many taken from the playbook that Purdue Pharma used to push oxycontin) to promote their drugs for weight loss. Things likePutting doctors on their payroll to promote their drugs to the media without disclosing their ties to the NovoCreating astroturf organizations that claim to be advocacy groups for higher-weight people but are, in fact, funded by Novo and other pharma and weight loss surgery groups.Marketing their drug through Grand Rounds presentationsCreating PSAs and Sponsored Content using people who (you can’t make this stuff up) play doctors on TVCo-opting the concept and language of anti-weight-stigma activists in order to sell their weight loss drugsAnd I’m far from the only person talking about this.Mikey Mercedes has publicly called this out. Louise Adams from Untrapped has been all over it (I had the chance to join Louise Adams and Fiona Willer on Louise’s Podcast All Fired Up to talk about this)Asher Larmie, The Fat Doctor, has also been talking about thisAnd there are plenty of others.Part of the issue is that in the United States pharma companies are allowed to market direct-to-consumers , and the rules and regulations that exist are often loosely enforced. That’s why I was thrilled to learn that The Association of the British Pharmaceutical Industry (ABPI,) a trade association that works in England, Scotland, Wales, and Northern Ireland in partnership with the government and the NHS on behalf of their members, had suspended Novo Nordisk for being in breach of the ABPI code of practice.Interestingly, just a month ago, the president of ABPI was Novo Nordisk UK General Manager and Corporate Vice-President Pinder Sahota. Sahota stepped down from the board in February “to avoid an ongoing process around a Novo Nordisk ABPI Code of Practice breach becoming a distraction from the vital work of the ABPI.”The complaint was made to The Prescription Medicines Code of Practice Authority (PMCPA) which is “the self-regulatory body which administers the Association of the British Pharmaceutical Industry (ABPI) Code of Practice for the Pharmaceutical Industry, independently of the ABPI. It was established by the ABPI on 1 January 1993.”The complaint centers around a LinkedIn post offering practitioners a free “weight management” course. The only “weight management” treatment covered in the course was GLP1-RA drugs. Novo Nordisk was, at the time, the only company selling these drugs. The course was “sponsored” (paid for) by Novo Nordisk, but that was not clear in the LinkedIn Ad.Not only did this “course” offer information, but they also offered a free Patient Group Direction (PGD). Per the NHS a PGD is “a written instruction for the sale, supply and/or administration of medicines to groups of patients who may or may not be individually identified before presentation for treatment. May or may not be identified means an individual can either be known to the service/have an appointment (e.g. a baby immunisation clinic) or not be known in advance of presenting at a service (e.g. a walk in centre).PGDs are not a form of prescribing. PGDs allow health care professionals specified within the legislation to supply and/or administer a medicine directly to a patient with an identified clinical condition without the need for a prescription or an instruction from a prescriber. The health care professional working within the PGD is responsible for assessing that the patient fits the criteria set out in the PGD.”The complainant pointed out that the PGD was part of what was being offered to individual health professionals by Novo Nordisk, that it had a value, and that it was being given to individuals for their own personal benefit to run private clinics. The complainant suggested that this amounted to bribing health professionals with “an inducement to prescribe.”The complainant noted that on the website the course had been run several times, so it was likely that a large number of health professionals had received this offer.The ABPI review panel found that the training was provided by a third party, but attendees and PGDs were sponsored by Novo Nordisk. The training mentioned three drugs, the first two (orlistat and naltrexone/bupropion) were presented as having significant side effects and contraindications, while the third drug, Novo’s Saxenda, did not include side effect information (though they are significant) and the training noted that Saxenda could be provided by an appropriate health professional with a valid PGD (which was provided by the course.)The training included 21 slides about Saxenda, but no such detail on the other two drugs.Sponsorship of third party trainings by drug companies are permissible by APBI “o

Transcript This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Reader Marcel sent me the following question:I just got diagnosed with sleep apnea. My doctor told me that if I could just lose 5-10% of my body weight, it would go away. I’ve yo-yo dieted all my life and sometimes got to 5% lost before it came back, but never even got to 10% and most times I ended up heavier than when I started. I’m nervous to try again, but sleep apnea is really scary.There are a lot of things that can contribute to obstructive sleep apnea (OSA,) including everything from enlarged tonsils to hereditary structural issues, to heart issues and more. It’s possible that someone’s size and/or the way that their adipose tissue is distributed could contribute to OSA. But it’s complicated, in part because sleep apnea is known to induce weight gain so when they say x percent of people who have sleep apnea are fat, we don’t know to what extent it may be a chicken and egg situation.It can also simply be a function of the number of fat people who exist. For example (and I’m using made-up numbers for this,) the statistic might say “being fat is a risk factor because 60% of people with sleep apnea in the US are fat.” However, if 70% of people in the US are fat and only 60% of people with sleep apnea are fat, then fat people are actually underrepresented. (Incidentally, I’ve seen a lot of this mistake happening with COVID numbers.) It may also be a function of testing bias – if fat people are tested much more often for sleep apnea than thinner people, then it would not be surprising if fat people had a higher incidence.It’s also important to understand that even if someone’s sleep apnea is caused by weight/adipose tissue distribution or body size in general (for example, body builders have also been shown to be at higher risk with associations to their BMI and also to their neck circumference,) that still doesn’t mean that weight loss is an appropriate treatment. For that to be true, weight loss would have to meet the requirements of an ethical, evidence-based intervention. Given that it fails the vast majority of the time, and has the opposite of the intended effect up to 66% of the time, it doesn’t qualify.While there is some short-term research that shows a decrease in OSA symptoms/severity with weight loss, those studies don’t capture the likely weight regain, nor do they separate the impact of the behavior changes that people make from the impact of weight loss (in research around other health issues, it’s been found that it’s likely the behavior changes, not the weight loss that create the health impacts.) There are other studies that find that, for example, “physical activity has been found to have a 32% reduction in the AHI (a reduction of 6.27 events/h) and a 28% reduction in daytime sleepiness, as well as a 5.8% increase in sleep efficiency and a 17.65% increase in VO2peak, having found no significant reduction in the BMI. (The role of physical exercise in obstructive sleep apnea, de Andrade 2016.) This is consistent with other research about movement and health. Of course, this isn’t a deep dive into the research, I just want to make the point that when people claim that the research shows that weight causes OSA and weight loss solves it they are not stating anything resembling a proven fact.Moving on to Marcel’s doctor’s claim that losing 5-10% of body weight will make the sleep apnea go away. There are people of all weights with (and without,) sleep apnea, so suggesting that losing a specific amount of weight will help is based on some questionable logic and math. For example,A 300-pound person has sleep apnea and is told that losing just 5%-10% (thus weighing 270-285 pounds) will make it go away.But if someone who weighs 270-285 pounds has sleep apnea, they are told that…losing 5-10% of their weight will make it go away.Then, a 200-pound person who has sleep apnea, even though they are 100 pounds lighter than the first person, will be told that…losing just 5-10% of their weight will make it go away.Also, remember that up to 66% of the time, weight loss ultimately ends up in regain. So if a 300-pound person has sleep apnea and tries to lose 5-10% of their body weight, but then regains to 315-320, they would be told that they should lose 5-10% of their body weight to make their sleep apnea go away…which would put them right back at 300 pounds.This is not scientific. Essentially, whatever weight/BMI a healthcare practitioner says someone should achieve in order to help their apnea, there are already plenty of people at that weight/BMI who have sleep apnea (and that’s before we point out that significant, long-term weight loss fails for the vast majority of people and that weight loss isn’t an ethical, evidence-based treatment for anything.)If you are dealing with OSA, there is a HAES Health Sheet here with weight-neutral options.Did you find this post helpful? Y

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In the early days of the pandemic studies were rushed out and highlighted in the media claiming that higher-weight people were at higher risk of COVID death. I wrote about the issues with this in my previous blog, as did Christy Harrison, Paul Campos and others.Now an umbrella review has been published. This is a review of existing systematic reviews and metanalyses.Quick background. A systematic review (SR) starts with a research question, creates inclusion criteria for evidence, and then attempts to gather and summarize all of the available empirical evidence that fits the inclusion criteria. A meta-analysis (MA) is the application of statistical methods to the results of the studies collected by the systematic review. An umbrella review (UR) synthesizes all of the available systematic reviews and meta-analyses about a broad research question, typically taking into account not just the findings of the SRs and MAs, but also the quality of evidence within them. This is important because if the SR/MAs include poor quality studies, then they risk poor quality summary/analysis/conclusions.So, this study “Risk of bias and certainty of evidence on the association between ob*sity and mortality in patients with SARS-COV-2: An umbrella review of meta-analyses” by Silva et al, 2023 looked at systemic reviews with meta-analyses (SR-MAs) “to evaluate the risk of bias and the certainty of the evidence of SR-MAs on the association between ob*sity and mortality in patients with SARS-CoV-2.”They begin that:“Poorly conducted SR-MAs can lead to inaccurate illustrations of evidence and misleading conclusions, leading to limited applicability.”Then point out that:“There are concerns that in the panic to provide answers to help administer the COVID-19 pandemic, SR-MAs are being conducted without many of the keystones of robust methods”They sought to answer two questions with their UR: 1. What is the quality and certainty of evidence on the association between ob*sity and mortality in patients with SARS-CoV-2?2. What is the magnitude of the association between ob*sity and mortality in patients with SARS-CoV-2 demonstrated by SR-MAsThey reviewed 24 SR-MAs from multiple countries. Ultimately they found that, while most SR-MAs did show an association between being higher weight and COVID mortality, there were serious questions as to the quality of the research that led to those conclusions.They found that “most SR-MAs had critically low quality, and…the certainty of the evidence was very low.” In fact, in terms of certainty of evidence, 21 of the 24 SR-MAs were classified as “very low.” In terms of quality, 66.7% of the SR-MAs were “critically low quality,” and 29.2% were “low” quality. Only one of the included SR-MAs reached the “moderate” quality level and it DID NOT find a significant link between being higher-weight and COVID mortality.The UR author’s explanation for this is that the pandemic created the need for fast information (which is, of course accurate) but that in the rush to get data “many of the keystones of robust methods are being forgotten.” I would add that, as we often talk about in research reviews here, when it comes to weight science, the keystones of robust methods are often thrown out the window regardless of how much time the authors have to conduct their research (Lucy Aphramor has an excellent piece about this.) For example, this has happened before. During the 2009 H1N1 outbreak, fat people had poorer health outcomes (and researchers and media were quick to jump on the bandwagon of assuming that fat bodies were the cause the and trying to figure out what about fat bodies caused this.) It turns out the actual issue was that fat people were systematically treated later with antiviral medication than thin people. Per a study on the subject (Sun et. al. 2016) “After adjustment for early antiviral treatment, relationship between ob*sity and poor outcomes disappeared.”The findings of this UR are, of course, a far cry from all the headlines claiming that being higher-weight created higher risk and from the subsequent programs and suggestions that fat people have an obligation to become thin (despite no evidence that that is even possible) as part of COVID mortality prevention. Unfortunately, when it comes to research, the media, and public health policy anti-fatness is often published, often enacted, and rarely questioned.Frustratingly, even the UR authors in their introduction section uncritically buy in to the pathologization of body size, and the blaming of health issues/deaths on higher-weight bodies rather than, at the very least, acknowledging the confounding variables of weight stigma, weight cycling, and healthcare inequalities. Still, perhaps there is some clarity in the fact that these findings come from researchers who seem to be fully invested in the anti-fat paradigm.Finally,

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!EDIT 7/4/25: I’m excited to say that a project I’ve been working on is now live. The In Our Image Database from the Fat Legal Advocacy, Rights, and Education (FLARE!) Project is a listing of imaging sites that accommodate higher-weight patients. You can search the database, add to it, and/or volunteer to help expand the project! Finding out that you need an x-ray, MRI, CT or other scan can be scary for people of all sizes, but fat* people can face a lot of additional and, unfortunately, well-founded fears about the experience. Here are some tips and tricks for people who offer these scans to make the experience better for higher-weight patients.I know that many people won’t be able to do all of these things, what I’m asking is that you use any power/privilege/leverage you have to do what you can (and know that anything you can do WILL make a difference) and then consider finding allies who you can work with to push for larger changes.1. Know what you are working withKnow everything you can about the equipment and facility. What is the weight-rating of the table/bed/chair? What is the bore size of the scanner? Are there any other size/weight limitations? If you don’t have the most accommodating equipment that exists, proactively create a list of who does so that you can refer patients. Make sure all of that information is easy to access for everyone who might be patient-facing.2. Know the people you are working withBe aware of all the patients you may work with. Sometimes when it comes to inclusion, identities can become siloed. So even if there are protocols for higher-weight patients and protocols for wheelchair users who need to transfer, there may not be protocols for higher-weight patients who are wheelchair users who need to transfer. Sometimes a lot of focus is put toward accommodating patients physically, but less focus is put on making sure patients, including neurodivergent patients, are psychologically comfortable. Consider bringing in educators and/or consultants to help you think through all the patients you might work with and proactively create protocols so that every patient will have a positive, seamless experience.3. Communicate what you are working with to the people you are working withGive as much information as you can – including the weight ratings and bore sizes of your equipment, any accommodations you offer (for size, disability, neurodivergence etc.) be honest about who you can’t accommodate (and offer referrals to places that can). Don’t wait for patients to ask and don’t make assumptions about who needs to know. Provide this information to every potential patient early, often, and through as many delivery methods as possible – on your website, when patients call, on their MyChart or other online patient record, in appointment reminder texts, literally in every possible way.Communicating about accessibility and accommodations helps people who need the access and accommodations AND it educates people who may currently have privilege that puts them in a situation where they don’t know what they don’t know. It can help them stop taking their access for granted, help them to be more educated for the people in their lives who may not typically be accommodated, and help them in the event that their needs change.4. Create an accessible experience start-to-finishIt’s not just about the equipment. Do you have armless chairs in your waiting room and in any treatment rooms? Do you have the largest possible gowns? If you take blood pressure do you have cuffs that work for all arm sizes? Don’t take the patient’s weight for no reason (ie: “routine weigh-in.”) If you truly need to get the patient’s weight (for example, if you’re using weight-based contrast medium dosing) instead of just asking their weight (which might be jarring/upsetting to them) explain it to the patient in a non-judgmental way. For example “The contrast is dosed by weight. We don’t care about your weight except to get the dose right!” There is a size-inclusive healthcare office audit here.5. Center the patient’s experienceStory time! (Shared with permission, of course.) I was recently acting as an advocate at an orthopedic appointment that included an x-ray. Ortho appointments can be some of the most fraught for fat patients so the patient was nervous and I was on high alert. We had talked through scenarios and worked out a signal they would use if they wanted me to jump in (in a nod to The West Wing, they would tug their ear lobe.)Things had gone very well so far - great chair options in the waiting area, no fat-shaming, a positive response to declining weigh-in, and the tech knew exactly what the weight-rating of the x-ray table was (650lbs). The patient had limited mobility and was moving slowly (because they had a knee injury, which is why they were at the orthopedist!) They explained that they could

Transcript:This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!I’ve been getting a lot of requests to write about Weight Watchers’ acquisition of Sequence, so here we go. One note that, in order to keep this from becoming Tolstoy-esque in length, there are a lot of links so that you can dig in more where you want!I’ve been writing about Weight Watchers (aka WW) for more than a decade and I’ve noticed that one thing you can always count on Weight Watchers to do is…anything it takes to keep their stock prices up.Using celebrities to create body shameAdvertising to people with eating disordersCreating an entire campaign to gaslight us into believing that they are solving weight stigma rather than creating itMarketing a dangerous weight loss app to childrenChanging their name to try to co-opt the work of anti-weight stigma activists to claim they are about “health,” not weight (while selling the same old fatphobia-driven weight loss) Keeping that going publicly while moving back to their old weight-focused messaging (and name!) in individual communicationsFunding research that grossly and purposefully misrepresents the data that shows their abject failure to create significant, long-term weight lossAnd now…taking advantage of proposed legislation to increase access to telehealth, and piggybacking on Novo Nordisk’s massive marketing campaign for their dangerous new weight loss drug, by purchasing a telehealth company whose focus is prescribing dangerous weight loss drugs.What is this company they are acquiring? Sequence is one of the scavenger companies that have popped up to capitalize on the massive marketing campaign around the new GLP-1 agonist class of weight loss drugs. Essentially the company employs a group of doctors and practitioners who prescribe weight loss drugs (including the new drugs as well as older drugs) with dangerous side effects and no long-term efficacy data, as well as a diet and exercise plan to people who pay a monthly subscription of $99 (which may or may not include their drugs.)Their marketing gives us the same old thing – big print that claims that people lose 15% of their body weight on average, small print that points out that this is for a people who have been on the program for at least 26 weeks, conveniently capturing the period when weight loss is expected (about the first year,) and not capturing the 2-5 years after when research shows that about 95% regain all of the weight that they lost, without any link to the actual study to see if they are ignoring drop out rates or using other sketchy research practices. And even that claim is contradicted on their “FAQ’s page” which says “Sequence members lose 5% of their body weight within 3 months, and 10% of their body weight within 6 months.” They, of course, leave out the fact that the research does not support the idea that 5-10% of body weight loss creates health changes. (In fact, they don’t discuss actual health at all, only body size changes, taking advantage of the common myth that weight loss automatically improves health.) And, again, all of this ignores the fact that almost everyone will regain all of this weight based on all the research that exists.They claim that medications “jumpstart” sustainable weight loss when there is absolutely no research to back that claim (and, in fact, the research says the opposite.) And if you dig into the website they are more honest that “The effects [of the “GLP Medications”] stop immediately if you stop taking the medication, and it is likely in most cases that some weight regain will occur.” (In fact, it is likely that people will regain all of the weight they lost and very likely more. Novo stopped the research after a year when people had gained back 2/3 of the weight that they lost in 68 weeks, but the trajectory was still going straight up.) What they don’t show is that there isn’t any data to suggest that the weight loss is sustainable at all. They have a “research” page, but there is literally no research there about their actual program available there, though there are a bunch of diet articles that look like they were copy/pasted from 1987 and one obligatory article on developing a “positive body image” among a sea of articles that pathologize fat bodies and encourage people to risk their health, lives, and quality of life trying to change those bodies.On almost every page they have their 15% weight loss claim with an asterisk that directs the reader to the claim “*Based on 5,377 members who have been on the Sequence program for at least 26 weeks. Average reported body weight lost was 15.17% and the top quartile lost an average of 19.90% of body weight.” I cannot find a published study with these numbers so for all I know they were produced via…rectal pull. What I do know is that, per Forbes and the Washington Post, they were founded in 2021, had 24,000 members at the end of February 2023 and annual revenu

Transcript:This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!I write and talk a lot about weight stigma and its negative impacts on health. Today I want to talk about a study that looks at how we can protect ourselves. In September of 2022, Angela Meadows and Suzanne Higgs published “Challenging oppression: A social identity model of stigma resistance in higher-weight individuals.” Big thanks to Dr. Meadows who read a draft of this piece and offered commentary which is quoted below.This study was the first to attempt to identify what factors predict whether a fat* person does or does not internalize weight stigma. They begin by explaining that, while higher-weight people make up about two-thirds of the population in western countries, weight stigma is still ubiquitous in every area of life including education, healthcare, employment, interpersonal interactions, and in the media. They also point out that being immersed in a culture of weight stigma leads many fat people to internalize that stigma, leading them to devalue themselves.They explain that “the most fundamental component of weight-related stigma directed at oneself remains the endorsement of negative stereotypes attributed to higher-weight individuals, applying those stereotypes to oneself, and exhibiting reduced self-worth as a result of one’s higher weight status.”The next piece of this is the fact that internalized weight stigma had been linked to “a wide range of negative health and behavioural outcomes in both treatment-seeking and community sample.”Given this, the ability to avoid internalizing weight stigma is “generally associated with superior psychological and physiological outcomes compared with stigma internalisation or inaction.”In order to identify predictors of weight stigma resistance, they examined factors including the alignment with the group “Fat.” They start from social identity theory, which is, as Meadows explains“A theory of intergroup behaviour that was developed in the 60s and 70s. Evidence from many types of marginalised groups suggest that where people can leave a devalued group, that is usually the strategy they pursue. This is what we knew from experience, but it hadn’t previously been applied to the idea that weight controllability beliefs constitute that permeable/impermeable group boundary, so should predict activism or alternative behaviours.”In the context of that framework, the assumption was that those who think weight is changeable are likely to be working to leave the “Fat” group to enter the “Not Fat” group, whereas those who have come to the conclusion that long-term significant weight loss is improbable (including through their own experience of weight-cycling) may come to view themselves as permanent members of the “Fat” group. For those members of the “Fat” group, the next determinant of stigma resistance becomes if they believe that they deserve lower status, or if they think that lower status is being unfairly foisted on them.The study authors created an online survey to measure perceived stigma, level of identification as an “overw*ight*/fat” person, perceived legitimacy of anti-fat discrimination, group permeability, stigma resistance, internalized weight stigma, and global self-esteem. Based on their answers, subjects were sorted into three groups: about a third were “Internalisers” who “tended to agree with statements relating to internalised weight stigma beliefs.” About 17% of the subjects were classified as “Indifferent” - they “tended to disagree or had no strong opinion about statements relating to either weight stigma internalisation or weight stigma resistance.” Finally, 50% were “Resisters,” those who “tended to disagree with or have no strong opinions about internalisation statements and tended to agree with statements about weight stigma resistance.”In the subsequent analysis, “perceived legitimacy of weight stigma” was the most important predictor of internalized stigma. Meadows explains“I think it’s easier to understand conceptually if you think of it as a kind of continuum (even though it’s not fully linear with internalisers at one end and resisters at the other). The point here is that legitimacy beliefs were the best predictor of whether people tended to be internalisers or resisters – internalisers had higher perceived legitimacy beliefs (although still not ‘high’) whereas resisters were waaaay down at the bottom of the measurement scale.”Investment in the “fat” group also predicted resistance, but people were able to reach “Resistor” status even if they didn’t invest in the “fat” group. Meadows says:To me, this is the most exciting and important piece. Group identity is usually considered the major determinant of activism/resistance. That resisters existed who weren’t identified with the group was super interesting – you could use an allyship angle. Everyone needs to fight stigma, whatever their own body looks

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!I’ve written before about weight stigma in healthcare practice, and I’m currently co-authoring a study with Dr. Lesleigh Owen about the harm weight stigma does to the highest-weight patients. Today I’m going to dig into the research that already exists that explores the harm done to fat* patients by weight stigma.As we get into the research, a few reminders:First, weight stigma is rooted in and inextricable from racism and anti-Blackness, and continues to do disproportionate harm to those communities today. I urge you to read 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 this.Second, typically research over-represents privileged people and under-represents (or fails to represent at all) marginalized people, and thus the harm done to them is also under- or un-represented.Third, I wrote here about how weight stigma research is often still rooted in anti-fatness. I recommend reading this to contextualize a lot of the research and researchers I will talk about here.Many of the studies that will be discussed in this article look at perceived weight bias/weight status. In this way, weight stigma can harm people of many different sizes, so just a reminder that weight stigma, in particular structural weight stigma, always does the most harm to those at the highest weights and/or those with multiple marginalized identities.I also want to point out how often the things that are correlated with both weight stigma and body size are blamed on body size itself without any discussion of weight stigma as a strongly researched possible confounding variable (this is also common with weight cycling and healthcare inequalities.)In this piece I’ll be looking at studies that show harm to physical and/or mental health, including iatrogenic harm, which means harm that is done by the healthcare system/healthcare practitioners. Weight stigma does much, much more harm in all aspects of the lives of higher-weight people that won’t be examined here. Also, this provides brief overviews of the studies included and is far from an exhaustive list. Please feel free to add other examples in the comments.Finally, just a reminder that my policy is that when I refer to studies that perpetuate anti-fatness and harm, I will provide enough information to Google them, but I won’t link to them directly. Last last thing before we dig in: studies refer to this variously as weight stigma, weight bias, sizeism, and other less common (sometimes more stigmatizing!) terms, I’m combining those for the purpose of this article.Content note: This section will discuss physical and psychological harm that can result from weight stigma, including bias and self-harm, and may be harmful/triggering to higher-weight people, so please take care of yourselfI think therefore I am: Perceived ideal weight as a determinant of health, Muennig et al., 2008This study looked at whether stress related to negative body image perception and the desire to lose weight could impact health, and found that the difference between actual and desired body weight was a stronger predictor of physical and mental health than actual body mass index (BMI) in cis women. “[cis] Women who say they feel they are too heavy suffer more mental and physical illness than women who say they feel fine about their size - no matter what they weigh.”The body politic: the relationship between stigma and ob*sity-associated disease, Muenniug, 2008This work examines the relationship between weight stigma and health issues, and finds that weight stigma may drive health issues that are typically blamed on body size.“Stigma and prejudice are intensely stressful. Over time, such chronic stress can lead to high blood pressure and diabetes.”The Weight of Stigma: Cortisol reactivity to manipulated weight stigma, Himmelstein et. al:Young women who were told in an experiment that their weights “weren’t ideal” experienced higher levels of the stress hormone cortisol, regardless of their actual size.“Experiencing weight stigma was stressful for participants who perceived themselves as heavy, regardless of their BMI. These results are important because stress and cortisol are linked to deleterious health outcomes...”Associations between perceived weight discrimination and the prevalence of psychiatric disorders in the general population, Hatzenbuehler, 2009* Perceived weight discrimination is associated with substantial psychiatric morbidity and comorbidity.* The results remained significant after adjusting for perceived stress (a possible confounding variable)* Social support did not buffer against the adverse effects of perceived weight discrimination on mental health.* Controlling for BMI did not diminish the associations, indicating that perceived weight d

Transcript:This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!The Ob*sity* Action Coalition (OAC) claims to be a non-profit advocacy group for higher-weight people. The truth from my perspective is that they are anything but.I wrote about the OAC in 2014 when their priority had been lobbying the AMA to declare that “ob*sity” is a disease. Today their priority is the “Treat and Reduce Ob*sity Act” the goal of which is to expand Medicare coverage for weight loss interventions, including specifically expanding coverage for weight loss drugs.These priorities make a lot more sense when you realize that the OAC is not an advocacy group for higher-weight people, but rather an organization that is predominantly funded by, and lobbies for the priorities of, the weight loss industry.When I first wrote about the OAC the “Platinum” level of their Chairman’s Council (a distinction for those providing funding of $100,000 or more annually) included:· Allergan – Manufacturers of the lap band· American Society for Metabolic and Bariatric [weight loss] Surgery· Covidien – “committed to better patient outcomes through bariatric surgery“· Eisai – manufactures of the weight loss drug Belviq (now pulled from the market)· Vivus – manufacturers of the weight loss drug QysmiaAll of these organizations stood to profit from the AMA’s declaration of being higher-weight as a disease (and the lobbying was successful, not only did the AMA declare living in a larger body to be a disease, but they blatantly ignored the findings of their own Committee on Science and Public Health which had studied the matter for a year and recommended against it in order to do the weight loss industry’s bidding.)Having simply existing in a larger body re-branded into a disease was a major step forward, but not the only step. The next big step for Big Pharma is insurance coverage for dangerous, expensive (and almost certain to fail) weight loss “treatments.”And now the OACs “Platinum” level is down to one company – Novo Nordisk. A company that, having made a literal fortune price gouging on insulin, has promised their shareholders that their new weight loss drug, Wegovy, will make them billions. The rest of the sponsorship levels are still chock full of weight loss companies. They’ve also separated their Chairman’s Council from what they are calling “Corporate Partners”. Here Novo is again the top funder at “more than $500,000 annually” with Eli Lilly kicking in “more than $100,000” and the list goes on. I’ve included the lists below.There is something else in common between the OAC of 2014 and today. At both times, they were involved in parallel campaigns that claimed to be about ending weight stigma, but were in fact about selling more weight loss interventions.We’ve seen this before. It was a tactic used by Purdue Pharma and other pharma and medical device companies to sell opioids – they created non-profits like the American Pain Foundation that were billed as advocacy groups for pain patients (a legitimate group of patients who deserve advocacy and treatment,) but were, in fact, funded by and acting in the interest of the pharmaceutical industry. The work of these non-profits influenced legitimate government and healthcare organizations to do the pharma companies’ bidding, including influencing the behavior of doctors and other healthcare providers with their patients, creating an explosion in pain diagnoses and opioid prescriptions.This is exactly what Novo Nordisk and other weight loss companies want to do, so it’s not surprising that they are taking a page or two from the Purdue Pharma Oxycontin playbook.Fool us once, a lot of people are harmed and killed in the service of pharma industry profits. Fool us twice, even more lives are irreparably harmed and lost. That is why it is critical that we not allow the OAC to get away with this - that we not allow them and their spokespeople to claim to be fighting weight stigma when they are really shilling for the weight loss industry.When you see “Ob*sity Action Coalition” you should think “Novo Nordisk and their weight loss industry buddies” and treat them accordingly, with extreme suspicion.Current “Corporate Partners”Note: the date represents how long they’ve been an “OAC Partner”Platinum (contributing more than $500,000 annually)Novo Nordisk (2013)Gold (more than $100,000 annually)Eli Lilly (2020)Silver (more than $50,000 annually)Boehringer Ingelheim (2010)Ethicon (2012)Medtronic (2010)Bronze (more than $25,000 annually)American Society for Metabolic and Bariatric Surgery (2005)Currax pharmaceuticals (2020)Fujifilm (2018)Patron(more than $10,000 annually)Bariatric Advantage Nutritional Products (2008)Intuitive (2021)Rhythm (2018)The Ob*sity Society (2012)Wondr Health (2017)Weight Watchers aka WW (2015)Source: https://www.obesityaction.org/corporate-partnersCurrent chairman’s council funders:Platinum (donates more than 100k annually

Transcript:This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Reader Eliah sent me the following email:I’ve seen you write about how the idea of “ob*sity”* as a disease is problematic which is I think why I started noticing that in all the articles about these new diet drugs it seems like it says at least once that “ob*sity is a disease like asthma or type 2 diabetes” I thought you might have some insight into the concept in general and why this specific phrasing is being used.This is a great question. This specific phrase “ob*sity is a chronic disease like asthma or type 2 diabetes” is indeed making the rounds. I’ll start by talking about the veracity of the claim, and then answer the question as to why people are saying it.Before I dig in, I want to be clear that there is absolutely no shame in having a disease or diagnosis of any kind, this is about the intentional misapplication of the concept and the damage it does.First let’s answer the basic question: Is “ob*sity” a chronic disease like asthma or type 2 diabetes? In order to get to the bottom of this, let’s examine each diagnosis in turn.In order to be diagnosed with asthma, there has to be documentation of signs or symptoms of airflow obstruction, reversibility of obstruction (that the signs or symptoms decrease with asthma therapy,) and no clinical suspicion of an alternative diagnosis.In order to be diagnosed with type 2 diabetes one of the following thresholds must be met (typically with at least one repetition): an A1C of greater than or equal to 6.5%, fasting blood glucose of greater than or equal to 126 mg/dl, a two-hour blood glucose of greater than or equal to 200 mg/dl on an Oral Glucose Tolerance Test, or blood glucose of greater than or equal to 200 mg/dl on a Random Plasma Glucose Test.In order to be “diagnosed” as “ob*se” one’s weight in pounds times 703 divided by their height in inches squared has to be 30.0 or higher. There is no shared symptomology among this group of people, it includes people with various health diagnoses, people without any health diagnoses, and with widely varying cardiometabolic health, body composition, etc. Literally, the only thing this group has in common is a similar ratio of weight and height (and being “diagnosed” using a deeply problematic math equation.)When you take into account the “class” system (ie: class 1, class 2, and class 3 ob*sity) the folly of this becomes even more apparent. Consider that, for class 1 ob*sity, 1 pound, or 1 inch in height canbe the only difference between someone who is “diagnosed” with “ob*sity” and someone who is not, again with no shared symptomology or cardiometabolic profile. Even more ridiculous, while class 1 and 2 each encompass a 4.9 point BMI spread, class 3 is defined as a BMI of 40 to…infinity. That does not have the ring of sound science.Then there is the issue of treatment. For both asthma and type 2 diabetes, treatments focus on managing the common symptomology. With “ob*sity” the “treatment” is focused on making the patient look different by changing their size. Setting aside that the “treatment” almost never works and has considerable risks, no matter what size someone ends up at, there will be people of that size who have the same (and different) actual health issues.So the answer to the question of whether ob*sity is a disease like asthma and type 2 diabetes is: No, it absolutely is not.This is pretty clear cut, so why are people (including doctors) still spouting this nonsense? In a word (or four): the weight loss industry. The classification of simply existing in a higher-weight body as a “disease” is the holy grail for them. It increases their market to every fat person for the entire time that they are alive. They’ve been pushing this (both blatantly and surreptitiously,) pouring money into the effort for many years. I’ve been writing and speaking about this since 2009, and there are many people who have been doing it far longer (including since before I was born.) It’s actually one of the first things I wrote about when I launched this newsletter. So we’ve heard them try to claim that being fat is a “chronic lifelong health condition.” The addition of this comparison to type 2 diabetes and asthma seems to be specifically in the service of selling diet drugs like Wegovy.Novo Nordisk’s research has shown repeatedly that, while people lose weight short-term on their drug (though even in their 68-week trial weight loss had leveled off by the end) as soon as people go off the drug the rapid weight regain begins. Participants regained 2/3 of the weight they had lost, and lost 2/3 of the cardiometabolic health benefits in just the first year off the drug. So Novo Nordisk’s (wildly profitable, completely untested) “solution” is just to suggest that people stay on the drug for the rest of their lives.So the use of this phrase is them trying to take advantage of people’s understanding that

Transcript:This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing at WeightAndHealthcare.com!Sam Sessamen is someone I’ve had the opportunity to work with multiple times over the last three years and her work is something that I’ve truly appreciated. Recently she told me about a new screening tool that she had created, and I wanted to share it here in case it’s helpful. Here is some background from Sam followed by a link to the screening tool.Tell us a bit about you and your backgroundI’m a therapist in NY that specializes in trauma and Eating Disorders. I am passionate about providing trauma informed and weight neutral care as a result of my own experiences with weight stigma and disordered eating. What made you decide to create this screening?Many people struggle with disordered eating, body image issues, disordered exercise and the impacts of weight stigma. If you rely solely on standardized diagnostic screening tools and the DSM criteria, you risk missing huge populations that could benefit from working on the above-mentioned issues.Can you share the screening tool development process with us?I wanted this screening to be as comprehensive as possible so anyone struggling in the following areas could be flagged as needing support: Attitude & Thoughts Towards Food, Unhealthy Food Behaviors, Unhealthy Exercise Patterns, Body Image Struggles & Common Medical Complications because of Disordered Eating. The screening questions in each category include DSM criteria, criteria for Orthorexia and reoccurring issues that I see in my own practice that aren’t typically included in a diagnostic tool (e.g. Do you feel like you are waiting to be happy until you can “lose the weight?”).Once I was happy with the questions and format, I put a call out on IG for the assessment to be reviewed. I had 5 HAES-aligned providers, including folks in larger bodies, review the assessment and give me feedback.Were there difficulties and barriers that you faced in putting the tool together?The most difficult part was trying to keep this assessment concise, specifically in the body image and attitudes toward food sections. Since weight stigma and diet culture have catastrophic effects, it would have been easy to continue adding examples of how diet culture and weight stigma show up in folks’ thoughts and behaviors.How do you hope that the tool will be used?First, it’s a screening tool to help mental health professionals identify folks that need help with anything that falls under the disordered eating umbrella. I specifically hope this will circulate to professionals that don’t specialize in Eating Disorders. Many disordered thoughts and behaviors go unflagged by those not trained in Eating Disorders because they are deemed ‘healthy’ by diet culture.Second, I hope it can be a trailhead for professionals and their clients to explore how diet culture and weight stigma impact many areas of clients' lives.You can find the screening tool here! Please note that it was created for individual patient care only and is not a standardized diagnostic tool. Please seek written permission from Samantha Sessamen, LMHC ([email protected]) if you wish to use this in any other context (educational purposes, trainings, etc).Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In part one of this series we looked at the phenomenon of BMI-based treatment denials. In part two, we looked at resources to fight these denials. Today we have a first-person patient experience. Beckie Hill is someone who had to battle to have the surgeries she needed, and it’s a battle she won, twice. So I asked her to share her story for the newsletter and she graciously agreed! The rest of this piece is in her words: I injured both my knees on 08/17/2019 while working. I had x-rays done, followed by a round of physical therapy, massage, medication, activity limitation, taping, and injections. It did not improve my range of motion, activity tolerance, and/or pain. At that time, my physiatrist and primary care physician referred me to an orthopedic surgeon. I saw him on February 3, 2020. He recommended surgery right away, for both knees, and requested authorization for the surgeries through my worker’s compensation insurance.On 02/19/2020, the utilization review (UR) company for the worker’s compensation insurance provided the following decision: “Recommend denial. Failed to meet the criteria for TKA since her BMI is ##, and the Medical Treatment Guidelines (MTGs) require the BMI to be less than ##”.The UR makes a recommendation to the worker’s compensation insurance and they can then agree or disagree with the UR’s recommendations. Worker’s compensation chose to deny surgery.I began the search of scholarly articles supporting knee surgery in larger-bodied patients. [Editor’s note – you can find a collection of those here.] I reached out to professionals within the weight-neutral community for articles, ideas and suggestions. My surgeon also provided documentation to worker’s compensation. He also had phone calls with the medical director. On 04/20/20, my surgeon informed the medical director that I would be in a wheelchair within 6 months.Worker’s compensation still denied the surgery.Worker’s compensation directed me to lose weight or undergo intentional weight loss surgery. The suggestions and denial of medically necessary surgery re-activated a pre-existing eating disorder of atypical anorexia and bulimia. I lost weight, but I was also very sick. I met with an intentional weight loss surgeon during this time, told them about the need for knee surgery, direction to lose weight, and my eating disorder. This surgeon emphatically indicated that weight loss was contraindicated for me from a nutritional, medicinal, and surgical basis. ***Please note, I would NOT have undergone surgery and have been offered weight loss medications many times and refuse to take them.Worker’s compensation was provided with documentation from the intentional weight loss surgeon and still denied the surgery.I ultimately retained an attorney to help me navigate this system given the stress and toll the process had taken on me.I was ultimately provided with a cane, walker, an electric scooter, and a disabled parking permit. I lost the job that I was injured at because they were not able/willing to accommodate my work restrictions. Commuting to my place of employment after that became very difficult, and that employer was not able to continue to accommodate my work-from-home status as they had during much of the pandemic. My third job wanted me to work more hours than I was released to do, even though I did try.My lawyer, worker’s compensation, and the attorney general had months of discussion and both knee surgeries were ultimately authorized. I had my right knee surgery on 12/29/2021, 680 days after the orthopedic surgeon’s recommendation. In June of 2022, my surgeon provided surgery information for the left knee surgery and worker’s compensation denied that surgery, again due to BMI. It was ultimately authorized and occurred on 08/10/2022, 904 days after the initial surgery recommendation.Did I ever get close to the BMI that the MTGs “required”? No, in fact, based upon the UR reports I have seen, it went up. It was far more important for me to nourish my body so that I could try to navigate life and recover from surgery if it was/were ever authorized.Not only has the denial of the surgery for each knee been physically traumatic, but it has also been professionally, mentally, emotionally, and financially devasting. I am an “N” of 1. I am not a BMI number. I am a human with a body that is different than every other body on this planet.I am doing okay with the knee recovery. Both surgeries went well and I have almost full ROM in my right knee, and I am about 5 weeks out from the left and doing more movement than the first surgery. There were no complications during or post-op, no issues with wound healing, and while I still have some pain, my surgeon did not anticipate being at maximum medical improvement for one year post-op.I had a surgeon willing and able to do the surgery. And yet, an archaic system and hum

Transcript:In part one we talked about the issues with BMI-based denials. Today we’ll talk about your options if you are facing a BMI-based healthcare denial. Part three will be the story of someone who successfully fought these denials.First of all, if your healthcare is being held hostage unless/until you reach a certain BMI (or lose a specific amount of weight etc.), please know that this is not your fault, even though it’s becoming your problem. Your options include finding different circumstances, fighting the denial, or trying to reach the BMI requirement. We’ll talk about each of these in turn. Note that, while the advice here may be helpful in other places, it is predominantly focused on the US experience and that it is generalized options and, as everything in this newsletter, is not medical advice.And remember, unfortunately you are not in control of the situation, so if you are not successful, that’s not because you did anything wrong, it’s because the system is rooted in weight stigma and really messed up.The basicsThe first place to start is by finding out as much as you can about the denial. If possible, you want to get this information in writing (for example, by sending emails or utilizing a patient portal like MyChart,) or recorded (you can try saying something like “I’m afraid I won’t be able to remember everything from the appointment, do you mind if I record it?”) You can also bring someone along to take accurate notes.Collecting as much information as you can upfront can make future steps easier. Just as a reminder, this situation should not happen. It is absolutely unfair that fat people should have to fight for the treatment that thin people get. Even if this is becoming your problem, it is not your fault. Here are some questions to start with:Where is the denial coming from?* It is typically the surgeon, anesthesiologist, facility, or insuranceWhat are they claiming is the reason for the denial?* Is it anesthesia risk? Risk of complications with the surgery? Concerns about recovery time/complications? Concerns about outcomes not being as good as a thinner person’s outcomes?* Rather than offering up these explanations, you can ask more circumspectly - “what concern is at the root of the denial?” Again, try to get this answer down verbatim.What are they hoping that weight loss will do?* This is typically tied to the answer to the question above. Getting the answer to this can be very helpful if you decide to fight the denial.Ok, let’s look at the three main options to handle these denials. Before I start I do want to be clear that aspects of privilege, socioeconomic status, and intersectional oppression pervade all of these options and have the greatest impact on those of the highest weights and/or who are multiply marginalized.Option 1: Finding different circumstancesStart with the information you gathered about the source of the denial. Here the fact that these limits are often applied utterly inconsistently can be helpful.If it’s the surgeon, you can try to find another practitioner. A place to start is Mary Lambert’s Weight Neutral Provider list.If it’s the anesthesiologist, you can see what the options are to get another anesthesiologist. One option is to ask if they offer weight loss surgery in the facility and, if so, if one of those anesthesiologists can do the anesthesia for your surgery. (This can be particularly helpful in situations where someone has been denied a surgery that they actually need/want because of anesthesia risk, and has then been referred to weight loss surgery.)If it’s the facility, you can see if the surgeon you want to work with has privileges at other facilities that might have different BMI limits, or you can try to find a surgeon who operates at a different facility.If it’s your insurance, then you could look at options to switch insurance coverage. Of course this can be difficult or impossible, especially if it’s your employer’s workers compensation plan. In this case you can also look at options for cash paying if that’s accessible to you.Option 2: Fight the denialStart with where the denial is coming from and look into the official process to challenge the decision. This may be found on the website of the facility or insurance company, or through a facility customer service representative, or ombudsman.Some denials are easier to fight than others. For example, if the denial is coming from a specific surgeon or facility, you may have more options since these are often arbitrary. On the other hand, if you are being denied a transplant, there is more of a standardized denial not that standardization makes this any less wrong, but it can make it more difficult to fight.If your surgeon is on board but the facility and/or insurance is not, then you may be able to enlist the surgeon to help you fight.Before we get into the counterarguments, I want to note that these are not necessarily based in social justice, but rather in a harm reduction model of findin

One of the ways that weight stigma harms fat people is through Body Mass Index BMI (and other weight-based) limits. BMI is a ratio of weight and height, and its use is deeply problematic in multiple ways. BMI and weight-based healthcare denials occur when people above a certain BMI or weight are refused medical procedures unless or until they meet the BMI or weight requirement. In part 1 of this three-part series, I’ll offer a general discussion of these limits, in part two I’ll provide some options and resources to help fight them, in part three I’ll share the story of someone who successfully fought BMI-based denial of surgery. I previously published specific resources to fight joint surgery denials and moving forward I will be compiling resources for other common types of denials as well. If you have a specific request, please feel free to share in the comments or email me directly. I do want to note that, while this information can be helpful to people outside of the US, these posts will focus on the US healthcare system.BMI limits are typically “justified” based on the idea that there are higher risks of complications during or after procedures for people above a certain BMI vs people below that BMI, or that higher-weight people’s outcomes won’t be as good as thinner people’s outcomes.The first thing I want to point out is that this is blanket discrimination based on a simple height/weight ratio. The people whose care is being denied can and do vary wildly in everything from body composition to metabolic health and more. The use of BMI also codifies racism and anti-Blackness into the process and I urge you to read 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 learn more.BMI limits are based on, and further perpetuate, weight stigma. In our current healthcare system, research, tools, best practices, education, and training are very often developed based on thin bodies (and to the exclusion of fat bodies,) so even if someone believes that higher-weight people have more complications and/or worse outcomes, that wouldn’t be surprising due to the ways that weight stigma impacts every level of their care. What BMI-based denials do is take this weight stigma further by deciding that instead of getting better at providing care to fat people, or at least allowing them to consent to take possibly greater risks in order to get care that can improve their health, quality of life, or potentially save their lives, higher-weight people will simply be denied care unless or until they become thinner.There are other issues with BMI limits as well:The research that is used to justify these denials can be questionable (at best,) and/or contradicted by other evidence which is not taken into account.Often patients are denied needed surgeries, but are then referred to weight loss surgery. This is particularly ridiculous when the risk cited in the former surgery is anesthesia (as if weight loss surgeries don’t also use anesthesia,) and/or the risks of the weight loss surgery far exceed those of the surgery the patient actually needs. When a doctor denies a needed surgery and refers the patient to weight loss surgery it’s important to understand that the doctor is mitigating their risk (of having a patient with complications/poorer outcomes) by recommending that the patient take much greater risk with their life and quality of life.On the flip side, patients who have had their healthcare team push weight loss surgery on them for years can find themselves denied a surgery that they actually need/want when the time comes.Sometimes a needed surgery is denied until either the person becomes thin, or until the situation becomes dire enough to be considered an emergency surgery, causing far greater risk since the person can’t plan for their procedure, and the surgery is performed by whatever surgeon and anesthesiologist are available. Sometimes those in power decide that what would be an emergency for a thin person does not warrant the needed treatment for a fat patient. This can and does lead to the death of fat patients.On the other hand, fat people in the emergency room have been offered surgeries (for example, gallbladder removal,) but after weathering the acute attack have said that they would prefer to have the surgery in a way that was more planned, only to then to have the procedure denied due to BMI limits.These limits can vary between surgeons, anesthesiologists, facilities, and insurance companies (including, and sometimes especially, workers compensation companies) who can have a financial incentive to deny them. That means that whether or not someone can get the procedures can be essentially arbitrary – if they happen to find the right practitioners, or facilities, or insurance company they will get the care they need. If not, they will be denied care and left to suffer.Sometimes these denials are

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!Stunkard et al.’s 1959 study “The Results of Treatment for Ob*sity: A Review of the Literature and Report of a Series” is one of the earliest studies that really sought to determine the success of weight loss interventions. As someone who works full-time pointing out that weight loss interventions almost never succeed at creating significant, long-term weight loss and often do harm, every time I read this study it is a combination of validating and incredibly frustrating.Content note: this post will include discussion of calories and weight loss so please make sure to take care of yourself. Let’s dig in:They begin by saying: “The current widespread concern with weight reduction rests on at least two assumptions: first, that weight-reduction programs are effective, second, that they are harmless.”They continue “Recent studies indicate that such programs may be far from harmless. This report documents their ineffectiveness.”Again, it’s validating to see that they were explaining this in 1952, but incredibly frustrating that the only thing that has changed since then is that the weight loss industry profits have grown exponentially, and the interventions have become more dangerous and more expensive.The study looks at weight loss success/failure in two ways. First, a review of the weight loss literature for the previous 30 years, and second, an examination of the outcomes of the treatment of 100 consecutive higher-weight patients at New York Hospital’s Nutrition Clinic.Literature ReviewHere they use a phrase that I say or write some version of pretty much daily. “Hundreds of papers on treatment for ob*sity* have been published in the past 30 years. Most, however, do not give figures on the outcome of treatment, and of those that do, most report them in such a way as to obscure the outcome of treatment in individual patients.” They point out the following issues:* Reporting the number of patients and total pounds lost without specifying how much/the average that each patient lost* Short-duration studies* Reporting as a percentage rather than a number of pounds* The exclusion of those who dropped out or were “uncooperative” who the authors explain likely represent intervention failure and comprise an “impressive part” of the study samplesThey point out that “if papers with these shortcomings are omitted, the vast literature on treatment for ob*sity shrinks to just eight reports.”I’ll point out that these are still incredibly common occurrences in weight loss research. That, to me, indicates that those doing the research aren’t interested in creating good research, but are interested in creating research to prop up the failed weight-loss paradigm. Anyway, back to Stunkard et al.The eight studies had subject groups ranging from 48-314. Of the eight studies, interventions ranged from “self-selected diet,” to starvation diets (from 600 to 1,000 calories per day), to amphetamines.Four of the studies had more people lose less than 10 pounds than those who lost 10 or more pounds. Only one had a majority lose more than 20 pounds. Overall, only 25% of people were able to lose 20lbs and only 5% where able to lose 40lb short-term (and remember that research since 1959 has repeatedly shown that about 95% of this small group will regain all of the weight within five years.)Study of 100 patientsMoving on to their study of 100 patients. Here they point out that the health of “most subjects” was good, suggesting that they were referred for “treatment” solely to manipulate their body size. They were prescribed diets of 800 to 1,500 calories (all below, and some far below, the caloric intake for the Minnesota Starvation Experiment.)They characterize the results of these 100 people as “even poorer than those reported in the literature.” Of the 100 patients, 39 dropped out after the first visit, 28 never returned to any clinic in the hospital (suggesting that the intervention lowered their overall healthcare engagement, which the authors refer to as “a rupture of at least two therapeutic relationships” since patients only come to the Nutrition Clinic by referral from another clinic in the hospital.) Only 12 managed to lose more than 20lbs and only one of those was able to lose more than 40lbs.In terms of maintenance of weight loss, they found that, of the 12 who lost at least 20 pounds only 6 had maintained at least a 20 pound loss a year later, a number that dwindled to 2 people after two years. Moreover, 4 had already regained all of the weight they lost at two years, the others had already regained significant amounts of weight. Of the two “successes,” at two years the man who had the greatest weight change (-51lbs) reported that the diet had been “associated with mounting tension which culminated in what was diagnosed as an acute schizophrenic reaction” requiring a four-month hospitalization and treatment w

In part 1 I talked about information that was brought to me by two senior residents who wanted people to know that they are being invited to “educational summits” that are actually being run by doctors with massive undisclosed ties to the pharmaceutical companies that make the drugs that are recommended in the summits. I did some digging around the company that is behind this to try to get some information about what’s going on.The company that created both of these summits is PCMG, Primary Care Metabolic Group. Their tagline is “Serving to Educate Primary Care Clinicians on Metabolic Issues.” The words “Evidence Based Medicine” appear prominently in the banner at the top of each page. Their homepage states:The Primary Care Metabolic Group (PCMG) is a national educational initiative providing comprehensive metabolic disease resources. PCMG’s mission is to provide an easily accessible repository of metabolic disease information for primary care clinicians that includes disease management and raising standards of patient care through the dissemination of best practices and educational information.Their ”services” include· Monthly metabolic disease news articles from our partners· Opportunities for FREE CME· Member discounts for upcoming CME conferences and summitsAs a quick aside, CME stands for Continuing Medical Education. Doctors must obtain a certain number of CMEs in order to maintain their state licensure. The number of CME hours and requirements as to topics varies by state. Full disclosure, many of the workshops/talks I give for physicians provide CMEs. None, as far as I know, has ever been sponsored by a pharmaceutical company and I don’t receive any money from the pharmaceutical industry.Back to PCMG. The word “partners” struck me in the first bullet point. What do they mean by “partners?” As I scrolled down the page I see that they are welcoming a new “collaborator” – the Ob*sity Action Coalition. It says “This national nonprofit coalition is fighting to eliminate weight bias and discrimination, elevating the conversation of weight and its impacts on health, and offering a community of support to people affected. OAC also offers resources for clinicians, as well as a database of clinicians who treat patients with ob*sity.”It doesn’t say that this “national nonprofit coalition” has Novo Nordisk (manufacturer of the weight loss drug Wegovy and one of the leading pharma companies price gouging on insulin) as its main funder, with the vast majority of its funding coming from pharmaceutical companies and weight loss surgery interests. It doesn’t say that their plan to “eliminate weight bias” is focused on pushing for insurance coverage of their dangerous drugs and surgeries, or that they are trying to sell the “we don’t want to stigmatize fat people, we just want to make as much money as we can trying to eradicate them from the earth” line that is not, in any way, an anti-stigma approach.After reading the entire website, I called PCMG to ask what they meant by “partners” as well as who was funding the free and discounted CME training.I spoke with Nora Williams. I opened by explaining that I was writing an article about CME trainings and I had a couple quick questions about how their trainings were structured. She interrupted me to say that she was “suspicious” because she didn’t know who I was, or what outlet I was writing for, or what my story was about (in my defense, she hadn’t let me get that far.) She told me that if I sent her an email she would “consider it.” For me, this has the ring of a company that knows they are involved in things that they would rather not have brought to light, but of course, that’s just my gut feeling. I emailed her after our call in the afternoon of 1/7/23 and am still awaiting a response.However, the email that she gave me led me to PCEConsortium.orgIn searching, I had already found Primary Care Respiratory Group – US (PCRG) which has a website that is almost an exact copy of PCMG, except replacing metabolic with respiratory. The Consortium site has a long list of free CME workshops.I wanted to look into their materials, so I started by downloading their free CME “Common Questions on Continuous Glucose Monitoring (CGM) in Primary Care” I am not an expert in CGM, but I do a lot of work around weight-neutral blood sugar management and so it’s an area where I felt confident that I had enough knowledge to understand the paper.The author is Eden Miller, DO (who you may recognize as having been a speaker at both the free summits and having taken $1,429,227.40 in industry payments.) Miller is the co-founder and CEO of Diabetes Nation - Diabetes and Ob*sity Care, and in this publication disclosed that she serves on the advisory board and speakers bureau for Abbott Diabetes, Boehringer Ingelheim, Eli Lilly, and Novo Nordisk; on the advisory board for AstraZeneca, Merck, Plenity, and Sanofi Aventis; and does research for Abbott Diabetes and Pendulum Pharmaceuticals.Here are some

In discussing weight stigma and diet culture in medicine in general and, recently, the new AAP guidelines that recommend “intensive” weight loss attempts to toddlers, a common question I get is - How did we get here? How did doctors get so totally invested in this paradigm that they can’t see past it? I think that a huge part of this is how enmeshed the weight loss industry is in every aspect of the healthcare system, including (and perhaps especially) provider education.Recently I was contacted by Dr. Clarissa O’Conor and Dr. Will Ward, both family medicine residents who wanted to let me know about something that has been happening in their program regarding the education they are being offered.Just for starters, some background about the process of becoming a doctor in the US - it is both intense and hierarchical. After four years of medical school, newly minted doctors enter their residency. This stage of their training is specific to their chosen specialty (for example, internal medicine, ob/gyn, family medicine etc.) At this point, they are medical doctors practicing under supervision. In their first year, residents are known as “interns,” in their second year they become “residents.” In later years (residency can last from 3-7 years depending on specialty) they become senior residents, overseeing the work of newer residents. Some senior residents will become a Chief Resident. Chief Residents lead a group of residents both clinically and administratively. Those who choose additional training in a subspecialty fellowship are known as “Fellows.” The doctors who contacted me are senior residents. They had been invited to a “Chiefs Resident Summit on Ob*sity” and a “Family Medicine Chiefs Resident Summit on Diabetes.” Both were free (to the attendees) and were billed as “evidence-based” educational conferences.One of the residents did some research and found that the seven speakers at the “Ob*sity” summit had collectively accepted $2,651,160 from pharma companies that market weight loss since 2015 (when data collection started). Five of the physicians accepted money from Novo Nordisk in 2021, with an average payment of $18,000. (As a reminder, Novo Nordisk sells the weight loss drug Wegovy which they promised their shareholders would be massively profitable.)The Summit on Diabetes was headlined by five doctors (some of whom also spoke at the ob*sity summit.) Collectively these doctors had taken $7,106,460 from pharmaceutical companies that sell diabetes medications and supplies.Note that these numbers only include direct payments. These doctors have also collectively received millions more in research payments and associated research funding. It also only includes data up to 2021 and we know that Novo Nordisk has been absolutely pouring money into their Wegovy campaign in order to make good on their promise to shareholders of doubling their ob*sity sales by 2025.You can see the resident’s full research spreadsheet here.In the “ob*sity summit lineup, in addition to taking a ton of money from industries whose products the summit promotes, the speakers who are physicians have all pinned their careers to the “body size as disease” framework, including several who own weight loss clinics. One speaker was the President of the “Ob*sity Action Coalition.” This is an astroturf organization that purports to be an advocacy group for higher-weight people but is, in fact, funded by and acting as a lobbying arm for the diet industry. Novo Nordisk is their chief funder. Let’s be crystal clear about what is happening. As part of their training, these doctors are being invited to “evidence-based, educational” summits, but what they are actually attending are, essentially, pharmaceutical company seminars. They are being indoctrinated with pharmaceutical/diet industry talking points without consent (or knowledge unless they do their own research (which it’s pretty difficult to find the time to do when you are training to be a doctor,) and under the guise of unbiased, expert tutelage. This is not ok. This is a big part of how another generation of doctors are proselytized into a weight loss paradigm that has been actively failing patients for at least a hundred years.In part two we’ll learn about the company behind this, and take a closer look at what they are passing off as “evidence-based medicine.” For now, another example can be found in Novo Nordisk’s horrifying nursing grand grounds, which I wrote about before. Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created