Weight and Healthcare

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In parts 1 and 2 we looked at studies that sought to determine the effects of semaglutide on kidney function. Today, in the final part of the series, we are going to discuss another such study called Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes by Perkovic et al., 2024. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is part 2 of my series on the research around GLP-1 drugs for supporting kidney function. In part 1 we looked at Long-term kidney outcomes of semaglutide in ob*sity and cardiovascular disease in the SELECT trial, today we'll look at “Semaglutide in patients with overw*ight or ob*sity and chronic kidney disease without diabetes: a randomized double-blind placebo-controlled clinical trial” Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

As I promised, I'm doing some deep dives into the research and claims around GLP-1 agonist drugs for actual health uses other than their use in managing Type 2 Diabetes. For this series, I'll be doing the deep dives as well as analyzing the studies using the framework that I discussed here.Kidney-related health is one of the claimed uses I'm most often asked about with GLP1s, that providers have told me they feel is one of the most promising, and which recently received FDA approval (for semaglutide), so I'm going to start there. I want to reiterate that while I have serious questions about the safety and efficacy (especially long-term of the drugs for intentional weight loss, they are solid Type 2 Diabetes drugs and they may have other health benefits. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I've been meaning to write a piece about “the basics” of weight and healthcare and a question from a reader gave me the perfect chance. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This came up during a monthly Subscriber Ask Me Anything. Many patients, of all sizes, choose to opt-out of routine weigh-ins for a lot of reasons. But what happens when you decline a routine clinical weigh-in (again, not a medically necessary weigh-in that has a specific medical purpose like dosing medication,) but one that is just being done because you are at a doctor's office) and they tell you that you aren't allowed to decline? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I recently heard from reader Evelynn who asked :It seems like every other day I see a new supposed use for the GLP drugs. This just seems fishy to me. Are they really some kind of all purpose wonder drug? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1 we began discussing the 2025 study “Weight Trajectory Impacts Risk for Ten Distinct Cardiometabolic Diseases” by Swartz et al. that tested for possible harms of weight cycling. In part 1 I offered a quick summary of the study as well as looking into the methodology. Today we're going to break down their discussion section. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we discussed the issues with the study “Energy expenditure and ob*sity across the economic spectrum” by McGrosky et al. Literally hundreds of people reached out to me to write about it and most of them were asking about the article from the Washington Post “What causes ob*sity? A major new study is upending common wisdom.” Today I'm going to talk about that article. If you haven't read part 1, I recommend checking that out first, because I'm going to be referring to it a lot. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Wow did a lot of you ask me to write about the article “What causes ob*sity? A major new study is upending common wisdom” from The Washington Post.The article is about a study called “Energy expenditure and ob*sity across the economic spectrum” by McGrosky et al.We'll talk about the study in part 1 and the reporting of it in part 2. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In part 1 we discussed general issues with claims about higher-weight patients and surgical outcomes. Today, we'll talk about three important questions I think we need to be asking about the idea of higher-weight people having higher complication rates and/or worse outcomes. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

BMI-based denials of care are devastating and can have serious negative impacts on people's health, lives, and quality of life. In some cases they are, in fact, life or death. I have a series here that talks about this in detail, including options if you are dealing with a BMI-based denial of care and resources if you want to fight them. Today I want to talk about a common reason that is used to (attempt to) “justify” BMI-based denials of care. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 I started discussing the ABC News article “GLP-1s work but when they're stopped, the effects stop too: Expert” We discussed the fact that in order to buy the claims their “expert” makes, you first have to buy the dubious claim that simply existing in a higher-weight body, regardless of actual health status, is a health condition requiring treatment (which I wrote about in detail here and here.) We also learned about Dr. Louis Aronne, the “expert” they are quoting who, prior to taking over a million dollars from the companies that manufacture these drugs, wrote three books over three decades claiming he had the secret to permanent weight loss. Today we're going to talk about the contents of the article. As always I'll indent the quotes from the article, you can skip them and still get the gist of this article. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

There are a couple of online articles floating around that literally hundred of you have asked me to write about. One is the Washington Post “reporting” on the study about eating and body size. That study is…a lot, so while I'm slogging through that article and the study it references, today I'm going to write about the other article. Published by ABC News and called “GLP-1s work but when they're stopped, the effects stop too: Expert” Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1, I offered a framework of questions for healthcare providers (or others) to ask themselves before they offer unsolicited health advice to a higher-weight person (or, really, any person.) Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

A couple years ago I wrote a piece about what to think about before offering unsolicited advice to higher-weight friends/family/strangers about their health. Today's piece extends from that. While it can apply to family/friends/randos at the drug store, this is intended for healthcare providers and other health/public health professionals and educators whether you are one yourself, or you want to share this with healthcare providers and educators you know.I've written extensively about the research and ethical issues with recommending weight loss, including the old “eat less and exercise more” nonsense, but even for those recommending health-supporting behaviors, a lot of harm can be done. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we discussed the basics of substituting weight loss for healthcare and accommodation. In part 2 we discussed issues with the likelihood of achieving weight loss, even if it was appropriate to insist that higher-weight patients become thinner before accessing care (and I do not think it is). In part 3, we discussed the issues of weight loss being promoted as a solution to accessibility. In part 4, we looked at a case study.Today, we're going to talk about what can be done to stop the harmful, dehumanizing practice of substituting weight loss for healthcare, both long- and short-term. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we discussed the basics of substituting weight loss for healthcare and accommodation. In part 2 we discussed issues with the likelihood of achieving weight loss, even if it was appropriate to insist that higher-weight patients become thinner before accessing care (and I don't believe it is.). In part 3, we discussed the issues with weight loss being promoted as a solution to accessibility. Today we'll look at a real experience with this. Many facilities, including physical and mental health in-patient facilities fail to have beds, chairs, lifts, imaging equipment etc. that appropriately accommodates higher-weight people. Instead of accommodating them, currently they can simply refuse to admit them. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we discussed the basics of substituting weight loss for healthcare and accommodation. In part 2 we discussed issues with the likelihood of achieving weight loss, even if it was appropriate to insist that higher-weight patients become thinner before accessing care.Today we're going to discuss the issues with delaying care for weight loss. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 of this series we looked at the basic issues of a healthcare system that is allowed to demand weight loss before patients are able to access healthcare. In this section, we'll look at BMI-based denials of care. These occur when a patient is denied care unless or until they reach a certain BMI. It is often justified by the idea that higher-weight patients have more complications/worse outcomes and that weight loss will improve this. But it's far from being that simple. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Substituting weight loss for health and/or healthcare accommodation is a primary source of harm enacted on higher-weight people by the healthcare industry. I've had a bunch of requests asking me to write about it from a macro perspective .This is complicated and there is a lot to discuss so I'm breaking it up into five parts. (I'm thrilled that you are reading this whether you stumbled onto it or are a free or paid subscriber and today I want to offer some extra gratitude to my paid subscribers - a series like this takes a lot of time to create and your support makes this kind of deep dive possible.) Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1 we looked at the basics of a study that compared the two newest GLP-1 weight loss drugs against each other - Novo Nordisk's Semaglutide (Wegovy) and Eli Lilly's Tirzepatide (Zepbound) The trial was funded by Eli Lilly and while many of the authors took money from the makers of both drugs, the only authors (some of whom were statisticians) who were employed by and owned stock in a drug company were from Eli Lilly. While that isn't proof of bias, it's certainly a red flag.Today we'll look at the study and its findings. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

On May 11, 2025, the study “Tirzepatide as Compared with Semaglutide for the Treatment of Ob*sity” was published in the New England Journal of Medicine.This study was, essentially, a cage match between the two newest weight loss drugs to see which one created more weight loss. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

The way that higher-weight patients are discussed (in research, in medical/healthcare education and training, and even in interventions meant to increase accessibility in healthcare) can vastly increase weight stigma among healthcare providers. Today I want to talk about three terms that are often used that create this issue. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I recently wrote about a study that questioned the assumption that higher-weight causes health issues. Today I'm writing about a study that questions the assumption that weight loss improves health issues in higher-weight people. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Weight stigma does untold harm and, especially in healthcare, it can be deadly. One of the most important things that each of us can do to reduce weight stigma and the harm it causes is to act (when we can) when we find ourselves in situations where weight stigma is happening.Today I have an example of quick push-back and a more in-depth example. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In the past we've talked about how the health issues that get blamed on being higher-weight may actually be due to weight stigma and/or weight cycling and/or healthcare inequalities. Recently reader Conner let me know what this 2021 study whose bottom line finding was “adverse consequences currently attributed to ob*sity could be attributed to hyperinsulinemia (or another proximate factor.” Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I got the following question from reader Jill who attended a recent talk that I gave at her medical center:”During the question and answer part you mentioned a contest to win weight loss surgery. Did that really happen? I hope you'll write about it on your newsletter.”Yeah, it did and yes, I will Jill, thanks for asking. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we talked about the general issues with giving the weight loss industry the benefit of the doubt. In part 2 we talked about the specifics of this for the GLP-1 weight loss meds. That brings us back to our original question from family doctor Elena:I'm a weight-neutral family doctor. I was talking to a colleague about my issues with the GLP-1s and how there is no evidence that supports that taking them for life will lead to sustained weight loss or health benefits. He said “There's no evidence that they won't.” It strikes me as wrong, but how do I argue with that?In some ways it can depend who you are talking to. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we discussed the general issues with giving the weight loss industry the benefit of the doubt. Today we are going to talk about this as it applies to GLP-1s. This started with an email I got from Elena:”I'm a weight-neutral family doctor. I was talking to a colleague about my issues with the GLP-1s and how there is no evidence that supports that taking them for life will lead to sustained weight loss or health benefits. He said “There's no evidence that they won't.” It strikes me as wrong, but how do I argue with that. “Here I'm going to suggest that it doesn't just feel wrong, it IS wrong on several levels. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I got this email from reader Elena:I'm a weight-neutral family doctor. I was talking to a colleague about my issues with the GLP-1s and how there is no evidence that supports that taking them for life will lead to sustained weight loss or health benefits. He said “There's no evidence that they won't.” It strikes me as wrong, but how do I argue with thatThis same question came up in our monthly subscriber Ask Me Anything as well. I'll address it specifically but first I want to talk about how this is part of a larger pattern of giving the weight loss industry the benefit of the doubt. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

We are going to start out today with the story of Dr Thomas Kraut and then talk about what it that story demonstrates and what we can do about it. Content note that this story is tragic. This was originally brought to my attention by reader Suzanne. I read every account I could about the situation and pieced them together. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I got a question from reader Giana who asked:I feel like I've seen a hundred news reports claiming that the GLP1 drugs will cure anything and everything…joint pain, heart attacks, addiction, on and on and on. Is it possible that they can do all of these amazing things or is this just the new snake oil?I've also seen a bunch of claims about the healing powers of GLP-1 drugs. It is possible that GLP-1s have health benefits, but there are some potential issues with these studies that I want to point out. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In parts 1 and 2 we looked into a 2018 journal article called Management of osteoarthritis of the knee in younger patients by Khan, Adili, Winemaker, and Bhandari. It turns out we aren't the only ones looking into it. As I was finishing up this piece, I was googling to make sure I had a list of all the links I used in the piece (while I don't include links to pieces with weight stigma here, I always keep a list in my draft,) I stumbled onto a letter responding to the Khan et al. article called “Is it weight loss or exercise that matters in osteoarthritis?” by Ilona Hale, MD, published in the Canadian Medical Association Journal, which is the same journal that published the Khan et al. article. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we began discussing the article Management of osteoarthritis of the knee in younger patients by Khan, Adili, Winemaker, and Bhandari and their claim that weight loss is an appropriate treatment for osteoarthritis. We examined one of their citations and today we'll look at the other. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Recently I received an email from a physician who had just attended a talk I gave. She asked what I thought about a study that “shows that weight loss is an evidence-based treatment for OA” (osteoarthritis). I started investigating the issues with the study and, in the course of researching and writing about it, I came across an absolute gem by Ilona Hale. In parts 1 and 2 we'll look at my analysis and in part 3 we'll look at Dr. Hale's. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I frequently write about types of weight stigma and bias. Today I want to talk about a specific form called Surveillance Bias, I've also heard it called Detection Bias or Testing Bias. I want to talk about how this kind of bias can lead to claims that a health issue is more likely to be found in a group of people when actually the difference is/may be because of the way that group of people were surveilled/tested.It's really important to look for this type of bias because when this happens, it can cause the wrong risk factor to be identified which can lead to over -treatment of some groups and under-treatment of others. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we looked at the 2022 article by Sierżantowicz et al., “Quality of Life after Bariatric Surgery A Systematic Review.” In part 2 we took a deeper look into two of the studies they included. In part 3 we'll examine their conclusions. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe