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Examining the intersections of weight science, weight stigma, and healthcare and what evidence, ethics, and lived experience teach us about healthcare and public health best practices for higher-weight people. weightandhealthcare.substack.com

with Ragen Chastain


    • Feb 25, 2026 LATEST EPISODE
    • weekdays NEW EPISODES
    • 8m AVG DURATION
    • 261 EPISODES


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    Latest episodes from Weight and Healthcare

    Study Links Weight Stigma and Inflammation Part 1 - Authors and Methodology

    Play Episode Listen Later Feb 25, 2026 23:38


    A new study in this vein has come out that looks at the link between weight stigma and inflammation. The study is called The Acute Inflammatory Effects of Weight Stigma: An Experimental Pilot Study and it was published in August, 2025. In part 1 we'll look at the study authors and the methodology, and in part 2 we'll look at the results. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    Healthcare's Weight Loss Best Case Scenario Problem Part 2 - GLP-1s

    Play Episode Listen Later Feb 21, 2026 7:13


    In part 1 we discussed the issues with the decades-long practice of healthcare providers prescribing behavior-based weight loss not based on the evidence (which shows that the vast majority of patients will lose weight short-term and then regain it long-term) but on the belief/hope that every one of their patients will experience the very rare “Best Case Scenario” of significant, sustained weight loss. Today we're going to talk about how the new GLP-1 weight loss drugs are taking this problem to new lows. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    Healthcare's Weight Loss Best Case Scenario Problem Part 1 - The Basics

    Play Episode Listen Later Feb 18, 2026 4:17


    When it comes to recommending weight loss, healthcare has always had what I call a Best Case Scenario Problem. I think the best way for patients to protect ourselves from this is to understand it so that we can spot it when it's happening so in Part 1 I'll examine how this works (in the past and currently) around behavior-based interventions and then in part 2 we'll look at how GLP-1s are driving an increase in this problem and creating even more harm and what we can do if this problem happens to us. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    Novo Nordisk Is In Trouble For Misleading Advertising - Again

    Play Episode Listen Later Feb 14, 2026 10:47


    I've had a bunch of requests to write about this so here you go! Novo Nordisk has a long and sordid history of misdeeds, many of which I've written about previously. Now they have a new one to add to the list. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    The Million Pound Challenge Part 2 - The Program

    Play Episode Listen Later Feb 7, 2026 7:46


    This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!In Part 1 we started discussing the “Million Pound Challenge” created by Toby Cosgrove and Dr. Michael Roizen in which they are “challenging” an unknown number of people to collectively lose one million pounds. In part 2 we'll discuss the program itself. (If you haven't read part 1, I recommend it to fully understand part 2.) As always I'll indent the quotes from the website so that you can avoid harmful weight stigma if you choose. They explain the program as a 3-step process:Step 1: Enroll Your OrgRegister your health system. Get access to a variety of resources in the Million Pound Challenge Tool Kit for your entire team.Step 2: Your Staff, Your WayEmployees can use the tools provided, join their own programs, work with providers—whatever works. Your organization decides how to structure participation.Step 3: Track ProgressThe only requirement? Track results with a monthly check with your Challenge coordinator. Watch as individual effort becomes collective momentum toward one million pounds.This is where they make things incredibly clear - literally the only requirement is to track weight loss. This isn't about health metrics, there is no way to make this program weight neutral or to focus on health - weight loss is the only metric and tracking it is the only thing the program requires.And when they blithely say “whatever works” let's be clear that a century of research finds that, unless their goal is to create weight cycling, nothing does. So there is no common intervention and all they are tracking is weight loss. Right. And how is weight loss tracked? Per the FAQs (emphasis mine)“Your Challenge ambassador must log your team's results monthly with your assigned Challenge Coordinator—this is the only requirement. Individual weights remain completely private. Only aggregate organizational totals are posted on the community leaderboard so you can see how your organization compares nationally.”Um, they aren't private if you have to share them with your company's challenge ambassador (and I have serious concerns that someone who would sign up for that job may be the last person that a coworker would want to tell their weight.) Workplace programs (or any programs) that include a weight loss component have significant risks to physical and mental health, including through eating disorders. But programs that compel people to compete solely on the basis of weight loss, as this one does, can actually encourage participation in dangerous behaviors in order to create weight loss.Measure your organization's progress, celebrate your success stories, and recognize your top-performing teams. Join leaders at quarterly events, Chamber Summit, Aspen Ideas Festival, and HLTH to keep momentum strong.Do. Not. Do. This. Another huge issue with this, and all workplace/organization weight-loss challenges, besides the issues with disordered eating and eating disorders and weight cycling, is that it can single out people who aren't participating or “achieving” in ways that create a hostile work environment for them. It can mean that those who have chosen an evidence-based weight-neutral path (either due to a history of eating disorders or other reasons) have to choose between their physical and mental health and being seen as “not a team player.” It can lead to organizations under valuing employees who, due to many reasons including disability, chronic illness, and more, cannot participate in the initiative at all (or in ways that make them “top-performing”) which can lead them to being seen by subordinates, peers, and bosses as a “drag” on the team or having less value to the organization. This is not surprising from someone like program co-founder Toby Cosgrove who once gleefully told the New York Times magazine that he didn't want to hire higher-weight people (as the CEO of the Cleveland Clinic,) but let's not follow in those bigoted footsteps.After 12 months, we'll have collectively proven what we've known all along—that sustainable health outcomes are achievable. Winners celebrated at HLTH 2026. Every organization recognized for leading the revolution.There is so much wrong with this that I scarcely know where to begin. As I said in part 1, “prove” is a very strong word so I expect robust research and lots of it (spoiler alert - I'm going to be disappointed again, but in no way surprised, again.) These two doctors should know better than to suggest that anything about “sustainable health outcomes” can be “proven” by a random “challenge” that only lasts a year has no common intervention, and only measures weight loss. This does not have the ring of sound science. The truth is, we can't even be sure how many of the participants would get thin enough that program co-founder Toby Cosgrove would think they deserved to be employed.I don't want to spend too much time analyzing the deck chairs on this titanic of a “challenge” but I do want to look at one of the “resources” they offer, called ‘Why Healthy Employees Don't Need Your Wellness Challenge.” First of all remember that this is NOT a wellness challenge (which would measure, you know, wellness) this is a weight loss challenge that only measures body size manipulation. Even if we ignore that, this “resource” is particularly horrifying, promoting the “Lifestyle 180” program. The program is based on the assumption that higher-weight people and those with chronic conditions are not already participating in health-supporting behaviors and should be “targeted”, by their employers (not their actual healthcare providers,) with “intensive, medically-integrated interventions.”Here again, this program teaches organizational leadership to see higher-weight people and those with chronic conditions as a liability to be solved and not as skilled and valuable employees, with the unspoken (except by Toby to the NYT magazine) takeaway to avoid hiring these people in the first place. This is likely to disproportionally impact higher-weight people, People of Color, and especially higher-weight People of Color. (Note that this is all wrapped up in the massive issues with U.S. employers providing healthcare which is, to use a technical term, a hot garbage mess that is beyond the scope of this post, but the idea that employers should have access to employee health information is obviously seriously problematic on its face.) The “resource” continuously suggests that employers focus on “the 20% of [ employees] driving 80% of the costs” ending with “that's where you win.”My main takeaway from this resource was that if an employer sent me an email that said “Your recent health screening showed some concerning trends We have a program specifically designed for you. Can we talk?” I should say, emphatically, no. Which would also be my immediate answer if asked to participate in this “challenge.”In Part 3 we'll talk about what you can do if your organization tries to push this kind of “challenge” on you.This month's online workshop is Weight-Neutral Joint Pain Management with sports medicine physicians Dr. Julia Bruene and Dr. Jeremy Alland. There is a pay-what-you-can-afford option and a video will be sent to all registrants.Details and registration here!If you appreciate the content here, you can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter (and the work that goes into it!) and get special benefits! Click the Subscribe button below for details:Liked the piece? Share the piece!More researchThe Research PostMore resourcesThe Resource Post*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's 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

    The Million Pound Challenge Part 1 - The Basics

    Play Episode Listen Later Feb 4, 2026 11:27


    Reader Shannon Roosma-Goldstein, MPH, BSN, RN, NPD-BC recently reached out to me because a professional healthcare organization she belongs to had sent her an email encouraging her, as a member, to participate with the organization in the “Million Pound Challenge.”In Part 1 we'll look at the basic issues with the challenge and who is behind it. In part 2 we'll look at the details of the program, and in part 3 we'll talk about what you can do if your workplace announces a program like this, including with sample letters written by Shannon that you can use as a template. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    Three Mistakes Providers Make Recommending Behaviors to Higher-Weight Patients

    Play Episode Listen Later Jan 31, 2026 7:14


    Behavior-based interventions (sometimes under the auspices of lifestyle medicine) can be evidence-based, health-supporting, and weight-neutral. Unfortunately, when it comes to recommending behavior-based interventions to higher-weight people, there are common mistakes that providers make. We'll talk about the mistakes and then what patients and providers can do to avoid and/or navigate them. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    Study Shows Rapid Weight Regain after Ceasing Weight Loss Drugs - Part 3 Media Coverage

    Play Episode Listen Later Jan 29, 2026 17:20


    In part 1 we started looking at a study called Weight Regain after cessation of medication for weight management systemic review and meta-analysis by West et al. and in part 2 we looked at the findings. Today I thought it would be helpful to look at how the media is covering this study so we can see how these findings translate. If you haven't read part 2 (or, at least, the summary) then I recommend starting there. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    Study Shows Rapid Weight Regain after Ceasing Weight Loss Drugs - Part 2 Findings

    Play Episode Listen Later Jan 24, 2026 18:34


    In Part 1 we began discussing Weight Regain after cessation of medication for weight management systemic review and meta-analysis by West et al. Today we'll discuss the findings. This is a long one so I've got a summary and then a deeper dive. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    Study Shows Rapid Weight Regain after Ceasing Weight Loss Drugs - Part 1 The Basics

    Play Episode Listen Later Jan 21, 2026 8:14


    I've received well over a hundred questions about this new study, all asking roughly the same thing - what does this mean?In Part 1 we'll talk about the study authors and methodologyPart 2 we'll talk about the findingsPart 3 we'll talk about how the media is covering the studyThe study we are looking at is called Weight Regain after cessation of medication for weight management systematic review and meta-analysis by West et al. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    The Case Against Blaming “Body Habitus” in Higher-Weight Patients' Radiology Reports

    Play Episode Listen Later Jan 17, 2026 6:15


    I was recently advocating for a patient who needed an emergency head CT to rule out some potentially serious complications. (Luckily she was fine and her symptoms had the least concerning diagnosis.) Of course, I have her permission to write about this.A content note, this post is going to include medical weight stigma.After the imaging was done and the report completed the doctor came into the room to tell her that everything on the CT looked “great”.The next day, the results were released to her MyChart and she had an unpleasant experience that I've heard from many other patients.The first line of the “impression” section was “Significantly limited evaluation due to body habitus.” That was also the first line of the “findings” section. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    What's with the Wegovy Pill - Part 3 Trial Findings

    Play Episode Listen Later Jan 14, 2026 8:21


    In part 1 we looked at the basics of the newly approved Wegovy pill for weight loss. In part 2 we began looking at the trial that was used for approval (Oral Semaglutide at a Dose of 25 mg in Adults with Overw*ight or Ob*sity.) Today we'll look at the findings of that trial. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    What's with the Wegovy Pill - Part 2

    Play Episode Listen Later Jan 10, 2026 7:47


    In Part 1 we looked at what Novo Nordisk's page said about the new Wegovy Pill for weight loss. Today we'll look at the trial. Now, Novo didn't link to the trial (or even mention the name or the authors) on the webpage. They did say twice that it was a 64 week trial. That threw me off for a minute because it was actually written up as a 71 week trial, but we'll get to that. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    What's with the Wegovy Pill - Part 1

    Play Episode Listen Later Jan 7, 2026 7:34


    Wow did I get a lot of requests to write about this! We'll start with some basic information today and then break down the actual trial data in the rest of this series. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    Reader Question - Weight-Neutral Ways to Navigate Resolution Season

    Play Episode Listen Later Jan 3, 2026 5:39


    I received the following question from reader Rebecca:This is my first New Years away from dieting and while I am happier (and healthier, though I know that's complicated) than ever. Still I am struggling with New Years Resolution season, do you have any tips for making non-diet resolutions that focus on my health?I'm happy to help, you are definitely not alone in trying to navigate this time of year in weight-neutral, non-diet ways! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    GLP-1s and Knee Osteoarthritis Part 3 - Behavioral Intervention Comparison

    Play Episode Listen Later Dec 20, 2025 8:52


    In part 1 we talked about a trial of semaglutide for knee osteoarthritis. In part 2 we compared that trial to a trial that used metformin. Today we're going to talk about research around behavioral (non-pharmacotherapy) weight-neutral interventions. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    GLP-1s and Knees Osteoarthritis Part 2 - Metformin Comparison

    Play Episode Listen Later Dec 17, 2025 16:15


    In part 1 we looked at a study of the effect of semaglutide 2.4mg (Wegovy) on knee osteoarthritis. Today we'll look at two studies that consider the effect of metformin and compare that with the semaglutide study. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    GLP-1s and Knee Osteoarthritis - Part 1 Semaglutide

    Play Episode Listen Later Dec 13, 2025 14:40


    I've received a number of questions about GLP1s and knee pain/osteoarthritis and in this series we'll look at what the research says.In part 1 we'll look at the trial for semaglutide and knee osteoarthritis.In part 2 we'll look at 2 studies that consider the effects of metformin on knee osteoarthritis.In part 3 we'll look at a study of a weight-neutral intervention Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    Quick Guide - Weight-Centric vs Weight-Inclusive Paradigm (Reader Question)

    Play Episode Listen Later Dec 10, 2025 3:47


    I received a question from reader Brit who said “I see you and other people talking and writing about the weight-inclusive and weight-centric (and sometimes weight-neutral and weight-loss paradigm). I think I know what they mean but could you give a quick explanation?I'm happy to Brit, sometimes it's good to go back to basics! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    Applying Lancet Commission's Concerning Ideas in the Real World - Part 2

    Play Episode Listen Later Dec 7, 2025 7:47


    In Part 1 we began discussing the article “Implications of a New Ob*sity Definition Among the All of Us Cohort” by Fourman et al. This is a study that took the recommendations of the (heavily financially entangled with the weight loss industry) Lancet Commission around increasing the methods by which “ob*sity” can be “diagnosed” (the massive issues with which I wrote about here,) and applied it to the All of Us population. So what did they find? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    Applying Lancet Commission's Concerning Ideas in the Real World - Part 1

    Play Episode Listen Later Dec 3, 2025 6:55


    I previously wrote about a Lancet Commission that published what I would describe as an opinion piece that they attempted to disguise as legitimate science. In it, they manipulated multiple research processes in order to create the largest possible market for the weight loss industry (in which the authors had massive financial entanglements) by wildly expanding the ways that someone might be “diagnosed” as “ob*se.” You can read about the whole sordid affair here. This has been a longtime goal of the weight loss industry and this group of financially entangled authors made it real, at least in their article.Now another group of authors have shown the reality if these ideas are applied in the real world. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    Dealing with Diet Culture and Weight Stigma at the Holidays

    Play Episode Listen Later Nov 22, 2025 8:59


    Today I'm taking a break from talking about weight and healthcare to write about navigating so much of the nonsense that happens during the holiday season. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

    Calculating the supposed "cost of obesity" - Part 1

    Play Episode Listen Later Nov 15, 2025 9:09


    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

    GLP-1s and Muscle Mass Part 3 - Dubious Claims

    Play Episode Listen Later Nov 12, 2025 7:44


    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

    GLP-1s and Muscle Loss - Part 2 Wegovy and Zepbound

    Play Episode Listen Later Nov 8, 2025 10:18


    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

    GLP-1s and Muscle Loss - Part 1 The Basics

    Play Episode Listen Later Nov 5, 2025 9:23


    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

    Quick Guide: Diet Drugs and Surgeries for Children

    Play Episode Listen Later Oct 29, 2025 5:06


    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

    Questions about the claimed benefits of weight loss

    Play Episode Listen Later Oct 25, 2025 8:25


    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

    What Going On With the Obesity Action Coalition

    Play Episode Listen Later Oct 22, 2025 18:59


    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

    Quick Guide - Expanding Thinking About Weight And Health

    Play Episode Listen Later Oct 18, 2025 3:47


    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

    New Drug to Tolerate Weight Loss Drugs?

    Play Episode Listen Later Oct 15, 2025 10:41


    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

    Identifying Two Dangerous Lies in Weight and Healthcare

    Play Episode Listen Later Oct 11, 2025 6:29


    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

    Reader Question - What's in it for Novo Nordisk?

    Play Episode Listen Later Oct 8, 2025 11:27


    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

    Analyzing ADCES Conversation Guide for Weight and Type 2 Diabetes - Part 3

    Play Episode Listen Later Oct 1, 2025 8:33


    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

    Analyzing ADCES Conversation Guide for Weight and Type 2 Diabetes - Part 2

    Play Episode Listen Later Sep 27, 2025 13:36


    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

    Analyzing ADCES Conversation Guide for Weight and Type 2 Diabetes - Part 1

    Play Episode Listen Later Sep 24, 2025 7:30


    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

    GLP-1s and Kidney Function - Part 3

    Play Episode Listen Later Sep 20, 2025 25:05


    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

    GLP-1s and Kidney Function - Part 2

    Play Episode Listen Later Sep 17, 2025 19:54


    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

    GLP-1s and Kidney Function Part 1

    Play Episode Listen Later Sep 13, 2025 22:03


    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

    Reader Question - Weight and Healthcare Basics

    Play Episode Listen Later Sep 6, 2025 10:37


    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

    What if they tell you that you have to weigh-in?

    Play Episode Listen Later Sep 3, 2025 5:40


    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

    Reader Question - All These Other GLP-1 Uses

    Play Episode Listen Later Aug 30, 2025 8:31


    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

    New Study of Harms of Weight Cycling - Part 2 Discussion

    Play Episode Listen Later Aug 27, 2025 12:36


    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

    WaPo Article Claims Food Causes "obesity" Part 2 - The Reporting

    Play Episode Listen Later Aug 20, 2025 13:46


    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

    WaPo Article Claims Food Causes "obesity" Part 1 - The Study

    Play Episode Listen Later Aug 16, 2025 15:45


    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

    Questions About Weight and Surgical Complications Part 2 - Three Questions

    Play Episode Listen Later Aug 13, 2025 8:03


    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

    healthcare weight three questions surgical complications
    Questions About Weight and Surgical Complications Part 1 - The Basics

    Play Episode Listen Later Aug 9, 2025 6:21


    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

    healthcare weight basics bmi surgical complications
    ABC News' Love Letter to Diet Drugs - Part 2 Sell the Premise, Sell the Bit

    Play Episode Listen Later Aug 6, 2025 13:08


    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

    ABC News' Love Letter to Diet Drugs - Part 1 Buy the Premise, Buy the Bit

    Play Episode Listen Later Aug 2, 2025 8:35


    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

    The dangers of giving unsolicited health advice to higher-weight people - Part 2

    Play Episode Listen Later Jul 30, 2025 8:09


    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

    4 Questions to Ask Before Making Health Recommendations to Higher-Weight People

    Play Episode Listen Later Jul 26, 2025 7:39


    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

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