Weight and Healthcare

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

In part one we looked at the 2022 article by Sierżantowicz et al., “Quality of Life after Bariatric Surgery A Systematic Review.” I do recommend reading that to understand the issues with the way “Health Related Quality of Life or HRQOL” is used in the studies we'll examine today as we take a deeper diver into two of the studies Sierżantowicz et al. included.Content note for discussion of suicide and self-harm. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

As I mentioned in part 2, when I teach research analysis, I recommend checking something I call “The Do-Do's” which encompasses two questions: Do the citations support the claims? Do the study data support the results?In part two we looked at the first question, today we'll look at the second question. 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!Content note: this piece will discuss research around binge eating, including behaviors and frequency. In part 1, we looked at the authors and methodology of a 2024 study called “Evaluating dietary restriction as a maintaining factor in binge-eating disorder” by Bartholomay et al., whose authors claim that the findings “challenge the assumption that dietary restriction maintains BE [binge eating] among all individuals with BED [Binge Eating Disorder]. Rather, results suggest that dietary restriction may be largely unrelated to BE maintenance in this population, and that reducing dietary restriction generally does not have the intended effect on BE frequency.”Too Long Didn't Read Version:When analyzing research, it's important to check to see if the research that the authors cite to support their claims actually does support their claims. In this case, these authors are drawing large, broad-based conclusions that would support a weight-centric/weight-loss paradigm based on small, short-term, and decades old studies that offer only weak conclusions. They are also completely ignoring the success of a weight-neutral intervention that is included in on of the studies they cite. Let's dig in!When I teach research analysis, I recommend checking something I call “The Do-Do's” which encompasses two questions: Do the citations support the claims? Do the study data support the results?In this part of our three-part analysis, we're going to examine the first question. Regular readers may have noticed me pointing out in my analyses how often the studies that are cited don't support the claims. In the case of this study, the question “do the citations support the claims” is particularly important since they are using them to bolster a very limited experimental design, so I've devoted this section to some examples.Bartholomay et al. claim:“randomized controlled trials conducted among individuals with overw*ight and ob*sity demonstrate that assignment to a low-calorie weight loss diet (e.g., 1200 calories per day) produced greater decreases in binge-eating symptoms than assignment to a wait list control group (Goodrick et al., 1998; Klem et al., 1997; Reeves et al., 2001).”What I want to note here is that the study authors have created a false binary between low calorie weight loss diets and wait list control group which would be bad enough. In this case, they've done so by blatantly ignoring the inclusion of a weight-neutral intervention in the very first study they cited.Let's look at the three studies they cited to, in theory, support this claim:The first study they cite is1998 Nondieting versus dieting treatment for overw*ight binge-eating womenG K Goodrick 1, W S Poston 2nd, K T Kimball, R S Reeves, J P ForeytDOI: 10.1037//0022-006x.66.2.363This study evaluated non dieting vs dieting treatment for what they described as “overw*ight binge-eating women.” There were 219 subjects and they were assigned randomly to diet treatment, non-diet treatment, or wait-list control (which is a form of control group in which participants are told that they were on a wait list for the intervention, while being offered no intervention.)The diet intervention was a restricted diet “reinforced with behavioral strategies” and the non-diet treatment was “therapy designed to help participants break out of their dieting cycles.” It involved 18 months of contact - 6 months of treatment followed by 26 bi-weekly maintenance meetings. They checked in on the subjects 6 months later and 18 months later and at both follow-up points the Binge Eating Scale of both the diet and non-diet group was significantly better than the weight list group and at 18 months both experienced weight gain. They concluded that “Results indicate that neither intervention was successful in producing short- or long-term weight loss.”I would suggest that this means that the weight loss intervention is a failure since its goal was weight loss and binge eating reduction but the non-diet intervention was a success since it's goal was to reduce binge eating disorder. I would also suggest that it may have been more effective if the therapy included more specific techniques to reduce binge eating.What it means for sure is that a higher-weight cis woman (the only group included in the sample and thus the only group we can draw conclusions about) who wants to reduce binge eating without risking the experience of another failed diet (and the physical and psychological risks that can come with it) would be best served by a non-diet approach.Second, they cite:1997 A descriptive study of individuals successful at long-term maintenance of substantial weight lossM L Klem 1, R R Wing, M T McGuire, H M Seagle, J O HillDOI: 10.1093/ajcn/66.2.239The study discusses the ridiculous National Weight Control Registry (NWCR) which I often use as a peak example of the embarrassingly poor methodology that gets passed off as research in the weight-centric paradigm. I've written about it in detail previously but the short story is that they collect commonalities among an incredibly small group of dieters (literally 10,000 out of what is estimated to be over a billion attmpts) and then make unsupportable claims about those commonalities. I am unclear why Bartholomay et al cited this since the only reference to binge eating disorders is two studies that happened to include those who binge that tracked the mean lifetime weight loss of participants in order to compare it to the mean lifetime loss claimed in the NWCR. Not only could I find no claim here about whether weight loss attempts impacted binge behaviors, what I did find was that:”20% of the sample indicated a worsening in time spent thinking about weight and 14% reported a worsening in time spent thinking about food.”I would argue that, being as generous as I possibly can, this study has nothing to do with the authors claims and, being a bit less generous, this could be seen as a bit of a refutation of the claims.And this is why we check the references. Finally they cite2001 Nutrient intake of ob*se female binge eatersR S Reeves 1, R S McPherson, M Z Nichaman, R B Harrist, J P Foreyt, G K GoodrickDOI: 10.1016/S0002-8223(01)00055-4In this very small, short study 46 cis women were given a behavioral self-management intervention (6 months of weekly, 1-hour classes taught by registered dietitians) and the other group was a wait list control group. The researchers wanted to measure any change in calories consumed, percentages of calories from fat, protein, and carbohydrates, grams of fiber per 1,000 calories and change in number of self-reported binge days.After 6 months they found no significant difference between nutrients in either group. The behavioral self management group reported a greater reduction in binge days than the control group.Their conclusion was quite weak, finding that “Our results suggest that collecting dietary information from participants identified with binge eating disorder is challenging. Dietitians who conduct behavioral weight management programs may require additional training in identifying and understanding the psychological characteristics of participants with binge-eating disorder.”For this conclusion to have merit, behavioral weight management programs would have to be effective and there is no research supporting that and plenty suggesting that it is not.Overall these studies are small, short term, and quite old. The most recent was conducted about 24 years ago. It makes me wonder if there really isn't more recent data, or if more recent data exists but didn't support their conclusion? Also, remember that Barholomay et al. claimed “randomized controlled trials conducted among individuals with overw*ight and ob*sity demonstrate that assignment to a low-calorie weight loss diet (e.g., 1200 calories per day) produced greater decreases in binge-eating symptoms than assignment to a wait list control group.”I think their claim is seriously overstated. First of all, they should have been clear that this was the case in short-term, small sample studies. They also failed to mention that a non-diet treatment also produced greater decreases in binge-eating symptoms than in weight list control group - I wonder why they left that out of everything?Ok, let's look at another claim from Bartholomay et al.. They claim that adolescent girls with BN (which they explain is “bulimia nervosa, a disorder characterized by both binge eating and extreme compensatory behaviors; American Psychiatric Association, 2013”) who were assigned to participate in a healthy dieting intervention promoting weight control through moderate reductions in caloric intake, exhibited greater reductions in binge eating than girls who were assigned to a wait list control group.The first issue here is the claim that there is any such thing as a “healthy dieting intervention.” This is, in fact, a claim and not a fact, and it requires evidentiary support, which they don't offer. They don't even offer a definition of “healthy” nor proof that this intervention is, in fact, healthy by any definition. Again as we often see in research propping up the weight loss paradigm the authors have substituted “just saying stuff” for anything resembling scientific precision. In this case they are repeating a mistake originally made in the 2006 study they are citing by Burton and Stice called “Evaluation of a healthy-weight treatment program for bulimia nervosa: a preliminary randomized trial.” This study included 85 cisgender female participants with “full- and sub-threshold bulimia nervosa” who were randomly assigned to a 6-session “healthy dieting intervention” or a waitlist control group and assessed after a 3 month follow up. Their conclusion was that “These preliminary results suggest that this intervention shows potential for the treatment of bulimia nervosa and may be worthy of future refinement and evaluation. Results also provide experimental evidence that dieting behaviors do not maintain bulimia nervosa, suggesting the need to reconsider maintenance models for this eating disorder.”In using this study to support their claim, Bartholomay et al seem to be heavily glossing over words like “preliminary” and “may be worthy.” Also, even if we believe the results (without a deep dive into them) the fact that people on diets can suppress binging (or report suppressing binging) over 9 months is a far cry from showing what impact that restriction has over the long term.Back to Bartholomay et al., they make another claim that“Importantly, although longitudinal studies indicate that self reported dietary restraint predicts the future onset of binge-eating symptoms (Field et al., 1999; Killen et al., 1994; Stice, 2001; Stice et al., 2002), these results stand in stark contrast with findings from experimental treatment studies testing the causal effect of dietary restriction and restraint on the maintenance of binge eating.”This is an odd claim that, to me, is made with far too much confidence/bias. Longitudinal studies look at a longer time period, often quite a bit longer, than experimental treatments. Bartholomay et al. do not have a method to determine whether any difference is due to experimental design or simply due to the fact that experimental treatment studies capture a much shorter time frame. If what is true is that people who are on diets can suppress binge behaviors short term, but that the restriction drives additional binge behavior long-term, then the longitudinal studies could be more accurate.Let me offer an example to help illustrate the issue: It takes from 10-40 years for symptoms of asbestos conditions to appear. Let's stay that a study claimed “Importantly, although longitudinal studies indicate that exposure to asbestos causes mesothelioma, these results stand in stark contrast with findings from [6 month - 1.5 year] experimental treatment studies testing the causal effect of asbestos on mesothelioma, which found no relationship.”If the effect takes longer to appear than the time over which the experiments are conducted, there is a significant risk of missing the effect. That effect may be identified by longitudinal studies.Overall, I don't think the studies they are citing come anywhere close to, as they claim:“challenge the assumption that dietary restriction maintains BE [binge eating] among all individuals with BED [Binge Eating Disorder]. Rather, results suggest that dietary restriction may be largely unrelated to BE maintenance in this population, and that reducing dietary restriction generally does not have the intended effect on BE frequency.”In part 3 we'll investigate to see if the rest of the article's data supports their conclusions. 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 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' Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Recently a reader reaching out asking me to analyze a 2024 study called “Evaluating dietary restriction as a maintaining factor in binge-eating disorder” The authors claims that their findings:“challenge the assumption that dietary restriction maintains BE [binge eating] among all individuals with BED [Binge Eating Disorder]. Rather, results suggest that dietary restriction may be largely unrelated to BE maintenance in this population, and that reducing dietary restriction generally does not have the intended effect on BE frequency.”But do they really? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

It can be difficult to tease apart what is real anti-weight stigma work and what is weight stigma in sheep's clothing. Here are some quick tricks to tell the difference. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I've written here many times about the ways that the weight loss industry has been attempting to co-opt the work of weight stigma/weight-neutral/weight inclusive experts and activists. More than 40 of you asked me to write about a piece by Amanda Velazquez, MD called “Promoting a Weight-Inclusive Approach to Treat Ob*sity” carried in both Medscape and MDEdge/Endocrinology that gives us a perfect example. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

One of the most vulnerable times for higher-weight patients in healthcare can be when they are in a healthcare facility. Recently I worked with an incredible woman with a complex health history who was scheduled for a surgery followed by a hospital stay. I was available to help remotely and she had a group of friends and family who would be on-site. One of the things I did to help prepare was create scripts for her family and friends to use. She kindly agreed that I could share them with readers here and they are below. These scripts are created for a hospital visit/procedure that is prepared for. They may also be used in emergency situations and/or in other healthcare facilities, and it may be helpful to share them with people who might help you in an emergency ahead of time.Some of these may help people of all sizes and, while I've written them from the advocate's perspective, they could be used by a patient as well. Of course you and/or your advocates, may choose to change these in whatever way makes sense for you. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

During the Q&A a physician raised her hand and asked me a question that I've been asked many times over the years. “I don't disagree with the information you presented about the failure rate of behavior-based weight loss attempts, but I do disagree with what you said about informed consent. If I tell patients that there is about a 95% chance that they will lose weight and gain it back then they will never try, what good does that do?” Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

The study “The Physiological Effects of Weight-Cycling: A Review of Current Evidence” published January 3, 2025 is making broad claims that “healthy individuals who struggle with overw*ight or ob*sity should not be discouraged from repeated attempts to lose the excess weight.” In part 1 we looked at the issues with the authors and the premise. In part 2 we looked at the issues with the studies they included, in this final part we'll discuss the issues with their interpretation and conclusions. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

We are back discussing the article “The Physiological Effects of Weight-Cycling: A Review of Current Evidence” published January 3, 2025. In part 1 we looked at the authors and the introduction, in part 2 we'll be looking at the studies they included. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

As more data has come out about the realities of GLP-1s for weight loss (including some people regaining weight while still taking the drug, and research showing that those who go off the drugs regain weight quickly, paired with their own research showing that by year four, 89.5% of patients were no longer on the drug,) there has been talk about the dangers posed by drug-induced weight cycling. As we've seen with other concerns around these drugs and intentional weight loss in general (like eating disorders,) suddenly I'm seeing articles and studies trying to minimize the concerns about weight cycling.Enter “The Physiological Effects of Weight-Cycling: A Review of Current Evidence” published January 3, 2025. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1, the amazing Leslie Jordan Garcia and I wrote about creating size-inclusive fitness spaces. Today, Leslie has created an audit that you can use to determine the size inclusivity of your fitness space and make changes! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Today I am thrilled to bring you the first of a two-part series about creating safe fitness spaces that I had the honor of co-writing with Leslie Jordan Garcia. You may remember Leslie from her 5 Questions With… feature, and you may know her as the incredible passionate multi-certified Anti-diet Ed Recovery, wellness practitioner, and fitness professional behind Liberati Wellness! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 of this series, Dr. Zed Zha shared a patient story of the harm that can happen when assumptions are made about the relationships between weight and inflammation. In parts 2 and 3, Dr. Zha examined common beliefs around inflammation, weight, and weight loss. In the final installment of this series, I'll look at two possible confounding variables that may be at the root of associations between weight and inflammation. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 Dr. Zed Zha discussed a patient experience that elucidated the issues that happen when assumptions are made about the relationships between weight and health. In part 2 she began a discussion of four conditions that must be met to rigorously prove the theorem that weight loss lowers inflammation - “weight ↓ → inflammation ↓”. In part 3 of this 4-part series, she'll discuss the third and fourth conditions. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In November I responded to readers' questions about a paper that was being teased to the media suggesting a new definition for “ob*sity.” The paper is now out, and it's even worse than I thought. I've had a lot of requests to write about it and there is a ton of media on it right now (though, sadly, not a ton of any kind of critical/investigative journalism.)As regular readers know, I am in the middle of a four-part series with Dr. Zed Zha about weight and inflammation. I'm pausing that today to give an overview of the issues with this article from the initial analysis that I've completed. After the final two pieces of the inflammation series are published, I'll have a deep dive into the massive conflicts of interest and methodological issues with this paper. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In Part 1, Dr. Zed Zha (M.D. and Fellow of the American Academy of Family Physicians) discussed a patient experience that illuminated the need to look beyond simple assumptions about weight and inflammation. In part 2 she will begin a deep dive into the research around weight, weight loss, and inflammation. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In discussions around weight and health, the concept of “inflammation” almost always arises. This is a complex discussion and so I am thrilled and honored to share a four-part series in which Zed Zha, MD, FAAFP (Fellow of the American Academy of Family Physicians) and I explore assumptions around weight, weight loss, and inflammation.Here now, Part 1 - Patient Story - as told by Dr. Zha Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

On Saturday I posted a piece helping patients navigate weight stigma in healthcare, today I want to offer some support to healthcare providers to avoid creating weight stigma. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Higher-weight people too often find themselves in healthcare situations where they are being treated poorly/unequally because of weight stigma. These situations are, sadly, too numerous to count and in some cases need to be addressed in very specific ways. In many cases though, there are some standard responses that higher-weight patients and/or those advocating for them can use to try to get appropriate care. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This came up in our monthly subscriber Ask Me Anything. When I break down research I often talk about using absolute risk reduction and statistical significance to determine the efficacy of an intervention. Another number that helps determine efficacy is the Number Needed to Treat (NNT). This number helps us understand how many patients need to be treated with an intervention in order to avoid a single negative outcome.  Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

You can't win if you don't play.That's what the PowerBall ad said. I could pay $2 for a ticket and possibly win a $20 million jackpot. Of course, I have a 99.9999997 percent chance of losing which may be why my stats teacher used to say that the lottery was a tax on people who didn't pay attention in her class.So why am I going on about the lottery in a newsletter about the intersections of weight science, weight stigma, and healthcare?Because I hear a similar type of “logic” all the time from the weight loss industry, lay people, even doctors. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I got the following question from reader Naomi“Thanks for the information on the CDC growth charts. I wonder if you could talk about how to understand them. My pediatrician said that my child is more than 120 percent of the 95th percentile. What the h e double hockey sticks does that even mean? Help!” I'm happy to try to explain. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Today we're going to talk about a new study called whose goal was to assess the “relationship of cardiorespiratory fitness (CRF) and Body Mass Index (BMI) on both cardiovascular disease (CVD) and all- cause mortality risk” by Nathan R Weeldreyer, Jeison C De Guzman, Craig Paterson, Jason D Allen, Glenn A Gaesser, and Siddhartha S Angadi. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

There are many ways that weight stigma occurs in healthcare. One that is harmful on multiple levels happens when higher-weight people are blamed for the ways in which healthcare fails them. This occurs when a patient is blamed for being “too big” for something they need.  Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I've now had eleven different doctors ask me about this article, so let's talk about it! Here is one of the emails:“I'm an MD and I just read this article in Medscape about “clinical ob*sity.” Should I be worried? I feel like I should be worried. I understand it hasn't happened yet, but it seems like one of those things that will happen all at once without any chance to pushback. Any ideas on how to handle this?”  Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Regular readers may know that while speaking and writing are my primary work, I'm also a Board Certified Patient Advocate and I sometimes work directly with patients, typically in emergency or complex medical situations. Recently I was advocating for a patient at a cardiology appointment (who has given me permission to share this.) I was waiting outside the treatment room while my patient got settled, near the area where the scale that is used for weigh-ins was located. In this practice each cardiologist has a nurse and the nurse is responsible for getting weight as well as actual vital signs. As I was standing there a nurse brought a patient over and asked them to step on the scale. The patient made an “Ugh” noise and the nurse laughed and said “I know, weighing in is the worst. I postponed my last appointment by two weeks so that I could lose five pounds first.”At that exact moment I was called into my patient's treatment room and so I switched my focus 100% to the patient but I am reaching out to start a dialog about this at the practice. So, what went wrong, and what go be done better? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received the following question from reader Jin,I'm a pharmacist and one of the things I've learned from following you over the years is the importance of language. I wanted to ask you about language like “anti-ob*sity” medication and “ob*sity treatment.” I notice that you still use terms like weight loss drugs and I imagine that is on purpose. I'd love to understand more about this. Feel free to make it a Substack post if you'd like.Thanks for noticing and thanks for asking Jin!   Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received the following question from reader Alina:I'm a family med doctor and I've started seeing lots of publications, even research, using the terms “person with ob*sity” and “person with overw*ight.” I took some CME [Continuing Medical Education] where they said that it was for weight stigma reduction. I'm not sure why, but it just doesn't feel right at all (Does person with overw*ight even make sense?) I would love to see a newsletter about this.Thanks for asking Alina, your feeling that something's not right here is spot on. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

There are many aspects of weight stigma within the healthcare system that harm higher-weight people. There is an issue that isn't often discussed that underpins many of the harms that the healthcare system does to higher-weight people.Research. Or a lack thereof.  Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we discussed a New York Times article about so-called “Ob*sity First Medicine” (OFM) which suggests that higher weight people with health issues should be targeted for weight loss treatment (in this case specifically the new GLP-1 diet drugs) treating them differently than thinner people with the same symptoms/presentations/diagnoses.Today we're going to look at an opinion piece in WaPo that discusses the same phenomenon.  Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Many of you reached out to me about two articles. One in the New York Times by Gina Kolata about so-called “Ob*sity First Medicine” - OFM (you may remember Kolata from a different article I wrote about that essentially lobbied for insurance coverage for weight loss drugs and failed to disclose that each person interviewed was on the payroll of the drug companies.) Another an opinion piece in the Washington Post by Leana S. Wen. We'll discuss the NYT article in part 1, along with some general issues and the WaPo article in Part 2.  Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received a reader question from Annilyn who said:“My doctor just suggested that I try the AspireAssist to lose weight. I didn't want to Google it because I think it will be really triggering but based on what he described, I just don't think this thing can be real, can it? Will you write about it?”I'm happy to write about this weight loss device Annilyn, and mostly I'm happy because it seems to be off the market, but we'll get to that. I think it's worth looking at the history and research around this thing as an example of what happens in a “thin my any means necessary” healthcare culture. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part one we looked at a lawsuit being brought by Jaclyn Bjorklund against Novo Nordisk (maker of Semaglutide - brand names Ozempic/Rybelsus/Wegovy) and Eli Lilly (maker of Tirzepatide - brand names Mounjaro/Zepbound) for the severe gastrointestinal side effects she experienced after taking Ozempic and then Mounjaro for type 2 diabetes. At the end I made the point that, for some people, the negative side effects don't end when they stop taking the medications and for others, the damage has been done. That brings us to Juanita Gantt. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

I received requests from a number of you to write about this situation. Jaclyn Bjorklund, a 44 year old woman from Louisiana is suing both Novo Nordisk and Eli Lilly.Content note: this piece will include details of severe gastrointestinal symptoms and conditions. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

This is the final part of the series about the study “Eating disorder risk during behavioral weight management in adults with overw*ight or ob*sity: A systematic review with meta-analysis” by Jebeile et al, 2023. In part 1 we talked about overarching issues with the science, in part 2 we talked about general issues with this specific study, and in part 3 we'll discuss the specific claims made.  Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

In part 1 we discussed the overarching issues with “Eating disorder risk during behavioral weight management in adults with overw*ight or ob*sity: A systematic review with meta-analysis” by Jebeile et al, 2023. Today we'll begin to dig into the specific issues with this study.Content note: in this piece I'll be talking about eating disorders, including specific behaviors, and weight loss methods that include eating disorder behaviors. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe