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.
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This episode discusses a systematic review questioning common assumptions about weight and health in diabetes prevention programs (DPPs). The study found no compelling evidence that weight loss is a significant mediator for program improvements, or even that it's not harmful. It highlights the scarcity of research on how DPPs achieve benefits and discusses the ethical and iatrogenic risks associated with weight-loss focused interventions, urging a shift in research and clinical focus.
I’ve previously written about research from Natasha Wiebe et al. that questions assumptions around weight and health. Today I’m back to discuss a new study “Associations of ob*sity, systemic inflammation, and hyperinsulinemia with the incidence of non-communicable chronic disease and mortality: A prospective cohort study” by Natasha Wiebe MMath, Stephanie Thompson MD, Peter Stenvinkel MD, Aminu Bello MD, Matthew T. James MD, and Marcello Tonelli MD. In part 1 we’ll discuss the study. In part 2 I...
In Part 1 we started talking about emails that I’ve been receiving from readers about the weight centric backslide including some initial ways that we can identify the issue and push back. Today we’re going to dig deeper. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe...
I’ve received a lot of reader emails like the one below from reader Jeannie. I feel like I’m seeing so many people, including dietitians and doctors, who used to be staunchly non diet getting back on the weight loss bandwagon. Suddenly they’re all “you can fight weight stigma and promote weight loss” and “o-word is a metabolic disease” - and “use people first language” and it’s like they were claiming to be non diet but it was only because they didn’t think they could shrink us but now they thin...
In part 1 we began discussing the study “Potential mechanisms for change in diabetes prevention programs: A systematic review” including the authors and the premise. Today we’ll look at the methodology and the findings. 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! Diabetes Prevention Programs are a group of programs that are created to prevent the onset of Type 2 Diabetes, often in people who have been identified as at-risk. Most include behavior changes, social support, and include weight loss as a metric and/or the primary outcome. The assumption is typically that any health changes and/or reductions in the development of T2D are ...
Recently I wrote about research around GLP-1s and nutritional deficiencies. In summary, we looked at a study that showed that most of the clinical trials aren’t studying this at all , and that when studies do consider this there are concerning findings, and, finally, the implications of all this . I was recently contacted by a Chicago-area private practice dietitian (MS, RDN, LDN) who had, in fact, written a letter to the editor of the journal that published one of the articles I looked at in Pa...
Remember when I wrote about the FDA Averse Events Reporting System and how the drug companies are required to report adverse events ? Novo Nordisk just got a warning from the FDA for…not doing that. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe...
I’m very excited to announce the culmination of a project I’ve been working on for Project HEAL. They are an incredible organization that works to break down systemic, healthcare, and financial barriers to eating disorder healing. They already had a series of templates for insurance appeals and they reached out to me to create a blog post and templates to appeal weight-based denials and failure to accommodate. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe...
In Part 1 we looked at the problematic justification used by the Colorado Legislature to pass legislation following massive lobbying from the weight loss industry and their astroturf “patient advocacy” groups . Today I am going to talk about the actual contents of the law and am grateful for input from an attorney with many years’ experience in health care law and regulation who was willing to provide thoughts but did want to note that they are not admitted to practice in Colorado. Get full acce...
A bill in support of weight loss interventions, particularly GLP-1 diet drugs, has passed the Colorado state legislature and been signed into law. Very similar bills are being pushed by the weight loss industry (and their astroturf “patient-advocacy” groups, particularly the “Ob*sity Action Coalition ”) in individual states and federally with the goal of increasing insurance coverage (and through that the market, and through that the profits) for weight loss drugs and other weight loss intervent...
I got the following question from reader LouAnna who asked “I just saw that they are developing even more new weight loss drugs of the GLP1 type that (supposedly, of course) create even more lost weight. What ever happened to the claim that we just need to lose 5-10% ? Don’t these new weight loss drugs already claim that they exceed that? Will it never stop?” This is a great question and I’m happy to offer my thoughts. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/...
In part 1 we discussed a study that showed that malnutrition is very rarely studied in randomized controlled trials for GLP-1s. In part 2 we looked at the findings of research that studied nutritional deficiencies in GLP-1 users. Today we’ll talk about the implications of these findings, including what we know, what we don’t, and what we should. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe...
In Part 1 we talked about a study that showed that most randomized controlled trials for GLP-1s failed to assess nutrition/possible nutrition deficits. Today I’m going to summarize some research that did look at these possible issues in people using GLP-1s. In Part 3 I’ll talk about the implications of all of this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe...
I subscribe to a borderline ridiculous number of medical publications from which I receive an absolutely ridiculous number of emails. One headline caught my eye “GLP-1s Bringing Back Scurvy?” Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
I received the following reader question: My name is Mary and I’m a family doc (you can use my first name if you print this.) I wouldn’t say that I’m fully onboard with being weight inclusive but I’ve been reading your work and I can’t deny that what you are writing makes sense and is grounded in research (some of which I had never heard of in any of my training.) I have been thinking about what you wrote when you said how important it is that we ask our patients questions instead of making assu...
In Part 1 we looked into the authors and methodology of the study The Acute Inflammatory Effects of Weight Stigma: An Experimental Pilot Study which was published in August, 2025. In part 2 we’ll look at the results. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe...
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...
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...
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 t...
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
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 websi...
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, incl...
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...
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/subs...
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...
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 methodology Part 2 we’ll talk about the findings Part 3 we’ll talk about how the media is covering the study The 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....
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 t...
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...
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...
