Weight and Healthcare

This Substack explores the intersections of weight science, healthcare, and public health with a focus on evidence, ethics, and the impact of weight stigma on higher-weight individuals. It critiques weight-based healthcare practices, diet culture, and pharmaceutical interventions, advocating for weight-neutral healthcare approaches and challenging prevailing narratives around weight and health.

Weight Stigma in Healthcare Weight Loss Industry Critique Ethical Issues in Weight Management Health at Every Size (HAES) Weight-Neutral Healthcare Practices Impact of Diet Culture Medical Bias and Discrimination Evidence-Based Approaches to Health Public Health and Obesity Narratives Weight Loss Drugs and Interventions

The hottest Substack posts of Weight and Healthcare

And their main takeaways

Reader Question - My Doctor Claims He Can "Jump Start" Weight Loss?

878 implied HN points • 04 May 24
🏥 Health & Wellness Weight Loss Nutrition Medical Ethics Body positivity Health Research
  1. Behavior-based weight loss interventions usually fail to produce significant, long-term weight loss for most people.
  2. The idea of 'jump starting' weight loss with extreme food/caloric restrictions is generally ill-advised as it can trigger famine responses in the body, making it a weight-gaining machine.
  3. Promoting or selling products like liquid diets by medical professionals is not legally prohibited, but the evidence does not support the effectiveness of 'kick starting' weight loss as a long-term solution.

The Myth of Kick-Starting Weight Loss - Part 2

678 implied HN points • 08 May 24
🏥 Health & Wellness Weight Loss Nutrition Research Health Issues Weight Stigma
  1. Extreme food/caloric restrictions for short-term weight loss have no basis in evidence for long-term significant weight loss.
  2. Tips like using aluminum foil, rearranging food in the cupboards, or changing plate sizes have no substantial evidence backing their effectiveness for sustainable weight loss.
  3. Recycled weight loss tropes without scientific evidence can perpetuate harmful weight cycling and health issues, so it's crucial to ask for research on weight loss claims.

The Semaglutide (Wegovy) Cardiovascular Outcome Trial - Part 1

838 implied HN points • 13 Apr 24
🏥 Health & Wellness Weight Loss Research Findings
  1. Wegovy is a weight-loss application for the drug Semaglutide (Ozempic), both owned by Novo Nordisk.
  2. The trial to determine Semaglutide's impact on cardiovascular health was designed by Novo Nordisk and authors with significant financial ties to the company.
  3. Results revealed a modest decrease in cardiovascular events with Semaglutide, but twice as many participants stopped taking it due to adverse events compared to the placebo group.

The Scientifically Shaky Definitions of "Obesity"

958 implied HN points • 27 Mar 24
🏥 Health & Wellness Obesity Health Issues Body positivity Weight loss industry Fat Activism
  1. The weight loss industry manipulates the definitions of obesity to suit their profit-driven agenda, claiming it as a disease and influencing healthcare elements.
  2. Common definitions of obesity by organizations like the CDC and NIH raise questions about objectivity and scientific accuracy in diagnosing obesity.
  3. The push by the weight loss industry to expand the market for weight loss drugs raises concerns about pathologizing higher-weight bodies and the need to shift away from a weight-centric paradigm.
Get a weekly roundup of the best Substack posts, by hacker news affinity:

Reader Question: What is Food Noise?

798 implied HN points • 06 Apr 24
🏥 Health & Wellness Nutrition Weight Loss Healthcare Medication Body Image
  1. Be cautious of the concept of 'food noise' promoted by weight loss drug makers as a rebranding of normal hunger or a way to profit off people's broken relationships with food.
  2. Some weight loss drugs aim to manipulate hunger signals through impacting the brain and gut, with unclear long-term effects and potential risks.
  3. The weight loss industry's push for drugs like GLP-1 agonists raises concerns about informed consent, lack of long-term research, and prioritizing short-term weight loss over potential health consequences.

Reader Question – What’s the Deal with Awaken180?

1417 implied HN points • 20 Jan 24
🏥 Health & Wellness Weight Loss Nutrition Research Coaching
  1. Awaken180 claims to create long-term weight loss, but lacks concrete scientific evidence to support their program.
  2. The program emphasizes weight loss over other aspects of health and success, disregarding the variety of body sizes and individual needs.
  3. Awaken180 relies on caloric and carbohydrate restrictions, potentially involving expensive prepacked food, and might not be sustainable for long-term weight loss.

Understanding the Obesity Bill of Rights - Part 1

659 implied HN points • 20 Apr 24
🏥 Health & Wellness Obesity Healthcare Weight Loss Activism
  1. The 'Obesity Bill of Rights' is part of a movement lobbying for insurance coverage for weight loss industry products and interventions.
  2. The language used in the 'Obesity Bill of Rights' is rooted in marketing from weight loss companies, not in science.
  3. The rights proposed in the 'Obesity Bill of Rights' seem to prioritize weight loss industry profits over actual healthcare for higher-weight individuals.

Four common mistakes that fitness pros make with higher-weight people

918 implied HN points • 16 Mar 24
🏥 Health & Wellness Fitness Weight Training Healthcare Body Acceptance
  1. Don't assume someone's fitness level based on their size - treat everyone with respect and provide options for all body types.
  2. Accept and accommodate all body sizes in fitness spaces - blame the equipment, not the clients, if the space isn't inclusive.
  3. Encourage strength training for all body types - emphasize the benefits of strength training and avoid pushing weight loss goals.

Wegovy for Cardiovascular Risk Reduction - Part 2

659 implied HN points • 17 Apr 24
🏥 Health & Wellness Weight Loss Cardiovascular Health Research Medication
  1. The trial data for Semaglutide (Wegovy) for cardiovascular risk reduction was manipulative and lacking in transparency, raising concerns about conflicts of interest and data sharing.
  2. The study demographics were concerning, with a lack of diversity and representation, particularly skewed towards white men, older participants, and those with existing heart disease.
  3. The actual cardiovascular risk reduction with Semaglutide was much lower than claimed, highlighting issues with study design, data presentation, and potential overemphasis on specific demographics in the results.

Reader Question- How Does Questionable Research Happen?

738 implied HN points • 03 Apr 24
🏥 Health & Wellness Research Weight Loss Physicians
  1. Questionable research can happen due to researchers being influenced by profit interests or an entrenched paradigm.
  2. Some researchers may design studies to support predetermined conclusions, leading to misleading results.
  3. Doctors involved with the weight loss industry may have subconscious biases towards promoting weight loss, despite evidence of its ineffectiveness and harms.

The Bellevue Hospital Weight Loss Surgery Factory

1397 implied HN points • 13 Jan 24
🏥 Health & Wellness Healthcare Ethics
  1. Bellevue Hospital's weight loss surgery program has been criticized for endangering patients and compromising urgent care due to financial incentives and high patient turnover.
  2. Patients at Bellevue Hospital often receive surgery dates quickly after minimal assessments, leading to insufficient risk understanding and inappropriate qualifications for procedures.
  3. The hospital's weight loss surgery assembly line approach includes rushing procedures, neglecting ethics like informed consent, and potentially harmfully pushing for surgeries despite minimal patient assessments.

Reader Question – What Should Disclosures in Weight Science and Weight Loss Research Include?

499 implied HN points • 01 May 24
🏥 Health Politics Research Funding Conflicts of Interest Transparency
  1. Research in weight science and weight loss should prioritize scientific integrity over business interests.
  2. Disclosures in research should be easily accessible within the study and in front of any paywall to inform decision-making.
  3. Disclosures should include details on study funding, financial entanglements with companies, organizations, and personal benefits for researchers.

Quick Guide – Creating a Size-Accommodating Office

439 implied HN points • 11 May 24
🏥 Health & Wellness Patient Care Inclusivity Body positivity
  1. Make sure your office has sturdy seating that can accommodate people of all sizes, from waiting rooms to treatment areas.
  2. Have the largest blood pressure cuffs available in every area where blood pressure is taken to ensure accurate readings for higher-weight patients.
  3. Provide the largest possible gowns for patients and consider if gowns are really necessary or if patients can wear their own clothing.

The Harm of Weight-Based Healthcare Inequalities

1238 implied HN points • 03 Jan 24
🏥 Health & Wellness Healthcare Inequalities Health Risks
  1. Healthcare inequalities based on weight can lead to delayed care and biased treatment, impacting higher-weight individuals negatively.
  2. Structural inequalities in healthcare settings can hinder access and quality of care for higher-weight patients, from chairs to medical equipment.
  3. Research bias and BMI-based denials of care contribute to systemic issues that harm higher-weight individuals in healthcare.

The Dangers of Medicare Coverage for Wegovy, Zepbound, and other Weight Loss Interventions

838 implied HN points • 21 Feb 24
🏥 Health & Wellness Pharmaceutical industry
  1. Medicare Part D plans are prohibited from covering weight loss medications by a law passed in 2003.
  2. The weight loss industry, led by pharma companies like Novo Nordisk, aims to get Part D coverage of these drugs, which could lead to significant costs for Medicare.
  3. Studies show that weight loss interventions in older adults can have negative health impacts, including increased mortality risk, muscle loss, and frailty.

5 Questions with Jessica Jones, RD, CDE

459 implied HN points • 27 Apr 24
🏥 Health & Wellness Nutrition Mental well-being Physical health
  1. Jessica Jones is a Registered Dietitian, Certified Diabetes Educator, co-founder of Food Heaven, and Diabetes Digital. She focuses on weight-inclusive care for diabetes management.
  2. She learned about weight-inclusive care from Evelyn Tribole and emphasizes separating health from weight, promoting holistic well-being and patient-centered care.
  3. Jones applies weight-inclusive concepts in her work through writing, podcasting, and counseling services, advocating for health improvement unrelated to weight loss.

How to spot an effort to trick you into lobbying for Novo Nordisk and Eli Lilly’s weight loss drugs

698 implied HN points • 13 Mar 24
🏥 Health Politics Weight Stigma Informed consent Medical Industry
  1. Big pharmaceutical companies like Novo Nordisk and Eli Lilly are trying to manipulate the healthcare industry to push insurance coverage for their weight loss drugs.
  2. These companies are using tactics like grassroots campaigns and lobbying efforts to pressure insurance companies and governments to cover their expensive drugs.
  3. To identify efforts to promote these drugs, watch out for claims that lack of access to weight loss medication is about fighting weight stigma, and be wary of campaigns that push for increased access to these drugs in the name of social justice.

Article Discusses How to End Weight Stigma in Eating Disorders Treatment

778 implied HN points • 28 Feb 24
🏥 Health & Wellness Eating Disorders Weight Stigma Research
  1. Weight stigma is prevalent in the eating disorders community on various levels, and addressing this issue is crucial for treatment.
  2. Treatment approaches should shift from a weight-centric focus to one that is weight-inclusive, prioritizing health behaviors and client autonomy.
  3. Provider education and competency need to be improved to reduce weight bias and promote structural interventions, rather than focusing on personal bias elimination.

Things to Stop Saying and Doing in Front of Higher-Weight Patients

798 implied HN points • 14 Feb 24
🏥 Health & Wellness Weight Stigma Body positivity Patient Advocacy
  1. Weight loss and food talk should not happen in healthcare settings without patient consent. It can be harmful and triggering, especially for patients recovering from eating disorders.
  2. Avoid any negative body talk in front of patients and do not label higher-weight patients as 'difficult' or 'challenging' based on their weight. Blaming the patient's body for healthcare failings is detrimental.
  3. Discuss sensitive topics like movement and repositioning out of earshot of the patient or involve them in the conversation. Healthcare should accommodate patients of all sizes without blaming the patient.

Zepbound/Mounjaro Tirzepatide for Weight Loss Part 3

818 implied HN points • 10 Feb 24
🏥 Health & Wellness Weight Loss Data Analysis Side Effects Research Ethics
  1. The study on Tirzepatide showed that weight loss for participants slowed after 36 weeks, with those switching to placebo experiencing weight regain while those continuing the drug had a slight weight reduction in the following 52 weeks.
  2. Side effects of Tirzepatide included gastrointestinal issues like nausea, diarrhea, constipation, and vomiting. Close to 82% of participants reported experiencing at least one adverse event during the treatment period.
  3. The study's findings indicate that a significant percentage of participants taking Tirzepatide did not meet the weight reduction thresholds, with a lack of diverse representation among participants and a lack of a weight-neutral comparator group presenting issues in the study design.

5 Questions With Chrissy King

539 implied HN points • 30 Mar 24
🏥 Health & Wellness Anti-racism Intersectionality Social justice
  1. Chrissy King focuses on creating an anti-racist and inclusive wellness industry through body liberation and intersectionality.
  2. She discovered the concept of weight neutrality and body-affirming care through her personal journey with body image and by reading 'The Body Is Not An Apology' by Sonya Renee Taylor.
  3. Chrissy advocates that weight does not equal health, challenges the notion that smaller bodies are healthier, and emphasizes unlearning biases like internalized white supremacy to truly support clients.

Case Study – Weight Stigma Impacts COVID-19 Vaccinations

678 implied HN points • 02 Mar 24
🏥 Health & Wellness Weight Stigma Healthcare access Inclusivity Medical Advocacy
  1. Weight stigma affects access to proper care, such as longer needles needed for COVID-19 vaccinations, especially for higher-weight individuals.
  2. Facilities should ensure they have the correct needle sizes available for all patients, regardless of weight, to provide optimum vaccine efficacy.
  3. Advocacy and awareness are needed to address discriminatory healthcare practices and promote fair treatment for all patients, including those who are higher-weight.

Reader Question – What are Weight-Related Health Conditions?

898 implied HN points • 24 Jan 24
🏥 Health & Wellness Health Conditions Research Weight Loss Healthcare Inequalities
  1. Weight-related health conditions are health issues that are often labeled as related to weight just because higher-weight individuals have them more frequently.
  2. The labeling of health conditions as 'weight-related' overlooks other factors like weight stigma, weight cycling, and healthcare disparities that could actually be the main contributors.
  3. The concept of 'weight-related conditions' is used to push for risky weight loss interventions and profits, but it doesn't necessarily support the health of higher-weight individuals.

Zepbound/Mounjaro (Tirzepatide) for Weight Loss - Part 1

818 implied HN points • 03 Feb 24
🏥 Health & Wellness Medication Weight Loss Side Effects Dosage Research
  1. Tirzepatide, known as Zepbound for weight loss, was initially a Type 2 diabetes medication by Eli Lilly that got FDA approval for weight loss due to its side effect of weight loss. It works by interfering with normal digestion processes and hunger signals.
  2. There are dosing differences between the diabetes and weight loss applications of Tirzepatide. For weight loss, patients are encouraged to continuously increase the dosage to the highest tolerable level, potentially facing side effects that impact their quality of life.
  3. The side effects of Tirzepatide/Zepbound can range from mild discomfort to serious conditions like thyroid C-Cell tumors, gastrointestinal diseases, and pancreatic issues. Patients need to be aware of potential risks, like drug interactions and impact on pregnancy.

Reader Question: What to do if you experience medical weight stigma

639 implied HN points • 06 Mar 24
🏥 Health & Wellness Weight Stigma Healthcare Resources Advocacy
  1. Weight stigma in healthcare is common and can have various forms, impacting patients differently depending on many factors.
  2. There are several ways to address and respond to weight stigma in healthcare, such as addressing it in the moment, submitting a complaint, or sharing experiences on review sites and social media.
  3. Taking action against weight stigma, like lodging complaints, can lead to changes in healthcare practices even if the outcomes are not always visible.

NYT Ethicist’s Weight Stigma Problem

1597 implied HN points • 01 Jul 23
🏥 Health & Wellness Weight Stigma Body positivity Mental health Healthcare Self-care
  1. The columnist's response perpetuated weight stigma by disregarding boundaries and making assumptions about health based on weight.
  2. It's essential to respect others' boundaries, especially regarding personal matters like weight and health.
  3. Approaching conversations about weight and health should prioritize well-being, avoiding judgment, and listening to the individual.

Reader Question - How to Find a Weight-Neutral Provider

579 implied HN points • 09 Mar 24
🏥 Health & Wellness Healthcare Weight-neutral care Lists Resources
  1. To find a weight-neutral healthcare provider, look for terms like weight-neutral, weight-inclusive, anti-diet, and Health at Every Size(tm).
  2. Utilize lists of vetted providers from organizations like ASDAH, Mary Lambert, Christy Harrison, and Jen McLellan.
  3. You can also ask in fat-positive groups for referrals, call ahead to inquire about weight-neutral care, or discuss your preferences with your current provider.

Doesn't FDA Approval Mean Weight Loss Drugs Are Safe? - Reader Question

758 implied HN points • 31 Jan 24
🏥 Health & Wellness Healthcare Weight Loss FDA Approval Drug Safety Research
  1. FDA approval of a drug does not mean it is completely without risks; it means the benefits are deemed worth the risks.
  2. The FDA assesses the risks and benefits of a drug based on the research provided by the pharmaceutical company before granting approval.
  3. When it comes to weight loss drugs, the risk/benefit analysis by the FDA may be skewed due to questionable research around weight and health, leading to a lower safety bar for approval.

Zepbound/Mounjaro Tirzeptatide for Weight Loss Part 2

718 implied HN points • 07 Feb 24
🏥 Health & Wellness Weight Loss Medical Industry Research Healthcare system Body positivity
  1. The concept of 'ob*esity' as a disease and the idea that it is progressive and relapsing are constructs of the weight loss industry and not scientifically supported.
  2. The study promoting Zepbound/Tirzepatide for weight loss has ties to the pharmaceutical industry, raising questions about potential bias and conflicts of interest among the authors.
  3. The lead author of the study, Louis J. Aronne, has a history of promoting weight loss methods without substantial research backing, raising concerns about the credibility of research surrounding weight loss drugs.

5 Questions with Christy Harrison, MPH, RD, CDN

599 implied HN points • 24 Feb 24
🏥 Health & Wellness Nutrition Mental health Wellness Body Image Eating Disorders
  1. Christy Harrison is an anti-diet registered dietitian and journalist who aims to challenge diet culture and promote body acceptance through her work.
  2. She learned about weight-neutral care around 20 years ago but fully embraced it later on through experiences in recovery and training in eating disorders.
  3. Harrison applies weight-inclusive principles in her work across various platforms like books, podcasts, online courses, and speaking engagements, critiquing diet culture and promoting critical thinking about wellness.

The Utter Ridiculousness of the 5-10% Weight Loss Recommendation

1318 implied HN points • 04 Oct 23
🏥 Health & Wellness Weight Loss BMI Health recommendations Research
  1. The recommendation for 5-10% weight loss to improve health is widespread but may not have significant impact on individuals' health conditions.
  2. The weight loss recommendation is based on flawed BMI categories, often leading to unrealistic goals for individuals, especially those with obesity.
  3. The focus on weight loss overlooks the importance of evidence-based, individualized medical interventions for all patients, regardless of size.

Physician Demonstrates Medical Weight Stigma and Bias

958 implied HN points • 06 Dec 23
🏥 Health & Wellness Weight Stigma Fat Activism Body positivity
  1. Weight stigma and bias in healthcare can impact fat people, leading to unequal treatment and discrimination.
  2. Healthcare providers should focus on finding solutions to accommodate and care for fat patients instead of blaming and stigmatizing them.
  3. Fat people deserve equal rights, healthcare, and the right to celebrate their bodies regardless of their size or health conditions.