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 - What's With Eli Lilly's Oscar Ad

439 implied HN points • 20 Mar 24
🏥 Health & Wellness Medication Weight Loss Healthcare system Insurance Coverage FDA Approval
  1. Eli Lilly and other pharmaceutical companies are focused on lobbying for insurance coverage of weight loss drugs, pushing for the idea of higher-weight bodies as a 'disease' worth medicating.
  2. The FDA approval for weight loss drugs like Zepbound requires different criteria based on BMI, raising concerns about the risk assessments being tied to body size.
  3. Pharmaceutical companies like Eli Lilly prioritize shareholder interests over customer concerns, raising questions about the true motivations behind their actions.

5 Questions With Medical Students for Size Inclusivity

639 implied HN points • 27 Jan 24
🏥 Health & Wellness
  1. Medical students are advocating for size inclusivity in healthcare, aiming for equitable treatment regardless of weight.
  2. Learning about weight-neutral care helps medical students challenge biases and provide comprehensive healthcare to patients of all body sizes.
  3. Resistance to weight-inclusive care exists in the medical field, but progress is being made towards more size-inclusive medical education and practices.

Goodbye To Jenny Craig

1178 implied HN points • 13 May 23
🏥 Health & Wellness Dieting Weight Loss Body positivity Health Research
  1. Jenny Craig, a popular commercial diet program, is shutting down after decades. Despite its promises of weight loss, it failed to show long-term results in studies.
  2. Commercial diet programs like Jenny Craig often rely on a cycle of success and failure, blaming clients for weight regain without acknowledging the limitations of restrictive diets.
  3. The closure of Jenny Craig is a reminder of the lack of evidence behind many weight loss programs, as clients are left without sustainable results.

Weight Loss and the Question Too Many Researchers Aren’t Asking

1138 implied HN points • 09 Jul 23
🏥 Health & Wellness Weight Loss Nutrition Weight Stigma
  1. Many weight loss interventions are based on flawed models and fail long-term, leading to weight regain as the body adjusts to food restriction.
  2. The focus on weight loss often overlooks the importance of ensuring that individuals receive adequate nutrition during interventions, potentially putting their health at risk.
  3. Moving towards a weight-neutral paradigm in healthcare can prioritize supporting the health of individuals of all sizes instead of promoting unhealthy weight loss methods and stigma.

Common Terminology and Statistics Issues- Part 2

738 implied HN points • 27 Dec 23
🏥 Health & Wellness Statistics Obesity Interventions Research Terminology
  1. Using percentages without proper context can be misleading, it's crucial to provide a full picture for accurate interpretation.
  2. Understanding the difference between relative and absolute risk in statistics can prevent manipulation and provide a clearer view of the data.
  3. Different methods for handling dropouts in trials, like LOCF and BOCF, can impact outcomes significantly and need careful consideration in research.
Get a weekly roundup of the best Substack posts, by hacker news affinity:

5 Questions With Leslie Jordan Garcia, MBA, MPH, CEDRS, PT, Body Liberation Coach

219 implied HN points • 15 May 24
🏥 Health & Wellness Weight-neutral care Community support Mental health
  1. Leslie Jordan Garcia is a body liberation coach with a background in community health and certifications in eating disorder recovery.
  2. She learned about weight neutral and body affirming care through personal experience transitioning to plus size and followed HAES principles.
  3. In her work, Leslie focuses on movement, pleasure, and embracing diverse identities, emphasizing that health is about more than just physical appearance.

Please stop telling patients with Type 2 Diabetes to “Just eat less sweets and carbs”

1078 implied HN points • 19 Aug 23
🏥 Health & Wellness Diabetes Nutrition Weight management Stress management Health Advocacy
  1. Telling Type 2 Diabetes patients to just eat less sweets and carbs is oversimplified and unhelpful advice, as the condition is complex and requires individualized approaches.
  2. Understanding the complexity of Type 2 Diabetes management is crucial for healthcare practitioners, as simple directives can be harmful and ineffective.
  3. Non-restrictive, weight-neutral strategies exist for managing blood sugar levels in Type 2 Diabetes, highlighting the importance of personalized care and professional guidance.

Novo Nordisk's Ethically Questionable Wegovy Publicity Stunt

1078 implied HN points • 09 Aug 23
🏥 Health & Wellness Pharmaceuticals Weight Loss Ethics Research Health Risks
  1. Novo Nordisk released a press release touting study results that were not peer-reviewed or published, raising ethical concerns.
  2. The study population in the trial for the weight loss drug Wegovy was limited to specific criteria, excluding certain groups for evaluation of benefits and risks.
  3. The publicity stunt around the drug's benefits showcases the pharmaceutical company's marketing tactics that may manipulate perceptions and stock prices.

The Concept of “Non-Compliance” and Weight Loss Recommendations

1058 implied HN points • 02 Aug 23
🏥 Health & Wellness Weight Loss Healthcare Body Acceptance
  1. Non-compliance labeling in healthcare can have negative implications on patients, especially when it comes to weight loss recommendations.
  2. There is a strong emphasis on the importance of reframing health as supporting behaviors rather than just focusing on weight loss as a measure of compliance.
  3. Many weight loss interventions lack long-term efficacy and can result in weight cycling, leading to patient dissatisfaction and potential harm.

The Problem With the AMA's New BMI Policy

978 implied HN points • 17 Jun 23
🏥 Health & Wellness Body positivity Medical Practices Weight Stigma Healthcare Inequalities
  1. The AMA's new BMI policy acknowledges the historical harm, racist exclusion, and limitations of using BMI, suggesting it be used alongside other measures.
  2. The AMA's recognition of the limitations of BMI doesn't fully address the core issue of pathologizing bodies based on size, perpetuating weight stigma and inequalities in healthcare.
  3. The AMA's connection to the weight loss industry raises concerns about their motives behind the new policy, impacting healthcare decisions and patient care.

Reader Question - Dealing with Diet Culture at the Holidays

758 implied HN points • 22 Nov 23
🏥 Health & Wellness Diet Culture Holidays Boundaries Body Image Support
  1. During the holiday season, there is often an increase in diet culture behaviors like food policing and body shaming.
  2. Strategies like ignoring/responding silently, setting boundaries, and engaging in conversations can help navigate inappropriate comments about food and body during gatherings.
  3. It's important to prioritize enjoying meals in peace and remember that others' opinions about our food choices are not our concern.

Case Study - Higher-Weight Patient Seeks CT Scan

798 implied HN points • 08 Nov 23
🏥 Health & Wellness Healthcare access Advocacy Body positivity
  1. Higher-weight patients may face challenges in accessing appropriate healthcare services, such as imaging scans like CT scans.
  2. Patients should not have to navigate through healthcare system barriers on their own and should receive accurate information about medical procedures upfront.
  3. Advocacy and education are important for challenging medical weight stigma and ensuring equitable healthcare access for all patients.

NYT Ethicist's Weight Stigma Hypocrisy Part 2

918 implied HN points • 05 Jul 23
🏥 Health & Wellness Weight Stigma Ethics Healthcare Body positivity Mental health
  1. The column discusses weight stigma and hypocrisy in healthcare, pointing out discrimination based on body size.
  2. It highlights the importance of respecting boundaries and being cautious with compliments related to body size manipulation.
  3. The response from the Ethicist regarding concerns about weight loss drugs brings to light inconsistencies and potential ethical issues.

Reader Question – Wegovy’s Side Effects - Part 1

798 implied HN points • 01 Nov 23
🏥 Health & Wellness Medical treatment Informed consent Side Effects Weight Stigma
  1. Healthcare practitioners should provide informed consent without patients having to ask for it, and dismissing concerns about side effects violates medical ethics.
  2. Wegovy, a weight loss medication, has serious side effects including contraindications for certain medical conditions, fetal harm, and common side effects like nausea and abdominal pain.
  3. The FDA-approved documentation and research show significant adverse events associated with Wegovy, challenging the idea that the drug is safe and raising important questions about long-term use.

Three Things That Should Be Required For Weight Loss Research

718 implied HN points • 18 Nov 23
🏥 Health & Wellness Weight Loss Research Health Impact Ethics Health Science
  1. Require five-year follow-up with mandatory publication to improve accuracy and information in weight loss studies
  2. Mandate essential information in bold print at the beginning of weight loss studies to ensure transparency and accessibility
  3. Implement a weight-neutral comparator group in weight loss studies to distinguish impacts of behavior changes from weight loss, reducing health risks

Eating Disorders Support ChatBot Promotes Weight Loss

858 implied HN points • 31 May 23
🏥 Health & Wellness Mental health Eating Disorders Support Weight Loss Nonprofit
  1. The National Eating Disorders Association replaced their helpline staff with an AI-driven chatbot after the staff unionized, which is concerning.
  2. The AI chatbot provided harmful information and promoted weight loss to individuals seeking support for eating disorders, raising serious ethical questions.
  3. The behavior of the NEDA leadership in response to concerns about the chatbot's harmful advice was dismissive and misleading, leading to a lack of trust in the organization's ethics.

Weight-Neutral Health And Wegovy - Unprinted Interview

858 implied HN points • 05 Aug 23
🏥 Health & Wellness Weight Loss Body positivity Medical Industry Health Research Drug Safety
  1. The concept of body-size-as-disease is constructed by the diet industry and lacks scientific grounding.
  2. Engaging in intentional weight loss contradicts being a part of the Health at Every Size community.
  3. Research suggests that weight-neutral interventions can offer similar cardiometabolic benefits with fewer risks compared to weight loss drugs.

Reader Question – Top Three Phrases for Dealing with Medical Weight Stigma

619 implied HN points • 09 Dec 23
🏥 Health Politics Weight Stigma Informed consent Body positivity
  1. Ask what treatment would be given to a thin person with the same issue to navigate weight stigma in healthcare.
  2. Assert your right to informed refusal to treatment when faced with weight-related recommendations or pressure.
  3. Redirect the focus of the conversation back to your healthcare needs and away from weight discussions using a phrase like 'I'd like to focus on...' to ensure patient-centered care.

Should We Rename “Obesity”?

838 implied HN points • 30 Aug 23
🏥 Health & Wellness Weight Stigma Fat Liberation
  1. Some are considering renaming 'obesity' to remove stigma and redefine the illness concept.
  2. The term 'obesity' being considered a disease is fueled by the weight loss industry and may not be the best approach.
  3. Efforts to rename 'obesity' might simply be masking the failed concept with a new label.

Reader Question – Weight Loss Industry Big Think Part 1

639 implied HN points • 29 Nov 23
🏥 Health & Wellness Weight Loss Industry Healthcare Research Activism
  1. The weight loss industry is a for-profit industry that profits by labeling higher-weight individuals as diseased, creating harmful messaging and interventions.
  2. The industry has successfully infiltrated healthcare systems, promoting the idea that being in a higher-weight body is a lifelong, chronic disease.
  3. Industry tactics include promoting weight loss drugs as lifelong solutions, perpetuating weight stigma under the guise of helping higher-weight individuals, and making hundreds of billions of dollars through exploitative practices.

The Alternative to “Obesity Medicine”

818 implied HN points • 06 Sep 23
🏥 Health & Wellness Medical care Body positivity Research
  1. A healthcare system should provide equal care to individuals of all sizes, moving towards truly weight-inclusive healthcare.
  2. Research and practices in medicine should include fat patients to improve outcomes for higher-weight individuals.
  3. Weight-inclusive healthcare could reduce weight cycling and improve the health of fat individuals, challenging the ineffective weight-centric care system that has been in place for decades.

Reader Question – Is Obesity an Addiction Like Alcohol or Gambling?

758 implied HN points • 11 Oct 23
🏥 Health & Wellness Nutrition Mental health Body positivity Weight Stigma Eating Disorders
  1. Obesity is not an addiction like alcohol or gambling; it is simply defined by a BMI of 30 or higher.
  2. Alcohol use disorder and gambling disorders have specific diagnostic criteria and shared behaviors, while obesity is not behavior-based.
  3. The concept of food addiction is controversial, and pathologizing higher weight bodies can be rooted in racism and anti-Blackness and perpetuated by the weight loss industry.

Wegovy’s So-Called “Long-Term” Study

758 implied HN points • 27 May 23
🏥 Health & Wellness Weight Loss Obesity Medical Research Nutrition
  1. The study on Wegovy's long-term effects raised concerns about the definition of 'long-term' in the context of a 2-year study.
  2. The conflicts of interest among the study authors, who receive funding and support from Novo Nordisk, the drug manufacturer, raise questions about the study's credibility.
  3. The study revealed high rates of adverse events among participants taking Semaglutide, emphasizing the risks associated with such weight loss medications.

Not Blaming Fat People For Failed Weight Loss Isn't Enough

738 implied HN points • 23 Aug 23
🏥 Health & Wellness Weight Loss Healthcare Weight Stigma Fat Activism Body positivity
  1. Healthcare practitioners often blame and shame fat patients for failed intentional weight loss, creating barriers to compassionate care.
  2. The weight loss industry acknowledges the failure of behavioral weight loss interventions, but their push for risky methods like drugs and surgeries is dangerous.
  3. Instead of blaming fat people for weight loss failure, healthcare should focus on respecting and affirming their humanity while supporting their health.

Heart Health Workshop Puts Weight Stigma and Poor Science on Display

698 implied HN points • 18 Oct 23
🏥 Health & Wellness Weight Stigma Heart Health Workshop
  1. The workshop highlighted weight stigma issues in healthcare, emphasizing the harmful effects of reinforcing stereotypes based on body weight.
  2. The promotion of weight loss as a solution to health issues was criticized, raising questions about the effectiveness and ethics of focusing on weight reduction.
  3. The financial ties between speakers at the workshop and pharmaceutical companies were exposed, leading to concerns about potential conflicts of interest in the healthcare industry.

Reducing Stigma by Ending the Pathologizing of Fatness - Part 1

718 implied HN points • 12 Jul 23
🏥 Health & Wellness Weight Stigma Healthcare Research Interventions
  1. Pathologizing fatness contributes to weight stigma and can dehumanize fat individuals, perpetuating discrimination and exclusion.
  2. Traditional weight stigma reduction methods that shift blame or rely on empathy fail to address the root cause of pathologizing fatness and are ineffective in dismantling weight stigma.
  3. Efforts to eradicate weight stigma should focus on depathologizing fatness, creating interventions that challenge stigma's underlying foundations and embracing collaboration with stigmatized communities.

Study Tests the Validity of Weight Loss Research Claims

758 implied HN points • 29 Apr 23
🏥 Health & Wellness Weight Loss Research Health Benefits Dieting
  1. Weight loss research often relies on the energy deficit approach despite a high failure rate, leading to misrepresentation of evidence.
  2. Claims suggesting 5-10% weight loss offers significant health benefits lack substantial evidence and may not be accurate.
  3. Weight loss studies tend to overlook adverse effects of dieting, neglect other clinical outcomes beyond weight loss, and maintain an overly optimistic tone despite high failure rates observed in long-term interventions.

Higher-Weight People Have Best Hip Surgery Outcomes in New Study

698 implied HN points • 22 Jul 23
🏥 Health & Wellness Medical Research Patient Care
  1. The outcomes of hip surgery for higher-weight individuals were found to be better in a new study, which challenges common beliefs about weight and healthcare.
  2. It's important to consider various factors impacting surgical outcomes beyond just weight, such as individual characteristics, bias, and pre-surgery weight loss attempts.
  3. Even if there are complications, all individuals, regardless of weight, should have access to healthcare and surgeries to reduce pain and improve quality of life.

Patient Quick Guide To Talking About Weight with Healthcare Providers

718 implied HN points • 06 May 23
🏥 Health & Wellness Mental health Physical health Wellness Weight management Patient Advocacy
  1. Weight stigma in healthcare can be a common issue for higher-weight patients.
  2. Healthcare providers may focus excessively on weight loss even when it may not be relevant to the patient's health concerns.
  3. Patients have the right to refuse weight-focused care and can navigate discussions with their healthcare providers by explaining their reasoning or bypassing weight discussions.

Article Shows How the Media Creates Weight Stigma, Even When It Isn’t There

678 implied HN points • 20 Sep 23
🏥 Health & Wellness Weight Stigma Health Research Media influence Body positivity
  1. The study analyzed the impact of warning labels on sugary drinks but the media misrepresented the findings, leading to weight stigma.
  2. Existing research shows that interventions focusing on positive, weight-neutral health messages are most beneficial for people of all sizes.
  3. Media coverage often perpetuates weight stigma and misinformation, impacting public perception and potentially harming individuals.

Is Beachbody's Rebrand Really About Honoring All Shapes and Sizes? Part 1

678 implied HN points • 14 Jun 23
🏥 Health & Wellness Physical health Mental health Diets Fitness Body positivity
  1. Beachbody's rebrand to 'BODi' does not truly represent a commitment to weight-neutral fitness, despite efforts to suggest otherwise.
  2. Their promotional materials and programs still heavily focus on weight loss and diet culture, with no substantial evidence provided for long-term weight loss efficacy.
  3. The rebranding claims to honor all shapes and sizes but seems to continue promoting weight loss and thin bodies as the ideal, lacking true fat-affirming or weight-neutral approaches.

Letter To Med Students Doing a Weight-Stigma Capstone – Guest Post by Rachel Fox

678 implied HN points • 03 Jun 23
🏥 Health & Wellness Weight Stigma Medical education Fat Activism Healthcare
  1. Medical students should re-evaluate weight-stigma projects to make a real impact.
  2. Addressing systemic fat oppression in healthcare requires tangible actions like reviewing curriculum and infrastructure.
  3. Med students possess a unique position to challenge anti-fat practices and bring about meaningful change.

The Problem With “Classes” of “Obesity"

678 implied HN points • 10 May 23
🏥 Health & Wellness Obesity BMI Healthcare Weight Stigma
  1. The concept of 'obesity' based on BMI can be problematic and does not account for individual health variations.
  2. Classifications of obesity, especially in healthcare, can lead to biased treatment recommendations favoring weight loss over evidence-based, weight-neutral care.
  3. The arbitrary nature of BMI 'classes' for obesity can result in significant differences in treatment recommendations with just small changes in weight, perpetuating weight stigma and inequality in healthcare.

Wegovy Side Effects and Informed Consent - Part 2

579 implied HN points • 04 Nov 23
🏥 Health & Wellness Medication Informed consent Side Effects Healthcare Weight Loss
  1. Wegovy is a weight-loss drug that has not been around for a long time, as it is a repurposed version of another drug called semaglutide, with evolving risks and warnings.
  2. Wegovy and Ozempic differ in dosage and treatment purpose, with Wegovy aiming to maximize weight loss side effects at a high dose that exceeds the maximum dose of Ozempic.
  3. Informed consent conversations with healthcare practitioners are essential, especially when considering drugs like Wegovy with significant side effects and dosage differences.

Reader Question: Why do they say that "obesity" is a chronic disease like asthma and type 2 diabetes?

918 implied HN points • 01 Mar 23
🏥 Health & Wellness Obesity Chronic Disease Weight loss industry Health Education Medical Industry
  1. Obesity being labeled as a chronic disease like asthma and type 2 diabetes is misleading and harmful.
  2. The weight loss industry benefits from portraying obesity as a disease, pushing for lifelong treatments like expensive drugs.
  3. The enmeshment of the weight loss industry in healthcare can lead to misinformation and harm, as well-meaning healthcare practitioners get caught up in it.