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© Ragen Chastain
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Examining the intersections of weight science, weight stigma, and healthcare and what evidence, ethics, and lived experience teach us about healthcare and public health best practices for higher-weight people.
weightandhealthcare.substack.com
weightandhealthcare.substack.com
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I was recently advocating for a patient who needed an emergency head CT to rule out some potentially serious complications. (Luckily she was fine and her symptoms had the least concerning diagnosis.) Of course, I have her permission to write about this.A content note, this post is going to include medical weight stigma.After the imaging was done and the report completed the doctor came into the room to tell her that everything on the CT looked “great”.The next day, the results were released to her MyChart and she had an unpleasant experience that I’ve heard from many other patients.The first line of the “impression” section was “Significantly limited evaluation due to body habitus.” That was also the first line of the “findings” section. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
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
Wow did I get a lot of requests to write about this! We’ll start with some basic information today and then break down the actual trial data in the rest of this series. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
I received the following question from reader Rebecca:This is my first New Years away from dieting and while I am happier (and healthier, though I know that’s complicated) than ever. Still I am struggling with New Years Resolution season, do you have any tips for making non-diet resolutions that focus on my health?I’m happy to help, you are definitely not alone in trying to navigate this time of year in weight-neutral, non-diet ways! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
In part 1 we talked about a trial of semaglutide for knee osteoarthritis. In part 2 we compared that trial to a trial that used metformin. Today we’re going to talk about research around behavioral (non-pharmacotherapy) weight-neutral interventions. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
In part 1 we looked at a study of the effect of semaglutide 2.4mg (Wegovy) on knee osteoarthritis. Today we’ll look at two studies that consider the effect of metformin and compare that with the semaglutide study. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
I've received a number of questions about GLP1s and knee pain/osteoarthritis and in this series we’ll look at what the research says.In part 1 we’ll look at the trial for semaglutide and knee osteoarthritis.In part 2 we’ll look at 2 studies that consider the effects of metformin on knee osteoarthritis.In part 3 we’ll look at a study of a weight-neutral intervention Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
I received a question from reader Brit who said “I see you and other people talking and writing about the weight-inclusive and weight-centric (and sometimes weight-neutral and weight-loss paradigm). I think I know what they mean but could you give a quick explanation?I’m happy to Brit, sometimes it’s good to go back to basics! Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
In Part 1 we began discussing the article “Implications of a New Ob*sity Definition Among the All of Us Cohort” by Fourman et al. This is a study that took the recommendations of the (heavily financially entangled with the weight loss industry) Lancet Commission around increasing the methods by which “ob*sity” can be “diagnosed” (the massive issues with which I wrote about here,) and applied it to the All of Us population. So what did they find? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
I previously wrote about a Lancet Commission that published what I would describe as an opinion piece that they attempted to disguise as legitimate science. In it, they manipulated multiple research processes in order to create the largest possible market for the weight loss industry (in which the authors had massive financial entanglements) by wildly expanding the ways that someone might be “diagnosed” as “ob*se.” You can read about the whole sordid affair here. This has been a longtime goal of the weight loss industry and this group of financially entangled authors made it real, at least in their article.Now another group of authors have shown the reality if these ideas are applied in the real world. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
Today I’m taking a break from talking about weight and healthcare to write about navigating so much of the nonsense that happens during the holiday season. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
Today will be the first post in a short series discussing attempts to “calculate” the (supposed) “costs” of “ob*sity.”Before we get into any of this I want to say unequivocally that anytime we try to calculate the cost of a group of people, including and especially, to support a call for their eradication, we are going down a very bad, very wrong road. So while I will be discussing the specific issues with these calculations, please always remember that the calculations shouldn’t be undertaken in the first place. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
In Part 1 we looked at the basics and early research around GLP-1s for weight loss and muscle loss. In part 2 we looked at recent research around the newest GLP-1 weight loss drugs, tirzepatide (Zepbound) and semaglutide (Wegovy).In this final part of the series we are going to talk about the justifications/excuses/spin that are happening around the loss of lean muscle mass on GLP-1s. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
In Part 1 we looked at an early study of GLP1 drugs and muscle loss. Today we’ll look at two more recent studies, one for Eli Lilly’s drug tirzepatide and one for Novo Nordisk’s drug semaglutide. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
As GLP-1 drugs get heavily marketed for weight loss, we know that when people stop taking the drugs they experience rapid weight regain. We also know that, while the claim is that if people stay on the drugs forever they’ll maintain the weight loss, there isn’t any research proving that and that in the longest study of these drugs for weight loss (4 years) they lost 89.5% of the sample.There is another aspect that I think is not being discussed nearly enough and that is the subject of how much of the weight that is lost is coming from what is known as lean body mass. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
Several months ago I was asked to complete an interview over email for online publication The Quo. I was recently told that the writer fell ill and that the piece won’t be published. The interview was, essentially, a quick guide to the issues with diet drugs and surgeries for children so I thought I would publish the answers here. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
I write a lot here about the fallacy of blaming health issues on body size. Today I want to talk about the tendency to credit weight loss for physical, psychological, and social benefits. For example, someone will (at least short term) lose weight and offer a testimonial about how much better they feel, how much more they are doing in the world etc. Or a study will determine that Health Related Quality of Life (HRQoL) has improved after weight loss.Just like a weight-centric healthcare system (and world) tends to completely uncritically blame weight for health issues, it also completely uncritically credits weight loss for health, life, and HRQoL improvements. Today I want to take a critical look at this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
I last wrote about the Ob*sity Action Coalition (OAC) in 2022 and you can read about their history in that post here. It’s time for an update. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
I got the following question from reader Katrina:“You spoke to my doctoral program recently and in the Q&A you said something about poking holes into people’s thinking where better ideas could fall in. In the past I’ve talked to my doctor about research. I love the research posts you make but I know my doctor isn’t going to read or listen to something that long (he really should he just won’t!) Do you have some quick questions I could ask to poke some holes in his thinking that better ideas could fall into?”Sure Katrina, here are my top 5 quick questions for when a doctor (or friend or family member or article etc.) makes claims that being higher-weight causes health issues and/or that weight loss is a treatment or cure. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
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