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.

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 new lows.

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 to us.

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.

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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 website so that you can avoid harmful weight stigma if you choose.

They explain the program as a 3-step process:

Step 1: Enroll Your Org

Register your health system. Get access to a variety of resources in the Million Pound Challenge Tool Kit for your entire team.

Step 2: Your Staff, Your Way

Employees can use the tools provided, join their own programs, work with providers—whatever works. Your organization decides how to structure participation.

Step 3: Track Progress

The only requirement? Track results with a monthly check with your Challenge coordinator. Watch as individual effort becomes collective momentum toward one million pounds.

This is where they make things incredibly clear - literally the only requirement is to track weight loss. This isn’t about health metrics, there is no way to make this program weight neutral or to focus on health - weight loss is the only metric and tracking it is the only thing the program requires.

And when they blithely say “whatever works” let’s be clear that a century of research finds that, unless their goal is to create weight cycling, nothing does.

So there is no common intervention and all they are tracking is weight loss. Right. And how is weight loss tracked? Per the FAQs (emphasis mine)

“Your Challenge ambassador must log your team’s results monthly with your assigned Challenge Coordinator—this is the only requirement. Individual weights remain completely private. Only aggregate organizational totals are posted on the community leaderboard so you can see how your organization compares nationally.”

Um, they aren’t private if you have to share them with your company’s challenge ambassador (and I have serious concerns that someone who would sign up for that job may be the last person that a coworker would want to tell their weight.)

Workplace programs (or any programs) that include a weight loss component have significant risks to physical and mental health, including through eating disorders. But programs that compel people to compete solely on the basis of weight loss, as this one does, can actually encourage participation in dangerous behaviors in order to create weight loss.

Measure your organization’s progress, celebrate your success stories, and recognize your top-performing teams. Join leaders at quarterly events, Chamber Summit, Aspen Ideas Festival, and HLTH to keep momentum strong.

Do. Not. Do. This. Another huge issue with this, and all workplace/organization weight-loss challenges, besides the issues with disordered eating and eating disorders and weight cycling, is that it can single out people who aren’t participating or “achieving” in ways that create a hostile work environment for them.

It can mean that those who have chosen an evidence-based weight-neutral path (either due to a history of eating disorders or other reasons) have to choose between their physical and mental health and being seen as “not a team player.”

It can lead to organizations under valuing employees who, due to many reasons including disability, chronic illness, and more, cannot participate in the initiative at all (or in ways that make them “top-performing”) which can lead them to being seen by subordinates, peers, and bosses as a “drag” on the team or having less value to the organization. This is not surprising from someone like program co-founder Toby Cosgrove who once gleefully told the New York Times magazine that he didn’t want to hire higher-weight people (as the CEO of the Cleveland Clinic,) but let’s not follow in those bigoted footsteps.

After 12 months, we’ll have collectively proven what we’ve known all along—that sustainable health outcomes are achievable. Winners celebrated at HLTH 2026. Every organization recognized for leading the revolution.

There is so much wrong with this that I scarcely know where to begin. As I said in part 1, “prove” is a very strong word so I expect robust research and lots of it (spoiler alert - I’m going to be disappointed again, but in no way surprised, again.) These two doctors should know better than to suggest that anything about “sustainable health outcomes” can be “proven” by a random “challenge” that only lasts a year has no common intervention, and only measures weight loss. This does not have the ring of sound science.

The truth is, we can’t even be sure how many of the participants would get thin enough that program co-founder Toby Cosgrove would think they deserved to be employed.

I don’t want to spend too much time analyzing the deck chairs on this titanic of a “challenge” but I do want to look at one of the “resources” they offer, called ‘Why Healthy Employees Don’t Need Your Wellness Challenge.”

First of all remember that this is NOT a wellness challenge (which would measure, you know, wellness) this is a weight loss challenge that only measures body size manipulation. Even if we ignore that, this “resource” is particularly horrifying, promoting the “Lifestyle 180” program. The program is based on the assumption that higher-weight people and those with chronic conditions are not already participating in health-supporting behaviors and should be “targeted”, by their employers (not their actual healthcare providers,) with “intensive, medically-integrated interventions.”

Here again, this program teaches organizational leadership to see higher-weight people and those with chronic conditions as a liability to be solved and not as skilled and valuable employees, with the unspoken (except by Toby to the NYT magazine) takeaway to avoid hiring these people in the first place. This is likely to disproportionally impact higher-weight people, People of Color, and especially higher-weight People of Color. (Note that this is all wrapped up in the massive issues with U.S. employers providing healthcare which is, to use a technical term, a hot garbage mess that is beyond the scope of this post, but the idea that employers should have access to employee health information is obviously seriously problematic on its face.) The “resource” continuously suggests that employers focus on “the 20% of [ employees] driving 80% of the costs” ending with “that’s where you win.”

My main takeaway from this resource was that if an employer sent me an email that said “Your recent health screening showed some concerning trends We have a program specifically designed for you. Can we talk?” I should say, emphatically, no.

Which would also be my immediate answer if asked to participate in this “challenge.”

In Part 3 we’ll talk about what you can do if your organization tries to push this kind of “challenge” on you.

This month’s online workshop is Weight-Neutral Joint Pain Management with sports medicine physicians Dr. Julia Bruene and Dr. Jeremy Alland. There is a pay-what-you-can-afford option and a video will be sent to all registrants.Details and registration here!

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*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’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.

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, including with sample letters written by Shannon that you can use as a template.

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.

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.

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.

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.