Weight and Healthcare

Regular readers may know that while speaking and writing are my primary work, I’m also a Board Certified Patient Advocate and I sometimes work directly with patients, typically in emergency or complex medical situations. Recently I was advocating for a patient at a cardiology appointment (who has given me permission to share this.) I was waiting outside the treatment room while my patient got settled, near the area where the scale that is used for weigh-ins was located. In this practice each cardiologist has a nurse and the nurse is responsible for getting weight as well as actual vital signs. As I was standing there a nurse brought a patient over and asked them to step on the scale. The patient made an “Ugh” noise and the nurse laughed and said “I know, weighing in is the worst. I postponed my last appointment by two weeks so that I could lose five pounds first.”

At that exact moment I was called into my patient’s treatment room and so I switched my focus 100% to the patient but I am reaching out to start a dialog about this at the practice. 

So, what went wrong, and what go be done better?

I received the following question from reader Jin,

I’m a pharmacist and one of the things I’ve learned from following you over the years is the importance of language. I wanted to ask you about language like “anti-ob*sity” medication and “ob*sity treatment.” I notice that you still use terms like weight loss drugs and I imagine that is on purpose. I’d love to understand more about this. Feel free to make it a Substack post if you’d like.

Thanks for noticing and thanks for asking Jin!  

I received the following question from reader Alina:

I’m a family med doctor and I’ve started seeing lots of publications, even research, using the terms “person with ob*sity” and “person with overw*ight.” I took some CME [Continuing Medical Education] where they said that it was for weight stigma reduction. I’m not sure why, but it just doesn’t feel right at all (Does person with overw*ight even make sense?) I would love to see a newsletter about this.

Thanks for asking Alina, your feeling that something’s not right here is spot on.

There are many aspects of weight stigma within the healthcare system that harm higher-weight people. There is an issue that isn't often discussed that underpins many of the harms that the healthcare system does to higher-weight people.

Research. Or a lack thereof. 

In part 1 we discussed a New York Times article about so-called “Ob*sity First Medicine” (OFM) which suggests that higher weight people with health issues should be targeted for weight loss treatment (in this case specifically the new GLP-1 diet drugs) treating them differently than thinner people with the same symptoms/presentations/diagnoses.

Today we’re going to look at an opinion piece in WaPo that discusses the same phenomenon. 

Many of you reached out to me about two articles. One in the New York Times by Gina Kolata about so-called “Ob*sity First Medicine” - OFM (you may remember Kolata from a different article I wrote about that essentially lobbied for insurance coverage for weight loss drugs and failed to disclose that each person interviewed was on the payroll of the drug companies.) Another an opinion piece in the Washington Post by Leana S. Wen. We’ll discuss the NYT article in part 1, along with some general issues and the WaPo article in Part 2. 

I received a reader question from Annilyn who said:

“My doctor just suggested that I try the AspireAssist to lose weight. I didn’t want to Google it because I think it will be really triggering but based on what he described, I just don’t think this thing can be real, can it? Will you write about it?”

I’m happy to write about this weight loss device Annilyn, and mostly I’m happy because it seems to be off the market, but we’ll get to that. I think it’s worth looking at the history and research around this thing as an example of what happens in a “thin my any means necessary” healthcare culture.

In part one we looked at a lawsuit being brought by Jaclyn Bjorklund against Novo Nordisk (maker of Semaglutide - brand names Ozempic/Rybelsus/Wegovy) and Eli Lilly (maker of Tirzepatide - brand names Mounjaro/Zepbound) for the severe gastrointestinal side effects she experienced after taking Ozempic and then Mounjaro for type 2 diabetes. At the end I made the point that, for some people, the negative side effects don’t end when they stop taking the medications and for others, the damage has been done. 

That brings us to Juanita Gantt.

I received requests from a number of you to write about this situation. Jaclyn Bjorklund, a 44 year old woman from Louisiana is suing both Novo Nordisk and Eli Lilly.

Content note: this piece will include details of severe gastrointestinal symptoms and conditions.

This is the final part of the series about the study “Eating disorder risk during behavioral weight management in adults with overw*ight or ob*sity: A systematic review with meta-analysis” by Jebeile et al, 2023. In part 1 we talked about overarching issues with the science, in part 2 we talked about general issues with this specific study, and in part 3 we’ll discuss the specific claims made.