What Does It Take to Change?

Opinions have been quietly changing about two possible treatments for childhood obesity that, up until recently, have pretty much been viewed as undesirable, and even dreaded. The most volatile reputation belongs to medication, specifically to the glucagon-like peptide-1 receptor agonists, also known as GLP-1 RAs. With this particular type of drug, it seems that the biggest percentage of conversation centers on two demographics: menopausal women and teens of either sex.

So far, the risks for teens seem mostly financial, promising to lock them into a lifelong “deal with the devil” whose hefty price will no doubt become increasingly unaffordable. Pharmaceutical products are not famous for any tendency to become less costly over time. Federal aid for medical expenses is drying up fast. Still, more parents will choose to spring for the GLP-1 subscriptions, even if it means raiding the college fund.

Inevitably, additional cases will go on record showing that these drugs can cause problems that are presently unclear or unsuspected. Even someone who is not the wagering sort can confidently bet on that.

And then, the knife

At some point, this will probably lead to an increase in the other dreaded outcome, bariatric surgery for teens, and even for children. Following that, history is expected to repeat itself and reveal still more reasons why the surgical option can also cause regrettable yet unfixable lifelong difficulties. We already know enough about that subject to be quite wary. Still, some doctors and parents will inevitably choose surgery as a prospect less odious than other possible grim outcomes.

What sort of problem could occur?

As previously discussed, harmful eating habits might result from our own past emotional upsets and psychological traumas. Registered dietitian and nutritionist Carly Zimmer reminds parents that good eating habits need support from the environment, and alerts us to some of the signs that this area has developed problems.

She teaches that weight loss medication is only a partial answer, because it either must continue throughout life, or else the subject needs to develop an entire brand new repertoire of habits around food and eating. Sadly, the most elemental fact about life is that it can change. A person may not always have the means to procure the GLP-1 meds.

An audacious proposal

In any case, the probability is strong that some day, the consumer will need to learn to live without the drug… so why not start now? If it is just a matter of developing new habits, why do people have such a hard time with the concept and the execution? The mind might recognize that change needs to take place, but how does this translate into action? If it is a mental/emotional health issue, how do we address that?

(To be continued…)

Your responses and feedback are welcome!

Image by geralt/Pixabay

Goodbye to 2025, and Try This

The facetious advice in the picture on this page has been seen millions of times online and is impossible to trace back to its source. But let’s lift a glass of sugar-free fizzy soda and drink to the health of its author. Yes, going forward into the new year, humans will continue to fight against our own best interests. Sooner or later (perhaps in 2026!) more of us will come to see the truth of another anonymous quotation:

You can fool some of the people all of the time, and fool all of the people some of the time, but — ultimately, eventually, inevitably — you can’t fool yourself.

This blog has pointed out many of the societal costs of obesity, so for the end of December, it gathers a little bouquet of talking points from the past year and the past few years, and some things to look out for in the coming months.

There are problems we don’t want to see our kids, or any kids, have to face in the upcoming year or any year subsequent to this one. In other words, let’s poke and prod ourselves to do something about looming obstacles and stop putting off the unpleasant tasks. To stall is to invite consequences that quickly outgrow the unpleasant stage and morph into real-life nightmares.

Interview with an expert

“Watchful Waiting Not Recommended For Childhood Obesity” is the title of a very recent piece by Tim Ditman, and let’s have a peek at what the expert he interviews has to say about the subject.

The American Academy of Pediatrics (AAP) has been taking a second look at some of its guidelines and softening its attitude toward surgery and medication. Some parents became nervous about venturing beyond the traditional guardrails of diet and exercise, and this is understandable.

Too often in life, the urge to “Do something!” becomes diverted or misapplied. The only thing worse than neglecting a problem is approaching it with the wrong tool. Maybe the error even lies in the mental construct of attack. Maybe “address” or “examine” is a better approach. So we do not want to start out with a misstep. When aiming for a compass bearing, even a single degree of error can lead to far, far from the intended destination.

One thing is for sure:

The AAP says waiting and hoping things get better is not a good choice.

Up until about age 12, sure, stick with the traditional methods, but beyond that age, “diet plus exercise” is not a sufficient prescription. The AAP is talking about, among other remedies, “in-person, family-based behavioral health treatment” for three months to a year. After passing that 12-year mark, the organization says, let’s start thinking about a pharmaceutical approach; and after the 13th birthday, in many cases surgery should not be arbitrarily ruled out.

Registered dietitian-nutritionist Carly Zimmer feels empathy for the difficulties that children face. Their lives are saturated with “activity” that involves mainly sitting on their ever-enlarging behinds, watching screens that glorify and strenuously recommend eating all the wrong stuff, and plenty of it. Yet and still, very often the food is not the enemy — the mind is.

Zimmer says,

Often our eating habits stem from events in our past, trauma or emotions. A mental health professional can dive into those topics and help establish a healthy relationship with food.

This is what needs to happen, not an eternal relationship with weight-loss meds acting as a band-aid, because a band-aid is glued to a person only to be replaced. That is why they are sold by the package. Commitment to a lifetime of regular injections of a very expensive drug is not a solution; not a win or a cure, or any other positive description of an outcome. It is a very poor alternative to what is ultimately possible, and many professionals are deeply committed to never settling for less.

Zimmer offers suggestions which, yes, have been heard before. That isn’t the point. If a concept has value, it is worth hearing a thousand times — until someone whose health hangs in the balance actually absorbs it. For parents, Zimmer suggests a technique that begins by adding, not subtracting. Go ahead and give the kid the same old cereal for breakfast, but offer fresh fruit, too. Maybe at some point, this particular individual will become more interested in the fruit and abandon the cereal.

Be the grownups

Get used to the idea that sometimes a child will be hungrier than other times, and don’t make a big thing out of it if they occasionally consume what you think is too much or too little. And forget that tired old “Join the clean plate club!” nonsense. Please do not set a heap of food in front of a kid. Let them start with a small serving of the fattening stuff, and maybe they will surprise you by scarfing down all the green beans.

Don’t let yourself be discouraged. You can place the same food in front of a child 20 times, only to see it scorned; and then, one day, they will eat it. When the child eventually caves and admits the stuff isn’t so bad after all, refrain from sarcasm. And now, Zimmer gives advice worth gold: “Don’t make exercise a chore.”

Parents, if there is some physical, active, calorie-burning activity your child enjoys, embrace it. Please. Find where the kid can go skateboarding or swimming, or learn gymnastics or Jiu-Jitsu, or whatever sort of exercise they can get behind. Please give them a chance to try an activity before committing to it. Make the time, find the money (it will probably not cost as much, ultimately, as weight-loss drugs or surgery), and figure out how to retain this as a major part of life, for as long as the child is into it. The rewards will be vast.

Your responses and feedback are welcome!

Source: “Watchful Waiting Not Recommended For Childhood Obesity,” RiverBender.com, 10/13/25
Image by JillWellington/Pixabay

FDA Approves Wegovy Pill

The landscape of medical weight loss just had one major change. On Monday, the Food and Drug Administration (FDA) approved a pill version of Wegovy, Novo Nordisk’s blockbuster GLP-1 weight loss drug, making it the first oral GLP-1 medication approved specifically for weight loss.

Until now, GLP-1 drugs such as semaglutide (found in Ozempic and Wegovy) and tirzepatide (used in Mounjaro and Zepbound) have only been available as injections. While highly effective, injections can be a barrier for many patients. The arrival of a daily pill could change that.

Novo Nordisk expects the Wegovy pill to be widely available in January, according to a company spokesperson. A competing oral GLP-1 pill from Eli Lilly is also expected to gain FDA approval in the coming months.

Why the Wegovy pill matters

GLP-1 drugs were initially developed to treat type 2 diabetes, but they quickly gained attention for their ability to drive significant weight loss. Their popularity has soared in recent years as obesity treatment has shifted toward more effective medical options.

Dr. Christopher McGowan, a gastroenterologist who runs a weight loss clinic in Cary, North Carolina, told NBC News:

This is a meaningful step forward in the field… It won’t replace injectables, but it broadens our tool kit in an important way.

Dr. McGowan emphasized that the form of the medication itself may help more people feel comfortable starting treatment:

Pills are familiar, nonintimidating and fit more naturally into most people’s routines… For many patients, a pill isn’t just easier, it’s psychologically more acceptable.

Novo Nordisk already sells an oral version of semaglutide called Rybelsus for diabetes, but it comes in a lower dose. The newly approved Wegovy pill is formulated specifically for weight loss, and at higher doses.

Cost, coverage, and access questions

Novo Nordisk has not yet released the list price for the Wegovy pill, which must be taken daily, but it is expected to cost less than the weekly injections. Insurance coverage, however, remains uncertain. Many private insurers restrict coverage of injectable weight loss drugs because of their high cost.

Medicare is legally barred from covering medications approved solely for weight loss. However, the Wegovy pill was also approved for lowering heart disease risk, which Medicare does cover — potentially opening the door for broader access.

In November, Novo Nordisk reached an agreement with the Trump administration to sell the lowest dose of the pill for $149 per month for people paying out of pocket, in exchange for tariff relief. Eli Lilly made a similar deal for its own weight loss pill.

How effective is the Wegovy pill?

Clinical trial data suggest the pill works nearly as well as the injectable version — if taken correctly. Phase 3 trial results published in The New England Journal of Medicine showed that participants taking the highest dose of the Wegovy pill lost an average of 16.6% of their body weight after 64 weeks. By comparison, those in the placebo group lost just 2.2%. That result is roughly on par with injectable Wegovy, which reduced weight by about 15% after 68 weeks in earlier trials.

However, adherence may be a major challenge. Dr. Shauna Levy, medical director of the Tulane Weight Loss Center, noted that the pill must be taken first thing in the morning, on an empty stomach, with no more than four ounces of water. Participants who failed to follow the strict schedule lost less weight, about 13.6% of their body weight on average.

The key uncertainty is how patients will do outside of clinical trials. The open question is “real-world performance,” Dr. McGowan said. “Will patients tolerate the daily dosing and strict timing? Will they stay on long enough to see meaningful results? We don’t know yet.”

Side effects and comparisons to injections

Like injectable GLP-1 drugs, the most common side effects reported with the Wegovy pill were gastrointestinal, including nausea and vomiting. In some cases, those effects may be stronger.

Dr. McGowan explained that side effects from the pill version can feel “more intense” because the medication reaches the stomach all at once. “The challenges we see with injectable GLP-1s don’t magically disappear with a tablet,” he said.

While the Wegovy pill delivers weight loss comparable to injectable Wegovy, newer injectable drugs still lead the field. Lilly’s Zepbound helped patients lose 22.5% of their body weight after 72 weeks in clinical trials, and its next-generation injection, retatrutide, produced average weight loss of 24% after just 48 weeks.

Novo Nordisk says the differences may come down to how the medication is absorbed. Because pills are broken down in the digestive tract, less of the drug reaches the bloodstream compared to injections. To compensate, the Wegovy pill is taken daily and at higher doses.

The pill’s effectiveness is closer to Lilly’s oral drug orforglipron, which led to about 10.5% weight loss after 72 weeks in late-stage trials. These figures, however, are not from direct head-to-head comparisons.

Avoiding past shortages

When injectable Wegovy first launched, it was plagued by prolonged shortages. This time, Novo Nordisk says it has increased pill production ahead of the rollout. Another consideration is that oral medications are often easier to manufacture than injectables, which could help prevent supply issues and improve access.

For now, the Wegovy pill represents a promising new chapter in the rapidly evolving science of weight loss treatment.

Your responses and feedback are welcome!

Source: “FDA approves Novo Nordisk’s Wegovy pill, the first and only oral GLP-1 for weight loss in adults,” PR Newswire, 12/22/25
Source: “FDA approves Wegovy weight loss pill from Novo Nordisk,” NBC News, 12/22/25
Image by JESHOOTS.com/Pexels

Additional Complicated Angles of Weight

All the behaviors that combine to define an eating disorder are just maladaptive coping strategies, writes Brittney Williams of Fairhaven Treatment Center. According to Internal Family Systems (IFS) theory, the inner “exiles” who perform those behaviors do not need to be banished, only freed of their painful burdens:

The goal of coming to see eating disorders as a “part” similar to the rest of an individual’s various “parts” gives a chance for them to be seen, heard, understood, and transformed.

In other words, the concept here is to own the eating disorder and the ghostly entities that inhabit you, because to admit in the first place that they exist is the only way to tame them.

“Parts work,” as pioneered by Dr. Richard Schwartz, is claimed to be effective not only with eating issues but with “many mental disorders.” According to this worldview, for a person to contain several beings is not a pathology but the natural order of things. Rather than suffer banishment, the multiple entities within should all be consulted and regarded, because if given the chance, they can and will prove helpful. In other words,

The foundation of this model offers a beneficial framework for clinicians to approach clients’ eating disorder behavior from an internal relational perspective rather than as maladaptive behaviors.

To shun the “parts” only nudges them into extreme “look at me” behavior, so it is much more helpful to grant them respectful attention. Trying to ignore them will not accomplish anything anyway, so you might as well give them a chance to be heard. The “parts” all want to help, and they are not going anywhere, so the smart thing to do is get to know them and understand what they bring to the table.

The downside

This all sounds very inspiring, but apparently it can go plenty wrong. Often, good intentions are not enough. IFS is sometimes paired with intuitive eating, “a non-diet approach to food intake that involves listening to your body’s hunger and satiety cues and eating accordingly… [Y]ou can eat what you want and when you want, as long as you are tuning into your body’s signals.”

Success depends on interoception, “the ability to perceive physical sensations that arise from within your body. Intuitive eating relies on interoception since you must be attuned to your hunger and fullness in order to give your body the fuel it needs.” It is all too easy to imagine how readily this philosophy could jump the track.

In one way, the IFS worldview is very positive, in assuming that your healthy self is tucked away in there somewhere — you just have to locate and connect with it. But matters are not always quite so simple. In group therapy, listening to the wrong person can be a problem. Artificial Intelligence entities, no matter how cleverly created, can be wrong. The “parts” of a person, the “managers” and “firefighters” who are meant to fix things, can be mistaken. They can give bad and even dangerous advice.

One aspect of relatability is in the bag already. Thanks to technology, AI can be engineered to speak in a voice so convincing that perfectly sane people are swindled into sending their life savings to bail their grandchildren out of jail.

So, why shouldn’t an equally convincing fake entity succeed in helping a person feel worthy and capable of making enormous life changes and losing 100 pounds? Or, if the human in need of therapy is a child, wouldn’t it be theoretically possible to dispose of breath and heartbeat entirely, and let AI help the kids adopt, painlessly, a lifestyle through which they would never become overweight in the first place?

Caution is advised

With self-protective clarity, a young teen in therapy might recognize that he or she has an absolutely terrible parent. (If they didn’t already know it.) Still, the knowledge does not imply a recommendation to murder that parent. This is where professionals really must possess skill, in the realm of helping patients transform pain and anger into positive outcomes. Sadly, that result is not always achieved.

How bad can it be? Of course, a response that triggers binge eating is apt to have quite different results from a response that triggers homicidal tendencies. Does a therapist ever fear setting off a murder or a suicide? Even worse, intentional harm of this kind has been done on purpose.

According to investigators, government agencies in the Sixties were involved in influencing some very bad people to become even worse, and earn public disapproval that would have political consequences. Basically, there is good brainwashing and bad brainwashing, and caution is advisable.

IFS has run into some trouble in this area. As its popularity grew, some families were inevitably shattered when false memories convinced patients that their parents had abused or tried to kill them. Rachel Corbett wrote about this in detail, explaining that thorough and comprehensive training is vital, especially when dealing with vulnerable people who are at a life juncture when they really could use some family support.

Your responses and feedback are welcome!

Source: “The IFS Model With Eating Disorders: ED is Just a Part of You,” EatingDisorderHope.com, 10/11/23
Source: “Eating Disorders and the Internal Family Systems Model,” EatingDisorderHope.com, 10/19/20
Source: “Using internal family systems with intuitive eating to enhance eating disorder recovery,” WithinHealth.com, undated
Source: “Grandparent Scams Take Advantage of Your Love for Your Family,” AARP.org, 02/13/25
Source: “The Therapy That Can Break You,” TheCut.com, 10/30/25
Image by GDJ/Pixabay

Some Complicated Angles of Weight

Although styles of therapy differ, it is widely accepted that the root of all psychological malfunction is pain. In the animal kingdom, the amoeba is about as simple a creature as can be. And yet, even the humble amoeba knows to avoid pain, and somehow recognizes the appropriate moment to flee from a molecule of poison.

In that respect, people are very much like amoebae, but have more freedom of choice in their reactions. Amoebae probably can’t even fight. Their choice of displacement activity is quite limited.

Now, what about the entities that facilitate the healing of pain? Psychologists, for instance — do they absolutely need to be human?

As we have discussed, one aspect of psychological therapy has developed quite rapidly and noticeably into an overwhelming issue. Can excellent results be achieved with less, or even zero, human interaction? Can human connection be adapted and reconceptualized into something equally curative, by perfecting the ability of Artificial Intellligence to imitate high-quality connection?

It’s not that surprising

One might ask, why shouldn’t this be the case? Look, for instance, at books. They are made from common materials, and from symbols that are very different from human speech or breath. Furthermore, vast numbers of humans have been and still are unable to read books — and yet the influence that books have exerted on many of us (for better or worse) throughout the ages is a true marvel.

An important aspect of convincing relatability is in the bag already. Thanks to technology, AI can be engineered to swindle people out of their life savings by speaking in a voice so relatable that a perfectly sane adult will think it’s their grandkid, in desperate need of bail money. Compared to such an accomplishment, the ability to sound like the world’s most empathic therapist is no big deal.

One thought leads inevitably to another

So, why shouldn’t an equally convincing fake entity succeed in helping a person feel worthy and capable of making enormous life changes and losing 100 pounds? Or, if the human in need of therapy is a child wouldn’t it be theoretically possible to dispose of breath and heartbeat entirely, and let AI help the kids adopt, painlessly, a lifestyle through which they would never become overweight in the first place?

How much actual personal contact between patient and therapist is actually optimal? Can a group of other people with similar problems serve the personal-connection need just as well?

Maybe so. Millions of group therapy participants will attest that to go through the self-discovery experience with a cohort of similarly affected others can be incredibly helpful. For many, it has been vital to associate with others who are on the same basic journey, but a little bit ahead.

As Alcoholics Anonymous and similar groups have demonstrated, we also benefit from hanging out with people who travel a little way behind us so we can take our well-deserved turn as experienced encouragers of others on the same path.

(To be continued…)

Image by dbutlerdidit/Pixabay

New Gut Research for Obesity and Diabetes

Scientists have long suspected that the trillions of microbes living in our gut do more than help digest food. Now, new research suggests they may play a direct role in shaping how our bodies handle sugar and fat — key factors in obesity and type 2 diabetes.

A recent study conducted at Harvard University, with support from Brazil’s São Paulo Research Foundation (FAPESP), has uncovered a network of small molecules produced by gut microbes that travel from the intestine to the liver and then throughout the body. These compounds, known as metabolites, appear to influence how the liver processes energy and how sensitive the body is to insulin. The findings were published in the journal Cell Metabolism and could open the door to new ways of treating metabolic disease.

The gut–liver highway

To understand the discovery, it helps to know how blood flows through the body. Much of the blood leaving the intestine doesn’t go straight into the general circulation. Instead, it travels through a special vessel called the hepatic portal vein, which delivers nutrients and microbial byproducts directly to the liver first.

“The liver is essentially the first organ to see what’s coming from the gut,” explains lead author Vitor Rosetto Muñoz, a postdoctoral researcher at the University of São Paulo who conducted part of the study at Harvard’s Joslin Diabetes Center. Once these gut-derived compounds reach the liver, they can be modified, broken down, or released into the bloodstream to affect other organs.

By comparing blood from the hepatic portal vein with blood circulating throughout the rest of the body, the researchers were able to pinpoint which metabolites come from the gut and how they may influence metabolism along the way.

Why the gut microbiome matters

In recent years, researchers have learned that people with obesity, insulin resistance, or type 2 diabetes often have a different mix of gut bacteria than people without these conditions. What’s been harder to determine is exactly how those microbes affect metabolism.

To explore this, the team studied mice with different genetic risks for obesity and diabetes. They analyzed metabolites in both portal vein blood and peripheral blood, offering a clearer picture of what the liver is exposed to right after digestion.

In healthy mice, researchers identified more than 100 metabolites enriched in blood traveling from the gut to the liver. But in mice genetically prone to obesity and diabetes (and fed a high-fat diet), that number dropped dramatically. This suggests that diet and genetics together can reshape the chemical messages sent from the gut to the liver.

Interestingly, mice that were naturally resistant to metabolic disease showed a different metabolite pattern altogether. This points to a complex interaction between a person’s genes, their environment, and their gut microbiome.

Disrupting the microbiome changes metabolism

To test whether gut bacteria were truly responsible for these changes, researchers treated some mice with antibiotics that altered their gut microbiome. As expected, this disrupted microbial populations and also shifted the types of metabolites found in the blood.

One metabolite that increased stood out: mesaconate, a compound involved in the Krebs cycle, which is the process cells use to generate energy. When scientists exposed liver cells to mesaconate and related molecules in the lab, they saw improvements in insulin signaling. The compounds also helped regulate genes linked to fat buildup and fat burning in the liver — two processes that are often impaired in metabolic disease.

These findings suggest that certain gut-derived metabolites can directly improve liver metabolism, even in the context of a high-fat diet.

What this could mean for the future

While this research was done in mice, it provides a detailed map of how gut microbes may influence metabolic health through the liver. The next step is to better understand how each metabolite is produced and how it behaves in the body.

Over time, this work could help scientists identify specific microbial byproducts that might be used as treatments—or inspire therapies that reshape the gut microbiome to improve insulin sensitivity and reduce the risk of obesity and type 2 diabetes.

So, remember: What happens in your gut doesn’t stay in your gut. It may travel straight to your liver and shape your metabolic health in powerful ways!

Your responses and feedback are welcome!

Source: “Harvard gut discovery could change how we treat obesity and diabetes,” ScienceDaily, 12/14/25
Source: “Metabolites produced in the intestine play a central role in controlling obesity and diabetes,” Agencia.fapesp.br, 11/26/25
Source: “Portal vein-enriched metabolites as intermediate regulators of the gut microbiome in insulin resistance,” ScienceDirect, 10/7/25
Image by Wassily Kandark/Pexels

So, relax. Eat cake.

Not long ago, we mentioned the experience of Kris, who totally recognized how much her emotional health depended on feeling so massively immovable that she could not be knocked down and rendered helplessly vulnerable. (To state it more theatrically, and sadly, she could absolutely never be “swept off her feet,” either, which was all according to plan).

As we have seen, Richard C. Schwartz and (unrelated) Mark Schwartz spent a decade refining the philosophies and practices of Internal Family Systems, stressing “the importance of working with the eating disordered part of self that encapsulates the trauma of the past.” The materials written for the public explained that, in contrast to other existing treatment facilities, Castlewood helped clients to heal the pain beneath their eating disorders “rather than just manage the symptoms.” They got in touch with their “parts” — the various inner beings known as Exiles, Managers, Firefighters, and other types.

When worlds collide

It seems unfair that even people who grow enough to accept and follow advice will still mess up so badly in choosing which advice to adopt. When taking action, it is also important to do the least possible harm. Listening to the wrong person and/or the lousy advice can be a problem at home, in group therapy, and basically whenever someone sets out to claim agency.

We could say that Kris had an inner advisor who advocated staying massively overweight for the sake of safety. And to all intents and purposes, it worked. But here is the problem. A “part,” be it manager, exile, firefighter, or whatever, could be mistaken in its opinion, and might be a wrong-headed advisor, just like a regular human. Real people and “parts” can all be mistaken, and so might people with degrees and headlines. And so might AI.

Important note: When a counselor helps a patient to identify the decent protective impulses that drive the parts called “firefighter” or “manager,” this is for identification purposes only, and does not imply endorsement or recommendation. To provide meaningful service, the professional really needs to have a handle on what’s what.

Today’s illustration features a slogan that has been seen, with creative variations, many times over the years, but to track and credit the original author would probably be impossible. Our most recent post asked if it is possible to facilitate the healing process without the participation of any actual second human.

And why not?

Well, why shouldn’t this be the case? It has already happened. Look, for instance, at books. They are made from common materials and from symbols that are very different from human speech or breath. Furthermore, vast numbers of humans have been and still are unable to read books — and yet the influence that books have exerted on humanity (for better or worse) is a true marvel.

Now, the real world connection, in-the-flesh, in the same space-time — how much of that is the minimum amount needed; the “necessary but not sufficient condition” that would be required to cause an effect? Is it the same in every case, and if not, then how do we tell the difference and decide how to proceed?

Okay, how about not very much?

One aspect of that psychological challenge has developed quite rapidly and noticeably into an overwhelming issue. Can excellent results be achieved with minimal human interaction, or even none at all? If the ability of AI to imitate high-quality connections could be perfected, then what? Well, first of all, forget all that, because it doesn’t meet the criterion of being human.

But what if AI works anyway? What if it learns to function incredibly well? Then, could human connectivity catch up and be similarly effective? Could human connection be adapted and re-conceptualized into something equally therapeutic?

Some people will always insist that AI is not human: end of story. Likely, there will always be others who insist that, of course, AI is drenched in humanity because people conceived and created it, and trained it on the works of thousands of unpaid creators, and so forth. Most likely, it is too soon to know.

Your responses and feedback are welcome!

Source: “The Therapy That Can Break You,” TheCut.com, 10/30/25
Image by Iffany/Pixabay

How Much Connection?

How often does it happen that a perfectly valid therapeutic approach fails, although there may be nothing wrong with that approach whatsoever? Maybe, for example, an outside force exerts a negative influence on the relationship between a therapist and the person being counseled. Among adults, an insecure partner, especially one who lives with the patient, can sabotage weight-loss efforts with ease.

In a far different setting, on the conceptual level, there may be difficulties, like those that can occur in the implementation of Internal Family Systems (IFS) theory. This modality is said to be designed for patients 18 and older, and may seem to have only a slight connection with childhood obesity — at the moment.

But if our current offspring emerge from their teens still carrying extra weight, the popularity of IFS guarantees that they will run into it sooner or later. It claims to be very successful in dealing with weight-control issues centering around either substance addiction (to food itself), or behavioral addiction (to the process of eating). IFS raises questions that may seem to stray far afield, but which provide glimpses into areas of human psychology that are quite different from jogging for miles, juggling calories, or judging portion sizes.

Human frailty never ends

In the Sixties, group therapy became popular and helped scads of people with various problems. There was a lot less obesity in those days, but for some folks, it was their main difficulty. For them, and many other types of help-seekers, there were side effects.

What if, during every group therapy session, a patient was fantasizing… “I’ll lose so much weight, and at our anniversary parties, I’ll tell the story of how we met because I couldn’t fit into my jeans, but my doctor fell in love with me. And he/she will playfully pinch my bottom, and all our friends will laugh and laugh…”

This is a tempting road to explore, because in the hearts and minds of most psychological counseling participants, to win the approbation of the therapist is golden. It is a powerful drive, and the possibility exists for a patient of any age or sexual orientation to develop very strong, situationally inappropriate feelings toward their therapist.

Another question

How heavy an effect does this need for approval, validation, and love exert in already-established obesity prevention programs? Everyone who enters therapy might not visualize an engagement ring, but plenty of us like to believe that we are the favorite patient, the one whose astonishing improvement makes it all worthwhile, not like those ordinary schlubs our therapist merely tolerates.

How does it tend to work out, for instance, in IFS, where the therapist has a chance to become acquainted with not just one aspect of the help-seeker, but with an entire cast of interior characters, each one of them whispering into the patient’s ear whenever they feel like it?

The future is now

All of this brings up a much bigger and potentially more dreadful problem that gains ground daily. Never mind being the favorite patient. Do we really, really need our psychological maladies to be addressed by a human intelligence or consciousness, at all? Or, for therapy to succeed, can a mere simulacrum do the trick? If we truly require a certain amount of human attachment in this context, how can the most useful amount of it, along with the correct amount of intellectual and emotional content, be achieved and maintained?

A human connection, whether through office visits or online counseling sessions, can affect a patient at any age, though with varying manifestations. In the case of weight-related problems, the relationship involves ideas and emotions about the body, and this additional dimension can be tricky.

What happens when human practitioners are replaced by chat robots and artificial intelligence? How has that method succeeded so far? In light of recent news reports about teenagers persuaded to commit suicide by human-imitating AI programs, the very existence of such an abomination is terrifying. (On the other hand, the issue becomes more complicated when, for instance, we learn that AI counseling may be of great help in preventing suicide among military veterans.)

Two views

Getting back to Internal Family Systems, here are two pertinent quotations from an article by Rachel Corbett, who conveys some of Richard Schwartz’s ideas about how the method that he originated (and developed at Castlewood Treatment Center) “is really the opposite of fragmenting people.” Corbett writes,

Clients come into treatment with their parts already intact — like a bulb of garlic, rather than the layers of an onion, he has said — “It’s not like I’m creating them.” Instead, IFS therapists work on “rounding up all those outlying parts and bringing them back home.”

Corbett views it all from another angle (and more about that is coming up next time). She cautions:

Most of Castlewood’s methods, starting with its use of IFS and the focus on trauma, contradict the prevailing playbook for treating eating disorders. Dredging up harrowing memories can overwhelm already fragile psyches and may lead to self-harm, substance abuse, or other unhealthy coping behaviors.

Your responses and feedback are welcome!

Source: “The Therapy That Can Break You,” The Cut, 10/30/25
Image by ThomasWolter/Pixabay

GLP-1 Medications Should Be Paired With Lifestyle Modifications

GLP-1–based therapies, popularized by medications like semaglutide and tirzepatide, are reshaping the way we think about obesity, metabolic health, and even chronic disease prevention. While these drugs first gained widespread attention for supporting significant weight loss, new research shows their influence reaches deep into multiple body systems.

At UC Davis Health, experts are taking a comprehensive look at how GLP-1 medications affect the entire body, from the gut and brain to the heart, muscles, and bones. Their findings point to a future where obesity treatment is not only more effective but also more holistic.

According to Miranda Stiewig-Rapp, assistant professor of endocrinology at UC Davis Health and incoming director of the system’s new Obesity Clinic (opening in 2026), GLP-1 agonists are redefining what’s possible in medical weight management.

Early clinical trials show average weight loss of 15-20%, compared to the 5-10% typically achieved with earlier generations of medication. And while these drugs offer powerful support, experts emphasize that pairing them with lifestyle changes creates the strongest outcomes.

The systemic impact of GLP-1 therapies

UC Davis Health recently brought together leading scientists, clinicians, researchers, and industry innovators to examine how GLP-1 drugs influence the body as a whole. Their findings reveal broad metabolic shifts that reinforce the importance of personalized nutrition, fitness, and long-term support.

The gut

GLP-1 slows gastric emptying, a mechanism that helps regulate blood sugar and prolong satiety. But it also influences the trillions of microbes that make up the gut microbiome.

These medications change how food moves through the digestive tract and alter fermentation patterns — shifts that can reshape the microbiome itself. A healthier microbiome can improve insulin sensitivity and support the metabolic benefits of GLP-1 therapies.

However, gastrointestinal side effects such as nausea, vomiting, or diarrhea remain common as the body adjusts. Supporting gut health with probiotics, fiber, and nutrient-dense meals can help minimize discomfort.

The brain

GLP-1 signals travel to the brain through the bloodstream and vagus nerve, reducing hunger and quieting the persistent “food noise” many patients describe.

Emerging research suggests that GLP-1 therapies may also influence reward pathways, potentially affecting cravings for sweets, fatty foods, and even substances like nicotine or alcohol. With appetite and reward signaling both shifting, many patients find it easier to adopt healthier eating patterns.

The muscles

While GLP-1 medications promote fat loss, rapid weight reduction may also lead to a loss of lean mass. Experts note that 15-25% of weight lost during calorie reduction — whether through medication or diet — can be lean mass.

Maintaining physical activity and prioritizing high-quality protein are essential for preserving muscle and keeping metabolism strong. Resistance training and structured exercise plans remain important companions to GLP-1 therapy.

The bones

Bone is metabolically active and responds to hormonal shifts, including those influenced by GLP-1. Rapid weight loss, reduced food intake, and nutrient gaps can place extra stress on bone density, especially in older adults and postmenopausal women. A balanced diet rich in calcium, vitamin D, magnesium, and protein, along with weight-bearing exercise, helps protect bone strength during GLP-1 therapy.

The heart

Beyond blood sugar control and weight loss, GLP-1 receptor agonists offer significant cardiovascular protection. Clinical trials show they reduce the risk of major heart events such as heart attack and stroke. Multi-agonist medications that combine GLP-1 with GIP or glucagon may enhance these heart benefits even further by improving fat metabolism and reducing inflammation.

Nutrition matters more than ever

Because GLP-1 medications suppress appetite, patients often eat less, which can make it harder to get the nutrients the body needs. Precision nutrition approaches can help close these gaps. The recommendations include choosing smaller, nutrient-dense meals; prioritizing high-quality protein; taking vitamins like B12, D, folate, magnesium, and iron; staying hydrated; and supporting gut health with probiotics and fiber.

Behavioral insights and BrainWeighve

At the 2025 conference on Obesity and Chronic Diseases (ICOCD) in Boston in November, Dr. Robert Pretlow, publisher of Childhood Obesity News, presented emerging insights into how GLP-1 medications interact with behavior, reward, and lifestyle habits. Dr. Pretlow’s core message was clear: GLP-1 medications work best when paired with lifestyle modification.

Dr. Pretlow is the creator of BrainWeighve, a weight loss app for overweight and obese children. In breaking news, Dr. Pretlow announced that the BrainWeighve clinical trial at U.C.L.A. has expanded to include 10 subjects currently taking GLP-1 medications. This addition aims to help researchers understand how lifestyle and behavioral tools can enhance — or possibly even reduce — the need for medication over time.

How GLP-1s affect the reward system

The mechanism of action for GLP-1 agonists is believed to involve the inhibition of reward cues, which may reduce cravings and compulsive eating behaviors. This could help “quiet” displacement mechanisms — behaviors people use to soothe emotional or psychological discomfort through food.

But a key question remains: What happens if displacement is never addressed?

According to Dr. Pretlow, pairing displacement interventions with GLP-1 therapy may allow patients to use lower doses of medication, support tapering off GLP-1s over time, help non-responders gain better results, and provide long-term tools for managing eating addiction and emotional hunger.

These early findings suggest that displacement activities — redirecting urges into harmless or productive behaviors — may offer meaningful support to individuals struggling with overeating.

The BrainWeighve study

These concepts are at the heart of BrainWeighve, a behavior modification and weight loss app currently in clinical trials at UCLA. The program is designed for obese teens and uses a self-directed, physician-supervised approach to tackle overeating one “problem food” at a time.

By helping participants rechannel emotional urges into healthier coping mechanisms, BrainWeighve aims to support sustainable weight loss — and reduce dependence on willpower alone.

As Dr. Pretlow summarized in his presentation:

Displacement activity may provide individuals with hope that they can curb overeating without relying entirely on medication or willpower.

Your responses and feedback are welcome!

Source: “UC Davis Health examines systemic impact of GLP-1–based therapies,” UC Davis Health, 12/5/2025
Source: “Treatment of Eating Addiction and Obesity As Displacement Activity: A Pilot Study,” ICOCD presentation, 11/7/25
Image by Dr. Pretlow

Listening to Internal Advice

It is worth mentioning here that many people, even in the healing professions, tend to discount emotional pain, as if it were a mere inconvenience or even a whim that someone can simply choose to shrug off. There seems to be a “Just say no to emotional pain” school of thought that tends not to work out well in everyday life. Really, the only people who “get” how crippling emotional pain can be are those whose lives are impoverished by it.

This might be why some practitioners obviously see great value in a basic Internal Family Systems concept, which is:

[D]isordered eating behaviors are not the problem themselves but rather attempts by protective parts to manage deeper emotional pain.

The internal beings called “parts” are also sometimes known as sub-personalities, thoughts, ideas, internal dialogue, feelings, sensations, symptoms, behaviors, defense mechanisms, maladaptive coping strategies, or even spirits.

The crowd

Among the inner multitude, one category of respondent, known as a “manager,” wants to protect the host and might be interested in setting up some rules. Also, those might be counterproductive rules that will wind up creating even more pain in the end. A manager sees a problem and proposes a solution, and strives to make something happen, even if it isn’t the optimal thing. Still, the managerial parts probably tend to have more common sense than those even more proactive parts that leap into the fray — known as “firefighters.”

Firefighters operate under a different set of criteria. They suit up, grab high-pressure hoses, mount ladders, and rush in to try and save the day. Their mission is to stop the immediate threat of psychic violence and destruction, even if it entails physical violence and destruction. Their priority is to end the inner pain, right now. The impulsive firefighters can be like enthusiastic amateurs who mean well, but do a sloppy job. If the only way forward is to tear down the museum-quality ancestral drapes to smother the fire with, a reactive guardian will do it.

Or that over-amped protector might pull some stunt like a spending spree, an unwise date, self-harm, violence, or even suicide. More likely, to terminate the current discomfort, this misguided volunteer might send the person on an eating binge. Sure, that is a variety of self-harm, but it smothers the present, in-your-face pain.

Thanks a lot

A binge is harmful enough, but there are, in fact, other shades and nuances of damage that must be written off as the inevitable consequence of avoiding immediate pain. Conversely, but for the same purpose of escaping today’s pain, tomorrow’s opportunity to heal might be put at risk by purging. If things continue badly, the firefighter’s next suggestion might be to exercise compulsively, or to try some nice numbing opiate.

Of course, all of this activity, however misguided or futile, takes place to protect the Exiles, the “parts” who are like ossified copies of the person at crucial stages when shattering life events took place. They broke off and live like hungry ghosts, unable to reconcile the horrible experiences they went through with a desire to keep on living, and yet unable to give up life as long as the tough old meat body is still hanging in there.

So, why not punish that animated corpse in some way, like the way that is so easily available in almost every society on Earth these days — by piling on the bulk until life becomes undesirable, and is sustainable only at a very high cost in daily pain?

Your responses and feedback are welcome!

Source: “Internal Family Systems and Eating Disorders: A Compassionate Approach to Recovery,” BalancedAwakening.com, undated
Source: “The IFS Model With Eating Disorders: ED is Just a Part of You,” EatingDisorderHope.com, undated
Image by cottonbro studio/Pexels

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Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.