Oprah and the Price of Success

What if, every time you went to the kitchen for a snack, your phone blew up with a few thousand condemnatory messages? By the early 2020s, Oprah Winfrey was accustomed to the extraordinary fact that every ounce of her body had its own crew of both admirers and detractors. Late in 2023, OprahDaily.com articulated the goal of its online presence:

— To bust medical myths and legitimize obesity as a chronic disease that requires intervention like any other condition, rather than a failure of willpower
— To discuss the safety and efficacy of the new weight loss drugs, such as Ozempic, Wegovy, and Mounjaro
— To help surface and bridge the inequities and prejudices and remove shame and stigma of living in a larger body.

The website also states that the show aimed “to mainstream the science and psychology” pertinent to the obesity epidemic and to give its diverse and unique audience “all the tools they need to manage their own medical care and mental health.”

Oprah talked about how rough it was to recover from knee surgery while at the same time inevitably gaining pounds, meanwhile still believing the whole enterprise of weight loss depended on her ability to summon willpower. When she heard about the GLP-1 medications, her gut feeling changed and she expressed the determination to try something new, saying,

Whatever your choice is for your body and your weight health, it should be yours to own and not to be shamed about it. I’m just sick of it, and I hope this conversation begins the un-shaming of it.

The world held some solace for her body issues, of course. Unlike most of the population, she could afford to hire custom clothing designers with a genius for draping the generous figure gorgeously. Still, it must be difficult to become comfortable with the knowledge that every time you step up on stage or out in public, millions of eyes are out there ready to judge you, inch by inch. That stuff can mess with your head.

The revolution

Early in 2024 when Oprah announced the end of her association with WeightWatchers, some fans and some chronic critics were upset. People can be very judgmental about the kinds of non-essential drugs they approve of for other people, regardless of whatever pharmaceutical help they themselves may depend on. The GLP-1 products are a sterling example of that impulse. When Oprah revealed that she used that particular remedy, some folks were outraged and others were sorrowfully disappointed — just like when any celebrity turns up in a certain genre of “the news” for any reason.

When Oprah made a decision about how to resolve her lifelong struggle with obesity, fans were already upset because she had discovered something better for her needs, and she was excoriated for realizing what was best for her. It was an honest revelation: “I can’t accept myself if I’m over 200 pounds, because it’s too much work on my heart. It causes high blood pressure for me. It puts me at risk for diabetes…”

That isn’t fat hate, but a simple realization by someone who simply wanted to stay alive and continue to contribute to society by entertaining and educating the public and engaging in philanthropy. By generously sharing her own life experiences, the poor woman became guilty of upholding the standard of the fat-phobic imperative, to be harshly judged by people who were gleeful about what they like to call flip-flopping.

The New York Times described Winfrey as someone who “has spent decades as a dominant figure in the country’s conversations about weight and dieting,” which is one way of saying that perhaps the public should leave the beleaguered woman alone already, and go pick on somebody else.

Your responses and feedback are welcome!

Source: “Oprah Discusses Weight Loss, Obesity, and Ozempic in Her Most Candid Conversation Yet”, OprahDaily.com, 09/20/23
Source: “What Oprah Winfrey said about drugs used for weight loss like Ozempic, Mounjaro,” 09/21/23
Source: “Oprah to Leave Weight Watchers Board,” nytimes.com, 02/29/24
Image by U.S. Govt./Public Domain

The Psychological and Social Complexities of GLP-1 Drugs

The last couple of weeks have been eventful in the realm of the ever popular GLP-1 meds, from positive news of yet another benefit to taking them (like lowering heart-related risks) to the sobering warning of a new, negative side effect on health, plus some substantial insurance coverage changes. Let’s take a look.

As has been established, GLP-1 receptor agonists (like semaglutide and liraglutide) and GLP-1/GIP combinations (like tirzepatide) help with weight loss by mimicking hormones that suppress appetite, slow digestion, and promote satiety. When paired with lifestyle changes, they can reduce body weight by 10%–20% over 9–15 months and improve cardiometabolic health. However, side effects like nausea, constipation, and loss of lean muscle mass are common and can prompt many to stop using the medication.

Psychological benefits and challenges

These medications can quiet obsessive food thoughts (“food noise”), reduce shame around eating, and give users a sense of mastery. However, they may also cause emotional side effects. Some users report a flattening of emotions or loss of pleasure in everyday experiences — possibly due to changes in the brain’s dopamine system. Studies show mixed results on whether GLP-1s increase depression or suicidal thoughts, with some linking them to mood issues and others finding mild improvements in depressive symptoms.

Psychologists are becoming essential in supporting GLP-1 patients by helping them adjust emotionally, manage disordered eating, and handle social stigma. Patients often face conflicting societal pressures — praised for losing weight, yet judged for using medication to do so. Therapy helps them navigate shifting body image, relationship dynamics, and grief over old habits or coping mechanisms (like using food for comfort).

Social and cultural complexities

The widespread use of GLP-1s brings up deeper issues around weight stigma, societal bias, and access. Some experts worry these drugs reinforce the idea that larger bodies are a problem to fix, potentially marginalizing people who are fat-positive or not interested in weight loss. Access is another concern: those with lower income or from marginalized communities may be less likely to afford or continue treatment.

Meanwhile, doctors may prescribe these drugs based on appearance, not medical need, and patients with eating disorders can misuse them. The rise of telehealth and loosely regulated medical spas also makes GLP-1s more accessible, sometimes in unsafe ways.

Role of psychology in GLP-1 use

Psychologists support patients by helping them:

• Develop sustainable, healthy relationships with food
• Prevent muscle loss through proper nutrition and exercise
• Strengthen body image and emotional resilience
• Navigate relationship changes and shifts in identity
• Cope with past trauma that may resurface with physical transformation

Some also use trauma-informed therapies like EMDR (Eye Movement Desensitization and Reprocessing) to help patients who used food to cope with abuse or fear the attention that comes with weight loss.

GLP-1s and addiction treatment

Emerging research suggests GLP-1s may help curb addictive behaviors, such as excessive alcohol use. A 2025 trial showed semaglutide reduced heavy drinking days and cravings in people with alcohol use disorder. The effect appears similar to how GLP-1s suppress appetite — by dulling the brain’s reward signals. More research is needed before these drugs are FDA-approved for addiction, but psychologists are encouraged to stay informed as more patients may use GLP-1s for this purpose.

GLP-1 medications offer significant promise for those struggling with obesity, providing both physical and emotional relief. But they also come with complex psychological and societal implications. Experts agree: The success of these drugs isn’t just medical — it’s behavioral. Psychologists play a vital role in helping patients navigate the inner changes that accompany dramatic outer transformations.

Alleviating migraines, but it’s a pancreatic risk

It’s been reported that in a small study, a GLP-1 drug shrank the number of days people spent with a migraine by almost half in a given month. However, the GLP-1 receptor agonists are under investigation by U.K. health authorities due to reports of serious pancreatic side effects, including nearly 400 cases of acute pancreatitis and up to 10 deaths.

The U.K.’s Medicines and Healthcare products Regulatory Agency (MHRA) and Genomics England are examining whether genetic factors may predispose certain individuals to these rare but serious complications. Tirzepatide-based drugs like Mounjaro and Zepbound appear to be more frequently linked to these reports.

While no direct causal link has been established, the investigation seeks to better understand who might be at greater risk. U.K. residents over 18 who experience severe reactions are encouraged to report them through the Yellow Card system and may be invited to submit further details and a saliva sample for research.

Experts stress that GLP-1 drugs remain approved and generally safe when prescribed and monitored by a doctor, but warn against obtaining them through unofficial channels.

CVS Caremark drops Zepbound from coverage, citing cost

Starting this week, CVS Caremark, one of the largest U.S. pharmacy benefit managers, will stop covering Eli Lilly’s Zepbound, a GLP-1 drug approved for chronic weight management, on its most common formulary, affecting 25–30 million Americans. Wegovy, a competing drug from Novo Nordisk, will remain covered, alongside a few less effective alternatives.

CVS says this move is designed to drive down costs by forcing drugmakers to compete, citing the high prices of GLP-1s as a major barrier to access. However, pharmacy benefit managers (PBMs) like CVS have been criticized for their role in rising drug prices.

Doctors and patient advocates argue that GLP-1s aren’t interchangeable, and abrupt coverage changes can disrupt patient care. Side effects, tolerability, and individual response vary, and switching medications mid-treatment can stall progress or worsen health outcomes.

Critics also say this move reflects a broader misunderstanding of obesity as a chronic disease, noting that insurance policies don’t treat obesity care with the same consistency or respect as other chronic conditions.

Providers report being overwhelmed with patient concerns and spending excessive time navigating insurance rules instead of delivering care. Another upcoming policy change: BCBS Massachusetts will stop covering GLP-1s for obesity in 2026, unless prescribed for diabetes.

In response, Eli Lilly is expanding access via its LillyDirect program, offering Zepbound for $499/month out-of-pocket. Still, many worry such policies will create greater inequality and care disruption for people managing obesity.

Your responses and feedback are welcome!

Source: “A new era of weight loss: Mental health effects of GLP-1 drugs,” APA, 7/1/25
Source: “Pill form of popular weight-loss drug lowers heart risks,” Harvard Health Publishing, 7/1/25
Source: “Popular weight-loss drugs show promising new power against debilitating migraines,” Fox News, 7/2/25
Source: “New Weight-Loss Drugs Under Scrutiny Amid Pancreas Concerns,” Science Alert, 7/3/25
Source: “Major insurance changes are coming to GLP-1 drugs for weight loss. Here’s how that could affect patients,” CNN, 7/1/25
Image by Leeloo The First/Pexels

Oprah and the Costs of Fame

In such a full and varied life as the one created for herself by Oprah Winfrey, there is a lot of sameness and also plenty of change. Against a backdrop of ongoing novelty, the media star worked hard to keep the content of her various productions fresh, relevant, and compelling. In 1998, Donald Trump was a guest on her show, where he hinted at perhaps having presidential ambitions.

The following year, Trump told the Larry King Live audience that if he ran for president, his VP pick would be Oprah, whom he described as great, terrific, special, fantastic, brilliant, wonderful, and exceptional (although perhaps not for the identical reasons that cultivate those adjectives from her fans). In social media posts, he quoted some of her original inspirational mottos.

In 2012, he announced “I adore Oprah,” and in a 2013 social media post, praised her for encouraging Lance Armstrong to say things on air that would “totally destroy his life.” The next year, Trump’s family was on Oprah’s show, not for the first time.

People who produce TV and people who like to be on TV really need each other, and all of show business is built on complicated relationships based on popularity, statistics, and many other factors. Status can fluctuate, influence can be resisted, and a lot of things can happen, especially when someone is a supremely multitalented woman who might even “beat herself up” to the extent of thinking, “Yeah, but I’m just basically famous for being fat.” It would not be unusual if such a thought crossed Oprah Winfrey’s mind. It’s all part of the struggle.

The weather changed, and a few years later, having been elected president without Oprah’s endorsement, Trump publicly described her as an asker of biased and slanted questions and a presenter of incorrect facts. Apparently she had said a few things that could be taken as roundabout criticisms. A poll said that if the presidential race was between the two of them, she would win. Before long, these two worldwide famous people had other disagreements as well, and Oprah urged voters to support the U.S. Constitution and the Democratic presidential candidate.

Celebrities everywhere

Around the same time, Oprah also talked with celebrities about weight issues. Actor Kirstie Alley, a veteran of a 30-year acting career, described herself as a food addict who had always been told that 135 pounds translated onscreen as “too fat.” She confided to Oprah and the audience, “I’ve hated myself. You beat yourself up.” Millions of the show’s viewers felt exactly the same — as did the show host.

Some time in 2022, Oprah showed the world a video in which she threw away a cake, symbolizing how she intended to “reset” her diet for the year. Apparently some viewers took that image as an admission that she hated all the overweight people in the world. This was read as her being a major contributor to “diet culture,” for which she was grudgingly forgiven a couple of years later.

Earthquake

Who can forget the huge controversy that ensued when Oprah quit WeightWatchers? The year 2017 had been a good year for both of them, with the program experiencing revenue growth, and her losing 42 pounds. Oprah was admired for her courage in admitting her problem and publicly working on it. But all along, there had been unease among some fans who felt put down or even betrayed. By literally buying into the company — she owned a lot of shares — it was almost as if their hero had become one of the oppressive fat-shamers making a profit from their misery. Some fans were never able to keep the different factors separate.

The situation became complicated when Oprah discovered the new weight-loss drugs and resigned from the WW shareholders board, and the organization reformed itself around a subscription telehealth platform through which members could be prescribed GLP-1 drugs, and things got crazy all over again and a lot of people had strong negative feelings about Oprah, even if they were not quite sure why.

Your responses and feedback are welcome!

Source: “Trump once said Oprah should be his VP,” YouTube.com, undated
Source: “The Long History Between Donald Trump and Oprah Winfrey,” Fortune.com, 02/19/18
Source: “Oprah to Leave Weight Watchers Board,” NYTimes.com, 02/29/24
Image by Pat Hartman

Oprah’s Ultimate Payback — Good for Bad

A 2017 article described Oprah’s concern for how girls born into poverty could be helped to achieve better lives for themselves and their families. It seems reasonable to assume that her own struggles contributed to forming her compassionate mindset.

She worked so hard to create a career and a presence in the world, it would have been only fair to assume that life would be smooth sailing from then on. But no. For decades, the weight issue hung around her neck like an albatross, causing her to be disrespected and even ridiculed. It is totally understandable that her ambition would be to help girls and young women chart their paths into lives that would bring them wisdom, success, and peace of mind.

Wouldn’t it be wonderful if adults could just dish out excellent advice and the young would unhesitatingly assimilate it? But to pass along wisdom is not that simple or easy. As Oprah said,

Every person has their own big questions that no one else can answer. One lesson I learned from all my years of interviewing is that the key to getting the answers you need lies in asking the right questions.

And nowhere is this more true than when a person questions herself! Some of the crucial queries are, “What makes you, you?” And, “Why does your presence on earth right here, right now, so truly matter?” Consequently, this leader created an institution where girls in grades 8 through 12 are given, along with a first-rate academic education, the opportunity to learn skills that will help them, their families, and their entire society — the Oprah Winfrey Leadership Academy for Girls.

Changing the world

In 2002, it started with a dream that materialized into a 52-acre campus in South Africa that includes 21 classrooms, a 600-seat theater, a 10,000-volume library, six laboratories, and very livable dorms whose design and fittings were supervised by the benefactor herself.

Each year, more than 6,000 hopeful candidates vie for the 60 places — meaning that only 1% of the applicants can be accepted. Oprah describes the student body as made up of individuals who possess resilience, courage, spirit, tenacity, charisma, and intelligence. OWLAG opened in 2007, and on the 10th anniversary, Malina Saval reported on it for Variety.com.

Up to that point, Oprah had invested $140 million in the school and its students. Saval wrote, “She pays for every sock, every uniform, every set of braces… When she visits, she spends at least a week on campus, conducting fireside chats with each student and teaching what she calls her Life Lessons 101 course. She is like a mother to these girls…”

The founder told the reporter, “When most girls come to my school they have suffered six major traumas on average… There was a time at the school during 2007, 2008, 2009, when we were losing a parent a week.” The reporter added, “Those same girls now attend top-tier universities… They’ve pursued post-doctorate degrees and secured prestigious jobs in major cities around the world.”

Rather than (like so many wealthy and successful people) turn her back and say, “I got mine, you go get yours,” Oprah Winfrey took her life experience, disappointments, aspirations, and ambitions as raw material and converted them into a powerful force for good. One final quotation from “Mom O”:

What poverty does is brainwashes you to believe that you are not enough. So what our school does is work at creating a foundation of worthiness. It’s a patriarchal environment, where they come from. Just being a girl makes you “less than.” I stand before them and tell them there is no bar, there is no ceiling. We’re not just going to crack the ceiling; it doesn’t exist.

Your responses and feedback are welcome!

Source: “What Oprah Knows for Sure About Life’s Big Questions,” Oprah.com, 12/12/17
Source: “Oprah Winfrey Leadership Academy for Girls,” OprahFoundation.org, undated
Source: “Oprah Winfrey’s Leadership Academy for Girls Marks 10 Years,” Variety.com, 08/03/17
Image by U.S. Embassy South Africa/Public Domain

New Monthly Obesity Injection Shows Promise

In a significant development for obesity treatment, a new once-a-month injection has shown impressive results in a clinical trial, helping participants lose up to 16% of their body weight (and even more under ideal conditions). The drug, maridebart cafraglutide (also called MariTide or AMG133), may reshape how obesity is managed, particularly for people seeking long-term, effective solutions without the hassle of weekly injections.

This breakthrough comes from a Phase 2 randomized controlled trial published in The New England Journal of Medicine. Conducted on nearly 600 adults with obesity — with or without type 2 diabetes — the study explored both the efficacy and safety of this long-acting peptide–antibody conjugate. Here’s what the results reveal, and why experts are paying attention.

Why this matters

Obesity is more than just a number on a scale — it’s a chronic metabolic condition that raises the risk for diseases such as type 2 diabetes, heart disease, and stroke. And it’s getting worse. According to the World Health Organization, as of 2022, 890 million adults and 160 million children worldwide were living with obesity.

Despite the availability of promising medications like semaglutide (Wegovy) and tirzepatide (Zepbound), there are still major challenges: frequent dosing schedules and issues with adherence. Many people struggle to stick with weekly injection regimens, and dropout rates are high.

That’s why maridebart cafraglutide is drawing attention. With dosing just once every four to eight weeks, this new drug could improve patient compliance and produce stronger long-term results.

The science behind maridebart cafraglutide

So, what is maridebart cafraglutide, exactly? It’s a dual-action molecule: A GLP-1 receptor agonist, which promotes satiety and lowers blood sugar, and a GIP receptor antagonist, which counteracts the hormone GIP (glucose-dependent insulinotropic polypeptide) believed to contribute to weight gain in certain contexts.

This dual mechanism is key. While some drugs activate the GIP receptor (like tirzepatide), others, like maridebart, block it. Both approaches, when combined with GLP-1 agonism, appear to support weight loss. It’s a surprising paradox and an area of ongoing research.

Maridebart’s extended half-life of 21 days — nearly triple that of the longest-acting once-weekly drugs — makes monthly or even bi-monthly administration possible. The innovation lies in how the peptides are bound to a monoclonal antibody, giving the drug its staying power.

The clinical trial’s design and participants

The Phase 2 trial included 592 adults, divided into 465 participants with obesity only and 127 participants with obesity and type 2 diabetes. Participants received injections every four or eight weeks, with varying doses. Some groups used dose escalation to minimize side effects.

After 52 weeks of treatment, researchers evaluated: body weight changes, blood sugar levels, body composition (fat vs. lean mass), and adverse events and side effects.

Substantial weight loss followed

Here’s what the study found after one year:

For participants without diabetes:

  • 3% to 16.2% weight loss in the treatment group (based on real-world conditions).
  • Up to 19.9% weight loss in the ideal-case (efficacy) analysis.
  • Placebo group lost only 2.5%.

 

For participants with diabetes:

  • 4% to 12.3% weight loss in the treatment group.
  • Up to 17.0% in the efficacy analysis.
  • Placebo group lost just 1.7%.

 

Notably, around half of the participants reached at least 15% total weight loss, a clinical benchmark known to drastically improve health. Under ideal trial conditions, 75% achieved that milestone.

Maridebart cafraglutide didn’t just help with weight — it also improved blood sugar control, particularly in participants with type 2 diabetes, and a fat (vs. lean mass) reduction of 36.8%.

Safety and side effects

While the trial showed promising results, it also raised some safety considerations. Gastrointestinal side effects were the most common, including nausea, vomiting, constipation, retching, and diarrhea. These symptoms were more frequent in participants who skipped dose escalation or started on higher doses.

Serious adverse events were rare.  Gallbladder issues were slightly more common in the treatment group than in the placebo group. Importantly, no unexpected safety signals emerged during the trial. Side effects were generally manageable and transient.

Why dose escalation matters

Gradual dose escalation and a lower starting dose greatly improved tolerability. This has influenced the design of the ongoing Phase 3 trial, where all groups are now using a more careful ramp-up strategy.

With up to 20% weight loss, improvements in metabolic markers, and a safety profile comparable to other GLP-1-based drugs, this monthly injection could change the game, especially for those who struggle with weekly dosing. As the Phase 3 trial progresses, the medical community is watching closely. If results hold, maridebart cafraglutide could soon be a powerful new tool in the global fight against obesity.

Your responses and feedback are welcome!

Source: “Once-Monthly Maridebart Cafraglutide for the Treatment of Obesity — A Phase 2 Trial,” The New England Journal of Medicine, 6/23/25
Source: “Once-monthly obesity injection shows double-digit weight loss in major clinical trial,” News Medical, 6/24/25
Image by Anna Tarazevich/Pexels

The Privilege to Give

Most of us who are not doctors or professors do not keep up with the medical journals. But we are all familiar with the previous decades’ level of obesity awareness, because it has been extensively (some would say oppressively) personified in — tah-dah! Oprah Winfrey.

Make a movie about the atomic bomb, and call it Oppenheimer. Make a movie about the never-ending struggle against body fat, and call it… Oh, never mind, let’s get serious. As Oprah has said,

I’ve been on this journey for most of my life… I don’t know if there is another public person whose weight struggle has been exploited as much as mine over the years.

Oprah has talked about a 1990 incident proving there are some human frailties from which wealth and fame cannot shield a person. It was the sort of humiliating misconception that could happen in anyone’s mind, no matter what their scale of living. On the cover of TV Guide magazine, there was a picture of her with the text, “Best and Worst-Dressed List.”

In a regular person’s life, it could have been a neighborhood news-sheet. In either case, the surprise was pleasant for only a second, until Oprah realized she had not been chosen as best-dressed. Instead, she had been picked to represent being a terrible example: “bumpy, lumpy and downright dumpy.” How many dollars would compensate for that embarrassment?

No such thing as bad publicity

The life of a star has a lot of downsides. An aspiring professional entertainer gets used to attracting disrespectful comments from segments of the public. It just comes with the territory. To be publicly recognizable is no asset to most people who value their mental health. But there is a tremendous upside.

Not everyone out there is paying attention to you for harmful reasons (especially if you are as charismatic as Oprah!). Exposure is the price of attention, and attention can be a very positive factor, because when the admiring fans hear about what you are doing, at least a percentage of them will do it too. So a wealthy, famous person is not only able to contribute financial support to a favorite cause, but is also able to inspire others. If the beloved entertainer can donate millions, even if that is only a fraction of their income, the ordinary person feels more like “What the heck, I’ll kick in one-tenth of a percent of my income, too.”

Oprah Winfrey’s influence has been vast because people believe and trust her, and sense the importance she places on retaining a genuine self, amidst the glitter and acclaim. Her rough childhood counted, too. Oprah had enough experience with the serious problems of life to want to help other people who face frightening challenges.

An Oprah-approved institution

We mentioned Shades of Hope Treatment Center, where in 2011, Oprah produced the reality TV show “Addicted to Food,” which followed eight people through the program. Oprah had been familiar with the facility for years.

Since the fall of 2003, singer Wynonna Judd had been confiding in her, in front of the cameras, about her severe food dependency. Like the ordinary citizens who were later featured on Oprah’s network show, Judd checked into the residential treatment center.

When the songstress was later interviewed by Larry King, she described her problem:

It was consuming a lot of my life… I mean food to me is what alcohol is to the alcoholic… You know the business. One minute you’re number one. The next minute you’re number zero. And I had just been using food for every emotion I had. If I was joyful, we’d go out to eat… [I]t became too much, so I did something about it.

People are not born knowing how to fix themselves, but there certainly are learnable skills that can lead strongly toward wellness. In many cases, this happens for many reasons and in many ways. This is why we need such institutions, as well as the current technology that fosters sophisticated levels of self-help.

Oprah’s charitable contributions, even when they have nothing to do with obesity, all aim to help build people better lives. We will next take a look at another of her projects which, while not directly connected to obesity, is aimed at helping young women build lives so satisfactory that they automatically preclude a lot of the self-destructive psychological pain that brings on addictive behaviors or even just carelessness, either one of which is capable of leading to medically significant obesity.

[Note: The photo is a wax figure.]

Your responses and feedback are welcome!

Source: “Oprah Reveals The Secret Behind Her Recent Weight Loss,” Essence.com, 12/08/23
Source: “Change is here. Hope is here.,” ShadesOfHope.com, undated
Image by Petr Kratochvil/License: CC0 Public Domain

Oprah’s Perennial Appeal

Oprah Winfrey is a certain kind of icon. She is absolutely not just another self-destructive doomed genius; never was and never will be a psychological basket case like Amy Winehouse, for instance. Oprah is brilliantly intelligent, and glamorous, capable of being a force of nature when necessary, and clearly a natural-born leader. But none of that could have happened without her relatability.

The reason people follow her is neither that she is so glitteringly different, nor that she is so very typical, although both are true. Her existence and accomplishments have led her to become a sort of template. At one point, during a panel discussion on “The State of Weight,” Oprah confirmed that her highest number had been 237 pounds, and added, “I’m Oprah Winfrey, and I know all that comes with that, but I get treated differently if I’m 200-plus pounds versus under 200 pounds.”

In other words, despite being wealthy and famous, she could still totally connect with the millions of women who feel that more body fat makes them “less than,” which had become the enlightened way to say “inferior.” Sitting for a magazine profile, she told a journalist,

I don’t know if there is another public person whose weight struggle has been exploited as much as mine over the years… This is a world that has shamed people for being overweight forever, and all of us who have lived it know that people treat you differently, they just do.

This talking point shone a light on the psychological double-bind that imprisons women regardless of their situations in life. The ambient culture brainwashes us every day into believing that carrying extra pounds is unacceptable and probably even immoral. That cruel mindset leads women into feeling scorn, rather than compassion — not only toward other women — but toward themselves. Just to put the icing on the cake, so to speak, we are supposed to go whole-hog with that belief, and are expected to condemn our sisters for being in the same physical condition that we fear and dread — if we are not in it already.

Through keeping an eye on Oprah, we follow every important twist and turn of the obesity issue in the fin de siècle period, and in the early years of our present century. As surely as Willie Nelson is Country & Western, Oprah Winfrey is Obesity Awareness.

History

Our take on the saga began with “Oprah Through the Years, Part 1” and so far has progressed through Part 21, and this conscientiously thorough coverage practically guarantees that there is something in it for everybody.

Then, the Childhood Obesity News blog gave Ms. Winfrey a well-earned break for a while, pausing an overview of her career about 10 years into the present century. In 2011, she produced a TV reality show called “Addicted to Food.” The venue was the Shades of Hope Treatment Center, a place to exorcise pain from the hearts of people who grew up in families characterized by dysfunction and/or abuse and/or addiction.

The program relied on numbers less than some others have done. Clients’ weights could be usefully recorded for the sake of the science, but did not have to be shared. One of the most audacious features of this program was the no-entertainment standard, which precluded both printed and televised media. You’re there to feel things, as a route to fixing yourself — so no hiding out in any media la-la land. (It does seem like this principle could usefully be emphasized, in programs everywhere, a lot more than it is currently.)

Here is a typical Shades of Hope quotation:

Your body, mind, and soul were designed to heal. Because we are holistic beings, all of these aspects of ourselves come into play when we heal — no matter what you’ve been through or are going through right now.

Next time, we pick up with Oprah again. Meanwhile, it is worth mentioning what might be called a universal truth. When it comes to kicking a habit, one factor carries over into many different therapeutic approaches: Their most outstanding and characteristic feature is the emphasis on keeping the commitment every second of every minute of every day.

Some people just are not cut out for that. Recovery is a long-term condition if ever there was one, and the better at it you are, the more chance you have of living long enough to develop real expertise. People can be quite adaptive when they want to be, which is why a tool like BrainWeighve, for an excellent example, can be surprisingly useful.

Your responses and feedback are welcome!

Source: “Oprah Reveals The Secret Behind Her Recent Weight Loss,” Essence.com, 12/08/23
Source: “Change is here. Hope is here.,” ShadesOfHope.com, undated
Image by vargas2040 cropped by Machocarioca/Attribution-Share Alike 2.0 Generic

David Kessler on the Science of Weight Loss

In his book Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight, former FDA Commissioner Dr. David A. Kessler presents an in-depth look at the science of weight loss and the forces that have fueled the obesity crisis in America. Deborah Vankin takes a look at the book for the Los Angeles Times and interviews Dr. Kessler.

“Ultraformulated” products, intentionally engineered

According to Vankin, Dr. Kessler argues that today’s food industry has deliberately crafted what he calls “ultraformulated” products — foods that are heavily processed, packed with calories, fast-digesting, and designed to be nearly impossible to resist. This strategic engineering by food manufacturers, he contends, has contributed to skyrocketing obesity rates. According to Dr. Kessler, 41.9% of U.S. adults are currently affected by obesity, and by 2030, that number could reach nearly half the population.

Dr. Kessler describes this as a “health catastrophe” that’s unfolding on a massive scale. The accumulation of visceral fat (fat that wraps around internal organs) has been linked to a wide array of serious health problems, including Type 2 diabetes, heart disease, hypertension, arthritis, dementia, stroke, and several types of cancer.

While GLP-1 medications like Wegovy and Zepbound have emerged as popular tools to reduce weight and food cravings, Dr. Kessler warns that they aren’t a silver bullet. These drugs come with their own risks, and there’s still much we don’t know about their long-term effects.

It’s personal for Dr. David Kessler

Dr. Kessler’s perspective is shaped by personal experience. Having struggled with compulsive eating since childhood, he knows firsthand how addictive certain foods can be, especially during his college and medical school years, when he relied on comfort foods as rewards. He has also faced challenges with the side effects of GLP-1 drugs. To truly address the obesity epidemic, he believes society must reframe how we understand addiction, moving away from a stigma-based model and recognizing how engineered foods help hijack the brain’s decision-making processes.

The interview takeaways

Dr. Kessler emphasizes that obesity should be treated as a long-term, chronic condition. In his conversation with the LA Times, he explores sustainable strategies for weight loss, how to approach GLP-1 use responsibly, the importance of body positivity, and ways to improve both health and longevity. Here’s a summary of the key points.

The root of the obesity crisis

Dr. Kessler identifies the “elephant in the room” as the addictive power of “ultraformulated” foods, engineered to overstimulate the brain’s reward circuits. He says,

Food is very, very powerful in changing how we feel. It’s not a question of willpower. Our bodies have experienced an insidious decline over the past half a century. And that’s been caused by this never-ending consumption of foods that can trigger the addictive circuits.

Food addiction and the role of the environment

To combat food addiction, Dr. Kessler suggests changing the cues in our surroundings that trigger cravings — like what we watch, the stores we pass, or the ads we see. Being realistic, he adds:

Many of us don’t have the opportunity to leave our environment. And the food industry isn’t prone to change their behavior any time soon. But we now have pharmaceutical aids to help tamp that down. The effect of these GLP-1 [weight loss] drugs on food noise, that’s the big discovery.

Dr. Kessler does not address the role that stress plays in driving compulsive eating, or the interplay between stress, displacement, and ultraformulated foods. Stress can definitely drive overeating, says Harvard Health Publishing, and research shows that stress shifts food preferences toward highly palatable foods.

Risks of GLP-1 drugs

While GLP-1s like Wegovy and Zepbound help reduce appetite, Dr. Kessler warns of serious health concerns such as malnutrition, gastroparesis, and hypoglycemia. Many patients are consuming dangerously low calories, and most prescribers lack training in obesity medicine. He calls for better labeling and more real-world research on long-term safety and discontinuation protocols.

Long-term weight management

Most people regain most of the lost weight after stopping GLP-1s, so the focus should be on learning sustainable habits while on them. Dr. Kessler advocates for using a full range of tools, including nutrition therapy, physical activity, and behavioral support, tailored to each individual. He says:

But the most important thing is to recognize that this is a chronic condition that needs continuous care, even after you’ve lost the weight.

Addiction vs. willpower

Dr. Kessler challenges the outdated notion that weight loss is just about “eating less and moving more,” arguing that brain chemistry plays a far more significant role. Recognizing this can reduce the shame and stigma many people experience when they struggle to lose weight.

Body positivity vs. health

Vankin asked:

There’s a delicate balance between the body positivity movement, which encourages people to accept their bodies as they are, and the health crisis that is obesity, which you say is a root cause of many diseases. How do you suggest we navigate that?

Dr. Kessler’s answer is on point:

That movement did a lot of good — it took the shame out of it, it took the stigma out. But it was at a time when we didn’t have effective tools to reduce visceral fat. You can love your body, but also do things for your health. Those things are not diametrically opposite. And I’m not comfortable with the amount of morbidity and mortality associated with visceral fat and saying we shouldn’t do something about that.

Public health concerns and institutions

Going further, Dr. Kessler is deeply concerned about the increasing burden of visceral fat-related diseases and believes the U.S. is unprepared for the long-term consequences. He also worries about the dismantling of public health institutions that were key to pandemic response efforts like Operation Warp Speed.

Even modest weight loss helps

The interview finishes on an encouraging note, that even small amounts of weight loss can meaningfully lower the risk of chronic diseases, with greater losses offering even more significant health benefits.

Your responses and feedback are welcome!

Source: “You need more than Ozempic to fight food addiction. Here’s how,” Los Angeles Times, 5/20/25
Image: Diet, Drugs, and Dopamine book cover, Amazon. Used under Fair Use: Commentary

GLP-1 and Akkermansia, the Rest of the Story

A few more things remain to be said about the bug (and tenant of our intimate innards) called Akkermansia muciniphila. As previously mentioned, its sole purpose in life is apparently to ensure that the human gut lining stays nicely knitted together and does not spring any leaks. And this is a worthy existence.

A person who wonders if they are hosting a beneficial proportion of this bug can find out from a stool test. Some of the circumstances that harm the organism are age, antibiotic use, stress, and a diet containing insufficient fiber. Unfortunately, the presence of oxygen prevents Akkermansia muciniphila from growing, so it is not available in food — with the sole exception of human breast milk, which is a great reason to breastfeed a baby for as long as possible. What a wonderful and irreplaceable gift to pass along to a newborn child!

It is possible to encourage one’s personal stock of the helpful bacterium by eating its favorite foods, like high-fiber vegetation and nondigestible carbohydrates. Note: People who suffer from, or are at risk for, inflammatory bowel disease should use caution and check with their doctors.

Now, what about the GLP-1?

Dr. Michael Ruscio informs us that, “In animal models, Akkermansia appears to stimulate the secretion of a hormone known as glucagon-like peptide-1 (GLP-1).” In other words, it’s like manufacturing gold. Imagine saying, “Farewell, Eli Lilly; au revoir, Novo Nordisk. From now on, I’ll be producing my own GLP-1 — right here in my own innards!”

This appears to be a real possibility. At the very least, it appears capable of keeping a microbiome in excellent health. If it can help us shed fat, too, so much the better!

Of course, we have to discount for “novelty bias,” and recall that the allure of the new tends to make people overlook shortcomings. The results gained so far in petri dishes and lab animals do not necessarily apply to human beings in the wild. It will take some time and a lot more study to get a handle on some of these questions.

In animals, at least, too much Akkermansia is as bad as too little. We should know a lot more about the bug before going overboard with the prescriptions, or before allowing civilians to overdose on it.

Dr. Ruscio points out that, despite strong evidence, “[W]e don’t know if low Akkermansia levels actually cause illness or not.” He also reminds us that we only have one small study to go on, so far, and consequently are a long way from knowing if this bug is our best bet for acquiring GLP-1 in aid of weight loss.

As scientists so often and so rightly repeat, more research is needed. We do not know enough about the metabolic effects and blood sugar benefits. “For now, existing probiotics (like Lactobacillus–Bifidobacterium blends) have more research and are more effective.”

And what about those claims of healing the leaky gut? “Basically, higher LPS suggests gut leakiness, and lower LPS indicates tighter intestinal wall junctions.” One study says,

After the participants took Akkermansia for 3 months, the researchers found they had lower serum LPS. This suggests that the gut wall had become less leaky, analogous to those fence boards fitting together more tightly.

While probiotics in general are useful for intestinal health and healing, Dr. Ruscio reminds us that Akkermansia has not been proven special in this area, and that above all, “[W]e should be careful not to try and micromanage the gut microbiome.” In other words, considering our vast ignorance of the whole field, we would do better to foster nourishment and balance in the whole system, rather than trying to pick a favorite based on abysmally scarce data.

The average cost of Akkermansia supplementation would be in the neighborhood of $60 to $80 per month, which is inexpensive compared to the standard GLP-1 meds — but nobody knows yet how much would be needed, for how long, or what happens when the patient quits swallowing extra bacteria? Anyway, here is Dr. Ruscio’s specific advice:

We’ll get more information on Akkermansia in time. But for now, it’s probably better and more cost-effective for your gut health to stick to the three well-studied probiotic categories. These are a Lactobacillus and Bifidobacteria blend, soil-based probiotics, and the beneficial yeast Saccharomyces boulardii.

Your responses and feedback are welcome!

Source: “Getting To Know Your Gut Bugs: Akkermansia Muciniphila,” DrHyman.com, 07/25/21
Source: “What Is Akkermansia? Here’s Everything to Know Before You Start Taking Supplements,” GoodHousekeeping.com, 05/13/25
Source: “Fact-Checking The 4 Most Popular Akkermansia Claims,” DrRuscio.com, 10/07/24
Image by vocablitz/Pixabay

GLP-1 and Akkermansia, a Glowing Prospect

We left off by mentioning Dr. Mark Hyman’s explanation of how acquaintance with the mucus-loving bacterium Akkermansia muciniphila offers a glimpse of an exciting future, featuring drug-free therapy that achieves sustainable weight loss. (Today’s post follows on from a very recent one, so get up to speed here.)

And besides, there does not seem to be a need for age limits. Imagine an affordable obesity prevention solution, for kids!

The backstory: Confronted by a serious personal health situation, Dr. Hyman discovered in himself “gut infections and really low levels of beneficial bacteria.” The mucus-loving Akkermansia, which normally accounts for between 1% and 5% of a human’s gut bacteria, was pretty much missing in him. But emerging research showed promise for this life form as “the next generation of beneficial gut microbes.” The field was on the verge of “an explosion… It’s been linked to positive health outcomes like weight loss, improved insulin resistance, lower inflammation, and more.” He wrote,

Akkermansia muciniphila feeds on mucin, a glycoprotein that regulates the thickness of our gut’s intestinal mucosal layer…. Akkermansia produces propionate and acetate, two short-chain fatty acids (SCFAs) that feed other beneficial gut bacteria…. SCFAs strengthen tight junctions (the glue that holds our intestinal cells together) and prevent unwanted materials from passing through and into circulation.

Ideally, the only substances that should pass through are “macro and micronutrients from real whole foods.” Some of the icky substances we do not want circulating at will are food particles, allergens, endotoxins, and fecal matter. The very undesirable condition that allows other stuff to circulate is known as intestinal hyperpermeability or, informally, as “leaky gut,” and is recognized as the cause of many chronic diseases.

Having a leaky gut causes the immune system to go haywire and become hypersensitive, constantly reacting to antigens (foreign proteins from food and bacteria) that enter the bloodstream unannounced.

It became increasingly obvious that Akkermansia is a good thing to have a sufficient supply of, and studies of obese adults found that high levels of this organism correlate with “healthier metabolic status and better clinical outcomes (fasting blood sugar, body fat distribution, and insulin sensitivity).” In mice, high levels of it are also associated with lower blood lipid levels, lower insulin resistance, and less adipose tissue inflammation.

One way to encourage the good bugs is to avoid highly processed foods. Another is to take it as a supplement, and a very recent article from GoodHousekeeping.com explores the possibility.

From January 2004 to February 2022, the annual number of studies published on Akkermansia grew by 33.36%, and researchers say it “is likely to remain a research hotspot in the foreseeable future.” Journalist Kaitlyn Phoenix has studied the subject in depth and quotes Madiha Saeed, M.D., on the basic mechanism of this organism’s unique talent. Akkermansia eats mucin, a protein in mucus,

[…] and produces short chain fatty acids that “strengthen the tight junctions in between our gut cells, keeping the bad stuff out of our gut…. The more mucin Akkermansia uses, the more it encourages the epithelial cells to make more mucin, which then improves gut function and overall health.

Here is an interesting detail from Dr. Michael Ruscio, DNM, DC, a doctor and clinical researcher who explores the tireless ability of Akkermansia to populate the mucosal lining of the intestines, both small and large. It appears very likely that this life form exists for the sole purpose of reinforcing the intestines to prevent their contents from seeping into other areas.

(Please return next week for the rest of this fascinating story.)

Your responses and feedback are welcome!

Source: “Getting To Know Your Gut Bugs: Akkermansia Muciniphila,” DrHyman.com, 07/25/21
Source: “What Is Akkermansia? Here’s Everything to Know Before You Start Taking Supplements,” GoodHousekeeping.com, 05/13/25
Source: “Fact-Checking The 4 Most Popular Akkermansia Claims,” DrRuscio.com, 10/07/24
Image by BLASfemia8145/Pixabay

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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.

Food & Health Resources