More About Offices, Desks, and Obesity

Note: This post will definitely make more sense if considered in context with its predecessor.

Journalist Rodney Wagner poses other pertinent questions and makes several points about desk dining. It can certainly get a person fed “without sacrificing productivity,” because the diner is still able to concentrate on the work being accomplished at the desk, while chewing and swallowing.

On the other hand, we might add, many authorities believe that a person’s full attention and conscious participation ought to be directed toward eating. Otherwise, they have not fully experienced the intake of nutrition, and are apt to overeat in compensation for that lack, and become obese.

At any rate, according to this authority, snacking at work can allegedly help to maintain mental energy and improve alertness (though it seems the same might be said of periodic exercise breaks, or inhaling a hit of oxygen). However, admittedly, there are also “numerous downsides to eating at your desk.”

The person’s attention may be distracted from the work at hand (especially, we presume, if eating involves consulting a menu and placing an order.) Worse yet, the average worker’s meal often tends to involve items purchased from snack vending machines, the contents of which are universally acknowledged to be unhealthful and fat-promoting.

At any rate, the availability of food and water to those who need them is a factor that a manager can affect. While many people do not care for the nanny-state implications, it is probably on the whole a good thing, when those in charge bear some degree of responsibility for the well-being of the workers.

Strength in motion

For the well-being of employees who like to burn calories by walking between the floors of a building, the security of stairwells should be assured. Overall, the important thing is to cultivate an awareness of how extensively employee health affects productivity, morale, and healthcare costs. Basic amenities like breathable air count for a lot. So really, the biggest error an executive can make is to assume that she or he might not be able to affect the situation positively.

Understandably, one of the myths that Dr. Lee identified is the fallacy of ineffectualness. An employer should never buy into the idea that little can be done to shrink obesity in the workplace. There is a cliche that fits the case very neatly: “If you’re not part of the solution, you’re part of the problem.”

The boss can make a difference

Often, there is a belief that not even the most well-intentioned business can do much to prevent obesity, which by extension implies there is nothing they can do to stem the rising costs of obesity that adversely affect the company’s bottom line. Dr. Lee resists this defeatist notion because the reach of the job may in fact be extensive:

Your workplace can affect your commuting, sleep patterns, relationships with family and friends, available food at home, energy to exercise, overall stress levels and many other aspects of your life… No matter how you prioritize work-life balance, your workplace does have an impact on the rest of your life […] and in turn obesity.

Of course, obviously, the job affects the weight class of the worker’s entire family, because if the pay is not sufficient to feed them well, the consequences will show up. Which brings the topic back to the cost of a health plan, if indeed such an amenity exists at all. A company with common sense ought to recognize that it is cheaper to pay for obesity prevention than for bariatric surgery.

At the same time, corporate leadership must have the sensitivity to prevent its caring approach from coming across as criticism or worse yet, as a threat. In some times and places, rules are in effect to shield workers from various types of discrimination — even from what might appear as fat-shaming.

Dr. Lee’s last word to the bosses is,

In the end, the heart of a business is its employees. Having employees who are overweight and unhealthy is akin to a football team trying to compete with chronically injured players. If you view obesity as a completely separate issue from your business, you do so at your peril. To make a real difference, you need to have real substantial change in the culture and operations of a workplace.

Your responses and feedback are welcome!

Source: “Source: “Is It Good to Eat While Working? Uncovering the Truth,” MeatChefTools.com, 02/03/25
Source: “Obesity Is Everyone’s Business,” Forbes.com, 09/01/15
Image by Pexels/Pixabay

Yale Study Explores How Obesity Impacts Health

A new research letter published in JAMA Pediatrics is shedding light on just how much obesity contributes to serious health conditions in young people. The study, led by Yale School of Medicine medical student Ashwin Chetty, estimates the extent to which obesity-related conditions (ORCs) can be tied to obesity and overweight in adolescents and young adults across the United States.

Chetty and his team used publicly available data from the National Health and Nutrition Examination Survey (NHANES) to dig into the numbers. The goal? To better understand how much obesity directly contributes to conditions like prediabetes, hypertension, and dyslipidemia, and how preventing or treating obesity might lower those risks.

As Chetty explains,

Obesity can cause hypertension, for example, but many people have hypertension who don’t have obesity. So, we want to know how many hypertension cases are caused by obesity. And that’s important because that gives us an estimate of the impact obesity has on hypertension and diseases like it and by extension, the impact that treating or preventing obesity can have on those diseases.

Building on previous research

This wasn’t Chetty’s first time tackling the question of obesity’s role in chronic conditions. While working with Alissa Chen, MD, MPH, and Alexandra Hajduk, PhD, MPH, he had already applied similar methods to study older adults ages 65 and up.

That earlier work sparked an idea. After meeting James Nugent, MD, MPH, at a pediatrics interest group, Chetty realized the same approach could be applied to adolescents and young adults, a group that hadn’t been studied as extensively. He teamed up with Dr. Nugent and Mona Sharifi, MD, MPH, to adapt the research for a younger population.

Just weeks before this new paper, the group had already published another piece in JAMA Pediatrics titled “Glucagon-Like Peptide-1 Receptor Agonist Eligibility Among US Adolescents and Young Adults.” Using those earlier definitions and methods, Chetty was able to compile fresh data for this latest study on ORCs.

A collaborative effort across specialties

One thing that stands out about this research is the cross-disciplinary teamwork. Physicians and researchers from adult medicine, geriatrics, and pediatrics — groups that don’t often overlap — came together to ask big-picture questions.

Chetty says,

We’re asking questions that bridge a lot of different populations… One of the nice things about being a medical student is that I can pivot between research on adults and research in pediatrics. The faculty who I worked with were all really open to taking part in this research. People’s openness to work on ideas that might not be squarely in their field of interest is something I really appreciate about the faculty at Yale.

What the numbers show

The findings highlight just how significant obesity’s impact is on young people’s health. The study estimated that 20–35% of adolescent cases of prediabetes, hypertension and dyslipidemia are attributable to obesity. Also, 40% of young adult cases of these same conditions can be traced back to obesity.

Chetty breaks it down:

Our interpretation of that statistical conclusion is if you were able to eliminate obesity from this population, you would reduce the prevalence of those obesity-related conditions by that amount.

Looking ahead

The team isn’t stopping here. The next step is to model the potential long-term benefits of treating obesity earlier in life. Could early intervention lower future rates of hypertension or diabetes? And what would that mean for overall healthcare costs?

Dr. Nugent praised Chetty’s initiative, noting,

This work is a testament to Ashwin who asked interesting questions and found clever ways to answer them with publicly available data. Not many people get published in JAMA Pediatrics twice in a year, never mind twice in the same month. And he’s not working with a million-dollar grant, he’s asking good questions and finding ways to answer them with NHANES data.

Your responses and feedback are welcome!

Source: “Examining the Impact of Treating and Preventing Obesity to Prevent Obesity-Related Conditions,” Yale School of Medicine, 8/25/25
Source: “Proportion of Obesity-Related Conditions Attributable to Obesity and Overweight in US Youth,” JAMA Pediatrics, 8/25/25
Source: “What’s the Cause of Obesity-Related Conditions in Youth?,” Medscape, 8/25/25
Image by Vitaly Gariev/Pexels

Offices, Desks, and Obesity

We are in the midst of examining a very detailed, decade-old Forbes.com article. Authored by Bruce Y. Lee, M.D., it explored some myths about the extent to which companies are able to influence the amount of obesity experienced within the ranks of their employees. At the time, contemporary Duke University research showed that obesity-related issues cost American businesses, overall, just short of $75 billion each year.

More specificity was found in this quotation:

Another study measured that while normal-weight employees cost on average $3,838 per year in healthcare costs, overweight to morbidly obese employees cost between $4,252 and $8,067. Each additional body mass index (BMI) point above normal weight costs $194-$222 per year per employee.

Significantly, bosses at every level were reminded that weight-related issues tend to sneak up and may not become obvious until after some real damage has already been done. Consequently, it is always wise to have a finger on the pulse of industry-wide trends and interventions.

High employee turnover is never a good sign, and obesity-related issues can influence employee behavior to a very great extent, so the smart executive keeps an eye on that area. Advice in this area can be just as true today as when businesses began to track such matters. Overall, the author urges bosses to remember that substantial change might be needed, and that…

[…] in the end, the heart of a business is its employees. Having employees who are overweight and unhealthy is akin to a football team trying to compete with chronically injured players. If you view obesity as a completely separate issue from your business, you do so at your peril.

But once the people in charge become aware of the potential undesirable impacts of obesity, relative to the big picture, they should not be discouraged by all the possible negative outcomes. As always, “fore-warned is fore-armed,” and it would be a mistake, according to Dr. Lee, for employers to think there was not much they could do.

In some work environments, for instance, it might help to offer the alternative of a standing desk. A slogan that was heard in this context was, “Sitting is the new smoking” — in other words, a harmful yet totally avoidable habit. Of course, many job descriptions preclude sitting and require constant standing. But in circumstances where sitting has always been considered the normal state for workers, to forbid it might be construed as gratuitous cruelty, and the basis for a legal challenge. Still, in many situations and workplaces, leeway could be built in.

While some things are simply not done — like a bank teller eating while taking care of customers at the window — in many situations company policy allows leeway for habits and preferences. Choosing a couple of articles at random brings to light some of the current thinking in this area. A website for professional chefs asks, “Is it good to eat while working?“:

A survey found that over 60% of employees regularly eat at their desks, indicating that this trend is not just common but almost normalized.

Amongst people who work seated at desks, perhaps. What about lifeguards? Firefighters? Heart surgeons? Okay, the author probably meant that, among the sub-population of office-bound, sedentary workers, more than half are accustomed to eating at their desks. (Leaving aside matters related to obesity, their habits might directly impact the company’s pest control budget.)

(To be continued…)

Your responses and feedback are welcome!

Source: “Obesity Is Everyone’s Business,” Forbes.com, 09/01/15
Source: “Is It Good to Eat While Working? Uncovering the Truth.,” MeatChefTools.com, 02/03/25
Image by StockSnap/Pixabay

Let’s Not Kid Ourselves

At this point, many of us are posing the rhetorical query, “How much does obesity cost the overall economy, anyway?” This sounds like a trick question, one posed not to extract a factual answer, but to take an indirect route toward confrontation with a really unpopular conclusion. It sounds this way because it is.

One reason the question is virtually unanswerable is, the price of each separate factor involved in bariatric medicine continues to rise. Another reason is that even with modern lightning-speed communication, it is still pretty difficult to guarantee that a pile of information about anything is the latest and greatest.

In many cases, multiple factors change too quickly to be meticulously tracked and compensated for. Sometimes, even experts review their work or the work of others and conclude that “Oops! Those numbers are on the wacky side.” We can take a snapshot that captures a moment in time and compare it to another snapshot in a later or earlier time frame, or in the same moment but in a different place.

A considerable fraction

Back in 2015, the management consulting firm McKinsey Global Institute announced that almost one-third of Earth’s population, or 2.1 billion people, were overweight or obese. In developed economies, “about 15 percent of health care costs […] are driven by [obesity].” Moneyweb.co.za noted that “healthcare costs are more than 40% higher for obese patients than normal-weight patients.”

The investment advice website added that the global impact of obesity was estimated to be “on a par with the impacts of smoking or armed violence, war and terrorism.” Expressed numerically, this figure amounted to around $2 trillion, or 2.8% of the global Gross Domestic Product. As the saying goes, “no matter how you slice it,” this was a real wake-up call. To put the icing on the cake, McKinsey issued the understatement of the century, namely, that “global disagreement on how to move forward is hurting progress.”

Some widespread misunderstandings

In the same year, a mere decade ago, Dr. Bruce Y. Lee compiled a list of seven myths that conspired to convince employers that they could safely ignore the encroaching threat of obesity — the first one being that obesity did not exist in their particular line of work. But in truth, few businesses were found to be exempt. While relatively few responsible authorities were paying attention, obesity had snuck into “nearly every country, income level, race, ethnicity and age group.”

Rising obesity rates were not random accidents, but established facts of life. Even if one particular corner of a commercial field had not yet been invaded, suppliers, subsidiaries, and other connected areas would be affected. And to simply hire skinny people was no solution, because the possibility that they could balloon up was always lurking.

The second prevalent myth was that obesity invariably sprang from each employee’s individual lifestyle choices. But the author pointed out how mistaken a boss would be to assume that anyone who put on pounds was simply lazy or lacking in self-control. To assume that everyone just needed to eat less and exercise more would be a serious error in judgment. People in positions of authority were urged to remember that behavior is governed by “a number of social, environmental, cultural, and financial factors,” which will be looked at in the next installment.

Your responses and feedback are welcome!

Source: “A fat investment opportunity, Moneyweb.co.za, 04/16/15
Source: “Obesity is Everyone’s Business,” Forbes.com, 09/01/15
Images by fabioeliasp1 and miosyn/Pixabay

In the Age of GLP-1 Weight-Loss Medications, Lifestyle Changes Still Matter

The rise of GLP-1 receptor agonists such as semaglutide and tirzepatide has transformed obesity management. Millions of patients now use these injectable drugs in pursuit of significant weight loss, and professional guidelines increasingly emphasize pharmacologic treatment. Yet, despite the promise of double-digit weight loss, many physicians still start with lifestyle interventions — nutrition, physical activity, and behavioral support — as the foundation of care.

At first glance, this may seem like resistance to innovation. In reality, it reflects a deeper philosophy shaped by evidence, clinical experience, and a long-term view of health outcomes.

Guidelines emphasize combination, not replacement

Current clinical guidance supports the use of weight-loss medications for adults with a BMI ≥ 30, or ≥ 27 with obesity-related conditions, provided that lifestyle changes alone haven’t been sufficient. Importantly, guidelines recommend combining pharmacotherapy with behavioral strategies rather than using medication as a standalone solution.

This shift from “last-resort” use of medication to a more proactive tool marks progress in obesity care. Still, the emphasis on adjunctive therapy reassures physicians who keep lifestyle-first approaches at the center of their practice. They aren’t ignoring guidance — they’re interpreting it through the lens of long-term sustainability.

Real-world data underscore the challenge

Clinical trials show dramatic results with GLP-1s, but real-world adherence is a major hurdle. A Cleveland Clinic study of 7,881 patients highlighted this gap:

  • 50% stopped GLP-1 treatment within one year.
  • 20% discontinued within three months.
  • More than 80% remained on subtherapeutic doses.

 

Weight-loss outcomes reflected these patterns:

  • Early discontinuers lost only 3.6% of body weight.
  • Patients who stayed on treatment lost 11.9% on average.
  • Those who reached full therapeutic doses achieved up to 18% loss, approaching clinical trial results.

 

For physicians like Dexter Shurney, MD, MPH, MBA, these findings validate a lifestyle-first model:

The majority of common chronic conditions — hypertension, CHF, hyperlipidemia, diabetes, depression, and obesity — are fundamentally lifestyle issues. Therefore, a lifestyle-first approach to care makes perfect sense because it addresses root cause.

Why lifestyle remains the foundation

Many clinicians see firsthand that without lifestyle changes, even the most effective drugs or surgeries can fail. Kenji Kaye, MD, an internist in Denver, explains:

Without foundational lifestyle changes, medications and surgery are destined to fail. We have seen many patients not lose weight or even gain weight despite max dosages of these pharmaceuticals.

Physicians stress that obesity is a multifactorial condition, shaped by diet, activity, genetics, hormones, and comorbidities. Addressing only one piece of the puzzle rarely yields durable results.

Dr. Shurney highlights another benefit: Lifestyle medicine reduces polypharmacy risk. Unlike single-condition drugs, lifestyle interventions improve multiple markers simultaneously — cholesterol, blood pressure, insulin resistance, and mental health.

In fact, intensive programs can yield rapid systemic improvements: Insulin doses cut in half within days for type 2 diabetes patients, plus 20–50% cholesterol reductions within two months.

Medications as strategic tools

Even physicians who prioritize behavior change often incorporate GLP-1s selectively. Elizabeth Slauter, MD, an obesity medicine physician in Texas, says:

Studies consistently show that the best outcomes with obesity medications occur when they are combined with lifestyle changes. So, it makes sense to start with lifestyle interventions as a foundational approach.

Barriers like high costs, inconsistent insurance coverage, and frequent shortages make long-term GLP-1 use impractical for many patients. For this reason, physicians frame medications as tools within a broader treatment plan, not as standalone solutions. As Dr. Kaye explains:

My usual practice is to discuss these medications as an option but only after a careful review of their food choices, activity level, health history, and current medications.

Navigating patient expectations

The popularity of GLP-1s in the media has created new dynamics in the exam room. Patients often request them directly, influenced by celebrity endorsements and online testimonials. Dr. Kaye sees this as an opportunity for education:

Medications like GLP-1s are mentioned almost everywhere including the media, pharmaceutical ads, and celebrity gossip. When a patient presents asking for a prescription, it is a perfect opportunity to really delve into the details of what these medications can offer and also the risks involved.

Expectation-setting is critical. Many patients assume they’ll only need medication short-term, but research shows discontinuation usually leads to weight regain. Helping patients understand the realities of long-term therapy protects both outcomes and trust.

System pressures and practice choices

Healthcare systems often incentivize quick, measurable results. Writing a prescription is more easily rewarded than time-intensive counseling sessions. Dr. Shurney explains:

The lack of reimbursement parity for lifestyle interventions is a disincentive to practice this way. It’s much easier to prescribe a medication and receive the “quality prize” for checking the drug adherence box than to prescribe lifestyle and not receive a similar financial reward.

To counter this, some physicians have shifted to direct primary care models, which allow longer appointments and more patient-centered counseling.

The long-term view

Ultimately, physicians who remain committed to lifestyle-first approaches are guided by long-term outcomes and healthcare sustainability. Dr. Kaye reflects:

After seeing many patients start down the pathway of pharmaceuticals and ultimately not reaching their goals reaffirmed my commitment to a more holistic approach. In my experience, without a strong foundation of lifestyle changes, the long-term success rate is low even with antiobesity medications.

Dr. Shurney adds a cautionary note:

What we risk are ever-higher healthcare costs, since these medications are very expensive and need to be taken for years, if not forever, to sustain the weight loss. Additionally, we still do not know the long-term effects of these medications.

Your responses and feedback are welcome!

Source: “Why Some Physicians Still Lead With Lifestyle-First Obesity Care Despite the GLP-1 Revolution,” Medscape, 8/12/25
Source: “Pharmacologic Treatment of Overweight and Obesity in Adults,” NIH.com, 8/20/24
Image by Los Muertos Crew/Pexels

The Devil Is in the Details

The most recent installment of this series focusing on the cost of obesity mentioned smart beds that can track patients’ vital signs, weight, and other factors.

It also mentioned a complex issue with which hospitals never cease to struggle: guaranteeing the correct amount of any medication to precisely fulfill the requirements of the patient’s body and condition. This obviously is of crucial importance not only to the clinically obese patient but to each and every patient. Meticulousness in this area is necessary for everyone from the pre-born infant to the geriatric patient who (where legal) opts for an assisted demise.

In the domain of medication, so much can go wrong. It must be the right medication, untainted, and within its use-by date. For numerous reasons, including public safety and legal liability, all the documentation has to be correct, and strictly accounted for. Substances need to be shipped and stored correctly. All communication regarding administration must be clear, accurate, timely, and easily accessible.

And of course, as already emphasized, the necessary factors include…

[…] a current, accurate weight instead of relying on a historical, stated, or estimated weight; and obtaining, documenting, and communicating patient weights in metric units only (i.e., grams or kilograms). Key patient information used to guide appropriate medication therapy includes age, weight, height, allergies, diagnoses, laboratory values, and vital signs…

The very explicit Pennsylvania Patient Safety Advisory is a good example of the thorough inclusion of multiple factors involved in risk reduction, like equipment cost, and its upkeep and repair cost, and the expense of training people to use it correctly. It comes as no surprise to see accurate weighing equipment at the top of the list, as always. As we have mentioned, such hardware includes “floor scales, stretchers and beds with built-in scales, and standing, chair, and wheelchair scales.”

The personnel who employ these devices are expected to be familiar with the manufacturers’ recommendations for keeping them accurately calibrated, lubricated, titrated, or whatever. And despite the USA’s stubborn refusal to join the world in using the metric system for general purposes, it must be employed in the realm of weights and measures having to do with humans and medications.

One important factor discussed by this document is that of organizational expectations. Specifically, the best practice is to specify and assume that…

[…] obtaining the patient’s actual weight is part of the mandatory nursing assessment and reweighing of the patient occurs as warranted, based on patient’s clinical condition. Consider requiring reassessment of a patient’s weight when initiating or changing the dose of weight-based medications, clinical situations in which weight fluctuations are expected, or situations in which a weight variation may impact the course of care.

In other words, stay on top of this factor. Even in situations where it may not seem very important, documentation creates reality. As more attention is paid to the phenomenon of weight fluctuation in patients, more factual information will accumulate and reveal its significance, for the good of future patients.

It is also recommended to pay meticulous attention to this factor, other than in the midst of an emergency, of course. And for goodness’ sake, be sure all pertinent weight stats are recorded clearly, and in a quickly findable location, in the patient records. The document contains even more suggestions about the administration and implementation of weight-related policies, and about sketching out contingency plans in advance.

Weight is one of the easiest variables to keep track of in a clinical setting, especially with the newest specially developed or adapted equipment. The weight factor’s ubiquity and banality place it in danger of being overlooked and undervalued, but excellent arguments can be made for paying meticulous attention to this issue.

Your responses and feedback are welcome!

Source: “Update on Medication Errors Associated with Incorrect Patient Weights,” PA.gov, June 2016
Image by geralt/Pixabay

Smart Beds — for Bariatric and Other Reasons

In the field of bariatrics, it seems obvious that heavy people face physical challenges and restrictions that can require some pretty elaborate equipment. It is also apparent that ever more complicated hardware must and will inexorably raise the total cost of healthcare. But obese people should not be assigned the whole blame. Increasingly, medical equipment related to weight is for everyone.

We spoke of the transfer safety factor, with an uncomfortable number of mishaps, resulting in what are somewhat euphemistically called “delays in care.” Moreover, for hospital inpatients of many sorts, continuous weight monitoring is increasingly seen as essential.

A company called SonderCare explains why:

A bed equipped with load sensors provides real-time information that derives from, and in turn affects, the patient. Treatment options can change minute-by-minute, rather [than] according to orders tied to an 8-hour shift.

Despite the best intentions of staff members, the big danger point connected with patient injuries is movement from place to place. If the patient can just stay right there in bed and be weighed, so much the better, because a potential cause of injury has been eliminated.

In this style of bed, load sensors convert the pressure they feel into electrical signals for crucial weight monitoring, while other technology includes keeping track of the patient’s vital signs. A sudden weight change, either up or down, may indicate a problem with the heart or kidneys, and can be quickly investigated.

In some conditions, fluid buildup may be detected before it causes serious damage. Overall, continuous weight monitoring, without the need for actual transfer of the body, greatly reduces injuries.

According to SonderCare,

Advances in bed technology include vital signs monitoring and alerts to prevent pressure ulcers, increasing safety and comfort for patients. Future innovations will incorporate smart fabrics and touch-sensitive sensors that offer real-time health updates directly into electronic medical records.

But wait, there is more…

Another entire area in which very large people can be particularly vulnerable is medication dosage. We are accustomed to the idea of child-size doses, to ensure that the young and vulnerable don’t get too much. But we think less often about the need for accurate measurement in the ratio of medication to body weight, in the case of an extremely large adult.

Both insufficient dosage and overdosage would be problematic. GoodRx.com says,

Some medication dosages are weight-based because your body weight or body composition could affect their absorption, distribution, metabolism, or elimination. These four factors predict how a medication will behave in your body. Drug toxicity can also play a role.

Changing any one of these factors can potentially make a medication more or less active in your body. In turn, this can lead to unwanted side effects or a less effective treatment.

Another paper points out that “the weight effect may be minimal or dosage can be affected only when weight is combined with other factors. Findings of sporadic studies in recent years indicated that fixed dosing was more advantageous than weight-based dosing in some cases…” It stresses that the medical facility needs to establish good processes for both weighing and documentation, and to ensure “sufficient and convenient availability of appropriate and properly functioning equipment for patient weighing and medication delivery.”

Insulin, antibiotics, and anesthetics are some of the drug types that need very careful consideration when prescribed. In the overall cost of obesity, this factor is not very large. Although considering it over and over again in each case certainly takes time, which adds up. But just one case that goes to court because a patient was under-treated or died from an overdose can become very expensive.

Any reader of this piece who treats lightly the matter of dosage calculation might take a look at this website, “How To Calculate Drug Dosage By Weight | Essential Guide.” This excerpt is just a tiny sample:

\[
\text{Required Volume} = \frac{\text{Total Dose}}{\text{Available Concentration}} = \frac{700 \text{ mg}}{250 \text{ mg/mL}} = 2.8 \text{ mL}
\]

Got that? This is why medical school is so expensive, and why physicians are so well-compensated. The matters discussed here are relevant not only to the status of obese children as they exist now. The whole area of concern involves viewing children not just as young people per se, but as precursors of the adults they will grow into.

We strive to avoid these very costly problems, both for the sake of each individual child and for the sake of the economy, as they will grow up to impact with their ever-increasing number of expensive obesity-related issues.

Your responses and feedback are welcome!

Source: “Do Hospital Beds Weigh You?,” SonderCare.com, 06/27/24
Source: “Weight-Based Dosing: What to Know About Medication Dosages and Body Weight,” GoodRx.com, 02/09/23
Source: “Weight-based dosing in medication use: what should we know?,” NIH.gov, April 2016
Source: “How To Calculate Drug Dosage By Weight | Essential Guide,” Wellwisp.com, undated
Image by [name not given]/Pixabay

Weight Loss Without the Nausea?

Weight loss and diabetes drugs currently available, such as Ozempic and Zepbound, often fail to provide lasting results. While GLP-1 drugs work by targeting brain neurons that regulate appetite, they frequently cause unpleasant side effects. According to researchers, nausea and vomiting force 70% of patients to stop treatment within a year.

Now, a Syracuse University-led research team believes they’ve found a new approach that could offer weight loss without the gastrointestinal distress that derails so many patients.

Dr. Robert Doyle, a medicinal chemist and the Jack and Laura H. Milton Professor of Chemistry in the College of Arts and Sciences at Syracuse University, is leading the effort. Dr. Doyle is also a professor of pharmacology and medicine at SUNY Upstate Medical University. He and his colleagues have identified a different brain target — one that focuses on cells supporting neurons rather than the neurons themselves. This breakthrough could help treat both obesity and diabetes in a safer, more tolerable way.

Looking beyond neurons

For decades, neurons have been the most obvious and well-studied targets for brain-related drug development. GLP-1 medications, for example, zero in on neurons in the hindbrain that control appetite. But Dr. Doyle’s team is taking a different route, exploring the role of “support” cells, including glia and astrocytes, which may also influence hunger and metabolism.

A recent collaborative research effort has found that these support cells play a role in reducing feelings of hunger, although this process has received far less attention in the scientific literature. Dr. Doyle explains:

We wanted to know whether support cells might produce new peptides or new signaling molecules that might be critical in body weight reduction.

How it works

To visualize the difference between neurons and their support cells, Dr. Doyle offers a simple analogy:

Think of each brain neuron as a light bulb and support cells as the components that allow the light bulb to brighten, including the wiring, switch and filament. All of those supporting parts beyond the light bulb play a role in making the light shine.

In their research, the team discovered that certain support cells in the hindbrain naturally produce a molecule called octadecaneuropeptide (ODN), which can suppress appetite. In lab experiments, when ODN was injected directly into the brains of rats, the animals lost weight and improved their glucose processing, an important factor for managing diabetes.

However, injecting substances directly into the brain isn’t a realistic option for human treatment. To solve this, the researchers engineered a new version of the molecule, tridecaneuropeptide (TDN), that could be administered via regular subcutaneous injections, much like existing GLP-1 treatments.

When tested in obese mice and musk shrews, TDN led to weight loss and improved insulin sensitivity without triggering the nausea and vomiting commonly seen with GLP-1 drugs.

A shortcut to appetite control

One of the team’s key objectives is to develop weight loss therapies that avoid stimulating neurons directly. TDN accomplishes this by bypassing neurons and targeting the downstream support cells responsible for appetite suppression.

Dr. Doyle likens the process to starting a race partway through rather than at the very beginning. He says:

Instead of running a marathon from the very beginning like current drugs do, our targeting downstream pathways in support cells is like starting the race halfway through, reducing the unpleasant side effects many people experience… If we could hit that downstream process directly, then potentially we wouldn’t have to use GLP-1 drugs with their side effects.

Or we could reduce their dose, improving the toleration of these drugs. We could trigger weight loss signals that happen later in the pathway more directly.

This “shortcut” approach could have major implications for the millions struggling with obesity or type 2 diabetes, particularly those who cannot tolerate current treatments.

From lab to clinic

To turn this scientific discovery into a practical therapy, a new company called CoronationBio has been launched. The company has licensed intellectual property related to ODN derivatives for treating obesity and cardio-metabolic disease from both Syracuse University and the University of Pennsylvania.

CoronationBio’s mission is to move promising candidates like TDN from the lab into clinical trials. They are collaborating with other companies in the biotech and pharmaceutical sectors to accelerate development, with hopes of starting human trials as early as 2026 or 2027.

If successful, the new treatment could address one of the biggest barriers in obesity care: Keeping patients on their medication long enough to see lasting benefits.

The future of appetite control

While the research is still in early stages, Dr. Doyle’s team is optimistic about the potential impact. By shifting the focus from neurons to their support cells, they hope to change how scientists and clinicians approach weight management and metabolic disease.

The concept isn’t just about creating a new drug; it’s about rethinking the biology behind appetite regulation. Support cells, once considered secondary players in brain function, may hold the key to more tolerable and effective treatments for chronic conditions that affect millions worldwide.

As Dr. Doyle and his colleagues continue refining TDN and preparing for clinical testing, the hope is that this line of research will not only expand treatment options but also offer relief to patients who have long struggled with both their weight and the side effects of current medications.

If their theory holds true in human trials, this could mark the beginning of a new era in weight loss medicine — one where the body’s own support systems are harnessed to promote health, without the misery that forces so many to give up on treatment.

Your responses and feedback are welcome!

Source: “Scientists uncover hidden brain shortcut to weight loss without the nausea,” ScienceDaily, 8/10/25
Source: “Shortcut to Weight Loss: No Nausea Required,” Syracuse University, 7/30/25
Source: “Hindbrain octadecaneuropeptide gliotransmission as a therapeutic target for energy balance control without nausea or emesis,” Science Translational Medicine, 7/23/25
Image by Amel Uzunovic/Pexels

Bariatric Hardware By the Numbers

In this series concerning the costs of obesity, today’s post is about equipment. We mention some specifics of why the issue is an ongoing and ever-growing problem for patients, family members, and/or caregivers, medical professionals, other hospital personnel, insurers, and basically the American public at large.

“Bariatric” is a term that refers not only to weight reduction surgery but to the entire field of obesity treatment. Let us confront the issue of equipment — first, by looking at some available devices. Several sources were consulted for bits and pieces of information; a typical website of this genre describes items designed for patients in their everyday lives at home and out in public.

Crutches can be found for people who weigh up to 650 pounds and maybe even heavier. There are canes guaranteed to support 500 pounds. Specialized companies make extra-wide, super-strong walkers. A combination walker and seat called a rollator will support up to 500 pounds and run you $800 or more.

An extra-wide wheelchair that supports up to 850 pounds can be had for just under $1,000, while a less sturdy model might go for half that price. And who would have guessed that a “transport chair” is a whole different category of item?

Other locales

For the home, a furniture company has designed a super-strong lounge chair that can be had for around $2,500, and a scooter available for approximately $3,750. A special bed for home use can serve a person of up to 450 pounds (or even heavier), but the basic horizontal structure itself is only the beginning. The side rails, for instance, may represent a separate, additional expense.

A home bed may cost around $3,000, but quite possibly might add up to more. In a hospital, a high-tech, specialized bariatric care bed could run for 10 times as much. A mattress particularly designed for very obese individuals is composed of different materials from the standard hospital mattress, and may cost as much as $4,000.

In either case, the patient will probably need a trapeze (around $1,000) to lift himself or herself off the bed’s surface and change the body position. For patients who need help when in physical therapy recapturing their ability to walk, there are ceiling lifts.

Similar devices are able to lift a very large person from the floor onto an exam table or bed. Although modern hospitals are designed from scratch with such contingencies in mind, the structure of a typical home might need some expensive refurbishment to handle a suspended load of this kind.

Different strokes for different folks

For more intimate needs in the individual’s bedroom and/or bathroom, there are transfer benches to help get a person on the toilet; bedside commodes (starting at around $200), shower chairs, raised toilet seats, toilet safety rails, and other beefed-up versions of standard items, and they all cost more if a lot of poundage is involved.

Equipment that will probably be found only inside a medical institution includes an extra-sturdy exam table that sells for around $2,000. For the use of the bariatric surgeon, special stapling equipment is available in the $4,000 – $5,000 range. But this begins to impinge on a whole different, related area.

Let’s take a moment to scope out an article about patient safety, with a long and explicatory title: “How Safety Is Compromised When Hospital Equipment Is a Poor Fit for Patients Who Are Obese.”

This assessment is five years old, but not much has changed since then:

Event reports […] indicate that some healthcare facilities do not have the necessary equipment to monitor and care for some individuals in this patient population, leading to embarrassment for patients, delays in care, and injuries to patients.

The most frequent problem situations involve imaging equipment, “especially MRI and CT scanners,” or at least events in the imaging department. Stretchers and wheelchairs are statistically implicated to a startling degree. Almost 75% of patient safety mishaps result in what is euphemistically called “a delay in care,” with most of the delays consisting not only of pausing to assess the damage, but in treating the resulting damage. Nobody wants this.

A huge field of knowledge is involved here, which mainly concerns adult patients rather than children. But this is the point we make again and again: The odds of an obese child growing into an obese adult are daunting. No parent wants to peer into the future and see this kind of picture. And looking at a bit of specialized bariatric equipment, and the associated prices, hopefully will cause some degree of a “scared straight” effect.

Your responses and feedback are welcome!

Source: “Bariatric durable medical equipment product guide,” Medline.com, undated
Source: “Bariatric and Heavy Duty Patient Lifts and Slings,” AdaptiveSpecialties.com, undated
Source: “How Safety Is Compromised When Hospital Equipment Is a Poor Fit for Patients Who Are Obese,” PatientSafety.pa.gov, March 2020
Image by dmchannelsng/Pixabay

The Growing Realization of Horror

Following along in this retrospective look at the alarming cost of obesity in the U.S. and the world, we note that a 2010 article in The Lancet had already proclaimed obesity to be, globally, a larger health problem than hunger. Soon afterward, the head of England’s National Health Service sounded an alarm, stating that “we are sleepwalking into the worst public health emergency for at least three decades.”

The World Economic Forum followed up on this shocking turn of events in 2015 (in an article which has vanished from the web), by stating that almost one-third of the Earth’s human inhabitants — in other words, 2.1 billion people — were overweight or obese. Why was this characterized as a more significant problem than hunger? Because…

That is nearly two and a half times the number of adults and children who are undernourished.

At that moment in time, obesity was deemed to be responsible for approximately 5% of the total deaths taking place among the world’s population. But well-being was not the only area of concern. The entire global economy was taking a beating:

This crisis is not just a pressing health concern; it is also a threat to the global economy. The total economic impact of obesity is about $2 trillion a year, or 2.8% of world GDP…

As World Health Organization (WHO) Director-General Margaret Chan has noted, “Not one single country has managed to turn around its obesity epidemic in all age groups.”

To make matters worse, this crisis did not, as might be reasonably expected, affect only impoverished countries — because well over half of the world’s obese people were located in developing countries, in which many people enjoyed more prosperity than they had ever been accustomed to. In places like China and India, thanks to new economic opportunities, the inhabitants of cities were ballooning up.

When previously hungry people suddenly find that food is available and that they are able to afford it, that is what they go for. Here is a painful example:

In the mid-twentieth century, for example, a boom in phosphate mining transformed the Micronesian island state of Nauru from a land of food shortages and starvation to the world’s leader in obesity and type-2 diabetes. In 2005, according to the WHO, 94% of men and 93% of women in Nauru were overweight, and more than 70% of the population was obese.

The combination of money and availability made people sent people around the bend, and who can really blame them? But casting blame was never an issue. For the authorities in charge of public health, the only issue at hand was what to do about the situation. The crisis could not even be characterized as unforeseen, because statisticians and the entire medical profession had been noticing it all along.

One unfortunate circumstance was that countries where people suddenly could afford more food than they needed did not necessarily also have the funds to provide health services that they also desperately needed. Increased disposable income perversely led to obesity that “can lock in poverty and perpetuate inequality.”

To address the crisis, the McKinsey Global Institute (MGI) identified 74 potential interventions and classified 44 of them as possessing sufficient data “to be able to measure potential impact if scaled up to a national level.” These tantalizing alleviating actions included subsidized school meals, better nutritional labeling on food products, and built environments that encouraged walking and other types of exercise.

One element in particular would prove to be increasingly crucial but also increasingly impervious to any resistance: the advertising of high-calorie food and drink. Still, undaunted by ever more alarming reality, the MGI went ahead with projections of what might, in a better world, come to pass:

If the United Kingdom, for example, were to deploy all 44 interventions, it could rein in obesity rates and help roughly 20% of its overweight and obese population return to a healthy weight within 5-10 years… Over the long term, savings from reduced health-care spending and gains from higher productivity could outweigh the investment needed to deliver interventions… In the UK, reversing obesity trends could save the National Health Service about $1.2 billion a year.

Dream on, MGI! When there are fortunes to be made selling sugar-saturated fizzy drinks to everyone from infants to geriatric patients, nobody wants to hear about interventions and alleviation and better health and blah-blah-blah. The voices of earnest experts who tried to warn of impending doom were drowned out by ever more obnoxious advertising. Throwing money at the problem did not help — because almost nobody cared to listen. The article ended by stating a dismal fact:

Today, investment in obesity research worldwide amounts to some $4 billion a year — just 0.2% of the estimated social costs of obesity.

Source: “What’s the best way of tackling obesity?,” WeForum.org, 12/15/14
Source: “Why Obesity Threatens the Global Economy,” WeForum.org, 04/07/15
Image by marlenemgm (modified)/Pixabay

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Profiles: Kids Struggling with Weight

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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