Drugs and Surgery — Reevaluation Is Inevitable

A person who lives for several decades is bound to notice something interesting, as time goes on — namely, that one generation’s scandal is the next generation’s yawn. Around the turn of the century in the USA, for instance, a decent man didn’t appear in public without a head covering; and not just any hat, but one with a hatband, a dent in the top, and a brim.

In 1900, women who initiated divorces were as rare as hen’s teeth. By the year 2000, it was quite ordinary to meet a woman who had divorced three or four husbands.

In some times and places, people are implacably set in their ways, while in others, they can’t stand to do things the same way from one week to the next. Philosophers have spoken millions of words about the human tendency to resist change, especially in instances where some members of the population are attempting to force others to act normally.

In that discussion, of course, one issue is all-important. Who is privileged to decide what is considered normal in society, as opposed to what is regarded as unacceptably deviant?

Today and us

“Who died and made you king?” is a sarcastic question that many people have good cause, several times a day, to telepathically ask a passerby some version of. More specifically, they cannot help wondering why they have to go through life hindered by the judgment of others regarding the size and condition of their bodies.

In a way, to be grossly obese is like having two heads — you just know that everybody is staring, and even if they don’t judge with hostility, they probably feel pity. So then, you spend the rest of the day mulling over the question of which is worse, hatred or contempt?

There may be nothing basically wrong, in an abstract sense, with the educational and medical establishments of society having concern about people’s health. In a general way, it is comforting to know that some of the people who run things are in charge of seeing that you don’t catch the plague or smallpox.

That is managed, in a civilized society, by having public health authorities in charge of identifying and sequestering people with a contagious disease, and convincing the healthy ones to get a shot or something, so they don’t catch the illness or spread it around. Even the most ideologically strict proponents of freedom can usually see the sense in that.

What authorities?

But when it comes to obesity, even the most convincing arguments about public responsibility for public health tend to break down. Many people feel that it is no one’s business, especially that of a government bureaucracy, to know how many pounds the scale registers when you step on it. Perhaps a valid civic-minded argument can be made for weighing a newborn baby, because at that age, weight is the most obvious characteristic that can be non-invasively measured.

But ought the authorities to care quite so much about a kindergartener’s poundage? Does the System really need to know the circumference of each 13-year-old’s waistline? Should the authorities embarrass your children at school by weighing them?

An overview

A while back, Childhood Obesity News quoted Southern California health official Jonathan Fielding:

Public health works by successive redefinition of the unacceptable.

Consider the saying, “First they ignore you, then they laugh at you, then they fight you, then you win.” Nobody is sure who first said those exact words. It is certain, however, that trade union activist Nicholas Klein expressed the same concept in different words, and many other people have, too. There was a time when nobody had ever heard of a five-day work week or a paid vacation.

But thanks to the efforts of millions of staunch labor supporters, the unacceptable was successively redefined and became the norm. A similar process occurred back when former First Lady Michelle Obama worked to warn against and prevent childhood obesity. Voices were raised against the tyranny of governmental interference in kids’ eating habits and of families’ responsibility in that area.

Still, after two presidential terms, fewer Americans were either ignoring or laughing at the concept that childhood obesity should be taken seriously. Now it appears that the same kind of gradual change might be taking place in regard to both weight-loss drugs and bariatric surgery for teens and maybe even children.

Your responses and feedback are welcome!

Image by Pat Hartman

Medicare May Open the Door to Affordable Weight-Loss Drugs

Millions of older Americans could soon gain access to popular weight-loss medications at a fraction of their current cost. The Centers for Medicare and Medicaid Services (CMS) announced a new voluntary model program that would allow certain Medicare beneficiaries to obtain GLP-1 drugs for obesity for as little as $50 per month.

Under current law, Medicare is prohibited from covering medications prescribed solely for weight loss. However, both the Trump and Biden administrations have argued that obesity should be treated as a chronic disease and that GLP-1 medications play an important role in preventing serious health conditions such as diabetes, heart disease, and stroke.

The newly announced initiative, known as Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE), is designed to expand access to GLP-1 drugs while keeping costs under control. CMS has negotiated discounted prices with drugmakers Eli Lilly and Novo Nordisk, pairing medication access with lifestyle and nutrition support through Medicare Part D plans.

CMS Administrator Dr. Mehmet Oz said the effort is intended to “democratize access to weight-loss medication” that has previously been out of reach for many Americans. The program aims to combine medical innovation with healthier living strategies in a way that benefits patients while limiting costs for taxpayers.

How the program would work

CMS plans to negotiate both pricing and eligibility standards with drug manufacturers. Under the agreement announced last month, eligible Medicare enrollees would pay $50 per month for certain GLP-1 medications approved for obesity and diabetes, while Medicare would cover an additional $245 per prescription.

Eligibility would be limited. Those who qualify include people who are overweight with prediabetes, individuals who have experienced a stroke or other cardiovascular events, and patients with obesity combined with diabetes or severe, uncontrolled high blood pressure. Officials estimate that roughly 10% of Medicare beneficiaries would meet the criteria.

Participation in the BALANCE model is voluntary for drug manufacturers, state Medicaid programs, and Medicare Part D insurers. State Medicaid agencies can opt in starting in May 2026, with Part D plans following in January 2027. In the meantime, CMS plans to launch a short-term demonstration program that could allow Medicare beneficiaries to access GLP-1 medications as early as July. That temporary program would run through December 2031.

A shift from previous policy debates

Last year, the Biden administration proposed reinterpreting Medicare law to allow obesity drugs to be covered as treatment for a chronic condition, an approach estimated to cost Medicare $25 billion over 10 years. That effort was paused earlier this year. The current plan, by contrast, includes negotiated price reductions, which the Trump administration says will make the expansion cost-neutral.

The agreement also extends to Medicaid. Eli Lilly and Novo Nordisk have committed to offering GLP-1 medications at lower prices to state Medicaid programs, although coverage decisions will depend on individual state negotiations. As of October, 16 state Medicaid programs covered GLP-1 drugs for obesity. However, several states, including North Carolina and Michigan, have recently scaled back coverage due to rising costs.

Industry and insurer reactions

Some insurers are cautiously optimistic. The Alliance of Community Health Plans noted that GLP-1 drugs have been shown to improve health outcomes, but also warned that side effects can cause many patients to discontinue treatment within the first year. The group said it is seeking more clarity on insurer costs and long-term sustainability.

With more than 70% of U.S. adults classified as overweight or obese, CMS argues that expanding access to effective treatments could significantly reduce the burden of chronic disease nationwide. Whether the BALANCE model succeeds may depend on how well it balances affordability, patient adherence, and long-term health outcomes.

Your responses and feedback are welcome!

Source: “Medicare opens door to covering blockbuster drugs for weight loss,” CNN.com, 12/23/25
Source: “US health agency unveils weight-loss drug coverage model,” Reuters, 12/24/25
Image by RDNE Stock project/Pexels

Goodbye to 2025, and Try This

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

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

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

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

Interview with an expert

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

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

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

One thing is for sure:

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

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

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

Zimmer says,

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

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

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

Be the grownups

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

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

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

Your responses and feedback are welcome!

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

Some Complicated Angles of Weight

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

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

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

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

It’s not that surprising

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

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

One thought leads inevitably to another

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

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

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

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

(To be continued…)

Image by dbutlerdidit/Pixabay

So, relax. Eat cake.

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

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

When worlds collide

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

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

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

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

And why not?

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

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

Okay, how about not very much?

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

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

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

Your responses and feedback are welcome!

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