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Questions Cost Money and So Do Answers

Pat Hartman July 17, 2025 No Comments

This little side project focusing on financial costs will look back, starting from about 15 years ago, and notice some of the many and varied expenses associated with obesity. The citations will not be comprehensive but representative, pointing out examples of the many different ways in which global obesity costs a planetary fortune.

To pluck from history a random example in the 2010 news, “Battelle, universities win $72.5M to end childhood obesity” was the headline of a story about the awarding of $23 million by the National Heart, Lung and Blood Institute to Battelle’s Health and Life Sciences Global Business, and of $49.5 million to be shared among five universities, from which investigators would…

[…] collaborate with local, state and national organizations to test long-term interventions through several levels of influence — community youth organizations, schools, primary care providers, home and families.

The Battelle grant was also allotted for the same purpose — to study the effectiveness (or lack thereof) demonstrated by community programs in preventing childhood obesity. At the time, 17% of America’s children and teens were reckoned to be obese. In pursuit of a solution to this ever-growing problem, a lot of money is spent in the halls of academia, every year, by many of the world’s more solvent countries, and there is nothing wrong with that.

At around the same time, the University of Minnesota received a $7 million federal grant to create a childhood obesity center to influence the habits of hundreds of preschool children, while Oregon State University received $5 million from the National Institute for Food and Agriculture, with which to “develop strategies to combat rural childhood obesity nationwide.”

Intense curiosity

As promised, this financial curiosity is not even limited to the United States. In 2011, in Canada, the Toronto Area Research Group initiated a study (nicknamed TARGet Kids), which is not as sinister as the terminology implies. Its structure, being based on the already established network of family clinics, promised the continuity and integrity that is essential to meaningful record-keeping.

Apparently, a child is expected to show up for more than a dozen doctor visits before their sixth birthday. For their own good, and for the benefit of society, the system tracks every physical manifestation, including weight, waistline, and BMI. It set out, as one researcher clarified, to “define parameters of what normal is” — in the face of a new, pervasive, and potentially very damaging reality.

More than 700 children entered the database. By the two-year mark, 3,500 were involved. The people who ran the study were particularly interested in kids’ relationships with electronic screens. They already knew a lot about older children, but very little about the youngest ones. Already clear, however, was the close association between screen viewing time and the tendency to gain weight.

Of course, there is an upside. Such close observation and frequent contact also facilitate the ability to notice when a child is heading in a bad direction. Along with that comes another advantage: the likelihood that if a pediatrician spots the need for a behavioral change, it can be implemented on the spot.

Knowledge about how this or any particular program actually works contributes to increased awareness of how much it costs, and about how much it is likely to cost moving forward; information that is increasingly vital.

Your responses and feedback are welcome!

Source: “Battelle, universities win $72.5M to end childhood obesity,” MedCityNews.com, 09/09/10
Source: “U aims to head off childhood obesity,” StarTribune.com, 09/09/10
Source: “OSU wins $5 million grant for rural childhood obesity research,” GazetteTimes.com, 01/13/11
Source: “Doctors target roots of childhood obesity,” ParentCentral.ca, 05/05/11
Image by Quince Creative/Pixabay

Why Early-Life Factors Matter in Childhood Obesity

Tatyana Meshcheryakova July 16, 2025 No Comments

Childhood obesity doesn’t start in elementary school — it often begins much earlier, sometimes even before a child is born. A new study published in JAMA Network Open reinforces what health experts have long suspected: Prenatal and early-life conditions significantly shape a child’s risk for obesity later in life. These findings emphasize the importance of early intervention to encourage healthy growth patterns from the very start.

Early clues to a long-term problem

The study analyzed data from nearly 9,500 children between the ages of 1 and 9, tracking more than 53,000 BMI (body mass index) measurements. Researchers used a sophisticated modeling approach to uncover how BMI changes over time, not just whether a child is overweight at a certain age, but how and when those changes occur.

Children were categorized into two groups: those with a “typical” BMI pattern and those with an “atypical” trajectory — a group at higher risk for long-term obesity.

In a typical pattern (89% of children), BMI rose in infancy, dropped to its lowest point around age 6, then steadily increased through age 9 — a process known as adiposity rebound. In an atypical pattern (11% of children), these kids had stable BMIs from ages 1 to 3.5, followed by a steep increase through age 9. By age 9, their average BMI reached 26.2 — well above the 99th percentile.

The researchers noted that the timing of adiposity rebound is crucial. When this rebound happens earlier than normal, it’s considered a red flag for accelerated growth and increased risk of obesity and cardiometabolic conditions later in life.

Risk factors start before birth

The study also explored what environmental and biological factors were most predictive of a child following an atypical BMI trajectory. Several key prenatal and birth-related factors stood out:

High maternal BMI before or during pregnancy
Excessive weight gain during pregnancy
Smoking during pregnancy
High birth weight
Preterm birth

Each of these increased the odds of a child ending up in the high-risk BMI group.

What’s happening inside the womb can also influence a child’s long-term health in less obvious ways. For example, maternal obesity and weight gain have been linked to disturbances in the development of the infant’s gut microbiome — the ecosystem of bacteria that affects digestion, metabolism, and immune response. A separate study in Clinical and Experimental Pediatrics found that children born to mothers with high BMIs were more likely to have microbiota profiles associated with obesity by the time they turned one, especially if delivered via cesarean section.

Why this study stands out

Most past research could only offer snapshots — a child’s weight at one age, compared with a benchmark. What makes this new study different is the ability to chart the shape of growth over time and detect deviations from normal development earlier than ever.

The researchers used a novel modeling technique called multiphase latent growth mixture modeling, which captures not just the amount of weight gain, but its timing and rate of change. While the method is more complex and computationally demanding, it provides a clearer, more personalized picture of how and when a child might be veering off a healthy growth path.

A call for early action

The key takeaway? Obesity prevention may need to start far earlier than preschool. By understanding the early-life factors that shape growth trajectories, parents and healthcare providers have an opportunity to intervene during critical windows, even before birth.

Whether it’s supporting maternal nutrition and prenatal care, encouraging breastfeeding, promoting gut health, or simply monitoring weight gain more closely during early childhood, the message is clear: The earlier we address the risk factors, the better the long-term outcomes for children.

As the authors concluded:

We identified modifiable early-life factors that may place children at risk for or protect children from childhood obesity.

What can parents do?

Here are some actionable steps to reduce the risk of early-onset obesity:

Maintain a healthy weight during pregnancy. Work with a healthcare provider to stay within recommended gestational weight gain guidelines.
Avoid smoking during pregnancy. It’s a known risk factor for various childhood health problems, including obesity.
Encourage breastfeeding. It can support a healthy gut microbiome and reduce obesity risk.
Watch for early signs of rapid weight gain. Regular pediatric visits with growth monitoring are essential.
Support a healthy diet and active lifestyle from the start. Good habits formed early are more likely to stick.

While genetics and lifestyle are part of the equation, this study reminds us that environmental and prenatal factors play a powerful role. The good news? Many of those factors are modifiable. With greater awareness and proactive care (starting before birth), families and communities can help change the trajectory for the next generation.

Your responses and feedback are welcome!

Source: “Prenatal and Early-Life Contributors to Childhood and Adolescent Obesity,” The American Journal of Managed Care, 7/10/25
Source: “Early-Life Factors and Body Mass Index Trajectories Among Children in the ECHO Cohort,” JAMA Network Open, 5/22/25
Image by Leah Newhouse/Pexels

Put On Your Long-Distance Glasses

Pat Hartman July 15, 2025 No Comments

Earlier this week, the Food Institute published a news story headlined “Crops Rotting in Fields With Undocumented Farmworkers Gone,” in which journalist Marcy Kreiter included such quotations as this one from farm owner Lisa Tate:

If 70% of your workforce doesn’t show up, 70% of your crop doesn’t get picked and can go bad in one day… Most farmers here are barely breaking even. I fear this has created a tipping point where many will go bust.

Here we are, once again living in a historical era where people think about money a lot. The topic of money and the subject of obesity impinge upon each other quite extensively. On the one hand, it looks like, for a while anyway, people will find their eating habits painfully costly, and that’s not even for occasional, treat-type eating — but for what used to be considered modestly normal fare, like maybe an omelet. Even way back in the 1950s, the phrase “What’s that got to do with the price of eggs?” could be heard, and it experienced a revival in the early part of this year when egg prices went bananas.

Now, the price of a fast-food drive-through lunch is more like what used to be dinner at a sit-down restaurant. So in a way, rising food prices many affect obesity rates simply because people will not be able to afford sufficient food. That definitely comes under the heading of “mixed blessing.”

On a related topic…

But what actually we hope to look at here is the overall cost of obesity to society as a whole, which is not negligible. Nor is the topic of only recent interest. Way back in 2012, for instance, journalist Jeff Springer compiled a very partial list of some of the ways in which obesity tends to cost everyone money, whatever their own personal weight might happen to be. For instance:

– Americans consume 938 million extra gallons of gas/year due to excess passenger weight which results in an extra $4 billion in obesity related gasoline costs.
– Airlines use an estimated 350 million additional gallons of fuel to handle excess weight in passengers (a cost which gets passed on to everyone)
– The estimated indirect cost of obesity in America is $450 billion per year

And all of that was more than a dozen years ago. On the individual level…

– Obesity costs the average man an extra $2,646 per year and the average woman an extra $4,879 on average

This could mean a lot of things, from the necessity to buy an extra airplane seat to the bespoke tailoring of plus-size shirts.

At any rate, in the following year, Cardiology Editor Chris Kaiser asked several sources about the government’s use of a 10-year window to calculate the amount of money it might save by projecting the cost of obesity prevention efforts into the future. Perhaps shockingly, a 75-year investment window has been suggested instead. Economist Alex Brill opined,

The 10-year window effectively distorts policymakers’ perspective on preventive health policies by focusing on the initial cost of the interventions and failing to capture the full scope of the policies’ impact in the long term… Properly modeled, effective obesity prevention measures will demonstrate their cost-containment effects outside the 10-year window.

Take, for example, one million American girls for whom early screening could catch their propensity for overweight before it is too late and potentially save, over time, more than 40 billion dollars. Similarly, participation in the Diabetes Prevention Program that steers a million women away from developing that condition could save, over time, nearly $20 billion. If a million older women were prescribed weight-loss drugs under Medicare Part D, the budget would experience a savings of more than $10 billion, over time. That in itself is a problem, as investors tend to want measurable results that manifest more promptly than “over time.”

The point being, when only a 10-year window of time is under consideration, only the costs for these interventions are apparent (not the payoffs), and interventions may tend to appear superfluous in the short run. By peering several decades into the future, it becomes evident that the savings would be considerable, and worth grasping for.

Your responses and feedback are welcome!

Source: “Crops Rotting in Fields With Undocumented Farmworkers Gone,” FoodInstitute.com, July 7, 2025
Source: “The Economic Costs of Obesity,” BusinessPundit.com, 08/15/12
Source: “Fighting Obesity Long Term Will Save Money,” MedPageToday.com, 04/27/13
Image by geralt/Pixabay

Oprah and the Price of Success

Pat Hartman July 10, 2025 No Comments

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

Tatyana Meshcheryakova July 9, 2025 No Comments

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

Pat Hartman July 8, 2025 No Comments

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

Pat Hartman July 3, 2025 No Comments

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

Tatyana Meshcheryakova July 2, 2025 No Comments

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

Pat Hartman July 1, 2025 No Comments

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

Pat Hartman June 26, 2025 No Comments

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

Intense curiosity

Early clues to a long-term problem

Risk factors start before birth

Why this study stands out

A call for early action

What can parents do?

On a related topic…

The revolution

Psychological benefits and challenges

Social and cultural complexities

Role of psychology in GLP-1 use

GLP-1s and addiction treatment

Alleviating migraines, but it’s a pancreatic risk

CVS Caremark drops Zepbound from coverage, citing cost

Celebrities everywhere

Earthquake

Changing the world

Why this matters

The science behind maridebart cafraglutide

The clinical trial’s design and participants

Substantial weight loss followed

Safety and side effects

Why dose escalation matters

No such thing as bad publicity

An Oprah-approved institution

History

Profiles: Kids Struggling with Weight

The Book

About Dr. Robert A. Pretlow

Presentations

Food & Health Resources