The Fast-Changing GLP-1 Landscape and Employee Coverage

GLP-1 medications continue to dominate conversations in the world of employer-sponsored health benefits, and it’s not hard to see why. These drugs have already reshaped care for millions of people living with type 2 diabetes and obesity, delivering meaningful improvements in weight (including in children), cardiovascular health, and overall quality of life. And their reach is expanding fast.

Beyond their well-established role in diabetes and obesity treatment, GLP-1s are now being researched for a wide range of additional conditions — everything from osteoarthritis and Alzheimer’s disease to diabetic complications — and even addiction. As scientific interest grows, so do the complexities employers face in managing pharmacy benefits, projecting future costs, and determining what coverage makes sense. This, of course, directly affects the employees and their families, including their kids.

Let’s take a quick look at the latest developments in the GLP-1 market and what they could mean for employer health programs in the months and years ahead.

Oral GLP-1s are poised to change the market

One of the most anticipated shifts in the weight-loss drug space is the arrival of oral GLP-1 therapies. Oral semaglutide — built on the same active ingredient used in Ozempic, Wegovy, and Rybelsus — is expected to receive approval soon for obesity treatment and for reducing cardiovascular risk in people with obesity. If authorized, it will become the first oral GLP-1 specifically approved for weight management.

Another contender, Lilly’s orforglipron, is expected to receive approval in 2026. Clinical trials show promising results: patients lost roughly 7.8% to 12.4% of their body weight over 72 weeks, only slightly below the outcomes typically seen with injectables.

Because many people prefer pills over injections, oral GLP-1s may boost both uptake and adherence. That likely means increased utilization and higher claims volume. What about pricing? Despite lower manufacturing costs, oral GLP-1s are unlikely to be much cheaper than injectables, and some may even carry a premium due to convenience and strong clinical outcomes.

Generics and new pricing pressures

Cost relief may finally be on the horizon, albeit slowly. Generic versions of Victoza (for diabetes) are already available, and the first generic alternative to Saxenda (for weight loss) has been approved. More generics for Saxenda are expected by March 2026, which should drive prices down.

However, employers won’t see generic versions of the most in-demand injectables (like Ozempic) until at least 2031. Another form of price pressure is emerging: semaglutide products (Ozempic, Wegovy, Rybelsus) appear on Medicare’s 2027 drug price negotiation list. New “Maximum Fair Prices” will be announced in November, and while manufacturers aren’t required to extend discounts to commercial plans, some ripple effects are possible.

What does it mean? Generics won’t dramatically reduce GLP-1 spending in the short term. Medicare negotiations may influence commercial pricing, but the extent is impossible to predict. And employers that currently exclude weight-loss drugs might consider a future “generic-only” benefit once Saxenda generics are plentiful and affordable.

Direct-to-consumer (DTC) models are shaking up pricing

The GLP-1 boom has sparked a wave of direct-to-consumer (DTC) offerings that drastically undercut typical retail prices. Lilly Direct (for Zepbound) and NovoCare (for Wegovy) give patients simplified access and steeply discounted rates. Novo Nordisk even partnered with Costco (yes, Costco) to offer Wegovy at its DTC price through Costco pharmacies. Employers that exclude weight-loss GLP-1s are exploring how to guide employees toward low-cost DTC options without adding these drugs to the plan.

Is this the next “Wonder Drug” class?

GLP-1 therapies continue to earn FDA approvals for conditions beyond diabetes and weight management. Recent developments include Wegovy being approved to treat metabolic-associated steatohepatitis (MASH), and Zepbound being approved for obstructive sleep apnea in people with obesity.

Meanwhile, ongoing trials are evaluating potential use in osteoarthritis, diabetic complications, Alzheimer’s, and addiction — studies that could dramatically widen the patient population in future years.

What does this mean for employer plans?

Employers that already cover GLP-1s for weight loss likely won’t see a large increase in utilization, since the affected populations overlap significantly. Employers that don’t cover weight-loss GLP-1s must make strategic decisions about new indications and potential cost implications, as rebates are typically unavailable unless all FDA-approved indications are covered.

It’s also worth noting that cost-benefit profiles vary widely by condition. In some areas, like MASH, GLP-1s may be cheaper than alternative treatments. In others, such as sleep apnea, they may cost more than existing non-drug therapies.

The weight-loss drug pipeline is exploding

GLP-1s may be leading the market now, but they’re far from the only players. More than 170 weight-loss drug candidates are moving through development pipelines across 82 manufacturers. Many follow GLP-1 pathways, but others target entirely different biological mechanisms, some of which may reduce common side effects like nausea.

One standout is Amgen’s MariTide, a monthly injectable that has shown an impressive 20% average weight loss in one year of clinical trials. Its monthly dosing may appeal to patients looking for convenience over weekly injections.

GLP-1 therapies and the broader weight-loss drug category are moving faster than almost any other segment of pharmacy benefits. For employers, that means the long-term strategy must remain flexible and data-driven as employees may increasingly request coverage for themselves and whoever else is included in their health plan.

Your responses and feedback are welcome!

Source: “Top Five Developments in GLP-1s, Weight-Loss Drugs,” CBIA.com, 11/12/25
Source: “Ozempic at Costco? Discount Giant Expands Into $100 Billion Weight-Loss Drug Market,” Yahoo.com, 10/19/25
Image by JESHOOTS.com/Pexels

The Basis of Castlewood

We mentioned Sybil, a best-selling book in the early 1970s, which, in subsequent years, unintentionally increased the amount of interest in a place called Castlewood Treatment Center. The Castlewood experience was later (very recently!) described by journalist Rachel Corbett as “The Therapy That Can Break You.” Corbett’s meticulous and thorough history provides a full picture of how the situation developed into a program that, however innovative and well-intentioned, did not turn out to be the epitome of childhood obesity prevention or treatment.

The methodology called Internal Family Systems, or IFS, started out hopefully, but was unable to provide the needed answers for many… and that is putting it mildly. On the other end of the spectrum, the psychological model either has been or could reasonably be characterized as weird, bizarre, contested, revolutionary, misinterpreted, harmful, and/or dangerous.

The ideas developed, held, and disseminated by founder Richard C. Schwartz had always encountered a certain amount of resistance, as unconventional ideas will tend to do. His theory was developed in the 1980s, when the public had not only been exposed to Sybil but also influenced by many similar publications that jumped on the sensationalist “multiple personalities” bandwagon. The literate world had experienced a couple of decades of ever-increasing interest in theories, which, in turn, contributed to a perfect storm in the realm of public willingness to consider unfamiliar and previously unacceptable ideas.

The backstory

Before Schwartz came along, there was a condition known as dissociative identity disorder, which meant that the patient’s body was inhabited by more than one complete personality. Since medical conditions were given Latin names, another self was called an “alter ego.” In literature, one of the fictional works that popularized the notion was Strange Case of Dr. Jekyll and Mr. Hyde by Robert Louis Stevenson, which emphasized the idea that the polarity between dual personalities must necessarily be “good versus evil.”

In the course of learning about dissociative identity disorder, psychiatry found that there might even be more than one alternative personality, along with the original and the first alter. There might be several multiples, who may or may not be aware of each other. They might battle for dominance, and could, at the very least, find many different ways to complicate and damage the life that the body they cohabited was trying to establish as an individual.

Not surprisingly, this condition was viewed as a sickness, or at the very least, an undesirable and potentially damaging condition. Alters might be discovered or uncovered through hypnosis, and the therapeutic approach taken by psychiatry was to attempt to knit the two, three, or more personalities into one entity that would function in harmony with itself.

The controversy

Critics maintain that there is no scientific basis for a belief that the condition, abbreviated as DID, even exists. On the other hand, brain scans (of which there are five distinct types: MRI, CT, PET, SPECT, and fMRI) had been used to prove quite a number of medical theories up until that point, so it is interesting to see what a typical scientific report says about dissociative identity disorder.

For instance, one publication described a meta-study that encompassed 13 studies on patients with dissociative identity disorder, depersonalization disorder, dissociative amnesia, and similar conditions, and what their various brain scans showed. Naturally and understandably, researchers always wish there were more hardcore studies to base conclusions on, but there is what some professionals consider pretty solid evidence to suggest “the existence of particular brain activation patterns in patients belonging to this diagnostic category.”

The Conclusions section of this particular paper goes into more detail about particular disorders, but the overall picture is this:

Prefrontal dysfunction is frequently reported in dissociative disorders. Functional changes in other cortical and subcortical areas can be correlated with these diagnoses. Further studies are needed to clarify the neurofunctional correlations of each dissociative disorder in affected patients, in order to identify better tailored treatments.

(To be continued…)

Your responses and feedback are welcome!

Source: “The Therapy That Can Break You,” TheCut.com, 10/30/25
Source: “Functional Neuroimaging in Dissociative Disorders: A Systematic Review,” NIH.gov, 08/29/22
Image by World Obesity Image Bank

An Ounce of Prevention, Part 3

As always, it is helpful to look at the various attempts that have been made to turn back the tide of childhood obesity, or at the very least, to prevent the surpassing of its current level. This series highlights why many parents so fervently hope that their children will not become obese, and how some parents want to do everything possible to keep this from happening. Sadly, circumstance has placed in the way of that worthy ambition a major stumbling block, i.e., the very fact that we are human.

If Earthlings are being surveilled and discussed by intelligent observers from somewhere else, our attitude toward food must leave them deeply puzzled. One extraterrestrial scientist says, “You know, I comprehend the ones who never have enough to eat. Their goal is basic survival, to sustain life itself. If they think about food and eating all the time, this is perfectly understandable.”

They just don’t get it

And the Extraterrestrial colleague says, “Sure. But look at the others, the ones who have so much food, they drown in it. They too think about consumption all the time! Build their day around it. Count up their energy units. All kinds of crazy nonsense that wastes the very essence of life they are so avid to preserve.”

The first ET scientist shakes one of its heads and says, “Check out this human specimen I’ve been observing. It does not want its body to increase in size. This could be prevented by causing some energy to be expended. So — and you won’t believe this — it goes out and activates its personal automated vehicle, in order to travel to the gym and — wait, what do they call it? — ‘Do some exercise’.”

It comes with the cream

Those researchers write a paper about how a little thing called “human nature” will always get in the way, warp our perceptions, pervert our best impulses, and waste our time and precious energy as we quarrel over details and side issues. Meanwhile, we are all in the same metaphorical sinking ship, and because of that, the best we can do, here on the Titanic, is to rearrange the deck chairs and play a tune, which explains the importance of Art in our relationship with the Universe.

Human nature has very much the appearance of being a package deal, where we must take the bitter with the better, and where we spend enormous energy to sabotage our own best interests. In the course of trying to solve our huge problems, we are capable of ideas and actions that turn out to be outrageously counterproductive. Often, enormous damage has been done before we figure this out, if we ever do. We humans are such contrarians, we are almost never able to totally stop working against our own best interests.

Parents are in a great position to understand how obesity works because they have gone through the experiences of being a child, an adolescent, and a young adult. Women are especially aware, because they are going to gain a certain amount of weight as expectant mothers, and of course, the fathers will notice the size increase too.

At any rate, it is to be hoped (though rarely achieved) that, once we understand what a drag it is to get out of obesity, we parents will be deeply inspired to instead prevent obesity. It is very easy to say that families should seek help from therapists. The next steps, finding a good therapist and affording the care, are quite a lot more difficult — and the hard part has not even started yet. Even with the aid of a professional, family conflicts and traumas can be incredibly difficult to cope with. Also, now in particular, the societal sources of help are drying up.

At any rate, after taking the long way round, we circle back to the main subject of this sequence, which is the type of therapy called IFS, or Internal Family Systems, about which there are two very important things to know. First, IFS has been widely utilized to address eating disorders and seems to have been promoted as particularly adaptable to this specific spectrum of problems.

Also, “Some patients say it’s destroyed their lives.”

(To be continued…)

Your responses and feedback are welcome!

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

GLP-1 Drugs and Youth: Why More Research Is Needed Before Expanding Use

In just a few years, medications like Ozempic and Wegovy have gone from niche diabetes treatments to global sensations. On social media alone, the hashtag #Ozempic skyrocketed from 2 million views in 2021 to over 1.2 billion by 2023, fueling massive demand and positioning GLP-1 drugs among the fastest-growing prescriptions of the century.

While originally intended for people with type 2 diabetes, these medications are now being hailed as revolutionary tools for weight loss. Their success has inspired both clinical innovation and public fascination, but it’s also raising difficult questions, especially as their use spreads to younger populations.

What are GLP-1 drugs?

GLP-1 drugs mimic natural gut hormones called glucagon-like peptide-1 analogs, which help regulate blood sugar and appetite. Older versions, such as exenatide and dulaglutide, have existed for decades, but newer formulations like semaglutide (Ozempic/Wegovy) are far more potent. They’re now considered a central part of modern obesity and diabetes care.

However, the rise of GLP-1 prescriptions isn’t limited to adults. In the United States, use among children and teens has surged nearly 600% in the past five years, driven by rising obesity rates and FDA approval for adolescents 12 and older. Yet despite this rapid growth, international data remain sparse, and pediatric guidelines lag far behind adult research.

How GLP-1s fit into pediatric weight management

According to the Global Obesity Observatory, the U.S. ranks among the top 10 countries for obesity rates. Traditionally, treatment for childhood obesity has focused on nutrition, physical activity, and behavioral change. But that approach is evolving.

In 2023, the American Academy of Pediatrics (AAP) updated its clinical guidelines, recommending that pediatricians consider weight loss medications for patients aged 12 and older with obesity (defined as a body mass index (BMI) in the 95th percentile or above). The AAP also suggests bariatric surgery for teens 13 and up who face severe obesity and related health complications.

Still, the AAP stresses that medication should not be the first step. Lifestyle and behavioral interventions — especially those involving family participation — remain the foundation of care. These programs focus on building sustainable habits around eating, exercise and emotional well-being, often requiring consistent, long-term engagement.

GLP-1 use around the world

While the United States has embraced GLP-1 medications more rapidly than most nations, the global picture looks very different. In the U.K., GLP-1s are only approved for people with a BMI over 30, and patients must reapply for treatment every two years. In the Netherlands, approval starts at a BMI over 35. In the U.S., insurance often covers the medication for just one year, even though it’s meant for long-term use.

Some countries, such as India and Canada, have begun crafting pediatric guidelines. The Indian Academy of Pediatrics permits GLP-1 use for adolescents 12 and older with severe obesity (BMI ≥ 40) or life-threatening complications. Similarly, the Canadian Medical Association Journal recommends combining GLP-1 therapy with behavioral and psychological interventions.

Yet, despite these developments, international research on pediatric use remains limited. Most studies focus on adults, leaving many unanswered questions about long-term safety, effectiveness, and psychological impact for children and teens.

Balancing benefits and concerns

GLP-1 drugs offer a promising new tool in the fight against childhood obesity, but they also introduce complex challenges. For one, starting these medications at a young age could mean lifelong use, with uncertain implications for physical and emotional development. Adolescents may not fully grasp the commitment or side effects that come with chronic medication use.

There’s also the question of mental health and body image. Adolescence is a sensitive time, and focusing heavily on weight can affect self-esteem, peer relationships, and social participation. For many families, the goal isn’t just weight loss — it’s helping children build confidence and lifelong healthy habits.

Finally, researchers simply don’t know enough about how GLP-1s affect children over the long term. Clinical trials in adults show promising results, but pediatric data trails far behind. Without clearer evidence, experts caution against over-reliance on these drugs before understanding their full impact. Until science catches up, one thing remains clear: when it comes to kids and GLP-1s, careful consideration is just as vital as clinical innovation.

Your responses and feedback are welcome!

Source: “How Ozempic and GLP-1s Are Changing Childhood and Teen Weight Management,” Think Global Health, 10/31/25
Source: “The Ozempic Era,” Medical University of South Carolina, 8/29/24
Image by Markus Winkler/Pexels

An Ounce of Prevention, Part 2

Yes, according to one of the most familiar platitudes in English, “An ounce of prevention is worth a pound of cure.” Probably every other human language on earth has an equivalent old saying, because it is just so ridiculously, platitudinously true.

In this context, the meaning is obvious. We try to tell kids: Please make every effort to not be an obese child, because as you grow up and inevitably grow older, something unpleasant is programmed to occur. Most likely, you will wake up and realize it is time to shed those extra pounds, because you’re not a kid anymore. In addition, the effort to lose those pounds will make your life much more difficult than it would have been, if you had never added them in the first place.

Of course, kids never listen anyhow. Maybe some grownups listen, and if they have kids, they might take that warning to heart — especially because they probably know the truth firsthand. It behooves every parent to try to figure out how to get this message across in a way that might penetrate the juvenile mindset.

The oldsters do not say “You’ll be sorry” out of love for the lilting rhythm of the phrase. Hey kids, we know for a certainty that you will be sorry, because we made the same stupid mistakes, and we are now sorry, and we don’t care who knows it.

Monkey see, monkey do

This cannot be said too often: Children are much more likely to imitate what they see at home every day, than to follow precepts that are taught in any other way. A childhood that features unmonitored eating habits is awfully hard to overcome. Not to become a fat kid is a very difficult life challenge. Careless and excessive consumption makes it almost impossible to ever stop being a fat kid.

The great majority of grownups probably have a profound personal understanding of how difficult it is not to remain a fat kid. In other words, most adults grasp, from their own experience, how hard it is to retreat from the categories of “overweight” and “obese.”

But as Werner Erhard has said, “Understanding is the booby prize.” An adult can realize how difficult it is to lose body weight, and grasp the meaning of the sentence all day long, but none of that can help much. It is probably already too late for them, and their awareness and experience do not seem to go very far toward helping the next generation.

Plenty of words out there

There are a lot of words we can use in trying to convey to a child the importance of eating only worthwhile foods, and even then, not too much of them. Here’s the catch. By the time a child can understand the words, she or he has already logged several years of much more convincing communication. Mr. or Ms. Grownup, that kid has had an eye on you from Day 1, clocking your every move. Every single treat, snack, and third helping. It’s all there, on the shelves of their brain libraries.

Why must so much emphasis be placed on the prevention of childhood obesity? Because of a fact that becomes increasingly difficult to ignore with each passing day. We cannot avoid noticing that childhood obesity almost inevitably leads to adult obesity.

Okay, admittedly, there is another possibility, one that is equally damaging. A person can spend an entire lifetime tirelessly, devotedly taking measures to fend off adult obesity; every minute of every day being acutely conscious of the weight-related consequences behind every bite of food. That sounds like zero fun.

A grownup can be in therapy, able to recall and comprehend in exquisite detail every single factor in three decades of life that led to being a 30-year-old who weighs 350 pounds. But… Understanding is the booby prize.

Your responses and feedback are welcome!

Image by endho/Pixabay

An Ounce of Prevention, Part 1

In the realm of wisdom passed down through the generations, one of the most tried-and-true (and trite) sayings is, “An ounce of prevention is worth a pound of cure.” The maxim includes two terms that measure weight, which is very appropriate because weight is the subject here.

In the USA and the world, the emphasis on childhood obesity is a vital part of the overall health picture. Why? Because “As the twig is bent, so grows the tree,” and also because other corny old sayings with the same meaning are found all over the globe and in a variety of languages. They are all truthful descriptions of a real phenomenon.

“Give Me the Child Until He is Seven, and I Will Show You the Man” is a saying whose attribution is contested, but whose veracity is rarely questioned. Adjusting for traditional sexism, of course, it means that anyone who is entrusted with the upbringing of a child, male or female, during those first six years, is pretty much guaranteed to produce a kid trained to their satisfaction.

An even deeper truth is at work here, which is the rule known as “Monkey See, Monkey Do.” In other words: Granted, it is very likely that a child can be trained by deliberate and purposeful instruction. Still, it is even more likely that the kid will pick up the habits and ways that are consistently demonstrated by adults and observed by the child, rather than the ones being programatically instilled. Because, to roll out yet another ancient proverb, “Actions speak louder than words.”

Digression: an impactful best-seller

In 1973, Flora Rheta Schreiber published the hefty (almost 500-page) non-fiction book titled Sybil. Consequently, most people heard about multiple personalities for the first time, as the patient in the book had 16 of them. This is mentioned only to establish that prior to the publication of Sibyl, most Americans had never heard of any of this stuff. Suddenly, the multiple personality concept achieved wide awareness. People — especially parents — were primed and ready to hear more.

Now, granted, the odds of any one particular child developing such a serious problem are slim. Still, it is one of many possibilities. Given the choice, most parents would rather not have a situation like this to deal with, for the sake of the child and of themselves and their other children, and indeed for the well-being of the general public.

In the intervening decades, various branches of the psychological arts have taken on the challenge of rationalizing and working with multiple personalities. Some people are comfortable explaining them as visitors from the past, who previously had bodies and all the other accoutrements of standard human life. These tourists can be accepted as perfectly legitimate echoes of a person’s own previous incarnations, who have returned to work out their karma.

Or maybe…

Another narrative requires absorbing some information about the theories of Richard C. Schwartz, who may be thought of in shorthand as the father of IFS, the initials that must become intimately familiar if the rest of this is to make any kind of sense. IFS stands for Internal Family Systems, the operating assumption and principle connected with Schwartz’s controversial Castlewood Treatment Center. In a very recent article, journalist Rachel Corbett announced right up front and up top,

Internal Family Systems is a widely popular trauma treatment. Some patients say it’s destroyed their lives.

Corbett backed this up by presenting a case study, that of teenager Elizabeth Lerz, who in 2011 convinced her parents that her eating disorder necessitated a stay at Castlewood. They were relieved that she was amenable to treatment and that they were able to afford the hefty fee. What could go wrong?

All too soon, the answer became apparent. Mr. and Mrs. Lerz discovered that after four months of inpatient therapy, their daughter had become a hostile stranger who made horrendous accusations against them. This is not the place to cover those aspects in detail. Suffice it to say that, after enormous legal expenses, followed by 14 years (and counting) of hostile alienation, the family never recovered.

(To be continued… )

Your responses and feedback are welcome!

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

Diabetes Still Rising Despite Weight-Loss Drug Boom

New data shows a surprising shift in America’s health landscape: fewer adults are obese today compared with just a few years ago. According to a new Gallup National Health and Well-Being Index survey released on October 28, 2025, an estimated 7.6 million fewer adults now meet the clinical definition of obesity than in 2022.

GLP-1 drugs may be part of the reason

The national adult obesity rate — defined as having a body mass index (BMI) of 30 or higher — has dropped from 39.9% in 2022 to 37% in 2025, Gallup found. It’s a modest but meaningful decline after decades of steady increases.

Experts suggest that a major contributor could be the growing use of GLP-1 injectable drugs, such as Ozempic and Wegovy. These medications, approved by the U.S. Food and Drug Administration for weight loss in 2021, help regulate appetite and make people feel fuller longer — resulting in significant weight reduction for many users.

A rapid surge in weight-loss drug use

In just the past year, GLP-1 use among adults more than doubled, according to Gallup. About 12.4% of respondents now say they use these drugs, compared with 5.8% in early 2024, when the survey first began tracking them.

The popularity of these injectables has soared so much that nine in 10 Americans are now aware of them, according to separate research from the Pew Research Center. Over half of U.S. adults believe that using GLP-1s for weight loss is a good idea.

At the same time, Medicaid coverage for these drugs has expanded: 13 states now fully cover GLP-1s for obesity treatment. However, major disparities remain — access to the drugs still varies widely across income levels, racial groups, and regions, as some research indicates. Some people even attempt to make GLP-1 compounds at home to cut costs, raising safety concerns. Yes, really. It’s called “gray GLP-1s,” or just “gray.” And we’ll look at it soon.

Experts say that a stronger insurance and pricing framework could make GLP-1 treatments more accessible and sustainable in the long run, potentially cementing them as a cornerstone of America’s obesity strategy.

Diabetes hits a record high

Even as obesity rates fall, the picture isn’t entirely bright. The same Gallup survey found that diabetes diagnoses have reached an all-time high of 13.8% among U.S. adults.

Among those with diabetes, 14.1% said they use GLP-1 drugs — a slightly higher rate than among the general adult population. While the medications can improve blood sugar control and aid weight management, they aren’t a cure. Experts caution that genetics, environment, and lifestyle choices still play major roles in both obesity and diabetes risk. GLP-1s are one tool among many — not a silver bullet.

Health beyond the injection

The findings highlight an important truth: While medical advances can make weight loss easier, lasting health improvements still depend on holistic habits. Balanced nutrition, regular physical activity, and preventive healthcare remain essential.

Your responses and feedback are welcome!

Source: “The obesity rate in the US has declined. Are GLP-1s responsible?,” USA TODAY, 10/28/25
Source: “Uptake of and Disparities in Semaglutide and Tirzepatide Prescribing for Obesity in the US,” JAMA Network, 4/29/25
Image by Moe Magners/Pexels

Obesity: Bug or Feature?

Of course, all of our children are bound to belong to some category or other — quiet or loud; emotional or stoic; wanderer or stay-at-home; academic or athletic. As they grow, they will expand into even more categories: married or single; white-collar or blue-collar; traveler or stay-at-home, and so on.

All else aside, an obese adult is surely one category that no one wants their child to grow into. This is why we work so hard to help our kids, and everybody’s kids, if we can, to avoid being overweight. Most people in that group seem to get kind of stuck in that role. It is a tough category to grow out of.

What parent wants to see their child insulted by some nobody who says, “You’re so fat, what are you gonna be when you grow up? A stand-up comedian?” That cruel person has a point, however rude and hurtful it may be. Statistically, among the professional funnyperson demographic, extremely hefty people have been over-represented.

Obese actor John Belushi

John Belushi used heavy drugs, heavily, which no doubt contributed more than anything else to the physically ramshackle condition he was in when he died at age 33. And there seems to be little doubt that an overdose killed him. But he was also extremely and unapologetically overweight.

For OKMagazine.com, an uncredited author wrote that throughout life, Belushi had been chronically stressed, and that had contributed to his drug addiction and also led to an eating disorder. His appetite was a topic of discussion in his circle, and one biographer said,

John had a huge appetite. The way he physically ate food was larger than life. He would stuff himself. He could not eat enough food.

All this earned Belushi a 24-page autopsy report after his death at “only 222 pounds.” Later, forensic pathologist Dr. Michael Hunter reported that obesity had done massive damage by stressing the star’s heart, causing hypertension and a mortal risk. Psychologist Dr. Linda Papadopolous informed the public that an emotionally disturbed person will binge-eat as a coping mechanism, adding, “And this certainly would have applied to John.”

As if drug addiction, massive overweight, early death, and wasting a prodigious talent were not enough already enough of a legacy, Belushi unintentionally left behind a loose end. Years later, a significant problem landed on people who had only wanted to honor him. These were creative artists who intended to commemorate his life and work in a documentary film.

More than 15 years ago, actor Emile Hirsch intended to play the lead in a Belushi biopic. The funding to start work had not materialized, and no contract had been signed. Yet the director told Hirsch to start putting on the necessary weight, then production would commence.

Hirsch later told journalist Samantha Bergeson,

There’s all kinds of tricks and transformations. Ultimately you have to get the spirit of him first, the most important thing. It’s kind of annoying though because people are automatically so obsessed with the weight. I’d be the biggest sucker in the known universe to go and, like, gain 100 pounds.

Whatever artistic and commercial advantages he might gain from making the film, the idea of wrecking his body for such an uncertain outcome was untenable. The actor went on to relate how he had confided to people that, instead, the whole project had been reconceptualized. The movie would feature a thin Belushi, so actually he intended to not gain, but to lose weight in preparation for the role. In other words, at least he got some fun out of messing with people’s heads.

Your responses and feedback are welcome!

Source: “Overweight & Out Of Control! What Caused John Belushi’s Shocking Death?,” undated
Source: “Emile Hirsch Says John Belushi Biopic Director Was ‘Stupid’ for Asking Him to ‘Gain 100 Pounds’ Before the Film Was Greenlit,” IMDb.com, 09/20/24
Image by OK Magazine

We Are All From Ipanema

The previous post referenced the Girl from Ipanema, who was, by the way, a real person. At the tender age of 17, Helô Pinheiro inspired the world-famous song. Between the days of her international fame and the present, things have changed a lot, as suggested by the title of a New York Times article, “Brazil, Land of the Thong, Embraces Its Heavier Self.” It was published almost four years ago, so matters could only have gotten worse since then. In fact,

In 2020, nearly 29 percent of Brazilians older than 20 were obese, up from roughly 15 percent in 2000, one of the largest increases of any country over that period … Among the 10 most populous nations, only Mexico, the United States and Russia had higher obesity rates, ranging between 31 percent and 37 percent, according to the data.

Journalist Jack Nicas took a penetrating look at the Brazilian city of Recife, which had been dubbed one of the fattest in the country. He spoke with Karla Rezende, an activist who worked for the passage of laws designed to make the lives of overweight and obese people a bit less traumatic.

When Rezende discovered that passenger plane seatbelts did not fit her, she went the political route and worked for laws that would cause that situation to be rectified. Reforms have included practical measures like the installation of larger desks in schools, as well as the requirement to make teachers conscious of weight-based discrimination so they can pass the knowledge on to students.

Fresh vocabulary

The official language of Brazil is Portuguese, which now contains the word “gordofobia,” meaning discrimination based on weight. Gordofobia is vigorously discussed on local television, and millions of citizens fill the social media with discussions of it. Here are two of the shocking subjects.

Brazil’s biggest pop star, Anitta, has made waves by including obese women in her music videos, and sometimes by not even editing out her own cellulite. And after the Brazilian country-music star Marília Mendonça died in a plane crash last year, some journalists and commentators who mentioned her weight in that context were widely criticized.

Making a federal case of it

While in some countries, overweight acceptance just quietly advances, in Brazil, it became a major focus of the media, and a topic of fierce debate on the city, state, and national levels. In 2015, federal law classified overweight as a form of disability that needed to be protected by such measures as wide seats on public transportation and in soccer stadiums. The state of Rondônia legislated a guarantee that overweight people should be entitled to dignified treatment and untrammeled access to all places, along with being shielded from gordofobia.

Three states adopted a day, September 10, when overweight people’s rights are promoted. This part is not written, but it is a fundamental human right: not to be expected to have a perfect body with perfect curves. Another unspoken but existing right is not to be coerced by public opinion into submitting to bariatric surgery because other people believe you take up too much space.

Longtime Childhood Obesity News readers will remember Rebecca M. Puhl, Ph.D., whose area of expertise is the treatment of obesity by media outlets. This scholar has taken quite an interest in how Brazil is handling the matter. Nicas mentions an example:

[A] judge ordered a comedian to pay a $1,000 fine for making jokes about an obese Brazilian dancer’s weight. “The defendant exuded unequivocal gordofobia,” the judge said in the ruling. Freedom of speech is allowed, the judge added, “but it’s the state’s duty to protect minorities.”

Dr. Puhl remarks that most other countries, including the USA, are lagging behind Brazil in making sense out of all this. We may not want to go as far as punishing comedians for what they say on a nightclub stage, but there are plenty of other areas where we could stand some improvement. In 1976, Michigan was way ahead of the crowd in passing a law that “formally protected people from weight discrimination,” but other states have not followed the example.

Meanwhile, Brazil has continued to enact statutes meant to discourage gordofobia. Still, residents of that country say that despite a decade of progress, the sought-after improvement has proceeded at a glacial pace.

What has happened much more quickly is the increasing poundage of almost everyone in almost every country on the planet.

Your responses and feedback are welcome!

Source: “Brazil, Land of the Thong, Embraces Its Heavier Self,” NYTimes.com, 02/27/22
Image by guertzen/Pixabay

The Fat Tax in Brazil

What 1960s worldwide hit went on to become the (probably) second-most recorded pop song in history? That’s right, “The Girl From Ipanema,” written by Vinícius de Moraes and Antônio Carlos Jobim:

Tall and tan and young and lovely
The girl from Ipanema goes walking
And when she passes
Each one she passes goes “Ah!”

Additionally, the cool swing and sway of her walk reminds onlookers of a dance called the samba… But what is the use of reminiscing about a sight that has become increasingly rare in Ipanema or anywhere else in Brazil? Sadly, the nation that The New York Times journalist Jack Nicas called “a country known for beach bodies” has changed a lot in the intervening six decades.

Brief digression

Obviously, no one here advocates that overweight and obese people should be mistreated in any way, whether at school, at work, or in the wild. On the other hand, it is a pretty good bet that most obese people would prefer not to be in that situation, which can be uncomfortable in many ways: physically, emotionally, and — as we have especially been looking these days — financially.

One current trend is that all sorts of people pay big bucks in efforts to counteract the unpleasant effects of obesity, their own and others’. But it does not have to be like this. If we could somehow manage to be honest with ourselves and tolerant of others, those two practices would go a long way toward figuring out how to turn this thing around.

Meanwhile, back in Brazil

Still, some might argue that there is such a thing as too much tolerance. For example, in Brazil, obese people are favored with “preferential seats on subways, priority at places like banks and, in some cases, protection from discrimination.”

Note: Many would say that “protection from discrimination” belongs on a different list, because everyone should be protected from discrimination at all times. Everyone has enough problems already, and nobody needs that nonsense.

At any rate, Nicas has described how new laws have “made Brazil the world leader in enshrining protections for the overweight” while an “accelerating movement” has caused the country to become “one of the world’s most accommodating places for people with obesity.” Nicas writes:

[T]he schools are buying bigger desks, the hospitals are purchasing larger beds and M.R.I. machines, and the historic theater downtown is offering wider seats.

Many citizens resent all this, reasoning that ultimately, sooner or later, one way or another, every customer pays for these seats and desks and beds and machines. Many people favor tolerance in theory but can’t help thinking that perhaps, in practice, there has been a bit too much of it. As Nicas reported in February, “Over the past 20 years, Brazil’s obesity rate has doubled to more than one in four adults.”

Each day when she walks to the sea…

Ipanema is an area of Rio de Janeiro that features a beach. More than a thousand miles north is Recife, another coastal metropolis with great beaches and a population of over four million, and the reputation, Nicas says, of being “one of the fattest cities in Brazil.” He speaks of a public school there that mandated classes on weight prejudice for teachers and students alike. Since the days of the Girl, this whole South American nation has gained weight.

(To be continued…)

Your responses and feedback are welcome!

Source: “Brazil, Land of the Thong, Embraces Its Heavier Self,” NYTimes.com. 02/27/22
Image by phadoca/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.