Home | Childhood Obesity News

Chasing Stigma Through the Ages

Pat Hartman August 25, 2026 No Comments

Because some truths are eternal, today’s post refers to a work published six decades ago, whose roots go back centuries. Written by Erving Goffman, its title is “Stigma: Notes on the Management of Spoiled Identity,” and its subject is one that concerns us because if our children grow up to be unacceptably obese according to the standards of the time and place, stigma is what they will face daily throughout their lives.

The word itself has a complicated origin, intertwined with not only punitive laws but with the Christian religion. Stigmata are wounds or scars that spontaneously appear on the body of a saint or other particularly holy individual, in locations (hands, feet, torso) commemorating the violence inflicted on Jesus during the crucifixion.

But no…

What we are talking about here is the other meaning, the intentionally inflicted wounds that served as warning labels, signaling to others that they should avoid a stranger because of potential trouble. The presence of those scars meant, “To help this escaped slave could get you imprisoned,” or “While this sinner did not do something bad enough for a sentence of execution, he was convicted of a serious crime, so steer clear.” It’s where the expression “He’s a marked man” came from — there would be a literal mark, usually on the face, the meaning of which was clear to the general public.

One of the points made by Goffman’s work is that “shifts have occurred in the kinds of disgrace that arouse concern.” To be stigmatized, a person no longer needs to be a fugitive or a convict — or to be held down and branded with a hot iron. A body that is too big, according to the standards of the time and place, is enough to signify that a person’s “social identity” is one that decent, upstanding, right-minded citizens might (and probably should) be repelled by. Because of this expectation, it is easy to “read” the stranger as worthy of blame for being dangerous, evil, or at the very least, weak.

The author’s extensive study of the subject causes him to occasionally throw in a phrase like,

A stigma, then, is really a special kind of relationship between attribute and stereotype.

How does this relationship manifest itself, out in the world?

The term stigma and its synonyms conceal a double perspective: does the stigmatized individual assume his differentness is known about already or is evident on the spot, or does he assume it is neither known about by those present nor immediately perceivable by them?

Then, in many instances, another if/then factor becomes apparent. Even in the case of obvious differentness, like skin color or obesity — does anybody really care? If they don’t, then the interaction or the relationship can move on to more relevant points.

But just in case

In reaction to a stigmatized individual, the author points out, we let our prejudiced mental stereotypes take over — “transforming them into normative expectations, into righteously presented demands.” Those demands can show up in many guises. For instance, if the morbidly obese stranger is gracious enough to make a little joke like, “Gee, I hope I don’t break your chair,” we might feel inclined to give that person a pass (at least temporarily) because they have bowed to our automatic revulsion by acknowledging how disgusting they are.

Our mental filing cabinet registers that gesture of surrender and makes a note: “At least she knows her place in the hierarchy of worthiness.” The overweight individual can mollify and (temporarily, anyway) neutralize our disgust by confessing to their inadequacy. A fat teenager can become acceptable and even popular within a friend group by frequently insulting himself and saving everybody else the effort.

Acceptance, even grace

A stigmatized person who bows to, and often acknowledges, the group’s stereotypes can earn forgiveness. In their subconscious minds, the others are doing the person a favor by granting a temporary pass into the human race. Of course, the trouble with a temporary pass is that it can be revoked at any time.

We are only on Page 5, and Goffman is just getting started. Here are a few more points:

By definition, of course, we believe the person with a stigma is not quite human. On this assumption we exercise varieties of discrimination…

We construct a stigma-theory, an ideology to explain his inferiority and account for the danger he represents…

We use specific stigma terms…

We tend to impute a wide range of imperfections on the basis of the original one…

Obviously, even the most limited and un-intellectually inclined “normal” individuals can generate sufficient insults, pranks, slurs, putdowns, slights, taunts, and sneers to make anyone’s life miserable. But wait, there is more:

Further, we may perceive his defensive response to his situation as a direct expression of his defect, and then see both defect and response as just retribution for something he or his parents or his tribe did, and hence a justification of the way we treat him.

When persecutors with a few more brain cells, material resources, and additional free time become involved, they have the means to concoct entire theoretical constructs and mythologies and old wives’ tales to justify the mistreatment of some particular type of person. Not only that, but they can accrue enough power and influence to affect the scientific fundamentals, and even the religious institutions and the legal underpinnings of a society, to the detriment of a chosen group.

(To be continued…)

Your responses and feedback are welcome!

Source: “Stigma: Notes on the Management of Spoiled Identity,” WordPress.com, 1963
Image by Tumisu/Pixabay

Words, Feelings, and Healthcare Professionals

Pat Hartman August 20, 2026 No Comments

A few years ago, someone noticed that while research had been done to determine how overweight people felt about the names that friends, relatives, and strangers chose to call them, nobody had really looked at patients’ emotional response to the terminology used by healthcare professionals. To make this inquiry involved surveying almost 3,000 adults (2,911 actually), of whom well over half (1,963) were actually overweight or obese. Others were the parents of children with weight problems, and all were asked to express their opinions about the relevant vocabulary.

The researchers chose 22 common English words and phrases, and here they all are:
Overweight, obese, higher weight, weight problem, unhealthy weight, weight, heavy, chubby, fat, extremely obese, large, plus size, curvy, big, BMI, high BMI, morbidly obese, very overweight, extra large, obesity, super obese, excess weight.

As it turned out, the great majority of respondents found “weight” and “unhealthy weight” to be the least offensive terms. Many people preferred references to the BMI number, despite the fact that it has become much less respected as a meaningful standard.

The reported reactions are complicated:

The term “BMI” may be perceived positively and thus preferred by people within the healthy weight range, while people living with overweight or obesity may consider the term BMI to represent a perceived threat, and do not prefer its use. Further research is required to explore these differences in the preference based on the word “BMI”.

Grownups do not want themselves or their children to be described as super-obese, extremely obese, extra-large, or even fat. And chubby? Forget it. Nobody thinks that word is softer or less offensive than any of the others.

Hurt feelings

Respondents reported their emotional states when offensive terminology is used. Not surprisingly, the feelings inspired by various rejected terms included sadness, anger, disgust, contempt, and several other negative states. The researchers discovered that parents react differently to certain words used by healthcare professionals in relation to the grownups themselves, versus when describing their children. The report duly observed that “HCPs working with adults and children should note these subtle nuances.”

They also suggested that clothing manufacturers might get a clue and stop using some of their accustomed descriptors. Young customers particularly do not want to hear “extra-large,” nor do they care for “super obese” or even the seemingly inoffensive “chubby.”

Fine distinctions

The findings included some noteworthy details. For instance, the word “obese” by itself inspires sadness, while more descriptive adjectives added to it, like “extremely” and “morbidly,” stir up feelings of disgust.

The researchers found this interesting because in other studies, when normal-weight participants are asked what, exactly, it is about heavy people that they find so objectionable, they tend to use the word “disgust” a lot. They often report how that emotion is responsible for their negative emotions, including weight bias, negativity, and extreme prejudice. One captivating detail is described here:

Interestingly, evidence suggests that although some parents might be upset by HCPs using the words “overweight” or “obese”, these terms would be concerning enough to motivate them to make changes.

Many of the results suggested that there are still more layers of meaning to sort through before coming to any definitive conclusions. For instance, advice has been offered to use “person-first language,” for example “person living with obesity” — but that construction apparently does not reduce patients’ hostility toward the term “obesity” itself. The consensus is that professionals need to show more compassion, and the best available advice so far seems to be this:

HCPs should use “weight” when discussing body weight with both adults and children. Given that “weight” was the uniformly preferred term across all BMI categories, and elicited the least negative emotional response… HCPs are advised to use weight neutral terms and ask people for their preferred weight-related terms, as not all terms are uniformly accepted.

(Note to any reader who looks up the document discussed here: The authors consistently use the word “adverb” when they mean “adjective.” But they are not English majors. The scientific aspects of their material are presumed to have passed inspection by many knowledgeable eyes.)

Your responses and feedback are welcome!

Source: “Preferences and emotional response to weight-related terminology used by healthcare professionals to describe body weight in people living with overweight and obesity,” Wiley.com, 06/09/21
Image by rhuf/Pixabay

Opposite Signals Both Promote Weight Loss

Tatyana Meshcheryakova August 19, 2026 No Comments

Scientists have solved a puzzling question about a brain receptor involved in appetite: How can activating it and blocking it both lead to weight loss? The answer appears to depend on location.

In a study involving mice, researchers at the University of Cambridge found that drugs targeting the glucose-dependent insulinotropic polypeptide receptor, or GIPR, can influence body weight through separate regions of the brain. Activating the receptor in the brainstem reduced appetite, while blocking it in the hypothalamus strengthened the brain’s response to signals of fullness.

The findings, published in Nature Metabolism, could help explain why obesity medicines with seemingly contradictory mechanisms can produce similar outcomes. They may also point toward more effective combinations of GIPR-targeting treatments and drugs that act on the GLP-1 receptor, the target of medicines such as Wegovy and Ozempic.

As we know, substantial and sustained weight loss is often difficult to achieve through changes in diet and physical activity alone. Newer obesity medications work partly by influencing the biological systems that control hunger, fullness, and blood sugar.

Wegovy and Ozempic, for example, activate the glucagon-like peptide 1 receptor, commonly known as GLP-1R. Other treatments act on GLP-1R and GIPR at the same time.

That is where the scientific puzzle begins. Mounjaro and Zepbound activate GIPR as part of their mechanism. MariTide, an investigational medicine in phase 3 clinical trials, takes the opposite approach by blocking GIPR while activating GLP-1R. Both strategies can support weight loss, even though one turns the GIP receptor on and the other prevents it from working.

The Cambridge research suggests these approaches are not producing the same effect in the same place. Instead, they appear to engage distinct brain circuits that ultimately lead to reduced food intake and body weight.

To investigate, the researchers used genetically engineered mice in which GIPR had been removed from selected parts of the brain. Some mice lacked the receptor in the brainstem, an area near the spinal cord that helps regulate appetite and nausea. Others lacked it in the hypothalamus, which plays a central role in hunger, energy balance, and body-weight regulation. A third group of mice had not been genetically modified and served as a control.

The animals received different combinations of three types of treatment: a GIPR agonist that activated the receptor, a GIPR antagonist that blocked it, and a GLP-1-based drug. The researchers then measured how much the mice ate, how their body weight and fat mass changed, how well they regulated blood sugar, and which parts of their brains became active.

By comparing the results among the three groups, the scientists were able to identify the brain regions required for each treatment to work.

The experiments indicated that GIPR agonists depend largely on the brainstem. When the receptor was activated in this area, the mice ate less and lost weight. But when GIPR had been removed from the brainstem, the appetite-reducing effect was weakened, suggesting that this region is a key site of action for drugs that stimulate the receptor.

This helps explain how medicines that activate both GIPR and GLP-1R can influence eating behavior. Their effects are not limited to the digestive system or the pancreas; they also involve neural circuits that help determine when an animal stops eating.

GIPR antagonists worked differently. Their weight-loss effects depended more heavily on the hypothalamus. In this part of the brain, GIPR appears to act like a “brake,” reducing the strength of fullness signals coming from the brainstem.

Blocking the receptor releases that brake. As a result, signals telling the brain that the body has had enough food may become more powerful.

This means that activating and blocking GIPR can each reduce eating, but they reach that outcome through different routes. Activation directly engages appetite-suppressing pathways in the brainstem, while antagonism appears to make the hypothalamus more receptive to signals of satiety. That distinction may also explain why both strategies can complement GLP-1 medicines.

The findings offer a clearer biological explanation for the design of MariTide, which combines GIPR antagonism with GLP-1R activation. Because the two components may act through separate but interacting circuits, combining them could potentially produce a greater effect than targeting either pathway alone.

The researchers also found signs that GIPR antagonism could strengthen the effects of medicines aimed at the amylin receptor, another emerging target for obesity treatment. If that finding translates beyond mice, blocking GIPR might eventually be used to enhance several different types of weight-loss drugs — not only GLP-1 therapies.

Dr. Jo Lewis, the study’s first author from the Institute of Metabolic Science at the University of Cambridge, said:

Understanding which brain circuits respond to these medications — and how they do so — could help us design better drugs that produce more weight loss with fewer side effects, and which might work in combination with other obesity medicines to even greater effect…

Our work also strengthens the idea that the brain is central to obesity treatment. Obesity drugs are not acting simply on the gut or pancreas. Instead, they have important effects on specific, identifiable brain circuits that regulate appetite and food intake.

The research provides a useful framework for understanding an apparent contradiction in obesity pharmacology. Drugs that activate GIPR and drugs that block it are not necessarily cancelling out the same biological process. They may be acting in different brain regions, on different circuits and at different stages of the body’s appetite response.

However, the work was conducted in mice. Further research will be needed to determine how closely the same mechanisms apply to humans and whether targeting these pathways in combination can reliably improve weight loss, blood sugar control, or tolerability in patients.

Even so, the results underline an important shift in the science of obesity treatment. The effects of these medicines cannot be understood solely by studying the gut, insulin production, or digestion. Their success may depend just as much on where — and how — they alter communication within the brain.

Your responses and feedback are welcome!

Source: “Scientists solve the mystery of a brain “switch” that can trigger weight loss in opposite ways,” ScienceDirect, 8/15/26
Source: “Distinct brain regions mediate regulation of food intake in response to GIPR agonism or antagonism,” Nature Metabolism, 7/24/26
Image by MART PRODUCTION/Pexels

Stigma and Association

Pat Hartman August 18, 2026 No Comments

Not long ago, an academic paper with several authors examined the existence and relationship of two concepts: weight stigma and weight stigma by association. The subjects were members of “a large, community-based sample.”

One objective was to rate parents on how caring and helpful they were willing to be, along with a rating to indicate how well they succeeded in that effort. When the results were tallied, it appeared that both obese parents and non-obese ones care equally for their children, be they daughters or sons. Furthermore, obese and non-obese parents are equally caring.

But: Obese parents are less effective, and parents of obese children are less effective.

One conclusion drawn by the researchers is that “Parents of children with obesity may experience weight stigma by association, which could have direct consequences for the parents, the children, and the parent-child relationship.” And, no matter how much they themselves weigh, parents of obese kids are rated as less effective. According to the authors of the paper,

There was also an effect of weight stigma wherein parents with obesity were also rated as less effective and helpful than parents without obesity.

Who is doing all this evaluating, and based on what standards?

It comes as no surprise to learn that a lot depends on who performs the evaluations. People who believe that parents are strictly and solely to blame for a child’s obesity do not care if those parents are themselves bulky or slender. The amount of censure is the same. And apparently, when either the young folks or their parents are obese, critics really don’t care how brilliant or talented the obese children in question may be. There is plenty of disapproval to go around.

One unfortunate result is that parents who are blamed and shamed “may internalize the negative parenting evaluations and subject themselves to further self-blame…,” which of course is exactly what their critics hope they will do. Even when parents exert themselves to make sure their methods “align with professional pediatric recommendations,” if their kids are overweight, those parents are still disrespected. The authors write,

One study found that parents who were stigmatized for their own weight reported greater use of restrictive feeding practices…

And yet, other research shows that when moms get strict about feeding, their kids are likely to eat more, not less. In effect, when an obese mama is picked on by someone who likes to stigmatize others, her kids will be even less carefully fed, and probably gain weight.

Another study dug deep and learned that when a girl is called “too fat” by a relative, her odds of being obese 10 years later increase by 62%. So maybe everyone should just pause and consider the many virtues of silence.

Several strengths

Characterized by its authors as possessing several strengths, this study is described as “the first randomized experiment to test weight stigma by association in a parent-child dyad using a large community sample.” Elaborate randomization standards are said to balance all potential variables and confounds across groups. It also involved large numbers of participants.

The authors note that their experimental stimuli “represented positive parenting practices” and
“used the same vignette of the parent-child dyad in all experimental conditions, which was crafted using the AAP parenting recommendations.” Summing up, they say,

Overall, the present randomized experimental study provides causal (rather than merely associative) evidence that weight stigma by association indeed occurs… Though a nascent area of research, weight stigma by association may have potential implications for parenting and effective pediatric obesity care.

Your responses and feedback are welcome!

Source: “Weight Stigma by Association Among Parents of Children with Obesity: A Randomized Trial,” ScienceDirect.com, 2022
Image by Tama66/Pixabay

Yale Study: Hunger Neurons in Weight Loss

Tatyana Meshcheryakova August 17, 2026 No Comments

For years, scientists believed that a group of brain cells known as agouti-related peptide, or AgRP, neurons played a straightforward role in metabolism: They stimulated hunger and resisted weight loss.

New research from Yale suggests the story is far more complicated.

In a study published in the Proceedings of the National Academy of Sciences (PNAS), researchers found that semaglutide, the active ingredient in Ozempic and other GLP-1 medications, appears to activate AgRP neurons rather than suppress them. Even more surprisingly, the study indicates that these hunger-promoting neurons may be necessary for maintaining the fat loss produced by the medication.

The findings challenge a long-standing assumption about the brain’s hunger circuitry and may help explain why newer GLP-1 therapies generate more substantial and lasting results than earlier weight-loss drugs.

Mateus d’Ávila, a Ph.D. candidate in neuroscience working in Tamas Horvath’s lab in the Department of Comparative Medicine at Yale School of Medicine (YSM) and first author of the study, said:

This completely changes how we think about the mechanism involved in these medications and provides new insight into the biology underlying their long-term effects, opening an avenue for the development of more efficient drugs.

The arrival of Ozempic and related GLP-1 therapies changed expectations, with some patients achieving sustained reductions of 10% to 15% of their body weight or more. Scientists know that these medications can reduce appetite and food intake. But appetite suppression alone may not fully account for their effectiveness.

Previous generations of weight-loss drugs could also substantially reduce hunger, yet they did not consistently produce the same degree of lasting weight loss as seen with semaglutide. That difference led the Yale team to suspect that GLP-1 medications were affecting additional biological systems.

One prominent theory held that the drugs worked partly by reducing the activity of AgRP neurons. Located in the brain’s hypothalamus, these neurons are strongly associated with hunger and feeding behavior. Because they encourage animals to seek and consume food, it seemed reasonable to assume that successful weight-loss treatments would need to inhibit them.

However, the role of AgRP neurons during long-term GLP-1 treatment had not been directly tested in a living organism. The Yale researchers set out to fill that gap.

Using a mouse model, the team combined several experimental approaches to examine what happened during semaglutide treatment. They tracked changes in body weight, food consumption, metabolism and energy expenditure.

The researchers also used genetic techniques to selectively remove or silence AgRP neurons. This allowed them to test whether the neurons merely responded to semaglutide or were actually required for the medication’s sustained effects.

The study results are striking. In mice genetically modified to lack AgRP neurons, GLP-1 treatment could initiate weight loss but could not sustain it. That suggested the neurons traditionally viewed as opponents of weight reduction were, in fact, helping preserve the drug’s long-term benefits.

Further investigations using electron microscopy, molecular biology and electrophysiology produced another unexpected finding: Semaglutide activated the AgRP neurons instead of inhibiting them. The researchers propose that this activation reflects the brain’s adaptation to the calorie deficit produced by GLP-1 treatment.

When calorie intake declines, AgRP neurons become more active as part of the body’s normal response to an energy shortage. Their best-known function is to increase hunger. The new study, however, suggests that their role is not limited to driving food intake. Under semaglutide treatment, the neurons may also participate in coordinating the loss of body fat.

In other words, the same neural system that signals a need for food may also help the body manage its energy stores during prolonged weight loss. This does not mean that hunger itself causes weight loss. Rather, it points to a previously unrecognized interaction between semaglutide, the brain’s response to calorie restriction, and the biological processes that determine whether lost weight stays off.

The discovery adds an important layer of complexity to scientists’ understanding of GLP-1 medications. Instead of simply shutting down the brain’s hunger signals, semaglutide may recruit parts of the hunger system and redirect their activity in ways that support sustained changes in body fat.

Because the study was conducted in mice, the results cannot yet be assumed to apply directly to humans. Researchers will need to determine whether the same neural mechanism operates in people taking semaglutide and other GLP-1 medications.

Still, identifying how the brain adapts during treatment could influence the next generation of obesity therapies. A more complete understanding of AgRP neurons might help scientists develop medications that preserve the benefits of GLP-1 drugs while improving their effectiveness, reducing unwanted effects, or helping a broader group of patients maintain weight loss.

d’Ávila said,

By identifying a previously unrecognized neural mechanism involved in sustaining weight loss, our work provides new biological insights that could eventually help researchers design therapies that are even more effective or have fewer side effects.

Your responses and feedback are welcome!

Source: “New study may change how we think about GLP-1s,” Yale News, 8/10/26
Source: “AgRP neurons are required for the weight-lowering effects of GLP-1 receptor agonists in female mice,” PNAS, 8/4/26
Image by denis1203.

Prepare for the Worst, Part 3

Pat Hartman August 13, 2026 No Comments

The posts in this sequence explore some of the dark corners of obesity-related attitudes, because parents of children who seem to be headed in that direction might benefit from awareness about the future possibilities. The intention here is not to frighten anyone into locking the potentially obese child into a closet where a few hundred calories per day can be passed through a slit in the door.

However, evidence exists in every corner and on every level of society that the life of a morbidly obese individual is not ideal. Of course, no parent is advised to make a child’s existence miserable in order to avoid obesity. On the other hand, no parent is advised to ignore a potential situation in the hope that it will just go away.

It has long been accepted that to attach “phobia” to a word does not exactly connote fear of the thing. “Homophobia,” for instance, is understood to signify an emotion closer to hatred, but it sounds more acceptable in polite society.

In a nightclub

This sentence in a Psychology Today article was written by Seth Meyers, Psy.D., about a live standup comedy performance where an obese comedian told a stupid joke that would not have been funny, or even interesting, no matter who might have said it. About the audience, Dr. Meyers observed,

They laughed because they hate fat people, and worse, because they believe fat people deserve such spite.

But then, the mental health professional pulled a switcheroo and went on to explain how that was not true at all, and actually, a totally different dynamic was in play. Here is what really happens when haters display their obnoxious behavior:

They’re taking a mental break — almost like releasing a valve with too much pressure — from judging themselves.

In this situation, the performer on stage has volunteered for a role that should have become obsolete centuries ago, and it’s not a court jester. In the olden days, anyone who mattered was forced to live in or near the royal palace, where the monarch could keep an eye on them, and also to make sure that the ruler could be seen to administer justice. But if the crown prince misbehaved, his sacred person could not be violated, so there was a staff member called the whipping boy, who would be punished instead, in the hope that the prince would feel bad and learn how to behave properly.

In modern times

So, what a professionally obese person does is fill the role of whipping boy, absorbing the scorn that members of the general public (in this case, audience members) secretly feel they themselves actually deserve. And at least the stage professional volunteered for the job. But the lady next to you in the airplane didn’t ask to be your whipping boy. She gets the job anyway, as you spend on her that disgust you actually feel for your own 30 extra pounds.

Meyers observes that “there appears to be limitless self-judgment out there in the universe,” which is reflected in the amount of judgment that the ordinary citizen is prepared to dish out, especially on obese people, who are pathetically easy targets. The random observer in the grocery store aisle will not be equipped with enough knowledge to judge you for eating your own hair, but will certainly be able to guess that you eat too many doughnuts.

And, parents: The world is full of sad, mad, self-hating people who can’t wait to judge, dislike, and embarrass your child, in the unconscious and very mistaken belief that pouring out scorn on somebody else will make them feel better, and heal their pain-filled lives.

Here is another thing: While helping our own child to grow up undamaged, we probably don’t particularly want to damage anybody else along the way, or contribute to the unhappiness of somebody we don’t even know. Also, Dr. Meyers suggests a way to help make the world a kinder, more understanding place by taking the Empathy Test.

Your responses and feedback are welcome!

Source: “The Psychology of Why People Dislike or Hate Fat People,” PsychologyToday.com, 05/06/11
Image by FreeFunArt/Pixabay

Are GLP-1 Medications Replacing Bariatric Surgery?

Tatyana Meshcheryakova August 12, 2026 No Comments

The treatment landscape for obesity is changing rapidly, particularly among adolescents and young adults. New research suggests that GLP-1 medications have quickly become the most common medical treatment for younger people with obesity, while the use of metabolic and bariatric surgery has declined substantially.

A study published in JAMA Pediatrics found that the number of adolescents and young adults receiving GLP-1 medications increased sharply between 2022 and 2025-2026. During the same period, the proportion undergoing metabolic and bariatric surgery dropped significantly.

The findings offer a glimpse into how quickly obesity treatment has evolved as medications such as semaglutide have become more widely available. They also raise important questions about equitable access to treatment.

Researchers from the study examined real-world treatment patterns among more than 204,000 adolescents and young adults between the ages of 12 and 29 who received obesity treatment. The team compared treatment during two periods: May through November 2022, before semaglutide became widely available for adolescents with obesity, and June 2025 through January 2026, when GLP-1 medications were much more established in obesity care.

Researchers looked at whether patients received GLP-1 medications, metabolic and bariatric surgery, or both. They also examined differences related to age, sex, race and ethnicity, insurance status, and neighborhood socioeconomic conditions.

The results showed a striking change in how younger patients were treated. In 2022, 88.2% of patients receiving obesity treatment were treated exclusively with GLP-1 medications. By 2025-2026, that figure had risen to 96.1%. At the same time, the proportion of patients receiving metabolic and bariatric surgery declined from 11.6% to 3.7%.

Combination treatment remained uncommon. Only about 0.2% of patients received both GLP-1 medications and bariatric surgery during the study periods.

According to lead researcher Sarah Messiah, Ph.D., M.P.H., the study represents a major turning point in pediatric and young-adult obesity treatment. She said:

Our team’s study captures an inflection point in pediatric obesity treatment… While only a small proportion of adolescents and young adults currently receive both therapies, combination treatment was virtually nonexistent before GLP-1 medications became widely available. We’re now seeing clinicians integrate these therapies in different ways as obesity care continues to evolve.

Does this mean bariatric surgery is going away? Not necessarily.

The study does not establish that GLP-1 medications are superior to bariatric surgery, nor does it suggest that surgery is no longer an important treatment option. Instead, the findings demonstrate how the availability of highly effective medications has changed clinical practice.

Metabolic and bariatric surgery remains an established treatment option for some adolescents and young adults with severe obesity, particularly when other approaches have not produced sufficient results. GLP-1 medications offer another option that can be used without surgery, potentially changing how doctors and families approach treatment decisions.

For some patients, medication may be preferred because it avoids an operation. Others may benefit from surgical treatment based on their individual health needs, severity of obesity, response to previous treatments, and other medical considerations.

While the rapid growth of GLP-1 use is significant, the study also revealed disparities in who receives these medications. Older patients, patients with commercial insurance, and people living in higher-income neighborhoods were more likely to receive GLP-1 treatment.

Those differences suggest that simply having effective obesity medications available does not mean every patient has equal access to them. Insurance coverage, medication costs, healthcare availability, and socioeconomic circumstances can all influence whether a patient is able to receive treatment.

This is particularly important as obesity medications become a more prominent part of care for adolescents and young adults. If access remains concentrated among people with greater financial resources or more comprehensive insurance, existing health disparities could persist or widen.

For families navigating childhood or young-adult obesity, the research highlights how quickly treatment options are changing. Just a few years ago, bariatric surgery was one of the major medical interventions available for young people with severe obesity who needed more intensive treatment. Today, GLP-1 medications are increasingly becoming part of the conversation.

Your responses and feedback are welcome!

Source: “GLP-1 drugs are changing how teens and young adults treat obesity,” Consumer Affairs, 8/4/26
Source: “GLP-1 use rising rapidly among U.S. adolescents, young adults,” UT Southwestern Medical Center, 7/20/26
Image by Pavel Danilyuk/Pexels

Prepare for the Worst, Part 2

Pat Hartman August 11, 2026 No Comments

At times, a potential difficulty does not look or sound like much of a threat, especially if no obstacle in that particular genre has been encountered or faced down before. But if and when a poisonous issue strikes, it can take over the entire universe for a while, and impede progress in sneaky and frankly ugly ways. In the sometimes precarious equilibrium of the family, this type of problem is never welcome; and to put up with it for even one day can feel far too long.

Here is the situation. Your daughter or son is overweight, or appears to be leaning in that direction. If and when this kid’s condition starts inspiring you to listen to a podcast about childhood obesity, or to schedule the yearly physical a couple of months early, you are in a good position to stock up on information. What can you do or say to meet the possibility of resistance from some unexpected quarter, and to minimize any threat to your child’s physical and psychological well-being?

Well, plenty, actually. This is why parents follow Childhood Obesity News, use resources like Brainweighve, and harvest random factoids that might come in handy someday. They (you, we) are to be congratulated for that diligence. The family ship makes a course correction and adjusts the sails, the mental, emotional, and physical parameters, to accommodate the new reality.

But — with a project like this, it often turns out that not all possible variables can be accounted for or addressed. For instance, in a clan situation, who wants to believe that some relative is out there feeling the urge to negate the efforts you make toward preventing your child from joining the ranks of a disrespected and ridiculed part of the general population?

Who and why?

The misguided individual might be an older relation who struggles with weight issues and who, consciously or not, follows the “misery loves company” philosophy. Maybe that cousin does not want to be the only obese person in the family circle, and he might even try to undermine your efforts to help the young child avoid obesity. Or it could be an aunt who believes that a teenager can be protected from sexual experimentation by a layer of subcutaneous fat.

If divorce is part of the history, there might be an unavoidable step-parent who is a bad influence or a worse example. This person might be simply careless, or actively desirous of causing trouble. Or, it might be a teacher who is all smiles and enlightenment on visiting day, but who believes that teens should be studying instead of dating; who secretly hopes to let them all share the misery she experienced during adolescence. It could be a family friend whose own kid isn’t very popular, and who feels a twisted need to level the playing field.

If your troubled child is in the teen years, it is possible that someone in his or her friend circle is a real nutcase who gets their kicks from manipulating people and situations in non-obvious ways and for unwholesome reasons.

The bottom line

The ground-level fact of the matter is, not all contingencies can be accounted for or handled.
Like it or not, plenty of folks harbor hostile feelings toward selected groups of their fellow humans. A disturbed individual may simply hate overweight people, or may feel even more animosity toward overweight people with caring parents.

There is no magic advice-wand to wave that can get rid of a lousy influence. For the parent of a growing child, one of the most frustrating problems is the inability to protect that kid from sabotage by a poisonous individual.

Somebody out there with a bad attitude might be hurting your child. If this is the case, maybe you can do something about it; maybe you can’t. But there is a catch. To interfere, or even acknowledge that a conflict exists, might only worsen the situation. For the target, the reason is largely irrelevant. What matters is the damage done.

Still, awareness is half the battle. If your child is dealing with obesity, either now or potentially, parental ignorance will not help. But — even the most healthily transparent child might be unwilling or unready to share some things, and there is nothing wrong with that.

To play detective might serve no purpose. The troublemaker is not interested in improving their character. Some folks are willing and even eager to hurt others for hundreds of misguided reasons, and sometimes they don’t even realize it themselves. It may even be that nothing can be done about this individual. We may have to face the fact that an ongoing situation can’t be avoided.

This message is not just for the custodial parent of a sensitive child, or one who has enough problems already. No, it is for any nearby grownup who might face the pain of knowing that a perfectly nice child is being attacked by some demons right now, or in all likelihood will soon be a target. While you may not be able to stop the pain, there is probably something good you can do.

Your responses and feedback are welcome!

Image by Sunriseforever/Pixabay

Prepare for the Worst

Pat Hartman August 6, 2026 No Comments

It may seem harsh, but a very effective way to develop awareness is to get a taste of some of the things that unfeeling strangers will be saying about your beloved children a few years from now if you don’t get out ahead of this potential problem. It’s a shameless scare tactic, an effort to shock any mom or dad into planning ahead, and vowing to never let their children feel the pain of being ridiculed and ostracized.

The object here is to provide motivation for parents who are not yet dealing with childhood obesity; to solidify their determination that the family will never need to deal with it:

This is how fat-shaming works: It is visible and invisible, public and private, hidden and everywhere at the same time… — Michael Hobbes

To quote what people have said and done is one way to predict what they intend to do. These examples represent how people might be treating your beloved child someday. Probably no one deliberately decides to have a child who will be disrespected or ridiculed because of their appearance. The very fact that we might envision such a fate, and dread it, could make us hate ourselves for being so prejudiced, or for even thinking of such a thing.

But let’s not lose the thread. These glimpses into a potential future are for the benefit of brand-new parents, or for couples still at the stage where parenthood is not yet even a special gleam in the eye:

I struggled with anorexia for years… My girlfriend at the time used to get so mad at me, because she assumed my need to lose weight and be “thin” extended to her. She was perfect and stunningly beautiful, and her fat was never a problem for me. My “fat” was. Because I had a mental illness that almost cost me my life… — crimsoncat21

Obesity prevention is a subject that future moms and dads should probably consider, sooner rather than later, especially if the tendency to be overweight runs in the family. Such a possibility needs to be acknowledged, brought up and discussed, to (hopefully) discourage unnecessary conflict later on. If either parent comes from a heritage where people tend to be overweight, to prepare for that eventuality cannot be wrong.

Could anyone be blamed for making an emotional plea to future parents? Something like, “People may be very disrespectful of your unborn child, someday. They may call your child names and hurt her or him with a thousand small, everyday hostilities. Please make it a priority to not let your child grow up fat.”

To be honest, thin people dealing with fat-phobia is just thin people trying not to look like me. NOT looking like me is worth everything they hate doing but force themselves to suffer through and everything they love but deprive themselves of. As though looking like me is the worst thing they could possibly imagine… — airagorncharda

Is it possible to ever say enough about fat-shaming? Apparently not, because the culture provides a boundless array of examples from which to choose. For the benefit of any reader who wishes to make an in-depth study of this discouraging phenomenon, we gather relevant quotations, useful to any parent or medical professional who has not yet developed a comprehensive mental grasp of the pervasive hate aimed at overweight people in our society:

It’s like the adults are giving the kids permission to view fatness as wrong and something that you need to change… In an effort to make students aware, the campaign had made one girl’s problem far worse… — Lindo Bacon

Journalist Bethany Brookshire interviewed writer, speaker and scientist Lindo Bacon about visiting a school to speak during National Childhood Obesity Month, and how a very large girl student cried because during that period, she came in for even more than the usual share of bullying.

We hope to capture the ear of parents who are not yet dealing with childhood obesity, with the object of motivating them to avoid the issue at all costs. Before that cute, cuddly baby even walks, is the appropriate time to start thinking about this issue and about how to head it off at the pass. Awareness is a wonderful way to begin — awareness of how much you really do not want to see your child or children become victims of fat-phobia.

Your responses and feedback are welcome!

Source: “Everything You Know About Obesity is Wrong,” HuffingtonPost.com, 09/19/18
Source: “crimsoncat21,” Tumblr, undated
Source: “Weight shaming is literally sickening,” ScienceNewsForStudents.org, 09/30/21
Image by Ari_Dit/Pixabay

Physicians, Heal Thyselves

Pat Hartman August 4, 2026 No Comments

A lengthy paper published five years ago discusses fatphobia from many angles, beginning with its progenitor and birthplace, which the authors identify as “diet culture.” In their view, fatphobia is a form of systemic oppression, known by its tendency to condemn the extra-large body as unaesthetic, unattractive, shameful, and even pathological.

The diet culture enthusiasts might even be regarded as cruel liars, who continue to insist that “health, happiness and moral virtue” can only exist in a slender body, and who aim to embarrass, shame, and even demonize their fellow humans by insisting on an ideal vision of beauty that can realistically be attained by only a lucky few.

For some reason unfathomable to many others, these harsh masters reserve their most severe criticism for women who have the nerve to violate the arbitrary rules of bodily perfection. Meanwhile, men do not come in for even a fraction of the condemnation heaped on their sisters, mothers, daughters and wives.

Now, here comes the cringe part…

Fingers are pointed where?

Authors Camille Cottais, Jeanne Pavard, and Marion Sanchez make the following observation:

Medical fatphobia is particularly widespread, discouraging or even preventing fat people from accessing health care.

The illustration on this page represents a quotation from an obese young man who said the worst thing that had happened to him in the past year was when his old physician retired and he suffered great dread about starting over with a new one.

Many doctors have been criticized for participating in the spread of the diet culture, about which these authors refer us to the work of “anti-diet dietician” Christy Harrison. She characterizes diet culture as a “belief system.” This means in practical terms that the active imagination can spin off into reflection on certain antiquated religious practices which still persist in some corners of the world. On holy days of atonement, believers demonstrate regret for their sins by flogging themselves or dragging heavy wooden crosses through the streets.

In the diet culture, we exhibit our faith by jogging along the boulevards or exercising in gyms with big windows at street level. In other words, we feel a need not only to obey the admonitions of proper behavior for the faith, but a compulsion to be seen doing that. And like religions (Methodist, Catholic, Lutheran, etc.), the diet culture has subdivisions: ketogenic, paleo, intermittent fasting, and so forth:

Examples of diet culture include labelling food as good or bad, promoting various kinds of restrictive diets, praising weight loss or eating, not allowing oneself to eat more than a certain number of calories, feeling guilty for eating “too much,” or exercising to punish oneself or to compensate for eating.

Various types of food are assigned moral values, just like the different degrees of respect shown to the housewife who scrubs the floor on her knees after the rest of the family are asleep, and another sort of woman, also up after midnight, who hangs out near the saloon. Some foods are demonized for containing too many calories, or the wrong kind. Meanwhile, a fresh fruit or vegetable is privileged to wear a halo — at least until a cyclosporiasis outbreak comes along and ruins everything.

We all live in this diet culture, existing in a constant state of awareness that even if we have — so far — managed to avoid being labeled fat, that horrid condition could very possibly be our fate next year. From then until forever, we will be punished by having our food choices condemned by the establishment, and possibly also by developing anorexia nervosa, binge-eating disorder, or worse.

And yet, the medical professionals who hope to prevent or reverse obesity in children cannot possibly all be repressive tyrants who anticipate punishing people with too many numerals in their waistlines. They did not make the time investment or endure the workload and expense of medical education only to acquire the privilege of looking down with scorn on overweight people.

Your responses and feedback are welcome!

Source: “Fatphobia: a pervasive and socially accepted discrimination,” GrowThinkTank.org, 07/19/21
Images by lapinvert and geralt/Pixabay

Chasing Stigma Through the Ages

But no…

But just in case

Acceptance, even grace

Words, Feelings, and Healthcare Professionals

Hurt feelings

Fine distinctions

Opposite Signals Both Promote Weight Loss

Stigma and Association

Several strengths

Yale Study: Hunger Neurons in Weight Loss

Prepare for the Worst, Part 3

In a nightclub

In modern times

Are GLP-1 Medications Replacing Bariatric Surgery?

Prepare for the Worst, Part 2

Who and why?

The bottom line

Prepare for the Worst

Physicians, Heal Thyselves

Fingers are pointed where?

Profiles: Kids Struggling with Weight

The Book

About Dr. Robert A. Pretlow

Presentations