The Mystery of Noncompliant Behavior

Nothing in life is ever straightforward. Either a habit of reading medical journals, or a familiarity with live patients, could lead a person to wonder what is going on in this topsy-turvy world. While some people can’t get seen at all about their health problems, and suffer for it, others have excellent access to care, and then mess it up by not following doctors’ orders.

As Dr. Fred Kleinsinger has pointed out, the term “noncompliance” has been abandoned by some, in favor of “nonadherence.” The latter is “less value-laden and does not imply a rigid hierarchical relationship between physician and patient.” In other words, in the minds of some patients, it’s all about a primal emotion: “You’re not the boss of me.”

But resentment toward authority is not the only obstacle to communication. A lot of patients have not had much formal education. They may be struggling with English as their second language, or be native speakers who just do not have very high comprehension of the language or enough native intelligence to “get it.” Many people are prone to be influenced by family members, their own unsatisfactory past experiences with the medical establishment, or the most recent television show they watched.

Patients may feel too intimidated to ask questions when they don’t fully understand what is going on. And with an aging population, Dr. Kleinsinger points out, progressive dementia is sometimes difficult to spot. People have been socialized into certain behaviors that reassure others, when they actually don’t have a clue. They may come from cultures where any hint of disagreement with a doctor is seen as serious disrespect.

The necessity of dealing with all these variables can sometimes turn a clinician into a genius intuitive diagnostician… and sometimes not. Overall,

The greater the discordance between the cultures of the practitioner and of the patient, the greater the opportunity for miscommunication and misunderstanding.

In his paper on noncompliant behavior, Dr. Kleinsinger points out that intellectual ability is not the only potential stumbling block. There is the whole realm of psychology, which he stretches to include “biological, environmental, cultural, and patient-specific factors,” some of which are denial, depression, and severe psychiatric illness. He also mentions that some patients experience material gain from their classification as medically disabled. But this may be a far-from-conscious process, especially when being ill earns extra respect and care from family members.

In addition, there is psycho-social stress. Dr. Kleinsinger writes,

Many of our patients face complex and stressful living situations. Realities such as poverty, long hours working in multiple jobs, difficult parenting problems, or troubled relationships can leave people exhausted, feeling besieged, and simply unable to cope with the added time and energy required to fully manage a chronic illness. Feeling trapped and hopeless destroys that sense of optimism for the future that usually helps motivate good self-care for chronic illness.

Also — and this is a big enough problem to comprise a whole separate category — if any type of addiction is an element of the picture, the problems multiply exponentially. The author says, “Treating the addiction is often prerequisite to treating comorbidities, but the denial that these patients usually have impedes effective medical care.”

Your responses and feedback are welcome!

Source: “Understanding Noncompliant Behavior: Definitions and Causes,”, Fall 2003
Image by r. mial bradshaw/CC BY 2.0

The Fat Tax in Medicine

People with obesity are accustomed to paying a “fat tax” at clothing stores, and when buying tickets for air travel, and in other ways both tangible and intangible. One type of fat tax is extracted by some medical professionals who have an attitude, or perhaps just honestly believe that being fat is 100% a person’s own fault, and anyone so irresponsible deserves whatever comes their way, be it disrespect, neglect, or even negligence.

This anecdote is one of many that illustrate the effects of the stigma that can affect a large-bodied person who seeks medical help:

Patty Nece told NPR affiliate WBUR that […] oftentimes clinicians attribute her pain to her weight rather than examining further causes. Upon becoming emotional in a doctor’s office about hip pain, she was once told “See, you’re even crying because of your weight,” by the physician, she recounted.

However, another medical professional later found that her pain was being caused by a severe curve in her spine, not her weight, according to WBUR.

This is from the text intro to a 34-minute podcast where experts and patients speak. An informant named Deana began to doubt her ability “to even be seen fully as a human being, let alone as a patient.” She told the interviewer:

I am an obese person. I am also a professional dancer. I avoided the doctor for eight years because of consistent dismissiveness. I went to a chiropractor for a dance injury and was met with doubt that the injury was in fact dance-related — and it happened because I did a drop split.

Regarding her book, You Just Need to Lose Weight and 19 Other Myths About Fat People, Aubrey Gordon was interviewed by Stephanie Sy for PBS. She reports that for office visits, fat patients are allotted less time than those who weigh less. Their acute problems are more likely to be misdiagnosed. They may go to a healthcare provider with a chronic or terminal illness, and be told to come back after they have lost weight. Gordon says,

Many patients end up postponing care, many patients end up avoiding contacting health care providers and many patients have worse health outcomes as a result.

We will say more about person-first language, which has been an important topic in the decade since the American Medical Association deemed obesity to be a disease, “in contravention to the recommendations of their own scientific committee.” Because nothing is easy, that decision has been shown to have both pros and cons. But, says a paper titled “What’s in a Word? On Weight Stigma and Terminology,” which deserves a more thorough reading,

[T]he result has not been that heavier people are treated more respectfully, or viewed by the medical profession in their complete personhood. Rather, anti-fat attitudes remain high among health professionals and specialists in the field.

Your responses and feedback are welcome!

Source: “Medical schools need to improve obesity training, physicians say,” 02/01/23
Source: “Medical Bias Against Obesity Is Preventing Patients From Receiving Proper Care,”, 06/23/22
Source: “Bestselling author dismantles myths about fatness in latest book,” PBS NewsHour on YouTube, undated
Source: “What’s in a Word? On Weight Stigma and Terminology,”, 10/05/15
Image by Dennis Sylvester Hurd/Public Domain

Some Problem Areas

Author Aubrey Gordon is no fan of the recent American Academy of Pediatrics guidelines. Talking about interventions for a fat adult is fine, but the AAP seems to be recommending dietary intervention for kids as young as 2 years. On the other hand, some would question why the author has a problem with that, since it is the easiest kind of intervention to implement. At such a tender age, kids are not in a position to fight back against the healthful diet, or to travel to the store on their own, and they usually don’t have any money.

Dietary intervention with an infant is not a radical notion, but a combination of science and art which is generally deemed to be helpful. In addition, it has been well established that the sooner obesity is prevented, the less likely it is to take over a life.

Gordon is also against “weight loss drugs including injections as young as grade school and weight loss surgery and permanent body-altering and life-altering lifelong surgical procedure as young as 13…” No argument there!

Stigma rears its ugly head

Author Virginia Sole-Smith gives a capsule description of one way in which obese people are traumatized:

Providers spend less time with patients with high BMIs, and are sometimes even less willing to perform standard care, like pelvic exams at the gynecologist’s office. And in 2019, Nutter surveyed 400 Canadian doctors and found that 24% admitted they were uncomfortable having friends in larger bodies, and 18% felt disgusted when treating a patient with a high BMI.

On the other hand, one of this writer’s grievances is that according to the findings of a 2011 study, “medical students were more likely to blame people for conditions like respiratory distress if they were in a bigger body, and tended to prescribe weight-loss strategies, rather than symptom management.” However, it is objectively true that obesity can cause respiratory distress, and this is particularly hazardous when a very large patient is on the operating table. To keep that person supplied with air is an extra challenge.

The other objection is even more shaky. A very large number of complaints accuse the healthcare industry of the exact opposite — of resting content with treating symptoms (to the benefit of the pharmaceutical industry) rather than addressing the root causes of physical malfunction. This is particularly true when the patients are economically disadvantaged. Money can often buy a cure for a condition that the poor are expected to endure by taking over-the-counter pain meds.

The situation is capsulized by a quotation from the producers of a live call-in program:

Conscious and unconscious negative attitudes from health care professionals have impacted the treatment and care of people living with obesity. Patients have reported that physicians blame their weight first and treat their presenting symptoms second — if at all.

Your responses and feedback are welcome!

Source: “How Fatphobia Is Leading to Poor Care in the Pandemic,”, 01/10/21
Source: “Patients report that weight stigma has led to difficulties getting treatment, and avoidance of seeking future healthcare,”, 08/08/22
Image by John Benson/CC BY 2.0

The Strong Voice of Aubrey Gordon

For quite a few years, Aubrey Gordon was known to the world only as Your Fat Friend. Her first published opinion piece was read by around 40,000 people. For years she wrote under a pseudonym. The approaching publication of her first book in 2021 inspired her, at age 37, to announce her true identity with the words, “I weigh 350 pounds. I’ve been waiting to meet you.”

Gordon is no stranger to Childhood Obesity News, having been quoted several times before the appearance of What We Don’t Talk About When We Talk About Fat. Somewhere along the line, she started a podcast called Maintenance Phase. Now, there is a second book, You Just Need to Lose Weight and 19 Other Myths About Fat People. The author was recently interviewed about it for PBS, and among other things, we learn that “fat” is (or should be) a neutral descriptor.

Why? Because we need a nonjudgmental word, and despite widespread belief to the contrary, the term “obese” is not neutral. In the original Latin, it meant that the people being described had literally eaten themselves into fatness. It presumes the person behaves gluttonously and has no self-control. But “fat” is straightforward and impartial, according to Gordon, and people should not hesitate to use it when describing themselves or others.

Flying While Obese

The book also discusses a factor we have mentioned, the likelihood of having a profoundly humiliating experience in an airplane. Other passengers will describe their flight as terrible, because they had to sit next to a fat person. In fairness, they should be mad at the airline, for not providing what the customers need. Instead, they are mad at fellow customers whose needs are not being met. Airlines show no apparent interest in solving the problems of certain passengers.

The professional problem

PBS interviewer Stephanie Sy mentioned to the author a myth that exists in the medical field, that “doctors are sort of neutral judges of health” and are not biased. Gordon replied that while medical students learn to do a great many things, they are not trained to examine their own preconceptions, and that gets in the way of practicing appropriate and humane medicine.

She shared her own unsettling story, dating back to her teen years when Fen Phen was considered a miracle drug, and she was on it…

[…] and it was pulled from the market within two years because it caused people’s hearts to stop and their lungs to fill with fluid until they essentially drowned.

Now, there is constant worry about heart-related problems in the future, and constant awareness of “the reality of being essentially sort of a ticking time bomb…”

Other Childhood Obesity News posts that mention or quote Aubrey Gordon:

“Coronavirus Chronicles — The Virus As a Driver of Change”
“Being Heard and Seen”
“Coronavirus Chronicles — Fear Creeps Closer”
“What’s Up With Cacomorphobia?”
“People of Size, and Their Voices”

Your responses and feedback are welcome!

Source: “Bestselling Author Dismantles Myths about Fatness in Latest Book,” PBS NewsHour on YouTube, undated
Image by Oxford Languages

Weight-Loss Drugs — Bait and Switch?

The promise of fitting into different clothes and being socially acceptable is the bait. And keeping the interest of a loved one. Oh, and being healthier. People have all kinds of reasons to pursue weight loss, and the GLP-1 drug makers are happy to sell it to them. But then the customer opens up the box and discovers that instead, they have been sold a life-long chemical dependency.

Despite all the social media rave reviews, some people who take weight-loss drugs do not get the desired results. One article offers several possible reasons. One is, “You’ve hit a plateau,” which is not helpful because it is not actually a reason but a tautology. The person already knows; what they are looking for is the cause of the plateau. Perhaps they need a stronger support network (either in the flesh, or online — like Dr. Pretlow’s W8 Loss 2 Go phone app that has helped so many young people, or his upcoming Brainweighve app.)


Celebrity fitness trainer Jillian Michaels, who has convinced at least eight family friends to quit Ozempic, says,

Once they get off of the drug, it does the rebound effect. So you’re not gaining anything. You get off the drug in a year and go all the way back. You’ve not learned anything. You’ve not built any physical strength or endurance. You haven’t learned how to eat healthy.

But that is not the most disturbing aspect. Some people on weight-loss meds really do learn how to exercise, and how to eat effectively. Yet, if they don’t refill the prescription, they get the dreaded result: their old self back. And reportedly, however long it took to gain the weight the first time around, the rebound effect brings it back faster.

Still, the “good habits” advice is definitely valid if they stay on the drug. When someone sits in a chair and eats cheeseburgers all day, nothing that comes in a syringe can help them.

All things considered, it begins to appear as if the true “secret” is to stay on a weight-loss drug forever.

For a diabetes website, Senior Content Manager Ginger Vieira wrote,

In a study that allowed patients to stop taking Mounjaro after one year, most patients regained the weight they lost, indicating a need to take a maintenance dose.

A maintenance dose

That is an interesting term. A heroin addict visits the pusher-man to get his maintenance dose because that’s what it is to him, too — the way to maintain the ability to function by not getting sick.

One helpful article for people whose progress toward weight loss has plateaued, says that maybe they need a simple dosage adjustment — a polite way of saying, “Increase the amount.” The user needs to take more, to get the same results as before. This is a familiar pattern found with several drugs of abuse. (Reminder: Any dose adjustment should be done under professional medical supervision.)

Author John Mac Ghlionn wrote about the disturbing news that the weight comes back if the drug is discontinued:

Why is this troubling? Because it’s effectively creating lifelong customers for the pharmaceutical industry. The younger they “sign” someone up, the more profitable the treatment process becomes. In truth, Ozempic is not a cure for anything; it’s an addictive drug.

Your responses and feedback are welcome!

Source: “Not losing weight on Ozempic? Here’s why that might be happening,”
Source: “Jillian Michaels Convinced 8 Friends to Stop Taking ‘Dangerous’ Ozempic Because of Rebound Effect,”, 02/17/23
Source: “Mounjaro: Its powerful potential to treat type 2 diabetes & obesity,”, undated
Source: “Ozempic, The Atlantic, and the Dangers of Anti-Exercise Rhetoric,”, 03/29/23
Image by Don Taylor/Public Domain

Till Death Us Do Part, Continued

When someone starts taking one of the new weight-loss medications based on synthetic glucagon-like peptide-1, the vow appears to be more binding than marriage. As we have seen, in a large number of cases the meds only work while the person is taking them.

All people with Type 1 and some people with Type 2 diabetes can expect to be injecting insulin forever, and like any other commodity where the demand grows every year, insulin is profitable. People need insulin like zombies need blood, and it looks as if soon, people will be needing their GLP-1 medications in the same implacable way. Already, there are reports of some unsatisfactory and worrisome outcomes.

Lowered expectations

A British website lists possible reasons why people taking these drugs might feel discontented, like the weight loss is just not happening. One reason is, they expect the change to be sudden and dramatic, which it may be for some, although that is not the norm. But three of the reasons are definitely “on you”:

You’re not getting enough sleep
You don’t have the right calorie intake
You haven’t found the right healthy lifestyle changes

The piece goes on to say that in order to manage weight in the long term, a person needs to establish healthy habits, and then stick with them. It appears as if this is not a widespread accomplishment. Even if it were, these meds do not seem to reward tenacity. However conscientious the person has become about diet and exercise, no effort seems to matter. There are dismal reports of people trying hard but doomed to failure. If the patient goes off the meds, everything falls apart.

The Journal of Pharmacology and Therapeutics noted that “ongoing treatment [of Ozempic] is required to maintain improvements in weight and health.”

Reading too much into it

It appears that one of the things people have been telling each other might not be true, which is the “training wheels” notion. Those meds were never intended to be transitional. Yes, good eating habits and exercise will help the injections do their job. But a lot of evidence has piled up to say a different truth: If you go off the stuff, even your new healthier lifestyle probably won’t help. The pounds will begin to accumulate.

Evidence shows that no matter how many excellent habits of diet and exercise someone has been practicing, nothing can stop the inexorable re-acquisition of weight. If a person loses their insurance or suffers some other misfortune and can no longer afford the meds, it’s over.

Forbes writer Alyssa Northrop quotes Dr. Christopher McGowan:

GLP-1 medications [like Ozempic] are designed to be taken long-term… They are chronic medications for the treatment of chronic conditions (both diabetes and obesity).

Researcher and essayist John Mac Ghlionn wrote about Ozempic (and, by extension, any drug of the same type). If someone decides to quit the medication, “there is an incredibly high chance that he or she will put all the weight back on.” Like many others, he is concerned that Ozempic has been approved for treating obesity in children.

Imagine how much worse things could be if these medications were made available over the counter.

Your responses and feedback are welcome!

Source: “Ozempic For Weight Loss: Risks, Side Effects And More,”, 04/26/23
Source: “Not losing weight on Ozempic? Here’s why that might be happening,”
Source: “Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension,”, 04/19/22
Source: “Ozempic, The Atlantic, and the Dangers of Anti-Exercise Rhetoric,”, 03/29/23
Image by Bruce Tuten/CC BY 2.0

Till Death Us Do Part

Here is more about the same weight-loss drugs, the ones based on synthetic GLP-1 (glucagon-like peptide-1), that have been referenced in several recent posts.

Mention was made of the weight rebound factor, an alternative way to say “When they quit, they regained all the weight they had lost.” To some interested parties, it comes as a big surprise that the weekly injection regimen will last forever.

Seemingly, every celebrity on the planet has been interviewed about Ozempic or Wegovy — which brand they use and what their experience has been. Or maybe, why they don’t want to go near the stuff. For RealClearScience, John Mac Ghlionn wrote about Ozempic that it “must be taken for the entirety of one’s life.”

Podcaster (“Not Skinny But Not Fat”) and model Remi Bader took Ozempic for a while, then stopped, and her binge eating came right back. Even worse, she regained all the weight she had lost, plus an additional, equal amount

Fellow podcaster Jackie Goldschneider calls the drug “an eating disorder in a needle” and says,

It’s just going to be a massive number of people who gain a huge amount of weight… There’s going to be a lot of people with eating disorders. You start dropping massive amounts of weight. That’s so addicting. That’s how I spiraled into anorexia. You get addicted to this new body and to the attention that comes with it.

In other words, now we’ve got people who don’t mind being stuck with (drug of choice) for life, along with enduring nausea and vomiting, or taking more meds to control those symptoms — all to avoid the possibility of developing a deadly eating disorder if they quit.

Training doesn’t help

In a prominent publication, an article about one brand of weight-loss medication made it clear that a person has to stay on it indefinitely — unless the were only using it to “jumpstart” healthier habits. But apparently, that is a big fallacy. Unfortunately, that is not how this works. It isn’t a jumpstart, or a kickstart, or a pair of training wheels; that’s baloney. Contributing health writer Lisa Rapaport wrote,

And even if people manage to maintain the eating habits they developed while on Ozempic, their blood sugar might still rise when they stop treatment because the drug boosts the production of insulin, a hormone involved in blood sugar control.

Still, the manufacturers of weight-loss pharmaceuticals have an answer for every criticism. The drug was not meant to be training wheels, or a life jacket to keep sick people afloat until they learn to swim. Comparisons are made with depression and diabetes — both conditions where the patient must expect to stay on the meds in perpetuity.

Your responses and feedback are welcome!

Source: “Ozempic Rebound Is Real,”, 01/30/23
Source: “Ozempic, The Atlantic, and the Dangers of Anti-Exercise Rhetoric,”, 03/29/23
Source: “Stars Who’ve Spoken About Ozempic — and What They’ve Said,”, 05/01/23
Source: “5 Things That Can Happen After You Stop Taking Ozempic,”, 03/07/23
Image by agressti vanessa/CC BY 2.0

On the Rebound, Continued

(Continued from our previous post, “On the Rebound“)

Patient Yolanda Hamilton lost 60 pounds on Wegovy, before a change in employment forced her to switch insurers. Suddenly her prescription cost nearly $1,400 unaffordable dollars per month. She soon gained back 20 pounds, with no end in sight. People reporter Vanessa Etienne wrote,

A study in the Journal of Pharmacology and Therapeutics found that a majority of people who take semaglutide gain most of the weight back within a year of stopping the medication.

One news source cavalierly dismissed this whole matter with a single sentence: “Anecdotally, many patients have had their weight rebound back soon after stopping.” But the writer compensates for it, sort of, by noting that “these are not medications to be used for vanity purposes,” meaning that its purpose is supposed to be to save lives.


Obesity expert Dr. Christopher McGowan told journalist Alyssa Northop about semaglutide, “[M]ost people will regain much of that weight if they discontinue using it.” Dr. Rekha Kumar, another weight-care expert, said, “[S]topping Ozempic completely will likely lead to regaining most of the weight lost within several months.”

The rebound effect is, basically, to be expected. Ania Jastreboff, M.D., Ph.D., and obesity expert at Yale University, explains why no one should be shocked by the body’s tendency to pile the weight back on again:

If you have a patient who has high blood pressure, they have hypertension, and you start them on an antihypertensive medication, and their blood pressure improves, what would happen if you stopped that medication? Well, their blood pressure would go back up — and we’re not surprised. It’s the same with anti-obesity medications.

What else is there?

All these things under discussion here are quite ugly. It’s like every cliché about being caught between a rock and a hard place, between the devil and the deep blue sea. Even with today’s inflation, $1,400 per month is an amount that makes a person sit up and take notice. So it’s that, or quit the drug and go through an embarrassing “withdrawal” that everyone can see, as the pounds relentlessly reclaim their old territory.

Many people live with debilitating physical conditions, but concerning obesity, the last word has not been said. It may not be inevitable. Disease or choice? For people who absolutely are imprisoned by genetics or unchangeable physical circumstances, all help should be extended. But it is also fairly obvious that an individual can do a lot to prevent obesity or to escape it before the chances get used up.

The most accessible escape route is childhood, before the body and mind are too set in their ways. Just as a window of time exists when languages can be easily absorbed, maybe there is a golden era in human life when we can truly be a product of our choices rather than our circumstances. And never need to face the threat of a “rebound effect” in our lives.

Your responses and feedback are welcome!

Source: “Ozempic Rebound Is Real,”, 01/30/23
Source: “How promising are new drugs to treat obesity and who should — and shouldn’t — use them?,”, 05/05/23
Source: “Ozempic For Weight Loss: Risks, Side Effects And More,”, 04/26/23
Image by Abdullah Bin Sahl/CC BY 2.0

On the Rebound

The obesity management drugs mentioned by Childhood Obesity News include Ozempic, Wegovy, Mounjaro, and others based on molecules that imitate glucagon-like peptide-1, known familiarly as GLP-1.

Writer Lisa Rapaport composed a list of the five things that happen when a person stops taking (in this case) Ozempic, but all drugs of this type are all based on the same chemicals, so the same results can be expected. The person’s blood sugar will become elevated, indicating the medical necessity for a different medication to be prescribed. The drug’s side effects, including the phenomenon known as “Ozempic Face,” will fade.

But the first two caveats, so eloquently phrased by Rapaport, are the most relevant:

1. Your Appetite Will Return
2. You Will Regain Weight

Such a reversion to the previous state is known as the “rebound effect,” and it is brutal. Here are only a few of the many available opinions about that, from diverse sources.

Writer Taylor Andrews quotes the Journal of Pharmacology and Therapeutics which revealed that patients who quit the weight-loss drug regained two-thirds of the fat they had started out with. On another front, addressing 2.2 million TikTok followers, Remi Bader…

[…] recently opened up about her experience gaining “double the weight back” once she stopped treatment… And when she decided to stop taking the drug, her binge-eating disorder almost immediately returned.

These drugs are not a substitute for conscious eating, nor for giving the body the motion and challenges it needs in order to remain viable. It now appears obvious that anybody who starts on them has made a lifetime commitment, because of a little seven-letter word: rebound.

Meredith Schorr, a young nurse who had gained 50 pounds during the worst of the COVID crisis, successfully shed the unwanted weight by taking Ozempic for 11 months. It caused so much internal discomfort, her doctor also prescribed something to alleviate nausea and vomiting. After a while, in hopes of starting a family, she very responsibly stopped taking the weight-loss drug, and for a short time things seemed okay. Then, after about five weeks, she began to feel ravenously hungry, and guess what?

Within two months of stopping Ozempic, she regained 10 lbs of the 50 she had lost.

(To be continued…)

Your responses and feedback are welcome!

Source: “5 Things That Can Happen After You Stop Taking Ozempic,”
Source: “Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension,”, 04/19/22
Source: “Nurse Who Took Ozempic for COVID Weight Gain,” 03/14/23
Image by Shal Farley/CC BY-SA 2.0

Weight-Loss Drugs, Exercise, and General Functionality

The previous post, about obesity management drugs that imitate a natural bodily ingredient called glucagon-like peptide-1, talked about the likelihood that taking these drugs will cause the destruction of not just fat cells but muscle cells. It ended with the observation that we don’t go around cutting off people’s heads (an average of 11 pounds) just to achieve weight loss.

In all seriousness, it is essential to maintain a high level of exercise to not only lose fat but build muscle mass. For the patient, it is essential to get enough protein.

“Simply put, you need to eat a 1:1 ratio of grams of protein to your starting weight in pounds,” Dr. Peter Attia says. He feels that when the Food and Drug Administration approves pharmaceuticals it does not pay enough attention to the exact type of weight loss that is being achieved.

The purpose should be to lose fat tissue, not muscle tissue, and to accomplish that takes a certain amount of work. These drugs have not been around long enough to allow researchers to perceive the whole picture.

Also, as Director of Cognitive Nutrition at Thrive Global and founder of Sia Health Bredesen writes for TIME, aerobic exercise activates the immune system, improves blood flow; improves metabolic health by increasing insulin sensitivity; reduces cardiovascular risk by strengthening the heart; boosts the mood, improves sleep, and “enlarges the hippocampus, the brain area involved in learning and memory.”

And don’t forget strength training. Bredesen writes,

[I]n a recent meta-analysis reviewing data from 1.5 million study participants, strength training activities were associated with a nearly 20 percent reduction in risk of cardiovascular disease, cancer, diabetes, lung cancer, and all-cause mortality.

The sad truth

Drugs of this kind are certainly not a substitute for exercise. Researcher and essayist John Mac Ghlionn describes a new study that found that…

[…] not only does exercise build stronger muscles and bones, it also improves an individual’s gut health. The researchers found that exercising for at least 150 minutes per week increases the diversity of the human gut microbiome… The gut, otherwise known as our “second brain,” utilizes the same type of neurons and neurotransmitters that are found in the central nervous system. Ozempic, it’s important to note, appears to actually disrupt the microbiome.

Taking Ozempic, Wegovy, Mounjaro, and similar drugs does not mean a person may now finally get away with eating as much as they want, of anything, and it certainly does not mean they can quit exercising, or continue to avoid it. Ideally, before prescribing, those patients are weeded out, just like obese bariatric surgery candidates who are psychologically unprepared and have an unhelpful attitude toward the whole procedure.

Your responses and feedback are welcome!

Source: “Peter Attia Says Ozempic Could Make You ‘Fatter’,”, 05/02/23
Source: “What the Ozempic Obsession Misses About Food and Health,”, 02/21/23
Source: “Ozempic, The Atlantic, and the Dangers of Anti-Exercise Rhetoric,”, 03/29/23
Image by naitokz/CC BY-SA 2.0

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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:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources