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Obesity Costs Come in Many Guises

Pat Hartman January 27, 2026 No Comments

One aspect of human life that seems stubbornly unchangeable is the close relationship between obesity and poverty. Also, in some countries, people from certain racial backgrounds tend to be more financially stressed, so minority status becomes an element of the equation. Of course, other factors might intervene too, like the COVID-19 pandemic, which was also inextricably linked to race, poverty, and obesity.

Describing the relationship between obesity and the pandemic, the authors of a scholarly paper specified these as the most common (but not only) forces tending to increase obesity during the period:

[…] sociodemographic factors, physical inactivity, sedentary lifestyles, reduced sleep quality, increased technology utilization, harmful substance abuse, unhealthy food consumption, and psychological problems…

Since then, numerous studies in several countries have made a stab at reckoning the collective weight gain of their respective populations during those years. “Lingering” is a poetic word, but it loses all its charm when applied to the retroactive effects of a worldwide health crisis. The results are still with us, due to a chillingly basic fact: Once it moves into a child’s body, unpacks, redecorates, and arranges the furniture, obesity is a very difficult tenant to evict.

Full employment for math nerds

The globe currently supports a dismaying number of children and teens who, in an alternative universe timeline, would have weighed 70 pounds today but actually weigh 95, and equally impressive hordes of others who in that imaginary universe would have weighed 120, but actually clock in at 145.

If they haven’t already done so, creative statisticians could make a pretty close guess regarding the total amount of weight collectively gained by humans in various demographic categories. We can only hope they will also devote significant energy to figuring out how to reverse the trend.

Hot off the presses

A brand new cross-sectional, multi-site study of Long COVID (also known as LC) shows that it prefers to strike obese rather than healthy-weight individuals. Whether or not their disease lasts for an abnormal length of time, obese patients “tend to suffer worse physical and mental health outcomes.” Many in the medical field are convinced that there will be another pandemic, and are eager to prepare, but are not finding the backup this would require from governmental and other institutions.

The eternal two-way street

Even five years ago, an association was being noticed between the pandemic and the amount of obesity, and since then, there has been plenty of opportunity for researchers to make meaningful connections. About 70% of Americans were overweight or obese then, and the Mayo Clinic’s Dr. Donald Hensrud told the press,

During the pandemic, fitness centers have been shut down, our activity may be decreasing, or we may be working from home and not moving as much. In addition, our diet has changed. We may be eating more comfort food or eating what happens to be around the house rather than getting something that is healthier.

Poverty and/or obesity led to more COVID-19 cases, which then contributed to more obesity, which was difficult for families to manage. Massive disruption of the national economy forced many working parents to change jobs, work fewer hours, pay more for child care, or in some other way have their financial situation negatively impacted. When life becomes chaotic, there is not only less money to spend, but people get careless and neglect little details like making an effort to “eat healthy.”

An article by Jeff Krasno, published only a few days ago, noted that COVID-19 has been listed as the cause of death for more than 1.2 million Americans, but there are solid reasons to believe that number should really be much higher. He adds,

Obesity, vaccination, and COVID mortality are not independent variables. They’re downstream of deeper forces, including long-standing health behaviors, trust in institutions, access to healthcare, socioeconomic stress, political identity, and media ecosystems…

How did a wealthy nation with extraordinary medical resources end up in such a sorry state?

Your responses and feedback are welcome!

Source: “Effect of the COVID-19 pandemic on obesity and its risk factors: a systematic review,” NIH.gov, May 2023
Source: “Obesity and Long COVID: intersecting epidemics?,” Springer.com, 01/22/26
Source: “How the COVID-19 pandemic has impacted issues of obesity,” MayoClinic.org, 01/19/21
Source: “The Political Fault Line: Politics, Obesity, & COVID,” Substack.com, 01/24/26
Image by jarmoluk/Pixabay

Global Damage and Expense

Pat Hartman January 22, 2026 No Comments

Over much of the planet, a large part of the economy is devoted to producing things called “food,” which, as Childhood Obesity News never tires of pointing out, would baffle interplanetary visitors. The explorers would be tapping on their translation devices, which would seem to be out of order, and sending them back to the technicians for recalibration.

The Earthlings seem to be pretty smart about some matters, but how do so many substances become itemized as “food” that not only lack any trace of nutritional value, but actually contain ingredients that do measurable harm?

Alien historians might search through the records of earlier times on Earth, when humans lived in small and isolated groups. In those simpler, more innocent days, in diverse eras and locations, many societies agreed on certain basic tenets. It is quite likely that a stranger wandering into the settlement would be offered, at the very least, water — and probably food, too.

Later, there would be time for the inhabitants and the newcomers to discover their points of philosophical disagreement and start to become suspicious of each other. Yet and still, an initial sharing of sustenance was very likely to be the first move.

Progress?

As society became more crowded and complicated, food would play a major role in gatherings and celebrations of every kind. For a joyous occasion like a wedding, immense efforts would be made to not only serve up nutritious substances, but to commemorate these significant occasions by offering special treats. The sharing of rare delicacies has become a matter of pride, and often of barely-concealed competitiveness, as hosts vie to be admired for their exceptional generosity.

Of course, there are still many places where food is scarce and limited to a few basic items, so that today’s menu of rice and fish will tomorrow be replaced by fish and rice. But marketing embraces almost the entire globe to the point where even the most remote locations receive shipments of modern, processed stuff called “food,” available to anyone who can afford it. And yet, basic nutrition is affected not positively, but negatively.

Those curious alien scientists would be hard-pressed to find a human population anywhere on Earth not affected by phthalates, which get into food by way of packaging, and have some connection with obesity, in addition to numerous other known and unknown negative effects on the human system.

An ugly example

Then, there is Bisphenol A (BPA for short), which also migrates from food packaging into the consumers of that food, and appears to be connected with not only obesity but several other undesirable consequences in the human body. For instance, as previously mentioned, when a high level of it shows up in the urine of a preteen girl, she is twice as likely to be obese as her friend whose lab results indicate a lower amount of it.

In the USA, the stuff was banned a while back from being used in any object that a baby might make oral contact with. But it is in everything, including bottles and the linings of metal cans that food is packaged in. More recently, it was found to be a frequent invader of the gut microbiome, a realm which we earnestly do not want invaded by nasty chemicals. No one who has been paying attention is surprised to find that its presence in that inner sanctum is associated with childhood obesity.

But although linkage has been noted over and over again by various researchers in different countries, apparently it is difficult to make the case for causation. So, for the time being, we must wait patiently to learn the amount of physical and financial havoc it has caused, specifically in the child and adult obesity realms.

Your responses and feedback are welcome!

Image by bahonya/Pixabay

Inside UCLA’s Fit for Health Program

Tatyana Meshcheryakova January 21, 2026 No Comments

As we’ve written time and time again, childhood obesity is a complex condition shaped by far more than diet and exercise alone. At UCLA Health’s Fit for Health Program, clinicians are embracing a comprehensive model that treats obesity as a medical, emotional and social condition — one that requires coordinated, compassionate care. Let’s take a quick look at what works in the current environment and what the challenges are.

Founded nearly 15 years ago by Dr. Wendelin Slusser, a UCLA Health physician specializing in clinical care, medical training and obesity research, the program has long focused on improving outcomes for children and adolescents. Since 2024, however, the clinic has expanded its reach and scope under new leadership.

Dr. Vibha Singhal, who took over the program last year, said she broadened its approach by integrating new therapies, obesity medications and bariatric surgeries related to weight loss. Beyond treatment, the clinic also serves as a learning environment, with undergraduates, medical students, residents, and fellows contributing to patient care.

Research is a central pillar of the program’s mission, Dr. Singhal said, noting:

I have my own lab where we have studies primarily around obesity and obesity treatments… Addressing food insecurity, how we can build that into our program, evaluating for potential eating disorders, evaluating the newer medications and the risks of infertility effects on the next generation.

Addressing food insecurity and eating disorders

For many families, access to healthy food remains a barrier to care. The program currently uses a small food bank grant to help clinicians address food insecurity among patients, Dr. Singhal said.

Eating disorders are another common challenge. Many patients struggle with binge eating and related conditions, according to Dr. Singhal. To meet these needs, the clinic relies on a multidisciplinary care team that includes psychologists, nutritionists and social workers who collaborate closely.

Dr. Natacha Emerson, the program’s psychologist, said:

We are sort of a one-stop shop… Unlike going to a doctor’s visit, where they just refer you to a psychologist or a dietitian, all three of those providers are actively working together to focus on shared goals to make sure that we are helping patients the way that they want to be helped.

Rapid growth brings new challenges

The demand for this integrated model of care has surged. Since October 2024, the clinic’s patient volume has doubled, Dr. Singhal said. To keep up, the program added two new physicians and expanded availability for nutritionists and psychologists.

Still, growth has brought strain. Dr. Singhal said:

We doubled the volume, but we didn’t double all our resources… It adds a lot of work on the team… It’s getting hard to keep up.

Insurance coverage remains a significant hurdle as well. Many obesity treatments are not covered, and Dr. Singhal said she anticipates further medication cuts at both the state and federal levels starting in January.

Serving vulnerable families

The clinic often serves families who are underinsured or undocumented, which can make accessing care difficult. Dr. Emerson noted that fear and uncertainty around immigration status can discourage families from seeking medical help. She said:

In the last year, we have had a lot of our patients who want to be healthier and have healthier bodies, but some of our families also have parents that are undocumented, and that has made seeking health care scary in this certain climate.

Telehealth has helped bridge that gap. According to Dr. Singhal, the clinic’s no-show rate has dropped as families increasingly return for care, including through video visits. Dr. Emerson offered:

Thankfully, we’re able to keep patients via video visit, which is sometimes a good way to make people feel more secure, especially when there are transportation and other barriers to getting to the clinic.

Integrating mental and physical health

A defining feature of the Fit for Health Program is its commitment to addressing mental health alongside physical health. Dr. Emerson said part of her role is identifying mental illnesses that may be influencing a child’s weight, allowing the team to intervene early and appropriately.

Dr. Singhal also shared a long-term vision for the clinic: creating a structured program specifically for patients with developmental disabilities, including autism, Down syndrome and genetic disorders.

Meanwhile, the program’s social worker, Bobby Verdugo, leads a mindfulness initiative that helps families navigate complex social and behavioral challenges. He said:

We tailor the (mindfulness) curriculum to the family… Some families may want to work a lot on portions, some want to work more on what they’re eating too fast and others on physical activity. We really adjust it to the family and I think that’s pretty unique — the ability to provide this intervention, to customize it to the family and then to continue to work with families in this kind of holistic, multidisciplinary way.

Redefining success beyond the scale

For many young patients, emotional well-being is just as important as physical health. Dr. Emerson said children often arrive with negative body image and pressure to be thinner rather than healthier — an expectation the clinic works to gently reshape.

At UCLA’s Fit for Health Program, progress is measured not just in pounds lost, but in confidence gained, barriers reduced and families supported, which we believe is an approach that reflects the true complexity of childhood obesity.

Speaking of UCLA…

Dr. Pretlow, the creator of BrainWeighve, a weight loss app for overweight and obese children, is conducting a BrainWeighve clinical trial at UCLA. The trial has expanded to include 10 subjects currently taking GLP-1 medications. This addition aims to help researchers understand how lifestyle and behavioral tools enhance medication or possibly even reduce the need for medication over time.

The program is designed for obese teens and uses a self-directed, physician-supervised approach to tackle overeating one “problem food” at a time. By helping participants rechannel emotional urges into healthier coping mechanisms, BrainWeighve aims to support sustainable weight loss — and reduce dependence on willpower alone.

Your responses and feedback are welcome!

Source: “UCLA Fit for Health Program adopts holistic approach to childhood obesity,” Daily Bruin, 1/14/25
Source: “Fit for Health Program,” UCLA.org, undated
Image by Los Muertos Crew/Pexels

More on Obesity’s Price Tag

Pat Hartman January 20, 2026 No Comments

There are plenty of places to buy food, ranging from a little taco-vending operation on wheels to a machine in the courthouse basement, to some enormous marketplace as big as an entire town might be in a different geographical area.

In much of America, the consumption of all this food is not just a thing we must do to support life, but an entertainment to alleviate boredom; a perverse sport; a status symbol; a “branding” activity meant to convey to onlookers some essential fact about oneself; an emotional bandage; a defiant gesture aimed at the parents and other authority figures who no longer hold power over us…

This list could be greatly expanded. Humans have a lot of reasons for doing a lot of things, including recreational eating, an activity that has, essentially, nothing to do with nourishment to keep the body functioning.

Through other eyes

Confronted with common grocery store items, visiting space aliens would be hard-pressed to identify many of them as having any connection with the function of supporting life. In fact, a scholar from another planet might be totally mystified by some products that are categorized as food. Even a starving human from a different sector of Earth might bypass certain alleged foodstuffs because they are not recognized as edible.

Sure, trading money for things is the entire basis of any national economy. People need to buy commodities and services. Companies need to sell them because otherwise, they must lay off all their workers, which creates another subgroup of Americans who can’t afford to buy anything. All of this is just the way things are supposed to work, under the system we have agreed to live by.

A slight problem

But how useful is a functioning system of commerce, when enormous fortunes are spent on things that make people unhealthy, and on patching up the damage done by those unwise purchases? Where wide varieties of food products are concerned, their main common characteristic is the tendency to cause obesity.

By strange coincidence, obesity is the very thing that keeps other companies in business. To those interplanetary visitors, humans would appear to be cartoon figures, handing out money from one pocket to buy things that make them fat, and dispensing money from another pocket to pay for substances, objects, and activities that they hope will prevent them from being fat.

Speaking of cartoons…

Research has shown statistically several ways in which obesity and poverty are linked. Remember that study released a few years back, whose headline proclaimed that “obesity is linked to higher rates of bankruptcy”?

How crazy is that? Sure, let the scholars relate going legally broke to alcoholism or drug addiction. That concept makes sense, not to mention a reasonable basis for the plot of the occasional dramatic film. Those are tragedies we can wrap our heads around. But for an individual or a family to face ruin on account of being too fat? Could that plot line support anything other than a comedy?

Economics professor Masanori Kuroki wrote,

Given the extent of the obesity epidemic facing the United States, the economic costs of obesity have been one of the most important topics in public health.

In 2008, the Centers for Disease Control reckoned that yearly American obesity-related medical costs added up to an estimated $147 billion (or around 220 billion today). According to an associated statistic, “There is a 70 percent chance that children who experience obesity will remain overweight or obese in adulthood.”

Another level

An additional factor here is that a whole major subcategory of philosophy is devoted to the error of conflating correlation with causation. Obviously, in this instance, any attempt to grasp the entire subject could easily lead to getting bogged down for a while.

We are taught that in the past, and even today in some places, to have a fat wife would earn a man status and respect, because her girth demonstrates to the world that he can afford to feed her above sustenance level. Another aspect could also foster a lengthy digression: the demonstrable fact that poverty and obesity are almost inevitably linked, and the price tag is enormous.

Your responses and feedback are welcome!

Source: “Obesity is linked to higher rates of bankruptcy, according to a new study,” TheLadders.com, 09/13/20
Image by agence-jaweb/Pixabay

Obesity’s Price Tag

Pat Hartman January 15, 2026 No Comments

These items relate to a subject often mentioned here: the societal cost of obesity. Every so often, along comes a news story that points out another example of how the system does not work as well as our society actually needs for it to work.

For instance, within the past year, India has been mentioned as a place where bariatric surgery has really caught on in a big way. Leaving all other factors aside for the sake of discussion, it is possible to question the benefit to society as a whole. It can’t be considered good for a society to have a large proportion of its members absorbed by the overwhelmingly intense preparation agenda for this sort of operation.

However much of a blessing it may be in a particular case, and in the long run, bariatric surgery is a very life-consuming project in terms of burning up time, energy, goodwill, money, and other resources.

But wait, there is more

Then, after the actual procedure, there is a similarly unproductive spell, as the patient is, to a greater or lesser degree, disabled for a considerable period of time. Even barring any unexpected side effects, there are new routines to learn and new norms to become accustomed to, on every side.

There will be medical self-care chores, and record-keeping, and check-up visits. Maybe time will be set aside for meditation. The patient actively participating in their recovery is unable to do very much else, at least for a while, if the newly required lifestyle is to “stick.”

To complete their usual work, or family caregiving, or volunteer activities in the community — effective participation in even one of those categories could prove to be too much to expect, and for quite some time. Somewhere along the line, a price is extracted from — and paid by — society as a whole.

A bit of history

By 2018, 60% of Americans — in other words, more than half of us, over 180 million people — were overweight or obese. That statistic was responsible for “$480.7 billion in direct health care costs in the U.S., with an additional $1.24 trillion in indirect costs due to lost economic productivity.”

The total amount of around $1.72 trillion was equivalent to almost one-tenth of the total Gross Domestic Product. As a risk factor, obesity accounted for close to half of the accumulated cost of chronic diseases in the USA. It should be, and is, possible to acknowledge this reality in a tactful, frank, non-judgmental way, not involving cruelty or injustice.

These words are worth repeating:

Whether or not it is their fault, and whether or not others spitefully blame them, and regardless of whether it is fair — in one way or another, obese people constitute an expense to society.

We also discussed whether poverty causes obesity, or obesity causes poverty, and concluded that both propositions are sadly and eternally true.

And another sad-but-true thing

If fat-shaming and fat-blaming have not been able to revolutionize the situation in all these years, those techniques are unlikely to bring about change in the future.

Your responses and feedback are welcome!

Source: “America’s Obesity Crisis: The Health and Economic Costs of Excess Weight,” MilkenInstitute.org,” 10/26/18
Image by bergy59/Pixabay

Inside America’s New Dietary Guidelines

Tatyana Meshcheryakova January 14, 2026 No Comments

The federal government has unveiled a sweeping overhaul of the nation’s dietary advice, signaling a sharp departure from decades of nutrition policy. Health Secretary Robert F. Kennedy Jr. announced new dietary guidelines last week that emphasize whole foods, protein, and healthy fats — while calling for a significant pullback from highly processed foods.

At a press conference, the administration introduced a newly redesigned food pyramid, one that looks nothing like its predecessors. In the new visual, red meat, cheese, vegetables, and fruits appear at the top, symbolizing foods Americans are encouraged to prioritize.

Kennedy framed the update as a historic turning point. He described the guidelines as the most significant reset of U.S. nutrition policy to date, arguing that past recommendations steered Americans toward foods that ultimately harmed public health.

“Protein and healthy fats are essential and were wrongly discouraged in prior dietary guidelines,” Kennedy said. “We are ending the war on saturated fats.”

Turning the pyramid upside down

The original food pyramid, introduced in the early 1990s, placed grains at its wide base, encouraging heavy consumption, while fats and oils sat at the narrow top. That model was retired in 2011, replaced by the “MyPlate” graphic championed by then–First Lady Michelle Obama. Now, the pyramid is back — but flipped on its head.

In an introduction to the new guidelines, Kennedy and Agriculture Secretary Brooke Rollins wrote,

We are reclaiming the food pyramid and returning it to its true purpose of educating and nourishing all Americans.

They also highlighted the health crisis driving the change, noting that more than 70% of American adults are overweight or obese. According to Kennedy and Rollins, the problem stems from a diet that has “become reliant on highly processed foods and coupled with a sedentary lifestyle.”

The guidelines call for a “dramatic reduction” in foods described as “highly processed foods laden with refined carbohydrates, added sugars, excess sodium, unhealthy fats, and chemical additives.” At the same time, they encourage diets that include meat and dairy and set limits on added sugar.

Pushback from nutrition experts

Not everyone is on board with the new approach. Some nutrition scientists argue that elevating red meat and saturated fat contradicts decades of research.

Christopher Gardner, a nutrition expert at Stanford University and a former member of the Dietary Guidelines Advisory Committee, stated:

I’m very disappointed in the new pyramid that features red meat and saturated fat sources at the very top, as if that’s something to prioritize. It does go against decades and decades of evidence and research.

Gardner favors shifting protein intake toward plant-based sources like beans rather than emphasizing animal protein.

Both the American Heart Association and the Academy of Nutrition and Dietetics also point to evidence linking excess saturated fat to heart disease.

According to NBC News, the American Heart Association said in a statement that it “commends” including several important science-based recommendations in the new guidance, including eating more fruits, vegetables and whole grains, while cutting back on added sugars and processed foods.

However, it continued,

We are concerned that recommendations regarding salt seasoning and red meat consumption could inadvertently lead consumers to exceed recommended limits for sodium and saturated fats, which are primary drivers of cardiovascular disease.

The American Medical Association (AMA) applauded the new guidance for spotlighting ultra-processed foods, added sugars and sodium, which it says fuel chronic diseases, including heart disease, diabetes and obesity.

Dr. Bobby Mukkamala, president of the AMA, said in a statement,

The Guidelines affirm that food is medicine and offer clear direction patients and physicians can use to improve health.

Marion Nestle, professor emerita of nutrition, food studies and public health at New York University, said that the advice to limit highly processed foods is a major improvement but that “everything else is weaker or has no scientific justification.” The new guidelines still retain a long-standing recommendation to limit saturated fat to 10% of daily calories. NBC News quoted Nestle’s email that states that the focus on protein…

[…] makes no sense (Americans eat plenty) other than as an excuse to advise more meat and dairy, full fat, which will make it impossible to keep saturated fat to 10% of calories or less.

Dairy takes center stage

One of the most notable changes is the elevation of cheese and other dairy products to the top of the pyramid. This shift opens the door for full-fat milk and dairy products to be offered in school meals, an idea once considered controversial.

Dariush Mozaffarian, a cardiologist, public health scientist, and director of the Food is Medicine Institute at Tufts University, said:

There’s growing evidence, based on nutrition science, that dairy foods can be beneficial… It’s pretty clear that overall milk and cheese and yogurt can be part of a healthy diet… Both low-fat and whole-fat dairy versions of milk, cheese and yogurt have been linked to lower cardiovascular risk… What’s quite interesting is that the fat content doesn’t seem to make a big difference.

Whole grains still matter, but not the refined ones

Although whole grains appear at the smallest point at the bottom of the new pyramid, the guidelines still instruct Americans to “prioritize fiber-rich whole grains.” The key difference is a sharper line drawn between whole grains and refined grains. The recommendations call for two to four servings per day of whole grains while significantly reducing refined carbohydrates such as white bread and many packaged or ready-to-eat foods.

Mozaffarian supports this part of the guidance, especially the focus on food processing. He said,

Highly processed foods are clearly harmful for a range of diseases, so to have the U.S. government recommend that a wide class of foods be eaten less because of their processing is a big deal and I think a very positive move for public health.

While the guidelines avoid the term “ultra-processed,” they repeatedly emphasize eating “real food that nourishes the body.” They also recommend no added sugar at all for children under the age of 10.

New guidance on alcohol

The updated guidelines also revise long-standing alcohol recommendations. Instead of specifying daily limits (previously up to one drink per day for women and two for men) the guidance now simply states: “Consume less alcohol for better health.”

The guidelines also clearly identify groups who should avoid alcohol entirely, including pregnant women, people recovering from alcohol use disorder, those who cannot control how much they drink, and individuals taking medications or managing medical conditions that interact with alcohol.

Although many Americans may never read the dietary guidelines themselves, their impact is far-reaching. These recommendations shape what’s served in school cafeterias, on military bases, and through federal nutrition programs for mothers and infants by setting standards for calories and nutrients.

As debate continues among scientists and health organizations, one thing is clear: The new dietary guidelines mark a bold and controversial shift in how the federal government defines healthy eating in America.

Your responses and feedback are welcome!

Source: “RFK Jr.’s new dietary guidelines go all in on meat and dairy,” NPR, 1/8/26
Source: “RFK Jr. rolls out new dietary guidelines backing more protein and full-fat dairy,” NBC News, 1/7/26
Image courtesy of USDA, used under Fair Use: Commentary

Drugs and Surgery — Reevaluation Is Inevitable

Pat Hartman January 13, 2026 No Comments

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

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

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

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

Today and us

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

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

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

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

What authorities?

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

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

An overview

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

Public health works by successive redefinition of the unacceptable.

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

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

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

Your responses and feedback are welcome!

Image by Pat Hartman

The “W” Words

Pat Hartman January 8, 2026 No Comments

Usually, when a word is abbreviated to only its first letter, it’s a curse word. “Watchful” and “waiting” are not generally considered to be vulgar expletives, but in this context, they might as well be.

Every year, it becomes more obvious that, in the struggle against epidemic obesity, “watchful waiting” is not a strategy likely to prevail. It has become obvious that the earlier someone enters the “overweight” category, the more time they are liable to spend there. The more years a person remains overweight, the more likely they are to occupy that demographic throughout life.

Watchfulness alone is not such a bad thing. We could, in fact, use more of it — for instance, when it comes to keeping an eye on the outrageous claims made by the food industry publicists whenever they think they can get away with it. Also, it has long been felt that elementary school meals could benefit from a little more scrutiny. Maybe, without violating any basic American principles, we could still find a way to minimize the devastating effects that result from the overabundance of fast food outlets.

Some very well-informed experts tell us that 80% to 90% of childhood obesity cases persist into adulthood — even when the person makes some efforts toward positive lifestyle changes.

Apparent progress plus disappointment

There has, over the past couple of decades, been a sort of overall gold-rush tendency to take childhood obesity more seriously, characterized by flashy but soon-forgotten headlines, and sporadically causing alarm in the anti-drug and anti-surgery factions. Meanwhile, deep and interesting work goes on more quietly in the background, for instance, on an identifying characteristic called the phenotype, which is made up of the combination of influences exerted by heredity plus environment.

For instance, as Tatyana Meshcheryakova, who is one of the writers on this blog, points out, Dr. Andres Acosta describes four categories of obesity phenotypes that can guide treatment recommendations:

Hungry Gut (HG). Patients experience rapid gastric emptying and feel hungry shortly after meals.

Hungry Brain. Individuals have impaired satiety and tend to overeat during meals.

Emotional Hunger. Emotional or hedonic eating behaviors dominate.

Slow Burn. Patients have a sluggish metabolism and burn fewer calories.

As the French say, “Vive la différence!” This research team discovered that when lifestyle interventions specifically tailored for each phenotype were applied and adhered to, “patients lost more weight and had greater metabolic improvement.” Better yet, Dr. Acosta’s lab “has developed a genetic test to predict the best responders to GLP-1 RAs, showing promise in identifying individuals who might benefit most.” Here, as in so many life situations, precision targeting works better than random stabs.

There is a limit

Subtlety is overrated, so let’s go right ahead and reveal the takeaway embedded in this post. Namely, in the catalogue of human frailties, another highly overrated item is the illusion of “watchful waiting,” a dodge that all too often is a coverup for a copout. We cherish a vague notion of doing something about a situation at a certain point in time, like when summer vacation starts.

Or when school is back in session… Or when that ongoing plumbing crisis is finally solved… Or after Melissa’s birthday, when she turns 14 and we can plan a serious talk…

“Watchful waiting” is a useful technique only in a limited number of situations, and any adult who finds themselves indulging/engaging in it too often, just might be deluded. This is worth considering. Sure, get a professional opinion. But Mom or Dad, don’t kid yourself.

Don’t fall for your own propaganda. If you have noticed that Junior tends to occasionally collapse a chair into a pile of splintered wood, more than likely, others have noticed it too. Maybe even Junior, who might be confused and ashamed and wishing for some kind of help, without knowing how to ask.

Bottom line: Watchful waiting is nowhere near as useful as active intervention.

Your responses and feedback are welcome!

Source: “Unlock your unique weight loss plan,” HelloAlpha.com, undated
Image by vandesart/Pixabay

Medicare May Open the Door to Affordable Weight-Loss Drugs

Tatyana Meshcheryakova January 7, 2026 No Comments

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

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

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

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

How the program would work

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

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

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

A shift from previous policy debates

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

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

Industry and insurer reactions

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

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

Your responses and feedback are welcome!

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

What Does It Take to Change?

Pat Hartman January 6, 2026 No Comments

Opinions have been quietly changing about two possible treatments for childhood obesity that, up until recently, have pretty much been viewed as undesirable, and even dreaded. The most volatile reputation belongs to medication, specifically to the glucagon-like peptide-1 receptor agonists, also known as GLP-1 RAs. With this particular type of drug, it seems that the biggest percentage of conversation centers on two demographics: menopausal women and teens of either sex.

So far, the risks for teens seem mostly financial, promising to lock them into a lifelong “deal with the devil” whose hefty price will no doubt become increasingly unaffordable. Pharmaceutical products are not famous for any tendency to become less costly over time. Federal aid for medical expenses is drying up fast. Still, more parents will choose to spring for the GLP-1 subscriptions, even if it means raiding the college fund.

Inevitably, additional cases will go on record showing that these drugs can cause problems that are presently unclear or unsuspected. Even someone who is not the wagering sort can confidently bet on that.

And then, the knife

At some point, this will probably lead to an increase in the other dreaded outcome, bariatric surgery for teens, and even for children. Following that, history is expected to repeat itself and reveal still more reasons why the surgical option can also cause regrettable yet unfixable lifelong difficulties. We already know enough about that subject to be quite wary. Still, some doctors and parents will inevitably choose surgery as a prospect less odious than other possible grim outcomes.

What sort of problem could occur?

As previously discussed, harmful eating habits might result from our own past emotional upsets and psychological traumas. Registered dietitian and nutritionist Carly Zimmer reminds parents that good eating habits need support from the environment, and alerts us to some of the signs that this area has developed problems.

She teaches that weight loss medication is only a partial answer, because it either must continue throughout life, or else the subject needs to develop an entire brand new repertoire of habits around food and eating. Sadly, the most elemental fact about life is that it can change. A person may not always have the means to procure the GLP-1 meds.

An audacious proposal

In any case, the probability is strong that some day, the consumer will need to learn to live without the drug… so why not start now? If it is just a matter of developing new habits, why do people have such a hard time with the concept and the execution? The mind might recognize that change needs to take place, but how does this translate into action? If it is a mental/emotional health issue, how do we address that?

(To be continued…)

Your responses and feedback are welcome!

Image by geralt/Pixabay

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