The Psychological and Social Complexities of GLP-1 Drugs

The last couple of weeks have been eventful in the realm of the ever popular GLP-1 meds, from positive news of yet another benefit to taking them (like lowering heart-related risks) to the sobering warning of a new, negative side effect on health, plus some substantial insurance coverage changes. Let’s take a look.

As has been established, GLP-1 receptor agonists (like semaglutide and liraglutide) and GLP-1/GIP combinations (like tirzepatide) help with weight loss by mimicking hormones that suppress appetite, slow digestion, and promote satiety. When paired with lifestyle changes, they can reduce body weight by 10%–20% over 9–15 months and improve cardiometabolic health. However, side effects like nausea, constipation, and loss of lean muscle mass are common and can prompt many to stop using the medication.

Psychological benefits and challenges

These medications can quiet obsessive food thoughts (“food noise”), reduce shame around eating, and give users a sense of mastery. However, they may also cause emotional side effects. Some users report a flattening of emotions or loss of pleasure in everyday experiences — possibly due to changes in the brain’s dopamine system. Studies show mixed results on whether GLP-1s increase depression or suicidal thoughts, with some linking them to mood issues and others finding mild improvements in depressive symptoms.

Psychologists are becoming essential in supporting GLP-1 patients by helping them adjust emotionally, manage disordered eating, and handle social stigma. Patients often face conflicting societal pressures — praised for losing weight, yet judged for using medication to do so. Therapy helps them navigate shifting body image, relationship dynamics, and grief over old habits or coping mechanisms (like using food for comfort).

Social and cultural complexities

The widespread use of GLP-1s brings up deeper issues around weight stigma, societal bias, and access. Some experts worry these drugs reinforce the idea that larger bodies are a problem to fix, potentially marginalizing people who are fat-positive or not interested in weight loss. Access is another concern: those with lower income or from marginalized communities may be less likely to afford or continue treatment.

Meanwhile, doctors may prescribe these drugs based on appearance, not medical need, and patients with eating disorders can misuse them. The rise of telehealth and loosely regulated medical spas also makes GLP-1s more accessible, sometimes in unsafe ways.

Role of psychology in GLP-1 use

Psychologists support patients by helping them:

• Develop sustainable, healthy relationships with food
• Prevent muscle loss through proper nutrition and exercise
• Strengthen body image and emotional resilience
• Navigate relationship changes and shifts in identity
• Cope with past trauma that may resurface with physical transformation

Some also use trauma-informed therapies like EMDR (Eye Movement Desensitization and Reprocessing) to help patients who used food to cope with abuse or fear the attention that comes with weight loss.

GLP-1s and addiction treatment

Emerging research suggests GLP-1s may help curb addictive behaviors, such as excessive alcohol use. A 2025 trial showed semaglutide reduced heavy drinking days and cravings in people with alcohol use disorder. The effect appears similar to how GLP-1s suppress appetite — by dulling the brain’s reward signals. More research is needed before these drugs are FDA-approved for addiction, but psychologists are encouraged to stay informed as more patients may use GLP-1s for this purpose.

GLP-1 medications offer significant promise for those struggling with obesity, providing both physical and emotional relief. But they also come with complex psychological and societal implications. Experts agree: The success of these drugs isn’t just medical — it’s behavioral. Psychologists play a vital role in helping patients navigate the inner changes that accompany dramatic outer transformations.

Alleviating migraines, but it’s a pancreatic risk

It’s been reported that in a small study, a GLP-1 drug shrank the number of days people spent with a migraine by almost half in a given month. However, the GLP-1 receptor agonists are under investigation by U.K. health authorities due to reports of serious pancreatic side effects, including nearly 400 cases of acute pancreatitis and up to 10 deaths.

The U.K.’s Medicines and Healthcare products Regulatory Agency (MHRA) and Genomics England are examining whether genetic factors may predispose certain individuals to these rare but serious complications. Tirzepatide-based drugs like Mounjaro and Zepbound appear to be more frequently linked to these reports.

While no direct causal link has been established, the investigation seeks to better understand who might be at greater risk. U.K. residents over 18 who experience severe reactions are encouraged to report them through the Yellow Card system and may be invited to submit further details and a saliva sample for research.

Experts stress that GLP-1 drugs remain approved and generally safe when prescribed and monitored by a doctor, but warn against obtaining them through unofficial channels.

CVS Caremark drops Zepbound from coverage, citing cost

Starting this week, CVS Caremark, one of the largest U.S. pharmacy benefit managers, will stop covering Eli Lilly’s Zepbound, a GLP-1 drug approved for chronic weight management, on its most common formulary, affecting 25–30 million Americans. Wegovy, a competing drug from Novo Nordisk, will remain covered, alongside a few less effective alternatives.

CVS says this move is designed to drive down costs by forcing drugmakers to compete, citing the high prices of GLP-1s as a major barrier to access. However, pharmacy benefit managers (PBMs) like CVS have been criticized for their role in rising drug prices.

Doctors and patient advocates argue that GLP-1s aren’t interchangeable, and abrupt coverage changes can disrupt patient care. Side effects, tolerability, and individual response vary, and switching medications mid-treatment can stall progress or worsen health outcomes.

Critics also say this move reflects a broader misunderstanding of obesity as a chronic disease, noting that insurance policies don’t treat obesity care with the same consistency or respect as other chronic conditions.

Providers report being overwhelmed with patient concerns and spending excessive time navigating insurance rules instead of delivering care. Another upcoming policy change: BCBS Massachusetts will stop covering GLP-1s for obesity in 2026, unless prescribed for diabetes.

In response, Eli Lilly is expanding access via its LillyDirect program, offering Zepbound for $499/month out-of-pocket. Still, many worry such policies will create greater inequality and care disruption for people managing obesity.

Your responses and feedback are welcome!

Source: “A new era of weight loss: Mental health effects of GLP-1 drugs,” APA, 7/1/25
Source: “Pill form of popular weight-loss drug lowers heart risks,” Harvard Health Publishing, 7/1/25
Source: “Popular weight-loss drugs show promising new power against debilitating migraines,” Fox News, 7/2/25
Source: “New Weight-Loss Drugs Under Scrutiny Amid Pancreas Concerns,” Science Alert, 7/3/25
Source: “Major insurance changes are coming to GLP-1 drugs for weight loss. Here’s how that could affect patients,” CNN, 7/1/25
Image by Leeloo The First/Pexels

New Monthly Obesity Injection Shows Promise

In a significant development for obesity treatment, a new once-a-month injection has shown impressive results in a clinical trial, helping participants lose up to 16% of their body weight (and even more under ideal conditions). The drug, maridebart cafraglutide (also called MariTide or AMG133), may reshape how obesity is managed, particularly for people seeking long-term, effective solutions without the hassle of weekly injections.

This breakthrough comes from a Phase 2 randomized controlled trial published in The New England Journal of Medicine. Conducted on nearly 600 adults with obesity — with or without type 2 diabetes — the study explored both the efficacy and safety of this long-acting peptide–antibody conjugate. Here’s what the results reveal, and why experts are paying attention.

Why this matters

Obesity is more than just a number on a scale — it’s a chronic metabolic condition that raises the risk for diseases such as type 2 diabetes, heart disease, and stroke. And it’s getting worse. According to the World Health Organization, as of 2022, 890 million adults and 160 million children worldwide were living with obesity.

Despite the availability of promising medications like semaglutide (Wegovy) and tirzepatide (Zepbound), there are still major challenges: frequent dosing schedules and issues with adherence. Many people struggle to stick with weekly injection regimens, and dropout rates are high.

That’s why maridebart cafraglutide is drawing attention. With dosing just once every four to eight weeks, this new drug could improve patient compliance and produce stronger long-term results.

The science behind maridebart cafraglutide

So, what is maridebart cafraglutide, exactly? It’s a dual-action molecule: A GLP-1 receptor agonist, which promotes satiety and lowers blood sugar, and a GIP receptor antagonist, which counteracts the hormone GIP (glucose-dependent insulinotropic polypeptide) believed to contribute to weight gain in certain contexts.

This dual mechanism is key. While some drugs activate the GIP receptor (like tirzepatide), others, like maridebart, block it. Both approaches, when combined with GLP-1 agonism, appear to support weight loss. It’s a surprising paradox and an area of ongoing research.

Maridebart’s extended half-life of 21 days — nearly triple that of the longest-acting once-weekly drugs — makes monthly or even bi-monthly administration possible. The innovation lies in how the peptides are bound to a monoclonal antibody, giving the drug its staying power.

The clinical trial’s design and participants

The Phase 2 trial included 592 adults, divided into 465 participants with obesity only and 127 participants with obesity and type 2 diabetes. Participants received injections every four or eight weeks, with varying doses. Some groups used dose escalation to minimize side effects.

After 52 weeks of treatment, researchers evaluated: body weight changes, blood sugar levels, body composition (fat vs. lean mass), and adverse events and side effects.

Substantial weight loss followed

Here’s what the study found after one year:

For participants without diabetes:

  • 3% to 16.2% weight loss in the treatment group (based on real-world conditions).
  • Up to 19.9% weight loss in the ideal-case (efficacy) analysis.
  • Placebo group lost only 2.5%.

 

For participants with diabetes:

  • 4% to 12.3% weight loss in the treatment group.
  • Up to 17.0% in the efficacy analysis.
  • Placebo group lost just 1.7%.

 

Notably, around half of the participants reached at least 15% total weight loss, a clinical benchmark known to drastically improve health. Under ideal trial conditions, 75% achieved that milestone.

Maridebart cafraglutide didn’t just help with weight — it also improved blood sugar control, particularly in participants with type 2 diabetes, and a fat (vs. lean mass) reduction of 36.8%.

Safety and side effects

While the trial showed promising results, it also raised some safety considerations. Gastrointestinal side effects were the most common, including nausea, vomiting, constipation, retching, and diarrhea. These symptoms were more frequent in participants who skipped dose escalation or started on higher doses.

Serious adverse events were rare.  Gallbladder issues were slightly more common in the treatment group than in the placebo group. Importantly, no unexpected safety signals emerged during the trial. Side effects were generally manageable and transient.

Why dose escalation matters

Gradual dose escalation and a lower starting dose greatly improved tolerability. This has influenced the design of the ongoing Phase 3 trial, where all groups are now using a more careful ramp-up strategy.

With up to 20% weight loss, improvements in metabolic markers, and a safety profile comparable to other GLP-1-based drugs, this monthly injection could change the game, especially for those who struggle with weekly dosing. As the Phase 3 trial progresses, the medical community is watching closely. If results hold, maridebart cafraglutide could soon be a powerful new tool in the global fight against obesity.

Your responses and feedback are welcome!

Source: “Once-Monthly Maridebart Cafraglutide for the Treatment of Obesity — A Phase 2 Trial,” The New England Journal of Medicine, 6/23/25
Source: “Once-monthly obesity injection shows double-digit weight loss in major clinical trial,” News Medical, 6/24/25
Image by Anna Tarazevich/Pexels

David Kessler on the Science of Weight Loss

In his book Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight, former FDA Commissioner Dr. David A. Kessler presents an in-depth look at the science of weight loss and the forces that have fueled the obesity crisis in America. Deborah Vankin takes a look at the book for the Los Angeles Times and interviews Dr. Kessler.

“Ultraformulated” products, intentionally engineered

According to Vankin, Dr. Kessler argues that today’s food industry has deliberately crafted what he calls “ultraformulated” products — foods that are heavily processed, packed with calories, fast-digesting, and designed to be nearly impossible to resist. This strategic engineering by food manufacturers, he contends, has contributed to skyrocketing obesity rates. According to Dr. Kessler, 41.9% of U.S. adults are currently affected by obesity, and by 2030, that number could reach nearly half the population.

Dr. Kessler describes this as a “health catastrophe” that’s unfolding on a massive scale. The accumulation of visceral fat (fat that wraps around internal organs) has been linked to a wide array of serious health problems, including Type 2 diabetes, heart disease, hypertension, arthritis, dementia, stroke, and several types of cancer.

While GLP-1 medications like Wegovy and Zepbound have emerged as popular tools to reduce weight and food cravings, Dr. Kessler warns that they aren’t a silver bullet. These drugs come with their own risks, and there’s still much we don’t know about their long-term effects.

It’s personal for Dr. David Kessler

Dr. Kessler’s perspective is shaped by personal experience. Having struggled with compulsive eating since childhood, he knows firsthand how addictive certain foods can be, especially during his college and medical school years, when he relied on comfort foods as rewards. He has also faced challenges with the side effects of GLP-1 drugs. To truly address the obesity epidemic, he believes society must reframe how we understand addiction, moving away from a stigma-based model and recognizing how engineered foods help hijack the brain’s decision-making processes.

The interview takeaways

Dr. Kessler emphasizes that obesity should be treated as a long-term, chronic condition. In his conversation with the LA Times, he explores sustainable strategies for weight loss, how to approach GLP-1 use responsibly, the importance of body positivity, and ways to improve both health and longevity. Here’s a summary of the key points.

The root of the obesity crisis

Dr. Kessler identifies the “elephant in the room” as the addictive power of “ultraformulated” foods, engineered to overstimulate the brain’s reward circuits. He says,

Food is very, very powerful in changing how we feel. It’s not a question of willpower. Our bodies have experienced an insidious decline over the past half a century. And that’s been caused by this never-ending consumption of foods that can trigger the addictive circuits.

Food addiction and the role of the environment

To combat food addiction, Dr. Kessler suggests changing the cues in our surroundings that trigger cravings — like what we watch, the stores we pass, or the ads we see. Being realistic, he adds:

Many of us don’t have the opportunity to leave our environment. And the food industry isn’t prone to change their behavior any time soon. But we now have pharmaceutical aids to help tamp that down. The effect of these GLP-1 [weight loss] drugs on food noise, that’s the big discovery.

Dr. Kessler does not address the role that stress plays in driving compulsive eating, or the interplay between stress, displacement, and ultraformulated foods. Stress can definitely drive overeating, says Harvard Health Publishing, and research shows that stress shifts food preferences toward highly palatable foods.

Risks of GLP-1 drugs

While GLP-1s like Wegovy and Zepbound help reduce appetite, Dr. Kessler warns of serious health concerns such as malnutrition, gastroparesis, and hypoglycemia. Many patients are consuming dangerously low calories, and most prescribers lack training in obesity medicine. He calls for better labeling and more real-world research on long-term safety and discontinuation protocols.

Long-term weight management

Most people regain most of the lost weight after stopping GLP-1s, so the focus should be on learning sustainable habits while on them. Dr. Kessler advocates for using a full range of tools, including nutrition therapy, physical activity, and behavioral support, tailored to each individual. He says:

But the most important thing is to recognize that this is a chronic condition that needs continuous care, even after you’ve lost the weight.

Addiction vs. willpower

Dr. Kessler challenges the outdated notion that weight loss is just about “eating less and moving more,” arguing that brain chemistry plays a far more significant role. Recognizing this can reduce the shame and stigma many people experience when they struggle to lose weight.

Body positivity vs. health

Vankin asked:

There’s a delicate balance between the body positivity movement, which encourages people to accept their bodies as they are, and the health crisis that is obesity, which you say is a root cause of many diseases. How do you suggest we navigate that?

Dr. Kessler’s answer is on point:

That movement did a lot of good — it took the shame out of it, it took the stigma out. But it was at a time when we didn’t have effective tools to reduce visceral fat. You can love your body, but also do things for your health. Those things are not diametrically opposite. And I’m not comfortable with the amount of morbidity and mortality associated with visceral fat and saying we shouldn’t do something about that.

Public health concerns and institutions

Going further, Dr. Kessler is deeply concerned about the increasing burden of visceral fat-related diseases and believes the U.S. is unprepared for the long-term consequences. He also worries about the dismantling of public health institutions that were key to pandemic response efforts like Operation Warp Speed.

Even modest weight loss helps

The interview finishes on an encouraging note, that even small amounts of weight loss can meaningfully lower the risk of chronic diseases, with greater losses offering even more significant health benefits.

Your responses and feedback are welcome!

Source: “You need more than Ozempic to fight food addiction. Here’s how,” Los Angeles Times, 5/20/25
Image: Diet, Drugs, and Dopamine book cover, Amazon. Used under Fair Use: Commentary

Obesity Guidelines Differ Between Adults and Children

Obesity is a growing health concern that often begins in childhood and continues into later life. Half of children with obesity stay obese into their teen years, and about 80% of those teens carry it into adulthood.

Despite the long-term nature of obesity, current clinical guidelines are usually split into rigid age categories. A recent review in Obesity Reviews analyzed existing obesity guidelines and found both overlaps and notable differences between recommendations for adults and children. The review looked at 39 guidelines issued between 2017 and 2023, containing a total of 1,248 specific recommendations.

The researchers found a lack of robust, adolescent-specific recommendations. This age group, caught between childhood and adulthood, often falls through the cracks.

Guideline differences

One major difference lies in how BMI is evaluated. Children’s BMI is measured using percentile curves that change with age and development, while adults use fixed BMI thresholds. For exercise, adults are advised to do both aerobic and strength training, while adolescents are typically only guided toward aerobic activity. Likewise, adults are given dietary options like low-calorie and low-carb diets or meal replacements, but these are largely absent — or even discouraged — for adolescents.

One reason for the limited dietary recommendations for teens is concern about how restrictive diets might impact growth. Still, a 2019 meta-analysis suggests such diets can work for adolescents, though more long-term research is needed.

When it comes to setting goals, pediatric guidelines recommend a slow and steady decrease in BMI, whereas adult guidelines often aim for a 5-10% reduction in body weight within six months. For children and teens, family involvement plays a big role in success, while adult patients are encouraged to focus on personal responsibility and education around health.

The report also highlighted a gap in guidance around metabolic and bariatric surgery (MBS) for teens. While surgery is suggested for teens with a BMI over 50, adults qualify at a BMI of 40. Few adolescent-specific recommendations exist due to a lack of research, though the authors expect more data to emerge in the coming years as obesity rates among teens rise.

The common ground

Despite these gaps, the review did identify some common ground. Both age groups are advised to have annual BMI screenings, undergo assessments for eating disorders and other obesity-linked conditions, and consider cognitive behavioral therapy. When surgery is being considered, both sets of guidelines support a team-based, multidisciplinary approach.

Your responses and feedback are welcome!

Source: “Obesity Guidelines Differ for Adult, Pediatric Patients,” AJMC, 6/13/25
Source: “Discrepancies Between Recommendations in Evidence-Based Guidelines for the Management of Obesity in Adolescents and Adults: An Evidence Map,” Obesity Reviews, 5/27/25
Image by Moe Magners/Pexels

Maximizing GLP-1 Treatment Success

A new joint advisory from four major clinical organizations provides a much-needed roadmap to help patients get the most out of GLP-1 medications for obesity. While GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy) and tirzepatide (Zepbound) have gained popularity for their powerful effects on weight loss, this new guidance stresses that medical therapy alone isn’t enough. Nutrition and lifestyle changes are key to long-term success.

The Obesity Society, American College of Lifestyle Medicine, American Society for Nutrition, and Obesity Medicine Association came together to publish a unified advisory titled “Nutritional Priorities to Support GLP-1 Therapy for Obesity.” Drawing on a broad base of clinical and research expertise, the team reviewed current evidence and developed eight core strategies to help clinicians support patients receiving GLP-1 medications:

(1) Patient-centered initiation of therapy; (2) careful baseline nutritional assessment; (3) management of GI side effects, (4) personalized, nutrient-dense, minimally processed diets; (5) prevention of micronutrient deficiencies; (6) adequate protein intake and strength training to preserve lean mass; (7) leveraging a good diet to maximize weight reduction; and (8) promoting other lifestyle changes around activity, sleep, mental stress, substance use, and social connections to maximize long-term success.

The clinical advisory, led by Advisory Chair Dariush Mozaffarian, M.D., DrPH, of Tufts University, Boston, was published simultaneously in Obesity, American Journal of Lifestyle Medicine, The American Journal of Clinical Nutrition, and Obesity Pillars.

The guidelines in more detail

Clinical trials show that GLP-1s can reduce body weight by 5% to 18%, with multiple benefits such as improved blood sugar levels and cardiovascular risk reduction. However, real-world results tend to be more modest, and several challenges can stand in the way of long-term success. These include side effects like nausea and vomiting, nutritional deficiencies due to reduced food intake, and loss of lean muscle and bone mass. Additionally, many patients struggle with adherence over time, often regaining lost weight once treatment stops.

To address these issues, the expert panel emphasized the importance of a patient-centered approach starting from the initiation of therapy. A thorough nutritional assessment should be done at the beginning of treatment to identify any pre-existing deficiencies or health risks. Managing gastrointestinal side effects early on is essential for helping patients stick with the medication.

When it comes to diet, the group recommends moving away from restrictive eating patterns and instead focusing on nutrient-dense, minimally processed foods tailored to each patient’s preferences and needs. Ensuring adequate intake of vitamins, minerals, and protein is especially important for preserving muscle and bone health during weight loss. In addition to proper nutrition, strength training and physical activity should be prioritized to support lean mass retention.

The advisory also encourages clinicians to look beyond diet and exercise. Sleep quality, mental health, substance use, and social support all play a role in achieving and maintaining healthy weight loss. By taking a holistic view, healthcare providers can create a more sustainable and supportive plan for patients on GLP-1 therapy.

Dr. Marc-Andre Cornier, President of The Obesity Society, said:

This guidance lays a nutrition roadmap to help providers support their patients on sustainable and lasting weight reduction journeys… It underscores the importance of nutrition on quality of life and is an important contribution to the literature about incorporating lifestyle interventions into obesity care.

For patients and providers alike, the message is clear: GLP-1 medications are a powerful tool, but their true potential is only realized when paired with smart, personalized lifestyle support.

Your responses and feedback are welcome!

Source: “Advisory: Nutrition Priorities for GLP-1 Use in Obesity,” Medscape, 6/4/25
Source: “Nutritional priorities to support GLP-1 therapy for obesity…,” PubMed, 5/30/25
Image by Pavel Danilyuk/Pexels

 

The MAHA Report’s Shortcomings and Mistakes

In a bold and sweeping move, the Trump administration released the “MAHA Report: Make Our Children Healthy Again,” a 72-page document outlining the rise of chronic illnesses among America’s youth. Spearheaded by Health Secretary Robert F. Kennedy, Jr., the report zeroes in on an urgent public health crisis — one that includes high rates of obesity, asthma, behavioral health disorders, and autoimmune conditions. Among these concerns, childhood obesity stands out as both emblematic of broader systemic issues and as a pressing problem that demands real solutions.

While the report identifies compelling drivers such as poor diet, environmental toxins, lack of physical activity, and chronic stress, experts argue that its proposed solutions fall short. The diagnosis is clear. The treatment? Frustratingly vague.

A real and rising epidemic

The numbers are hard to ignore. According to the Centers for Disease Control and Prevention (CDC), roughly one in five children in the U.S. is obese. Obesity in childhood is not just about weight; it significantly increases the risk of developing type 2 diabetes, cardiovascular disease, and mental health challenges later in life.

The MAHA report acknowledges this epidemic, pointing to dietary patterns dominated by ultra-processed foods, lack of exercise, and toxic environmental exposures as major contributors. And many experts agree. Dr. William Dietz of George Washington University noted that targeting ultra-processed foods is an important step, though it needs nuance and depth, not just broad condemnation.

Yet, while the report shines a spotlight on known issues, it seems to sidestep a critical aspect of the obesity conversation: socioeconomic inequality.

Poverty, processed foods, and missed opportunities

One of the most glaring oversights in the MAHA report is its limited engagement with poverty as a root cause. Processed foods are cheaper and more accessible than fresh, nutrient-rich alternatives, especially in underserved communities where food deserts persist. Families grappling with low incomes may rely on inexpensive, calorie-dense foods simply to feed their children.

Rather than addressing this systemic problem through programs like expanded school meal funding or subsidies for fresh produce, the report offers proposals that critics describe as “splashy,” such as removing food dyes or funding small-scale research trials — steps that may look good in headlines but lack the structural force needed to shift real-world outcomes.

Mixed messages on prevention and research

The MAHA report calls for a shift toward preventive medicine, urging NIH and FDA to support more research into the health effects of diet and chemicals. On paper, this looks promising. However, in practice, the Trump administration has simultaneously enacted cuts that directly undermine these goals.

Thousands of federal employees have been laid off, and budget cuts have hit agencies such as the CDC and NIH — organizations tasked with the very research and data collection the report claims to champion. Dr. Dietz warns that such cuts may erode our ability to monitor obesity trends, making it harder to assess progress over time.

This contradiction raises the question: Can we fight an epidemic without the tools to measure and understand it?

Overmedicalization and lifestyle solutions

Another area of focus in the report is “overmedicalization”— the idea that the healthcare system is too focused on treating disease rather than preventing it. On this point, there’s widespread agreement. Childhood obesity cannot be solved with a prescription pad alone.

Instead, a comprehensive prevention model would include:

  • Parent-infant training in emotional regulation
  • Robust nutrition education in schools
  • Community-based fitness initiatives
  • Subsidized access to whole, unprocessed foods
  • Improved urban planning to ensure walkable neighborhoods and safe parks
  • Policies addressing environmental pollutants

 

And while the report mentions lifestyle medicine and surveillance of pediatric drugs, it doesn’t go far enough in proposing how such a shift would be funded or implemented at scale.

What else is missing?

Ultimately, the MAHA report highlights an urgent problem but falls short of a strategy to fix it. Childhood obesity isn’t just a matter of bad personal choices or isolated environmental exposures. It’s the result of systemic forces: poverty, inequality, food industry lobbying, and crumbling public health infrastructure.

Lauren Wisk from UCLA points out that real progress will come from social policies that address root causes, not just from banning food dyes or launching a few more studies. For instance, universal school meal programs, expanded SNAP (food stamp) benefits, and tighter regulations on junk food marketing to kids could move the needle far more than flashy headlines.

If the administration is serious about “making our children healthy again,” it must follow up this report with policies that put science, equity, and prevention at the forefront. Otherwise, this report may end up as just another diagnosis without a cure.

AI only makes it worse

In a follow-up development, the Trump administration has issued corrections to the report after journalists discovered several flawed and nonexistent citations, casting doubt on the report’s scientific integrity. Investigations by a nonprofit NOTUS and NBC News revealed that at least four referenced studies do not exist, including one falsely attributed to epidemiologist Katherine Keyes.

Dr. Keyes commented:

I can confirm that I, and my co-authors, did not write that paper… I was surprised to see what seems to be an error in the citation of my work in the report, and it does make me concerned given that citation practices are an important part of conducting and reporting rigorous science.

The report’s credibility has come under further scrutiny due to its anonymous authorship, limited medical representation among commission members, and questionable interpretation of cited research. Out of 522 total references, seven could not be verified, and some included URLs containing “oaicite,” suggesting that generative AI may have played a role in compiling sources.

Additionally, researchers like Mariana Figueiro, a professor at the Icahn School of Medicine at Mount Sinai, have stated that their studies were misrepresented. Her work on melatonin suppression in college students was incorrectly cited as evidence about children’s sleep and screen time. She said:

The conclusions in the MAHA report are incorrect and misrepresented our finding… We looked at melatonin suppression, not sleep onset. We also used college students, not children as subjects. Finally, the journal name was incorrect.

Unsurprisingly, these errors have sparked criticism over the report’s scientific validity and its use in shaping national health policy.

Your responses and feedback are welcome!

Source: “MAHA Commission report paints a dark picture of U.S. children’s health,” NPR, 5/22/25
Source: “Trump admin corrects RFK Jr.’s MAHA report after citation errors,” NBC News, 5/30/25
Source: “The MAHA Report Cites Studies That Don’t Exist,” NOTUS.org, 5/29/25
Image by Markus Winkler/Pexels

New Study Links Childhood Weight Patterns Before Age 9 to Obesity Risk

Children don’t all grow the same way. A recent study from the NIH-funded Environmental Influences on Child Health Outcomes (ECHO) Program, reported in JAMA Network Open, sheds light on how early weight trends can signal future health concerns. Researchers tracked nearly 9,500 children’s body mass index (BMI) from infancy through age 9 and identified two distinct growth patterns.

Most kids (about 89%) followed a typical growth curve where BMI naturally dropped between ages 1 and 6, then gradually increased again. However, about 11% showed a different trend — their BMI remained stable from ages 1 to 3.5, then climbed sharply through age 9. Children in this group were significantly more likely to have obesity by age 9, with BMI measurements above the 99th percentile.

The study also found that certain early-life factors may raise the risk of obesity later on. These include being born with a high birthweight, maternal smoking during pregnancy, having a mother with a high BMI before pregnancy, and excessive weight gain during pregnancy.

Childhood obesity, defined as a BMI at or above the 95th percentile for a child’s age and sex, often results from excess body fat and can lead to serious health problems like heart disease and type 2 diabetes later in life. Without intervention, kids who follow these higher-risk growth patterns may continue to struggle with weight into adolescence and adulthood.

To better understand these trends, researchers used data from medical records, parent-reported measurements, and both in-person and at-home evaluations. Their goal was to track how BMI changed over time and uncover any links to early childhood experiences.

Lead researcher Chang Liu, an assistant professor of psychology at Washington State University, said in a news release:

The fact that we can identify unusual BMI patterns as early as age 3.5 shows how critical early childhood is for preventing obesity… Our findings suggest there are important opportunities to reduce childhood obesity, such as helping pregnant women quit smoking and manage healthy weight gain, as well as closely monitoring children who show early signs of rapid weight gain.

Your responses and feedback are welcome!

Source: “Early childhood weight patterns linked to future obesity risk,” News Medical, 5/22/25
Source: “Preschool BMI Can Predict Childhood Obesity Risk,” HealthDay News, 5/28/25
Image by Nataliya Vaitkevich/Pexels

A Drug-Free Approach to Weight Loss

While semaglutide-based drugs like Ozempic and Wegovy have become popular tools for weight loss, many people still prefer to lose weight without relying on medication. For those looking for a natural approach, research shows that certain nutrients and eating habits can stimulate the same biological pathways that these drugs target.

Specifically, eating more fiber and healthy fats — like those found in olive oil and avocados — as well as paying attention to meal timing, food order, eating speed, and chewing thoroughly, can naturally boost the body’s production of GLP-1, a hormone that plays a key role in appetite control and digestion.

Mary J. Scourboutakos, Adjunct Lecturer in Family and Community Medicine, University of Toronto, who has a Ph.D. in nutrition, doled out advice and looked at some studies supporting it. According to Dr. Scourboutakos,

A strategic approach to weight loss rooted in the latest science is not only superior to antiquated calorie counting, but also capitalizes on the same biological mechanisms responsible for the success of popular weight-loss drugs.

Semaglutide medications work by increasing levels of GLP-1 (glucagon-like peptide 1), a hormone that signals fullness and slows digestion. They also block DPP-4, an enzyme that normally breaks down GLP-1 quickly. This dual action allows the hormone to remain active in the body for much longer (sometimes up to a week), helping people feel full for extended periods and eat less as a result.

But medication isn’t the only way to elevate GLP-1, as we’ve explored in some of our previous posts. There are some less expensive regimens that could serve as alternatives to taking weight loss drugs.

What you eat matters

Fiber, especially from beans, vegetables, whole grains, nuts, and seeds, is a powerful GLP-1 booster. When gut bacteria ferment fiber, they produce short-chain fatty acids that trigger GLP-1 release. This may help explain why higher fiber intake is consistently linked to weight loss, even without cutting calories.

Monounsaturated fats, like those in olive oil and avocados, can also increase GLP-1. Nuts like pistachios, which are rich in both fiber and healthy fats, have also been shown to boost GLP-1.

How you eat is just as important

Beyond food choices, how you eat can also influence GLP-1. Meal sequence makes a difference: eating protein before carbs, or vegetables before carbs, leads to greater GLP-1 release than the reverse order.

Timing matters too

Like other hormones, GLP-1 follows a daily rhythm. Eating a meal in the morning, such as at 8 a.m., triggers a stronger GLP-1 response than eating the same meal in the evening. This helps explain the wisdom behind the saying, “Eat breakfast like a king, lunch like a prince, and dinner like a pauper.”

The pace of eating  and chewing also affects GLP-1 levels

One study found that slowly eating ice cream over 30 minutes led to higher GLP-1 levels than eating it quickly in five minutes. However, when vegetables are eaten first, the speed of eating seems to matter less in terms of blood sugar response.

Even how well you chew your food can play a role. Chewing cabbage, for example, increased GLP-1 levels more than drinking it as a purée.

Food vs. medication

While these dietary strategies can raise GLP-1 levels, the effects are still modest compared to medications, Dr. Scourboutakos points out. For example, a Mediterranean diet was shown to raise GLP-1 to around 59 picograms per milliliter, while even the lowest dose of Ozempic can push levels to 65 nanograms per milliliter, which is over 1,000 times higher.

Still, when it comes to long-term health outcomes, food may have the edge. Dr. Scourboutakos writes that…

[…] when you compare long-term risk for diseases like heart attacks, the Mediterranean diet lowers risk of cardiac events by 30 per cent, outperforming GLP-1 medications that lower risk by 20 per cent. While weight loss will always be faster with medications, for overall health, dietary approaches are superior to medications.

Dr. Scourboutakos’ advice for a drug-free weight loss approach includes:

  • Eating a substantial breakfast, or frontloading your calorie intake earlier in the day
  • Including a fiber-rich food at every meal
  • Making olive oil a regular part of your diet
  • Eating protein and vegetables before carbohydrates
  • Snacking on fiber- and fat-rich nuts like pistachios
  • Chewing your food thoroughly
  • Eating slowly and mindfully

What else can you do to lose weight without the meds?

A recent article on the Medical News Today website also dug deep into some proven, drug-free strategies to lose weight and keep it off. Besides of the ones mentioned above and a few other, most obvious ones like recommending regular physical activity. The three we’d like to mention are intermittent fasting, tracking your progress, and getting enough sleep.

Intermittent fasting

Intermittent fasting involves cycling between periods of eating and fasting, typically within a set window of time each day. It encourages weight loss primarily by helping people consume fewer calories overall. A 2022 meta-analysis found that intermittent fasting, when practiced for up to 26 weeks, can be just as effective for losing weight as a traditional low-calorie diet. Of course, fasting isn’t for everyone, even adults, so it’s best to consult your doctor.

Common forms of intermittent fasting include:

  1. Alternate-day fasting: This method involves fasting every other day, while eating normally on non-fasting days. A modified version allows 20–30% of daily caloric needs on fasting days.
  2. The 5:2 diet: Fast (or drastically reduce calorie intake) for two days each week and eat normally on the other five.
  3. The 16:8 method: This plan limits eating to an eight-hour window each day (e.g., noon to 8 p.m.) and involves fasting for the remaining 16 hours. It’s often referred to as time-restricted eating.

Tracking your weight-loss progress

Keeping a record of daily food intake, physical activity, and weight progress can significantly support weight loss goals. Using journals, apps or online trackers helps people become more aware of their habits and encourages healthier choices.

A 2020 review found that this kind of self-monitoring can drive behavior change and increase motivation. A 2021 study also linked consistent food and weight tracking with more successful weight loss, particularly among users who logged their meals diligently. Additionally, a 2022 review suggests that wearable fitness trackers can improve activity levels, fitness, and body composition.

Getting enough sleep

Finally, this article took a comprehensive look at childhood obesity causes and treatment. We’ve covered plenty of that over the years on this blog, but the article reminds us that…

Studies show children who sleep less are more likely to be overweight or obese, and the risk increases with shorter sleep duration. A review of 17 studies found that children of all ages who slept less than the recommended amount had a 58% increased risk of being overweight or obese.

(Here’s a link to the study.)

So, just how much sleep do children need? The American Academy of Sleep Medicine recommends (and the American Academy of Pediatrics endorses) the following amounts of sleep by age group:

Ages 4-12 months: 12-16 hours (including naps)

Ages 1-2 years: 11-14 hours (including naps)

Ages 3-5 years: 10-13 hours (including naps)

Age 6-12 years: 9-12 hours

Age 13-18 years: 8-10 hours

Even though these natural strategies may seem obvious and may not match the potency of medications, they offer a sustainable, side-effect-free way to manage weight and improve overall health.

Your responses and feedback are welcome!

Source: “Nature’s Ozempic: What and how you eat can increase levels of GLP-1 without drugs,” The Conversation, 5/15/25
Source: “How to naturally lose weight fast,” Medical News Today, 5/14/25
Source: “Childhood Obesity Causes and Treatments,” Very Well Health, 5/13/25
Image by Vanessa Loring/Pexels

New Research on GLP-1 Receptor Agonists vs. Pediatric Obesity

There’s been much debate whether GLP-1 receptor agonists should be given to children to treat obesity, and whether it is even safe to do so. New findings presented at the European Congress on Obesity (ECO 2025) that is happening this week suggest that children with severe obesity are more likely to see a significant reduction in their BMI when GLP-1 receptor agonists are included in their treatment.

What the study showed

To explore the effectiveness of these medications, Dr. Annika Janson, researcher at the National Childhood Obesity Centre, Karolinska University Hospital, Stockholm, Sweden, and a team of researchers studied their impact when added to an existing intensive treatment program for pediatric obesity.

The study analyzed data from 1,126 children (ages 0-16, about 52% boys) with severe obesity, classified using criteria from the International Obesity Task Force, who were enrolled in the National Childhood Obesity Centre in Stockholm. All participants were undergoing intensive health behavior and lifestyle treatment (IHBLT), a comprehensive program that works with families, schools, and other support systems to improve various health-related behaviors, including nutrition, physical activity, screen time, and mental health. A multidisciplinary team typically provides this care.

Starting in 2023, GLP-1 medications — first liraglutide, then semaglutide — were incorporated into treatment for some patients. Approximately 25% of the children in the study were prescribed one of these GLP-1 drugs.

The caveats

The study authors did establish that GLP-1 medications can be given to kids from the age of 12 as “clinical trials have shown children lose 5-16% of their body weight after a year of treatment.” This comes with warnings and call for safety precautions — as it should.

According to Dr. Janson,

[…] treating children in real-life situations has challenges that don’t come up in research studies. Children have varying degrees of obesity, co-morbidities and complications and may have faced problems in supply of the drug, financing it or taking it. As a consequence, it is difficult to isolate the effect of adding GLP-1 drugs to the plethora of treatments that are already available.

This echoes the opinions of another group of researchers that looked into treating pediatric obesity using liraglutide. The study authors said:

This meta-analysis suggests that liraglutide could be a useful therapeutic option in pediatric obesity, especially in patients who have not achieved significant weight reduction with conventional interventions… However, its implementation should be individualized, considering the potential adverse effects, and rigorous monitoring should be carried out to ensure safety.

An added benefit

Dr. Janson’s study also suggests that weight loss injections like liraglutide may also reduce family conflicts around food and mealtime stress. Families reported less tension and fewer arguments around food, with children experiencing less constant hunger and being more open to other lifestyle changes.

Dr. Janson said:

For some children, not always feeling hungry is a completely new experience… While not a solution for every case, GLP-1 medications offer real benefits for many children with severe obesity, and more should have access to them.

Your responses and feedback are welcome!

Source: “GLP-1 drugs linked to significant BMI reduction in children with severe obesity,” News Medical, 5/12/25
Source: “Systematic Review and Meta-Analysis of Liraglutide Treatment in Children Who Are Overweight or Obese: A Therapeutic Paradigm Shift?,” Cureus, 5/8/25
Source: “Weight loss jabs in obese children can help avoid mealtime rows, study says,” The Guardian, 5/12/25
Image by Guduru Ajay bhargav/Pexels

Jamie Oliver Continues His Quest to Improve School Lunch, Now in the U.S.

Renowned chef and children’s health champion Jamie Oliver has brought his Ministry of Food’s 10 Skills Food Education program to the U.S. for the first time on May 1, 2025. He is now making promo rounds, including news and talk shows like Good Morning America and Live With Kelly & Mark.

After seeing major success in the U.K., this free and forward-thinking initiative aims to teach middle and high school students the core cooking skills they need to make healthier choices that last a lifetime. With an ambitious target of reaching one million students worldwide by 2030, the program provides teachers and community groups with hands-on lessons, videos, recipes, and tools designed to help young people build confidence in the kitchen.

Again, it’s free, but schools need to sign up. And in case you were wondering, The “Ministry of Food” part comes from Oliver’s 2008 book, “Jamie’s Ministry of Food: Anyone Can Learn to Cook in 24 Hours” (you can find some of the recipes here).

A long, tough uphill battle dating way back

Recently, Jamie Oliver opened up about the toughest battle of his career — transforming school lunches in the U.K. From public backlash to political breakthroughs, one chef’s mission to feed kids better sparked a national movement and lasting change. Thanks to our head writer Pat Hartman, this blog also followed Oliver’s difficult yet determined journey through the years, like this 2016 post on the Oliver vs. sugar debate and the 2012 post about his crusade against childhood obesity in the U.S.

In a candid interview featured in a new episode of Netflix’s “Chef’s Table: Legends,” Oliver revisits the stormy days of his school food campaign, calling it the “most miserable” period of his life. His mission was simple: get healthier, more nutritious meals into British schools. But what seemed like common sense to him — feeding kids better — quickly turned into a national controversy. Oliver’s efforts famously signaled the end of unhealthy cafeteria staples like the Turkey Twizzler, sparking fierce pushback from some parents who went as far as delivering junk food through school gates.

Oliver recalls:

I just wanted to fix it all… I was like the enemy… The bins at the end of lunch were full of my food…

Despite the discouragement, Oliver remained determined. He later realized the resistance wasn’t about the food itself but familiarity. “Those kids were probably the fourth generation that hadn’t learned to cook at home or at school,” he explained. It wasn’t just a change in menu but a cultural shift.

Oliver says:

I was told a child needs to try something 14 times before accepting it. They need love and encouragement, just like your own child.

Getting policymakers on board proved equally frustrating. Oliver recalled the challenge of getting government officials to move past budget concerns. But the tide finally turned with the release of his Channel 4 documentary “Jamie’s School Dinners.” The series captured public attention and coalesced political will. Within weeks, Oliver had a meeting with then-Prime Minister Tony Blair, who agreed to fund sweeping reforms in school food standards.

Blair himself appears in the “Chef’s Table” episode, praising Oliver’s enduring influence:

Jamie’s much more than a chef. He made cooking cool and linked food to health and nutrition long before it was mainstream.

A few words about “Chef’s Table: Legends”

If you are not familiar with “Chef’s Table,” it’s an acclaimed docuseries in its second decade that spotlights some of the world’s most visionary and captivating chefs. The latest installment, currently playing on Netflix, features legendary chefs Jamie Oliver, José Andrés, Thomas Keller, and Alice Waters. Not only are they culinary icons but they’re also compassionate advocates for a better world, feeding those in crisis, and creating healthier lifestyles for us all.

A glimpse at Oliver’s worldview

In a recent roundtable interview, Oliver spoke about how he got into cooking (“And when I say cooking saved me, I don’t think I’m exaggerating”), and the one ingredient that he absolutely could not live without:

Olive oil. We grew up using butter and lard and ghee. But olive oil is the connector. It’s the thing that allows you to transmit flavor and spice and herbs. And of course, it’s the healthiest oil on the planet, full of polyphenols.

We will leave you with one more quote, which was Oliver’s response to the question about the one thing he wished people understood about food:

I think, now more than ever, cooking is freedom. Cooking is the amazing ability to nourish yourself and your family and the people that you love with deliciousness and truth. And it’s a real superpower.

If I had one wish in the world, it would be that every 16-year-old kid would leave high school knowing 10 recipes to save their life, the basics of nutrition, where food comes from, and how it affects their body.

It is not a luxury; it’s a necessity. It’s a life skill. Every time you’re trying to fix a problem, you’re looking at the most vulnerable within the problem.

And in the U.K., we have free-school-lunch kids, and the parents of those kids have to be earning a very small amount of money to get that free school lunch. Filling that child’s tummy and that child’s mind is really exciting.

For me, that just gives you a template for true hope. And to truly be fair, to truly be a democracy, you have to have hope — that no matter where you come from, as long as you apply yourself, as long as you turn up, as long as you’re kind, the sky’s the limit.

Your responses and feedback are welcome!

Source: “Culinary Legends Gather Around the Chef’s Table For Its 10th Anniversary,” Netflix, 4/25/25
Source: “Jamie Oliver shares cooking lessons,” Good Morning America, 4/29/25
Source: “Episode Guide,” Live With Kelly & Mark, 5/1/25
Source: “Jamie Oliver admits controversial school dinners campaign was ‘most miserable’ time of his life,” Tyla.com, 4/28/25
Image: Screenshot of Jamie Oliver’s Ministry of Food’s Ten Skills Food Education Program homepage, used under Fair Use: Commentary

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Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

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

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

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

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

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

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

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

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

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

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

Food & Health Resources