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Zepbound vs. Wegovy, and New Diabetes Study

Tatyana Meshcheryakova April 2, 2025 No Comments

In the ongoing battle against obesity and type 2 diabetes, two medications — Zepbound (tirzepatide) and Wegovy (semaglutide) — have emerged as leading treatments. Both are FDA-approved and have demonstrated effectiveness in weight management, but they differ in mechanisms, dosage, and overall effectiveness. If you’re considering either of these drugs for weight loss or for weight loss of your kids, here’s what you need to know, according to VeryWellHealth.com.

How do these medications work?

Zepbound and Wegovy belong to a class of medications known as GLP-1 receptor agonists, which help regulate blood sugar levels and metabolism. However, Zepbound (tirzepatide) has an added advantage: It is also a glucose-dependent insulinotropic polypeptide (GIP) receptor agonist. This dual action may contribute to greater weight loss and improved blood sugar control compared to semaglutide.

Both drugs slow down gastric emptying, making you feel fuller for longer, which helps reduce appetite and calorie intake. Research suggests that tirzepatide’s additional GIP receptor activation enhances its effectiveness.

Effectiveness for weight loss

Both medications are effective for weight loss, but studies suggest tirzepatide may be superior. Consider these findings:

A 2024 study found that patients with obesity or overweight treated with tirzepatide experienced greater weight loss compared to those on semaglutide.
A 2023 review revealed that tirzepatide users had an average total body weight loss of 17.8%, compared to 12.4% for semaglutide users.
A 2021 study indicated tirzepatide was more effective than semaglutide in reducing blood sugar levels in people with type 2 diabetes over 40 weeks.

While these studies indicate tirzepatide’s potential advantages, it is important to note that the dosages in these studies were not always equal, which could impact the results. More direct comparisons are needed to confirm these findings.

Dosage differences

Both medications are taken via weekly subcutaneous injections, but their dosage regimens differ:

Tirzepatide (Zepbound) Dosage:

Initial dose: 2.5 mg per week for four weeks
Dose increases: Gradual increments of 2.5 mg every four weeks
Maximum dose: 15 mg per week

Semaglutide (Wegovy) Dosage:

Initial dose: 0.25 mg per week for four weeks
Dose increases: Gradually up to 0.5, 1.0, 1.7, or 2.4 mg
Maximum dose: 2.4 mg once weekly

Side effects and safety

Both medications share common side effects, including:

Nausea
Vomiting
Diarrhea
Constipation
Decreased appetite
Stomach discomfort
Fatigue
Heartburn

Muscle loss has been reported in patients taking both medications, but this can also occur with significant weight loss.

Cost and availability

One major concern for many patients is affordability. The annual cost for GLP-1 receptor agonist drugs can range from $5,000 to $10,000 in the U.S. While tirzepatide tends to be more cost-effective than semaglutide, prices depend on insurance coverage and availability of manufacturer discounts.

Previously, both drugs experienced shortages, leading to increased demand for compounded versions. However, as of February 2025, neither medication was still in shortage.

Can you switch between the two?

Yes, switching between these medications is not uncommon, especially if one is not yielding the desired results. However, a healthcare provider should always guide the transition to ensure safety and effectiveness.

Which one should you choose?

Both Zepbound and Wegovy can effectively aid in weight loss, but the choice depends on individual factors such as:

Effectiveness: Tirzepatide may offer superior weight loss benefits.
Cost: Tirzepatide tends to be more affordable, but insurance coverage varies.
Age Restrictions: Tirzepatide is not currently approved for use in children.
Tolerability: Both drugs have similar side effects, but individual experiences may differ.

GLP-1 Drugs for Type 2 diabetes may not be safe for Type 1 patients

Then there’s this. Medications originally developed to manage type 2 diabetes may not be suitable for patients with type 1 diabetes, according to researchers from the Johns Hopkins Bloomberg School of Public Health.

A recent study highlights concerns regarding the use of GLP-1 receptor agonists among type 1 diabetes patients. GLP-1 receptor agonists have been available for over two decades to help manage type 2 diabetes. Over time, some were also approved for reducing cardiovascular disease risk and treating obesity. However, type 1 diabetes patients have started using these drugs even though they were excluded from clinical trials due to concerns about hypoglycemia (dangerously low blood sugar levels).

Unlike type 2 diabetes, which is characterized by insulin resistance, type 1 diabetes is an autoimmune condition where the body does not produce insulin, requiring lifelong insulin therapy. The study, which analyzed over 200,000 anonymized medical records from 2008 to 2023, found a significant increase in obesity rates among individuals with type 1 diabetes across all age groups and ethnic backgrounds.

The findings, published on March 3 in Diabetes, Obesity and Metabolism, emphasize the need for more research on the use of GLP-1 receptor agonists in type 1 diabetes patients. Senior author Dr. Jung-Im Shin, an associate professor at the Bloomberg School’s Department of Epidemiology, commented:

These findings highlight the urgent need for better data — including clinical trials — on the effectiveness and safety of GLP-1 receptor agonists in people with type 1 diabetes, to inform clear guidelines on their use in these patients.

As usual, more studies need to happen, and researchers have their work cut out for them.

Your responses and feedback are welcome!

Source: “Zepbound (Tirzepatide) vs. Wegovy (Semaglutide) for Weight Loss,” VeryWellHealth.com, 3/31/25
Source: “Weight-Loss Drug Use Has Risen Sharply Among Children and Adults With Type 1 Diabetes,” John Hopkins Bloomberg School of Public Health, 3/26/25
Source: “Trends in obesity and glucagon-like peptide-1 receptor agonist prescriptions in type 1 diabetes in the United States,” Diabetes, Obesity and Metabolism, 3/3/25
Image by Chokniti Khongchum/Pexels

Eating Disorders at Home

Pat Hartman April 1, 2025 No Comments

Historically, the relationship between food calories, energy expenditure, and fat was not thoroughly investigated or catalogued. But even before the reign of the enormous British monarch Henry VIII, it was understood that eating a lot made people grow large. Rather than a cause for criticism, obesity was social currency, proof that a breadwinner was indeed prosperous enough to overfeed himself and his family. Such people were looked up to as role models. Now, we know better, but don’t always do better.

In an essay about the societal ramifications of eating disorders, eating disorder therapist Kate Sutton wrote,

Social interactions play a significant role in the development and maintenance of eating disorders through various mechanisms…

Then she went on to give examples. At any type of gathering, there are others to whom a person can make self-comparisons. Even for kids with a restricted upbringing, whose only contacts are made in homes and at church, and maybe not even at school, there is still plenty of opportunity for comparison and judgment. Those factors of course lead inevitably to self-judgment, and from there, to seeking a way to change the self in order to be more acceptable to the majority.

Adults of course play a huge role, particularly with regard to children and youth. The relentless pressure of influence is out in the open, because of the presumption that grownups are supposed to be teaching, through every possible means, at every moment. With adult peer pressure, the methods and effects are more sly and insidious. Among a group of young people, peer pressure can go either way, advocating either conformity or non-conformity.

… Or else!

At any age, the pressure is felt in various forms. Some people can give you a look that just makes you want to sink through the floor. Others may talk about you, or to you. The message is delivered loud and clear: You are inadequate and you need to change, before the situation reaches the point where no one wants anything to do with you. Peers and random strangers are bad enough, but when a family member starts picking on you, even with alleged best intentions, it’s the worst. There is no escape. You live in the same house with this person whose eyes critically weigh you every day, and who keeps track of every bite you put into your mouth.

Obviously, in recent decades inescapable media influence has changed the culture immensely, with magazines, advertisements, television, movies, and the internet relentlessly illustrating exactly how thin human beings are “supposed to be.” The cultural pressure from those multiple sources has been documented extensively.

But even before media saturation, even before that influx of visual overload, some segments of the population were relentlessly pressured about excess weight because of professional requirements. As Sutton wrote,

In certain sports and professions where appearance and weight are emphasized, such as ballet, gymnastics, modeling, swimming, and wrestling, there is a heightened risk of developing eating disorders due to the pressure to maintain a specific body type.

The insidious factor, as “Counselor Kate” reminds readers, is that the family is where an environment is easily created that normalizes disordered eating behaviors, ranging from mild to severe, for no good reason (as ballet training, for instance, might be excused as), but just because.

As we have seen, entertainer Marc Maron describes his mother as a former obese child and a “functioning anorexic” who reacted with panic to the presence of overweight people, and whose main mission in life was to keep her own weight below 120 pounds. He in turn was indoctrinated to be phobic about butter, cheese, and double chins.

This type of upbringing is a constant reminder, “There’s good enough, and there’s not good enough, and you are very close to the edge.” Relentlessly delivered day after day, a message of this sort can be extremely damaging. In this respect, a person with the career of professional comedian is very fortunate, because there is somewhere to “put” the trauma.

Your responses and feedback are welcome!

Source: “Understanding How Eating Disorders Affect Friends and Social Circles,”
CounselOrkate.com, undated
Image by Pixabay/Free for use under the Pixabay Content License

The Rise of Bulimia

Pat Hartman March 27, 2025 No Comments

A recent post asked the question, “When did bulimia become “a thing”? The short answer is, more recently than anorexia.

Back in the Middle Ages, the phenomena that we today identify as eating disorders had religious overtones. People who refused food as a form of spiritual discipline, known as ascetics, were sometimes revered and sometimes persecuted. A condition known then as “wasting disease” probably encompassed what later came to be known as anorexia. The term “anorexia nervosa” was coined in 1874 and “bulimia nervosa” was named more than a hundred years later.

In the earlier part of the 20th century, anorexia was an upper-class disease, but in the 1970s it became more democratic. It has been called the most deadly of any psychiatric disorder because even though it may take years, many of the victims do succeed in eventually starving themselves to death.

Over the years, knowledge about anorexia and bulimia grew hand-in-hand. For Psychology Today, Emily Deans, M.D., wrote,

Bulimia (binging and then purging via exercise, vomiting, or laxatives) is first reliably described among some of the wealthy in the Middle Ages, who would vomit during meals so they could consume more. Apparently this behavior did not happen in ancient Rome despite a common conception otherwise.

Plain old binge eating disorder does not include purging or indeed any other effort to avoid obesity. Of the obese individuals who look for medical help today, about one-third of them are binge eaters. Quite recently, purging disorder has also been recognized as a separate entity.

Dr. Emily Deans also wrote,

The eating disorders also appear to be genetic, perhaps related to inherited differences in serotonin receptors. Much of the natural progression of anorexia can be explained by disordered thinking about body image combined with the process of starvation itself.

Anorexia afflicts about 0.5% of women and 0.1% of men. Bulimia around 1-3% of women (also 0.1% of men), and binge eating disorder 3.3% of women and 0.8% of men.

Now to back up a little, Britt Berg, M.S., compiled for the Eating Recovery Center a comprehensive history of eating disorders that fills in more details. Binge eating used to be called Night Eating Syndrome until psychiatrist Albert Stunkard clarified that it can occur at any time of day, changing the name of it to the more familiar Binge Eating Disorder, shortened to BED.

Anorexia nervosa, over time, underwent a transition from signifying “a pursuit of spiritual perfection to a pursuit of bodily perfection,” to identification as a distinct disease. Also, in due course, the medical profession realized that women were not the only sufferers of any of the disorders, because men are also affected. An interesting detail about the evolving state of the art is:

“Parentectomy” was considered an appropriate treatment for anorexia nervosa well into the 20th century. Essentially, a person with an eating disorder would be separated from their parents as a “cure.”

In the 1970s, in the United States, England, France, and Germany, eating disorders of every kind increased dramatically. Over the years, as successive editions of the Diagnostic and Statistical Manual of Mental Disorders were published, descriptions of the various conditions became more detailed and differentiated. Just over 10 years ago recognition of BED as a distinct entity allowed victims to obtain insurance coverage for treatment.

Berg notes that now, the available treatment for eating disorders includes a range of care levels including inpatient, residential, partial hospitalization programs, intensive outpatient programs, and virtual intensive outpatient programs. Consequently many therapeutic approaches are employed, including:

Acceptance and commitment therapy (ACT)
Cognitive behavioral therapy (CBT)
Dialectical behavior therapy (DBT)
Exposure and response prevention (ERP)
Emotion-focused family therapy (EFFT)
Family-based treatment approaches (FBT)

Next: More questions and answers.

Your responses and feedback are welcome!

Source: “A History of Eating Disorders,” PsychologyToday.com, 12/11/11
Source: “Bulimia Nervosa/Purging Disorder,” NCBI.NLM.NIH.gov, April 2017
Source: “Let’s Get Real About the History of Eating Disorders,” EatingRecoveryCenter.com, 07/13/23
Image by Alexa/Pixabay

Addressing Pediatric Obesity With Digital Tools and Personalized Care

Tatyana Meshcheryakova March 26, 2025 No Comments

Currently, one in five children and adolescents in the U.S. has obesity — a rate that has steadily increased over the past decade. Between the early 2010s and 2020, childhood obesity rates rose from 17.7% to 21.5%, according to a study published in JAMA Pediatrics. In response to this growing crisis, the American Academy of Pediatrics (AAP) released updated clinical guidelines in 2023, recommending at least 26 hours of health behavior and lifestyle treatment within three to twelve months. While welcomed by pediatricians, these recommendations posed a significant implementation challenge. Enter Dr. Yum, highlighted in a recent article on Medscape.

Bridging the gap with practical solutions

Dr. Nimali Fernando, a pediatrician in Virginia, understood the difficulties families faced in maintaining a nutritious diet. In the 2010s, she founded Yum Pediatrics, a teaching kitchen and garden that served as a foundation for practical nutrition education. Realizing the potential of digital tools to expand her reach, she transitioned from private practice in 2023 to launch Touchpoints, a multimedia program under Dr. Yum’s umbrella, designed to help clinicians implement the AAP guidelines.

Through step-by-step modules on topics like mindful eating, picky eating, and food insecurity, Touchpoints equips pediatricians with structured conversation guides to engage families. These resources provide a practical solution for overwhelmed healthcare providers who may lack nutrition training but want to offer evidence-based guidance.

The reality of implementing new guidelines

Although the AAP guidelines were well-received, logistical challenges remain. Many pediatric clinics lack access to multidisciplinary teams, leaving primary care providers to shoulder the responsibility of obesity management. Furthermore, insurance companies often do not reimburse for lifestyle and behavior treatment programs, making implementation even more difficult.

To navigate this issue, clinicians bill office visits under comorbid conditions associated with obesity, such as high cholesterol, sleep disturbances, or prediabetes. This approach allows them to provide personalized care while addressing the broader health concerns linked to weight management.

Expanding access through telehealth

Recognizing the importance of accessibility, some pediatricians conduct the Touchpoints program entirely through telehealth. This method aligns better with families’ schedules and fosters a consistent relationship between providers and patients. By meeting monthly, pediatricians can offer ongoing support and track progress effectively.

Telehealth also enables a whole-family approach to weight management. With rising rates of eating disorders post-pandemic, Touchpoints promotes a food-neutral and weight-neutral perspective, reducing stigma and fostering sustainable healthy habits.

Tools for sustainable change

Currently, over two dozen clinicians subscribe to Touchpoints, with researchers from UTHealth Houston launching a study to assess its impact on BMI changes among patients. However, many of the resources remain free through the original Dr. Yum website. One standout feature, the Meal-o-Matic, allows families to create customized recipes based on available ingredients, empowering children to take ownership of their meals. Through meal tracking and photo uploads, children engage with their progress in a supportive, interactive way.

Getting started with pediatric weight management

For pediatricians interested in expanding their approach to obesity care, the AAP offers valuable resources, including staff training on weight bias and stigma. Additionally, the CDC provides a list of evidence-based weight management programs ready for implementation.

Starting small can be an effective strategy. For example, begin with two or three motivated families, using intake forms and food journals to identify those most likely to commit to the process. Naturally, positive outcomes depend on a family’s readiness to engage.

A study on digital health interventions

While digital health strategies may benefit children and adolescents struggling with overweight and obesity, their role in replacing or enhancing components of standard multicomponent care remains uncertain, according to an umbrella review published in Obesity Reviews.

To assess the impact of digital health interventions on weight management in young people, researchers conducted a comprehensive review of existing reviews and meta-analyses. The selected studies focused on the effectiveness and experiences of digital health technologies in managing obesity among children and adolescents (aged 0 to 19) based on the World Health Organization (WHO) criteria.

The review encompassed 16 systematic reviews and 10 meta-analyses, with 15 primarily relying on quantitative data from primary studies. Nine reviews exclusively included randomized controlled trials (RCTs), while the remaining seven incorporated both RCTs and non-RCTs. Most of the primary studies were conducted in high-income regions such as the United States, Europe, and Oceania, with limited representation from middle- and low-income countries.

The number of participants across the included reviews ranged from 195 to 5,777. When evaluating body mass index (BMI) scores, researchers observed small but statistically significant effects of digital interventions on body measurements.

The researchers concluded:

Overall, digital health interventions had a small impact on anthropometric measures when assessing BMI and BMI-z-scores… It remains unclear how these interventions could complement or replace elements of standard care for children and adolescents with overweight or obesity.

It takes a village

Obesity management is not limited to pediatricians alone. Nurses, dietitians, and nutritionists can all play a role in delivering weight management programs. By integrating digital tools, structured programs, and telehealth solutions, pediatricians can make a meaningful impact in the fight against childhood obesity — one family at a time.

Your responses and feedback are welcome!

Source: “Digital Health Interventions May Aid Pediatric Obesity Treatments,” Endocrinology Advisor, 3/18/25
Source: “Digital health interventions to treat overweight and obesity in children and adolescents: An umbrella review,” Obesity Reviews, 2/19/25
Source: “Feeding Change: How Dr. Yum Is Helping Pediatricians Tackle Childhood Obesity One Meal at a Time,” Medscape, 3/21/25
Image by Alex Green/Pexels

The Obesity-Related Addiction That Isn’t Even Fun

Pat Hartman March 25, 2025 No Comments

People with bulimia have a lot going on. It’s not simply that they can’t see themselves accurately. Visual hallucinations are only one aspect of an entire array of sensual experiences. An anorexic person can eat a teaspoonful of rice and feel full. Looking bloated is not the worst nightmare; feeling bloated is.

Just like other types of enthusiasts, some folks who cherish and cultivate their eating disorders have favorite slogans that they live by. A person may be horrified by the concept of foreign matter being inside her or his body, even if that intrusive substance is food. They don’t like excess fat on their communication, either. Why say “Emptiness is freedom” when “Empty is free” conveys the message so eloquently?

The quest for emptiness becomes grotesque and horrifying. An 80-pound person wrote:

i purge for 45 mins to 2 hours flushing over and over again
i am bloated (not as bloated as i was before purging my binge), and i feel like things are still inside me
i never feel empty, even when i restrict or when i get hunger pains after my b/p session

Another appreciates precision in distinguishing similar but not identical phenomena: “I frequently get the hunger feeling after purging, but never the truly ’empty’ feeling. I consider those two distinct sensations.” But wait, it gets worse, in the next entry:

Well yes, I do get the empty feeling. I purge down to my morning weight or less… When I get to the point that I taste literally just bile and it burns coming up, I feel pretty empty… When I push [on my stomach], it feels like there’s nothing in there at all. It’s not every time because I just don’t have the willpower to stand there all night and push it all out, but it does happen.

In looking forward to the day when they can live in their own place and make up the rules, a person might fantasize about “keeping the refrigerator and cupboards empty, and free of food.” (There’s that “f” word again.) Again and again, respondents mention the adjectives light, fresh, thin, empty, and free. One person says,

I get so frustrated seeing my parents bring a bunch of junk into the house. It’s very triggering having it just there… When I’m on my own I finally won’t have to worry about binging… And no one will be there to pressure me to eat.

People with these feelings may not even be able to define exactly what the emptiness represents freedom from, or what it replicates — but isn’t part of the ideal of freedom, the concept of not needing to explain your dream or its conditions to others? Shouldn’t it be a basic rule of human conduct, that each person is allowed the leeway to chase their own particular definition of the ideal life? The philosophical ramifications are deep and wide.

If someone wants to be very skinny, why should they not be allowed to pursue their vision of fulfillment (which paradoxically, in this case, is emptiness) — just like the person who aspires to drive a race car or climb a mountain? Those are, after all, life-threatening modes of existence, and the lucky drivers and mountaineers who make it through might win piles of money and acclaim.

Okay, maybe this line of thought goes a bit too far into the territory of the absurd. But people who are mentally or emotionally disturbed do not know that. They may deeply believe in their right to self-destruct, borrowing the reasoning of patriots and freedom-lovers everywhere, to rationalize their lifestyle to themselves and justify it to others.

But the person who binges and purges, what do they get in return for all that risk? Disapproval, scorn, and possibly torture (unwanted treatment) in a place with locked doors. This quotation illustrates the common tendency to regard doctors and other medical personnel as the enemy:

I got out of hospital today for refeeding syndrome (ironically not ED related) I have physical issues that cause malnutrition but also some food body issues that no one really knows about other than I have low self esteem/can’t see myself as others do. They haven’t connected those two, luckily.

Other respondents are eager to share thoughts like these:

I also have no interest in gaining back to a healthy bmi…
I know I would feel that way no matter how low it went so it’s completely illogical and unsustainable…
I have felt more confident in myself since being underweight. Even if I’ll never feel beautiful or thin I can rationalise the thoughts… So in a way I have a peace of mind…
just feel sad and lost and stuck…

So many questions arise, like, when did bulimia become a “thing?” Do the afflicted people discover the behavior by themselves, or learn it from peers or older relatives? Did people binge and purge during the two world wars? Did the disorder even exist then? During the Depression? Did bulimics rejoice that cupboards were bare and no one had enough to eat? Did banquet guests in ancient Rome really vomit on purpose just so they could gobble down more food?

Currently, is binging and purging an American phenomenon, or does it span the globe? If not for the cultural trend toward fat-phobia and fat-hate, would people choose to live this way?

Your responses and feedback are welcome!
Source: “ED Support Forum, EDSsupportForum.com, 06/06/20
Source: “ED Support Forum,” EDSsupportForum.com, 02/24/17
Source: “ED Support Forum,” EDSsupportForum.com, 11/01/22
Image by Gerd Altmann/Pixabay

Matters Worth Pondering

Pat Hartman March 20, 2025 No Comments

Unfortunately, there is more to say about bulimia, binging and purging, and the connection (or not) between severe, life-threatening eating disorders and the obesity epidemic that has, over the past few decades, inexorably overtaken large segments of humanity.

We have seen how individuals who are into binging and purging, or binging without purging, or purging only, have all kinds of unusual traits (such as being unable to see their mirror reflections accurately) and unconventional ideas (like a longing for non-existence.)

They quote slogans like “Why am I not dead yet” (without a question mark, which makes it sound more like a declaration of intent.)

In this realm of knowledge, it seems as if every answer spawns more questions:

— Why do many eating disorder victims declare themselves as having a very real death wish?
— Is that self-hatred related to the culture’s disgust in regard to obesity?
— Does the effort to end childhood obesity drive the tendency toward anorexia and bulimia?
— Does the same impulse to self-harm which drives the kids who starve themselves, also motivate the kids who seem determined to eat themselves into an early grave?
— Do both of those conditions stem from the same root cause?
— Do people in both those camps see themselves as doing these aberrant behaviors for the same reasons, even though the end results are radically different?
— Do they perceive themselves as doing for different reasons the harmful behaviors that culminate in identical results?

Here is a tough one: In light of the widespread concern over both childhood and adult obesity, what are we to make of the fact that services and institutions are much more likely to cater to severely underweight anorexics than any other type of eating-disordered patient? Anorexia accounts for only less than 10% of eating disorder sufferers, and even among anorexics, the majority are not in the life-threatened category.

Is it the glamour? Perhaps coaxing a person of waif-like thinness to partake of nourishment is aesthetically more appealing than convincing a tub-of-lard-proportioned individual to stop eating so much.

As for victims of the unglamorous disorder known as binge eating, the writer Róisín points out that due to societal fatphobia and other factors, it seems that the medical profession “does not view them as worthy of resources.” There are pragmatic and political aspects. Róisín goes on to say,

Whilst crime is treated as the problem in and of itself, instead of as a result of poverty and state abandonment, eating disorders are similarly seen as the primary issue to solve, instead of a symptom of a wider problem… By applying a universal approach to a complex mental illness, treatment perpetuates the very problem it professes to be solving… We cannot rely on getting rid of an eating disorder whilst coping with the same circumstances that enabled the illness to develop in the first place…

The issue has been contemplated from even more doctrinaire points of view. Alice Weinreb writes of how “second-wave feminists… analyzed anorexia and bulimia as a way to articulate the dangers posed by postwar consumer capitalism for girls and women”:

The analysis hinged upon the paradoxical meaning of consumption in postwar capitalism, which was the cause of and symbolized by the deadly self-denial of the anorexic and the irrational gorging and purging of the bulimic. Eating disorders thus expressed the gendered and destructive impacts of late-modern capitalism on the female body, combining the demand for unbridled consumption and individual empowerment with expectations of female self-denial and physical smallness.

So, there is a lot going on. As previously noted, one trait that people who binge tend to share is a total lack of discrimination. Food preferences have nothing to do with it. They will consume whatever happens to be available, regardless of quality; and whether they like it, or even hate it, is irrelevant. Basically, no food is off-limits, When the urge to stuff themselves hits, all bets are off. Of what help, then, is any advice to identify “problem foods” and describe strategies to avoid them — when literally any food is a problem food to these individuals?

Here is a matter that parents would prefer not to think about. It harks back to Tom Jones, an entertainment film made more than 60 years ago, which included a “lusty dining scene” that attracted considerable attention and comment at the time. One reviewer referenced the “lascivious meal, a lusty marriage of food and sex.”

Critic Wook Kim wrote, “The dinner begins innocently enough, but their furtive glances soon turn into almost incandescent gazing: even a village fool can see where this is going.”

The question is… but what has this to do with the contemporary child who consumes a whole package of cookies in one sitting?

Your responses and feedback are welcome!

Source: “Tom Jones (1963) – Lusty Dining,” YouTube.com, undated
Source: “Of Lust, Ladies, And Lobsters,” NPR.org, 08/06/09
Source: “Top Ten Memorable Movie Eating Scenes,” TIME.com, 01/05/12
Image by Jean Louis Mazieres/Attribution-NonCommercial-ShareAlike 2.0 Generic

Online Weight-Loss Drug Providers Pivot to HRT

Tatyana Meshcheryakova March 19, 2025 No Comments

In an unexpected twist, the rise of online weight-loss drug providers is driving renewed interest in an older, once-stigmatized treatment: hormone replacement therapy (HRT). As more women seek solutions for menopause-related symptoms, including weight gain, online healthcare platforms are stepping in to fill the gap.

Why the change?

As we’ve previously discussed, regulators declared that popular weight-loss drugs Wegovy and Zepbound are no longer in short supply. As a result, consumers who have relied on less expensive, compounded versions — often obtained through telehealth services or medical spas — will need to find other options.

As reported in Stat,

In the last two years, hundreds of businesses have cropped up to meet the surge in demand for the obesity and diabetes medications known as GLP-1s. The majority prescribe compounded copies of the drugs — a tenuous business strategy as shortages of the branded versions of the medications have come to an end.

Now, some businesses are setting their sights on another opportunity in compounding: hormones.

This leaves consumers potentially having to shell out the big bucks for the branded versions, and telehealth companies finding another cash cow.

As explained in a recent SELF article,

In theory, the FDA’s removal of GLP-1s from its shortage list should mean any patient who needs the brand-name drugs will be able to get them. But it’s more complicated than that. While the compounded options that have been filling the gap aren’t FDA-approved (a red flag), they have been available at much lower prices — making their imminent illegality a potential access issue.

Why this matters

Many women struggling with menopause symptoms find themselves facing a shortage of specialized healthcare providers. Turning to the internet for solutions, they are increasingly discovering comprehensive telemedicine platforms that offer not only GLP-1 weight-loss drugs but also HRT. While this growing market provides convenient access to treatments, it also raises concerns about patient care quality, the safety of compounded medications, and the evolving nature of doctor-patient relationships.

A booming market

The global HRT market was valued at nearly $21 billion in 2022 and is projected to surpass $35 billion by 2030, according to Grand View Research. This rapid growth reflects increasing awareness and acceptance of menopause treatments that were previously difficult to obtain. The demand is also fueled by a broader consumer interest in health and wellness, along with the rising popularity of GLP-1 medications for weight management.

Beth Mosier, a director in West Monroe’s healthcare M&A group, notes that the expansion of GLP-1 offerings has created a natural pathway for integrating HRT. “It coincides with increased consumer demand for more holistic health solutions,” she says.

Major players enter the space

The weight-loss and wellness industry is quickly adapting to this trend. Earlier this month, Noom announced its entry into the HRT market, joining platforms like Midi, which already offer both GLP-1s and HRT. Additionally, Hims & Hers is expanding its services to include care for perimenopause and menopause.

Women between the ages of 40 and 60 represent a key customer base for Noom, making HRT a strategic addition to their GLP-1 offerings. Noom CEO Geoff Cook says:

As menopause approaches, metabolic shifts occur, altering how the body processes sugars and fat, leading to symptoms like hot flashes, mood changes, and weight gain.

A 2023 Mayo Clinic study published in Menopause found that using HRT alongside GLP-1 drugs like Ozempic and Wegovy resulted in approximately 30% greater total body weight loss than GLP-1s alone. Other studies have echoed these findings, reinforcing the synergy between the two treatments.

The growing role of telehealth

For years, high-end medical aesthetic and wellness clinics have combined GLP-1 and HRT treatments to optimize weight management and overall health. Now, telehealth providers are embracing this model, offering convenient and often more affordable access to these therapies.

Mosier says,

They’re realizing they can address not just weight concerns but also muscle mass, sleep, and quality of life… Telemedicine is catching up to what high-end clinics have been doing for years.

The risks of direct-to-consumer care

Despite the benefits, the surge in direct-to-consumer HRT services comes with risks. Unlike traditional in-person care, online platforms shift more responsibility onto patients, particularly when compounded medications are involved.

Dr. Robert Kauffman, a professor in the Department of Obstetrics and Gynecology at Texas Tech University, acknowledges the positive shift in attitudes toward HRT but raises concerns about the quality of care. He says:

Most of us who specialize in menopausal medicine are pleased that more women are open to hormone therapy… But are these services encouraging women to bypass in-person exams, where critical health information can be uncovered?

The financial incentives driving companies into this space also raise red flags. “There’s a huge profit motive,” Dr. Kauffman warns. “How often are these doctors following up with their patients?”

The bottom line

The intersection of weight-loss treatments and menopause care is creating new opportunities for both patients and healthcare providers. As telehealth platforms expand their offerings, they provide unprecedented access to treatments that were once difficult to obtain.

As with any rapidly growing market, caution is warranted. Women considering these services should weigh the convenience of telemedicine against the benefits of traditional in-person care, ensuring they receive comprehensive and safe treatment.

Your responses and feedback are welcome!

Source: “As GLP-1 compounding stares down a wall, telehealth companies pivot to hormones,” STAT, 3/11/25
Source: “Online GLP-1 sales fuel hormone replacement therapy,” Axios, 3/11/25
Source: “Access to Compounded GLP-1s Is Drying Up. Here’s What to Know About the Copycat Weight-Loss Drugs.,” SELF, 3/13/25
Image by RDNE Stock project/Pexels

Why Am I Not Dead Yet

Pat Hartman March 18, 2025 No Comments

As previously suggested, the ED Support Forum and other websites of its kind might constitute either a blessing or a curse. We reviewed a few of the various suggestions offered to eating disorder sufferers involved with refeeding, and worse yet, with refeeding syndrome. That condition may lead to consequences as severe as seizures.

One young woman reported in a post that she had suffered three of them, but told no one “because then they would find out about my ED, lol.” Laugh out loud, indeed. A paranoid mind might suspect that the forum exists, literally, to support eating disorders themselves, rather than the overcoming of them.

The contradictions and restrictions involved in maintaining binge eating disorder are exhausting. Keeping up with all the rules is like a full-time job, and the prospect of suffering the equally self-imposed penalties is dreaded.

A phrase seems to turn up frequently in the forum questions and answers about the hellscape known as disordered eating: “Why am I not dead yet” — without a question mark, which seems to remove it from the realm of the ordinary interrogatory. Put that way, the tone is not questioning, but resigned. Seemingly, the only thing a victim hates more than the eating disorder is the prospect of release from it.

That lying mirror

A peculiarity of pathologically emaciated individuals is the inability to actually see themselves in mirrors, photos, or the flesh. To themselves, they look repulsively fat, always. A forum participant known as Hiraeth_, a bulimia patient who accumulated more than 5,000 posts on the site, reminisced about the time when she had made herself so ill the question was legitimate — “Why am I not dead yet?” In one post, she named her ultimate goal as “being so […] thin that even I can see it.”

To maintain her “ideal” weight of 50 kilograms (110 pounds) she binged and purged almost every day, and took laxatives multiple times per day. A court ordered her into a hospital, where despite observation and strict rules, she still managed somehow to almost kill herself. That episode was followed by a year of being “in and out of hospital so many times I lost count, literally.” She writes,

After that horrible year, it surprisingly went better. I didn’t get hospitalized for 14 months. Until last week, lol. I hope this rollercoaster won’t start over again. Because this time, I bet I can’t be saved.

The gender factor

For whatever reasons, few eating disorder studies include males, but, surprise!

Despite the stereotype that eating disorders only occur in women, about one in three people struggling with an eating disorder is male, and subclinical disordered eating behaviors (including binge eating, purging, laxative abuse, and fasting for weight loss) are nearly as common among men as they are among women.

One might think that this refers to gay men, but one would be mistaken. Despite the shortage of reliable and wide-ranging statistics, it is suspected that males binge almost as often as females, although females are more likely to purge. Furthermore, it appears that women are more likely to purge in reaction to “normal” consumption patterns, and in the absence of binge eating.

Back to the ED Support Forum, one individual reported that she or he had been binging and purging for nearly five years, yet their blood work remained “completely normal,” which is “a bummer” because “I’m kinda hoping this kills me but it might take longer than I intended.”

The whole mess raises philosophical questions that can probably not be answered, such as: What does this have to do with the worldwide epidemic of childhood obesity? In a sense, it is almost as if the BP (binge and purge) people are some strange order of penitents doomed to suffer their ailment to compensate for all the planet-smothering obesity.

Like religious zealots who parade through the streets flogging themselves with whips, it is their destiny to take upon themselves the world’s sins of overindulgence, and somehow restore balance to the cosmic order. The one thing they cannot abide is the sin of obesity.

Your responses and feedback are welcome!

Source: “Search results for query: refeeding,” EDSupportForum.com, 2023
Source: “Bulimia Discussions,” EDSupportForum.com, June 2016
Source: “Eating Disorders in Men and Boys,” NationalEatingDisorders.org, undated
Source: “Bulimia Discussions,” EDSupportForum.com, 2016
Image by Gareth Williams/Attribution 2.0 Generic

Mutual Aid for Eating Disorders

Pat Hartman March 13, 2025 No Comments

One dangerous aspect of the World Wide Web is that young people can go there to be coached on exactly how to slim down in hazardous ways, by experts, i.e. other kids — or worse yet, adults — who are only too happy to indoctrinate them. The uninhibited spread of dangerous knowledge has been an ongoing problem ever since online forums were invented.

The one consulted here is ED Support Forum, a useful font of information on these topics, for better or worse. It apparently intends to help people escape from problem conditions, but in the course of helping, of course, readers will unavoidably find out a lot about how to acquire and maintain dangerous conditions.

The site is a huge resource, sorted into categories, where even those with unusual and arcane issues can find kindred souls. For instance, they ask each other about refeeding syndrome — a frequent consequence of malnutrition, whatever the cause, and not a challenge for amateurs to be handling on their own. Refeeding is the process of reconditioning the patient’s body to accept food without going all haywire from electrolyte imbalance and other complications. Refeeding syndrome is when it goes all haywire anyway.

The looming hazard posed by refeeding syndrome is a major reason for wanting to make sure that misguided young people do not become involved with any of the pathological and often grotesque efforts to lose weight in unsafe ways. Asking advice from people in the same boat is not a great choice but it’s as far as many people will go. They’re giving each other advice about how to manage refeeding syndrome at home, on their own. One poster asks,

Has anyone ever been thru refeeding at home? Went 8 days fasting with very little liquid. Then tried consuming the last 3 days. Every time I try, I break out in sweats head to toe. Then nausea. My lower legs and feet and ankles are swollen and even after hours of elevation don’t go down much. I have passed out a few times. My blood pressure is low. Last check was 86/58.

This person goes on to say that they have social anxiety, and rarely leave home, so of course going to a hospital “isn’t an option.” So they request not to be offered any advice like calling 911 or visiting a doctor or the emergency room. But then their next post says they “did end up at ER sunday.” The poster wrote:

Because of malnutrition/starvation/dehydration my body is trying to hold on to fluid nutrients or whatever it can. Fluid in chest/abdominal wall is what is causing the pain… I’m weaker now than I was Sunday. Still swollen. Wt up 8 lbs from swelling. My stomach has been removed and I’ve had 3 bowel resections.

This really sounds like hell on earth, and another member of the forum confirms that “refeed edema is super painful… Stick to whole foods, avoid processed since processed has high levels of sodium,” and goes on to give other advice gleaned from research papers. Another amateur counselor notes that the mental health toll an eating disorder imposes can be devastating. Implementing “damage control” is exhaustingly time-consuming, and the whole process is something “you can really beat yourself up over.” They write,

You will have to challenge your perfectionism which the ED is tightly bound around, so that’ll freak it out. Unfortunately, challenging perfectionism a little might be what keeps you mentally and physically safer during your ED.

Another person, and just for ease of communication we’re going to assume this is a female, confides that her “ED brain” looks in the mirror and sees a big, fat blob that absolutely needs to continue losing weight. Even if her calorie count is tiny, the ED brain gets angry. When the number on the scale goes up by even one pound, the ED brain tells her she is a failure, and is only happy when the number decreases. The person writes:

Then my little bit of sanity I have left sees the real me in the mirror and thinks I look disgusting… That this is the one body I’ll ever get and I’m ruining it… Also stop losing before I get put in forced recovery.

“Dark Seas” contributes information about how prickly and defensive her ED brain is, because when someone advises her not to vomit, or offers some other helpful advice, the ED brain hisses, “Of course they’d say that, because they don’t want me to be skinny.” So even a helpfully-intended intervention is received as an insult and a challenge.

Your responses and feedback are welcome!

Source: “Refeeding at Home,” EdSupportForum.com, 05/22/24
Source: “How to avoid/lessen binging,” EdSupportForum.com, 01/25/24
Source: “ed brain vs rational mind,” EdSupportForum.com, 06/11/22
Source: “ED Brain,” EdSupportForum.com, 03/08/22
Image by Edvard Munch/CC BY 4.0 rawpixel.com

The Lasting Impact of Early-Life Responsive Parenting on Childhood Weight

Tatyana Meshcheryakova March 12, 2025 No Comments

Childhood obesity remains a pressing public health issue in the United States, with over 22% of children between the ages of six and 19 classified as obese. While diet and exercise are often the focal points of obesity prevention efforts, a new study from the Penn State College of Medicine and the Center for Childhood Obesity Research at Penn State University suggests that responsive parenting during early childhood could play a critical role in shaping long-term weight outcomes.

Insights from the INSIGHT study

The research, part of the ongoing INSIGHT study, explored the effects of early-life parenting interventions on childhood weight. The study followed two groups of first-time mothers and their children from birth through age nine. One group received training on responsive parenting practices, which encouraged mothers to attune to their child’s emotional and physical needs, particularly in areas such as feeding, sleep, play, and emotional regulation. The control group, by contrast, received education on household hazard prevention.

Published in JAMA Pediatrics on March 10, 2025, the study builds upon previous findings that demonstrated a positive impact of responsive parenting on children’s weight through age three. The latest results show that children whose mothers received responsive parenting education had lower average body mass index (BMI) levels through middle childhood compared to their peers in the control group. Notably, the effects were more pronounced among female participants, indicating that this approach may be particularly beneficial for young girls.

The challenges of sustaining early gains

Despite the promising early outcomes, the study revealed that the benefits of responsive parenting interventions diminished over time, with BMI differences fading by age nine. Dr. Ian Paul, principal investigator and University Professor of Pediatrics at the Penn State College of Medicine, emphasized that while the intervention had a meaningful early impact, sustaining these effects in an environment that promotes unhealthy weight gain remains a challenge.

He said:

Our intervention stopped when the participating children were 2 years old and focused on the parenting of young children rather than behaviors and risk factors that emerge among school-aged children… While we are delighted that we made an impact early on, the fact that the beneficial effects disappeared by age 9 is not surprising, given the obesogenic environment we live in.

Dr. Jennifer Savage, another principal investigator and Director of Penn State’s Center for Childhood Obesity Research, echoed this sentiment, highlighting the importance of ongoing support for families beyond early childhood.

A call for a life-course approach

The study’s findings reinforce the notion that diet and exercise alone are not enough to combat childhood obesity. Instead, responsive parenting practices may help establish healthy growth patterns that reduce the risk of obesity as children grow. However, to sustain these benefits, researchers advocate for a broader, life-course approach that includes continued support for healthy habits throughout childhood and adolescence.

By integrating responsive parenting strategies into early childhood care and complementing them with ongoing reinforcement, healthcare providers, educators, and policymakers can help foster healthier futures for children. As this research suggests, equipping parents with the tools to respond to their child’s developmental needs may be an essential component of long-term obesity prevention efforts.

Your responses and feedback are welcome!

Source: “Early-life responsive parenting intervention yields lasting but diminishing benefits on child weight,” Penn State Health News, 3/10/25
Source: “Long-Term Effects of a Responsive Parenting Intervention on Child Weight Outcomes Through Age 9 Years,” JAMA Pediatrics, 3/10/25
“Effect of a Responsive Parenting Educational Intervention on Childhood Weight Outcomes at 3 Years of Age: The INSIGHT Randomized Clinical Trial,” PubMed, 8/7/18
Image by Vanessa Loring/Pexels

How do these medications work?

Effectiveness for weight loss

Dosage differences

Side effects and safety

Cost and availability

Can you switch between the two?

Which one should you choose?

GLP-1 Drugs for Type 2 diabetes may not be safe for Type 1 patients

… Or else!

Bridging the gap with practical solutions

The reality of implementing new guidelines

Expanding access through telehealth

Tools for sustainable change

Getting started with pediatric weight management

A study on digital health interventions

It takes a village

Why the change?

Why this matters

A booming market

Major players enter the space

The growing role of telehealth

The risks of direct-to-consumer care

The bottom line

That lying mirror

The gender factor

Insights from the INSIGHT study

The challenges of sustaining early gains

A call for a life-course approach

Profiles: Kids Struggling with Weight

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About Dr. Robert A. Pretlow

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