Can New Weight-Loss Drugs Surpass The Current Ones?

Are the weight loss medications currently on the market possibly being overused or not used as intended? Yes and yes. The article published in Axios, “Wegovy and Ozempic stars dim amid overuse concerns,” quotes a few specialists voicing their concern. One of them is Peter Antall, chief medical officer of digital chronic health company Lark. He says,

There is almost like a backlash kind of a sentiment going on… I don’t believe that we’re having second thoughts about the power of the medication. But I think the shine is coming off how they’re being used in real practice… That’s where many of us are concerned.

Another expert is obesity specialist and gastroenterologist Dr. Christopher McGowan, who penned his opinion in MedPage Today. He explained why his “perspective has shifted based on real-world experience.” Dr. McGowan is “deeply concerned about how GLP-1 medications are being used.” He writes:

The benefits of these drugs cannot be denied when they are taken as intended — meaning indefinitely. But what happens to the body and mind when these medications are discontinued? This is where the problem lies…

Noting that “from an efficacy standpoint, these drugs ‘work’,” but only for those who can “afford, tolerate, and sustain GLP-1.” They lose weight and enjoy other benefits such as improvements in various conditions, including kidney disease, sleep apnea, osteoarthritis — the list goes on. However, Dr. McGowan’s parting words send a chill:

 I fear we will look back on this era — after patients have spent tens of thousands of dollars, endured uncomfortable and sometimes serious side effects and experienced recurring weight gain and resurgent food noise — and ask: Even if these drugs ‘work,’ did they really work? Or did they ultimately harm our patients, our society, and our economy? It’s a sobering thought, but one I fear is all too real.

New kids on the block

Pharmaceutical companies are fully aware of current concerns and are actively testing a new wave of weight-loss medications, or planning more trials for the current ones, with a goal of enhancing their effectiveness and offering additional health benefits beyond shedding pounds.

Current treatments like Ozempic and Wegovy, which contain semaglutide — a GLP-1 receptor agonist that helps regulate blood sugar and appetite, are expensive, require weekly injections, and must be taken long-term to prevent weight regain. Drug makers hope that new alternatives will overcome these challenges. Plus, the global market keeps expanding and the demand is surging, so we are sure Big Pharma sees the dollar signs as well.

Let’s take a quick look at what medications we should expect to improve, and what the manufacturers and the researchers plan for them in 2025, as outlined in a recent article published in Nature.

Tirzepatide

Tirzepatide, marketed as Mounjaro and Zepbound, activates both GLP-1 and another hormone, GIP, which plays a role in fat metabolism. In clinical trials, it helped participants lose up to 20% of their body weight over 72 weeks, outperforming semaglutide, which leads to about 15% weight loss in a similar timeframe. Additionally, tirzepatide reduced heart weight, lowered fat around the heart, improved mobility, and decreased blood pressure and inflammation.

A major trial set to conclude in 2025 will explore its impact on heart disease in people with obesity and diabetes.

Retatrutide

Developed by Eli Lilly, retatrutide stimulates GLP-1, GIP, and glucagon receptors, showing even greater potential than existing drugs. In trials, participants lost an average of 24% of their body weight over 11 months. This medication also helped regulate blood sugar in diabetics and is now in phase III trials, expected to conclude by 2026.

Experts believe that combination therapies like retatrutide could be particularly effective, as obesity is a complex condition that benefits from targeting multiple biological pathways.

Orforglipron

Unlike Ozempic, which requires injection, orforglipron is a daily pill that mimics GLP-1’s effects. In early trials, it led to a 10% weight loss over 26 weeks while improving blood pressure and reducing circulating fat molecules.

Eli Lilly anticipates completing phase III trials in 2025, with potential U.S. regulatory approval in 2026. Experts suggest that if oral drugs like orforglipron prove effective, they could disrupt the market by offering a more convenient and cost-effective option.

MariTide

Amgen’s experimental drug MariTide, which stimulates GLP-1 while inhibiting GIP activity, is designed to be taken via monthly injections. In a 52-week study, it resulted in up to 20% weight loss. Unlike other treatments, MariTide appears to help maintain weight loss for months after stopping the medication, an issue seen with semaglutide and tirzepatide.

This potential for sustained results could make it a more attractive option for patients reluctant to commit to lifelong treatment.

CagriSema

Novo Nordisk’s CagriSema, a blend of semaglutide and cagrilintide, has shown superior weight-loss outcomes compared to its individual components. A 68-week study saw participants lose approximately 23% of their body weight.

Muscle preservation and metabolic treatments

Several companies are exploring synthetic amylin-based therapies, which help regulate appetite and blood sugar while preserving muscle mass — an advantage over GLP-1 drugs, which can lead to muscle loss. Novo Nordisk’s amycretin, a combination of GLP-1 and amylin, led to a 22% weight reduction in just 36 weeks.

Another experimental drug, enobosarm, developed by Veru, was found to preserve muscle in older adults with obesity when combined with Wegovy. Future studies may investigate how to help older or frail individuals lose weight while maintaining muscle strength and preventing osteoporosis.

Emerging therapies targeting cannabinoid receptors, which influence hunger, have shown early promise, with more research expected in 2025.

The bottom line

Looking ahead, researchers hope to shift the focus from simple weight loss to a broader understanding of obesity as a metabolic disease. Some believe that the next major breakthrough could come from a treatment that addresses inflammation, a key factor in obesity — though results from human trials are still a long way off.

Even if these new treatments aren’t widely available in 2025, researchers believe that the coming year will provide key insights into which therapies will be most effective and accessible in the near future.

Your responses and feedback are welcome!

Source: “The weight-loss drugs being tested in 2025: will they beat Ozempic?,” Nature, 2/6/25
Source: “Wegovy and Ozempic stars dim amid overuse concerns,” Axios, 2/11/25
Source: “I No Longer Think GLP-1s Are the Answer,” MedPage Today, 1/30/25
Image by Chokniti Khongchum/Pexels

Oversize Bodies and Itty-Bitty Genes

The big complicating factor here is epigenetics, for which the Cleveland Clinic offers an elegant definition:

Epigenetics is the study of how our environment influences our genes by changing the chemicals attached to them. What we eat, our physical activity level, access to resources and more affect those chemicals, in turn shaping our health.

As it turns out, a lot of aspects of the human condition which were assumed to be hardwired, or totally determined by genes, are actually malleable, whether or not we currently understand the processes behind how all of this works.

So, on one level, the genes we inherit say “This is how it’s gonna be.” Then, the science of epigenetics comes along and says, “Except when it isn’t, and boy oh boy, do we ever still have a lot to learn about that!”

Today we consult the National Library of Medicine for an overview of contemporary knowledge and thinking about the relationship between obesity and genetics. The authors are Ekta Tirthani, Mina S. Said (both of Rochester General Hospital), and Anis Rehman (Northern Virginia Medical Center). There is, to use a non-technical and totally accurate phrase, a lot going on. The only factor that is a bedrock certainty is maternal health — and just to deal with that one aspect requires “a team of obstetricians, pediatricians, nutritionists, geneticists, psychologists.”

Diagnosis of genetic and/or epigenetic origins of obesity

Here is an abbreviated version, just the highlights, of the authors’ explanation of how to figure this out in any individual case, and it is no walk in the park:

Endocrine causes of obesity […] must be ruled out early with history, physical examination, and lab work. Syndromic obesity can sometimes be distinctly diagnosed based on the presence of physical features… After basic lab work is done […] physicians can check leptin, insulin, and proinsulin levels. If all the above blood work is negative genetic testing can be carried out.

This is where it gets really complicated, involving arcane lab work that is only available in a few advanced facilities, and costs a bundle because of the expensive equipment required, along with the detailed high-level knowledge in obscure fields. But wait, there is more.

Research is necessary into the individual’s family history and personal history, as well as several other areas of life: psychosocial environment, habitual dietary practices, everyday activities, purposeful exercise, medications, and the subject’s (or patient’s) unique pattern of weight gain and loss thus far.

Two drugs are FDA-approved for treating genetically caused obesity, while several others (like the semaglutide and liraglutide we hear so much about) are working hard to prove their worth in that arena.

Even when obesity is passed down through the genes, various interventions can make a difference. The implementation of many different interventions can eliminate, at least partially, the validity of “I can’t help myself, it’s genetic” as a rationale. Sometimes the problem is clearly not genetic.

Or is it? An entire branch of philosophy could be based on arguing that, ultimately, everything and anything in the realm of human behavior might be genetic in origin. The manuscript describes these areas in much greater detail. The interventions that are mentioned and their mechanisms include:

— Bariatric surgery can cause changes in adipocyte-derived exosomal micro-RNA and cause epigenetic changes in differential methylated regions…
— Regular exercise can cause widespread changes in DNA methylation… For patients who maintain their weight loss, the DNA methylation profiles resemble lean individuals…
— Fasting can cause changes in DNA methylation of genes…
— The use of probiotics, prebiotics, and fecal transplant can restore gut flora and cause positive epigenetic modifications…

One principle is impossible to overemphasize: Obesity is multifactorial. In this area of human health, genetic factors do not equal the Implacable Hand of Fate or any such fatalistic notion. There is, in other words, plenty of room for improvement.

(To be continued…)

Your responses and feedback are welcome!

Source: “Epigenetics,” ClevelandClinic.org, undated
Source: “Genetics and Obesity,” Genetics and Obesity, nih.gov, 07/31/23
Image by Kevin Simmons/Attribution 2.0 Generic/

Oprah Through the Years, Part 16

The previous post discussed a stressful event from when Oprah Winfrey’s career was just taking off — her interrogation and public shaming by comedian Joan Rivers who was, on that day, not very humorous at all.

We do not presume to read Oprah’s mind. But a rudimentary understanding of human psychology (and especially, personal experience with therapy) could inspire a person to imagine how the effects of such strenuous and ubiquitous harping on weight could cultivate a preoccupation with the subject that would carry into the future.

It could set up an ongoing conflict between being perpetually overweight oneself, and the seeming necessity to buy into the fat-hating, fat-shaming culture that America and many parts of the world had converted to. This is what appears to have happened to Oprah, while at the same time, over the ensuing years, she also had learning experiences and personal revelations about the harm caused by the whole anti-fat zeitgeist.

The path of twisted reasoning

It might make sense to perceive that 1985 event as something that loomed large in her subconscious, drawing her more and more into the fat-despising state of mind, while at the same time coping with the mental conflict that demanded she must of course despise herself. It would, after all, be a logical conclusion. If you are required to hate Fat, and yet also supposed to love yourself, well, that is simply too much cognitive dissonance for the mind to handle. Therefore, if you hate fat and and are fat, you must necessarily hate yourself — which somehow turns out to be easier than exploring the illogical root of the contradiction.

Aunt Joanie really cares

Also, logically, if such a prominent person as Rivers took the trouble to give advice — rough as that widely broadcast counseling session had been — it must mean that she truly cared, and only wanted the best for this TV guest who aimed for a career in entertainment. It was as if a respected aunt warned a troubled teenager that she had better straighten up and fly right, before she encountered the juvenile justice system and wound up in the reformatory.

If fat is bad, then as an honest and upright person you must hate all the fat, even your own. And if that awful stuff is part of you, you must be pretty awful. So to redeem yourself, the least you could do is become a missionary for the abolition of fat — which might account for the many shows having to do with overweight that Oprah produced and hosted over the years. Who knows? It might even connect to her later alignment with WeightWatchers, which could, uncharitably, be read not only as an investment opportunity, but also as “virtue signaling.”

In 1986, with the humiliation by Rivers still fresh, Oprah told her TV audience, “I still hate myself because of my weight.” Soon afterward came the quotation we already mentioned, which included the damning words,

If you can’t fit into your clothes, it means the fat won. It means you didn’t win.

And it’s not as if Oprah had never recognized the issue. For at least a decade, it had already loomed large in her mind. As far back as 1977, when she first consulted a diet doctor, she had been striving to win. Whenever a new fad diet came along she tried it, with consistently unsatisfactory results.

The session with Joan Rivers was later confirmed to be connected with the incident (three years later, in 1988) that Oprah eventually came to recognize as the “biggest, fattest mistake” of her career. In an article published only last year, Clare Stephens wrote,

Oprah recently acknowledged her role in perpetuating diet culture during a livestream for Weight Watchers. “I’ve been a major contributor to it.” she said… The wagon of fat has gone down in pop culture history as an example of our pathological obsession with weight loss…

[T]he wagon of fat seems like the insidious start of it all. A moment of stigmatizing fat, and telling an audience of primarily women that if they just cared enough, theirs could be set aside too, rather than attached to their bodies.

Your responses and feedback are welcome!

Source: “In 1985 Joan Rivers asked Oprah a Question,” MamaMia.com, 05/13/24
Image by Pat Hartman

Unlocking Brown Fat’s Power: A New Strategy Against Obesity

A groundbreaking study from the National Cancer Research Centre (CNIO) has revealed an innovative approach to combating obesity by enhancing the body’s natural ability to generate heat. Researchers have discovered that blocking the mitochondrial protein MCJ in brown fat significantly increases thermogenesis, leading to weight loss in obese mice and providing protection against obesity-related diseases such as diabetes. The study was recently highlighted in SciTechDaily.

Obesity and its global impact

Obesity is a pressing global health issue, affecting over 650 million people and contributing to the rise of cardiometabolic diseases and cancer risk. The study, led by Guadalupe Sabio from CNIO and Cintia Folgueira from CNIO and the National Centre for Cardiovascular Research (CNIC), sheds light on a crucial biological mechanism that could pave the way for new therapeutic strategies.

The role of MCJ in energy metabolism

At the heart of this discovery is MCJ, a mitochondrial protein that regulates energy production within cells. The researchers found that eliminating MCJ in obese mice led to a marked increase in heat production, resulting in significant weight loss. Furthermore, the transplantation of MCJ-deficient fat tissue into obese mice also triggered weight reduction, underscoring the protein’s pivotal role in metabolic regulation.

Understanding brown fat and thermogenesis

Adipose tissue, commonly known as body fat, is not merely a passive energy reservoir but an active participant in metabolic regulation. There are two primary types of adipose tissue. White adipose tissue (WAT), which primarily stores energy. Brown adipose tissue (BAT) is rich in mitochondria and specializes in thermogenesis — the process of generating heat in response to cold and other stimuli.

The authors write in Nature Communications:

Obesity is the result of either excessive food intake or inadequate total energy expenditure. We now know that adipose tissue –body fat–, in addition to storing energy, plays a crucial role in the management of that energy by the body. Adipose tissue is a complex organ that acts as a regulator of the whole body’s metabolism, and therefore modulating its function could well be a way to combat obesity.

For years, scientists have sought ways to activate brown fat as a means to combat obesity. “Understanding how brown fat generates heat is essential if we want to leverage it as a tool against obesity,” explains Sabio. The CNIO study now identifies MCJ as a key player in this process.

A new path to weight loss and disease prevention

By blocking MCJ, brown fat burns more energy, leading not only to weight loss but also to improved metabolic health. Mice lacking MCJ in their brown fat exhibited protection against common obesity-related health issues, including diabetes and high blood lipid levels. According to lead researcher Beatriz Cicuéndez, this protection is attributed to the activation of the catabolic pathway — a vital metabolic route that enhances fat, sugar, and protein consumption to produce heat.

Future therapeutic potential

The findings highlight MCJ as a promising therapeutic target for obesity treatment. However, before moving to clinical applications, further research is necessary to assess whether MCJ plays critical roles in other tissues. Additionally, scientists are investigating how changes in fat metabolism might influence cancer progression or conditions like cachexia, a syndrome characterized by extreme muscle and fat loss.

Looking ahead

This discovery opens up exciting possibilities for developing new obesity treatments that harness the body’s natural energy-burning mechanisms. By targeting MCJ, researchers may unlock a novel approach to weight management and metabolic disease prevention, bringing hope to millions struggling with obesity worldwide.

Your responses and feedback are welcome!

Source: “Goodbye Obesity: Scientists Uncover Fat-Burning Protein Switch,” SciTechDaily, 1/27/25
Source: “Absence of MCJ/DnaJC15 promotes brown adipose tissue thermogenesis,” Nature Communications, 1/13/25
Image by Total Shape/Pexels

Oprah Through the Years, Part 15 — Up Against the Wall

About Oprah Winfrey’s childhood, we know that the earliest part of it was spent with her single mother and her grandma, in an unstable and impoverished existence. It is hard to find information on whether she was overweight. From age nine she was sexually abused by two family members and an unrelated person, and at 14 gave birth to a child who died soon afterward. Then, she went to live with her father.

Although that situation was an improvement in many ways, she was still not okay, and said later, “The deepest pain I carried was believing I was unworthy.” The combination of shame, uncertainty, and a conviction of one’s own lack of value can certainly cause a person to find solace in food, if it is available.

From a medical source we learn that very young (11 to 14) pregnant patients are more apt to have obesity. It does not seem clear whether they start out that way, but this seems a likely possibility because the insecurity caused by being overweight can make them easy targets for predatory males. Another study concluded that teen births are associated with becoming overweight or obese later in life. Yet another affirms that…

Many teenage mothers struggle with proper nutrition during and after pregnancy. This can lead to long-term health problems, including obesity, diabetes, and osteoporosis.

We have said enough already about Oprah’s rise through the ranks into a stellar career, but this post intends to track the dark side of it, the period when she was doomed to participate in the general culture of fat-hating and fat-shaming. Her media career seemed in some ways to drift toward “specializing” in overweight, often with her own buxom figure as Exhibit A.

Probably no one else in history has so publicly shared the personal battle with obesity. The intensity of the fixation waxed and waned as other subjects captured her attention, and increased professional opportunities and personal initiatives took over. Somehow though, weight always seemed to remain a bedrock foundation of concern and obsession.

The Joan Rivers debacle

In an earlier post we mentioned the mindset of a fat-hating culture, and here is an ugly example of it. The year 1985 dumped Oprah right into a psychological river filled with rapids and sharp rocks: a TV appearance that was a striking example of the anti-fat trend, so extreme she felt compelled to bring it up almost 40 years later.

Oprah, who had just entered her 30s, appeared on The Tonight Show, with comedian Joan Rivers as guest host (and inquisitional prosecutor of heretics). The raucous Rivers did not set the precedent for speaking out against fat, but she definitely endorsed it. Clare Stephens for MamaMia.com transcribed the dialogue, which is edited here for length:

Rivers: So, how did you gain the weight?
Oprah: I ate a lot.
Rivers: You shouldn’t let that happen to you! You’re very pretty.
Oprah: (begins to say something)
Rivers: I don’t want to hear! You’re a pretty girl and you’re single, you must lose the weight.

Decades later, Oprah recalled how the audience laughed uneasily as Rivers wagged her index finger accusingly, while Oprah wanted nothing more than to crawl under her chair and hide. She reflected on the incredible rudeness of a host marring the national television debut of a younger woman by scolding her for her weight. And still, Oprah wasn’t off the hook. Rivers then mentioned a young singer who, according to her, was very chubby and needed to lose weight — and then went on to justify her own uncouth behavior by cranking the outrageousness up a notch:

You must tell a friend the truth! You must say “You’re still a pig, lose more weight.” That’s a friend.

Still stinging from exposure to this vicious mindset, a few months later Oprah, at almost 200 pounds, began hosting her own TV show in Chicago.

Your responses and feedback are welcome!

Source: “The Oprah Winfrey Success Story,” TheStrive.co, 01/27/23
Source: “Rising from the Ashes: The Story of Oprah Winfrey’s Transformation,” Substack.com, 01/26/25
Source: “Pregnancy before 16 increases long-term health complications for girls and babies,” Utswmed.org, 04/11/23
Source: “The Effects Of Teenage Pregnancy On Physical Health,” CatchNutrition.com, 11/04/24
Source: “In 1985 Joan Rivers asked Oprah a Question,” mamamia.com, 05/13/24
Image by aphrodite-in-nyc/Attribution 2.0 Generic

Oprah Through the Years, Part 14 — What’s in a Word?

Back in 2010 Oprah Winfrey admitted to her audience, “I’ve never liked the term ‘food addict.'” Of course, over time, she had casually referred to herself as one of them, because it was the hip terminology, and because this is what a popular personality and influencer does. It’s the first lesson a stand-up comic learns, too. Start out with self-deprecation. Make fun of yourself, and the crowd will be on your side. Oprah went on to say,

I realize that I really have been one. And believe me, I — like so many of you — have punished myself for that. But I know that I’m not alone, and I know that the battle hasn’t ended.

In late 2023 the star confirmed that she was taking something, and made a public statement about how her thinking had evolved:

I had an awareness of [weight-loss] medications, but felt I had to prove I had the willpower to do it. I now no longer feel that way.

Some critics objected to her breakup with WeightWatchers, seemingly on the grounds that nobody should ever be allowed to change their mind, even when they recognize that previous moves may have been less than brilliant. Many people, having dared to move in a new direction, have been shocked to find it was not tolerated by either friends or the public.

Oprah described the benefits of changing her mind about the medication. The widely-quoted statement says,

The fact that there’s a medically approved prescription for managing weight and staying healthier, in my lifetime, feels like relief, like redemption, like a gift, and not something to hide behind and once again be ridiculed for.

As part of the 2024 Teapot Tempest, Vanessa Romo of NPR reported that Oprah intended to elevate the conversation, advocate for health equity, and work to reduce stigma. In particular, her intention was to ditch shame, both the kind dispensed by others and the brand she manufactured herself. She was finished with five oppressive decades of feeling like, “Why can’t I just conquer this thing?,” and refused to believe any longer that a lack of willpower was a personal failure.

Meanwhile, she was hiking, hydrating, timing her meals more sanely, and still tabulating WeightWatchers points. Because, and this is a very important point that people would rather not acknowledge — you still have to do the work.

Further thoughts

A few years later, Oprah spoke of having had a revelation while moderating a panel on weight:

I realized I’d been blaming myself all these years for being overweight, and I have a predisposition that no amount of willpower is going to control. Obesity is a disease. It’s not about willpower — it’s about the brain.

She then consulted a doctor and was prescribed one of the new meds. On the shame issue (and many other matters) we see how Oprah adjusts her mind around new information, and can bring a large portion of America along with her. She has become something far more potent than a mere “influencer,” and is perceived as a moral arbiter.

This too led to her separation from WeightWatchers, which is a whole saga in itself. She added, “For the people who think that this (medication) could be the relief and support and freedom that you’ve been looking for your whole life, bless you.”

The part about obesity being a disease in the brain, is complicated in and of itself. Ultimately, everything is brain-linked in one way or another. And the connection between obesity and lab animal brains is different in quantity and quality from the connection between obesity and human brains. A person can think, “As long as I will need to wash a bowl anyway, I might as well have a large serving of stew, because that will justify using up the dish soap to wash just one dish.” No lab rat is capable of that quality of reasoning!

In the 2024 TV special, Oprah revealed,

All these years, I thought all of the people who never had to diet were just using their willpower, and they were for some reason stronger than me. And now I realize: y’all weren’t even thinking about the food! It’s not that you had the willpower; you weren’t obsessing about it!… I’m not constantly thinking about what the next meal is gonna be…

How many times have I blamed myself because you think, ‘I’m smart enough to figure this out,’ and then to hear all along it’s you fighting your brain.

Your responses and feedback are welcome!

Source: “The Highs and Lows of Oprah Winfrey’s 50-Year Weight Loss Journey,” MSN.com, 2024
Source: “Oprah Winfrey Reveals She Uses Weight-Loss Medication as a ‘Maintenance Tool’: ‘I’m Absolutely Done with the Shaming’,” People.com, 12/14/23
Source: “After nearly a decade, Oprah Winfrey is set to depart the board of WeightWatchers,” NPR.org, 03/01/24
Source: “Oprah Winfrey says she has released the shame of being ‘ridiculed’ for her weight for 25 years,” ABCNews.go.com, 03/19/24
Source: “Oprah Winfrey reveals she starved herself ‘for nearly five months’ in ABC weight loss,” USATODAY.com, 03/18/24
Image by Javcon117*/Attribution-ShareAlike 2.0 Generic

A “Strong” Study Looks at Pediatric Obesity Treatment

Children who respond positively to pediatric obesity treatment show significantly lower risks of health problems and early death in young adulthood, according to a study published on January 21 in JAMA Pediatrics.

The gist of the study

Led by Resthie R. Putri, Ph.D., and a team from the Karolinska Institutet in Stockholm, Sweden, the researchers analyzed data from 6,713 children and adolescents with obesity, drawn from Sweden’s Childhood Obesity Treatment Register (BORIS) and compared them to general population data. The study used baseline information collected between 1996 and 2019 and analyzed outcomes in 2023.

Study’s results

The study tracked health outcomes for young adults, ages 18-30, from 2005 to 2020. The participants included children aged 6-17 who had received at least one year of obesity treatment. These individuals were compared to a group from the general population matched for sex, birth year, and geographic location.

The research team categorized the participants’ responses to obesity treatment based on changes in their body mass index (BMI) standard deviation scores. These categories included poor, intermediate, good, or remission of obesity. Health outcomes in young adulthood that were assessed included type 2 diabetes, dyslipidemia, hypertension, depression or anxiety, and the need for bariatric surgery.

The findings showed that compared to a poor treatment response, those who achieved obesity remission or had a good treatment response were at much lower risk for early death. Additionally, a good response was linked to a lower likelihood of developing type 2 diabetes, dyslipidemia, and requiring bariatric surgery. Only the remission group showed a reduced risk for hypertension. However, treatment response did not appear to influence the risk of depression or anxiety, a noteworthy observation as it suggests that these mental health conditions need to be addressed separately from obesity.

The study’s large sample size and Sweden’s universal healthcare system, which facilitated continuous data tracking, were key strengths. The authors noted that the results may not be applicable to other countries, as the study’s findings are based on Swedish data.

The commentary

One of the study’s authors, Emilia Hagman, who is a principal researcher at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet, commented:

The results are very good news. Whether or not the treatment of obesity in childhood has long-term health benefits has been debated, since weight-loss is hard to maintain… This emphasizes the importance of providing early treatment, as we know that timely intervention increases the likelihood of success and helps mitigate the long-term health risks associated with obesity.

In an accompanying commentary, Leonard H. Epstein, Ph.D., and colleagues praised the study for its robust design and the insights it offers into how much weight change is needed for significant health improvements, which could inform future treatment guidelines. However, they pointed out that the study didn’t specify the types or intensity of treatment provided to the children, which makes it difficult to compare with U.S. guidelines from the American Academy of Pediatrics (AAP).

The commentary also highlighted a key finding: Younger children (ages 6-11) had a higher rate of achieving good responses or remission compared to adolescents (ages 12-17). This suggests that earlier intervention in childhood may lead to better outcomes, emphasizing the importance of starting obesity treatment early rather than waiting to see if the child will “outgrow” the condition.

The bottom line

The study also found no strong connection between obesity treatment response and anxiety or depression, thus suggesting that these conditions should be treated independently of obesity. The study provides important evidence on how pediatric obesity treatment affects long-term health, including risks for cardiometabolic diseases, the need for bariatric surgery, and even mortality. This information is vital for refining clinical guidelines and improving obesity treatment strategies.

Your responses and feedback are welcome!

Source: “Successful Pediatric Obesity Treatment Linked With Long-Term Health,” Medscape, 1/22/25
Source: “Effect of Pediatric Obesity Treatment on Long-Term Health,” JAMA Network, 1/21/25
Source: “Weight-loss treatment for children with obesity has lasting effects, finds study,” MedicalXPress, 1/21/25
Image by Ketut Subiyanto/Pexels

Oprah through the Years, Part 13 — As a Co-operative Endeavor

We were discussing the book It’s Not Who You Know… It’s Who You Train, which Oprah collaborated on with Bob Greene. It starts with “Oprah’s Story,” and she also wrote chapter introductions. The amount of impetus that she gained through association with him is incalculable, perhaps partly because it has been a learning process all around. With luck, nobody comes fully formed to any relationship. With more luck, and maybe one or two other conditions, a healthy relationship is beneficial to both parties.

Greene is quoted as saying, “Two of the most accepted ways to deal with stress are to overeat and be a workaholic.” And it sounds like Oprah had been doing both, for a long while. But even here, there is ambivalence. For many people, the workhorse lifestyle has its advantages. Labor is a socially acceptable displacement activity for excess brain energy, and is generally more beneficial than overeating.

The person’s health may suffer in either case, but at least a workaholic is probably able to keep up with the bills. But there is a catch. Displacement activity, even the culturally approved kind like overworking oneself, is not always helpful… not when it is the symptom of a problem which, sooner or later, some effort ought to be made to fix.

It had to end

Oprah had been falling back on what, if viewed in a certain light, might seem like the perfect excuse. For a long time, she simply believed she did not possess willpower, just like she didn’t have blue eyes or size 7 feet. Ever since Greene began to influence her life, Oprah was obliged to think about his questions like, “Why is food my drug of choice?”

But at some point, the cognitive dissonance must have become impossible to ignore. Perhaps one morning, she awakened to the stark reality that sometimes, two things simply cannot both be true at the same time. Eventually, this paradox would become impossible to ignore. There must have been a day when Oprah asked herself something like this: “Let’s face it, I am famous and wealthy and most gloriously loved. If I don’t possess willpower, then how did I accomplish so much in terms of tangible, recognizable, undeniable success?”

Maybe this opens up an entirely new realm of possibilities. Maybe having willpower is not enough. Maybe the whole issue of avoiding obesity isn’t even about willpower. Or maybe Oprah had as much willpower as anyone, but it just wasn’t being properly deployed. Or maybe, in this instance, willpower was basically not the right tool for the job.

When things don’t add up

In 1988, a slim version of her former self had told the worldwide audience, “If you can believe in yourself, and believe that this is the most important thing in your life… you can conquer it.” But four years later, her weight almost hit 240 pounds, so obviously, an element was still missing from the equation.

The international star had been working intensely for years on projects and programs, using her sharp mind and many talents, not only to further her own career but to help and honor hundreds of thousands of people in ways both tangible and inexpressible. Oprah was stepping up in a brave new role. Her relationship with the world was changing, and so was her relationship with herself.

In 2020 she took a gigantic step in a fresh direction by featuring someone other than herself on the cover of O, The Oprah Magazine. This was Breonna Taylor, the medical technician who had been killed by police under extremely dicey circumstances. It indicated a new direction.

It might be useful to understand some things about Oprah’s decision-making process and the values behind it and so forth. We also speculated on how the different vocabularies used in various academic disciplines could obscure the fact that sometimes, wise and learned people might be talking about the same thing, and possibly with basic agreement on some essential point, even on the verge of finding philosophical harmony — but language gets in the way.

When a huge number of people are in trouble for wanting what they want, such as to indulge an insatiable appetite; and if that seems to others to be an undesirable condition or outcome; then perhaps the trick is to figure out why the person wants what they want. Helping Oprah to decipher this vital matter might be the main function that mentor Bob Greene has served.

(To be continued…)

Your responses and feedback are welcome!

Source: “It’s Not Who You Know… It’s Who You Train,” ChicagoTribune.com, 08/19/21
Image by Gerald Mendoza/Attribution 2.0 Generic

Oprah Through the Years, Part 12 — Bob Greene, Willpower, and Motivation

The previous post included some of the thoughts Dr. Pretlow has published on the subject of will/willpower. Now we look at precepts passed on to Oprah Winfrey by her longtime health and weight management coach, Bob Greene.

As reported in a Good Housekeeping article by Kate Coyne, the first inquiry that one should make to oneself is, “Do I have poor willpower?” As suggested in Part 8, the answer to that, in Oprah’s case, must have been an overwhelming “No!”.

Then comes a harder question: “Why is food my drug of choice?” For everyone who has ever engaged in a battle with their own body fat, figuring that out is a much more complicated challenge, which most folks apparently never quite manage to meet.

Possibly that difficulty is connected with the second Greene precept — taking responsibility. No fair blaming of family members, or job stress, or any other external factor. “If you’re offering up a lot of excuses, you’re wasting your time.” What is the antidote to time-wasting excuses? Stating goals, and making a solid commitment to meet those goals. It might help to draft a contract with oneself, and officially sign it — with the same degree of seriousness that one would give to any other binding legal document.

Adhere to your contract

An interesting feature of Greene’s philosophy is that he emphasizes the concept of willpower — “Your inner strength is most important” — and as suggested previously, perhaps everyone is naturally endowed with a great amount of inner strength, and the problem lies in their tendency to use it for different purposes, such as resisting any change in lifestyle or behavior.

Greene realizes that behavior change might have a better chance if it is introduced gradually, so don’t embark on an ambitious structured workout plan right from the jump. Use stairs instead of elevators, and if there are errands you can accomplish on foot, do that rather than drive. Walk the dog twice around the block instead of once. Just kind of creep up on change at first, and that deep-down revulsion against exercise might remain dormant. Then, follow his plan for a gradual increase.

The same goes for food, he advises. At first, cut out about 10% of the customary caloric intake; start learning about simple versus complex carbohydrates; cultivate a taste for vegetables; and enjoy a little bit of fat. And then, look into timing. At least three hours before sleep, stop eating. And over the long haul, expect ups and downs. There may be discouraging periods when it seems like nothing changes, so rather than give in to hopelessness, figure out how to cope with that.

Who you know

In 2021, Greene published a book titled It’s Not Who You Know… It’s Who You Train, referring of course to Oprah, who also had a hand in the authorship. Weight loss isn’t the main thing, but wellness is. Achieve a higher level of general wellness, and most people will find that weight loss comes much more easily. A person can lay a solid foundation for success by identifying and dealing with their emotional issues, and by pinpointing their counterproductive methods of stress alleviation and substituting more helpful ones.

An uncredited Chicago Tribune reporter wrote,

Although he was schooled to treat weight as a physical problem, his experience working with overweight people made it clear to him that psychological factors are crucial. Greene learned to probe for the reasons people seek comfort in food. “We need to start thinking about their motivations,” he says.“When I started employing that philosophy, that’s when I started having extreme success.”

Actually, maybe the motivation question is not that mystifying. Even an amoeba knows enough to take action to avoid pain. It probably also seeks pleasure. At any rate, Green provides a list of 10 habits which, if followed, will make a significant difference. One can will oneself into doing some things. For instance: always look for a way to turn a minus into a plus. Greene recognizes, for instance, that Oprah faces a lot of obstacles, starting with an inherently slow metabolism.

But even that, he turns into a plus, by acknowledging the stumbling block she deals with, and praising her for overcoming it:

“She can look at food and put on weight,” he says… “That’s why I think she’s one of best examples for other people… For her to get on the cover of Shape, I know how hard she needs to work. It’s harder than [it is for] 99 percent of the people.”

Your responses and feedback are welcome!

Source: “The Healthy Way to Lose Weight,” GoodHousekeeping.com, 04/05/04
Source: “ It’s Not Who You Know… It’s Who You Train,” ChicagoTribune.com, 08/19/21
Image by Get Everwise/Attribution-ShareAlike 2.0 Generic

The “Miracle Drugs” Are Not Without Risk

A new study of glucagon-like peptide-1 receptor agonists (GLP-1RA) effects revealed that they have proven benefits for weight management. However, less is known about their impact on various organs and body systems.

Carissa Wong, New Scientist Health Reporter, in her recent article, offered her takeaway:

Drugs like Ozempic and Wegovy, called GLP-1 agonists, carry more benefits than risks when taken for their approved uses, according to a comprehensive analysis of their effects on 175 conditions. The same may not be true for people taking the drugs for other uses, however.

News Medical also reported on the study, mentioning that demand for weight-loss medications like Ozempic and Wegovy continues to rise, with one in eight Americans using (or had used) them to treat conditions such as diabetes, heart disease, or obesity. Often referred to as “miracle drugs” by the media, patients, and some doctors due to their significant weight loss effects, GLP-1RAs also include drugs like Mounjaro and Zepbound.

The study’s findings

A new study conducted by researchers at Washington University School of Medicine in St. Louis and the Veterans Affairs (VA) St. Louis Health Care System assessed health outcomes in over two million people with diabetes who were using these weight-loss drugs. The study found notable improvements in cognitive and behavioral health, but also uncovered potential risks, such as an increased likelihood of pancreatitis and kidney issues. The study was published on January 20 in Nature Medicine.

The study’s senior author, Dr. Ziyad Al-Aly, a clinical epidemiologist and nephrologist at WashU Medicine, emphasized the importance of thoroughly examining the effects of these drugs, given their rapid rise in popularity and relatively recent emergence.

For the study, WashU Medicine researchers analyzed de-identified health records from the U.S. Department of Veterans Affairs, comparing outcomes between veterans using GLP-1RAs for diabetes and those on traditional medications like Jardiance, Glipizide, and Januvia. The dataset included over two million veterans treated for diabetes between 2017 and 2023, spanning various ages, races, and genders.

The benefits and the risks

The results showed that GLP-1RA drugs were linked to significant improvements in mental and behavioral health, including a reduced risk of seizures, addiction to substances like alcohol, cannabis, stimulants, and opioids, and even a lower likelihood of suicidal thoughts, self-harm, bulimia, and psychotic disorders like schizophrenia. These medications were also associated with a decreased risk of neurocognitive conditions such as Alzheimer’s and dementia.

Dr. Al-Aly explained that these drugs work on brain areas involved in impulse control and reward, which could help explain their effectiveness in reducing both appetite and addiction behaviors. Additionally, they seem to reduce brain inflammation, which may contribute to improved brain health and a reduced risk of Alzheimer’s and dementia.

However, the benefits, while meaningful, are modest, with reductions of around 10% to 20% for most outcomes. Despite this, Dr. Al-Aly emphasized that even small improvements can be valuable, particularly for conditions like dementia, where effective treatments are limited. These drugs may also be more beneficial when combined with lifestyle changes or other medications.

The study reaffirmed previous findings that GLP-1RA drugs can lower the risk of heart attacks, strokes, and other cardiovascular issues. However, it also highlighted some negative side effects, including gastrointestinal problems like nausea, vomiting, diarrhea, and, in rare cases, stomach paralysis. These side effects are already well-known in the medical literature and have been observed anecdotally.

More concerning, though, are the potential risks to the pancreas and kidneys. While these adverse effects are relatively rare, they can be severe, and Dr. Al-Aly stressed that doctors need to monitor patients carefully for signs of pancreatitis and kidney issues, which can develop without obvious symptoms until they are advanced and harder to treat.

An unexpected self-reported side effect

Journalist Johann Hari was recently interviewed by A. Pawlowski, TODAY Health Reporter, about his journey of taking Ozempic and Wegovy. He was prescribed the drugs in 2023, for weight loss, as Hari weighed 203 pounds and had a body fat percentage of 32%. Eventually, Hari lost 42 pounds and wrote a book, “Magic Pill: The Extraordinary Benefits and Disturbing Risks of the New Weight-Loss Drugs.”

To the interviewer’s question about what specifically bothered Hari about taking the meds, he replied:

For myself, the one risk that I didn’t see coming was the psychological effect. That was really strange. For the first six months I was taking the drug, I was getting what I wanted — I was losing loads of weight, my back pain went away, all sorts of good things happened.

But I didn’t actually feel better in my emotions. If anything, I felt slightly worse. I realized it was about my inability to comfort eat, and how bad that was making me feel.

No longer being able to use food as a stress-coping mechanism, Hari had to face “the deep underlying emotional reasons why you ate in the first place.” He said,

I realized how much of my eating was about the need to comfort myself — stuffing myself to calm myself. And I couldn’t do that when I was on Ozempic.

The bottom line remains the same. While GLP-1RA medications offer broad health benefits, the study underscores that they are not without risks. Their potential applications are vast, but careful monitoring is essential to manage the associated risks.

Your responses and feedback are welcome!

Source: “How GLP-1 drugs like Ozempic and Wegovy affect risk of 175 conditions,” New Scientist, 1/20/25
Source: “Benefits and risks of popular weight-loss drugs revealed,” News-Medical, 1/20/25
Source: “Is Ozempic a ‘magic’ drug? Author who lost 42 pounds on benefits, ‘very real concerns’,” TODAY, 6/20/25
Image by Andres Segura/Pexels

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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