Oprah Through the Years, Part 21

Courtesy of the Oprah Winfrey Network, March of 2011 brought the TV audience a new reality show, “Addicted to Food.” It was recorded on location at the Shades of Hope Treatment Center, a facility specializing in eating disorders and addiction. Shades of Hope founder and CEO Tennie McCarty has found that addicts come from homes affected by dysfunction, abuse, addiction, or some combination of all three. The work that must be done is “to delve deep within and confront not only the outward behaviors of addiction, but also the secrets, pain, self-loathing, and blame that lie beneath.”

How long does that take? At minimum, 42 days, which is the length of the Intensive Residential Program. This has been shown to be enough time to dig into the psychological issues, learn the tools of recovery, and achieve a solid state of abstinence. The process is not easy, and the rules are strict, for good reason. No alcohol, no smoking, no other types of addictive substances are allowed, because to run a program meant to end one sort of addiction while allowing other addictive substance to be used is just plain silly.

While a client’s weight may be tracked, it is not revealed. The point is to get away from the idea that “it is always about the numbers and the connection of worth/control/success to the number on the scale.”

And that’s not all…

Oh — and no TV, or books or magazines are allowed either, because people need to be thinking about their own issues, not about the larger world or some imaginary characters. McCarty explains that the goal is to allow all the negative feelings to emerge and “slap the client in the face.” Hopefully, that blow will metaphorically knock the mask right off, exposing the anger and all the other stuff. When this happens, the client is said to be “showing up.”

The Intensive period includes Family Week, and then another week in which to process whatever transpired during that time, and to figure out what’s next — which might be a transitional period, either still at the Shades of Hope, or at another facility. Or perhaps it is time to return home, and get back to school, work, or whatever.

But… and this is a big but…

None of these stages can be regarded as an end point, because this is not a race where a person breaks through a ribbon at the end of the course. Nope, says McCarty. It’s all about a lifelong commitment, during which the individual must be constantly on guard because that inner void still cries out to be filled, and “switching” addictions is definitely a real possibility, to be avoided at all costs. Day by day and minute by minute, the commitment — to use new attitudes and new tools to change old patterns — must be scrupulously kept.

McCarty offers five helpful “tips” for recovery, more thoroughly described on her page, and worth looking into:

1. Be conscious of what you eat.
2. Eat with intention.
3. Maintain a healthy meal plan.
4. Eat by the clock.
5. Recovery is not a diet, but a way of life.

The show made at this “extremely difficult rehab center” involved eight clients, and it must have been edifying for Oprah to recognize which one (or ones) she most closely identified with. Seven years later, InTouchWeekly.com made an attempt to follow up on the participants, which proved to be rather half-hearted and largely unsuccessful. But their website also contains the trailer for the original show, which is pretty interesting. SocialWorkersSpeak.org also took note of the series and made some comments.

In the next chapter of Oprah Winfrey’s life of up-and-down weight shifts, we will see things take off in a whole different direction.

Your responses and feedback are welcome!

Source: “Addicted to Food Q&A: Tennie McCarty and Tough Love,” Oprah.com Source: “Remember Oprah’s Reality Show ‘Addicted to Food’? Here’s What the Cast Is up to in 2018,” InTouchWeekly.com, 03/01/18
Source: “Oprah Winfrey Network’s ‘Addicted to Food’ Tackles Emotions Behind Eating Disorders,” SocialWorkersSpeak.org, 05/12/11
Image by Pat Hartman

Oprah Through the Years, Part 20

We left off last time by mentioning how the rules change. This is one of life’s little jokes. As soon as you get used to one condition or set of circumstances, it will probably be necessary, before too long, to readjust to something else. For humans, the primary survival trait is adaptability, and the young are better at it. This is one reason why, when correctly applied, being like a little child is a very desirable state.

Youth is when many people are easily able to swallow and assimilate anything without suffering a physical penalty. As the body ages, it becomes less tolerant and… the rules change. When something else is going on at the same time, this fact might be easy to ignore. In the case of Oprah Winfrey, trainer and friend Bob Greene pointed out that her thyroid issue was an easy excuse to fall back on, and that she had “absolutely” done so on more than one occasion.

People are usually pretty good at generating excuses for not achieving their dreams. Just like a regular human, the global influencer and star had a particular and individual issue to deal with. In her case, it was a medical condition that required expert management, as well as patient compliance.

At the same time, like billions of regular people, Oprah was getting older every minute. As time goes on, and even with dedicated effort, it becomes more and more difficult to stave off weight gain.

In human history, this has rarely been the case. For obesity to become a significant problem, a society has to reach the stage of having food surplus to its needs. The civilization advances to where it can afford to have some members unable to defend themselves, and dependent on others for their continued well-being. When the society has abundant food, and physical fitness is not a priority requirement, people can become obese.

The Bob Greene worldview

Greene theorized that no one, be they an anonymous teenager or a world-famous star, would ever be able to completely overcome food addiction; that the problem would never completely disappear, and would always need conscious and diligent management. He also suggested that no one could properly start the recovery journey without squarely facing five crucial questions:

What are you hungry for?
Why are you overweight?
Why have you been unable to maintain weight loss in the past?
What in your life is not working?
Why do you want to lose weight?

The last query is a particular challenge, because the seeker is quite likely to come up with the wrong answer. “Then I’ll be happy” is not the right one, because it encompasses only two possible outcomes, neither of which can satisfy, as Greene explains:

You never reach that size or weight and you’re never happy. And even worse, you reach that size and weight and realize it has nothing to do with your happiness.

The following year, 2010, was when Oprah famously stated for publication that she was not fond of the term “food addict,” but…

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.

This admission seems to cover two bases: First, it pleads guilty to the same fat-hate that dwells in the heart of even the most compassionate person. Also, it appears to confirm that the last person anyone is ever able to forgive is their own self.

Your responses and feedback are welcome!

Source: “Oprah’s Weight Loss Confession,” Oprah.com, undated
Image by Oprah.com/Fair Use

FDA Ends Compounding for Popular GLP-1 Drugs

 

Due to limited availability and high costs, many Americans have turned to compounding pharmacies for weight-loss medications. However, this alternative will soon be unavailable.

Federal regulations allow compounding pharmacies to produce copies of drugs during shortages. Recently, though (as it’s been widely reported) 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.

This has left patients like Amanda Bonello, a mother of three from Marion, Iowa, feeling anxious. She has been using a compounded version of tirzepatide, the active ingredient in Eli Lilly’s Mounjaro (for diabetes) and Zepbound (for weight loss). With Zepbound’s retail price averaging nearly $1,300/month, Bonello fears she won’t be able to afford the brand-name drug.

She said,

It feels like we’re stranded while Big Pharma controls the only food supply, letting those who can’t pay go without.

In response, industry groups representing compounding pharmacies and suppliers have filed lawsuits to continue selling these medications. Meanwhile, patients have launched an online petition urging regulators to extend the use of compounded GLP-1 drugs, approve generic alternatives, or push pharmaceutical companies to lower prices. The petition also calls for health insurers to cover these medications.

What’s the status of compounded Wegovy and Zepbound?

Soon, compounding pharmacies will no longer be permitted to produce and sell these weight-loss drugs for widespread use. The government has set a transition period, with compounded versions of Zepbound and Mounjaro already being phased out. Compounded semaglutide (found in Wegovy and Ozempic) will remain available for a short time longer.

In December, the FDA announced that tirzepatide was no longer in shortage, giving pharmacies until February 18 to stop compounding, distributing, or dispensing the drug. Suppliers selling bulk batches have until March 19 to cease distribution. The Outsourcing Facilities Association, an industry trade group, has sued the FDA in Texas to delay enforcement of these restrictions.

In response, the FDA has asked the court to deny the request, arguing that upholding its decision would protect patients and align with Congress’ goal of encouraging drug development while permitting compounding only in temporary shortages.

Last month, the FDA also determined that Novo Nordisk’s semaglutide supply had stabilized. Pharmacies must stop selling compounded semaglutide by April 22, while suppliers must halt distribution by May 22.

What should patients who take compounded weight-loss drugs expect?

Pharmacists supplying compounded weight-loss and diabetes drugs are already informing customers about the upcoming changes. Some have stopped refilling prescriptions, while others are hesitant to start new patients on compounded versions, knowing they will soon need to switch to the brand-name medications.

A study found that within a year of stopping semaglutide, a group of 327 patients from the U.S., Europe, and Japan regained two-thirds of the weight they had lost while on the drug. The study also reported a decline in their overall health.

Jennifer Burch, an independent compounding pharmacist in North Carolina, educates her patients about how compounded drugs are only available when the FDA deems the brand-name versions to be in shortage.

She frequently hears from people interested in starting on compounded tirzepatide. But with the shortage ending, she advises against it if they cannot afford the brand-name medication long-term.

She said:

We want to be upfront with them… We don’t want them to feel abandoned.

Some patients are asking doctors for long-term prescriptions to stockpile the medication for up to a year. However, doctors are reluctant, as they need to monitor patients’ weight loss and overall health.

Burch said:

I had a provider tell me yesterday, ‘I’m worried about writing a 12-month prescription. What if the patient comes back weighing 100 pounds? That’s not the goal.

Are efforts being made to lower brand-name weight-loss drug prices?

Most major employers and private insurers cover diabetes medications like Ozempic and Mounjaro. However, fewer than half of large employers cover GLP-1 medications for obesity. As a result, many patients must pay out of pocket for drugs that can cost about $1,300 per month before discounts.

Congress has scrutinized pharmaceutical companies over the high costs of these drugs, prompting some manufacturers to introduce discounted options.

Eli Lilly reduces price for Zepbound

As was reported by major media outlets, including Reuters, Eli Lilly reduced the cash price for lower-dosage vials of Zepbound through its LillyDirect website. A one-month supply of 2.5 mg now costs $349, while the 5 mg version is priced at $499. Higher dosages (7.5 mg and 10 mg) are now $599 and $699 per month, respectively, with an initial discount to $499 for the first fill and refills within 45 days.

Meanwhile, legal battles over the FDA’s decision continue. The Outsourcing Facilities Association recently sued the agency again, challenging the determination that Wegovy and Ozempic are no longer in shortage. The group had previously sued over the ruling on tirzepatide.

In the tirzepatide lawsuit, the OFA argued that the FDA’s decision effectively created a new rule without proper regulatory procedures. The court has not yet issued a ruling, and the FDA has stated it will hold off enforcing the February 18 deadline until the court decides.

For Bonello, the FDA’s declaration means she must now explore other options. Initially, she had hoped to switch to compounded semaglutide, but she realizes that’s only a temporary fix.

Her employer-sponsored insurance covers GLP-1 medications for diabetes but not for weight loss. Since she doesn’t have diabetes — though her blood sugar is elevated, and her family has a history of the disease — she isn’t eligible for coverage.

Even with Eli Lilly’s discounted $499 price for higher dosages, Bonello says she still can’t afford it while covering her other expenses.

“That’s more than my phone bill and car insurance combined,” she said.

Your responses and feedback are welcome!

Source: “These discounted versions of popular weight-loss drugs are going away: What to know,” USA TODAY, 3/2/25
Source: “Lilly offers weight-loss drugs in vials at a discount to fight competition,” Reuters, 2/25/25
Image by Anna Shvets/Pexels

Oprah Through the Years, Part 19

As we learned, during a decade or so of time the weight issue was not a major problem for Oprah. She had found a large amount of inner peace in not hating any part of herself, not even the pockets of cellulite. But old mental habits die hard, and there are contradictions involved in embracing the self, no matter how calorically challenged, while also carrying out public activities (on national television, for instance) that might be regarded by the cynically minded as the very embodiment of fat-hate.

Imagine this scenario: The problem you overcame, and so triumphantly buried with a great deal of ceremony (and publicity), has clawed its way out of the grave, hitched a ride on a garbage truck, and is now demolishing your front door. What could be more disheartening? Oprah Winfrey, after a lot of emotional ups and downs, had reached a pretty good emotional equilibrium and, if there was any justice, ought to have been able to coast.

Instead, after being advised to “learn to embrace hunger,” she gradually gained back 40 pounds. Some of the difficulty was simply due to nature taking its course. As a human body ages, multiple processes are responsible for making it less resilient. It does not mend itself like it used to, and pain occurs in parts you never even knew you had. The entire organism might suddenly begin to demonstrate an uncanny propensity to grow.

O, the publication

At the beginning of 2009, the cover of Oprah’s very own slick magazine showed her current self next to an earlier, much slimmer version, and the words “How did I let this happen again?”… all of which looked like a pretty clear case of fat-hate. The inside pages held her musings on that subject, including a strong suspicion that the ultimate cause was a life out of balance, “with too much work and not enough play, not enough time to calm down… I let the well run dry.”

The conclusion seemed to point in a productive direction:

I don’t have a weight problem — I have a self-care problem that manifests through weight.

In that same year, a segment of the immensely popular “The Oprah Winfrey Show” featured 16 teens participating in “a grueling eight-hour intervention where they confront the reasons why they’re overweight.” Author Natalie Flynn described it as “humanizing” and as a way for booth the participants and the audience to grasp “what living with obesity truly entails.”

A recent Salon.com article looked back over that time with a congratulatory pronouncement:

[W]hat Winfrey has largely consistently managed to get right is her approach to childhood obesity. In her recent special and in old episodes […] Winfrey allows children to speak candidly about their weight, often showing in raw detail how obesity takes a toll on them mentally, socially and physically.

Cynics might have identified it as just another, though perhaps superficially compassionate, demonstration of how obsessed society is with maintaining a standard of fat-hate, while at the same time blaming the victims for “abusing food.” That in itself is a tricky phrase, which could logically encompass chaining up food in a basement and striking it with a belt.

Meanwhile, Bob Greene was also in the public eye, providing for the official website “Oprah’s Weight Loss Confession.” Some of the problems in the media star’s case, not relevant to most teenagers, were the concurrent challenges presented by worldwide success. Oprah had met and overcome so many obstacles, he theorized, that it was difficult for her to grasp the inevitable challenge of aging, which means “the rules change.”

Your responses and feedback are welcome!

Source: “The Highs and Lows of Oprah Winfrey’s 50-Year Weight Loss Journey,” EOnline.com, 03/24/24
Source: “On abandoning ‘fattertainment’: Why the way we talk about childhood obesity matters,” Salon.com, 03/22/24
Source: “Oprah’s Weight Loss Confession,” Oprah.com, 01/05/09
Image by aphrodite-in-nyc/Attribution 2.0 Generic

Oprah Through the Years, Part 18

We have discussed the concept of displacement and its various manifestations. In the most primitive sense, displacement is an escape valve for the mental energy generated by a threatening situation. In the most elemental case, the choices might be limited to “fight” or “flight.”

In the simplest terms, someone with a threatening food addiction might opt to fight, by getting into a program of some kind; or to flee by ignoring the threat and by putting all that mental energy into (for instance) online gaming, a very sedentary occupation that offers a lot of opportunity for snacking.

But we humans are more complicated than that, and sometimes our wires get crossed. A previous post offered the example of the so-called “fitness freak,” who trades in their doughnut habit for an obsession with working out, losing fat, and gaining muscle — to a degree that bystanders might call obsessive. But as long as a displacement activity keeps the person away from their drug of choice, while at the same time doing no harm, and while actually achieving good results, why not just accept it and move on?

The fly in the ointment

For Oprah Winfrey, however, no amount of activity could displace her craving for bread and potatoes and a whole lot of other edibles. For decades, she was a whirlwind of energy, constantly involved with professional obligations and thoroughly invested in charitable efforts.

Going back to the most elementary definition of displacement behavior, she focused on helping people flee or fight; to escape or defeat obesity. One of her 1995 TV episodes on “fattertainment” was optimistically described like this: “By providing solutions, rather than showcasing problems, the show hopes to use the power of broadcasting in a positive manner.”

Three young girls had written to the host about their uncomfortable feelings and experiences around excess weight. Oprah’s crews filmed their families and the girls and their mothers appeared on the show to talk about the “emotional roadblocks” that contribute to obesity among the young.

On the personal level

In 1995, at age 47, Oprah started to work with trainer Bob Greene, because like any sane person, she realized that having an intellectual realization is not the same thing as living the newly revealed truth. Still, it took a few more years and some unnerving heart palpitations to really jolt her into high gear. Eventually, it occurred her that “taking care of my heart, the life force of my body, had never been my priority” — and then proceeded to organize life differently with an eye toward shrinking the influence of the three ominous O’s — “Overeating. Overstressing. Overdoing.”

Furthermore — and this appears to be a vital element of the whole equation — to quote Oprah, “I no longer hated any part of myself, including the cellulite.” Ten years later, the cover of O magazine feature a toned 160-pound Oprah. By this time, she thought the actual battle with excess weight had been won. Looking back later, she said,

I’d conquered it. I was so sure, I was even cocky. I had the nerve to say to friends who were struggling, ‘All you have to do is work out harder and eat less! Get your 10,000 steps in! None of that starchy stuff!’

Not long afterwards, puzzled medical professionals diagnosed her first with hyperthyroidism, then with hypothyroidism, and what with one thing and another, exercise began to seem less of a priority, and she was warned by a doctor that it would be necessary to “learn to embrace hunger,” which she was in no way prepared to do.

Your responses and feedback are welcome!

Source: “On abandoning ‘fattertainment’: Why the way we talk about childhood obesity matters,” Salon.com, 03/22/24
Source: “Making Peace With My Body,” Oprah.com, 08/01/02
Source: “The Highs and Lows of Oprah Winfrey’s 50-Year Weight Loss Journey,” MSN.com, 03/24/24
Image by aphrodite-in-nyc/Attribution 2.0 Generic

Greaux Healthy Releases Childhood Obesity Prevention Toolkit

Childhood obesity is a growing concern across the nation, with Louisiana ranking third in the country for prevalence. Addressing this public health crisis requires a multifaceted approach rooted in evidence-based care and practical resources. Recognizing this urgent need, Greaux Healthy, a public service initiative powered by LSU’s Pennington Biomedical Research Center in collaboration with the State of Louisiana, has launched the Childhood Obesity Prevention, Evaluation, and Treatment Toolkit.

This comprehensive resource is designed to equip healthcare providers with the latest scientific evidence and actionable strategies to prevent, evaluate, and treat childhood obesity and its related comorbidities. Developed in alignment with the 2023 American Academy of Pediatrics (AAP) clinical practice guidelines, the toolkit serves as a quick-reference guide that can be seamlessly integrated into various pediatric healthcare settings across Louisiana.

A practical, evidence-based approach

The Childhood Obesity Prevention, Evaluation, and Treatment Toolkit synthesizes the latest research into a streamlined resource, offering clear and practical guidance for healthcare professionals. Dr. Amanda Staiano, Director of Pennington Biomedical’s Pediatric Obesity and Health Behavior Laboratory and a key contributor to the toolkit, highlights its significance:

The comprehensive nature of this toolkit provides pediatricians with a quick reference for evaluating childhood obesity and its comorbidities and approaches for treating children and adolescents with overweight and obesity, all grounded in scientific evidence.

The toolkit’s user-friendly format allows providers to efficiently integrate scientifically validated protocols into their clinical routines, ensuring early intervention and improved health outcomes for children.

Key features of the toolkit

  • Rapid Evaluation Protocols: Simplified guidelines for assessing obesity and associated health risks.
  • Step-by-Step Treatment Strategies: Evidence-based recommendations for behavioral counseling, pharmacotherapy, and referrals for advanced care when needed.
  • Family-Centered Tools: Resources to support sustainable lifestyle changes for children and their families.

 

Pennington Biomedical Medical Investigator Dr. Stewart T. Gordon, FAAP, underscores the importance of the toolkit in addressing a statewide health challenge:

The Greaux Healthy team looks forward to working with all Louisiana pediatric health care professionals — including pediatricians, family physicians, nurse practitioners, physician assistants, dieticians, behavioral health providers, nurses, and health educators — to improve access to prevention, evaluation, and treatment of childhood obesity.

A call to action

Dr. John Kirwan, Executive Director of Pennington Biomedical, reinforces the urgency of this initiative:

Waiting or delaying treatment is not an option when it comes to childhood obesity. Our goal is to provide health care providers with the tools they need to make informed decisions and offer comprehensive, effective treatment to improve the health and future of our children.

With childhood obesity being a chronic disease affecting thousands of Louisiana children, the launch of this toolkit marks a critical step forward in improving pediatric healthcare. By equipping providers with the necessary resources, Greaux Healthy and Pennington Biomedical are fostering a healthier future for children and families across the state.

Healthcare professionals are encouraged to utilize this free, evidence-based resource to enhance their clinical practice and help combat childhood obesity effectively. You can download it here.

Your responses and feedback are welcome!

Source: “New toolkit empowers health care providers with evidence-based strategies for childhood obesity prevention and treatment,” Medical XPress, 2/20/25
Image by Katrin Bolotsova/Pexels

Oprah Through the Years, Part 17

This post picks up from where an earlier one left off: with Oprah Winfrey in the late 1980s. She was an incredibly popular show-biz figure and media icon, whose global fame spread partly because of her wide variety of interests. Her opinions were respected, her tastes admired, and droves of people relied upon her judgment in such matters as which books to read. Fans responded to her empathy, spontaneity, generosity, and numerous other attractive personal qualities, and related to her like a sister or dear friend.

People, especially women, trusted Oprah and felt understood by her. As both a television host and a sympathetic surrogate friend, she must have felt strong pressure to cover the issue of overweight and everything connected with it, because such a large portion of her audience was dealing with the specter of obesity, and needed help. At the same time, a person in her position would be well-advised to tread carefully, and avoid promoting the anti-obesity culture or appearing as an anti-obesity crusader. Coming from her, any hint of blame or shame could alienate the audience.

An ancient shadow

These conditions resembled an ancient philosophical and theological conflict that so many individuals and institutions over the centuries had to face, and somehow reconcile: how to love the sinner but hate the sin. How to deplore the existence of too much fat, without insulting those who grew too much fat and then suffered for it.

Oprah was not yet the mega-wealthy star she would eventually become, but one thing was clear, and worth repeating :

All the fame and the success doesn’t mean anything if you can’t fit into the clothes. If you can’t fit into your clothes, it means the fat won. It means you didn’t win.

Also, on the personal level, for Oprah to actively campaign against obesity was at the same time to wage war against herself. This was especially evident in the aftermath of the much-regretted 1988 “wagon of fat” TV appearance. To continue wearing those skinny jeans, it would only be necessary to remain on a liquid diet for the rest of her life.

The winds of change

A couple of years later, she told a magazine reporter about the four months of enforced starvation that preceded the wagon stunt and confessed, “I thought I was cured. And that’s just not true. You have to find a way to live in the world with food.” At which point, she did a 180-degree turn and decided to never diet again. By 1992, her weight had reached a peak 237 pounds, too much for a 5’7″ frame to carry. At some point she met trainer Bob Greene and they had a conversation which she recalled years later for her O magazine.

He asked why she was overweight; she replied that she loved food. This was not the exact answer Greene was hoping to elicit, however, and it was quite some time before Oprah was comfortable with admitting that the purpose of eating so much food was to numb her emotions.

As we have mentioned, the investigation into any one person’s obesity needs to include several aspects of family and individual history. Of course their habitual dietary practices are a big factor, but so are their other customary activities, including purposeful exercise. Also to be considered are the psychosocial environment, medications, and their idiosyncratic pattern of weight loss and gain.

Oprah had never consulted a psychiatrist, but subsequent conversations with Greene turned out to be, in her words, “priceless therapy.”

Your responses and feedback are welcome!

Source: “The Highs and Lows of Oprah Winfrey’s 50-Year Weight Loss Journey,” MSN.com, 2024
Source: “Top 10 Oprah Moments,” TIME.com, 05/25/11
Source: “Oprah Winfrey’s Weight Loss Journey,” EOnline.com, 03/24/24
Image by Pat Hartman

New Study Finds Self-Guided Family-Based Treatment Effective for Childhood Obesity

Childhood obesity is a growing concern worldwide, with one in five children in the U.S. affected. In southern Italy, four in 10 children are overweight despite it being the birthplace of the highly praised Mediterranean Diet. And South Korea is now has the highest obesity rate in East Asia among children and adolescents. And that’s just in the news this week. The list grows and grows.

While traditional obesity treatment methods have been effective, they often come with significant barriers, such as time commitment, cost, and access to specialized care. However, a new clinical trial from UC San Diego suggests that a self-guided version of Family-Based Treatment (FBT) could be a game-changer, offering a more accessible, affordable, and equally effective alternative.

What is family-based treatment?

FBT is a well-established approach to treating childhood obesity that involves working closely with families to promote healthier behaviors. Traditionally, healthcare professionals guide families through a structured program focused on encouraging physical activity, teaching healthy eating habits, and developing age-appropriate behavioral skills.

The new study from UC San Diego’s Center for Healthy Eating and Activity Research (CHEAR) found that self-guided FBT provides the same benefits while reducing the time, cost, and scheduling constraints associated with clinician-led programs.

A more flexible, cost-effective approach

Dr. Kerri Boutelle, senior study author and director of CHEAR, highlighted the limitations of traditional FBT:

While effective, it can be time-intensive, expensive, and offered at limited times, making it difficult for many families to participate.

In contrast, self-guided FBT condenses the program significantly. Instead of the traditional 26 hours of treatment over six months, the self-guided model requires only five hours of treatment within the same timeframe. Families complete 20-minute sessions every other week without the need for a trained clinician, making it a viable option for busy households and those facing financial challenges.

The importance of family involvement

Unlike adult obesity, which is often addressed individually, research shows that a family-based approach is most effective for children. Traditional FBT typically involves parents and their children (ages 8-15) in small group sessions, fostering a supportive environment. However, Dr. Boutelle’s research suggests that direct work with parents — rather than relying on group sessions or extensive clinician involvement — is the key to success.

She said:

While some families may benefit from the standard approach, providing more flexible and accessible alternatives like self-guided FBT can help us make a wider impact on childhood obesity.

Dr. Boutelle emphasized that this model allows treatment to be delivered in medical offices, enabling physicians and healthcare providers to support families without requiring extensive training.

Addressing the complexity of childhood obesity

Obesity in children is a multifaceted issue influenced by diet, physical activity, genetics, and environmental factors. Key contributors include:

  • Diet: High consumption of sugary drinks, processed foods, and large portion sizes.
  • Physical Activity: Sedentary lifestyles, excessive screen time, and limited exercise.
  • Genetics: Some children may be genetically predisposed to weight gain.
  • Environment: Accessibility to unhealthy foods, lack of safe spaces for physical activity, and social norms promoting sedentary habits.

 

With obesity linked to serious health concerns such as type 2 diabetes, high blood pressure, and mental health issues, accessible and effective treatments are crucial. The self-guided FBT model offers a promising solution, making evidence-based care more widely available to families who might otherwise struggle to access traditional programs.

Looking ahead

The findings from UC San Diego’s research underscore the need for innovative approaches to tackling childhood obesity. By offering a flexible, cost-effective, and family-centered solution, self-guided FBT has the potential to reach more families and create lasting health improvements for children nationwide.

As Dr. Boutelle puts it:

There’s no reason to require extensive in-person treatment when we can achieve the same results in a way that fits into families’ lives more easily. Our goal is to ensure that more children receive the help they need without unnecessary barriers.

With ongoing efforts to expand awareness and accessibility, self-guided FBT could soon become a standard tool in the fight against childhood obesity.

Your responses and feedback are welcome!

Source: “UC San Diego clinical trial: Family-based treatment best for obese children,” SDNews.com, 2/14/25
Image by Agung Pandit Wiguna/Pexels

Genes, From Must to Maybe — Continued

Up until recently, genes and epigenetic variations have dictated how the inheritance of obesity works. Sure, they “contribute to obesity by influencing the function of metabolic pathways in the body and regulating neural pathways and appetite centers.” Certainly, they “influence insulin resistance, dyslipidemia, inflammation, hypertension, and ectopic fat deposition.”

Of course, genetic mutations “can be inherited in an autosomal dominant or autosomal recessive manner and are influenced by genetic mechanisms of deletion, genetic imprinting, and translocation.” So far all these factors, as described in the book Genetics and Obesity, have been unrelentingly true.

Multiplicity of causation

But, as previously discussed, genes and their complex epigenetic mutations no longer hold the monopoly on defining or deciding fate for all humans, all the time.

First, science learned a lot about how epigenetic modifications happen during the development of the fetus. Of course, such a possibility had been suspected. But we have come a long way from the days when, for instance, the grotesque physique of the so-called Elephant Man was blamed on his pregnant mother having been frightened by the sight and behavior of an elephant.

The advance of science caused such beliefs to be dismissed as mere superstition. Then, science progressed even further to discover that disorders actually can grow from the horrors of war and other emotionally devastating roots.

Things that can happen

Epigenetic development, including changes to the insulin metabolism of a fetus, can be influenced by maternal over-nutrition and also by maternal under-nutrition. For the unborn child such disturbance can be a survival adaptation, but once born and exposed to other nutrition sources, it can lead to inescapable difficulty in survival.

The authors of Genetics and Obesity mention how…

The rising prevalence of obesity and type 2 diabetes in developing countries like India and sub-Saharan Africa confounded epidemiologists for the longest time and is now known to have its origins explained by the theory of fetal programming.

Another source of trouble, quite understandably, is maternal exposure to toxins like those introduced by cigarette smoking, and other endocrine-disrupting chemicals now recognized as obesogens. Maternal stress, caused by such events as natural disasters and their grievous consequences, is strongly suspected. Fetal metabolic derangement can stem from the mother being very young, or seriously underweight, or suffering from diabetes.

Multifactorial, again

The nourishment absorbed by a person as a baby and as a small child are both, of course, very influential in either a positive or negative way. Treatment with antibiotics in the first year of life has been linked to subsequent obesity, as well as non-alcoholic fatty liver disease and other conditions later in life. Even paternal over-nutrition, low protein intake, pre-diabetes, and other conditions can affect a child’s development. Mind you, this is the father! These causes have recently been looked at much more closely than ever before.

Then, there is syndromic obesity, so named because it results from syndromes with such distinctive names as Prader-Willi, WAGR, SIM1, Bardet-Biedl, and Fragile X. Also, there is monogenic obesity, which “generally involves mutations in the leptin signaling pathway leading to suppression of anorexigenic and activation of orexigenic pathways.” Furthermore, around 60% of inherited obesity is now understood to be of polygenic origin, affecting appetite control, energy balance, and many other factors.

Your responses and feedback are welcome!

Source: “Genetics and Obesity,” NIH.gov, 07/31/23
Source: “Joseph Merrick — The Elephant Man,” LondonMuseum.org, undated
Image by Cory Doctorow/Attribution-ShareAlike 2.0 Generic

Genes, From Must to Maybe

DNA is the instruction book that directs the activities of cells. Epigenetics is the field of knowledge about the heritable changes in the workings of genes, and more importantly, about how their actions can be modified without disturbing the DNA sequence itself.

The epigenome consists of all the genes in the body, plus everything else that influences them for better or worse; and it is malleable. Here is a quotation from the National Human Genome Research Institute:

The epigenome consists of chemical compounds that modify, or mark, the genome in a way that tells it what to do, where to do it, and when to do it. Different cells have different epigenetic marks. These epigenetic marks, which are not part of the DNA itself, can be passed on from cell to cell as cells divide, and from one generation to the next.

Shockingly, over recent decades, it has begun to look as though a person’s genetic makeup does not actually imply inexorable Fate, but resembles something more like a set of very strong suggestions. Even without crazy science-fictional editing tools like CRISPR (clustered interspaced short palindromic repeats), unsatisfactory genes can be outsmarted and over-ruled by the human organism itself.

Moreover, the person who inhabits the body is clueless about the remodeling project. It seems nothing short of miraculous, that thousands of genetic diseases are now seen as potentially fixable by a one-time CRISPR treatment. But all along, Nature has been busy re-arranging the genetic furniture. This quotation is from the Cleveland Clinic:

[The epigenome] changes over time. That can be both good and bad. It’s good in the sense that things like nutritious food, exercise and manageable stress can result in epigenetic changes that can promote health. But other factors like processed foods, smoking and lots of stress can cause epigenetic changes that can harm health.

Various epigenetic changes affect the metabolism, the aging process, brain disorders, inflammatory and autoimmune diseases, the tolerance for neoplasms, and even susceptibility to substance use disorders. It comes as no surprise that these alterations also make a difference around the heritability of obesity. Here are words from the book Genetics and Obesity, by Ekta Tirthani, Mina S. Said, and Anis Rehman:

About 50% of the time, obesity in childhood is carried into adulthood in a phenomenon known as “tracking.” Around 250 genes are now associated with obesity. The FTO gene on chromosome 16 is the most important and carries the highest risk of the obesity phenotype.

So, this is a serious matter, and what are we doing about it? Genetically predisposed obesity can now be treated with “early lifestyle interventions, bariatric surgery, and medications.” Better yet, the discipline of endocrinology “can help treat and control diabetes and other cardiometabolic parameters that cause epigenome changes passed on from generation to generation.”

Out in the world, however, researchers do need to deal with some complications:

In genome-wide association studies done so far, most subjects have European ancestry. However, 47% or the vast majority of patients grappling with the burden of obesity in the United States are of African-American and Hispanic/Latino descent.

Obviously, other countries might also face such problems when attempting to study variegated populations. But the future of the field shows incredible promise in the areas of obesity and metabolic disorders. For instance,

The use of histone deacetylators is now being suggested […] for its use in lifestyle medicine, and research in this field is ongoing. Methylation Quantitative Trait Locus (meQTL) studies are now being used to further epigenetic studies. New Nutri-pharmacogenomic studies are expanding our understanding of how nutrition affects genetics.

The heritability of obesity is easier than many other characteristics to observe and verify with the naked eye. It also is relevant to a very large chunk of the population, and thus likely to attract research grants and generate useful publicity. It should not be a chore to convince the public and the relevant institutions and funding sources of the vital importance of this kind of research, and of the financial support necessary to make it all happen.

Your responses and feedback are welcome!

Source: “National Human Genome Research Institute,” Genome.gov, undated
Source: “Epigenetics,” ClevelandClinic.org,” undated
Source: “Genetics and Obesity,” NIH.gov, 07/31/23
Image by National Human Genome Research/Public Domain

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Profiles: Kids Struggling with Weight

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The Book

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

About Dr. Robert A. Pretlow

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

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