There’s a “mad endo” on TikTok who posts “dramatic readings” of insurance rejections and prior authorizations, among other things, and I suggested she check out this newsletter after finding out she’s totally fine prescribing these drugs for weight loss… she says she checked it out and didn’t like the science. As if science is something to be liked or disliked! Then she doubled down and posted about someone’s weight loss “success” using several of these meds over a measly 3 year period (there’s been weight cycling in this time too), and it just breaks my heart. I can’t help but wonder if the sale rep’s gifts and butt-kissing are really that good or if people genuinely think they’re doing god’s work by trying to eliminate people who look like us. Maybe it’s both. Money and god complexes are powerful things.
You've hit on the main thing that terrifies me about these drugs - they exist at the confluence of greed and people who truly think they're doing good. Each of these can and do cause enormous harm on their own, but together they're so much worse.
At this point, I think if a provider is comfortable providing these drugs for weight loss, what other red flags are they choosing to ignore in their practice? It scares the crap out of me.
Considering doctors are basically trained in school that having higher body fat is almost always going to end up deadly somehow and that weight loss should be achieved no matter what, I reckon these folks genuinely do believe they’re doing good for mankind. Granted maybe they don’t care enough to read studies about these medications and how they can become useless after a few years.
Appreciate this so much! I do have one question. Please know that this is coming from a place of wanting to have a rebuttal for every argument, not a “gotcha.” Supporters of using this for weight loss have been saying that the drug has been used for decades for weight loss in Europe and has been thoroughly studied there. Do those studies have the same flaws in terms of time frame, etc?
I'm not sure those supporters are coming with accurate information - do you happen to know where in Europe they are claiming or what studies they are talking about? The EU only approved semaglutide for weight loss in 2021. The NHS approved it in 2023. They've already launched investigations into dangerous side effects. Also, Novo has also already been caught in shady practices there that I wrote about here:
Thank you so much for this article. I am new to all of this re-education; I started listening to Maintenance Phase a year ago and have been listening and reading to many podcasts, books and newsletters since then.
I do have a question about one line in your article, that “I also want to be clear that while the concept is often co-opted, it is impossible to be part of Health at Every Size community and to engage in intentional weight loss.”
I have been with an ED for over 30 years and continue to work to unpack my own stuff in therapy, through journaling, etc. My ED has taken many forms over the years, including intentional weight loss. I’m curious where the above comment leaves me as a physician who is trying to re-educate myself in order to take better care of my patients. Does this statement imply that I can’t offer my patients excellent care until I fully deal with all of my own stuff? This leaves me feeling a bit helpless, given that I’ve been working on myself for decades and I’m not healed yet.
As a survivor of multiple violent losses, I am certainly still working on my stuff around these losses but do not feel that my unfinished work around these losses precludes me from being a good trauma surgeon and surgical critical care doctor. Does it make harder sometimes? Yes. Do I have to be really mindful about not dragging my stuff into the hospital with me? Yes! Do I fail sometimes? Definitely. Yet the idea of not practicing medicine until I solve all these issues would mean I would never practice again because I think this work will last a lifetime. For example, I’d be lying if I said that I don’t think of my father- who was shot to death- when a patient with a gun shot wound arrives in the trauma bay, especially when the patient’s injury pattern is similar to my dad’s. But the thought is fleeting and I’ve learned how to acknowledge it and keep moving to save the patient’s life.
Same goes for my ED (no doubt linked, in part, to my losses). This work will probably go on for my whole life. I’m super curious to hear your thoughts because I want to do better by all of my patients (and do feel that I’ve been able to make some changes since learning so much in the past year).
Thank you for your insight! This is a concept I’ve thought about a lot, but that specific comment offered me the opportunity to articulate this question. I really appreciate your time.
I would think of it like an additional credential you are pursuing. This one takes time. Not having it doesn’t make you a bad surgeon, but having it will make you a better one.
I’m not Ragen but I have medical PTSD (and actually worked in healthcare before going to college many many years ago) and I’d like to respond from my own personal POV.
First, I’m really sorry for your losses. I’m sure that makes it harder for you to practice medicine, but I think it also probably gives you a unique empathetic POV that patients and their families find supportive during their own tragedies.
As for your ED, if you’re actively working to overcome this, then hopefully that involves acknowledging your own shortcomings biases when working with patients. For example, if a fat patient comes into your ER with chest pain, I hope you give them the same differential with shame-free, blame-free care that you’d give a thin person with the same symptoms. I hope you recognize your implicit bias, as well, and work to compensate for the seeds of bias your ED (and society at large) planted over the years.
Patients know their doctors are only human. We aren’t expecting perfection. But we deserve care from providers who recognize their own limitations and are working hard to level the playing field to improve patient care. We also need doctors who are actively trying to prevent oppression, while recognizing they hold a LOT of power over someone who may well be having the worst day of their life when they meet you.
After a lifetime of terrible healthcare, and permanent damage due to delayed diagnoses of autoimmune disease and spinal cord injury, I struggle to trust any provider. But I really respect anyone who recognizes their power and is actively trying to do better. I thank you, and I wish you lots of luck and success.
Thank you for your thoughtful reply. It maddens me and saddens me that our entire system malfunctions on so many levels. I have many patients with medical PTSD and recognize that this adds a whole other layer of complexity when attempting to get care.
I continue to become (and remain) aware of my biases- not always comfortable but certainly necessary to be a better person and provider.
There’s a “mad endo” on TikTok who posts “dramatic readings” of insurance rejections and prior authorizations, among other things, and I suggested she check out this newsletter after finding out she’s totally fine prescribing these drugs for weight loss… she says she checked it out and didn’t like the science. As if science is something to be liked or disliked! Then she doubled down and posted about someone’s weight loss “success” using several of these meds over a measly 3 year period (there’s been weight cycling in this time too), and it just breaks my heart. I can’t help but wonder if the sale rep’s gifts and butt-kissing are really that good or if people genuinely think they’re doing god’s work by trying to eliminate people who look like us. Maybe it’s both. Money and god complexes are powerful things.
You've hit on the main thing that terrifies me about these drugs - they exist at the confluence of greed and people who truly think they're doing good. Each of these can and do cause enormous harm on their own, but together they're so much worse.
YES! It really is terrifying to me too.
At this point, I think if a provider is comfortable providing these drugs for weight loss, what other red flags are they choosing to ignore in their practice? It scares the crap out of me.
Considering doctors are basically trained in school that having higher body fat is almost always going to end up deadly somehow and that weight loss should be achieved no matter what, I reckon these folks genuinely do believe they’re doing good for mankind. Granted maybe they don’t care enough to read studies about these medications and how they can become useless after a few years.
Appreciate this so much! I do have one question. Please know that this is coming from a place of wanting to have a rebuttal for every argument, not a “gotcha.” Supporters of using this for weight loss have been saying that the drug has been used for decades for weight loss in Europe and has been thoroughly studied there. Do those studies have the same flaws in terms of time frame, etc?
I'm not sure those supporters are coming with accurate information - do you happen to know where in Europe they are claiming or what studies they are talking about? The EU only approved semaglutide for weight loss in 2021. The NHS approved it in 2023. They've already launched investigations into dangerous side effects. Also, Novo has also already been caught in shady practices there that I wrote about here:
https://weightandhealthcare.substack.com/p/need-audio-and-graphic-novo-nordisk
https://weightandhealthcare.substack.com/p/novo-nordisk-gets-caught-in-shady
I'm happy to look into any studies about this, I'm just not sure what they are referring to?
I want to say it was Norway? But I’m bad at geography. Let me see if I can find it again. But even this is helpful to know!!! Thank you!
Thank you so much for this article. I am new to all of this re-education; I started listening to Maintenance Phase a year ago and have been listening and reading to many podcasts, books and newsletters since then.
I do have a question about one line in your article, that “I also want to be clear that while the concept is often co-opted, it is impossible to be part of Health at Every Size community and to engage in intentional weight loss.”
I have been with an ED for over 30 years and continue to work to unpack my own stuff in therapy, through journaling, etc. My ED has taken many forms over the years, including intentional weight loss. I’m curious where the above comment leaves me as a physician who is trying to re-educate myself in order to take better care of my patients. Does this statement imply that I can’t offer my patients excellent care until I fully deal with all of my own stuff? This leaves me feeling a bit helpless, given that I’ve been working on myself for decades and I’m not healed yet.
As a survivor of multiple violent losses, I am certainly still working on my stuff around these losses but do not feel that my unfinished work around these losses precludes me from being a good trauma surgeon and surgical critical care doctor. Does it make harder sometimes? Yes. Do I have to be really mindful about not dragging my stuff into the hospital with me? Yes! Do I fail sometimes? Definitely. Yet the idea of not practicing medicine until I solve all these issues would mean I would never practice again because I think this work will last a lifetime. For example, I’d be lying if I said that I don’t think of my father- who was shot to death- when a patient with a gun shot wound arrives in the trauma bay, especially when the patient’s injury pattern is similar to my dad’s. But the thought is fleeting and I’ve learned how to acknowledge it and keep moving to save the patient’s life.
Same goes for my ED (no doubt linked, in part, to my losses). This work will probably go on for my whole life. I’m super curious to hear your thoughts because I want to do better by all of my patients (and do feel that I’ve been able to make some changes since learning so much in the past year).
Thank you for your insight! This is a concept I’ve thought about a lot, but that specific comment offered me the opportunity to articulate this question. I really appreciate your time.
I would think of it like an additional credential you are pursuing. This one takes time. Not having it doesn’t make you a bad surgeon, but having it will make you a better one.
Thanks and this resonates! I’ll keep up the work and continue looking for learning opportunities.
I’m not Ragen but I have medical PTSD (and actually worked in healthcare before going to college many many years ago) and I’d like to respond from my own personal POV.
First, I’m really sorry for your losses. I’m sure that makes it harder for you to practice medicine, but I think it also probably gives you a unique empathetic POV that patients and their families find supportive during their own tragedies.
As for your ED, if you’re actively working to overcome this, then hopefully that involves acknowledging your own shortcomings biases when working with patients. For example, if a fat patient comes into your ER with chest pain, I hope you give them the same differential with shame-free, blame-free care that you’d give a thin person with the same symptoms. I hope you recognize your implicit bias, as well, and work to compensate for the seeds of bias your ED (and society at large) planted over the years.
Patients know their doctors are only human. We aren’t expecting perfection. But we deserve care from providers who recognize their own limitations and are working hard to level the playing field to improve patient care. We also need doctors who are actively trying to prevent oppression, while recognizing they hold a LOT of power over someone who may well be having the worst day of their life when they meet you.
After a lifetime of terrible healthcare, and permanent damage due to delayed diagnoses of autoimmune disease and spinal cord injury, I struggle to trust any provider. But I really respect anyone who recognizes their power and is actively trying to do better. I thank you, and I wish you lots of luck and success.
Thank you for your thoughtful reply. It maddens me and saddens me that our entire system malfunctions on so many levels. I have many patients with medical PTSD and recognize that this adds a whole other layer of complexity when attempting to get care.
I continue to become (and remain) aware of my biases- not always comfortable but certainly necessary to be a better person and provider.