All this talk about how women’s body image being distorted by *The Patriarchy* is a bunch of bunk. Women do it to themselves. Men really aren’t all that picky.

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As a physician first and plastic surgeon second I know enough about metabolism, nutrition, exercise, and the fact that no operation, procedure, therapy, or drug has all benefits and no downside to know that this too- the Ozempic fad- will pass. Obesity is complex, but not in the way suggested by ideological zealots who include climate change and the patriarchy in its causes. The UK has it basically correct. Not everyone is destined genetically to be thin as determined by some arbitrary scale, such as the BMI chart. An NFL linebacker weighing 280 lb with less than 5% body fat will be obese on that chart. Obesity is much like porn, sometimes not easy to pin down, but you know it when you see it. You don't need a scale. I counsel overweight and obese patients every day and I always tell them the same thing. The equation for weight gain, overweight, and obesity remains the same as it always has: calories in must equal calories out or you will gain weight. We are not plants and cannot manufacture calories from sunlight. No one, shy of very uncommon hormonal disorders, will gain weight if they consume fewer calories than they expend. The challenge is to find the sweet spot where a person is comfortable, feels good, and has a good quality of life. Nothing has replaced a healthy, limited calorie, largely plant-based diet combined with a program of regular physical exercise in maintaining weight and, more importantly good health and well being. That equation is too simple, or too hard, for too many people. As to the obese body positivity ideologues who relentlessly push the message that they are happy in their bodies, I am not buying it. I believe they are trying very hard to convince themselves that what they see in the mirror, and feel, is not real. Is there such a thing as self-gaslighting? As with so many "revolutionary" things in medicine, we will find that there is a real downside to Ozempic and one day we will ask, "Whatever happened to that Ozempic thing?" Mark my words. R. Bosshardt, MD, FACS

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Recent reporting from The New York Times describes childhood obesity as “complicated,” and the Centers for Disease Control (CDC) defines obesity as a “complex disease” that can be impacted by “social determinants of health,” like racism and climate change.

With caveats that genetics must play a part and it is definitely more difficult for some than others, how can it in any way be professional (and based on what evidence) to remove (or seriously downplay) personal responsibility (including parental responsibility to children) from the equation in how to maintain a healthy weight with good diet and exercise?

I long ago gave up the belief that any government agency (or the NYT) is concerned with truth and reason. But I flit between pity and disdain for those who listen to and believe these charlatans.

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I have been overweight my entire life, but it didn't stop me from living my life. I have an advanced degree, a successful career and a great husband and grown kids. I have enormous willpower, but I've never been able to lose the weight - despite the fact that I eat healthy and don't overeat. And now I have Type 2 diabetes. I started Mounjaro (similar to Ozempic) in August and my A1C has dropped from 10 to 5.6, my cholesterol has improved and my liver enzymes went from off the charts to normal. And I have lost 50 lbs so far! For the first time in my life I feel normal! For the first time in my life I don't obsessively think about food and dieting. For me the pros definitely outweigh the cons, but to use this or Ozempic to lose 20 lbs is definitely not a risk I would take.

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In neither the debate or the article did I find much discussion about my typical Ozempic patient, who is a fifty something woman with all the metabolic syndrome findings and uncontrolled diabetes. The patients I prescribe GLP-1 agonists for are not people who are doing it to look better, they're fighting serious chronic diseases. And these drugs are often much better than other diabetes medications (insulin actually causes weight gain). Obviously, diet and exercise come first, but once you get past a certain point, you need medication.

I have to say I didn't quite grasp why it was that I keep hearing about prescriptions that I write not being filled and I have attending doctors trying to dissuade me from prescribing these drugs not because they're clinically harmful, but because they're hard to get. There's something gross about the idea of Malibu narcissists monopolizing all the supply and leaving Kentucky farmers stuck with (overpriced) insulin.

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Ugh... really???

”the Centers for Disease Control (CDC) defines obesity as a “complex disease” that can be impacted by “social determinants of health,” like racism and climate change.”

And...”we’ve been inundated with messages of “body positivity” for years, even as (or possibly because) more than two-thirds of Americans are overweight or obese.”

The UK got it right:

The UK’s National Health Service is more clear-cut: “Obesity is generally caused by eating too much and moving too little.”


Our runaway healthcare costs are driven by obesity. Obesity-related diseases include heart disease, stroke, type 2 diabetes and certain types of cancer.

Part of the solution is to tax sugary foods. A tax on “added” (not natural) sugar, say 1¢ per gram so that a 12oz can of soda with 38g would cost an additional 38¢, would steer people away from unhealthy foods. The money collected could pay for a public awareness campaign and subsidize fruits and vegetables in low income areas.

Could it work? Yes! Along with a public awareness campaign, the cigarette tax reduced the percentage of adult smokers from 65% to 14% over the past 50 years.

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I think Semiglutide can be a wonderful drug for those with type 2 diabetes. However, it's super annoying that the answer America's unhealthy food supply created by Big Food, is a drug created by Big Pharma.

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Back in the day, when I was a model with a then-fairly-Big-Name agency, we used to have a Dr. FeelGood who maintained us all on Dexadrine.

I had a face like an angel's, but Nature designed me to be the big-boned Neapolitan mother of 12! I am 5'10, and my normal resting weight is 165-170. Thanks to all that Dexadrine, I got down to 125—which, by the way, was still _fat_ by the modeling agency's standards: Thus, today, I am just a simple country healthcare economist instead of a contestant on D-List-Celebrity Big Brother, hustling used syringes from Khloe Kardashian's scullery maid on the chance they might still contain the wee-est dollop of Ozempic.

All that long-winded paragraph by way of saying: Same As It Always Was. 😀

On principle, I think anyone should be able to do anything they want to their own bodies—drugs, tattoos, piercings, other body mods (under which category I assign most surgical gender tweaks.). So long as it doesn't actively harm me or impel my participation (which I don't want to give!) in any way, have at it.

But, of course, I have thoughts.

Thought 1: _Weight_ is one of the few really reliable class indicators society has left.

Thought 2: Standards of beauty historically have been quite fluid. But this fetishistic adoration of extreme slenderness has been with us now for at least 100 years, since the flappers of the 1920s. I wonder why that is?

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The corruption of medicine is breathtaking. They tell people that short term improvements in weight loss and insulin levels are worth risking cancer later. They tell us that we have to save granny by injecting children with experimental jabs that have a negative cost-benefit analysis for them and thus that sacrificing the young to the ghoulish pretensions of the old to live forever is our moral duty. They tell confused, suffering, mentally ill people that they can actually turn them into the opposite sex and then mutilate their bodies beyond recognition and shame and cancel them as “bigots” when they complain. I don’t know where the ethics went but this isn’t the medical profession I joined 15 years ago. It’s a horror show and it has to stop.

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You have to love the NHS: The UK’s National Health Service is more clear-cut: “Obesity is generally caused by eating too much and moving too little.”

We live in an over drugged society. Depressed: take a pill. Think you are a different sex: take a pill. To heavy: take a shot.

Actually work to improve yourself…. THAT’S SEXIST/RACIST/TRANSPHOBIC or some other issue related with being "alt-right".

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Another quick fix. In a few years we will be lamenting the consequences while big pharma and the shysters' count their money.

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The first few paragraphs resemble something from the 1960s Twilight Zone. Ms. Barone's life plan is slim down with one drug and take a break in order to freeze her eggs-the implication being that a surrogate will carry the baby. We're afraid of China? I think we're doing a pretty good job of destroying ourselves.

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This is so dangerous. My client’s 37 year old cousin was taking this for weight loss and just died. Her pancreas was severely damaged and her kidneys failed. Taking anything comes with risks and clearly those risks aren’t being shared with these people! There is no magic pill.

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UK is right CDC, once again, wrong.

Not sure I see the climate change angle, it’s hot forcing people to eat ice cream?

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This is, once again, a parenting failure. When I was growing up we always ate home cooked meals (by a mother who was not a great cook) took our sack lunch to school and was constantly hungry because our meals were smaller. Because we were active, we were distracted and didn’t lay around and eat. I am now the mother or 3 kids and I prepare food. It doesn’t have to be perfect to be a ton healthier then takeout. Keeping children skinny saves them a lifetime of struggle. Of course, the parents need to walk the talk. Cut the carbs- pasta and bread and soda should be limited. Don’t have junk food in the house. Portion size matters. Yes you will have complaining but in the long run your kids will thank you.

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Hi Bari,

I listened to the podcast and have been reflecting about it quite a bit. I worked infitness for more than 15 years, as a personal trainer, massage therapist, diet consultant and health coach. I found that most people had success with their weight loss goals when they stuck to ANY program. People of all weights, sizes, ages, etc. that part never mattered. The ones that had success and kept it off were just diligent and kept at it for life. When people say they try everything and it doesn’t work, what gets left out of that is that people lie. I know because they admitted it to me. No client ever didn’t lose weight if they followed a program. Like I stated, any program. It just takes consistency, that’s it.

So, to imply that exercise and eating right don’t work and we should just give up on them and try this drug is a terrible idea. It also fails to see that the drug actually proves that diet and exercise work. If the drug prevents a person from eating as much and they lose weight, that is precisely the way anyone else does it as well, limiting caloric intake. I had clients that did no exercise but had restricted caloric intake and lost weight over time. I guess it’s so frustrating to have listened to that whole conversation and not one person pointed out this fact. That if the drug works because people restrict food intake, then restricting food intake works with or without the drug. Make sense? It seemed obvious to me on its face but no one pointed it out.

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