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PODCAST

Weight and Healthcare

with Ragen Chastain

Examining the intersections of weight science, weight stigma, and healthcare and what evidence, ethics, and lived experience teach us about healthcare and public health best practices for higher-weight people. weightandhealthcare.substack.com

health & fitness medicine

All Episodes

9:46

Weight Loss Is Not a Substitute for Healthcare: Part...

Weight and Healthcare ·

2025/07/23

In part 1 we discussed the basics of substituting weight loss for healthcare and accommodation. In part 2 we discussed issues with the likelihood of achieving weight loss, even if it was appropriate to insist that higher-weight patients become thinner before accessing care (and I do not think it is). In part 3, we discussed the issues of weight loss being promoted as a solution to accessibility. In part 4, we looked at a case study.Today, we’re going to talk about what can be done to stop the

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5:04

Weight Loss Is Not a Substitute for Healthcare: Part...

Weight and Healthcare ·

2025/07/19

In part 1 we discussed the basics of substituting weight loss for healthcare and accommodation. In part 2 we discussed issues with the likelihood of achieving weight loss, even if it was appropriate to insist that higher-weight patients become thinner before accessing care (and I don’t believe it is.). In part 3, we discussed the issues with weight loss being promoted as a solution to accessibility. Today we’ll look at a real experience with this. Many facilities, including physical and mental

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3:56

Weight Loss Is Not a Substitute for Healthcare: Part...

Weight and Healthcare ·

2025/07/16

In part 1 we discussed the basics of substituting weight loss for healthcare and accommodation. In part 2 we discussed issues with the likelihood of achieving weight loss, even if it was appropriate to insist that higher-weight patients become thinner before accessing care.Today we’re going to discuss the issues with delaying care for weight loss. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

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8:15

Weight Loss Is Not a Substitute for Healthcare: Part...

Weight and Healthcare ·

2025/07/12

In part 1 of this series we looked at the basic issues of a healthcare system that is allowed to demand weight loss before patients are able to access healthcare. In this section, we’ll look at BMI-based denials of care. These occur when a patient is denied care unless or until they reach a certain BMI. It is often justified by the idea that higher-weight patients have more complications/worse outcomes and that weight loss will improve this. But it’s far from being that simple. Get full access to

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6:49

Weight Loss Is Not a Substitute for Healthcare: Part...

Weight and Healthcare ·

2025/07/09

Substituting weight loss for health and/or healthcare accommodation is a primary source of harm enacted on higher-weight people by the healthcare industry. I’ve had a bunch of requests asking me to write about it from a macro perspective .This is complicated and there is a lot to discuss so I’m breaking it up into five parts. (I’m thrilled that you are reading this whether you stumbled onto it or are a free or paid subscriber and today I want to offer some extra gratitude to my paid subscribers - a

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16:29

Weight Loss Drug Cage Match - Part 2 Study Insights

Weight and Healthcare ·

2025/07/05

In Part 1 we looked at the basics of a study that compared the two newest GLP-1 weight loss drugs against each other - Novo Nordisk’s Semaglutide (Wegovy) and Eli Lilly’s Tirzepatide (Zepbound) The trial was funded by Eli Lilly and while many of the authors took money from the makers of both drugs, the only authors (some of whom were statisticians) who were employed by and owned stock in a drug company were from Eli Lilly. While that isn’t proof of bias, it’s certainly a red flag.Today we’ll look at

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7:31

Weight Loss Drug Cage Match Study - Part 1 The Basics

Weight and Healthcare ·

2025/07/02

On May 11, 2025, the study “Tirzepatide as Compared with Semaglutide for the Treatment of Ob*sity” was published in the New England Journal of Medicine.This study was, essentially, a cage match between the two newest weight loss drugs to see which one created more weight loss. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

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7:14

3 Things to Stop Calling Higher-Weight Patients Right...

Weight and Healthcare ·

2025/06/28

The way that higher-weight patients are discussed (in research, in medical/healthcare education and training, and even in interventions meant to increase accessibility in healthcare) can vastly increase weight stigma among healthcare providers. Today I want to talk about three terms that are often used that create this issue. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

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10:54

Study questions the claimed health benefits of weight...

Weight and Healthcare ·

2025/06/14

I recently wrote about a study that questioned the assumption that higher-weight causes health issues. Today I’m writing about a study that questions the assumption that weight loss improves health issues in higher-weight people. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

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6:03

Letter Pushes Back Against Weight Stigma in Research

Weight and Healthcare ·

2025/06/11

Weight stigma does untold harm and, especially in healthcare, it can be deadly. One of the most important things that each of us can do to reduce weight stigma and the harm it causes is to act (when we can) when we find ourselves in situations where weight stigma is happening.Today I have an example of quick push-back and a more in-depth example. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

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4:55

Research questions the relationship between weight...

Weight and Healthcare ·

2025/06/07

In the past we’ve talked about how the health issues that get blamed on being higher-weight may actually be due to weight stigma and/or weight cycling and/or healthcare inequalities. Recently reader Conner let me know what this 2021 study whose bottom line finding was “adverse consequences currently attributed to ob*sity could be attributed to hyperinsulinemia (or another proximate factor.” Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

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7:03

Reader Question - Was there really a contest to win...

Weight and Healthcare ·

2025/06/04

I got the following question from reader Jill who attended a recent talk that I gave at her medical center:”During the question and answer part you mentioned a contest to win weight loss surgery. Did that really happen? I hope you’ll write about it on your newsletter.”Yeah, it did and yes, I will Jill, thanks for asking. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

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5:21

Why Not Give The Weight Loss Industry the Benefit of...

Weight and Healthcare ·

2025/05/28

In part 1 we talked about the general issues with giving the weight loss industry the benefit of the doubt. In part 2 we talked about the specifics of this for the GLP-1 weight loss meds. That brings us back to our original question from family doctor Elena:I’m a weight-neutral family doctor. I was talking to a colleague about my issues with the GLP-1s and how there is no evidence that supports that taking them for life will lead to sustained weight loss or health benefits. He said “There’s no

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5:55

Why Not Give The Weight Loss Industry the Benefit of...

Weight and Healthcare ·

2025/05/24

In part 1 we discussed the general issues with giving the weight loss industry the benefit of the doubt. Today we are going to talk about this as it applies to GLP-1s. This started with an email I got from Elena:”I’m a weight-neutral family doctor. I was talking to a colleague about my issues with the GLP-1s and how there is no evidence that supports that taking them for life will lead to sustained weight loss or health benefits. He said “There’s no evidence that they won’t.” It strikes me as wrong,

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5:56

Why Not Give The Weight Loss Industry the Benefit of...

Weight and Healthcare ·

2025/05/21

I got this email from reader Elena:I’m a weight-neutral family doctor. I was talking to a colleague about my issues with the GLP-1s and how there is no evidence that supports that taking them for life will lead to sustained weight loss or health benefits. He said “There’s no evidence that they won’t.” It strikes me as wrong, but how do I argue with thatThis same question came up in our monthly subscriber Ask Me Anything as well. I’ll address it specifically but first I want to talk about how this is

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5:57

The Serious Toll of Healthcare Provider Weight...

Weight and Healthcare ·

2025/05/17

We are going to start out today with the story of Dr Thomas Kraut and then talk about what it that story demonstrates and what we can do about it. Content note that this story is tragic. This was originally brought to my attention by reader Suzanne. I read every account I could about the situation and pieced them together. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

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6:32

Analyzing Claims of GLP-1 Health Benefits

Weight and Healthcare ·

2025/05/10

I got a question from reader Giana who asked:I feel like I’ve seen a hundred news reports claiming that the GLP1 drugs will cure anything and everything…joint pain, heart attacks, addiction, on and on and on. Is it possible that they can do all of these amazing things or is this just the new snake oil?I’ve also seen a bunch of claims about the healing powers of GLP-1 drugs. It is possible that GLP-1s have health benefits, but there are some potential issues with these studies that I want to point

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7:46

Weight and Osteoarthritis Study - Part 3 Letter to...

Weight and Healthcare ·

2025/05/07

In parts 1 and 2 we looked into a 2018 journal article called Management of osteoarthritis of the knee in younger patients by Khan, Adili, Winemaker, and Bhandari. It turns out we aren’t the only ones looking into it. As I was finishing up this piece, I was googling to make sure I had a list of all the links I used in the piece (while I don’t include links to pieces with weight stigma here, I always keep a list in my draft,) I stumbled onto a letter responding to the Khan et al. article called “Is

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8:06

Weight and Osteoarthritis Study - Part 2 Citations

Weight and Healthcare ·

2025/05/03

In part 1 we began discussing the article Management of osteoarthritis of the knee in younger patients by Khan, Adili, Winemaker, and Bhandari and their claim that weight loss is an appropriate treatment for osteoarthritis. We examined one of their citations and today we’ll look at the other. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

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6:02

Weight and Osteoarthritis Study - Part 1 Study Claims

Weight and Healthcare ·

2025/04/30

Recently I received an email from a physician who had just attended a talk I gave. She asked what I thought about a study that “shows that weight loss is an evidence-based treatment for OA” (osteoarthritis). I started investigating the issues with the study and, in the course of researching and writing about it, I came across an absolute gem by Ilona Hale. In parts 1 and 2 we’ll look at my analysis and in part 3 we’ll look at Dr. Hale’s. Get full access to Weight and Healthcare at

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