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Tag: Weight Loss

  • Can Onions Help with Weight Loss, Cholesterol, and PCOS? | NutritionFacts.org

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    Let’s talk about treating weight loss, cholesterol, and PCOS with diet. What can an eighth of a teaspoon a day of onion powder do for body fat, and what can raw red onion do for cholesterol?

    In one of my previous videos about onions, I talked about the data supporting—or not supporting—the role of onions in boosting testosterone in men, protecting bone health, controlling allergies, and dealing with the side effects of chemotherapy. What about weight loss? Enter the “Effect of Steamed Onion (ONIRO) Consumption on Body Fat and Metabolic Profiles in Overweight Subjects.” Researchers used steamed onions, which aren’t as spicy and have a weaker smell, so they could better disguise them as a placebo. They dried them into onion powder and gave people a minuscule amount—about an eighth of a teaspoon (300 mg) a day. Surely, a little daily dusting of onion powder wouldn’t affect people’s weight. But check out the results reported in the abstract: Measurements using a DEXA scan showed a significant reduction in body fat mass, and a CT scan revealed a significant decrease in whole, visceral, and subcutaneous fat areas.

    Hold on. If a little onion powder is so effective for weight loss, why wasn’t it featured in my book How Not to Diet? Because, as so often happens in studies, the spin in the abstract doesn’t accurately represent the actual data. The DEXA scan results measured no significant change of fat in the group that got the placebo capsules. They only appeared to lose about a spoonful (7 g) of fat, whereas the group unknowingly taking an eighth of a teaspoon of onion powder stuffed into capsules lost nearly one and a half pounds (0.64 kg) of body fat—a significant drop from baseline, but not a statistically significant drop compared to the placebo group, meaning the loss could have just been due to chance. Same thing with the CT scan results: 5 times more loss of overall fat and over 30 times more loss of the dangerous visceral fat, but the results did not reach statistical significance compared to placebo.

    A more recent study tried four teaspoons (9 g) of onion powder a day and similarly failed to accelerate the loss of visceral, total, or subcutaneous fat compared to placebo—but the placebo was also four teaspoons (9 g) of onion powder a day. They used yellow onions versus white onions, and it seems they both may have caused a loss of abdominal body fat, without a significant difference between them. Either way, you might look at these two studies and think, sure, but what are the downsides? It’s only an eighth of a teaspoon of onion powder a day, so why not give it a try? It can’t hurt, but we just don’t have enough evidence to be confident it will actually help.

    Let’s talk about polycystic ovary syndrome, also known as PCOS. It’s one of the most common hormone disorders, affecting 5% to 10% of reproductive-aged women. In addition to causing symptoms like irregular periods, “PCOS is a pre-diabetic state, with decreased insulin sensitivity.” PCOS treatment is challenging due to medication side effects. So, are there dietary options? How about a randomized controlled clinical trial of raw red onion intake?

    Why onions? Well, onion extracts can evidently improve blood sugar and insulin sensitivity in rats with diabetes and, more importantly, were found to reduce blood sugar levels in humans with diabetes, but evidently not in non-diabetic humans. People with PCOS are kind of pre-diabetic, so would it work for them? First, let’s look at those other two studies. To study the “Metabolic Effects of Onion and Green Beans,” people with diabetes spent a week eating either a small onion (60 g) each day or the same diet with about six cups (600 g) of green beans instead—and both approaches worked. The onion lowered people’s blood sugar levels by about 10% compared to a non-onion control diet, while the green beans lowered them by roughly 15% compared to the control.

    Here’s the study that supposedly shows no blood sugar benefits for people without diabetes. It’s true—onions don’t seem to lower normal blood sugar levels, which is a good thing, but check out what happens when you feed people sugar. Have people consume about two and a half tablespoons (50 g) of corn syrup, and their blood sugar levels shoot up over the next two hours before their body can tamp it back down. But give people the exact same amount of sugar along with more and more onion extract, and the blood sugar spike is significantly dampened, almost as much as if you had instead given them an antidiabetic drug, as you can see below and at 4:00 in my video Onions Put to the Test for Weight Loss, Cholesterol, and PCOS Treatment.

    We see the same blunting effect on blood sugar when people get a shot of adrenaline and eat onion extract, compared to receiving adrenaline without the onion extract, as you can see below and at 4:11 in my video.

    So, are there blood sugar benefits for both people with and without diabetes? No difference was found in blood sugar levels or other markers of insulin resistance between the high-onion and low-onion groups of PCOS patients, nor were there any differences in a marker of inflammation between the two groups. But women with PCOS aren’t just at higher risk for diabetes and inflammation—they are also at higher risk for high cholesterol.

    Women with PCOS are over seven times more likely to have a heart attack and develop heart disease, the number one killer of women. But consuming raw red onion appears to be effective in lowering cholesterol, though the group that ate more onions only dropped their LDL cholesterol about 5 points (5 mg/dL), which was not significantly different than the group that ate fewer onions.

    I did find this study from 50 years ago where researchers fed people nearly an entire stick (100 g) of butter, and their cholesterol shot up about 30 points within hours of consumption but by only 9 points or 3 points when combined with about a third of a cup (50 g) of raw or boiled onion. The moral of the story: Don’t eat a stick of butter.

    Doctor’s Note

    Check out the previous video I mentioned: Friday Favorites: Are Onions Beneficial for Testosterone, Osteoporosis, Allergies, and Cancer?.

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    Michael Greger M.D. FACLM

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  • Gordon Ramsay slams ‘stupid’ Ozempic-inspired restaurant menu trend

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    As Ozempic and Mounjaro reshape eating habits, some restaurants are adapting — and Gordon Ramsay isn’t impressed.

    The celebrity chef and star of Fox’s “Next Level Chef” said he thinks the new trend of GLP-1-inspired menus at restaurants is “stupid.”

    “If I ever hear that word again, the ‘Mounjaro menu,’ I will [expletive] flip my lid,” Ramsay told Tasting Table.

    OZEMPIC BOOM COLLIDES WITH AMERICA’S EATING HABITS AS RESTAURANTS SHRINK PORTIONS

    “I’ve never heard anything so embarrassing in all my [expletive] life that chefs are now getting organized with smaller tasting menus to support the weight-loss jab. I’ve never heard anything so stupid in all my life.”

    Ramsay said dining out is meant to be “a celebration.”

    Celebrity chef Gordon Ramsay recently said GLP-1-inspired restaurant menus are “stupid.” (Pablo Cuadra/Getty Images)

    “It’s a reconnection. It’s a moment of no politics. It’s a moment of neutral ground, having fun, catching up and enjoying,” Ramsay added. 

    “To supplement those menus with tasting menus that are Mounjaro kitted out for small portions, I find it embarrassing.”

    Fox News Digital reached out to the Washington, D.C.-based National Restaurant Association for comment.

    FAST FOOD GOES GLP-1: SHAKE SHACK JOINS PROTEIN CRAZE WITH NEW OZEMPIC-FRIENDLY MENU

    Recent research suggests that when GLP-1 users go out to eat, they aren’t abandoning restaurants altogether — they’re ordering differently.

    A January study from Chicago-based research company Circana found that GLP-1 users decreased the average number of items ordered per visit by just 1%, while favoring main dishes over sides.

    Young friends having fun eating brunch at healthy food restaurant, salads, veggie burgers, fried eggs and smoothies and juices seen on table.

    Some restaurants and fast-food chains are catering to GLP-1 users with menus offering smaller portions. (iStock)

    The research also showed growing demand for vegetables, fruit and nutrient-dense foods.

    That’s prompted many restaurants and fast-food chains to adapt, offering smaller portions targeting the GLP-1 consumer.

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    Minnesota-based chef Andrew Zimmern told Fox News Digital last year that restaurants should be offering “more affordable menus with smaller portions of meat or animal protein as the centerpiece of the plate, so that more people can engage in restaurant culture.”

    Ramsay also railed on some other recent restaurant trends, including smashed avocado.

    “Foams … look like your cat’s puked up on it.”

    “Do you have any idea how many ways you can make a delicious avocado?” Ramsay told Tasting Table.

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    “I had an avocado soup in Oaxaca a couple of months back, a beautiful chilled avocado soup with queso fresco and finished with a beautiful little pickled habanero, and it was exceptional. But if I still see this word ‘smashed avocado,’ honestly, it frustrates the hell out of me.”

    Gordon Ramsay smiles while sitting on a couch during a recording of "The Jennifer Hudson Show."

    Ramsay also revealed some of his other restaurant pet peeves. (Michael Yarish/WBTV via Getty Images)

    His other pet peeve, Ramsay revealed, is foam.

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    “Foams are for shaving, right?” he said. 

    “Foams have a 30-second window. After that, on the plate, they look like your cat’s puked up on it.”

    Fox News Digital reached out to Ramsay’s representatives for additional comment.

    TEST YOURSELF WITH OUR LATEST LIFESTYLE QUIZ

    Fox News Digital’s Deirdre Bardolf contributed reporting. 

    Peter Burke is a lifestyle editor with Fox News Digital. He covers various lifestyle topics, with an emphasis on food and drink.

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  • Weight-Loss Devices to the Extreme | NutritionFacts.org

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    Let’s discuss the safety and efficacy of various weight-loss methods, ranging from Botox and corsets to siphons and tapeworms.

    A moderately obese person doing moderately intense physical activity, like biking or brisk walking, would burn off approximately 350 calories an hour, but most drinks, snacks, and other processed junk are consumed at a rate of about 70 calories (293 kJ) per minute. Therefore, it only takes five minutes to wipe out a whole hour of exercise.

    Enter the AspireAssist siphon assembly.

    It’s a percutaneous gastrostomy device, meaning surgeons cut a hole in a person’s stomach and tunnel a fistula out through the abdominal wall. So, after each meal, the person can attach a suction gadget to the hole and directly drain out their stomach contents, as you can see below and at 0:47 in my video Extreme Weight-Loss Devices.

    This means you could gorge on donuts, spew them out through the hole in your stomach, then gorge on more donuts. Have your cake, and eat it, too…and two, three, and four times!

    It seems to be the quintessential American invention, straight from the land that brought us Jell-O salads, spray cheese, and deep-fried Snickers bars. Patients do lose weight, perhaps in part because the fistula may interfere with the relaxation of the stomach wall during a meal. The process also requires drinking lots of water and thoroughly chewing food, both of which may help with weight loss by increasing hydration and slowing the eating rate. Patients also started making healthier choices to avoid the unpleasant sight of gastric aspirate from unhealthy foods. (The tubing is clear, and, evidently, fried foods look particularly gross as they are pumped out.)

    All patients need to take supplemental potassium, since it’s sucked out in stomach juices. Otherwise, they risk becoming potassium-deficient (a common complication in bulimia), but most side effects are just minor wound complications. Serious adverse effects, like abdominal abscesses, are rare. The big selling point is that the siphon device doesn’t change the gastrointestinal tract’s anatomy. That seems like a low bar, but in today’s Wild West world of weight-loss procedures, you can’t take anything for granted. Take the duodenal-jejunal bypass liner, for example.

    Gastric bypass surgery works in part by cutting out a portion of the small intestine so it’s no longer in the flow of food, thereby helping to prevent the absorption of calories. Instead of major surgery, how about just dropping down a couple of feet of plastic tubing to line the intestinal walls? The problem with the EndoBarrier is that it has to be anchored in the digestive tract. This is accomplished with 10 barbed hooks that cause lacerations, accounting for the majority of the 891 adverse effects reported in 1,056 patients—nearly 9 out of 10 people. Severe penetrating trauma, resulting in esophageal perforation or liver abscesses, is rarer (occurring in only about 1 in 27 patients).

    Concern has been raised about the “palatability” of the AspireAssist stomach pump, but the most cringeworthy endoscopic procedure I discovered in my research was intestinal “resurfacing.” Why cover the inside of your intestines with plastic to prevent absorption when you can just “thermally ablate the superficial duodenal mucosa”? In other words, have your intestinal lining burned off—or rather, “resurfaced.”

    Surgeons have tried injecting Botox into the stomach walls of obese individuals, hoping it would partially paralyze their gastric muscles, slow stomach emptying, make people feel fuller longer, and lose weight. It didn’t work.

    Researchers in Sweden tried randomizing people to wear corsets for 12 to 16 hours a day, seven days a week, for nine months. And it didn’t work. The study participants just didn’t wear the corsets—they were “perceived as uncomfortable.” Duh.

    “Sanitized tapeworms” have evidently been widely advertised as a weight-loss remedy since back in the early 1900s. The fact that living tapeworms have been discovered during bariatric surgery operations suggests that infesting yourself with parasites may not be particularly effective either.

    Speaking of disgusting strategies, how about disgust itself? A study entitled “Harnessing the Power of Disgust: A Randomized Trial to Reduce High-Calorie Food Appeal Through Implicit Priming” tried using subliminal messages to ruin people’s appetite. Just before showing images of healthy foods, researchers briefly flashed happy images—such as a group of kittens—for 20 milliseconds. That’s too quick to consciously register, but the hope was to plant a positive imprint on the brain. Before showing images of high-calorie foods like ice cream, they flashed negative scenes, like a cockroach on a pizza slice, vomit in a dirty bathroom, and a burn wound. Apparently, it worked! Subjects subsequently reported a reduced desire to eat high-calorie foods, though this wasn’t tested directly. The researchers concluded that subliminal revulsion might be “a successful tactic to combat the onslaught of food cues that promote unhealthy eating….”

    The rest of the world looks on, bemused by American machinations, penning commentaries like “Don’t Let Them Eat Cake! A View from Across the Pond.” A paper in the journal Obesity Surgery entitled “What Are the Yanks Doing?” reviewed “The U.S. Experience with Implantable Gastric Stimulation,” inserting electrodes into the muscular layer of the stomach wall. When that didn’t work, colon electrical stimulation was tried.

    Even more shocking were studies like “Repetitive electric brain stimulation reduces food intake in humans.” Though placing deep-brain electrodes is considered a complication-prone operation, scientists have long pondered whether “placing an electrode somewhere in the brain could make people eat less.” Holes were drilled through the skulls of five obese individuals, and wires were pushed into their brains for “electrostimulatory exploration.” Once the researchers poked around and found spots where they were able to elicit convincing hunger responses, they sent in enough juice to fry out electro-coagulatory lesions. It seemed to work in cats and monkeys, but the researchers found that burning holes in people’s brains did not result in weight loss in obese humans. Thankfully, as I explained in my book How Not to Diet, healthy, sustainable weight loss isn’t brain surgery.

    Doctor’s Note

    Check out Is Gastric Balloon Surgery Safe and Effective for Weight Loss?.

    What about drugs? See Are Weight Loss Pills Safe? and Are Weight Loss Pills Effective?.

    So, what’s the best way to lose weight? I wrote a whole book about it! How Not to Diet is focused exclusively on sustainable weight loss. Borrow it from your local library or pick up a copy from your favorite bookseller. (All proceeds from my books are donated to charity.) To whet your appetite, take a peek: Trailer for How Not to Diet: Dr. Greger’s Guide to Weight Loss.

    For more on this topic, check out related posts below.

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    Michael Greger M.D. FACLM

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  • From Gastric Balloons to Fake Knee Surgeries: When the Fix Is an Illusion | NutritionFacts.org

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    Sham surgery trials have shown that some of our most popular surgeries are themselves shams.

    Intragastric balloons “arrived with much fanfare in the 1980s,” since they could be implanted into the stomach and inflated with air or water to fill much of the space. Unfortunately, surgical devices are often brought to the market before there is adequate evidence of effectiveness and safety, and the balloons were no exception.

    The “gastric bubble” had its bubble burst when a study at the Mayo Clinic found that 8 out of 10 balloons “spontaneously deflated,” which is potentially dangerous because they could pass into the intestines and cause an obstruction, as you can see below and at 0:40 in my video Is Gastric Balloon Surgery Safe and Effective for Weight Loss?.

    Before balloons deflated, however, they apparently caused gastric erosions in half the patients, damaging their stomach lining. The kicker is that, in terms of inducing weight loss, they didn’t even work when compared to diet and other behavior modification strategies. Eventually, intragastric balloons were pulled from the market. But now, balloons are back.

    After a 33-year hiatus, the U.S. Food and Drug Administration started approving a new slew of intragastric balloons in 2015, which immediately resulted in the placement of more than 5,000 devices. By then, the Sunshine Act had passed. It forced drug companies and the surgical and medical device industry to disclose any payments made to physicians, shining a disinfecting light on industry enticements. By now, most people know about the overly cozy financial relationships doctors can have with Big Pharma, but fewer may realize that surgeons can also get payments from the companies for the devices they use. The 100 top physician recipients of industry payments received an unbelievable $12 million from device companies in a single year. Yet outrageously, when they published papers, only a minority disclosed the blatant conflict of interest.

    The benefit of balloons over most types of bariatric surgery is that they’re reversible, but that doesn’t mean they’re benign. The FDA has released a series of advisories about the risks, which include death. But how could someone suffer a stomach perforation with a smooth, rounded object? By that smooth, rounded object causing the patient to vomit so much that they rupture their stomach and die. Nausea and vomiting are unsurprisingly “very common side effects,” affecting the majority of those who have balloons placed inside of them. Persistent vomiting likely also explains cases of life-threatening nutrient deficiencies after balloon implantation.

    Some complications, such as bowel obstruction, are due to the balloons deflating, but others, oddly enough, are due to the balloons suddenly overinflating, causing pain, vomiting, and abdominal distention, as you can see below and at 2:45 in my video.

    This issue was first noticed in breast implants, as documented in reports such as “The Phenomenon of the Spontaneously Autoinflating Breast Implant.” Out of nowhere, the implants can just start growing, increasing breast volume by an average of more than 50%. “It remains an underreported and poorly understood phenomenon,” one review noted. (Interestingly, breast implants were actually used as some of the first failed experimental intragastric balloons.)

    As with any medical decision, though, it’s all about risks versus benefits. Industry-funded trials display “notable weight loss,” but it’s hard to tease out the effect of the balloon on its own from the accompanying “supervised diet and lifestyle changes” prescribed in the studies. In drug trials, you can randomize study participants to sugar pills, but how do you eliminate the placebo effect of undergoing a procedure? Perform sham surgery.

    In 2002, a courageous study was published in The New England Journal of Medicine. The most common orthopedic surgery—arthroscopic surgery of the knee—was put to the test. Billions of dollars are spent on sticking scopes into knee joints and cutting away damaged tissue in osteoarthritis and knee injuries, but does that actually work? People suffering from knee pain were randomized to get the actual surgery versus a sham surgery, in which surgeons sliced into people’s knees and pretended to perform the procedure—even splashing saline—without actually treating the joint.

    The trial caused an uproar. How could anyone randomize people to get cut open for fake surgery? Professional medical associations questioned the ethics of the surgeons as well as “the sanity” of the patients who agreed to be part of the trial. Guess what happened? The surgical patients got better, but so did the placebo patients, as you can see below and at 4:42 in my video.

    The surgeries had no actual effect. Currently, rotator cuff shoulder surgery is facing the same crisis of confidence.

    When intragastric balloons were put to the test, sham-controlled trials showed that both older and newer devices sometimes fail to offer any weight-loss benefit. Even when they do work, the weight loss may be temporary because balloons are only allowed to stay in for six months (at which point the deflation risk gets too great). Why can’t you keep putting new ones in? That’s been tried; it failed to improve long-term weight outcomes. A sham-controlled trial showed that any effects of the balloon on appetite and satiety may vanish with time, perhaps as your body gets used to the new normal.

    What sham surgery trials have shown us is that some of our most popular surgeries are themselves shams. Doctors like to pride themselves on being men and women of science. For example, we rightly rail against the anti-vaccination movement. Many of us in medicine have been troubled by the political trend in which people “choose their own facts.” But when I read that some of these still-popular surgeries are not only useless but may actually make matters worse (for example, increasing the risk of progression to a total knee replacement), I can’t help but think we are hardly immune to our own versions of fake news and alternative facts.

    Doctor’s Note

    Next in this two-part series is Extreme Weight-Loss Devices.

    For more on bariatric surgery, check out related posts below.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Borrow it from your local library or pick up a copy from your favorite bookseller. (All proceeds from my books are donated to charity.)

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    Michael Greger M.D. FACLM

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  • Serena Williams displays sculpted physique in micro shorts after 34lbs weight loss transformation

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    Serena Williams may have come under fire for promoting her 34lbs weight loss with the aid of the GLP-1 company Ro during a Super Bowl commercial, but that hasn’t stopped her from showing off her slimmed-down physique.

    The 44-year-old shared a new video on Wednesday, which you can watch below, that highlighted her body transformation as she worked up a sweat in her home gym.

    Returning to her fondness for pole dancing to help keep her in shape, Serena displayed her impressive strength as she lifted herself on the pole before using just her arms and core muscles to keep her elevated.

    Wearing a pair of micro white shorts and a matching crop top, Serena’s sculpted muscles on her legs and abs were clearly visible.

    WATCH: Serena Williams displays 34lbs weight loss during pole dancing workout

    Serena has been open about her weight loss transformation and how GLP-1 medication assisted her in losing the baby weight she gained during her second pregnancy with daughter Adira in 2023. 

    Serena’s struggle to lose weight despite her high fitness level and healthy diet spurred her to make the decision. 

    © Instagram
    Serena showed off her sculpted physique while pole dancing

    “I am a very good use case of how you can do everything – eat healthy, work out to the point of even playing a professional sport and getting to the finals of Wimbledon and U.S. Opens – and still not be able to lose weight,” she told Women’s Health. 

    “[GLP-1 medication is] not a shortcut. It’s not a copout. This is just another tool to support my health journey.

    “I would never take a shortcut to living a healthy life. It’s really about using the tools available to you to support your health. That’s why it’s so important to be transparent with my story.”

    The tennis star showed off her toned physique© Serena Williams in pale blue satin swimsuit
    Serena has lost 34lbs using GLP-1 medication

    During her Super Bowl commercial for Ro, Serena opened up about her personal weight loss journey and revealed she had lost 34 pounds over the past year.

    In the sleekly produced ad, Serena is shown injecting the medication using a pen device, scrolling through the Ro mobile app, and unveiling a new pill version of the treatment. 

    Alongside the weight loss, she shares that she experienced reduced knee joint stress, steadier blood sugar levels, and lower cholesterol – positioning the transformation as both physical and health-focused.

    Serena appears in a new ad for Ro© Ro
    Serena used the GLP-1 company Ro to help her lose weight

    Serena previously admitted she felt blindsided by how difficult it was to lose weight postpartum.

    “I never was able to get to the weight I needed to be no matter what I did, no matter how much I trained,” she told People. “It was crazy because I’d never been in a place like that in my life where I worked so hard, ate so healthy, and could never get down to where I needed to be at.

    Serena William awards show black dress gold sleeves© Getty Images
    Serena said she struggled to lose weight after the birth of her second daughter

    “I had never taken shortcuts in my career and always worked really hard. I know what it takes to be the best,” she said. “So it was very frustrating to do all the same things and never be able to change that number on the scale or the way my body looked.”

    After starting the GLP-1 medication in 2024, Serena says the results were transformative. “I lost over 31 pounds using my GLP-1, and I was really excited about that weight loss. I feel great. I feel really good and healthy. I feel light physically and light mentally.”

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    Jenni McKnight

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  • Is Fasting an Effective Treatment for Diabetes? | NutritionFacts.org

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    By losing 15% of their body weight, nearly 90% of those who have had type 2 diabetes for less than four years may achieve remission.

    Currently, more than half a billion adults have diabetes, and about a 50% increase is expected in another generation. I’ve got tons of videos on the best diets for diabetes, but what about no diet at all?

    More than a century ago, fasting was said to cure diabetes, quickly halting its progression and eliminating all signs of the disease within days or weeks. Even so, starvation is guaranteed to lead to the complete disappearance of you if kept up long enough. What’s the point of fasting away the pounds if they’re just going to return as soon as you restart the diet that created them in the first place? Might it be useful to kickstart a healthier diet? Let’s see what the science says.

    Type 2 diabetes has long been recognized as a disease of excess, once thought to afflict only “the idle rich…anyone whose environment and self-support does not require of him some sustained vigorous bodily exertion every day, and whose earnings or income permit him, and whose inclination tempts him, to eat regularly more than he needs.” Diabetes is preventable, so might it also be treatable? If we’re dying from overeating, maybe we can be saved by undereating. Remarkably, this idea was proposed about 2,000 years ago in an Ayurvedic text:

    “Poor diabetic people’s medicine
    He should live like a saint (Munni);
    He should walk for 800–900 miles.
    Or he shall dig a pond;
    Or he shall live only on cow dung and cow urine.”

    That reminds me of the Rollo diet for diabetes proposed in 1797, which was composed of rancid meat. That was on top of the ipecac-like drugs he used to induce severe sickness and vomiting. Anything that makes people sick has only “a temporary effect in relieving diabetes” because it reduces the amount of food eaten. His diet plan—which included congealed blood for lunch and spoiled meat for dinner—certainly had that effect.

    Similar benefits were seen in people with diabetes during the siege of Paris in the Franco‐Prussian War, leading to the advice to mangez le moins possible, which translates to “eat as little as possible.” This was formalized into the Allen starvation treatment, considered to be “the greatest advance in the treatment of diabetes prior to the discovery of insulin.” Before insulin, there was “The Allen Era.”

    Dr. Allen noted that there are clinical reports of even severe diabetes cases clearing up after the onset of a “wasting condition” like tuberculosis or cancer, so he decided to put it to the test. He found that even in the most severe type of diabetes, he could clear sugar from people’s urine within ten days. Of course, that’s the easy part; it’s harder to maintain once they start eating again. To manage patients’ diabetes, he stuck to two principles: Keep them underweight and restrict the fat in their diet. A person with severe diabetes can be symptom-free for days or weeks, but eating butter or olive oil can make the disease come raging back.

    As I’ve said before, diabetes is a disease of fat toxicity. Infuse fat into people’s veins through an IV, and, by using a high-tech type of MRI scanner, you can show in real time the buildup of fat in muscle cells within hours, accompanied by an increase in insulin resistance. The same thing happens when you put people on a high-fat diet for three days. It can even happen in just one day. Even a single meal can increase insulin resistance within six hours. Acute dietary fat intake rapidly increases insulin resistance. Why do we care? Insulin resistance in our muscles, in the context of too many calories, can lead to a buildup of liver fat, followed by fat accumulation in the pancreas, and eventually full-blown diabetes. “Type 2 diabetes can now be understood as a state of excess fat in the liver and pancreas, and remains reversible for at least 10 years in most individuals.”

    When people are put on a very low-calorie diet—700 calories a day—fat can get pulled out of their muscle cells, accompanied by a corresponding boost in insulin sensitivity, as shown below and at 4:43 in my video Fasting to Reverse Diabetes.

    The fat buildup in the liver has then been shown to decrease substantially, and if the diet is continued, the excess fat in the pancreas also reduces. If caught early enough, reversing type 2 diabetes is possible, which would mean sustained healthy blood sugar levels on a healthy diet.

    With the loss of 15% of body weight, nearly 90% of individuals who have had type 2 diabetes for less than four years can achieve non-diabetic blood sugar levels, whereas it may only be reversible in 50% of those who’ve lived with the disease for longer than eight years. That’s better than bariatric surgery, where those losing even more weight had lower remission rates of 62% and 26%, respectively. Your forks are better than surgeons’ knives. Indeed, most people who have had their type 2 diabetes diagnosis for an average of three years can reverse their disease after losing about 30 pounds, as you can see below and at 5:37 in my video.

    Of course, an extended bout of physician-supervised, water-only fasting could also get you there, but you would have to maintain that weight loss. One of the things that has been said with “certainty” is that if you regain the weight, you regain your diabetes.

    To bring it full circle, “the initial euphoria about ‘medicine’s greatest miracle’”—the discovery of insulin in 1921—“soon gave way to the realisation” that, while it was literally life-saving for people with type 1 diabetes, insulin alone wasn’t enough to prevent such complications as blindness, kidney failure, stroke, and amputations in people with type 2 diabetes. That’s why one of the most renowned pioneers in diabetes care, Elliott Joslin, “argued that self-discipline on diet and exercise, as it was in the days prior to the availability of the drug [insulin], should be central to the management of diabetes….”

    Doctor’s Note

    Check out Diabetes as a Disease of Fat Toxicity for more on the underlying cause of the disease.

    For more on fasting for disease reversal, see:

    Fasting is not the best way to lose weight. To learn more, see related posts below.

    What is the best way to lose weight? See Friday Favorites: The Best Diet for Weight Loss and Disease Prevention.

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    Michael Greger M.D. FACLM

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  • Online marketplaces flooded with misleading ‘faux-zempic’ weight-loss supplements, Which? warns – Tech Digest

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    Online marketplaces and high-street health retailers are being flooded with weight-loss supplements making misleading claims.

    That’s according to a major investigation by the consumer association Which? which has warned that these products are flouting strict advertising rules.

    Which?’s researchers found bogus claims on popular platforms, including Amazon, eBay, and Temu. Well-known high street retailers including Holland & Barrett and Superdrug were also identified in the report.

    Current UK laws state that companies cannot make health claims about a product without evidence. Any specific claim must be listed on an approved official health register.

    However, Which? found that many brands are making outlandish promises with very little enforcement.

    One supplement on eBay claimed that raspberry fruit extract helps the body burn fat at a higher rate. In reality, such claims have been repeatedly rejected due to a lack of evidence.

    The investigation discovered that some major retailers use website categories like “fat burners” to sell basic vitamins. Holland & Barrett listed Acai Berry tablets in its fat burner section despite no weight-loss ingredients being present.

    Superdrug included a cinnamon supplement under appetite suppressants even though the product made no such claim. This practice can mislead shoppers into buying items they believe will help them lose weight.

    Even more concerning were products claiming to target specific body parts or mimic medical jabs. One supplement on Temu promised to shred stomach fat fast. Another on Amazon claimed users would lose centimetres from their waistlines in just four weeks.

    Rules set by the Advertising Standards Authority prohibit brands from predicting how much weight someone will lose or where they will lose it from.

    Products are also forbidden from claiming they are as effective as prescription weight-loss medication. Which? found a listing on eBay for a pill that suggested it was just as effective as prescription options.

    This creates a dangerous confusion for consumers seeking medical results from unregulated supplements. Following the report, more than 50 misleading listings were taken down by the retailers involved.

    Says Sue Davies, Which? Head of Consumer Policy:

    “It’s really worrying that online marketplaces and popular health retailers are promoting misleading health supplements.

    “Not only does this make it impossible for shoppers to trust the claims they see online, but it also means people could be wasting their hard-earned cash on products that just don’t live up to the claims.

    “Better oversight of the industry is desperately needed so the government and regulators can crack down on these misleading listings and ensure that any sellers who break the rules are properly held to account.”

    Right of replies

    A government spokesperson said: 

    “Food labels must be easy to understand, accurate and honest.

    “Any claims about the health benefits or nutritional value of supplements need to be backed by science and officially approved by authorities.

    “Companies that break these rules may be subject to enforcement action by local authorities.”

    An Amazon spokesperson said:

    “We require all products offered in our store to comply with applicable laws, regulations and Amazon policies.

    “We develop innovative tools to prevent unsafe products from being listed. We continuously monitor our store, and we take action to maintain a safe selection for our customers, including removing noncompliant products and outreach to sellers, manufacturers, and government agencies for additional information, when appropriate.

    “We have removed the highlighted products in question.”

    An ASA spokesperson said: 

    “Our rules are clear that ads mustn’t make unauthorised health, medical or weight-loss claims. In particular, ads can’t claim or imply that a food supplement can provide effects associated with prescription-only weight loss medicines.

    “We recognise that these kinds of ads can target potentially vulnerable people who may be concerned about their weight or health. We’ve been using our AI-powered Active Ad Monitoring system to proactively monitor supplement ads.

    “This has enabled us to identify and ban a number of ads that have broken our rules, including several ads for ‘faux-zempic’ supplements that misleadingly claimed to produce effects similar to prescription-only weight-loss medicines.”

    A spokesperson for Coolkin said: 

    “Our products are certified before they are put on the shelves. There is no problem.”

    An eBay spokesperson said: 

    “Consumer safety is a top priority for eBay. We have reviewed the listings identified by Which? and have removed all items that are against eBay policy.

    “We use enforcement measures to help prevent unsafe items from being listed on eBay. These include seller compliance audits, block-filter algorithms, AI-supported monitoring by in-house specialists, and close partnerships with regulators. These measures help prevent millions of potentially unsafe items from being listed each year.”

    Holland and Barrett said: 

    “We are committed to providing high-quality, science-backed products that reflect the latest guidance. Product categorisation is intended to support customers to navigate our website, and we regularly carry out detailed reviews led by our science and regulatory teams to ensure this is consistent and helpful.

    “Following our latest review, the H&B Acai Berry tablets now sit within our Superfood category.”

    An Internal Youth spokesperson said:

    “We have passed on your points to our marketing department who will be addressing each concern and actioning anything deemed inappropriate on our product listing immediately.”

    Lynda Scammell, head of borderline products at the Medicines Healthcare products Regulatory Agency said: 

    “If a product offered as a food supplement contains medicinal ingredients or makes medicinal claims to treat or prevent disease, it will be considered a medicine and regulated under medicines law.’

    “Any weight loss product which is presented in a way that is typical of authorised medicines, or which has a product name which is similar to the name of a prescription medicine to the extent that it may cause confusion in the mind of the average UK citizen is not permitted.”

    A Pharmaslim spokesperson said: 

    “The product is manufactured in the UK in a licensed facility and is a food supplement, not a medicinal product. We do not make medical or therapeutic claims for it. For completeness, the listing you are referring to is not currently active, as the product is out of stock. We are reviewing the points you raise regarding product naming and marketing presentation.”

    A spokesperson for Superdrug said: 

    “Our customers’ health and wellbeing is always a priority. Superdrug Marketplace is a curated platform where third-party sellers must adhere to strict listing guidelines, including alignment with UK health authority recommendations. We do not intend to make unjustified health claims, and any categorisation on our website is designed to help customers navigate products rather than imply specific health outcomes.

    “Upon being made aware of Which?’s findings, we have paused all retailing of the highlighted product. We have also reviewed the category in question, and will take further action where necessary to ensure our content remains compliant and clear for customers.”

    A Temu spokesperson said: 

    “After receiving the inquiry, we immediately removed the products listed in the report pending further review and are working with the sellers involved to rectify their descriptions.

    “Temu maintains strict requirements for dietary supplements, requiring documentation such as HACCP certification and composition reports.

    “Following ASA’s advice on food supplements, Temu has been enforcing and will further enhance its review process. We are also providing additional compliance training to remind sellers of their obligations to meet the required regulatory standards.”

    Formula Max and Pslalae did not respond to Which?’s requests for comment.

    For latest tech stories go to TechDigest.tv

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  • Weight loss drugs could save airlines money on fuel as Americans slim down

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    Airlines could have weight loss drug manufacturers to thank for savings if passengers become lighter, allowing carriers to spend less money on fuel.

    As GLP-1 medications for weight loss become accessible to more Americans, they are expected to have a slimming down effect on society. The implication for airlines is lower fuel consumption and therefore cost savings, a recent analysis from Jefferies Research Services shows.

    Fuel costs are directly related to the weight of planes, including passengers, their luggage and other essential cargo. A heavier plane requires more fuel, while a lighter aircraft uses less.

    Airlines have always taken steps to keep aircraft as light as possible and limit fuel consumption, from serving pit-less olives to using thin or light paper stock, according to the Jefferies analysis.

    Airlines “have a long history of searching for unique methods to reduce the weight of the aircraft, in turn reducing fuel consumption and limiting an airline’s largest cost bucket,” analysts said in the report.

    They have no ability to limit how much passengers weigh, however.

    If weight loss drugs like Ozempic and Wegovy lead to a 10% slimmer society, the analysts found that would translate to total airline passenger weight declining by 2%. For airlines, this means 1.5% in fuel savings, plus a 4% boost to earnings per share, according to the analysis.

    Jefferies used the example of a Boeing 737 Max 8 aircraft to model the savings. It weighs 99,000 pounds empty and can carry 46,000 pounds of fuel. If it seats 178 passengers with an average weight of 180 pounds, plus about 4,000 pounds of other cargo, its total takeoff weight reaches 181,200 pounds. By contrast, if passengers slim down by 10%, to weigh an average of 162 pounds, that aircraft’s total weight drops to 177,996 pounds.

    Jefferies found that translates to $580 million in fuel savings annually for the top four carriers in the U.S. — American, Delta, Southwest and United. Those airlines are expected to spend $38.6 billion combined on jet fuel this year.  

    Jefferies conducted the study in response to pharmaceutical companies developing weight loss pills and following a 2023 report it released studying the effects of weight loss on fuel costs.

    “With the drug now available in pill form and obesity rates falling, broader usage could have further implications for waist lines,” analysts said.

    Edited by

    Alex Sundby

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  • Wegovy injections vs. pills: Doctors explain the differences

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    Wegovy injections vs. pills: Doctors explain the differences

    When it comes to GLP-1 pills vs. injections, doctors share which form may be best for you.

    Updated: 3:01 PM PST Jan 15, 2026

    Editorial Standards ⓘ

    GLP-1 (glucagon-like peptide-1 receptor agonists) like Ozempic and Wegovy continue to make headlines as more research points to the benefits of taking these medications. Traditionally, patients administer these via injection, but now, one medication in particular is available to take in pill form. So, which works best: Wegovy injection vs. pill? And is the answer the same for all GLP-1s?First, GLP-1s are a class of drugs that mimic the GLP-1 hormone that’s naturally released in your GI tract when you eat, explains Mir Ali, M.D., medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA. These medications help to moderate blood sugar levels, reduce feelings of hunger in the brain, and delay emptying in the stomach, making you feel fuller, longer. As a result, a side effect is weight loss. There are some buzzy GLP-1 medications that have become household names, like Wegovy and Ozempic, but there are also other options you may not have heard about.Ultimately, the best GLP-1 medication is one that you and your healthcare provider agree will best serve your needs. But learning more about the medication you intend to use can’t hurt. Here, find the major differences between GLP-1 injections and pills.There are a lot of medications that fall into the GLP-1 class, including injectable drugs and pills. Some popular ones include Ozempic, Rybelsus, and Wegovy.It’s worth noting that Wegovy (the main active ingredient of which is semaglutide) is the only GLP-1 pill that’s approved for weight loss by the U.S. Food and Drug Administration (FDA). While Rybelsus is sometimes used off-label for weight loss, it’s technically FDA-approved for blood sugar management in people with type 2 diabetes (the same goes for Ozempic). So, keep in mind that the information ahead speaks primarily to Wegovy.Wegovy injection vs. pill: How does each work? GLP-1 injectable medications are usually injected into the belly. “GLP-1 injections deliver the medication into the subcutaneous fat, where it is slowly absorbed,” explains Christoph Buettner, M.D., Ph.D., chief of the division of endocrinology at Rutgers Robert Wood Johnson Medical School. “These drugs have a long half-life, about five to seven days, which is why they only need to be taken once a week.”After they’re injected, the medication steadily enters the bloodstream and activates the GLP-1 receptor, Dr. Buettner explains. Once it’s in your body, the medication signals to your brain to take in less food, says Martin Binks, Ph.D., professor and chair of the Department of Nutrition and Food Studies at George Mason University College of Public Health. “They also help delay stomach emptying, which ultimately improves satiety and reduces hunger,” he says. “The combined influences of these medicines regulate metabolism and appetite.”The GLP-1 pills work similarly, but these contain a higher dose of medication to compensate for absorption into the digestive tract, Dr. Binks says. (The injectable medications have lower doses of medication because they’re slowly released into the bloodstream and bypass the gastrointestinal tract, Dr. Ali explains.)These medications are taken by mouth once a day. They usually need to be taken on an empty stomach, and you can’t eat or take most other medications for up to an hour afterward, Dr. Buettner points out. “These requirements can be inconvenient for many patients,” he says.Which is most effective for weight loss?It depends. There have been a few clinical trials on the impact of GLP-1 injectable medications on weight loss with different results. However, People usually lose about 15% of their body weight while using semaglutide medications like Wegovy.Meanwhile, during clinical trials for the Wegovy oral route, people who took the pill lost about 16.6% of their body weight. (That’s compared to 3% weight loss achieved by people who used a placebo.)While Rybelsus isn’t FDA-approved for weight loss, people typically lose around eight pounds while taking this medication.Which works best?There are a few things to consider. “Both injectables and pill forms can be helpful,” says Dina Hagigeorges, PA.-C., a physician assistant who specializes in weight and wellness at Tufts Medicine Weight + Wellness – Stoneham. “Unfortunately, cost and insurance coverage are a huge deciding factor, as not all insurance plans cover these medications for people.” When paid for out of pocket, injectable GLP-1 medications are usually much more expensive than their oral counterparts.There’s a larger body of research to support injectable medications for weight loss, although the Wegovy pill shows promise, Dr. Ali says. “If someone can tolerate injections, it’s usually the better way to go—they’re taken less frequently,” he says. But these medications aren’t a good fit for people who are scared of needles, and they have to be refrigerated, Dr. Ali points out.“The pills are a good option for people who don’t like injections, and you can easily take them with you when you travel,” Dr. Ali says. “But they have to be taken daily, which is not for everyone.”Side effectsThe side effects are similar for both medications, Dr. Buettner says.These side effects may include:NauseaVomitingDiarrheaConstipationUpset Stomach “The most important thing is choosing a medication that you can use consistently and that aligns with your personal priorities—whether that’s maximum weight loss, convenience, avoiding injections, or simplifying your routine,” he says. “Many patients try one form first and later switch based on their experience.”So, talk to your healthcare provider and keep the line of conversation open. You may find one form of GLP-1 feels like a more natural fit over another.

    GLP-1 (glucagon-like peptide-1 receptor agonists) like Ozempic and Wegovy continue to make headlines as more research points to the benefits of taking these medications. Traditionally, patients administer these via injection, but now, one medication in particular is available to take in pill form. So, which works best: Wegovy injection vs. pill? And is the answer the same for all GLP-1s?

    First, GLP-1s are a class of drugs that mimic the GLP-1 hormone that’s naturally released in your GI tract when you eat, explains Mir Ali, M.D., medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA. These medications help to moderate blood sugar levels, reduce feelings of hunger in the brain, and delay emptying in the stomach, making you feel fuller, longer. As a result, a side effect is weight loss.

    There are some buzzy GLP-1 medications that have become household names, like Wegovy and Ozempic, but there are also other options you may not have heard about.

    Ultimately, the best GLP-1 medication is one that you and your healthcare provider agree will best serve your needs. But learning more about the medication you intend to use can’t hurt. Here, find the major differences between GLP-1 injections and pills.

    There are a lot of medications that fall into the GLP-1 class, including injectable drugs and pills. Some popular ones include Ozempic, Rybelsus, and Wegovy.

    It’s worth noting that Wegovy (the main active ingredient of which is semaglutide) is the only GLP-1 pill that’s approved for weight loss by the U.S. Food and Drug Administration (FDA). While Rybelsus is sometimes used off-label for weight loss, it’s technically FDA-approved for blood sugar management in people with type 2 diabetes (the same goes for Ozempic). So, keep in mind that the information ahead speaks primarily to Wegovy.

    Wegovy injection vs. pill: How does each work?

    GLP-1 injectable medications are usually injected into the belly. “GLP-1 injections deliver the medication into the subcutaneous fat, where it is slowly absorbed,” explains Christoph Buettner, M.D., Ph.D., chief of the division of endocrinology at Rutgers Robert Wood Johnson Medical School. “These drugs have a long half-life, about five to seven days, which is why they only need to be taken once a week.”

    After they’re injected, the medication steadily enters the bloodstream and activates the GLP-1 receptor, Dr. Buettner explains. Once it’s in your body, the medication signals to your brain to take in less food, says Martin Binks, Ph.D., professor and chair of the Department of Nutrition and Food Studies at George Mason University College of Public Health. “They also help delay stomach emptying, which ultimately improves satiety and reduces hunger,” he says. “The combined influences of these medicines regulate metabolism and appetite.”

    The GLP-1 pills work similarly, but these contain a higher dose of medication to compensate for absorption into the digestive tract, Dr. Binks says. (The injectable medications have lower doses of medication because they’re slowly released into the bloodstream and bypass the gastrointestinal tract, Dr. Ali explains.)

    These medications are taken by mouth once a day. They usually need to be taken on an empty stomach, and you can’t eat or take most other medications for up to an hour afterward, Dr. Buettner points out. “These requirements can be inconvenient for many patients,” he says.

    Which is most effective for weight loss?

    It depends. There have been a few clinical trials on the impact of GLP-1 injectable medications on weight loss with different results. However, People usually lose about 15% of their body weight while using semaglutide medications like Wegovy.

    Meanwhile, during clinical trials for the Wegovy oral route, people who took the pill lost about 16.6% of their body weight. (That’s compared to 3% weight loss achieved by people who used a placebo.)

    While Rybelsus isn’t FDA-approved for weight loss, people typically lose around eight pounds while taking this medication.

    Which works best?

    There are a few things to consider. “Both injectables and pill forms can be helpful,” says Dina Hagigeorges, PA.-C., a physician assistant who specializes in weight and wellness at Tufts Medicine Weight + Wellness – Stoneham. “Unfortunately, cost and insurance coverage are a huge deciding factor, as not all insurance plans cover these medications for people.” When paid for out of pocket, injectable GLP-1 medications are usually much more expensive than their oral counterparts.

    There’s a larger body of research to support injectable medications for weight loss, although the Wegovy pill shows promise, Dr. Ali says. “If someone can tolerate injections, it’s usually the better way to go—they’re taken less frequently,” he says. But these medications aren’t a good fit for people who are scared of needles, and they have to be refrigerated, Dr. Ali points out.

    “The pills are a good option for people who don’t like injections, and you can easily take them with you when you travel,” Dr. Ali says. “But they have to be taken daily, which is not for everyone.”

    Side effects

    The side effects are similar for both medications, Dr. Buettner says.

    These side effects may include:

    • Nausea
    • Vomiting
    • Diarrhea
    • Constipation
    • Upset Stomach

    “The most important thing is choosing a medication that you can use consistently and that aligns with your personal priorities—whether that’s maximum weight loss, convenience, avoiding injections, or simplifying your routine,” he says. “Many patients try one form first and later switch based on their experience.”

    So, talk to your healthcare provider and keep the line of conversation open. You may find one form of GLP-1 feels like a more natural fit over another.

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  • The Hidden Costs of Bariatric Surgery | NutritionFacts.org

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    Weight regain after bariatric surgery can have devastating psychological effects.

    How Sustainable Is the Weight Loss After Bariatric Surgery? I explore that issue in my video of the same name. Most gastric bypass patients end up regaining some of the fat they lose by the third year after surgery, but after seven years, 75% of patients followed at 10 U.S. hospitals maintained at least a 20% weight loss.

    The typical trajectory for someone who starts out obese at 285 pounds, for example, would be to drop to an overweight 178 pounds two years after bariatric surgery, but then regain weight up to an obese 207 pounds. This has been chalked up to “grazing” behavior, where compulsive eaters may shift from bingeing (which becomes more difficult post-surgery) to eating smaller amounts constantly throughout the day. In a group of women followed for eight years after gastric bypass surgery, about half continued to describe episodes of disordered eating. As one pediatric obesity specialist described, “I have seen many patients who put chocolate bars into a blender with some cream, just to pass technically installed obstacles [e.g., a gastric band].”

    Bariatric surgery advertising is filled with “happily-ever-after” fairytale narratives of cherry-picked outcomes offering, as one ad analysis put it, “the full Cinderella-romance happy ending.” This may contribute to the finding that patients often overestimate the amount of weight they’ll lose with the procedure and underestimate the difficulty of the recovery process. Surgery forces profound changes in eating habits, requiring slow, small bites that have been thoroughly chewed. Your stomach goes from the volume of two softballs down to the size of half a tennis ball in stomach stapling and half a ping-pong ball in the case of gastric bypass or banding.

    As you can imagine, “weight regain after bariatric surgery can have a devastating effect psychologically as patients feel that they have failed their last option”—their last resort. This may explain why bariatric surgery patients face a high risk of depression. They also have an increased risk of suicide.

    Severe obesity alone may increase the risk of suicidal depression, but even at the same weight, those going through surgery appear to be at a higher risk. At the same BMI (body mass index), age, and gender, bariatric surgery patients have nearly four times the odds of self-harm or attempted suicide compared with those who did not undergo the procedure. Most convincingly, so-called “mirror-image analysis” comparing patients’ pre- and post-surgery events showed the odds of serious self-harm increased after surgery.

    About 1 in 50 bariatric surgery patients end up killing themselves or being hospitalized for self-harm or attempted suicide. And this only includes confirmed suicides, excluding masked attempts such as overdoses classified as having “undetermined intention.” Bariatric surgery patients may also have an elevated risk of accidental death, though some of this could be due to changes in alcohol metabolism. When individuals who have had a gastric bypass were given two shots of vodka, their blood alcohol level surpassed the legal driving limit within minutes due to their altered anatomy. It’s unclear whether this plays a role in the 25% increase in prevalence of alcohol problems noted during the second postoperative year.

    Even those who successfully lose their excess weight and keep it off appear to have a hard time coping. Ten years out, though physical health-related quality of life may improve, general mental health can significantly deteriorate compared to pre-surgical levels, even among those who lost the most weight. Ironically, there’s a common notion that bariatric surgery is for “cheaters” who take the easy way out by choosing the “low-effort” method of weight loss.

    Shedding the weight may not shed the stigma of prior obesity. Studies suggest that “in the eyes of others, knowing that an individual was at one time fat will lead him/her to always be treated like a fat person.” And there can be a strong anti-surgery bias on top of that—those who chose the scalpel to lose weight over diet or exercise were rated more negatively (for example, being considered less physically attractive). One can imagine how remaining a target of prejudice even after joining the “in-group” could potentially undercut psychological well-being.

    There can also be unexpected physical consequences of massive weight loss, like large hanging flaps of excess skin. Beyond being heavy and uncomfortable and interfering with movement, the skin flaps can result in itching, irritation, dermatitis, and skin infections. Getting a panniculectomy (removing the abdominal “apron” of hanging skin) can be expensive, and its complication rate can exceed 50%, with dehiscence (rupturing of the surgical wound) one of the most common complications.

    “Even if surgery proves sustainably effective,” wrote the founding director of Yale University’s Prevention Research Center, “the need to rely on the rearrangement of natural gastrointestinal anatomy as an alternative to better use of feet and forks [exercise and diet] seems a societal travesty.”

    In the Middle Ages, starving peasants dreamed of gastronomic utopias where food just rained down from the sky. The English called it the Kingdom of Cockaigne. Little could medieval fabulists predict that many of their descendants would not only take permanent residence there but also cut out parts of their stomachs and intestines to combat the abundance. Critics have pointed out the irony of surgically altering healthy organs to make them dysfunctional—malabsorptive—on purpose, especially when it comes to operating on children. Bariatric surgery for kids and teens has become widespread and is being performed on children as young as five years old. Surgeons defend the practice by arguing that growing up fat can leave “‘emotional scars’ and lifelong social retardation.”

    Promoters of preventive medicine may argue that bariatric surgery is the proverbial “ambulance at the bottom of the cliff.” In response, proponents of pediatric bariatric surgery have written: “It is often pointed out that we should focus on prevention. Of course, I agree. However, if someone is drowning, I don’t tell them, ‘You should learn how to swim’; no, I rescue them.”

    A strong case can be made that the benefits of bariatric surgery far outweigh the risks if the alternative is remaining morbidly obese, which is estimated to shave up to a dozen or more years off one’s life. Although there haven’t been any data from randomized trials yet to back it up, compared to non-operated obese individuals, those getting bariatric surgery would be expected to live significantly longer on average. No wonder surgeons have consistently framed the elective surgery as a life-or-death necessity. This is a false dichotomy, though. The benefits only outweigh the risks if there are no other alternatives. Might there be a way to lose weight healthfully without resorting to the operating table? That’s what my book How Not to Diet is all about.

    Doctor’s Note

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your library or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

    This is the final segment in a four-part series on bariatric surgery, which includes:

    This blog contains information regarding suicide. If you or anyone you know is exhibiting suicide warning signs, please get help. Go to https://988lifeline.org for more information.

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    Michael Greger M.D. FACLM

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  • Book excerpt:

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    We may receive an affiliate commission from anything you buy from this article.

    Broadcasting superstar Oprah Winfrey, who has struggled with weight for much of her life, and Dr. Ania Jastreboff, of the Yale School of Medicine, have teamed up to examine the biology of obesity, offering a new way forward.

    Their new book is “Enough: Your Health, Your Weight, and What It’s Like To Be Free” (‎to be published Jan. 13 by Avid Reader Press).

    Read an excerpt below, and don’t miss Jane Pauley’s interview with Winfrey and Jastreboff on “CBS Sunday Morning” January 11!

    “Enough: Your Health, Your Weight, and What It’s Like To Be Free”

    Prefer to listen? Audible has a 30-day free trial available right now.

    Enough Shame and Blame

    My patient Alice began experiencing self-blame in childhood. Her well-intentioned mom put her on diets when she was in her early teens. Even before that, she had started to develop what she eventually called the “self-hatred voice.” She vividly remembers when she was ten years old, sitting in the front yard with her legs bent, seeing the inside curvature of her leg and wanting it to be smaller. “This is the line where your muscle is, and on the inside is a curve. That’s the fat and the extra skin. I thought, ‘Oh, if I could just cut that off, then my leg would be perfect.’ I had a pen, and I drew the line where I thought my legs should be and where the fat should be cut off. I just knew that I was larger than I wanted to be.” Alice lived in Vermont at the time, and her mother had a garden where she grew all sorts of vegetables—lettuce, carrots, cucumbers. “I just remember eating salad, so much salad!” Alice recalls. At thirteen, she sat at the table, thinking, “Here’s a plate with three pieces of lettuce and a carrot,” and wondering how she was going to get through basketball practice or soccer without passing out or blowing the game for her teammates.

    A few years later, her mother put herself and Alice on a no-carb diet. “Atkins was kinda big,” Alice says. Her father and two younger brothers were exempt; it was only for the girls of the family. Which basically meant Alice and her mother were still eating everything from the garden, except no turnips, because turnips had “too many carbs.”

    After three days, Alice revolted. She reached for some crackers in the cupboard: “Mom, I just ate an entire sleeve of saltines!” Hearing this, her mother was not upset with her. Alice shared, “She was desperate for carbs, too, and ate three saltines herself. And then dutifully returned to her no-carb diet.”

    At sixteen, Alice started tracking her weight for sports. The self-hatred voice in her mind began to be very specific and explicit. “The cupcake you just ate—what is the number of calories in it? What is the number of carbs?” She described that it wouldn’t let up, not even for just one tiny-teeny bite. It was unrelenting.

    Fast-forward more than thirty years, and by the time Alice was nearly fifty, she had tried every diet and workout program under the sun: forty-seven of them, to be exact. Atkins, keto, South Beach, the Zone, low carb, no carb, ultra-low fat, liquid only, Jillian Michaels, Jane Fonda, Suzanne Somers, full-body HIIT workouts, gym memberships, a YMCA weight coach, DietBet, StepBet, a Mediterranean diet, a vegetarian diet, the raw food diet, intermittent fasting. She’d even tried hypnosis. She had three teenagers, a fulfilling job in communications, and a loving boyfriend. She struggled with obesity despite spending much of her adult life tracking every morsel of food, eating mostly healthful meals, and exercising every day. She had successfully lost weight countless times. That wasn’t the issue. The problem was that she always gained it back. She always blamed herself for having obesity. She did not know about the biology of obesity, yet.

    From “Enough: Your Health, Your Weight, and What It’s Like To Be Free” by Ania M. Jastreboff, M.D., Ph.D., and Oprah Winfrey. Copyright © 2025. Reprinted by permission of Simon & Schuster, Inc. All Rights Reserved.

    Get the book here:

    “Enough: Your Health, Your Weight, and What It’s Like To Be Free”

    Buy locally from Bookshop.org

    For more info:

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  • “Enough”: Oprah Winfrey on her weight-loss lessons

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    Our first question to Oprah Winfrey: “You always wear really beautiful clothes. Always have. And I wonder if it’s a joy to get dressed now?”

    “I can tell you what a joy it is to actually pack clothes that you know are gonna fit and you’re gonna feel good in them,” Winfrey replied. “I mean, it is a joy to get dressed. That is such a powerful first question, Jane Pauley, really!”

    Powerful is one of the superlatives befitting Oprah Winfrey, one of the best-known and most-admired people on the planet, and one of the richest. But for all her success, she seemed powerless against a weight problem, a deeply personal struggle she has waged publicly and openly. 

    In 1985, when her talk show, “AM Chicago,” was getting national attention, Oprah appeared on “The Tonight Show” with guest host Joan Rivers.

    “And I’m sitting there, and we’re toward the end of the interview, and Joan turns to me and, ‘So, tell me, you know, how’d you gain the weight?’” Oprah recalled. Her response? “I ate a lot.”

    “I was stunned in that moment, when I look back and I see that moment. But I left feeling humiliated and embarrassed, but not the least bit anger, not the least bit of anger or being upset about it,” she said.

    Why? “Because I thought, ‘She’s right.’”

    Jane Pauley interview Oprah Winfrey. 

    CBS News


    Over the next 40 years, Oprah would gain and lose hundreds of pounds. In the fall of 1988, after a strict four-month liquid diet, a new svelte Oprah appeared wearing size 10 Calvins, weighing 145, and pulling a wagon with 67 pounds of animal fat

    It was all back, plus 25 more, when she went to the Daytime Emmy Awards four years later. “And I go to the Emmys praying not to win, literally praying not to win, because I don’t want to have to get up out of my seat and have everybody watch me do that walk to the stage,” she said.

    She started over again the next day, working out with an on-call personal trainer this time. In 1994 she even ran a marathon.

    Oprah knew how to lose weight … she did it over and over. She says her body was seeking a range of 211 to 218. “So usually, by the time I would hit 211 when I first went on the diet for the wagon of fat and pulled out the wagon of fat, when I did my first marathon, once I get to 211, I go, ‘Oh, I gotta do something.’ But now I understand that the biology of me, which is different than the biology of you and everybody else – every body, all of us, has our own – but no matter what I did, no matter how hard I worked, no matter what, it was always trying to get my body back to 211.”

    Not because 211 is her ideal weight, but rather a “set point”: a genetically-influenced weight range. Oprah calls it the “enough point.”

    “Enough” is also the title of a new book she co-wrote with Dr. Ania Jastreboff from the Yale School of Medicine, who says, for most people, an enough point is “the weight that they kind of always gravitate to.”

    enough-cover-avid-reader-press-900.jpg

    Avid Reader Press


    So, to lose weight, you cut back on calories, and start craving high-fat food , or you eat less – but nothing changes. “Our body’s like, ‘Well, if you’re gonna eat less, then I’m gonna make you more efficient. I’m gonna make you burn less,’” said Jastreboff. “So what happens is, together, collectively, we end up eating more, and burning less.”

    “It’s the enemy within, which is in our brains,” I said. “So, now that we know what the problem is, the hormones that drive people, why don’t people just stop obeying it?”

    “That would be like trying to control something that is not in your control,” Jastreboff said. “That would be like holding your breath for the rest of your life. Every time somebody says, ‘Just eat less, move more,’ we’re asking our patients to control their biology and hold their breath. And it’s just not possible. And why would we do that? We don’t do that for any other disease.”

    And that’s what the American Medical Association says obesity is — a disease. A treatable disease. But the good news is that, if it’s a disease, it’s not your fault.

    “It’s not my fault, Jane! It’s not my fault,” Oprah said. “And I could weep right now, could weep right now. I’m not going to! But I could weep right now for all of the many days and nights I journaled about this being my fault, and why can’t I conquer this thing?”

    In the last decade, nearly a dozen weight management drugs have been approved for chronic weight management.  And for millions, drugs like GLP–1s are the answer to their prayers. Finally, a scientifically-supported, medically-approved weight-loss strategy that worked. And yet, Oprah resisted. “I was so motivated by shame that I felt I could not take the drug,” she said, “because if I took the drug – I, who had been the poster child for I can do it, I can do it, I can do it, willpower, willpower, let’s just get more willpower – if I couldn’t do it, then I would be shamed, and ashamed of myself for not being able to do it myself.”

    The medications don’t work for everyone, and some can’t tolerate side effects ranging from nausea to gallstones. But it’s been two years since Oprah finally started medication, and it’s working for her. She says she is now down to her marathon weight of 155. “And so, that’s it for me. I’m gonna just try to maintain,” she said.

    “Well done. Because I thought 160 was your goal weight?” I asked.

    “Yeah, yeah, it was,” Oprah said, “but as I continue to work out here the combination of the medication and hiking every day and resistance training has given me the body that I had when I was running a marathon. So, I was 40 and feeling really good, but to be able to be 71 and feel that I am in the best shape of my life feels better than it did when I was 40.”

    “I would submit that you would have been a phenomenal success, but I don’t think you would have become ‘Oprah’ if you hadn’t had the weight issue and been open about it and shared it,” I said.

    “Yeah. I would agree with that,” she said. “And that’s why I don’t have any regrets about it. There’s a wonderful spiritual, African American spiritual, called, ‘I Wouldn’t Take Nothing For My Journey Now.’ 

    I wouldn’t take nothing for my journey now
    for my journey now
    for my journey now
    I wouldn’t take nothing for my journey now.

    “I wouldn’t change the journey,” she said. “because I think the struggle with the weight actually helped me be more relatable and relate more to other people who were in their own struggles. But I’m glad now to be in a position where I feel the healthiest and strongest I have ever been.”

    READ AN EXCERPT: “Enough” by Dr. Ania Jastreboff and Oprah Winfrey

    jane-pauley-oprah-winfrey-golf-cart.jpg

    Jane and Oprah out for a ride. 

    CBS News


    “I feel free”

    Oprah Winfrey grew up riding on dirt roads. Now, on her sprawling Montecito estate near Santa Barbara, California, she owns the road.  She took me for a ride: “This used to belong to my neighbor,” Oprah said. “So, this is 23 acres. Her house used to be right there. We took this fence down, so this became my whole backyard, this.”

    Around here, all of the views are spectacular, especially the one looking back.

    Born in Mississippi in 1954, Oprah Winfrey was a teen beauty queen who became a local TV reporter in Nashville, and then an anchor in Baltimore. “The beautiful thing about my life was that I started out in local television, as you did,” Oprah said. “And when you start out locally, you get this, like, little teeny-tiny thing. But I failed. I failed in Baltimore.

    “They brought me in as a 22-year-old with an anchor guy, white-haired Jerry Turner, who was the most popular local anchor in the country, not just Baltimore. And he totally hated me. He resented me. He would do everything he could to condescend to me any way. I remember one time we were on the set and he said to me, ‘So, you’re from Mississippi? Can you name all the tributaries of the Mississippi River?’

    “And I was, like, ‘All the tributaries of the Mississippi River? No, I can’t.’ He goes, ‘Well, what school did you go to?’ ‘Well, I went to Tennessee State.’ ‘Was that an accredited school? So, you got a degree?’ I mean, that kind of thing. This is in-between the commercial breaks.”

    “Boy, that happened to me in Chicago,” I said. “Started in September, basically was taken off the late news in the spring.”

    Maybe we share a few things. I was a shy kid from Indiana who started as a local reporter in Indianapolis, and wound up on national TV – and Oprah was watching. “You were such an inspiration. I remember calling Gayle that morning, ‘Oh my God.’ It just, it was unbelievable.”

    “Well, that I inspired you!”

    But Oprah famously went on to build her worldwide media empire, and a following that some world leaders can only dream of. 

    I asked, “You have such power. Now that you are this woman undeterred by weight – ‘weight noise’ – what are you gonna do?”

    “That’s a beautiful question, but I don’t feel compelled to do anything,” Oprah replied. “I don’t know what it means actually, other than I feel free.”

    And what about her name being credibly bandied about for the presidency? “No, it’s not gonna happen,” she said. “What I really want to do is to continue to use who I am and what that represents as a force in the world, as a force for good, and to allow people to not let the noises of the world steal their joy.”

    “You are such a person of positivity!”

    “I am indeed,” she agreed.

    For all of her astonishing success, it seems that Oprah is still always aware of how far she’s come – how she became something so much bigger than television. “I have to say, there’s a wonderful poem by Countee Cullen called ‘Yet Do I Marvel.’ And I would have to say, yet do I marvel at that, myself,” she said.  

    “Sometimes in the early spring, the frogs are in the pond, and I can open the door and I can hear the frogs out at night. And it sounds just like Mississippi, being on the porch in Mississippi. But the distance from Mississippi to Montecito cannot be measured. It just cannot be measured. And I marvel at, how did this happen? How did it happen that I was able to navigate the waters of racism and sexism and misogynism and all the things that we had to endure? Yet do I marvel!”

    And marvelous, it is.

    I said, “We have little bits of things in common, I’m happy to say. Little bits of things.”

    “Yes. A lot,” Oprah said, “because we were women of this business at a time when it was really tough to be in this business. And now it’s become something else. It’s become something completely new.”

    “But both. It was a time that was tough to be a woman in the beginning. But boy, was the timing good!”

    “Boy, was the timing good! We made the best of it. Yes, we did.”

    jane-pauley-with-oprah-winfrey.jpg

    Jane Pauley with Oprah Winfrey. 

    CBS News


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  • Is Surgery Necessary to Reverse Diabetes? | NutritionFacts.org

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    Losing weight without rearranging your gastrointestinal anatomy carries advantages beyond just the lack of surgical risk.

    The surgical community objects to the characterization of bariatric surgery as internal jaw wiring and cutting into healthy organs just to discipline people’s behavior. They’ve even renamed it “metabolic surgery,” suggesting the anatomical rearrangements cause changes in digestive hormones that offer unique physiological benefits. As evidence, they point to the remarkable remission rates for type 2 diabetes.

    After bariatric surgery, about 50% of obese people with diabetes and 75% of “super-obese” diabetics go into remission, meaning they have normal blood sugar levels on a regular diet without any diabetes medication. The normalization of blood sugar can happen within days after the surgery. And 15 years after the surgery, 30% remained free from their diabetes, compared to a 7% remission rate in a nonsurgical control group. Are we sure it was the surgery, though?

    One of the most challenging parts of bariatric surgery is lifting the liver. Since obese individuals tend to have such large, fatty livers, there is a risk of liver injury and bleeding. An enlarged liver is one of the most common reasons a less invasive laparoscopic surgery can turn into a fully invasive open surgery, leaving the patient with a large belly scar, along with an increased risk of wound infections, complications, and recovery time. But lose even just 5% of your body weight, and your fatty liver may shrink by 10%. That’s why those awaiting bariatric surgery are put on a diet. After surgery, patients are typically placed on an extremely low-calorie liquid diet for weeks. Could their improvement in blood sugar levels just be from the caloric restriction, rather than some sort of surgical metabolic magic? Researchers decided to put it to the test.

    At a bariatric surgery clinic at the University of Texas, patients with type 2 diabetes scheduled for a gastric bypass volunteered to stay in the hospital for 10 days to follow the same extremely low-calorie diet—less than 500 calories a day—that they would be placed on before and after surgery, but without undergoing the procedure itself. After a few months, once they had regained the weight, the same patients then had the actual surgery and repeated their diet, matched day to day. This allowed researchers to compare the effects of caloric restriction with and without the surgical procedure—the same patients, the same diet, just with or without the surgery. If there were some sort of metabolic benefit to the anatomical rearrangement, the patients would have done better after the surgery, but, in some ways, they actually did worse.

    The caloric restriction alone resulted in similar improvements in blood sugar levels, pancreatic function, and insulin sensitivity, but several measures of diabetic control improved significantly more without the surgery. The surgery seemed to put them at a metabolic disadvantage.

    Caloric restriction works by first mobilizing fat out of the liver. Type 2 diabetes is thought to be caused by fat building up in the liver and spilling over into the pancreas. Everyone may have a “personal fat threshold” for the safe storage of excess fat. When that limit is exceeded, fat gets deposited in the liver, where it can cause insulin resistance. The liver may then offload some of the fat (in the form of a fat transport molecule called VLDL), which can then accumulate in the pancreas and kill off the cells that produce insulin. By the time diabetes is diagnosed, half of our insulin-producing cells may have been destroyed, as seen below and at 3:36 in my video Bariatric Surgery vs. Diet to Reverse Diabetes. Put people on a low-calorie diet, though, and this entire process can be reversed.

    A large enough calorie deficit can cause a profound drop in liver fat sufficient to resurrect liver insulin sensitivity within seven days. Keep it up, and the calorie deficit can decrease liver fat enough to help normalize pancreatic fat levels and function within just eight weeks. Once you drop below your personal fat threshold, you should then be able to resume normal caloric intake and still keep your diabetes at bay, as seen below and at 4:05 in my video. 

    The bottom line: Type 2 diabetes is reversible with weight loss, if you catch it early enough.

    Lose more than 30 pounds (13.6 kilograms), and nearly 90% of those who have had type 2 diabetes for less than four years can achieve non-diabetic blood sugar levels (suggesting diabetes remission), whereas it may only be reversible in 50% of those who’ve lived with the disease for eight or more years. That’s by losing weight with diet alone, though. For people with diabetes, losing more than twice as much weight with bariatric surgery, diabetes remission may only be around 75% of those who’ve had the disease for up to six years and only about 40% for those who’ve had diabetes longer, as seen below and at 4:41 in my video.

    Losing weight without surgery may offer other benefits as well. Individuals with diabetes who lose weight with diet alone can significantly improve markers of systemic inflammation, such as tumor necrosis factor, whereas levels significantly worsened when about the same amount of weight was lost from a gastric bypass.

    What about diabetic complications? One reason to avoid diabetes is to avoid its associated conditions, like blindness or kidney failure requiring dialysis. Reversing diabetes with bariatric surgery can improve kidney function, but, surprisingly, it may not prevent the occurrence or progression of diabetic vision loss—perhaps because bariatric surgery affects quantity but not necessarily quality when it comes to diet. This reminds me of a famous study published in The New England Journal of Medicine that randomized thousands of people with diabetes to an intensive lifestyle program focused on weight loss. Ten years in, the study was stopped prematurely because the participants weren’t living any longer or having any fewer heart attacks. This may be because they remained on the same heart-clogging diet but just in smaller portions.

    Doctor’s Note

    This is the third blog in a four-part series on bariatric surgery. If you missed the first two, check out The Mortality Rate of Bariatric Weight-Loss Surgery and The Complications of Bariatric Weight-Loss Surgery.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local library, or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

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    Michael Greger M.D. FACLM

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  • Wegovy is now available as a pill. Here’s what you need to know

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    (CNN) — Americans seeking to lose weight now have a new option – taking Wegovy as a daily pill, rather than a weekly injection.

    Patients with a prescription could obtain the starter 1.5 mg dose of the tablet as of Monday, with the higher doses becoming available by the end of the week, according to manufacturer Novo Nordisk.

    Being able to address obesity with a GLP-1 pill is a significant advance in weight management. Eli Lilly is expected to receive US Food and Drug Administration approval for its oral medication, which is called orforglipron until it receives a brand name, by summer.

    But the arrival of an oral option has also sparked a multitude of questions. Here’s what we know:

    Where can I get the Wegovy pill?

    The tablet form of Wegovy can be found at pharmacies, including CVS and Costco, certain telehealth providers, such as Ro and LifeMD and Weight Watchers, NovoCare Pharmacy, GoodRx and other locations.

    Will it be hard to find?

    While overwhelming demand led to initial shortages of the GLP-1 injections, Novo Nordisk said it is confident that it can meet the demand for the Wegovy tablet.

    The Danish drug maker noted that it has invested in its manufacturing capabilities for several years. The Wegovy pill is produced entirely in its North Carolina facilities.

    How much will the pill cost?

    The 1.5 mg starter dose of the pill costs $149 a month for patients who pay cash, as part of a recent deal Novo Nordisk made with the Trump administration. The 4 mg dose costs the same amount until April 15, after which the price will increase to $199.

    However, the 9 mg and 25 mg doses cost $299 a month.

    That compares to a $349 monthly price tag for the injectable version for self-pay consumers, though new patients can receive two months of the lowest two doses for $199 each until March.

    Patients whose insurance plans cover the drug for obesity could pay as little as $25 a month for the pill or injection under a savings program offered by Novo Nordisk.

    How is the pill different from the injection?

    The pill uses the same active ingredient, semaglutide, as the injection. They’re approved by the US Food and Drug Administration for the same groups of people: those with obesity, typically defined as having a body mass index of 30 or higher, and those with overweight, or a BMI of 27 or more along with a weight-related health issue such as high blood pressure.

    The main difference between the two is how you take them – as a daily pill versus a weekly shot. The pill also must be taken on an empty stomach, with a small amount of water and no other food, drink or medicines for at least 30 minutes.

    The medicine won’t be effective if patients don’t wait 30 minutes to give the tablet time to absorb, according to Novo Nordisk.

    How much weight could I lose?

    The Wegovy tablet and injection resulted in similar weight loss in clinical trials.

    The pill showed average weight loss of 14% over 64 weeks, compared with 2% for a placebo. The injection showed weight loss of 15% in its key trial, versus 2% for placebo.

    Eli Lilly’s orforglipron showed 11% weight loss over 72 weeks on its highest dose, compared with 2% for the placebo group. Zepbound, Eli Lilly’s injectable weight loss drug, showed weight loss of 21% on its highest dose, compared with 3% for those on a placebo.

    What are the side effects of the Wegovy pill?

    Like all medicines in the class known as GLP-1s, the Wegovy pill is also associated with side effects such as nausea, vomiting, constipation and diarrhea. The pill and injection had similar tolerability in clinical trials.

    Should I consider switching from the injection to the pill?

    That depends on your specific circumstances, doctors say. If you’re someone who’d prefer a daily pill to a weekly shot, and can deal with delaying food, drink and other medications for 30 minutes after taking the Wegovy pill, it might be the right choice. Others may prefer the simplicity of a weekly injection, if they don’t mind needles.

    Dr. Jorge Moreno, an obesity specialist with Yale Medicine, said a switch to the pill may be a consideration for people who’ve experienced more tolerability issues with the injections.

    “If patients have not tolerated the injection or are having a tough time going up on the dose, they may opt to switch to the Wegovy pill,” Moreno told CNN.

    Dr. Judith Korner, an endocrinologist and director of the Metabolic and Weight Control Center at Columbia University Vagelos College of Physicians and Surgeons, pointed out that the weekly injections might be “a bit longer-lasting,” and so any uncomfortable side effects patients experience “may last longer than if you take a pill” as well, where “if you really don’t like the way you feel you don’t take it the next day.”

    If you miss a dose of the pill, that dose should be skipped, and the next dose should be taken the following day.

    Both doctors emphasized that cost also plays a large role in decision-making.

    “Insurance coverage is still hard to predict at this point,” Moreno said. “I am hopeful with lower costs for the Wegovy pill, more insurances will opt to cover it.”

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    Tami Luhby, Meg Tirrell and CNN

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  • Novo Nordisk debuts Wegovy weight-loss pill in the U.S.

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    A pill form of weight-loss drug Wegovy, manufactured by Danish drugmaker Novo Nordisk, is now available in the U.S., giving Americans access to an oral medication to treat obesity.

    The starting dose of the daily Wegovy pill, at 1.5 milligrams, is now available for $149 per month for self-paying patients, Novo Nordisk announced on Monday. A 4 mg dose of the medication is available for the same price through April 15, after which the cost will rise to $199.

    Ed Cinca, senior vice president of marketing and patient solutions at Novo Nordisk, said in a statement that the new drug represents a “significant innovation,” describing it as the “first and only” GLP-1 pill for weight loss. 

    The Food and Drug Administration (FDA) approved the pill version of Wegovy in December. Competitor Eli Lilly’s obesity pill, orforglipron, is still being reviewed by the FDA.

    The Novo Nordisk pill contains 25 milligrams of semaglutide, the same ingredient in injectables Wegovy and Ozempic. It also has similar side effects as the injectable version of the medication, including nausea and diarrhea, according to Novo Nordisk. 

    The new Wegovy pill provides Americans an alternative, and more convenient, option than injectable treatments, which have dominated the weight-loss market since they were introduced. Roughly 1 in 8 Americans has used an injectable GLP-1 drug for weight loss or another condition, according to a recent survey from nonprofit group KFF. 

    Like the injectable version of Wegovy, the pill is intended to help patients shed body weight when coupled with diet and exercise. Novo Nordisk said that people who used the oral medication during phase 3 of clinical trials lost about 14% of their body weight, while those who stayed on the treatment lost about 17%.

    Edited by

    Alain Sherter

    The Associated Press

    contributed to this report.

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  • Jeremy Clarkson, 65, shares little-known side effect of ‘astonishing’ weight loss drugs

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    Jeremy Clarkson has revealed that the increasingly popular weight loss drug Mounjaro has helped him to lose three stone, but also shared some more surprising side-effects of the jab that are much less mentioned.

    In an interview with The Sun, he gave his fans an insight into the other impacts that the medication has had on him, which included not being quite so “quick-witted” and being “grumpier” and a diminished libido, though he confessed that he did not face some of the more common side effects such as constipation.

    © Amazon Studios
    Jeremy Clarkson presents the Amazon series Clarkson’s Farm

    He told the publication: “I find myself doing Hot Seat [Who Wants To Be A Millionaire?], thinking: ‘Oh [expletive], I should have said that, but too late now’. But who’s to say I wouldn’t have thought that when I wasn’t on [Mounjaro]?

    “Constipation? No, I don’t have that. Diminished libido? I’m 65, it’s hard to know what’s causing that. I’ll ask [my wife] Lisa when I get back home.”

    Recommended videoYou may also likeWATCH: Jeremy Clarkson shows off beautiful unseen corners of Diddly Squat Farm

    He also explained that he had lost weight over the course of six months thanks to the medication, though it has slowed down at the moment.

    The Clarkson’s Farm star added: “I’m nearer to [David] Gandy now than I was a year ago, in the same way that tectonic activity means that South America is moving closer to Australia – not by much. But I can go much further, I can take the dogs out for longer now, so it keeps her happy. I’m much healthier.”

    On another lesser-known side-effect, the 65-year-old shared that his feet have shrunk: “The shoes I was wearing last year are falling off me as I’m walking around. I think I might be the first person in the world to lose weight on my feet.”

    What is Mounjaro and what are the side effects?

    The once-a-week weight loss jab has been mentioned everywhere in the last year, drawing attention thanks to its promise of appetite suppression and weight reduction. However, as with any medication, it is crucial to understand the full picture.

    Mounjaro is the brand name for tizepatide, a drug that mimics two naturally occurring hormones in the body. Dr Angela Kwong, a GP with a special interest in obesity management, spoke to HELLO!, explaining to us that: “Mounjaro is approved in Australia for the treatment of type 2 diabetes, weight management in adults with obesity, or those with weight-related health conditions, and most recently, obstructive sleep apnoea in adults with obesity.”

    Woman using injection pen to administer weight loss drug -© Getty Images
    Weight loss medications are being used more and more

    Leading pharmacist Jason Murphy told us: “The active ingredient, tirzepatide, targets both GLP-1 and GIP receptors. That dual mechanism makes Mounjaro different from many other weight loss injections and helps deliver stronger appetite control and more effective weight loss results when used alongside diet and exercise.”

    As for the side effects, Dr Kwong explained to us that: “The most common side effects are gastrointestinal, nausea, vomiting, constipation, bloating, diarrhoea, and a reduced appetite. These tend to be mild and improve over time as your body adjusts to the medication.” The adjustment period for side effects varies between individuals, but subsides once your body gets used to the medication.

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    Josh Osman

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  • Bariatric Surgery: Risks in the OR and Beyond | NutritionFacts.org

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    The extent of risk from bariatric weight-loss surgery may depend on the skill of the surgeon.

    After sleeve gastrectomy and Roux-en-Y gastric bypass, the third most common bariatric procedure is a revision to fix a previous bariatric procedure, as you can see below and at 0:16 in my video The Complications of Bariatric Weight-Loss Surgery.

    Up to 25% of bariatric patients have to go back into the operating room for problems caused by their first bariatric surgery. Reoperations are even riskier, with up to 10 times the mortality rate, and there is “no guarantee of success.” Complications include leaks, fistulas, ulcers, strictures, erosions, obstructions, and severe acid reflux.

    The extent of risk may depend on the skill of the surgeon. In a study published in The New England Journal of Medicine, bariatric surgeons voluntarily submitted videos of themselves performing surgery to a panel of their peers for evaluation. Technical proficiency varied widely and was related to the rates of complications, hospital readmissions, reoperations, and death. Patients operated on by less competent surgeons suffered nearly three times the complications and five times the rate of death.

    “As with musicians or athletes, some surgeons may simply be more talented than others”—but practice may help make them perfect. Gastric bypass is such a complicated procedure that the learning curve may require 500 cases for a surgeon to master the procedure. Risk for complications appears to plateau after about 500 cases, with the lowest risk found among surgeons who had performed more than 600 bypasses. The odds of not making it out alive may be double under the knife of those who had performed less than 75 compared to more than 450, as seen below and at 1:47 in my video.

    So, if you do choose to undergo the operation, I’d recommend asking your surgeon how many procedures they’ve done, as well as choosing an accredited bariatric “Center of Excellence,” where surgical mortality appears to be two to three times lower than non-accredited institutions.

    It’s not always the surgeon’s fault, though. In a report entitled “The Dangers of Broccoli,” a surgeon described a case in which a woman went to an all-you-can-eat buffet three months after a gastric bypass operation. She chose really healthy foods—good for her!—but evidently forgot to chew. Her staples ruptured, and she ended up in the emergency room, then the operating room. They opened her up and found “full chunks of broccoli, whole lima beans, and other green leafy vegetables” inside her abdominal cavity. A cautionary tale to be sure, but perhaps one that’s less about chewing food better after surgery than about chewing better foods before surgery—to keep all your internal organs intact in the first place.

    Even if the surgical procedure goes perfectly, lifelong nutritional replacement and monitoring are required to avoid vitamin and mineral deficits. We’re talking about more than anemia, osteoporosis, or hair loss. Such deficits can cause full-blown cases of life-threatening deficiencies, such as beriberi, pellagra, kwashiorkor, and nerve damage that can manifest as vision loss years or even decades after surgery in the case of copper deficiency. Tragically, in reported cases of severe deficiency of a B vitamin called thiamine, nearly one in three patients progressed to permanent brain damage before the condition was caught.

    The malabsorption of nutrients is intentional for procedures like gastric bypass. By cutting out segments of the intestines, you can successfully impair the absorption of calories—at the expense of impairing the absorption of necessary nutrition. Even people who just undergo restrictive procedures like stomach stapling can be at risk for life-threatening nutrient deficiencies because of persistent vomiting. Vomiting is reported by up to 60% of patients after bariatric surgery due to “inappropriate eating behaviors.” (In other words, trying to eat normally.) The vomiting helps with weight loss, similar to the way a drug for alcoholics called Antabuse can be used to make them so violently ill after a drink that they eventually learn their lesson.

    “Dumping syndrome” can work the same way. A large percentage of gastric bypass patients can suffer from abdominal pain, diarrhea, nausea, bloating, fatigue, or palpitations after eating calorie-rich foods, as they bypass your stomach and dump straight into your intestines. As surgeons describe it, this is a feature, not a bug: “Dumping syndrome is an expected and desired part of the behavior modification caused by gastric bypass surgery; it can deter patients from consuming energy-dense food.

    Doctor’s Note

    This is the second in a four-part series on bariatric surgery. If you missed the first one, see The Mortality Rate of Bariatric Weight-Loss Surgery.

    Up next: Bariatric Surgery vs. Diet to Reverse Diabetes and How Sustainable Is the Weight Loss After Bariatric Surgery?.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local library, or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

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    Michael Greger M.D. FACLM

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  • Bariatric Weight-Loss Surgery and Mortality | NutritionFacts.org

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    Today, death rates after weight-loss surgery are considered to be “very low,” occurring in perhaps 1 in 300 to 1 in 500 patients on average.

    The treatment of obesity has long been stained by the snake-oil swindling of profiteers, hustlers, and quacks. Even the modern field of bariatric medicine (derived from the Greek word baros, meaning “weight”) is pervaded by an “insidious image of sleaze.” Beguiled by advertising for fairy tale magic bullets of rapid, effortless weight loss, people blame themselves for failing to manifest the miracle or imagine themselves metabolically broken. On the other end of the spectrum are overly pessimistic practitioners of the opinion that “people who are fat are born fat, and nothing much can be done about it.” The truth lies somewhere in between.

    The difficulty of curing obesity has been compared to learning a foreign language. It’s an achievement virtually anyone can attain with a sufficient investment of energies, “but it always takes a considerable amount of time and trouble.” And, of those who do stick with it, most will regain much of the weight lost. To me, this speaks to the difficulty, rather than the futility. It may take smokers an average of 30 attempts to finally kick the habit. Like quitting smoking, curing obesity is just something that has to be done. As the chair of the Association for the Study of Obesity put it, it doesn’t take “will power” to do essential tasks like getting up at night to feed a baby; it’s just something that has to be done.

    Our collective response doesn’t seem to match the rhetoric or reality. If obesity is such a “national crisis” reaching alarming proportions, dubbed by the post-9/11 Surgeon General as “every bit as devastating as terrorism,” why has our reaction been so tepid? For example, governments meekly suggest the food industry take “voluntary initiatives to restrict the marketing of less healthy food options to children….” Have we just given up and ceded control?

    Our timid response to the obesity epidemic is encapsulated by a national initiative promulgated by a Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council: the “small-changes approach.” Since “small changes are more feasible to achieve,” suggestions include “using mustard instead of mayonnaise” and “eating 1 rather than 2 doughnuts in the morning.” Seems a bit like bringing a butter knife to a gunfight. Proponents of the small-changes approach lament that, unlike other addictions—for example, alcohol, cocaine, gambling, or tobacco—we can’t counsel our obese patients to give up the addictive element completely, as “[n]o one can give up eating.” But just because we have to breathe, doesn’t mean it has to be through the end of a cigarette. And just because we have to eat doesn’t mean we have to eat junk.

    What about bringing a scalpel to the gunfight instead? The use of bariatric surgery has exploded from about 40,000 procedures noted in the first international survey in 1998 to hundreds of thousands performed now every year in the United States alone. The first technique that was developed, the intestinal bypass, involved carving out about 19 feet of intestines. More than 30,000 intestinal bypass operations were performed before we recognized “catastrophic” and “disastrous outcomes” resulted from these procedures. This included protein deficiency-induced liver disease, “which often progressed to liver failure and death.” This inauspicious start is remembered as “one of the dark blots in the history of surgery,” as I discuss in my video The Mortality Rate of Bariatric Weight-Loss Surgery.

    Today, death rates after bariatric surgery are considered “very low,” occurring on average in perhaps 1 in 300 to impacting 1 in 500 patients. The most common procedure is stomach stapling, also known as sleeve gastrectomy, in which most of the stomach is permanently removed. Only a narrow tube of the stomach is left so as to restrict how much food people can eat at any one time. It’s ironic that many patients choose bariatric surgery convinced that, “for them, ‘diets do not work,’” when, in reality, that’s all the surgery may be—an enforced diet. Bariatric surgery can be thought of as a form of internal jaw wiring.

    Gastric bypass, known as Roux-en-Y gastric bypass, is the second most common bariatric surgery. It combines restriction—stapling the stomach into a pouch smaller than a golf ball—with malabsorption by rearranging one’s anatomy to bypass the first part of the small intestine. It appears to be more effective than just cutting out most of the stomach, resulting in a loss of about 63% of excess weight compared to 53% with a gastric sleeve. But gastric bypass carries a greater risk of serious complications. Many are surprised to learn that new “surgical procedures…do not require premarket testing and approval by the Food and Drug Administration (FDA)” and are largely exempt from rigorous regulatory scrutiny.

    Doctor’s Note

    I didn’t know there wasn’t some kind of approval process for new surgical procedures!

    This is the first video in a four-part series on bariatric surgery. Coming up are:

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local public library or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

     

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    Michael Greger M.D. FACLM

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  • Christopher Schwarzenegger shows off his new buff body in flattering sweater after incredible weight loss transformation

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    Christopher Schwarzenegger showed off the major weight loss progress he’s made. Katherine Schwarzenegger shared a video of the family’s Christmas festivities in which Christopher, 27, was seen at the holiday dinner table wearing a fitted black sweater, dark grey pants and black leather sneakers. 

    In the hilarious video, Christina Schwarzenegger was seen hugging her brother-in-law Chris Pratt for the online “hug your brother-in-law challenge.” Check out the video below.

    Recommended videoYou may also likeChristopher Schwarzenegger shows off his new buff body after weight loss transformation

    Christopher previously opened up about his weight loss journey in May 2025, and he revealed during the Inaugural Beacher Vitality Happy & Healthy Summit, that it took him over five years to get to his goals, and that “it was a big process.” Overall, he has impressively shed over 100 pounds.

    © Getty Images
    Christopher has lost over 100 pounds

    The Director of Development at Indus Valley Media recalled that he became initially motivated to shed the weight after he went overseas and realized that his weight prevented him from crossing off his bucket list.

    The University of Michigan graduate shared: “I started in 2019, when I was living in Australia. I was on this big trip. I made it a big [deal] like, ‘Oh, I’m going to go out and do all this stuff, be in Australia,’ and I just saw how much my weight was prohibiting me from doing the everyday activities. I was like, ‘I want to go skydiving.’ And my friends were like, ‘Yeah, no shot.’ I was like, ‘Yeah, I can’t skydive.’”

    He started his weight loss journey in 2019© Getty Images
    He started his weight loss journey in 2019

    That moment inspired him to turn his life around by firstly giving up bread during lent, which is a Christian religious observance that lasts 40 days. He shared: “I lost 30 lbs. just through that.” He further explained that his weight loss success was “not an overnight thing.” Christopher continued to regularly incorporate strength training, hiking, and walking into his fitness routine.

    Christopher became dedicated to his fitness routine© Getty Images
    Christopher became dedicated to his fitness routine

    Despite Christopher’s success, he’s not done yet. He expressed: “It took a lot of trial and error, and even still to this day … when you’re saying, ‘oh, before and after photos’… I don’t feel like I’m an ‘after’ yet. I don’t feel like I’m at the point.”

    His father Arnold Schwarzenegger applauded Christopher’s continued dedication and discipline when it comes to his health.

    Arnold applauded Christopher's health journey© WireImage
    Arnold applauded Christopher’s health journey

    Arnold expressed: “I could never go and say to him, ‘you’re overweight.’ We just kept introducing healthy foods. We introduced him always to the gym and all of that kind of stuff. And then, out of nowhere, he decided that he wanted to be lean. And now he is. So that is of course fantastic, the self-discipline and the self-motivation. I always felt one day it will have to come from him—and it did,” per The Sunday Times.

    Christopher has put the work in and we look forward to cheering him on as he keeps getting closer to his personal weight loss goal.

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    Nova M Bajamonti

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  • 12/23: CBS Evening News

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    12/23: CBS Evening News – CBS News









































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    At least 2 killed in Pennsylvania nursing home explosion; California flooding threat grows as wildfire survivors face Christmas evacuation.

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