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STAT teamed up with Word In Black, a network of 10 Black news publishers, to report over the past year on the impact of new weight loss drugs on Black America.

When was the last time you thought about your weight?

If youre like most of us, it was probably today while getting dressed.

In the United States, youd think the greatest achievement in life is fitting into a smaller clothing size. We praise people for their efforts to lose weight, no matter the cost. And the societal obsession with weight loss has only gotten stronger with the arrival of Ozempic and a new wave of anti-obesity drugs. GLP-1 drugs started as treatments for type 2 diabetes and have since been approved for obesity and heart disease all chronic conditions more likely to affect Black Americans.

But to think about taking the expensive drugs means grappling with affordability and access, as well as centuries of oppression, systemic discrimination, and monitoring of Black bodies. Its not easy being Black and living in a larger body in a world that worships whiteness and thinness. So, we wanted to hear voices from the Black community about living in the age of Ozempic.

How do Black people feel about their health, the new obesity tools, and the relentless pressure to not be fat?

Word In Black and STAT surveyed and conducted extensive interviews with more than a dozen people nationwide. We wanted to get as many voices from the Black community as possible, but it became clear that the burden to lose weight falls far more often on women.

They spoke with brutal honesty as they shared their journey with weight loss, and their encounters with family and a medical system rooted in anti-Blackness.

Here are their stories in their own words, edited for brevity and clarity.

Sudi Kamose, Dundee, Fla., 33, teacher

I was at home and my moms co-worker came over and asked me what I wanted to be when I grew up. I said a model. She said, you cant do that unless you lose weight and then my mom agreed.

That has stuck with me since, and those dreams were gone because I kept gaining weight. That memory started everything I was 10. I struggled with disordered eating. Since age 11, I would go on diet after diet. It took me until, like, two years ago, to realize what I was doing was very disordered.

In 2020, I went to the doctor because my heart rate was high, and it was skipping a beat. The cardiologist said my heart was fine but that Im too large, and that its putting a strain on my heart. He said I needed to cut everything that I was eating in half. At this point, I was barely eating. I tried telling him my diet consisted of cereal he didnt believe me.

I told him I dont know what I should be eating. Im also on antidepressants. He said, it doesnt matter what you eat, you just have to cut everything in half. The cardiologist said, You cant be happy if youre overweight, I dont care what any of them say, theyre not happy.

That experience at the doctors office pushed me to be where I am now. He used my depression against me, and that was wrong. I never went back. I only got the courage to write a complaint in February of 2023.

Theres definitely a racial component to it. The way we as a society started to pathologize fat bodies or stigmatize them, is because its further away from whiteness. I think doctors need to recognize theres always been body diversity. And this is an issue because people are trying to profit off of our pain and our suffering.

The journey to being diagnosed with PCOS [polycystic ovary syndrome] was a very long one. I went to the doctor after I noticed I was gaining weight. I kept trying to lose weight and of course I wasnt believed. My diagnosis came when I had my period for three months straight. I did not want to go to the doctor because I was so afraid they were going to tell me it was my fault. Which happened anyway.

I finally went because I was bleeding so heavily, I could not work. I had to have someone come into my classroom so I could go and change my pad like every hour. Finally, I went to the gynecologist, and at 25 they diagnosed me with PCOS. Because of insulin resistance, that could be the cause of me gaining weight. And I realized it was not my fault, even though they kept telling me it was my fault.

It was a roller coaster of emotions, to lose weight and not lose weight. It really contributed to my depression, because its upsetting when you have a goal and everybody in the world is telling you, you are wrong for existing the way you are. And youre trying to change it but its not changing.

Moving forward, Im learning to dismantle my own internalized fatphobia and continue accepting myself. I still struggle with my ideal body type and what that would look like. My end goal is to understand that despite what body I reside in, I am still worthy of pursuing happiness, joy, and having fun.

Alishia McCullough, formerly of Carolina Shores, N.C., 29, licensed clinical psychotherapist

As a teenager, I dealt with a lot of restrictive eating. Sometimes it would mean eating a can of fruit a day or grabbing snacks throughout the day. I didnt have a lot of education or awareness about my body.

At that time, I would hear negative connotations about Black food, being labeled unhealthy or unclean. I started to internalize those messages and thought the way my family cooks and eats isnt acceptable. So I followed very rigid and restrictive diets as a way to modify my body the ideal was to be thin.

Now, Im so much more intentional about how I respond to my body. I dont look at food as good or bad. More so, what does my body need to feel nourished?

It wasnt until I got into graduate school where I learned the term eating disorder I could resonate with that experience. In grad school, I interned at a counseling center where I started to help lead their eating disorder support groups. But I noticed the training was through a white lens. I had to work with clients with a diverse background to learn that the BIPOC experience is different.

The medical field uses BMI to equate weight with health. But theres lots of research to show that BMI is a made-up construction the purpose was to see what the average white man looks like. That instrument got adapted into mainstream society, when insurance companies figured out they can use it as a way to increase peoples premiums, recommend weight loss surgeries and medications and quite honestly discriminate against certain patients.

In my household, we grew up watching My 600-Pound Life or The Biggest Loser, with constant messages from the media showing that fatness is bad, fatness is disgusting. The premise of these shows is this idea that these people are thin, lovable, desirable people within a fat body. And if you can burn off all the fat, you can uncover the person within.

A lot of our bias is coming from these media messages. When people say youre fatter and more likely to have chronic illness, I challenge back and say, do thin people also not experience chronic illness?

The way we define health is so limited. Our mental health and stress go into our health concerns. Were seeing higher rates of health issues in Black communities but a big part of it could be that we have been exposed to so much chronic stress over time, that its manifested into health issues that we dont see in other communities. I think it is a result of living in these very racially high-stress environments, and its been passed through generations. When we look at health, it does need to be more expansive healing our culture systemically and culturally can play a big piece too.

Its not actually the fat itself that makes people unhealthy. A lot of times its the fatphobia and weight stigma they experience when they go to a health care provider. If folks go to their provider and know theyre gonna say all these negative things about their body, they are less likely to see a medical provider.

Ive heard so many stories of folks being dismissed because a provider blamed everything on a persons weight.

Fatness was not labeled as unhealthy or bad until Black folks were enslaved. Body size became a way of creating a culture of hierarchy around human worthiness. And it became this whole messaging around Black people being gluttonous, or promiscuous, and all these things associated with the Black body.

Our medical system could benefit from seeing people as experts on their body.

As Black women, theres so many layers in our relationship to our bodies. On one hand were lifted up as the standard, we see that with the [Brazilian butt lift]culture, and on the other hand, were being degraded and hypersexualized.

One of the things diet cultures promote is thinness at all costs. Youd rather be thin and dead than another size and alive.

Jonathan Gustave, Orlando, Fla., 38, licensed marriage and family therapist

Ive been overweight my entire life. As I got older, I realized that losing weight had a lot to do with how I saw myself. I felt that if I didnt lose weight, Id be less than a person and less than acceptable in society.

My relationship with food has been very terrible. As a child, my father abandoned my mother and I, in a cold basement of Chicago. Then, my mother disowned me, she left me in the hands of my grandparents, she never came back for me.

And my grandmother suffered with a lot of depression after my grandfather passed away when I was 5 years old. There was a lot of abandonment and neglect in my life from the time I was born, until I got married and had my own family.

Ive learned that every single human being desires connection, in some way. So, in the times that I was bored, lonely, and frustrated as a child, I found comfort and connection with food. It just became a crutch for me, because of the lack of connection that I had with family members.

I was recently diagnosed with type 2 diabetes in August 2023, and I was forced to change my diet. I also have more love in my life my wife and my kids. So, I do my best to connect with them, so that I dont seek that connection and comfort from food. But its difficult because Ive been operating like this for 37 years.

Funnily enough, people have never said that I was overweight. But thats because Im 6 feet 8 inches, my weight now is like 335. My weight has fluctuated from 320 to 365 throughout my adult life.

My primary care physician suggested that I get on Ozempic. Now that Im type 2 diabetic, if I stay in this range, the cascade effects of losing a toe, foot, going on dialysis, and kidney failure has me more focused on my body being healthier.

Tigress Osborn, Phoenix, Texas, 49, executive director of the National Association to Advance Fat Acceptance

Theres an increasing discussion around the idea that obesity is, in the words of obesity experts, a complicated chronic disease. There are many people who are resistant to the framing of obesity as a disease, and its not because we are in denial about whether there are health impacts of being in a larger body. Its because we are resistant to our bodies being inherently pathologized, medicalized, and classified as a problem.

The only way obesity is classified as a disease is through correlation with other diseases. Some of those same diseases correlate with Blackness.

A lot of Black folks are bigger because we have different body types that werent taken into account when we created these standards of how we designate body types. These huge capitalist entities are increasingly seeing Black folks as a market. As a fat liberationist, my perspective is that anti-fatness is a much more serious problem for Black and brown folks than being fat.

When I think of fatness, its just a kind of human diversity.

Anti-fatness is a form of systemic discrimination its pervasive and insidious. One of the systemic injustices is the medicalization of fat.

So, what I want is for people of all sizes to have true body autonomy. Where we are presented with research that starts from a neutral perspective.

One of the challenges when we are talking about weight loss drugs is that we are talking about them as the end of fatness. Its all over the media, Ozempic, Ozempic, Ozempic. And the chorus behind that is, so why are you still fat?

People are still fat because even if they take these drugs, fat people are still gonna be fat. If I lose 20% of my body weight right now, Im still going to be a visibly fat person. Im not going to turn into Beyonc by taking Ozempic, even if I take it for the rest of my life.

Culturally, weve been waiting for magic. And we like the narrative that magic has arrived. But those of us who are more suspicious of that narrative may be more cautious in relation to our health choices and may choose never to opt into these drugs.

Novo Nordisk has never had my best interest at heart. The idea that we can undo the social or systemic pieces, by asking individual fat people to lose weight, is preposterous. Injustice should not be solved by asking the people who are subject to the injustice to change themselves.

Im a pretty confident fat girl. Im middle-aged, disabled, fat, and Black there is no cultural preferencing of me in the world. Ive learned to self-advocate for myself and Im willing to. We want to build a world where people dont have to advocate for themselves because were all advocating for each other at a community level.

I am aware of the days that I am unhappy in my body. Its hard to live in a fat disabled body. I celebrate my body a lot, but Id be lying if I said there were never moments where I think it would be easier if I had some other body. But I dont have that as a permanent mentality the way many people do.

The reason I feel like that is because the world is terrible to this body. I want the world to treat me better as an individual in my body and everyone better in that way.

I am concerned that we as a community buy into these oversimplified health narratives like soul food makes all Black people unhealthy, but is it though, or is it racism?

Timothy Conley, Los Angeles, 46, department chair of cinema and film at California College of ASU

When I was a child, I was bullied. My family has a way of saying things that can be hurtful. Even my own relatives made fun of my weight when I was a kid. I was sad and I felt like the only friend I had was food. I started gaining weight in elementary school.

Around 2007 and 2008, I lost 123 pounds. I was eating six meals a day like a bodybuilder. I was in pretty good physical shape, but I was not in a good emotional shape.

A lot of it was ego driven. Someone bet me that I couldnt get down to a certain weight. Off of that bet, I was determined to get down to that weight. The problem was there were no healthy mental, emotional habits as I began to lose weight, I was just determined to prove people wrong.

So, I ended up gaining all that weight back, and more. I became a type 2 diabetic in 2012.

I was completely depressed. Growing up in the Black community, there was no promotion of seeking therapy, or other pathways outside of the Black church. What happens after church on a Sunday? Mac and cheese, fried chicken, barbecue ribs, greens, cakes, and pies that was not a place I could go to for health and wellness.

I have been as heavy as 422 pounds and as lean as 250 pounds. Even when I weighed more than 400 pounds, because of my height of 6 feet 6 inches, and being an ex-athlete, I dont look like an obese person, I look like a large ex-football player.

My relationship with food has been like a rough marriage that needs counseling. I love food, but then I hate food. Im addicted to fast food.

I used to be the guy that at 1 a.m., Im go through the Jack in the Box drive-thru and load up on the $1 menu. I would eat all that food and somehow go to sleep after.

I used food as a coping mechanism, like some people use alcohol or drugs.

I looked forward to the sensation, the taste of refined sugar and processed crap. I tried going to Overeaters Anonymous; that didnt last very long, because I wasnt really connecting with anybody. There were no Black folks in there, it was a bunch of white folks in a room.

Now, I am an advocate of mental health support, especially in the Black community. Personally, I think that every human being on this planet should have somebody to talk to, that is not a relative or a loved one. The problem is the medical industry has made this unaffordable or really hard to access.

Before going to therapy, I used to say I hate you in the mirror. Even when I lost all that weight I hate you.

Sixteen years since thats happened, Ive done a lot of work. Now my practice is being mindful. I use positive affirmations for myself and tell myself that its going to be OK and that youre loved. And loving myself regardless of what size Im at because you got one shot at this thing called life, in this body, and youve got to make the most of it.

Ozempic was a suggestion from my doctor to get my A1C blood sugar levels down. The challenge with Ozempic is Im not really hungry, so I have to remind myself to eat.

I started Ozempic in the middle of October. Ive had issues with diarrhea and nausea, and some stomach pain when Im eating certain foods. My doctor didnt give me a time frame he said its either Ozempic or surgery. Its a big industry to keep people on drugs, and Ozempic is making a lot of money.

Im hopeful that itll be worth it. Im at an age now, where a lot of folks that look like me start passing away as they enter their 50s. I do have my concerns because I know the medical industry makes a lot of money especially off of the Black and brown community.

DJ Rock, Brooklyn, N.Y., 28, fitness instructor

Ever since I started my transition and gone on estrogen hormones, weight distributes differently. Its more difficult for me to put off weight. In the past few years, Ive seen a lot of weight gain, a rapid transformation in my body. That has taken a while to get used to.

In some ways, gaining weight has been really exciting. I feel like I have an ass now. Ive talked to other trans women about the way our bodies and muscles work is just so different now than it used to be. That brings up anxiety.

Ive had some surgeries to feel better in my body, and part of that has been a fat transfer from my stomach to my hips.

There are some things that all women experience, which is societal pressure to look a certain way. For trans people in particular, there are concerns with my body for safety reasons. As a Black trans woman, I do feel safer after having gender-affirming surgeries because of my ability to not get outed when I walk down the street.

Ive connected transness, weight loss, and my fitness journey as like this loss of control. You just kind of get on hormones because I want to look a certain way, but I have to wait and see what happens with my body. Its kind of scary.

Most gym people fall into this cycle of bulking and cutting. For me, its constantly a challenge. I lose some weight and my stomach looks flatter and Im feeling good, but then my ass looks smaller. Then I want to gain weight and grow my ass back.

Ive never tried weight loss supplements. As a fitness instructor, Ozempic feels like cheating.

I dont think its cheating for everyone. I would never blame or fault someone for being on Ozempic. I would support my clients if they decided that was best for them. For me, it feels like I cant do it.

As a woman, I think about my body way more than I ever did before. Also, as someone who is always on display as a fitness instructor. Once I had gender-affirming surgery it felt like this is the body Im supposed to be in. In a weird way, thinking of my weight is gender euphoric because I really am a Black woman.

Paige Booker, San Diego, 34, IT supervisor

I ended up ballooning towards the end of college. I didnt realize I had gotten so much bigger until I saw my photos from my wedding. When I saw the pictures, I was like, Oh, my goodness, who is this?

Ive talked about this in therapy a little bit: When I was younger, I remember sneaking food in my room. As an adult, Ive come to realize Im an emotional eater.

Even when I was much smaller, growing up in the South, I had what we call a frog in my arm.

Im not supposed to be in this large body. It did not always used to be this way. I need to do what I can, to make it a body that Im proud of. What I found works for me is tracking my food, because I didnt know how much I was or wasnt eating. Most of the time, Im looking at the number on the scale, but Im into checking in more with how I feel. Ive tried a lot of different exercises like CrossFit, strength training, cardio boxing, HIIT, tennis, and hiking to see what sticks.

I feel like weight loss culture is ingrained in Black women. Theres always this need or feeling to be whatever is trending at the time. That changes, which makes it harder to always love who you are and celebrate your own uniqueness. I think about how many Black women I know who use waist trainers, or drink detox teas.

Especially if you have something special coming up, theres this need to put it all into overdrive. We deprive ourselves in order to be rewarded with a good time. Which is really sucky.

For all the things that have been said to me about my body, my husband has been a huge help as well. Hes like a cheerleader hes always complimented my body; hes never made me feel negatively about my body. While I have external sources that say, do better and be smaller, I also have my own voice and the voice closest to me thats saying youre doing good.

Joycelyn Terri Turner, Desoto, Texas, 59, corporate trainer

I gained weight in adulthood; after my only brother was killed in a car wreck when I was 29. I was very comfortable and happy in my body until my brother was killed. Ive always been a foodie after he died, food was my comforter. Food was always there if I didnt have anyone to talk to. It was there when I got home from work and when I woke up in the morning.

I went through a periodic succession of losses. My father died in 1990. My brother died in 1994. My mother died in 2003. In 2008, 2011, and 2019 I lost three very close girlfriends who were like sisters to me.

When I recognized I had a problem, it was about 10 years after my brothers death. From 1994 to 2015, I gained 140 pounds. I had gone through diets, fitness clubs, exercising on my own, and with friends. But in 2015, I made the decision to get gastric sleeve surgery. Once I had the surgery, I lost 95 pounds within six to seven months. Since then, Ive kept off 90 of the 95 pounds.

Growing up, I was always on the thin side. And I had a very positive self-image. As I gained weight, it was interesting to see the different treatment I received from people. That was new for me, not shocking, but surprising. When I was smaller, guys readily opened doors, but when youre a big girl, theyre not tryna open the door.

Im not nearly as confident walking into a room as I was, when I was smaller. As a smaller person, my attitude is very open and joyful. As a bigger person, Im much more reserved I dont like that because thats not who I am.

I would say for the past 10 years, its been hard for me to warm up to people, because Ive had so many losses. Im afraid to feel. As far as my psyche goes, Im coming to grips that Im a survivor. And my body is going to be what my body is going to be.

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Black voices, Black bodies: Life in the age of Ozempic - STAT

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Ozempic is no laughing matter for the comedian. Handler revealed her "anti-aging doctor" prescribed the medication without her realizing what the drug was.

"I didn't even know I was on it," she said during the Jan. 25, 2023 episode ofCall Her Daddy. "She said, 'If you ever want to drop five pounds,this is good.'"

But while she tried the drug, Handler noted that she didn't like how it made her feel.

"I came back from a vacation and I injected myself with it," she recalled. "I went to lunch with a girlfriend a few days later, and she was like, 'I'm not really eating anything. I'm so nauseous, I'm on Ozempic.' And I was like, 'I'm kind of nauseous too.' But I had just come back from Spain and was jet-lagged."

Ultimately, Handler stopped using the drugbecause it wasn't medically necessary for her, adding thatshe gave away the remaining doses to friends.

"I've injected about four or five of my friends with Ozempic, because I realized I didn't want to use it because it was silly," she said. "It's for heavy people. I have people coming over to my house, and I'm like, 'OK, I can see you at 1, I can see you at 2.'"

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Why Real Housewives of Dubai's Caroline Stanbury Used Ozempic During "Midlife Crisis" - E! NEWS

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A mum whose shock shopping trip inspired a weight loss transformation has revealed how she managed to shed almost four and a half stone.

Emma Vyse decided she needed to change her lifestyle habits for good upon realising she was a dress size 22 while out looking for new clothes.

The mum had not long jet off to Turkey where she sadly felt self-conscious about her weight only wore oversized clothing.

READ MORE: Mum unrecognisable after seven stone weight loss - this is how she did it

Though her size was affecting her mentally, the mum also struggled lifting heavy items at work and feared she would one day develop diabetes. Thats when the 38-year-old made the decision to sign up to Greater Manchester and Cheshire slimming group Beeweighed in September 2023.

By watching her calorie intake and exercising, Emma, who has a six-year-old daughter Olivia and three step children, watched as the pounds fell off. Previously tipping the scales at 16st 3.5lbs, her motivation has seen her drop down to 11st 12lbs a total loss of 4st 5.5lbs.

The mum, who is now a dress size 14, says the main key to her weight loss success is intermittent fasting, which sees her only eat between the hours of midday and 8pm.

Intermittent fasting is an eating pattern that may benefit heart health, reduce inflammation, improve cell repair processes, and help burn fat. The idea behind intermittent fasting is that it gives the body a break from digesting food, which can potentially lead to a lower calorie intake than someone who eats regularly.

Emma, who lives in Crewe, Cheshire, told the Manchester Evening News: My dad is diabetic and I didnt want it. I also felt embarrassed when I went shopping. I exercise including spin classes and invested in a walking pad. I also bike to work. I fast between midday and 8pm so I only eat between those hours. Im feeling a lot more confident and I have more energy.

Emma, who could order takeaways including Chinese food or a kebab twice a week, feared she would develop diabetes with the condition running in her family.

She puts her weight gain down to snacking on chocolate at work and eating late at night while already feeling full.

Im very proud, she added. I couldnt have done it without Beeweighed or my leader Vanessa. Its a lifestyle choice, not a diet I think. My husband is very supportive too.

Lynda Leadbetter, owner of Greater Manchester and Cheshire group Beeweighed, which offers national online classes, said: Emma is smashing her weight loss goals and is loving the meetings that are held by my amazing leader Vanessa. Vanessa says shes a big part of the groups and shes really proud of her.

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Mum who shed almost four and a half stone shares secret key to weight loss success - Yahoo News UK

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Emily Lankiewicz

In 1918, Lulu Hunt Petersone of the first women in America to earn a medical doctoratepublished the best seller Diet and Health With Key to the Calories, makinga name for herself as an apostle for weight reduction in an era when malnutrition was a far greater public health threat than obesity. She pioneered the idea of measuring food intake via the calorie, which at the time was an obscure unit of measurement familiar only to chemists.

A century later, the Centers for Disease Control and Prevention reports that 42 percent of American adults are clinically obese and that Type 2 diabetes is on the rise. With those who can afford it now turning to pharmaceuticals to help them lose weight, well examine why and how calorie counting has failed to help Americans maintain a healthy weight.

In this episode of Theres More to That, we hear from food historian Michelle Stacey about Peters legacyand from Ronald Young Jr., creator and host of the critically acclaimed podcast Weight For It, about how American society continues to stigmatize what he calls fat folks for reasons that have nothing to do with public, or even individual, health.

A transcript is below. To subscribe to Theres More to That, and to listen to past episodes on the complex legacy of Sojourner Truth, how Joan Baez opened the door for Taylor Swift, how machine learning is helping archeologists to read scrolls buried by the eruption of Mount Vesuvius nearly 2,000 years ago and more, find us on Apple Podcasts, Spotify or wherever you get your podcasts.

Chris Klimek: Michelle Stacey is an author and Smithsonian contributor who writes about the history of the American diet.

Michelle Stacey: Ive written about food and food in America for years, and we have a long history of food fad-ism.

Klimek: She says that diet crazes are uniquely American.

Stacey: I mean, even back in the 19th century there were crazy fads. There was one thing that was called Fletcherizing, and it was the idea that you had to chew every mouthful of food hundreds of times, which is grotesque when you think about it. Most of the rest of the world really thought about food as first of all sustenance, but also largely pleasure, tradition, joy, sharing, and Americans have long wanted to discount that part of the equation.

Klimek: Michelle says that a big part of this is Americas fixation on the calorie, a unit of energy that somewhat nonsensically became the center of our food and diet world, but it didnt really have to be that way.

Stacey: Our national way of looking at it is very numbers-oriented and very control-oriented. I was researching the history of the calorie, and I had an old diet book Id picked up years ago, and I was flipping through it, and this little pamphlet fell out, and it was by Lulu Hunt Peters, and it was literally printed in 1929.

Klimek: When it comes to diet fads in America, movements have come and gone. Right now, Ozempic is the new craze, but Michelle says it all goes back to this woman named Lulu Hunt Peters. Shes the person who got America obsessed with calorie counting, but not without her own flair for personal branding, as Michelle could see in this pamphlet.

Stacey: It was called Reducing and Gaining, and in parentheses it said, Petersizing. And I thought, Wow, this womanshes a marketer. And it was like a sign to me that I had to write more about her. She was such a character. I really wish I could have met her. Her personality just leaps off the page in a very modern way. She was very well known in her time. She was a phenomenon. She wrote the first diet best seller ever, and then it stayed on the best-seller list for five years in the early 1920s, which was amazing. And hardly anybody knows who she is now.

Klimek: From Smithsonian magazine and PRX Productions, this is Theres More to That, the show where if youre listening to this now, we think you look great just the way you are. On this episode, find out how America got hooked on calorie counting, and why the system continues to endure. Im Chris Klimek.

Klimek: Michelle Stacey recently wrote a feature about Lulu Hunt Peters for Smithsonian magazine. We began our conversation by talking about Peters origins.

Stacey: She was born in New England. She went to college, a teaching college, which is what young women did around the turn of the last century. At some point she moved to California and became a doctor, got her medical degree in 1909, one of a tiny percentage of doctors at the time who were female. She was very active in all kinds of medical groups in Southern California in the 1910s and really very prominent in that world. She was the female head of the pathology lab at Los Angeles Hospital, stuff like that. But what she really wanted to be known for was that she had lost 70 pounds. She had been 220 pounds, and she ended up at 150, which by the way was not where she wanted to end up. She wanted to [weigh] even less, and she decided that the method that she had found everybody should know about. She was almost like a proselytizer for the calorie, and for calorie counting.

Klimek: So more than the fact that she was one of the first women to become a medical doctor in the United States, it was her dramatic weight loss that she wanted people to know about.

Stacey: Yeah, absolutely. It was her greatest triumph, the way she writes about it. She wrote in her book about how when she got her first jobs in medicine at the hospital, she was still so fat, and she felt like she should have repaid some of her salary because she couldnt have been that good a worker if she was so fat then.

Klimek: Wow.

Stacey: Yeah, very judgmental! And the funny thing about her is when she writes about weight and diet and the calorie, which is her obsession, she is so open. She will tell you how she hated herself when she was fat and how she goes crazy for candied nuts and eats 4,000 calories at one time, but the rest of her life is a real secret.

Klimek: Do we know what her personal story behind her weight loss was?

Stacey: Well, after the book came out, she ended up writing a syndicated newspaper column for years, and the title of one of her columns was A Disgrace to Be Fat. And she felt like this was completely a personal choice. You could be fat or you could be not fat. So when she learned about the calorie, which was a very new concept at that time, mostly it was something that scientists and chemists knew about, and it was something that was being discussed as a way to figure out: Whats the perfect diet for humans? How can you eat just the right amount for the least amount of money? That was the approach. She came across it in medical school and she learned about the calorie and flipped it around. She thought, Well, if its good for fighting hunger, then what about if youre fat? Maybe its good for getting rid of extra weight.

So she used these brand-new calorie charts to make herself eat between 1,000 and 1,200 calories a day, which is very low, and the weight just kept coming off, and she lived that way the rest of her life. And then she felt like this was her mission, and she would write about it with such fervor. She would address her readers as if they were sitting in the room with her and say, I know you dont want to be fat. I know youve tried to lose weight for years. I was the same way, and it can be done. She would speak almost like a minister. She would say things like, Verily only food maketh fat. And Yea, I will save you even as I saved myself, I will save you. And she got this huge following. People would write letters to her when she was doing the newspaper column, and she would write back to them in her column and say, Mary, Im so proud of you. Youve lost 20 pounds. I know you can do more.

Klimek: So how did Dr. Peters popularize the calorie?

Stacey: First, she started giving lectures, and then she wrote this book. It came out in 1918. Again, she was a great marketer, and the first thing she did was she serialized the book in a newspaper before the book came out. So it really raised its profile and it was well reviewed, and people were talking about it as this new way of thinking about food that was so cool. And then the first World War ended, and she ended up going to the Balkans for two years on a Red Cross journey, and she came back, and her book had been selling like crazy. So her publisher said, Well, why dont you write a new chapter at the end, and well reissue it? And then it just built from there. I think the first year she was on the best-seller list was 1922. The extra chapter she did was so funny because it was all about how she gained all this weight and she was in the Red Cross because she ignored her own teachings and she thought, Oh, Im working so hard and Im riding donkeys over rough trails, and so I can eat whatever I want.

And then she finally gets in front of a full-length mirror for the first time in months and shes like, Oh, my God, and starts starving herself again. Her struggle with weight was a huge part of the story that she was telling.

Klimek: Who was Dr. Peters book popular among?

Stacey: Women.

Klimek: Okay, women, all right. Tell me more.

Stacey: I mean, women were the ones who were writing to her. They were the ones who were engaging with her, and its not like there werent some men out there who wanted to lose weight. Every now and then in her book shell mention men, but it is really about women, and it was women who were just snapping up the book right and left and reading her newspaper column.

Klimek: What is the tone of the book overall?

Stacey: Its hard to describe. Its so unusual. Whats so funny in her book is that she had her 10-year-old nephew, who she called the little rascal, do all these little stick-figure drawings throughout the book. Theyre so funny. I mean, it was just part of her folksy approach. I mean, its really like having a conversation with her. But, no, her whole message is, You can do this, you can do this, absolutely. Anybody can do this if you just count your calories, and it doesnt matter which foods youre eating, all that matters is the number of calories.

One historian that I talked to about Lulu said that at that time and writing from the point of view that she was writing, which is, Ive been there, Ive done this, I know it can be done, she felt it gave her a pass to be I mean, this historian used the word bigotry, to just be bigoted about fat people. And she makes up derogatory names, silly names like Mrs. Sheesasite and Mrs. Tiny Weyaton and stuff. And yet people, they didnt take it personally, I guess. They felt like, Well, I dont want to weigh a ton. Every chapter ends on a now Im going to tell you how to do it tone. But, yeah, the way she talks would be so unacceptable today. But the thing that strikes me in thinking about her is that were still very, very judgmental about weight. We just dont admit to it as easily.

There was an article in the Economist in the last year or two, and it was about the economics of slenderness, especially with women much more than with men. Literally, you will earn more money if you are not fat. We are still penalizing being heavy even while the majority of Americans now qualify as overweight. But its very hard for people to change their weight. And it is possible, but counting calories has been studied and tested for decades and very rarely leads to permanent weight loss.

The story of dieting for weight loss over the last century, which has really, since its been a thing, is that when it fails, the dieter is always blamed, and she blames herself or he blames himself. And, in fact, our government guides have been telling us for decades that its our fault. The calories are the biggest count on the nutrition label, and all of the dictums from the USDA over the last few decades, many people feel very misguided to cut fat, to not worry about carbs. And, in fact, weve seen a huge surge in obesity since they started giving that message. Again, its not working. But people tend to blame themselves.

Klimek: To pull back a little bit here, what is a calorie? What is it actually measuring?

Stacey: Its measuring heat. Various Europeans have been circling around this, but its generally credited to Nicolas Clment, a French chemist and physicist. At least he seems to be the first one to mention it in scholarly articles [in the 1820s]. And it was actuallyyou cant really say inventeddefined, I suppose, having nothing to do with food. It had to do with steam engines. And the early researchers wanted to have a measure of how much fuel it took to produce X amount of energy. And so what it measures is how much fuel it takes to raise a certain amount of water one degree.

And very early on after it was defined, more European researchers, and these were mostly in Germany, started saying, Well, our bodies are kind of machines. Food is our fuel like our coal that makes the steam, and it runs our body and it heats our body. So these researchers started measuring foods. They would set it on fire, basically, and see how long it took to raise this amount of water by one degree centigrade. And they started assigning values to all these different foods based on how they incinerate.

Klimek: They are burning foodstuffs and measuring the resulting temperature of water around it?

Stacey: Yeah, theyre putting food in a little incinerator thing. It was called a calorimeter. And then they started creating these things called respiration calorimeters, which are when you put an animal or ultimately a human into this chamber where everything is regulated, and theyre measuring what goes in, what comes out, oxygen, carbon dioxide, but also what food is going in, what food is being excreted. I mean, these were experiments where they would weigh feces. And what that was looking at was what happens to this food when its in the body? And so they got more refined about what a piece of bread was worth in calories.

Klimek: So are calories an effective way of measuring what we eat?

Stacey: Yes and no. I mean, when I tell people the calories dont count, and people say, What? I count my calories all the time, people still do this all the time, they count in a macro way. If you eat 10,000 calories worth of food for a period of time, you will gain weight. And if you cut your calories way back for a period of time, you will lose weight. But its not the whole story at all, which is why many calorie-restrictive diets dont work, because your body is not a steam engine. It is way more complex. Steam engines dont have hormones, and hormones affect how hungry we are, our metabolism, how fast our little motor is running. It affects our satiety, when you feel like youve eaten enough.

Klimek: So prior to Dr. Peters idea of we should count our calories and restrict them, what was weight loss like before that? What were people trying?

Stacey: There was not much of an effort before that. One reason that Lulu got so popular was that fashions were really changing. And until the first decade of the 20th century, having a little extraI mean, nobody wanted to be fat, but having a little extra poundage was actually seen as a sign of privilege and comfort, and it was also seen as feminine. So as long as you had a nice strong corset to give you a waistline, all your other clothing was covering all ills. And a bunch of things started to change at the beginning of 20th century that made people want to be more slender.

Thorstein Veblen in his book The Theory of the Leisure Class wrote about conspicuous consumption and conspicuous waste. Conspicuous consumption was mansions on Fifth Avenue and Rhode Island cottages. And the conspicuous waste was that if you were wealthy enough, you didnt have to worry about food, therefore you could worry about being slender for the next ball gown youre going to slip into. And so then the leisure class became more associated with slenderness, and this was happening at the same time that fashions were really changing. And the Gibson Girl, which was a famous series of illustrations around the turn of century, very buxom girl, hourglass figure, the fashions around that started to change in the first decade of the 20th century.

And you started having these very slimmed-down skirts that were called hobble skirts that you could hardly walk in, they were so slim. But for that, you really had to have a pin-like physique. You no longer had the big bustle or the big hoop skirt to cover your behind, so to speak. So fashions and socioeconomic changes worked together, and then by the time we got to the 20s, you had legs being exposed, you had the flapper look, which was the opposite of curvaceous. So all of that pushed it in that direction.

Klimek: Where did Dr. Peters go once her book becomes a best seller and she gets her syndicated column? Whats the arc of her career?

Stacey: Well, the arc of her career was sadly cut short. She was very big in the 20s. She was traveling the country giving speeches all the time, and then she got on a boat to England for a medical conference. She got sick on the boat and arrived in London deathly ill and died of pneumonia in 1930.

Klimek: How has the narrative around body weight changed in the century or so since?

Stacey: In some ways its changed very little. I think thats why aside from the fat-shaming stuff Lulu sounds so modern. She talked about 100-calorie portions of things. Her whole book was set up in terms of: This much chicken is 100 calories, this much applesauce is 100 calories. You go to the grocery store, and theres all packages that are 100-calorie. A 100-calorie granola bar, a 100-calorie whatever. I think she influenced decades of how weve dealt with food and even forecast a lot of things.

In her book, she talks about getting little clubs of women together to lose weight together. And because this was during World War I, she called them Watch Your Weight Anti-Kaiser Classes, because she felt it was a patriotic act to not be fat, because that food should be going to the troops, and it was a patriotic thing to not hoard fat in your own body. But when she describes these classes, they sound identical to Weight Watchers, which started in the 60s. Lulu had said, You should weigh yourself once a week in this little group and trade tips and talk about what youre doing and how youre counting your calories. And, decades later: Weight Watchers.

Klimek: The advent of drugs like Ozempic runs counter to Dr. Lulu Hunt Peters vision. In a way, they have the same outcome, meaning it can make people thin, but the mechanism is a lot different than calorie counting.

Stacey: They work on, it seems like, a hormonal basis. And what these drugs point to is that its the opposite of the calorie. The calorie assumes that we all have control over our eating, and what Ozempic and these drugs point to is that eating is subject to way more than just our conscious control, and it involves how those hormones affect how quickly we digest our food, which apparently is one of the tricks of these drugs, is just that the food moves more slowly through your digestive system, and you just dont feel like eating for hours. I dont think we know yet, but I think itll be interesting to watch how attitudes may change and approaches may change.

Klimek: For some context on the legacy of Lulu Hunt Peters, I called up my friend Ronald Young Jr. Hes the host of a podcast called Weight For It, where he examines how he and others feel about weight and body image.

Ronald Young Jr.: I felt like there was a lot of stuff that I wanted to talk about personally when it came to weight, especially how I feel about my own weight and the conversations that were not having in society when it comes to weight. The more I thought about it, the more I thought about the connection between the idea of waiting to enjoy the life that you want because you are waiting to lose weight. Once I had a name in mind, it made it pretty easy for me to decide what types of stories I wanted to tell about weight, and thats how the podcast was born.

Klimek: What were the strategies that you used when you wanted to lose weight?

Young: I mean, the standard, man. Just do the cardio. You lift the weights, you eat a lot of chicken and brown rice and raw almonds and try to get that eight hours of sleep. Wash, rinse, repeat every day. What I found for me is, one, it just feels like the mental game sometimes that people are locked into feels different. For instance, you havent brought it up, but Ill break it up. I remember the first time somebody told me about Ozempic, and I remember one thing that they said is that they say it quiets the food noise in your mind. And I remember saying that is probably one of the few positive things that I like about Ozempic, which is that it acknowledges that there are people whose brains work differently from others, which means that if you are saying to Ronald, Well, youre just not locked in, and youre a trainer and youre ripped, and youre saying, Well, Im locked in, thats why Im ripped, no, you dont have any food noise in your brain, and I do. You know what I mean?

If we also acknowledge that difference, then maybe you would be talking to me differently when you were trying to get me to work harder in the gym or get me to be motivated. When I think about the things that worked for me and the things that didnt work, it never takes into account the differences in our genetics and in our minds when it comes to trying to lose weight for people or trying to, again, get to this amorphous area of perfection that were likely never going to get to because we are genetically different. And thats not to say that theres not people out there who have, again, worked hard and kept it off. You know what I mean? Which I always struggle with because Im always like, Does that come with any sacrifices? And what does that actually look like? Its not just a success story where they just ride off and theyre happily ever after. What do they have to consistently do in order to keep it off?

Thats what I did to lose weight. But oftentimesand, again, Im using so many air quotes, this is audioI failed at it.

Klimek: The idea of failure goes back to Dr. Peters conflation of weight loss and morality. I asked Ronald what he thought about her writings.

Young: I mean, its a story for its time. Its just not surprising that of that era here we have yet another story of people trying to solve fat. You know what I mean? And I think what youll find is, especially in the United States, there are sinister strategies and policies that serve to keep the status quo as much as possible. So when you think about the idea of the ways in which we connect being fat to being less than, its just not surprising that you keep having scientists and social scientists coming up with strategies in order to solve for fatness. And in those days, you could be louder about something that was utterly disrespectful. You know what I mean? Today, they know you cant just say, Get those unsightly pounds off, you look terrible. Get out of here. You cant really say that anymore. But you could say things like, Hey, you want something thats going to flatter your body, and this helps you get your body to a place where you feel good about yourself. Theres just different language.

And I feel like thats something weve been wrestling with as Americans probably even globally, but definitely as Americans for a long time, which is: How do we actually address this distasteful thing that we dont like? And at that time, it was fat.

Klimek: Do you think we are any more sympathetic or nuanced in our thinking about this now a century later? Or do we just learn to hide our prejudices better or use some softer-sounding euphemisms?

Young: I think youve already answered your question, Chris. Because one of the hottest stories is: Who in Hollywood is using Ozempic right now? And even amongst my peers and colleagues, someone already asked me if Im going to start taking Ozempic. You think about how that language has changed. Now that weve made obesity a disease, its like, Oh, well then medicine cures disease. Youre still trying to cure fatness. You know what I mean? So, yeah, our language has changed, but the intent hasnt changed at all. Were still trying to do the same thing weve always done, which is just get rid of these unsightly people that we find distasteful, especially knowing that Ozempic is supposed to be for diabetics so that theyre more effective in their use of insulin. So to know that thats the case, and now its this crazy side effect that everyones homed in on, I dont know, it just doesnt sit right with me.

To be clear, I think if people want to use Ozempic for whatever reason, I think that is perfectly fine. You really have to make your own choices for yourself. But what makes me struggle is the ways in which were talking about it as this miracle catch-all drug that will get us to a destination that I think we need to be, again, doing some large self-interrogation, saying, Is this a place that we all really need to go as a society? I think the answer is no, but I dont know that as a society weve answered that way.

Klimek: In Weight For It, Ronald discusses bariatric surgery at length, sometimes called gastric bypass surgery. This is a measure that some people take when they want to lose weight that involves making physical alterations to the digestive system, but the procedure comes with serious risks, and Ronald sees it as another medicalized, potentially dangerous option presented as a cure to fatness similar to Ozempic.

Young: We havent done enough studies on Ozempic to talk about the long-term effects of being on Ozempic. Were talking about something that if its turning off the food noise in your brain, and when you go off it, it stops doing that, then are you just going to be on Ozempic the rest of your life? Ive talked to people who have used Ozempic who are just like, Yeah, Im fine. Ill take a shot and then once I get in gear, Ill lose the weight, and then Ill be fine. Ill go off Ozempic and I wont need to do it anymore. And Im just like, Thats not a solution. And, also, if that is a solution, is that how you want to solve it? It still feels equally drastic in terms of you plunging yourself in the unknown rather than accepting your body as it is and demanding that the world be more progressive and change.

The other thing that I think is I think people forget that you will gain and lose weight your entire life for a variety of reasons. Theres probably ways and methods that you could be healthier or you could take care of yourself in a way that was advantageous to you without you having to make these huge sacrifices or drastic sacrifices that require you to spend the rest of your life committed to a weight-loss journey. I just feel like Ozempic is more of that. You know what I mean? Ozempic is bariatric surgery. I just feel like they are of the same brand, if you will.

Klimek: We also asked Ronald about the state of the body positivity movement in America. Body positivity began as a pushback to toxic diet culture but, like other movements, has become complicated over time. Ronald spoke about companies that play into this dynamic.

Young: Capitalism always morphs, man. Theyre going where the money is, and if the money and the buzz is toward body positivity, then thats the adjustment that businesses are going to make. So its not surprising to see people with a lot of half-baked body positivity ideas, especially these companies that are doing it in some ways. But you walk into the store and you cant even get all the sizes in the store. So theyll be like, Were doing this plus-size campaign, and then in some cases, theyve been quietly retracting them and putting the regular sizes back in the store. I know thats happened with a couple of retail stores. So theres a lot of businesses out there that are willing to make changes if youre still going to spend your money, but the minute the money moves and the interest in the culture moves, then those changes will often retract back unless weve really moved forward as a society and decided that this is something that needs to be here and were going to put our dollars behind it.

Klimek: Thank you, Ronald, for this conversation. Its a joy to talk to you, buddy.

Young: Thanks for having me, Chris, and congratulations on your podcast as well. I love it.

Klimek: To read Michelle Staceys reporting on Lulu Hunt Peters and the origins of the calorie, head to SmithsonianMag.com. Well also have a link in our show notes along with a link to Ronald Young Jr.s podcast, Weight For It.

Klimek: Before we end our episode, as always, we have a dinner party fact for you, but this one also comes with a dinner party game.

Nina Goldman: Hi, my names Nina Goldman, and I am a copy editor here at Smithsonian magazine, and we recently ran an excerpt from Sabrina Sholts new book, The Human Disease. She talks about hands and their role in disease transmission, but to get there, she talks about hands in general. I learned something new. I mean, I knew that we have opposable thumbs. Everybody learns that in school, and we know theyre important, but I never thought about why theyre called opposable thumbs. Did you know, Chris?

Klimek: I mean, I just assumed it was because theyre facing your other fingers.

Goldman: Exactly. Its because you can put them in opposition to the pads of your other fingers, which allows us to pinch things and manipulate them a lot more easily than our other mammalian relatives, I guess. But some other primates do have opposable thumbs, but theyre not as powerful as ours for a bunch of reasons, one of which is that they have very long fingers, and so its harder for them to get the tips of their fingers to touch the tip of their thumb. Weve got stubby little fingers compared to a chimpanzee, and so thats one of our evolutionary advantages.

So I learned this fact while I was working on the article, and Ive enjoyed telling it to people, because it immediately makes them do silly things with their hands, trying to get the pads of their index and pinky finger to touch, which you cant unless youre super double-jointed. And so I thought if youre at a dinner party and you want to share this fact, you could get people to try to eat with a fork and knife without their thumbsor chopsticks. So thats why theyre called opposable thumbs.

Klimek: Theres More to That is a production of Smithsonian magazine and PRX Productions. If you like this show, thank you. Also, please consider leaving us a review on Apple Podcasts. It really helps other people find our show.

From the magazine, our team is me, Debra Rosenberg and Brian Wolly.

From PRX, our team is Jessica Miller, Genevieve Sponsler, Adriana Rozas Rivera, Ry Dorsey and Edwin Ochoa. The executive producer of PRX Productions is Jocelyn Gonzales. Our episode artwork is by Emily Lankiewicz. Fact-checking by Stephanie Abramson. Our music is from APM Music.

Im Chris Klimek. Thanks for listening.

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How Americans Got Hooked on Counting Calories More Than a Century Ago - Smithsonian Magazine

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Obesity doesnt just bring immediate health concerns for children with excess body fat. It brings worries for the future, too.

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Early obesity establishes a pattern that can lead to a lifetime of weight and health challenges. Kids who carry extra pounds are more at risk of developing chronic, life-altering medical conditions as they grow up.

At the moment, thats a stark reality of whats ahead for more than 160 million young people around the world living with obesity. That figure includes more than 14.7 million children in the United States.

These numbers continue to grow, too, fueling talk of an obesity epidemic among our youngest generation. Childhood obesity now qualifies as the most common chronic disease affecting youths.

To learn more about the long-term consequences of this trend, we turn to Lina Alkhaled, MD, a specialist in pediatric obesity.

So, when is a kid considered to have obesity or overweight? Thats an assessment made using body mass index (BMI) plus a BMI-for-age-and-sex growth chart, according to Dr. Alkhaled. (BMI uses a ratio of height and weight measurements to estimate body fat.)

Children whose BMI places them in the 95th percentile or above on the growth chart are considered to have obesity. Placement in the 85th to less than the 95th percentile qualifies as experiencing overweight.

Using the chart makes the determination process different from the BMI-only method used for adults without regard to age or sex.

There is not an absolute BMI number that defines obesity in children, clarifies Dr. Alkhaled. Instead, we plot the BMI value on certain curves for males and females. Based on where that point lands, we can define obesity or overweight.

It should be noted, too, that obesity is a complex chronic disease. Many factors including genetics and socioeconomic status contribute to why some children gain more weight than others. Its often not as simple as just food intake and activity levels.

No matter the cause or reason behind an obesity diagnosis, excess fat can bring associated health complications. Those extra pounds strain a body while forcing it to work harder to function.

As one group of researchers eloquently put it, obesity serves as the soil for the development of other diseases. Here are a few of those potential health risks.

Excess weight can take a toll on the heart, forcing it to work harder to circulate blood around a larger body. Obesity can also fuel heart disease risk factors such as high blood pressure (hypertension) and high cholesterol.

Early obesity increases the risk of heart issues later in life. A 2023 study found that kids with higher BMI are 40% more likely to experience cardiovascular disease in adulthood.

Those same researchers reported that children with multiple obesity-related risk factors such as high BMI, high blood pressure or high cholesterol could have up to a nine-times greater risk of a heart attack or stroke.

When you tie all of these factors and complications together, they can lead to heart diseases in the future, says Dr. Alkhaled. Theyre very closely linked.

Your body breaks down the food you eat into glucose (sugar) to provide the energy you need to power through the day. Insulin, a hormone made in your pancreas, plays a key role in regulating this process.

Obesity can lead to insulin resistance, meaning your body doesnt respond as it should. This can lead to high blood sugar levels (hyperglycemia) and the development of diabetes.

Increases in diagnoses of childhood diabetes have mirrored the rise in obesity, notes Dr. Ahlkaled. Research shows that children with obesity are more likely to develop lifelong diabetes than those with lower BMIs.

Early-onset diabetes also increases the risk of heart disease, as well as complications like kidney disease, eye disease and nerve damage.

Obesity at an early age creates an inflammatory environment that appears to suppress a bodys ability to ward off cancer later in life. Studies show that higher BMI during childhood may increase the risk of:

Overall, theres a strong connection between obesity and cancer. The U.S. Centers for Disease Control and Prevention (CDC) reports that obesity and being overweight elevate the risk for 13 different kinds of cancer.

Carrying extra weight doesnt just take a physical toll on a person. Theres a mental one, too.

Research shows that children with obesity are 32% more likely to have depression than children at a healthier weight. This elevated risk of depression carries over into adulthood, too, says Dr. Alkhaled.

Excess weight can also lead to low self-esteem, eating disorders and social anxiety in children, which can become lifelong issues.

It has been found that children with obesity may have a very poor quality of life, even poorer than kids with cancer, shares Dr. Alkhaled. It can have a very negative impact on mental health.

Many of the health issues noted here arent just because of early-in-life obesity. Often, theyre a byproduct of continued obesity into adulthood.

Consider these study findings:

But its important to note that these statistics arent destiny: Children who attain a healthier weight before adulthood usually have similar health outcomes to those who never had obesity, says Dr. Alkhaled. Managing obesity early can help prevent future complications.

Guiding children with obesity toward a healthier weight begins with encouraging lifestyle changes, says Dr. Alkhaled. Positive steps include:

If lifestyle adjustments dont bring changes, talk to your childs healthcare provider about options such as medications that can help manage obesity.

Talk to your child openly about obesity, too, and explain how making changes is about being healthier in the present and future. Avoid blaming or shaming language or focusing too hard on weight numbers.

Address obesity from a health standpoint, advises Dr. Alkhaled. Explain to your child what they can do to feel more energized during the day, sleep better at night and live a healthier and hopefully longer life.

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Why Childhood Obesity Can Be a Long-Term Concern - Health Essentials

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THE DIETING CONCEPT of 'calories in, calories out,' is nothing newbut its new moniker, 'CICO' is.

Most people are acquainted with traditional weight-loss plans based on the premise of creating a calorie deficiteating fewer calories than your body needs so that your body will utilize fat stores for energy, explains Mindy Haar, Ph.D., R.D.N.,and assistant dean at

But before you jump on the CICO bandwagon, its important to understand a few key elements of how your metabolism and your body works when it comes to dieting and weight loss. Indeed, there's both a healthy and unhealthy way to do CICO. Heres what you should consider before you adopt the CICO approach to losing weight.

The growing diet trend, of CICO, puts the calorie-counting method of weight loss front and center.

The CICO plan operates under the premise that you'll lose weight by consuming fewer calories than your body uses to perform its daily functions.

Theres no way this popular diet is as simple as counting calories, right?

"The idea of calories in and calories out is absolutely the backbone of weight loss," says Bethany Doerfler, M.S., R.D.N., Clinical Dietitian at Northwestern University. "But metabolism and weight loss are so much more complex than that."

Thankfully, putting the CICO M.O. into action is a lot simpler than understanding the science behind weight loss and your metabolism. "Theres no real plan with CICO," says Dezi Abeyta, R.D.N., a Men's Health nutrition advisor and author of The Lose Your Gut Guide.

And that's actually not a bad thing.

On CICO you just consume fewer calories (calories in, or CI) than you burn (calories out, or CO) every day. And, honestly, any dietbe it keto, paleo, Whole30, or otherwisecan be a complicated method for consuming fewer calories than you burn. CICO attempts to simplify everything.

That said, let's complicate things just a bit so that you can understand the mechanism by which CICO argues that it works.

Basal metabolic rate (BMR) is the amount of calories your body burns to stay alive. This figure is individual specific and determined by a number of factors including height, weight, and age. Online calculators offer an estimate, and some doctors use breathing machines that deliver more precise and customized BMRs.

Then lifestyle factors like physical activity need to be accounted for since you're probably not lying in bed all day. Again, online calculators and formulas offer rough estimates of how many calories your body uses.

Losing weight requires eating fewer calories than your body needs to maintain its activity level. Here's where CICO comes in.

On the CICO diet you track how many calories you consume daily by way of the aforementioned calculators and then you try to eat fewer calories a day.

So, let's say that you figure out your calorie need for the day is 2,600 calories. You could then aim to eat 2,200 calories daily in an attempt to lose weight.

Run a calorie deficit and youll start to drop pounds.

And, really, there are no off-limit foods as long as you stay under that calorie threshold for the day.

"Everything is on the table," says Abeyta. "So if you wanted to drink beer and eat wings every day, you couldas long as you either consumed less of those things or exercised more to maintain a calorie deficit." Is that a good way to approach CICO in terms of building long-term health? Absolutely not.

So the premise of CICO is rooted in simplicity, but the actual execution of the CICO diet can be challenging. Calorie counting requires meticulous tracking, which can be especially hard to do when dining out or if you're traveling.

Plus, math.

But people have seen results on the diet.

It depends what you mean by "work."

It's generally accepted that most diets work because of a calorie deficit, says Abby Langer, R.D. So if we're talking about the CICO diet and short-term weight loss, sure, it can work.

"However, calories as we know them are so arbitrary," Langer says. "The calorie was invented a really long time ago and isnt necessarily accurate in terms of how our bodies metabolize each individual food. Were learning so much more about how calories are absorbed."

Your body takes in more calories from food that's been processed, or broken down from its natural form, she explains. "So if you have a smoothie youre going to absorb a significant portion of those calories compared to if you eat that food raw or cooked," says Langer.

Emerging research shows your body handles ultra-processed items like chips or Twinkies differently than kale or bananas. "Those [packaged snacks] are going to be viewed very differently on a cellular level," says Bethany Doerfler, M.S., R.D.N., Clinical Dietitian at Northwestern University.

The National Institute of Health found that ghrelin, a hormone that drives hunger, is higher when people consume ultra-processed foods compared to after eating a well-balanced diet, according to 2019 research published in Cell Metabolism.

Heavily-processed foods high in sugar, fat, and salt, may spike insulin levels and cause your body to store more fat, explains Doerfler.

Then, you have to consider the benefits of a fiber.

"Fiber-rich foods provide a certain level of satiety and fullness," says Doerfler. The nutrient also promotes healthy gut bacteria, which scientists believe may determine a person's weight.

"By laser-focusing on calories, you may forget about filling fiber, muscle-building protein, and disease-fighting micronutrients," says Abeyta.

Its great to know how many calories you eat daily, in general. "If youre self-motivated and know that a good diet includes lean proteins, colorful produce, quality fats, and fiber-rich carbs, well, then CICO can help you lose weight and improve your health," Abeyta says.

But if your diet is still rich in junk foodeven if you're eating less of it and you're losing weightyou're not not eating a diet that sets you up for long-term health.

For some who choose to practice it, the CICO diet can help you lose weight and improve your health, as you can include more nutrient-dense, fiber-rich foods into your meals without breaking the calorie bank.

The main benefit of the CICO diet is its simplicity and flexibility, and as long as you stick to your calories, you can eat whatever you want, says Ana Reisdorf, M.S., a registered dietitian and founder of The Food Trends. Consistent calorie-tracking can lead to effective weight loss, as it raises awareness of portion sizes and food choices."

But its not just the 'CI' or calories in aspect of this plan that helps you. The 'CO' or calories out component of this lifestyle matters, too. Exploring a CICO-based plan leads you to first consider how many calories you are expending each day and how that can be increased, explains Haar.

Your total expenditure is based on basal metabolic rate (how many calories you use when at rest for basic functions that include breathing, maintaining body temperature, brain and nerve functions) plus energy used for digestion and physical activity.

While age, gender, height and genetics are influential factors that cant be modified, the amount of muscle mass you have increases caloric needs even when resting and increasing all types of exercise adds to calorie expenditure as well, says Haar. Aside from weight loss, increase in aerobic capability and strength training has a plethora of other health benefits.

No diet is a one-size-fits-all solution. CICO is no exception, and it certainly isnt for everyone. As always, talk with your primary care physician or a trusted healthcare practitioner before embarking on any new lifestyle and diet routine to make sure its safe for you.

Haar perceives the major flaw with the CICO diet that in focusing on calorie numbers alone in an effort to lose a substantial amount of weight fast, individuals may reduce calories to unhealthful levels where they are not getting adequate nutrients.

While the scale may show big losses, the pounds lost may have resulted from dangerous water loss, as well as a breakdown of muscle tissue, says Haar. Gradual weight loss of one-to-two pounds per week is more healthful and likely to be sustained. The most important factor in weight management is that any lifestyle changes you make should be permanent. Any diet pattern that is followed temporarily can result in significant weight loss, but this loss is rarely sustained."

In addition, Haar warns that its possible to eat just the right number of calories to sustain a one-to-two pound/week weight loss, but the food pattern consists of ultra-processed, low-fiber foods contributing to other health situations. Thus, food quality, not just quantity, is important to consider, she says.

Riffing on that sentiment, Residorf says that focusing solely on calories can lead to poor food choices, as not all calories are nutritionally equal. Of course, 300 calories from a doughnut versus 300 from lean chicken and vegetables will have vastly different effects on the body, she says. This approach that can lead to nutritional deficiencies and an unbalanced diet.

The emphasis on calories rather than food quality might also encourage eating low-calorie yet nutrient-poor processed foods, which can make you hungrier so it is hard to stick with the calorie restriction," she says.

We've talked about this a little already from a physical standpoint, but it's also important to talk about diet from a mental perspective.

Counting calories isn't inherently problematic, says Doerfler. But there are exceptions.

"I like that this diet has brought back to the forefront looking at calories and seeing where your high-calorie food comes from," she says. "Almost all the time those calories come in the form of refined snack foods and sugar-sweetened beverages. The hope is that those calories would be used for smarter and healthier eating."

Realizing that morning bagel with cream cheese tops more than 600 calories could inspire you to choose a satisfying meal that contains fewer calories, like oatmeal and peanut butter.

Plus, apps like MyFitnessPal are useful ways to monitor what you're eating. People who spent just 15 minutes a day logging food lost about 10 percent of their body weight in one month, according to a 2019 study published in the journal Obesity.

That said, counting calories can feel like a chore, lead to obsessive behavior, and even spark binge eating, says Langer.

"When youre drilling everything down to numbers it takes away all the joy of food and disconnects us from nourishing our bodies," she asserts. "This perpetuates diet culture by being punishing."

Stressing over numbers can be a trigger to binge for people with eating disorders. If you have a history of disordered eating, consult a dietitian who can customize a plan that works for you.

"If you ever find yourself 'running off' indulgences or skipping meals for the sake of CICO, thats a signal flare," says Abeyta.

And strict diets don't take birthdaysor any other celebratory meal, reallyinto consideration.

"People are not quite so robotic," says Doerfler. "Even if someone needs 1,200 calories a day to lose weight, most people are not adhering to that 100 percent of the time."

Ultimately, the best diet is one that doesn't consume your every thought. Dieting becomes an issue when you refuse to eat even though you're hungry, says Langer.

"If you have to pee you wouldnt say, 'No, I cant pee for another three hours,'" she asserts.

Langer recommends listening to your body's natural hunger cues and taking a more relaxed approach.

"Stop thinking of food as good or bad and just eat," she says.

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The CICO Diet - How It Works, Side Effects, Effectiveness - Men's Health

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Counting calories, eschewing carbs weve tried it all when it comes to weight loss.

Up to 50 percent of women are dieting at any given time, according to Livestrong, and yet sixty-two percent of adult Americans are overweight or obese. Ninety-seven percent of people who lose weight regain everything they lost, according to Harriet Brown, author ofBody of Truth: How Science, History, and Culture Drive Our Obsession with Weightand What We Can Do About It. A recent studyeven found that reducing portion sizes and cutting calories couldhinder, not help, weight loss.

But just because traditional diets dont work doesnt mean its impossible to shed extra pounds. Here are five reasons why its so hard to lose weight by dieting and the one solution that will solve this age-old problem once and for all.

It can sometimes feel like even if you stick to your diet for weeks, one bad day can send your weight skyrocketing back to pre-diet figures.

This, according to Farrell Cahill, PhD, a researcher at Memorial University of Newfoundland, isnt just an impression; its because were genetically predisposed to hang onto weight.

Were the only species that survives under what we call the thrift-gene hypothesis, he explains. This theory states that natural selection led those of our human ancestors who could survive off of the smallest amounts of food to survive and procreate.

They were the most efficient at gaining weight, he says. So were the generation that has the ability to gain a significant amount of weight from small amounts of food, because thats what we needed to do 5,000, 10,000 years ago.

In other words, today, our genes are fighting against us and this isonly exacerbated by the way that people try to lose weight.

Weight loss is done too extremely, Cahill explains. So when you put yourself through that, those starvations, those immediate changes to your diet, your body goes into a mode of making sure youre not going to lose weight.

Worst of all, when you go back to your pre-diet way of eating, even briefly, youre now prompting your body to be more physiologically apt to gain weight.

Your body will try to gain more weight because it thought that the starvation and extra exercise is due to some sort of physiological anomaly, he explains. Your body, physiologically, doesnt know what your mind is trying to communicate.

Whereas our ancestors had to hunt and gather for food, today, were exposed to it all the time and its not the fiber- and nutrient-dense food that weve sought out for centuries.

Packaged foods with added sugar usually taste impossibly delicious and cause massive spikes of dopamine, a neurotransmitter involved in reward, explains Max Lugavre in New York Times bestseller Genius Foods. What nobody tells us as we peruse the aisles lined with air-pumped bags of bliss is that these foods are literally engineered to create insatiable over-consumption, designed in labs by well-paid food scientists to be hyper-palatable.

Ive been thin my whole life, and fit, says JD Roth, co-creator of NBCs The Biggest Loser. Cookies call me in the middle of the night, just like they call everyone else. I dont keep cookies in the house!

For optimum weight loss, its ideal to take a page out of Roths book and eschew these foods entirely.

Stick to foods that will naturally regulate your hunger, allowing you to eat less, says Lugavere, noting that foods high in protein the most satiating macronutrient and fiber are ideal.

Food addiction is a real problem, as physiological as it is psychological.

Lugavere writes in Genius Foods that the more we consume of certain foods, the more we require to reach the same pleasure threshold.

The way sugar stimulates the release of dopamine resembles drugs of abuse, he writes. In fact, in animal models, rats prefer sugar over cocaineand rats really like cocaine.

This is specifically true of certain foods, such as fructose, which he writes has been shown to promote its own consumption.

When rats were fed the same number of calories from either fructose or glucose, glucose (like potato starch) induced satiety (feelings of fullness). Fructose, on the other hand, actually provoked more feedingit somehow made the rats hungrier.

But the psychological side of this food addiction is just as important.

Roth notes that the recidivism rate for someone who loses 100 pounds is identical to that of people addicted to drugs and alcohol. This issue, he explains, is linked to the fact that, unlike people trying to stay away from drugs or alcohol, everyone is confronted by food on a daily basis.

Youre faced with your addiction at minimum three times a day, he says, noting that the omnipresence of food makes it particularly difficult to avoid, even outside of mealtimes.

You cant even go to a store to buy a television, he says. When you get to the front of the line theres a whole section of candy on your way to the register.

The deprivation brought about by a dieting mindset, however, makes this constant exposure to food even worse.

People always say, Im on a diet, and Sunday is cheat day, says Roth. If you were an ex-crack addict, do you only do crack on Sundays?

Diets are problematic, perhaps above all, because they call for restricting food for a predefined period of time.

Were predetermined, in this country, emotionally, to think that the word diet has a start and an end, says Roth. Youre trying to get to a wedding. Youre trying to look good in a bikini. Or whatever it is. You eventually take your foot off the gas when the diet is over.

This is, in large part, due to the fact that people want to diet intensely for a short period of time.

We go too extreme, says Cahill. We put ourselves through suffering, so that means our quality of life decreases because we got rid of all the foods that give us pleasure.

And, contrary to popular belief,Increasing physical activity and dieting dont increase your quality of life not initially, at least, says Cahill.

In deciding that a diet will someday end, we set ourselves up for failure.

Once the program is over, he says, you wont be able to maintain that weight loss, because youre gonna go back to the behaviors, which you havent changed.

Anyone who has attempted a weight loss regimen may be struck, first and foremost, by the physicality of it: restricting portions, eating less, spending more time at the gym.But more than those physical changes, weight loss is an uphill emotional battle.

Many foods, especially packaged foods, increase the production of hormones like dopamine that make us feel good.Since many of us are faced with an inordinate number of stressors on a day-to-day basis, we turn to food for comfort.

Your mood is affected by dopamine, and the same dopamine you get from eating a donut is the same dopamine you get from going for a walk, says Roth.

But it goes deeper than that. Food can be an emotional crutch for many, and by not getting to the bottom of these emotional issues, people are often setting themselves up for failure before the diet even begins.

Were always eating for a reason, says Roth. You cant eat yourself to 400 pounds, because you like pizza. Youre eating yourself to 400 pounds because youre unhappy. So dont try to stop eating the pizza. Try to start figuring out why youre eating it.

Drew Manning, the personal trainer of Fit2Fat2Fit fame, notes that he was confronted with this emotional side of the battle when he attempted to lose the 75 pounds he had purposefully gained, in an attempt to understand where his clients were coming from.

He notes that for most Americans, the perception of health and fitness has to do with our own self-worth and our value.

We think we are more valuable, or were worth more, if were skinny, or we have the body that we see on Instagram.

Confronting this misconception is a major key to a better approach to lasting weight loss.

Obviously, there are ways to lose weight and keep it off, all of which boil down to two major premises: making small, sustainable changes, and making them with the mindset that this is your new lifestyle, your new reality.

Many small changes over time will be able to allow for you to have not only weight loss, but a consistent weight loss thats now maintainable, explains Cahill.

Instead of setting yourself up for failure, set yourself up for success. Remove trigger foods from your home; prepare healthy meals;surround yourself with people who share your goals who will encourage you when you succeed, and when you fail.

This is a journey, says Manning. Not a destination. There is no finish line. This is something that has to become part of your lifestyle every single day.

Related on Organic AuthorityThe Expert-Backed Truth About Coconut Oil for Weight Loss Intermittent Fasting: Health Fad or Healing Practice? 5 Ways to Help Your Weight Loss Transformation Last

Emily Monaco is a food and culture writer based in Paris. Her work has been featured in the Wall... More about Emily Monaco

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Pharmaceutical investing has seen huge moves in the industrys stocks over the past year, with one area grabbing particular attention: obesity drugs.

Since the end of 2022, the booming marketand potential for massive growthfor obesity drugs has led to big rallies for the stocks of the two manufacturers leading the race to market: Novo Nordisk NVO, producer of Ozempic and Wegovy, and Eli Lilly LLY, which manufactures Mounjaro and Zepbound. Both stocks are posting their biggest gains when it comes to year-to-date performance since 1997.

The challenge is that both stocks currently trade in overvalued territory, according to Morningstar analysts. Investors looking to put new money to work in companies developing products in this potentially significant market must decide which of the more attractively valued competitors are best positioned to muscle their way in.

And with a new stream of studies being published, like Wegovys longest clinical trial to date, comes increased tensions between the drugmakers.

We think current share prices do not properly account for expected price declines and competition, let alone the risk of patients discontinuing therapy due to tolerability, cost, or long-term safety issues, says Karen Andersen, healthcare strategist at Morningstar.

Other Big Pharma companies looking to gain traction with their own obesity drugs include Roche RHHBY, Pfizer PFE, and Amgen AMGN.

Novo Nordisk: 60.6%

Eli Lilly: 78.1%

Pfizer: negative 17.9%

Amgen: 44.7%

Roche: negative 14.7%

Amid the obesity epidemic in the United States, pharmaceutical companies have been attempting to develop effective treatments for years. I dont think weve ever seen this sort of level of innovation, says Damien Conover, director of healthcare research for Morningstar. Historically, obesity has been an area of a lot of failed drug development. Its always dangerous to say, This time, its different. But this time, it really does seem different.

Andersen adds: So it was a sort of slow realization after the data, approval, shortages and then it took off. I think we had all been expecting less, given that the launch of Novos previous obesity drug, Saxenda, wasnt very successfulalbeit with about 5% weight loss.

However, investors have now definitely taken note, changing the landscape of pharma stocks. That came in part as Lilly has seen unparalleled efficacy in its weight-loss drug therapy, and its stock reflects that progress with its big 2023 rally. Meanwhile, Novo has become the largest company in Europe as measured by market capitalization.

Underlying these gains are expectations of massive growth for these drugs. Conover and Andersen project that the global market for obesity drugs will be $120 billion by 2031 and most of the market will be relatively split between Novo and Lilly. The overall market for the kinds of treatments employed in these medicationswhich are known as GLP-1s and are also used to treat Type 2 diabetesis seen as even larger, at some $170 billion.

Conover and Andersen forecast that over 25% of obese Americans and 15% of overweight Americans will receive treatment in 10 years, and the vast majority will receive branded GLP-1 therapies. They predict the bulk of those sales will go to Novo and Lilly.

With new gates being opened for these drugs, investors have multiple variables to consider when it comes to stocks that can benefit.

One of the biggest factors will be pricingboth the prices manufacturers can charge and what end consumers pay after insurance. Both Lillys Zepbound and Novos Wegovy have a listed monthly price over $1,000. But this is not necessarily reflective of what the typical consumer will be billed; the net payment could be discounted by as much as 79%. Such pricing could make a big difference in sales.

Its such a big market that you dont need to change the penetration levels that much and you would have substantially different projections, says Conover.

Meanwhile, already-intense competition is being fueled by a steady stream of studies of drug effectiveness. The first-of-its-kind clinical trial examining the long-term effects of Novos Wegovy found that people on the drug maintain weight loss for up to four years, on top of reducing the risk of heart disease. These findings could act as a catalyst for insurance companies and governments to cover Wegovy more liberally.

That competition is part of the reason Conover and Andersen expect a substantial pricing decline over time. They estimate companies are currently charging an average of $7,000 for obesity drugs, but that will likely decline to under $3,000 by 2031.

Competition and efforts to expand commercialprivate payerreimbursement contracts tend to lead to lower prices at bigger volumes, Andersen says.

Although many unforeseen corners could lie ahead, one thing is clear: Lilly and Novo revolutionized the weight-loss landscape through years of continual therapy improvements. They had been on this steady path until they got to the point where this obesity data came out, Andersen explains. It had somehow broken through this barrier for prior obesity drugs, since their efficacy was undeniable, and it really turned a corner.

Novo and Lilly are kind of doing their own thing in the stock market, and really in innovation, says Conover. They are bringing out some of the most powerful new drugs for sales generation, in our estimation.

Andersen says, I think were at a point in this market where its accepted that Novo and Lilly are both strong players and poised to benefit incredibly. I think it would be tough to really take down either, unless there was some drastic reduction in supply or a massive safety issue that we somehow didnt see until now.

However, for investors, there are valuations to consider. Lilly is currently trading at a price/fair value ratio of 1.45, meaning it is 45% overvalued compared with Conovers fair value estimate of $540. Meanwhile, Novo has a price/fair value ratio of 1.55, based on Andersens fair value estimate of $86.

We expect Lilly to partly elevate capacity constraints for Mounjaro and Zepbound in the second half of the year, Conover says. Lilly expects to increase the drugs production by 50% by the end of the year. With demand outstripping supply, we expect Lilly to sell what it can produce.

Pfizer has been considered a significant contender, but recently it provided lower-than-expected 2024 guidance, which brought its Morningstar fair value estimate for the companys stock from $47 to $42 per share. The companys 2024 projection included covid-19 product guidance of $8 billion, which was $5 billion lower than our expectation, Conover says.

However, Pfizers diverse line of drugs and vaccine provide for a steady cash flow, and the market is still significantly undervaluing its stock price, with the last closing price being $28.50.

Another aspirant is Amgen. They are committed to entering the obesity marketeither with the lead candidate (similar to Lillys Zepbound, it is targeting GLP-1 and GIP hormones) or additional drugs that are in phase 1 and preclinical studies, says Andersen. We expect phase 2 data from the lead AMG133 program in the second half of 2024. The key selling point so far, based on phase 1 data, could be that it requires less frequent administrationit could be administered monthly, instead of the weekly Zepboundand may lead to longer maintenance of weight loss after stopping therapy.

In addition, Andersen says Amgens offering has showed compelling speed of weight loss. It will be interesting to see longer-term data to see the final plateau of weight loss. She adds that, given the minimal data so far from the company, Amgen is sort of a wild card, as it could either be best-in-class or encounter issues with tolerability or safety that make it less compelling.

In the first quarter, Amgens sales grew 22%, raising its fair value estimate to $317. Amgens stock is also undervalued, currently trading at $314.54.

Then there is Roche, which in 2023 entered the fray with the acquisition of private biotechnology company Carmot, which has three clinical-stage obesity drugs in the works. Investors might be better served by taking a less focused approach toward investing in obesity stocks and consider a firm like Roche, where we like the overall portfolio and investors get some exposure to new obesity drug development, Conover says.

Heres a look at Morningstars take on key obesity drug developers and their stocks:

We are raising our Eli Lilly fair value estimate to $540 from $500 following stronger-than-expected first-quarter results. In particular, pricing drove 10 percentage points of the 26% top-line growth seen in the quarter, which is expanding gross margins faster than we expected. We believe the strong pricing power of weight-loss drug Mounjaro supported a major part of the pricing gains. While Lilly expects a deceleration in pricing gains in the second half of the year as discounts related to saving cards annualize, the robust pricing power showcases the strength of Lillys wide moat.

Read more of Damien Conovers analyst notes here.

Novo Nordisk reported constant currency sales growth of 24% in the first quarter, in line with the 25% constant currency sales growth assumption we had built into our model for 2024. First-quarter growth was heavily driven by GLP-1 sales growth in diabetes (32%, mostly from Ozempic) and obesity (42%, mostly from Wegovy).

Management increased constant currency sales growth guidance for 2024 by 1 percentage point (from a range of 18%-26% to a range of 19%-27%), and weve increased our sales growth assumption to 26%. We think operating income growth could be slightly higher at 29%, also at the high end of managements updated guidance. This increased our fair value estimate from DKK 570/$84 to DKK 600/$86, but share prices are still 45% higher than our increased valuation.

While we continue to see Novo Nordisk as a wide-moat firm, with strong intangible assets surrounding its cardiometabolic business, we think the high obesity drug demand and scarcity of supply have driven share prices above their intrinsic value. We assume that Novo Nordisk is capable of growing GLP-1 sales across indications from roughly $24 billion in 2023 to nearly $75 billion by 2031, prior to the patent expiration for semaglutide, the molecule in Ozempic and Wegovy. We think current share prices do not properly account for expected price declines and competition, let alone the risk of patients discontinuing therapy due to tolerability, cost, or long-term safety issues.

Read more of Karen Andersens analyst notes here.

We dont expect to make any changes to our CHF 379/$55 fair value estimate for Roche following the companys first-quarter results. Roches pharmaceutical and diagnostics divisions each grew at a 2% rate at constant currency, with 7% underlying constant-currency growth after removing the headwind from reduced covid-related antibody and diagnostic sales.

Management maintained its guidance for mid-single-digit constant-currency sales growth and core earnings per share growth for the full year. We expect covid and foreign-exchange headwinds to subside for the remainder of the year, allowing Roches underlying growth to become more apparent to investors. While this is not a year for significant new launches, we expect significant pipeline data amid a pipeline reshuffling that prioritizes higher-impact programs in immunology (Roivants TL1A) and obesity (Carmots CT-388).

Beyond 2024, we think Roche is capable of mid- or even high-single-digit annual growth (and core operating margins remaining in the mid-30s), with higher growth possible if these in-licensed programsor in-house programs like Alzheimers disease drug candidate trontinemab or oncology drug candidate tiragolumabreach the market. We think Roches pharmaceutical innovation and diagnostics dominance support a wide moat.

Read more of Karen Andersens analyst notes here.

We are holding steady to our fair value estimate and wide moat rating for Pfizer following first-quarter results that largely matched our expectations. The company is tracking well to meet its goal of $4 billion in cost cuts by the end of 2024, which should improve operating margins. We believe the market is underappreciating the margin expansion based on the cost cuts, and we view Pfizer as undervalued.

Following overinvestment during the pandemic, Pfizer is reducing costs to adapt to the slowing demand for covid products. While we still expect a tail of close to $8 billion annually for Pfizers covid vaccine Comirnaty and treatment Paxlovid, this is down from the over $50 billion sold in 2022. Following the cost-cutting, we expect operating margin to return to over the 30% range more typical of Pfizer before the pandemic.

Read more of Damien Conovers analyst notes here.

Amgens first-quarter product sales grew 22%, or 6% excluding the October 2023 acquisition of rare-disease firm Horizon Therapeutics, slightly ahead of our expectations. Management narrowed its top- and bottom-line guidance for the full year. In conjunction with earnings, Amgen announced that it has completed an interim analysis of a phase 2 trial of obesity drug candidate maritide (AMG 133). Although Amgen did not disclose many details, management was encouraged enough to announce that the program will move to phase 3 in obesity, obesity-related indications, and diabetes, an area where theoretical concerns about blood sugar effects of the drug had previously made development less appealing. We think the most likely scenario is that interim data showed manageable tolerability, solid safety, efficacy that rivals the top drug candidates in development (around 25% weight loss), and a differentiated dosing profile (monthly or perhaps quarterly dosing).

We had previously included a 30% probability of approval and $4 billion in probability-weighted sales by 2033 in our Amgen valuation. Given this confirmation of positive phase 2 results, were raising our probability of approval to 60%, which raises our sales estimate to $8 billion by 2033. Weve also included higher capital expenditures beginning in 2025 to support a 2027 launch; we see Amgens strong experience with antibody manufacturing as lending credibility to its ability to supply the market. In addition, if dosing is in fact quarterly instead of the once-weekly dosing for current obesity treatments, manufacturing could be less demanding.

Read more of Karen Andersens analyst notes here.

Excerpt from:
Obesity Drug Stocks: Where to Invest Now - Morningstar

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Up to 70 million Americans are sleep-deprived. But those hours of lost sleep add up to a bigger health deficit than you may realize, says sleep medicine specialistNancy Foldvary-Schaefer, DO, MS.

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Sleep is foundational to health and wellness, Dr. Foldvary-Schaefer says. We know that getting enough sleep and getting enough good sleep is necessary for cardiovascular health, metabolic health and even brain health.

Exactly how is a lack of sleep harmful to your health? Lets take a look at what happens to your body when you dont get enough rest.

There are lots of reasons why you need sleep. It allows your body to:

Sleep is an active process for every organ of the body, including the brain, Dr. Foldvary-Schaefer says. We need sleep so we can restore nutrients, clear toxic materials and recharge for the next day.

Even missing as little as 1.5 hours can have an impact on how you feel, causing short-term problemslike:

During periods of sleeplessness, hidden health hazards accumulate that cant be covered up with concealer or reversed with caffeine. Dr. Foldvary-Schaefer notes. Everything from your cardiovascular system to your immune system feels the impact.

Beyond feeling groggy feeling and sleeping past your alarm,sleep deprivationaffects many parts of your body and brain.

So, what exactly happens when you dont get enough ZZZs? Lets take a look at the many possible effects of sleep deprivation.

If your internal batteries feel depleted by the early afternoon, thats a clear sign of lack of sleep and no, a late-day cup of coffee wont cure it.

If you wake up in the morning and you arent refreshed, and you feel exhausted or are yawning excessively during the day, those are all signs of insufficient sleep or another sleep disorder, Dr. Foldvary-Schaefer states.

Sleep deprivation causes fatigue, low energy and excessive sleepiness, which can affect your ability to do things you love and simply complete day-to-day tasks.

If youre stumbling through the day with fewer than seven hours of sleep, youre likely to start literally stumbling.

A 2021 study found that sleep deprivation had a significant negative effect on gait (the way you walk), while other studies have found that a lack of sleep can affect your sense of balance. Both can put you at risk for accidents, falls and injuries.

Its no big revelation that a night of bad sleep can make you feel irritated, emotional and short-tempered the next day. And chronic sleeplessness can quickly morph into mental health concerns.

Mood disorders like depression and anxiety are also connected with chronic insomnia and sleep deprivation, Dr. Foldvary-Schaefer cautions.

For example, research shows that people with insomnia are twice as likely to experience depression. It also shows that about 80% of people with depression experience insomnia.

In other words, sleeplessness can be a symptom of mental health issues, but it can also be a contributor to them, which creates a frustrating chicken-and-the-egg cycle.

Wait, where did I put my keys?A lack of sleep affects your ability torememberand react, which can cause your brain to go blank on the most routine of tasks.

Deep stages of sleep are responsible for learning and memory. These include rapid eye movement (REM) sleep and deep non-REM sleep (also known as Delta sleep or slow-wave sleep, or SWS).

When sleep is interrupted or cut short by going to bed too late or not getting eight hours in bed at night, your brain isnt able to properly catalog its memories, Dr. Foldvary-Schaefer explains.

She points to studies that show that students who pull all-nighters dont do any better on their tests the next day: Even though theyve put in more hours, theyve deprived themselves of the sleep that was needed to really ingrain those memories into their brains, she says.

Sleep deprivation can also cause neurological disturbances like:

Deep sleep allows our brains to clear the toxins that accumulate during our waking hours, Dr. Foldvary-Schaefer explains, so that we dont develop neurodegenerative diseases like Alzheimers disease.

Research shows that this process takes seven to eight hours (and sometimes more). In other words, if youre losing sleep, so is your brain.

If youve ever walked into the office and been told, You look tired! (Ugh, rude) you know what we mean: When you dont get enough sleep, it can show on your face.

Sleep deprivation can cause:

Theres also a link between lack of sleep and an increase in the amount of cortisol in your body. Cortisol can break down collagen, the protein that keeps skin smooth, which means a lack of sleep could mean more wrinkles.

When you burn the candle at both ends, your immune system takes a hit. You may be more prone to getting sick and slower to bounce back from viruses like the cold or flu.

Thats because when you sleep, your body producescytokines, proteins that send signals to other cells to keep your immune system functioning (which is a good thing!). But when youre sleep-deprived, your body instead starts to make more white blood cells. This creates an imbalance that weakens your immune system over time.

After consecutive days of not getting enough sleep, you may start to become more susceptible to certain illnesses, Dr. Foldvary-Schaefer explains. Plus, as lack of sleep affects your immune systems ability to fight against illnesses, it may take you longer to recover.

In the short term, even a couple of bad nights sleep can make you feel hungrier especially for sweets and snacks. And chronic sleep deprivation is a risk factor for weight gain and obesity.

Why?Lack of sleep disrupts these key hormone levels in your body:

Lack of sleep makes it harder to lose weight, too. A review of studies on sleep deprivation and weight found that people who got enough high-quality sleep were more likely to be successful in their weight loss efforts than people who were sleep deprived.

Are you stressed because you cant sleep, or are you having trouble sleeping because youre stressed? This is another Which came first? scenario with the same result: You, mega-frazzled and unable to catch that shut-eye you so desperately need.

It all comes back to cortisol, the stress hormone: Sleep deprivation may raise cortisol levels, which can contribute to weight gain, heart disease, anxiety, signs of aging and so much more.

On the other hand, Dr. Foldvary-Schaefer says, a good nights sleep naturally reduces cortisol levels.

Sure, you wouldnt drive while drunk, but would you drive while exhausted? You shouldnt. Sleep deprivation puts you at a higher risk for car accidents.

Driving after 20 hours without sleep is like driving with a blood alcohol content (BAC) of 0.08%, the legal limit in most U.S. states. The National Highway Traffic Safety Administration reports that drowsy driving accounts for thousands of crashes, injuries and fatalities each year.

Not getting enough sleep also hurts your heart.

Sleep deprivation can lead to hypertension (aka high blood pressure). And one study found that people diagnosed with sleep deprivation have a higher risk of hypertensive heart disease, which is the result of long-term unmanaged high blood pressure.

Plus, untreatedsleep apneaand other chronic sleep disorders put you at a higher risk for health conditions like arrhythmias (abnormal heart rhythm), obesity and Type 2 diabetes, which can all contribute to cardiovascular disease.

Studies on these topics are all evolving, but there's a lot of evidence to suggest that short sleep meaning less than seven hours on average for adults is harmful to your health, Dr. Foldvary-Schaefer says.

Chronic sleep deprivation is associated with an increased risk of other conditions, too.

When your body doesnt get the restoration it needs, that leads to a buildup of toxins and inflammatory markers that we believe underlie the development of a number of chronic diseases, Dr. Foldvary-Schaefer warns.

Not getting enough sleep raises your risk for:

Theres good reason to teach kids healthy sleep habits from an early age: Chronic sleepiness in kids and teens has seriously dangerous effects on their development.

A lack of sleep can lead to:

Unless youve really been making a point to get enough sleep, chances are high that youre not getting enough. Recent studies show that at least 30% of American adults are sleeping less than seven hours per night

But most people need at least that much, according to a report from theNational Sleep Foundation. It breaks down sleep recommendations into nine age-specific categories, with a slight range that allows for individual preferences:

Genetic, behavioral andenvironmental factorshelp determine how much sleep each individual needs. But Dr. Foldvary-Schaefer says a minimum of seven hours of sleep for adults is a step in the right direction to improve your health.

If you eat well and exercise regularly but dont get at least seven hours of sleep every night, you may be undermining all of your other efforts. And were not being dramatic! Sleep isnt a luxury; its a necessity.

Adults need seven to eight hours of sleep each night not just once in a while, Dr. Foldvarey-Schaefer says. If youre not getting that, youre likely chronically sleep deprived. Its the most common cause of tiredness in our society today.

Heres how to start taking steps to get better sleep:

Tried everything and still cant seem to wake up well-rested? It might be time to bring in the professionals.

If you snore (or suspect you do) or otherwise just cant seem to get a good nights sleep, make an appointment to chat with a healthcare provider. They may recommend a sleep study to rule out any sleep disorders and get to the root of the problems so that you can finally start getting the beauty rest you reserve.

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13 Effects of Sleep Deprivation - Health Essentials

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How we test

Our team of certified personal trainers, strength coaches, and qualified experts researched and tested more than 30 workout apps. We focused on key factors such as workout variety, accountability, and interactive features.

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We called upon certified personal trainer and editor Amanda Dvorak, exercise physiologist Dr. Chris Mohr, and professor and strength and conditioning coach Dr. Jen Roper to complete this roundup. The information in this article was reviewed for accuracy by fact checker Kelly Uhler.

If youre committed to crushing your fitness goals, theres nothing wrong with seeking some support. However, you dont have to break the bank to get help with building muscle, burning fat, and becoming your best self. While many workout apps have pricey subscriptions, plenty of cost-free platforms provide the tools you need to start (and stay) on the path to success.

To help you find the right fit, weve researched and tested more than 30 fitness apps to evaluate key criteria such as ease of use, equipment demands, and workout variety. Our mission to find the best free workout apps helped us identify worthy contenders. The apps that made our list come at no cost or at least include an excellent trial period that may convince you to find some room in your monthly budget.

Caliber offers a free-forever version that arms you with ample resources to start your fitness journey. Learn why it earned the nod as our best overall free workout app by reading our in-depth review, complete with testing notes.

Although you must pay for group and one-on-one training, the free version of Caliber still provides excellent resources and tools.

Caliber comes in several different tiers, which allows you to select the level of support you need. The free version includes useful resources that can help you accomplish your goals.

Pros

Community support via groups

In-app performance metrics tracking

Robust library of curated workout plans

Cons

Premium package has an expensive starting price of $200 a month, which is high for a workout app

Personalized macros only available with paid versions

Limited fitness tracker integration

As a fitness coaching program rooted in scientific principles, Caliber checks all the boxes we look for in the best workout apps . The first paid tier, Caliber Plus, comes with access to a library of coach-created workouts. The next tier, Caliber Premium, starts at $200 a month for individual coaching. One of our product testers invested in the one-on-one option and found the $200 price tag well worth it due to the high-quality programming and accountability she received from her coach.

However, you dont have to spend a single cent to reap some of the benefits of this data-driven platform. Calibers free-forever version contains a vast library of more than 500 exercises, each featuring a demo video, detailed instructions, and a color-coded diagram displaying the body parts involved. By also including key points and form takeaways, Caliber easily earned 5 out of 5 stars for instruction from our tester.

So many people would benefit from simple instruction and understanding of how different exercises affect different muscles. The exercise library and demo videos provided with Calibers free version is a fantastic offering, in and of itself. Many of my clients would benefit from this.

Chris Mohr, Ph.D., RD, Fortune Recommends Advisor

Although you dont get access to a coach with the free version, you dont have to plan your own daily workouts. During the set-up process, youll complete a quick assessment. The evaluation will give the Caliber algorithm the necessary data to generate a custom workout program for you. This can be especially helpful for beginners who are unfamiliar with how to structure a strength training routine.

In addition, the app allows you to track your progress by recording and charting strength and body metrics like your weight, waist size, and body fat percentage. While stepping on a scale is one way to assess your progress, keeping track of your body composition via other methods can provide better insight. ( 1 ) This can help you stay invested in your success by developing self-accountability, which is particularly important since you wont be working with a coach.

In addition to body composition, waist circumference is another useful and very simple tool to assess health. There has been research connecting waist circumference to blood pressure and even all cause mortality, among others, says Mohr. ( 2 , 3 )

You can also lean on another user-friendly feature for additional support: groups. Our product tester joined several, including ones for mountain biking, cycling, and swimming. Research shows that external factors like social support and engagement can help with motivation and accountability. ( 4 )

Each group has its own social feed where you can post things and interact with other people. Although theres not a ton of engagement, that could change as Caliber expands, our team product tester explained.

While our tester gave the app a perfect score for interactive features, she wished it integrated with Garmin, Fitbit, and other fitness trackers. As of this writing, it only integrates with the Apple Watch.

Overall, the free version of Caliber offers plenty of valuable tools and resources for both beginners and more experienced users. If you need more support in the form of nutritional guidance, routine check-ins, and fully personalized programming, you can always upgrade to the Premium tier.

Caliber users on the Apple App Store appreciate how the app has helped them become more accountable and invested in their health and wellness.

Caliber is a fantastic way to build a habit of working out, especially if, like me, youre moderately new to weight lifting/fat burning. The app tracks your progress and shows stats so you can see improvement over time, which is very motivational for me. The app also connects to third-party apps to help you track calories, etc.

Alexey Laduda, Apple App Store user

However, customer Patrick Rizk called out a few areas for improvement in his review on the Google Play Store.

Provides novel strength and balance scores to visualize progress, but the algorithm doesnt incorporate them to give tailored recommendations, which greatly reduces their utility, he said. Automatic weight progression is a basic function that most competitor apps have and is conspicuously missing.

Launched by fitness influencer Kayla Itsines, the Sweat App offers women everything from nutritional guidance to on-demand classes.

Training Plan Customizable

Designed for women, the Sweat App includes customizable training plans and meal planning assistance. After trying out the platform for free for seven days, you can sign up for the full version to gain even more features.

Pros

Can easily modify a program

Cons

Some users describe the programs as repetitive

Primarily pre-recorded workouts

Some recipes are overly complicated and require numerous ingredients

Fitness influencer Kayla Itsines spearheaded an effort to help women get healthier via the Sweat App. The app features various workout programs that include everything from postpartum training to its flagship BBG program (Bikini Body Guide), now known as High Intensity with Kayla. The app also features nutrition plans, community challenges, and on-demand classes led by certified personal trainers.

Although Sweat is only free during the seven-day trial period, women can get a first-hand look at how much the platform offers. Those with long-term goals can decide whether to invest in a monthly subscription thatll allow them to receive individualized attention and support.

To explore all Sweat had to offer, our product tester downloaded the app, inputted her fitness goals and other pertinent information, and received a personalized training plan. She rated the setup process 5 out of 5 stars. She also found the apps interface easy to navigate, which led to a score of 4.5 out of 5 stars for ease of use.

From a training perspective, Sweat covers just about every modality you can think of, including weightlifting, HIIT, yoga, pilates, and barre. In addition, there are zero-equipment versions of programs featuring straightforward movements, which allowed our reviewer to deeply connect with the targeted muscle.

What our tester says:

Offering the ability to exercise without equipment is a fantastic option, given many people may either not have any or not belong to a facility that does. That said, bodyweight workouts are a great option for improving strength and cardiorespiratory fitness, and having guidance around how to perform various exercises to support your goals is great. ( 5 )

Chris Mohr, Ph.D., RD, Fortune Recommends Advisor

The Sweat App has received positive feedback from women who needed structure, accountability, and support from a workout app.

A reviewer on the Apple App Store with the username Hxnxlei highlighted how the app motivated her to start working out again after a two-year hiatus.

The variety in programs makes it suitable for any kind of workout goal. I can see how the intensity and difficulty of BBG might be unmotivating for some though, so its great that Kayla has recently added more beginner weeks! The community tab is filled with supportive women!

Hxnxlei, Apple App Store user

Still, a few reviews criticized the app for having occasional bugs and glitches. Several customers on both the Apple App Store and the Google Play Store expressed that the suggested meal plans and recipes contained too many ingredients, which can prove problematic if you have a limited budget, time, or culinary skills.

From strength training to recovery, Fiit offers plenty of options for those who enjoy group classes but dont want to travel.

Training Plans More than 30

Fiit covers all the bases with a wide variety of workouts and training plans. Users can access all group classes at no costa great feature for those who enjoy training in that type of engaging setting.

Pros

Syncs with fitness trackers and devices

Works with mobile devices, TVs, laptops, tablets, and desktops

Records performance metrics

Caters to all fitness levels

Cons

Some classes may be too intense for beginners

No 1:1 coaching or accountability

Cant fast forward or rewind classes

Men (and women) who love the interactive aspect of group fitness classes will truly appreciate Fiit. Available in both free and paid versions, this app offers 2,000 workouts ranging from strength training to cardio to yoga.

The free version gives you unlimited access to all group classesa major plus for those who value that added motivation from training alongside others (virtually, in this case). Plus, you can invite family and friends to join, which can be another source of accountability and self-motivation. ( 6 )

The workouts vary in length, with some taking as little as 10 minutes and others lasting for one hour. If youre a guy whos always on the go, you can still squeeze in a quick workout before you head out the door. Or, you can take a longer-duration session for a true full-body workout.

Another user-friendly feature Fiit offers: the ability to complete workouts with zero gym equipment. The platform has hundreds of bodyweight classes that only require a phone, TV, or laptop for streaming.

While the free version gives you plenty to work with, upgrading to the Essential or Unlimited tiers opens the door to more training possibilities. Luckily, you dont have to fully commit to either option. Fiit offers a 14-day free trial that allows you to test additional features like Apple and Google Health integration, performance metrics tracking, and exclusive workouts.

Ultimately, you can start with the free version and enjoy unlimited access to all of Fiits group classes before considering upgrading to the Essential ($80 per year) or Unlimited ($120 per year) tiers.

Fiit customers enjoy the quality of the workouts and that theyre challenging without being too time-consuming.

This app is fantastic! Ive been completing FIIT workouts for about 3 months now, and it has completely changed my view on working out! The Base FIIT camps are great for an out of shape beginner like myself, and they prepare you for heavier workouts through lots of technique and form practice, and stretching. The flow yoga classes too, are also super useful as a supplemental cooldown/stretch session.

Aurora Siegler, Android app user

However, one common pain point customers highlight is the inability to fast forward or rewind classes.

This is really important as sometimes you dont quite understand how to do a move and want to rewind to see it properly, wrote Android user Hussein Ladha.

Designed for Apple Watch users, Train Fitness allows you to automatically track and log over 100 exercises using AI technology.

Accountability Community feed

Think of Train Fitness as a tool to get more insight into your workouts rather than something that will guide you on how to train. Its a convenient way to log every rep without having to do it yourself.

Pros

Sturdy and high-quality mattress

Nice option for stomach sleepers

Good option for back sleepers

I also like this for heavier sleepers

Cons

Pretty high motion transfer

Luxury Firm is too firm for side sleepers

Customer service was longer than average

Gym-goers whose workout routine wouldnt be complete without their Apple Watch shouldnt hesitate to download Train Fitness. Powered by intuitive AI, this app doesnt provide programs or workouts to follow. Rather, it allows users to focus more on their technique and less on counting their reps by recording them for you.

When paired with the Apple Watch, AI algorithms automatically detect what exercise you are performing based on the movement of your wrist. Train Fitness tracks more than 100 exercises using this method, and you can also manually enter data for more than 400 exercises.

In addition, you can filter and review their workout data by multiple metrics. The interface has easy-to-read graphics and charts that show your progress with particular lifts. This may help you identify weak points and potentially inspire you to change your program to push through plateaus.

Moreover, Train Fitness encourages you to stay connected with other users by sharing your completed workouts on your social feed. You can also challenge a friend, which can give both of you extra motivation to not to skip out on your next gym session.

Unfortunately, this app doesnt give you training plans to implement in the gym. So, if youre searching for a structured routine, Train Fitness isnt for you. However, if you have an Apple Watch and a gym membership (or even a full home gym ), you can take advantage of this technology and get more insight into your workouts without having to do anything extra.

Featuring a rebuilt search function and notifications page, this AI-driven workout tracking app generates positive user feedback for being easy to use and accurate.

I have been amazed at the accurate ability of the application to recognize specific workouts while I am at the gym, a user named Gym Geno wrote in their review on the Apple App Store. I highly recommend using this app because not only can experienced gym enthusiasts maximize their workout sessions, but this platform can also teach newcomers as well.

Another reviewer on the Apple App Store with the username KaseyLynn R. shared a similar sentiment about Train Fitness.

I absolutely love this app! It makes my workouts so easy. I used to log with a pen and paper but that got hard and annoying. This app also helps me know what muscles need rest and what muscles need attention.

KaseyLynn R., Apple App Store user

A free app that includes classes and periodized programs, Nike Training Club can help you get more out of your dumbbell workouts.

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The 9 best free workout apps for 2024, according to a certified personal trainer - Fortune

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