Category: Wellness

Canadians love sports.

We love watching them, talking about them and loudly offering coaching advice from the couch. With World Cup soccer bringing even more excitement to the game here in Canada—hooray for Canada!—plenty of children and adults are feeling inspired to get out and play.

Sports are good for our bodies, our confidence and our social lives—but injuries can happen whether you are playing soccer, baseball, football, hockey or pickleball.

The best protection is preparation. Warm up before you play, build strength gradually, wear the right footwear and equipment, drink water and give your body time to recover. Consider making an appointment with our physiotherapy team before injury happens. We help children and adults improve strength, balance, mobility and movement so they can play more safely—and keep doing the activities they love.

If injury does happen, pay attention to pain, and always take a possible concussion seriously. And don’t go about the job of healing your body on your own. Trust our physiotherapy team to work with you step by step from injury to back to playing. We’re experts at helping active bodies stay active!

Below, we take an indepth look at the most common injuries in popular sports, along with simple ways to help prevent them and keep yourself—or your child—safely in the game.

Most sports injuries are things such as sprains, strains, bruises and sore muscles. Broken bones and concussions also happen, particularly in sports involving falls, fast movement or contact between players.

A sprain happens when a ligament—the tissue connecting one bone to another—is stretched or torn. An ankle sprain is probably the example most people know.

A strain affects a muscle or tendon. Pulled hamstrings, tight groin muscles and sore shoulders often fall into this category.

Fractures, or broken bones, are more likely after a hard fall, awkward landing or collision.

A concussion is a brain injury caused by a blow to the head or body. A person does not have to be knocked unconscious to have one. Headaches, dizziness, nausea, confusion and balance problems can all be signs of a concussion.

Canadian injury data shows that sports and recreational activities are a common cause of concussions in children and teenagers. In one reporting period, approximately 46,000 Canadian children and youth between the ages of five and 19 received medical care for a concussion.

Soccer involves much more than running in a straight line. Players accelerate, stop suddenly, pivot, kick, jump and sometimes collide with another player.

That makes ankle and knee sprains, muscle strains and bruises fairly common. Fractures can happen after a fall or collision, and concussions may be caused by contact with another player, the ground or the ball.

Children may also develop overuse injuries when they play on several teams or increase their training too quickly. Adults often run into trouble when they return to soccer after a long break and immediately expect their bodies to perform as they did years ago.

Enthusiasm is wonderful. A gradual return is usually wiser.

A physiotherapist can help a player build strength in the muscles surrounding the hips, knees and ankles, work on balance and identify movement patterns that may increase the chance of injury.

Baseball is fun but it does place a lot of demand on the body.

Repeated throwing can irritate the shoulder and elbow, particularly in young pitchers. Players can also experience ankle and knee sprains, pulled muscles, finger injuries and bruises from the ball.

Children should not be encouraged to pitch through pain. A sore arm is not a sign that they need to “toughen up.” It may be a sign that they are throwing too often, using poor mechanics or simply need rest.

Adults joining a casual game should also take a few minutes to warm up before throwing as hard as possible from the outfield. Your shoulder will appreciate your caution.

If shoulder or elbow pain keeps coming back, one of our physiotherapists can assess strength, mobility and throwing mechanics and recommend exercises based on the player’s age and activity level.

Children’s football includes running, sudden changes in direction and, depending on the type of league, tackling and frequent physical contact.

Bruises, sprains, strains and broken bones can happen. Head injuries are another important concern. Canadian injury-surveillance data has found that traumatic brain injuries, including concussions, make up a notable portion of football injuries among boys aged 10 to 14.

Well-fitted equipment helps, but equipment is only one part of prevention. Children also need proper instruction, sensible limits on contact during practice and coaches who take possible concussion symptoms seriously.

Any child suspected of having a concussion should leave the game and be assessed. They should not return to play that day.

Hockey is fast, physical and played on a very hard surface. Add skates, sticks, boards and a puck, and it is easy to see why injuries happen.

Common hockey injuries include groin and hamstring strains, ankle and knee sprains, shoulder injuries, cuts, bruises and broken wrists, hands or collarbones. Concussions are also a concern, especially in children’s and youth hockey.

Adult pickup hockey deserves a special mention.

Many adults arrive at the rink after sitting at a desk, tie their skates, circle the ice twice and then launch themselves into a full-speed shift. That is a fairly dramatic request to make of cold muscles.

A better plan is to warm up your hips, legs and core before stepping onto the ice, then use the first few minutes of skating to build your speed gradually.

Our physiotherapists can also help hockey players work on hip mobility, leg strength, balance and core control before the season starts—or before returning to the ice following an injury.

Pickleball is social, easy to learn and accessible to a wide range of players. Those are some of the reasons it has become so popular.

But easy to learn does not mean physically effortless.

Pickleball involves quick starts, sudden stops, reaching, twisting and plenty of side-to-side movement. Players may also move backwards when balls are hit high and long, which can dramatically increase the risk of falling.

Common pickleball injuries include:

These injuries are especially common when someone goes from being relatively inactive to playing several times a week.

Pickleball has a way of going from a once a week game to a 5x a week habit. You try it once, have a wonderful time and suddenly find yourself booking courts for Tuesday, Thursday, Saturday and “maybe just a quick game” on Sunday.

The number of new friends you have may be delighted. Your body may prefer a more gradual schedule.

A Winterberry physiotherapist can help new and experienced pickleball players improve leg strength, balance, shoulder mobility and movement on the court. This can be especially helpful for adults returning to sport after a long break or managing an old knee, hip, back or shoulder problem.

You do not need an elaborate training program to reduce your chance of injury. A few basic habits can go a long way.

Your warm-up should prepare you for the movements you are about to make.

Before soccer or football, begin with brisk walking or light jogging. Add a few controlled lunges, side steps and changes of direction.

Before baseball, warm up your shoulders and upper back, then begin throwing gently over a short distance. Build up the speed and distance rather than starting with your hardest throw.

Before hockey, try squats, side lunges, calf raises and hip movements before putting on your skates. Once you are on the ice, begin with easy skating.

Before pickleball, walk briskly for a few minutes, then add calf raises, gentle squats and side-to-side movements. Start with dinks and controlled rallies before moving into harder shots and faster points.

The warm-up does not need to take forever. It just needs to happen.

Strong muscles help support the joints and absorb some of the force created by running, jumping, turning and stopping.

The right exercises depend on the sport, the person and any previous injuries. A soccer player may need to focus on hip, knee and ankle control. A baseball player may benefit from shoulder and upper-back strength. A hockey or pickleball player may need more work on balance, leg strength and quick changes of direction.

This is one of the ways our physiotherapists can help before an injury occurs. You do not have to wait until something hurts to book an appointment.

Footwear matters, particularly in sports that involve fast changes of direction.

Running shoes are designed mainly for forward movement. They may not provide enough side-to-side support for pickleball, tennis or other court sports. Court shoes are generally a safer choice.

Soccer cleats, baseball shoes and skates should fit properly and suit the playing surface. Shoes that are worn out, too loose or too tight can affect balance and increase the chance of injury.

Helmets, shin guards, pads, mouthguards, safety eyewear and other protective equipment only help when they fit correctly.

Check children’s equipment regularly. Kids grow quickly, and gear that fit at the beginning of the season may not fit several months later.

A helmet can reduce the chance of certain head injuries, but no helmet can prevent every concussion. Safe play, good technique and proper concussion management still matter.

A common cause of sports injury is doing too much before the body has had time to adjust.

This can happen when a child joins several teams at once or when an adult returns to a sport after months—or years—away.

Start with shorter sessions and allow time for recovery between games. Gradually increase how often and how intensely you play.

Feeling good after one game does not always mean your body is ready for five more.

Take a quick look at the field, pitch, rink or court before playing.

Watch for wet grass, uneven ground, holes, poor lighting or loose equipment. On a pickleball or tennis court, remove stray balls, bags and water bottles from the playing area.

At the rink, look for rough patches in the ice and make sure doors near the playing surface are closed properly.

It only takes a moment to spot a hazard that could ruin the rest of your season.

Fatigue can affect balance, coordination and decision-making.

Bring water and take breaks, particularly during long games or hot weather. Children may need reminders because they are often too busy having fun to notice that they are thirsty.

Adults are not always much better.

There is a difference between ordinary effort and pain that signals a problem.

Sharp pain, swelling, weakness, instability or discomfort that changes the way you move should not be ignored. Continuing to play may turn a minor injury into something that takes much longer to heal.

Stopping does not mean you are giving up. It may be the decision that gets you back into the game sooner.

Early physiotherapy treatment may help reduce pain, restore movement and prevent a small problem from becoming a longer-term one.

Possible signs of a concussion include:

Anyone with a suspected concussion should stop playing and receive an appropriate medical assessment. They should not return to the game that day.

Seek urgent medical attention if symptoms become severe or worsen, particularly if the person has repeated vomiting, a worsening headache, increasing confusion, weakness, a seizure or loss of consciousness.

Rest is part of playing well.

Children need time away from organized sports during the week and throughout the year. Adults also need recovery days, especially when they are new to a sport or returning after an injury.

Rest does not always mean doing nothing. It may mean walking, stretching gently or choosing a lighter activity while sore muscles recover.

You do not have to be injured to benefit from physiotherapy.

The Winterberry Physiotherapy team can assess your strength, balance, mobility and movement before you begin a new sport or return after time away. Your physiotherapist can then recommend practical exercises to help prepare your body for the demands of soccer, baseball, football, hockey, pickleball or another activity you enjoy.

Physiotherapy may help you:

And, of course, injuries can still happen—even when you do everything right.

If you do get hurt, our team is here to help you understand the injury, manage pain and work toward a safe return to activity. Your treatment plan will depend on the injury, your health and the activities you want to get back to doing.

The answer to avoiding sports injuries is not to stop playing.

Being active supports strength, balance, heart health, mobility and mental well-being. Sports also give us something that can be harder to measure: laughter, friendship and a sense of belonging.

Choose an activity that suits your health and current fitness level. Prepare your body, wear the right equipment, pay attention to pain and take head injuries seriously.

Then get out there and enjoy yourself.

And when you head to the pitch, field, rink or pickleball court, invite a friend to join you. Sports are fun, but they are even better when we make room for a new player.

If pain, stiffness, weakness or an injury is keeping you—or your child—on the sidelines, the Winterberry Physiotherapy team is here to help. Contact us to book a physiotherapy appointment in Hamilton and take the next step toward getting back to the activities you love.

This article provides general information and is not a substitute for individual medical advice. Seek appropriate medical care for a suspected concussion, fracture or serious injury, or for symptoms that are severe or getting worse.

May is National Physiotherapy Month — a time to recognize and celebrate the physiotherapists, physiotherapist assistants, students, and clinic teams who help people across Ontario move, recover, strengthen, and return to the activities that matter most.

Each year, the Ontario Physiotherapy Association uses National Physiotherapy Month to raise awareness about the role physiotherapy plays in the health and well-being of people across the province. It is also a chance to shine a light on the dedicated professionals who support patients in hospitals, rehabilitation centres, long-term care homes, community clinics, private practices, home care settings, and beyond.

Our physiotherapy team is part of the everyday care network that helps patients feel supported, understood, and encouraged as they work toward their goals. Some patients come to physiotherapy after an injury. Others are recovering from surgery, managing pain, improving mobility, rebuilding strength, or trying to stay active and independent. Every patient’s story is different — and that is exactly why the work of physiotherapy matters so much.

National Physiotherapy Month gives us a moment to pause and recognize not only the care patients receive, but also the people behind that care.

Here at Winterberry Physiotherapy, we are grateful for our dedicated team, including Joshua, Joya, and Tani, our physiotherapists, and Abigail, our Physiotherapy/Occupational Therapy Assistant. Along with our administrative and reception team, they help create a welcoming, supportive experience for patients from the moment they book an appointment through every step of their care.

Physiotherapy is often associated with recovery, but at its heart, it is also about possibility. It is about helping someone feel more confident going up the stairs. It is about supporting a safe return to work, sport, walking, gardening, travel, or family life. It is about giving patients tools, education, and encouragement so they can take an active role in their health.

That kind of care takes skill, patience, problem-solving, and compassion — and we are proud to celebrate the professionals who provide it.

This month, we extend our appreciation to physiotherapists and physiotherapy teams across Ontario. Thank you for the work you do every day to help people move better, feel stronger, and live more fully.

And to our own Winterberry Physiotherapy team: thank you for bringing your knowledge, kindness, and commitment to our patients and community. We are grateful for the difference you make.

If you would like to learn more about Winterberry Physiotherapy or book an appointment with our team, please call 365-218-0088 or visit our Physiotherapy page.

If you’ve been searching for physio in Hamilton, you may be wondering what actually happens at your first appointment.

Maybe you’re dealing with pain, stiffness, an injury, reduced mobility, or something that just doesn’t feel quite right. Your first physiotherapy visit is designed to help your physiotherapist understand what’s going on, assess how your body is moving, and create a treatment plan that supports your recovery.

At Winterberry Physiotherapy in Hamilton, your first visit includes a full initial assessment and a treatment session, so you can leave with a clearer understanding of your condition and a plan for moving forward.

Your first physiotherapy appointment is called an initial assessment. This appointment usually takes 45 minutes to 1 hour.

During your first visit, your physiotherapist will begin with a comprehensive review of your medical history, current symptoms, lifestyle, and goals. This helps us better understand your concerns and what you want to get back to doing.

Your physiotherapist will then complete a physical assessment. Depending on your needs, this may include looking at your:

This assessment helps your physiotherapist identify what may be contributing to your symptoms and how best to support your recovery.

After your assessment, your physiotherapist will explain their findings and develop a personalized treatment plan based on your needs and goals.

Your treatment plan may include hands-on therapy, therapeutic exercises, education, mobility work, strengthening, stretching, or other physiotherapy techniques depending on your condition.

At Winterberry Physiotherapy in Hamilton, our physiotherapists also provide a treatment session at the end of your first assessment, with no extra charge.

Your progress will be monitored and reassessed regularly, so your treatment plan can be adjusted as your body improves. With consistent care and commitment, many patients begin to notice meaningful improvements within 4 to 6 weeks.

For your first physiotherapy visit, wear comfortable clothing that allows you to move easily.

Depending on the area being assessed, it may be helpful to wear or bring:

Your physiotherapist may need to observe how the affected area moves, so clothing that allows easy access to the area being assessed is best.

Winterberry Physiotherapy is located in Hamilton, and parking information is available when you book your appointment or contact the clinic.

If you are unsure where to park or how to access the clinic, our team can provide directions before your visit so you know exactly where to go when you arrive.

Booking an appointment with Winterberry Physiotherapy in Hamilton is simple.

Book by emailing us at physio@winterberrymedical.ca
Or call us at 365-218-0088

In many cases, you do not need a doctor’s referral to see a physiotherapist. However, some insurance plans may require a referral for coverage. It is always a good idea to check with your benefits provider before your appointment.

Your first physiotherapy appointment usually takes 45 minutes to 1 hour. This gives your physiotherapist time to complete a full assessment, discuss your concerns, and begin treatment.

Yes. At Winterberry Physiotherapy in Hamilton, your initial assessment includes a treatment session at the end of your first visit, with no extra charge.

Please bring any relevant medical information, imaging reports, referral notes if you have them, and a list of current medications or health concerns. You should also bring your insurance information if you plan to submit your visit through benefits.

Wear comfortable clothing that allows you to move. If your physiotherapist needs to assess your knee, hip, shoulder, back, or another specific area, clothing that allows access to that area is helpful.

The number of sessions depends on your condition, goals, and how your body responds to treatment. With consistent care and commitment, many patients begin to notice meaningful improvements within 4 to 6 weeks.

Yes, Winterberry Physiotherapy in Hamilton is accepting new physiotherapy patients. You can book an appointment online or contact the clinic for more information.

At Winterberry, our promise of “Helping you live your best life” goes beyond primary care. That is why we added a full Physiotherapy clinic in 2025. Our physiotherapy team plays an important role in helping you recover from injuries, manage work related, repetitive injuryies, heal after surgery, and maintain or improve mobility.

Our physiotherapists and assistants are caring, skilled, and experienced professionals committed to delivering high-quality care and meaningful outcomes. Every treatment plan is tailored to you. We consider your goals, daily activities, and health history to create a plan that supports your recovery. Whether you are healing from a recent injury, living with a long-term condition, or managing work-related strain, our team is here to help.

What Physiotherapy Can Do for You

Physiotherapy focuses on restoring movement, reducing pain, and improving strength and function. According to the Ontario Physiotherapy Association (OPA), physiotherapists are university-educated health professionals trained to assess and treat conditions that affect how the body moves.

Your treatment may include hands-on therapy, guided exercises, movement training, and education. The goal is not only to relieve discomfort but also to help you move with greater confidence in your daily life.

Your care begins with a detailed evaluation. We take time to understand where you feel discomfort and what may be causing it. By addressing the root cause — not just the symptoms — we aim to support long-term improvement and reduce the chance of recurrence.

A Collaborative, YOU-Focused Approach

Your care team includes registered physiotherapists and physiotherapy assistants who work closely together to provide consistent, attentive support throughout every visit.

You can expect:

• A comprehensive first visit
• A treatment plan designed around your goals
• Clear explanations about your condition and expected recovery timeline
• Guided exercise programs
• Ongoing progress reviews and adjustments as needed

We believe education is a key part of recovery. When you understand your condition and the purpose behind your treatment plan, you can take an active role in feeling better and staying well.

Integrated Care Within Winterberry

One of the benefits of receiving physiotherapy at Winterberry is access to integrated care. Your physiotherapist collaborates with physicians, nurse practitioners, and other healthcare professionals within the clinic. This coordinated approach ensures your treatment plan supports your overall health needs.

Whether you are addressing muscle and joint injuries, posture concerns, balance challenges, or recovering after surgery, our physiotherapy team is committed to helping you return to daily activities safely and confidently.

Committed to High Standards

Physiotherapy is a regulated health profession in Ontario. Your physiotherapist meets strict professional standards and continues ongoing education to stay current with best practices. As part of a broader professional community, including the Ontario Physiotherapy Association, our team provides care grounded in current evidence and clinical expertise.

At Winterberry, physiotherapy is more than a treatment session — it is a partnership in your wellness, built on professionalism, compassion, and expertise.

If you would like to learn more about how physiotherapy can support your health and mobility, we welcome you to connect with our team. Call us at 365‑218‑0088, or send an email to: physio@winterberrymedical.ca

Calling all 12-18 year olds! Book an appointment and let’s check-in and chat about your physical and mental health including stressors and goals.  Winterberry is a safe and supportive space,  let’s get you ready for back to school together.  

Booking is easy, just click here to visit our online appointment page.

Photo by Parker Gibbons on Unsplash

At Winterberry we encourage you to protect yourself from COVID-19 if you are in a high risk category. We are opening up evening vaccination appointments to make getting your shot easy and quick.

You are at high risk if you are any of the following:

    • Adults 65 years of age and older.  

    • Adult residents of long-term care homes and other congregate living settings

       for seniors.  

    • Individuals 6 months of age and older who are moderately to severely  

       immunocompromised (due to an underlying condition or treatment).  

    • Individuals 55 years and older who identify as First Nations, Inuit, or Metis

       and their non-Indigenous household members who are 55 years and older. 

As part of our ongoing commitment to help our patients live their best life we are sharing the full USA Today series on “Rethinking Obesity”. The following is #5 in the series.

ILLUSTRATION BY TRACIE KEETON/USA TODAY; AND GETTY IMAGES

Karen Weintraub USA TODAY

Published 5:01 AM EDT Jul. 26, 2022 Updated 9:01 PM EDT Jul. 31, 2022

Editor’s note: Part 5 of a six-part USA TODAY series examining America’s obesity epidemic.

For two decades, Charleah Torres-Vega, 43, refused to donate her favorite dress – a blue strapless number – hoping it would someday fit again.

After giving birth to her fourth child, the 5-foot-4 Boston resident weighed 236 pounds, or 62 pounds above the cutoff for clinical obesity.

“It was a shocking number and also very frustrating,” she said.

For decades, medicine has had little to offer people such as Torres-Vega, even as the majority of Americans added extra pounds. 

There’s no other common disease for which only 3% to 4% of patients can get evidence-based treatments that are actually helpful, said Torres-Vega’s doctor, Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital and Harvard Medical School.

“It’s hurtful to me to see that this is how we treat patients with obesity,” she said.

Finally, that’s starting to change. 

Despite decades fighting America’s obesity epidemic, it’s only gotten worse. To try to understand why, USA TODAY spoke with more than 50 experts for this six-part series, which explores emerging science and evolving attitudes toward excess weight.

As the scientific understanding of weight loss deepens, the tools for addressing it are improving.

A year ago, an injectable diabetes drug called semaglutide, from Novo Nordisk, won approval from the Food and Drug Administration. It offered three times the weight loss potential of existing drugs: 15% of a person’s body weight.

Another drug, tirzepatide, was approved in mid-May for the treatment of diabetes. A study released in June showed it’s also effective at helping people lose weight. Virtually all 2,500 trial participants lost at least 5% of their body weight over a year and a half. More than half lost 20%.

With mostly manageable side effects, these medications and more in the pipeline have the potential to transform the nation’s obesity epidemic, said Dr. Katherine Saunders, a weight loss specialist at the Comprehensive Weight Control Center at Weill Cornell Medicine in New York.  

Dr. Katherine Saunders, a weight loss specialist at the Comprehensive Weight Control Center at Weill Cornell Medicine

“It does feel like we’re at an incredibly exciting time where the medications we have available are helping so many people to lose very clinically significant weight,” Saunders said.

The big question is whether people will be able to access them – or want to. The new medications are expensive and often not covered by insurance. Staying healthy also requires regular exercise and maintaining a balanced diet, Stanford and others said, so the shots aren’t a simple solution.

As with drugs to treat other chronic illnesses, anti-obesity medications are intended to be taken for a lifetime. Stop taking the weekly injections, doctors say, and biology will ensure the pounds return. 

As a medical student, Stanford was taught all about rare diseases she has never seen in decades of practice. But her professors spent almost no time talking about a condition that now affects at least 40% of Americans.

She was drawn to the medical treatment of obesity in part because she can make a profound difference in her patients’ lives and in part because she’s Black.

“I could see the disproportionate impact,” Stanford said. Black women have the highest rates of excess weight in the United States: More than half are considered to have obesity, and 30% more meet the definition of overweight. 

“I felt like I needed to be at the front lines of being able to address this,” she said. 

Torres-Vega is a rare exception. She was able to lose weight through force of will.

In 2019, her primary care doctor said her blood pressure was on the rise, so she went back on the Beachbody diet and exercise plan. She committed to make more time for herself and stay disciplined.

She fed her family chickpea protein pasta and cauliflower rice and switched to 99% fat-free ground turkey instead of ground beef for her spaghetti sauce.

“I still eat everything I love,” she said, even if it’s in a slightly different form. “I don’t believe in deprivation.”

She ate more fresh, organic vegetables and fruit, made sure she had lean protein, controlled her portions and started accounting for the bites she took as she cooked nightly meals for her family.

Her husband also has lost weight, and she’s teaching her children good food habits.

“Improving our healthy relationship with food has been a journey,” she said. 

By late last year, the paralegal and Beachbody coach managed to reach her longtime goal of 160 pounds, her high school weight. The skinny jeans she had bought for her 30th birthday were so baggy she could fit her whole body in one leg.

But she was terrified it would all come back. Again.

Rebound is a concern after all forms of weight loss. Sometimes people bounce back and end up even heavier than when they started, said Dr. William Dietz, director of the Sumner M. Redstone Global Center for Prevention and Wellness at The George Washington University. 

Someday, researchers may find a “switch” in the brain or the gut that can be reset so formerly heavy people won’t have to keep fighting those extra pounds forever. Until then, Dietz said, medications are probably a lifetime commitment.

The full anti-obesity dose of semaglutide, sold under the brand name Wegovy, lists for $1,350 to $1,700 a month, typically costs $1,600 to $1,700 a month, though some stores charge as much as $6,000.

Even at that price, Novo Nordisk hasn’t been able to keep up with demand.

The company put advertising and new prescriptions for weight loss on hold late last year. In a memo posted to its website, Novo Nordisk said it can supply maintenance doses for those already on the drug but has stopped providing low-dose ramp-up prescriptions. Shortages, it said, will “continue into the second half of 2022 when we expect to stabilize supply.”

Eli Lilly, which makes tirzepatide, hasn’t yet set a price for weight loss, though it costs about $1,000 a month for the same dose that treats diabetes. The company has pledged to make it accessible to treat obesity. 

At the moment, most insurance companies and Medicare don’t offer coverage for obesity other than some nutritional counseling. 

Stanford said she is battle-hardened after years of fighting insurance companies. Massachusetts now has some of the best weight loss coverage in the country, she said.

Thanks in part to her efforts, Blue Cross Blue Shield of Massachusetts offers visits with staff nutritionists for obesity without the need for prior authorization. Many of its plans provide reimbursement up to an annual cap for weight loss programs, according to spokesperson Amy McHugh.

But still, many Americans can’t get routine coverage even to see a nutritionist unless they’ve been diagnosed with diabetes or another serious weight-related problem. 

New medications are changing the struggle to lose weight. Share this story.Share on Facebook

Medications are covered only for people with high BMIs or related health problems “consistent with evidence-based best practices,” said David Allen, a spokesperson for America’s Health Insurance Plans, an industry group. “In some cases, plans may require individuals to partake in a period of behavioral modifications, increased physical activity and dietary changes.”

Obesity costs the U.S. medical system about $173 billion a year, roughly four times the amount spent annually to fund the National Institutes of Health. Medical bills for someone with obesity run $1,861 more than for a person weighing in the “normal” range.

Fundamentally, there’s not much incentive for insurers to cover weight loss treatments, said Dr. David Rind, chief medical officer for the Institute for Clinical and Economic Review, a Boston-based nonprofit that evaluates medical procedures.

Most treatments for diabetes, high blood pressure and high cholesterol are inexpensive generics, so insurance companies would end up paying more if they replaced these with a costly weight loss drug, Rind said. He noted insurers are supposed to cover treatments that improve health, and “weight loss treatments can result in important health gains.”

Coverage isn’t needed for people with just 10 pounds to lose, said Dr. Louis Aronne, an obesity medicine specialist at Weill Cornell Medical Center in Manhattan, who helped lead the tirzepatide trials. But in less than 10 years, a quarter of Americans are projected to have a BMI of 35, well above the benchmark for obesity, and related diabetes rates will continue to rise, he said. 

Those people deserve to have their medication covered by insurance now rather than having to wait to get sick, he said. 

Older, inexpensive anti-obesity medications still have a role to play, too, Saunders said.

They don’t trigger anywhere near the kind of weight loss as the newer generation of drugs. Most can help people lose about 5% of body weight. But they can be useful for modest weight loss and in combination, as part of a comprehensive treatment plan.

Saunders provides the kind of intensive, personalized counseling that most Americans can’t access, but her company, Intellihealth, has launched a digital program called Evolve and a telehealth practice called Flyte that she hopes will spread her approach.

In her own practice, she starts with each new patient taking a detailed history of their weight gain and barriers to weight loss. She also runs a panel of labs to identify contributors to weight gain and ensure their kidney and liver functions are OK. Then she gives them feedback on lifestyle approaches they can try.

If they’ve already tried them all, she said, “then I’ll say ‘OK, you’re a good candidate for anti-obesity medication.'”

Modest weight loss of 5% can improve some health metrics, like blood pressure and markers of diabetes, research shows. But even that amount of weight loss is difficult for most people to achieve through diet and exercise. 

And it doesn’t always help. Famously, a trial of more than 5,000 participants with diabetes and either obesity or overweight was stopped after nearly a decade when weight loss of more than 6% failed to improve heart health.

Generally, though, more weight loss has been shown to lead to more improvements. 

In a study of people with a BMI of 40, a 13% median weight loss led to a 40% drop in Type 2 diabetes and sleep apnea and a roughly 20% decline in rates of hypertension, high cholesterol and asthma.

• Know that it’s not your fault if you’re carrying extra weight. The way the human body evolved, combined with easily available and low-cost processed food make weight gain likely and weight loss challenging. 

• Fitness matters more for health than a number on a scale. Find physical activities you enjoy and commit to move a total of least 30 minutes a day, five days a week. 

• Make sure to average at least 7 hours of sleep a night. Disconnecting from electronics for 90 minutes before bedtime can help. 

• If you’re concerned about weight, prioritize not gaining more and the quality of foods you eat. 

• Chose whole foods, like fruits, vegetables, nuts, healthy oils, fermented dairy products and fatty fish, which have a healthier mix of nutrients and make you feel fuller. 

Reducing cancer risk requires people with obesity to lose about 20% to 25% of their body weight, according to a study in June. Until now, that kind of weight loss has been achievable only through surgery, though the new medications might get some people there.

(Studies of tirzepatide haven’t yet confirmed that weight lost with the drug leads to substantial health benefits, though “all of the metabolic parameters measured were improved,” Aronne said. Some research has found health benefits with semaglutide. About 75% of weight lost with both medications comes from fat and 25% from muscle, he said.)

Dr. Ali Aminian, who led the recent cancer study, was surprised to see that so much weight loss was needed to improve cancer risk. 

This means it’s increasingly important for people to have a way to dramatically reduce their weight, said Aminian, a surgeon who directs the Bariatric and Metabolic Institute at the Cleveland Clinic. Until now, that has been possible only with surgery.

Just 1% to 2% of people who qualify for weight loss surgery actually go under the knife.

“Why are we not using the thing that solves many of the disease processes that are affecting our country?” Stanford asked.

Some of that lack of use is because of fear. In the earliest days of bariatric surgery, death was a very real risk.

Though death remains a slim possibility, safety has improved substantially, Aminian said. Almost all surgeries are now done through “keyhole” openings rather than large incisions in the abdomen.

The lack of insurance coverage also keeps weight loss surgery from many who would benefit. It typically runs $15,000 to $20,000, Aminian said.

To qualify for coverage, someone must have a BMI over 40 or a BMI over 35 with a serious weight-related health problem, such as Type 2 diabetes, high blood pressure or severe sleep apnea. Someone 5-foot-5 would have to weigh more than 240 pounds and someone 5-9 more than 270 to reach a BMI of 40.

Although new medications are getting close, no other weight loss approach has proved as effective as surgically shrinking someone’s stomach and rerouting the small intestine. With surgery, people can quickly lose dozens of pounds and 30% to 40% of body weight, Aminian said.

They may regain some of that lost weight in the years after surgery, but unlike with dieting, the rebound is rarely complete, and fewer than 5% of patients end up heavier five to 10 years after surgery, Aminian said.

For most people, surgery improves obesity-related conditions such as asthma, hypertension, fatty liver disease, metabolic syndrome, diabetes, heart failure, polycystic ovary syndrome, menstrual dysfunction, excess hair, arthritis and sleep apnea, Aminian said. Often, these vanish within a few months.

Weight loss surgery improves quality of life, and the 10-year death rate after surgery drops by nearly 40%.

Aminian would like to see insurance cover surgery sooner, before patients reach extreme levels of obesity and suffer severe health problems. Just as it’s easier to treat cancer caught at an early stage, so the health consequences of obesity are more treatable or preventable if weight gain can be stopped.

“If a patient is 500 pounds, 600 pounds with all those complications, sometimes you feel like it’s already too late to intervene,” Aminian said.

Once people gain weight, something changes about the way their body self-regulates that makes it nearly impossible to go back, Aronne said.

Consuming too many calories too quickly overloads the nerves in the brain that receive signals from hormones, he said.

“As you get more damage there, fewer hormonal signals are able to get through and tell your brain how much you’ve eaten and how much fat is stored,” Aronne said. “As a result, your body keeps expanding your fat mass.”

After decades of struggling to understand this process, researchers have finally figured out how to manipulate two of those naturally occurring hormones, called GLP-1 (short for glucagon-like peptide-1) and GIP (for glucose-dependent insulinotropic polypeptide).

GLP-1 is a fullness signal and GIP seems to amplify GLP-1’s effect, Aronne said. 

Still, one medication alone is never going to be the solution to obesity, Saunders said.  

Obesity is a complex problem with many factors contributing to weight gain and multiple barriers that prevent weight loss, she said. “It’s all about optimizing diet and physical activity, and then we need as big of an armamentarium of medications as we can get.”

As with any medication, they’re not for everyone. Some people suffer severe stomach problems, though doctors who use them routinely say they can help patients work through most of them. 

Dr. Zhaoping Li, chief of the Division of Clinical Nutrition at the University of California, Los Angeles, said stomach discomfort is part of how the drugs work. “That’s how it makes you not want to eat,” she said.

Saunders said she had one patient who was vomiting every five hours after taking the drug. Clearly, it wasn’t a good fit.

But for most people, symptoms can be controlled by fine-tuning the dosage of the anti-obesity medication and adding or eating smaller meals. “Treatment needs to be personalized and complemented by close monitoring,” she said.

The coronavirus pandemic helped Torres-Vega lose weight. Instead of spending time commuting, she was able to work out at home early in the morning. She had more time to cook. And with that extra time and growing kids, she was finally able to prioritize her own needs.

“Being able to shut out most of the world,” she said, “helped me have much success.”

But she wanted something in addition to her new attitude to help her stay in control of her weight.

In January, under the direction of Stanford, Torres-Vega began taking semaglutide. She has been thrilled with the results. She no longer eats mindlessly and has been able to disconnect food from emotions such as  happiness, sorrow and boredom.

Unlike many patients, Torres-Vega said she has no side effects from the medication. She doesn’t mind that she’ll probably have to take the medications forever to keep her weight where she wants it. 

She just wishes she had learned sooner to think about obesity as a chronic disease to be managed rather than as a moral failing. “That would have helped me not be so hard on myself.”

Torres-Vega’s medication sits at the head of a long line of potential new approaches to weight loss.

“There are other advances to come that are going to continue to improve outcomes,” Aronne said. 

Semaglutide acts on one biological pathway. Tirzepatide acts on two. The next-generation drug, now in animal studies, acts on three and could offer even more weight loss potential, he said.

Aronne said he went into weight loss research decades ago to address suffering. He didn’t think it would take this long to help people. But now that he has effective medications to offer, he finds it incredibly gratifying.

“It’s fantastic when you can help people who want to be helped,” he said.

As for Torres-Vega, the blue strapless is now a regular part of her wardrobe. “I’m having fun dressing the body I’ve always wanted and worked hard to achieve.” 

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

As part of our ongoing commitment to help our patients live their best life we are sharing the full USA Today series on “Rethinking Obesity”. The following is #4 in the series.

ILLUSTRATION BY TRACIE KEETON/USA TODAY; AND GETTY IMAGES

Karen Weintraub USA TODAY

Published 5:02 AM EDT Jul. 26, 2022 Updated 8:28 AM EDT Jul. 29, 2022

Editor’s note: Part 4 of a six-part USA TODAY series examining America’s obesity epidemic.

Nathaniel Louis Brown always loved his food, especially spaghetti and potatoes. On a typical night, he would eat three dinner-plates full. On holidays, Brown, 64, served himself on a platter. 

He knew he should cut back, but he didn’t have anyone who cared enough to tell him to eat less. Plus, food helped him curb life’s stresses and his constant worry. 

Then came the heart attack. 

Brown’s life is far from perfect, but he wasn’t ready for it to end. 

“I want to try to live up to 100, 120. I know that ain’t going to happen, but that sounds good to me,” said Brown, a former long-haul truck driver, factory worker and prison guard now living in Indianapolis. 

The social, racial and economic inequities that people like Brown face help explain why the nation’s obesity epidemic remains so challenging.

It’s nearly impossible to change a lifetime of eating and exercise habits and stick with them, studies show.  Many people like Brown live in areas where it’s tough to access healthy foods or exercise safely and affordably. The economics of eating in America make high-calorie foods an easy go-to. 

People with obesity “are victims of the system they don’t control,” said Daniel Clark, a medical sociologist at Indiana University and the Regenstrief Institute, a research organization in Indianapolis. Instead of blaming people for being overweight, “we should be shaming the system and the industry that has profited from all these added pounds and poor health.” 

Marion Nestle, nutrition researcher

Nutrition researcher Marion Nestle likes to ask a simple question: Who would gain if people weighed less and ate more healthfully? 

In the U.S., she can think of only a few. “You have enormous forces in society that benefit from people being overweight,” said Nestle, an emerita professor at New York University. “The diet industry benefits. The health care industry benefits. The drug industry benefits. The food industry benefits.” 

The cost of food pushes people toward extra pounds, said Adam Drewnowski, an epidemiologist at the University of Washington. 

Fresh strawberries, for instance, offer about 40 calories for $1, while Halloween candy provides about 2,000 calories for the same $1, he said. 

“It’s not that people are making wrong choices about what to eat,” Drewnowski said. “They are not even choices.” 

The poorest people aren’t the ones who struggle most with obesity, Drewnowski said. It’s those like Brown, who work their whole lives but still need the cheapest options. 

“I call it a visible symptom of economic oppression,” he said.  

Despite decades fighting America’s obesity epidemic, it’s only gotten worse. To try to understand why, USA TODAY spoke with more than 50 experts for this six-part series, which explores emerging science and evolving attitudes toward excess weight.

Obesity concentrates in neighborhoods that have few financial resources as well as limited social capital, he said. “The effect is to concentrate poor health in a given area.” Those same neighborhoods probably lack medical care resources, he said. “It’s a downward spiral.” 

In King County, Washington, where he lives, Drewnowski said obesity can vary by 600% depending on a person’s address. “A mile or two down the road, things change,” he said. “It’s amazing.” 

Race is sometimes connected to these social factors, but not always. A cohesive, largely Blackneighborhood might have the resources to demand safe streets, parks and grocery stores with healthy food. 

Mexican American immigrants are healthier for the first decade or so after they arrive in the United States, regardless of their income, Drewnowski said. It’s only after their children persuade them to switch to an American diet that the pounds start to creep on and health problems accumulate, research has found.

The coronavirus pandemic and its financial consequences made the situation worse. 

Food insecurity, which affects at least 10% of the population, appeared to increase over the last two years, said Dr. Wudeneh Mulugeta, an internal and preventive medicine specialist at Cambridge Health Alliance and Harvard Medical School. Demand at his Massachusetts organization’s food bank doubled or tripled at the start of the pandemic.

His research shows that people who were food-insecure and lived unhealthy lifestyles before the pandemic – maybe they smoked or their diets weren’t great – were also at higher risk for gaining more weight over the past two years than their neighbors. 

“Not everyone gained weight,” he said. But those who did were the most vulnerable to begin with.

After the heart attack and two stent placements, it took Brown a few months to muster the energy and motivation to get out of bed.

Eventually he joined Healthy Me, a lifestyle management program offered to patients at Eskenazi Health in Indianapolis. 

Brown began taking classes on nutrition and exercise. For the first time in his life, someone took the time to help him learn how to be healthier. 

“I never had anybody instruct me or try to help me with my food conditions,” he said. “I appreciate what they’re doing for me.”

He has dropped nearly 40 pounds in the past six months and his diabetes has come under better control, though he still has 70 more pounds to go to get below the 220 he weighed in high school.

“I think I’d feel better and get off all this medication I’m on,” he said, adding that he still takes 16 pills a day. “I always wanted to be slim. I’m embarrassed about the fat on my belly, the fat on my arms, on my chest.”

So now he reads nutrition labels and attends low-impact exercise classes three days a week. He has cut way back on salt and learned to control his portions – eating “on a saucer” instead of several dinner plates at a time. He has given up his daily habit of drinking an entire 2- or 3-liter bottle of soda pop. He saves half for another day.

“It isn’t easy,” said Brown, who moved from his native Terre Haute to Indianapolis three years ago to take care of an ailing uncle. The older mandied this spring.

• Know that it’s not your fault if you’re carrying extra weight. The way the human body evolved, combined with easily available and low-cost processed food make weight gain likely and weight loss challenging. 

• Fitness matters more for health than a number on a scale. Find physical activities you enjoy and commit to move a total of least 30 minutes a day, five days a week. 

• Make sure to average at least 7 hours of sleep a night. Disconnecting from electronics for 90 minutes before bedtime can help. 

• If you’re concerned about weight, prioritize not gaining more and the quality of foods you eat. 

• Chose whole foods, like fruits, vegetables, nuts, healthy oils, fermented dairy products and fatty fish, which have a healthier mix of nutrients and make you feel fuller. 

Brown doesn’t have friends in his new city and hears from family members only a few times a month. He said some people avoid him because of his size, and he wishes he had a girlfriend or someone to push him a little more. “They’ll go to somebody slimmer or looking better.” 

Where he lives, there are no groceries within walking distance, and the nearest place with food, a Dollar General, doesn’t carry fresh fruit.

His goal now is to build up enough strength to be able to work out at a gym, though the closest one is 5 miles away, and with gas hovering near $5 a gallon, he’s not sure he’ll be able to get there very often. 

“I’m doing the best I can,” he said.

Clark, of Indiana University, recently helped lead a study trying to unpack the habits, behaviors and patterns that lead to weight gain among people of limited income. 

All the participants were enrolled in Healthy Me, the same program Brown joined, and half received eight to 12 text messages a day asking about their food and exercise-related activities and offering tips for healthier behaviors.

Neither group lost weight by the end of the six-month study.

Clark said he’d like to try again with a younger group of people, less trapped by their habits and with less weight to lose.

He was surprised at how much weight many of the participants were carrying. The mean body mass index of the group was 45, substantially above the cutoff for obesity of 30.  An average-height woman, at 5-foot-5, would have to weigh more than 270 pounds to reach a BMI of 45. 

Daniel Clark, a medical sociologist at Indiana University and the Regenstrief Institute

Many of the participants had hypertension and diabetes; most were nonwhite. 

They were not healthy people, Clark said, and unfortunately, his study did not uncover “actionable” patterns or ways to help them get healthier. Participants, he said, had accumulated disadvantages over generations and the course of their lifetimes and were still plagued by limited access to healthier foods and activities.

One thing it showed again, he said, is that even with support, losing weight is incredibly hard.

“For 30 years our field’s been doing behavioral counseling for weight loss. It’s total nonsense,” he said. Biology and a lack of resources makes it nearly impossible for someone carrying dozens of extra pounds to make themselves thin. “It’d be an inhuman amount of self-control to achieve (weight loss) and sustain it. Why we’ve kept on with this line of work just baffles me.”

Making a difference at a national level requires many more programs like Healthy Me, he said, and dramatic changes from government and industry.

It’s not just obesity or poverty or racism that’s fueling the poor health of Americans, Clark said.

“It’s not one factor,” he said. “It’s the inequality itself.”

Stress contributes to obesity at a biological level by causing the body to hold on to nutrients as well as by “provoking behaviors that are obesogenic,” such as overeating, said NiCole Keith, a physical activity researcher and Clark’s collaborator at Indiana University and the Regenstrief Institute.

Poverty makes life more stressful. So does racism.

“Being a minority in America is stressful – full stop,” Keith said.

People without economic resources lack the discretionary income to spend on healthy food or workout clothes. They don’t have the time to exercise or live in neighborhoods where it’s safe to go for a walk. They don’t have backyards where they can grow fresh fruits or vegetables.

“Even if you have access to healthy food or you have a community garden in your neighborhood,” Keith said, “if you’re not used to tasting this other kind of food, or you’re not used to the discomfort of sweating … you’re not going to do it.”

There also are cultural factors that might stand in the way of living a healthier lifestyle, she said.

Obesity is “steeped in generations,” Keith said. Some people expect they’ll gain weight because all their relatives and friends have, or they cook the way they do because that’s the way their family always has.

It can be seen as rude to turn down food someone offers, she noted. And “if you tell somebody ‘I’m on a diet,’ they say, ‘Oh, you look beautiful,’ or ‘You’re perfect – why do you want to change?’ Or for people of color, ‘Why are you succumbing to European standards of what’s beautiful?'” Some cultures view excess weight and lack of exercise as an indication of wealth and social status.

Mulugeta said he treats many immigrant patients who have different views of healthy weight and diet than American health care providers. Doctors, he said, must respectthese patients’ backgrounds and perceptions to care for them effectively.

“We have to come with an understanding of the cultural context and meeting patients where they are,” Mulugeta said, “and discussing the reasons why we as medical professionals are concerned with excess weight.”

Research suggests food advertising has a bigger effect on Black kids than their white counterparts. 

On TV alone, Nielson data from 2019 found Black youths see 75% more fast food ads than their white counterparts, nearly 1,000 a year. And that doesn’t include social media, which tends to attract more Black and Hispanic young people, said Shiriki Kumanyika, a research professor at the Dornsife School of Public Health at Drexel University, who is leading a new national campaign called Operation Good Food and Beverages that addresses such advertising. 

Black young people may be particularly responsive to seeing themselves in a positive light in food ads. Advertising, she said, “normalizes unhealthy eating in ways that can become part of your identity – what people like you are supposed to be eating.”

Instead, her group, supported by a youth advisory panel basedin Baltimore, sees healthy eating as a way to stand up for racial identity, challenge the existing food environment and tie into a positive message of social justice, she said. 

“Of course, this is good for all communities,” not just Black communities, Kumanyika said. “But because we have more of the problem and less of the solution, we decided we’d better take the lead on this.”

Ultimately, every effort to combat obesity will fail if healthy foods aren’t made less expensive, said Marlene Schwartz, director of the Rudd Center for Food Policy & Health at the University of Connecticut. 

“If people can’t afford to eat the healthy food,” she said, “none of the rest of it really matters.” 

Economic support could prevent food insecurity and allow people like Nathaniel Brown to afford healthy food such as fruits and vegetables, Drewnowski said. 

“The way not to go in my opinion is local, organic, minimally processed salads that you prepare at home after you’ve come back from two jobs.” That’s just not realistic, he said. Nor is everyone growing vegetables in their backyard. Not everyone has a backyard.

The U.S. government simply needs to do more to help combat obesity, said nutrition and public policy expert Nestle.

“They should be frantic about obesity,” she said. “They should be up in the middle of the night worrying about what’s going to happen as it becomes normalized in society and more and more people put on more and more and more weight.”

Discouraging people from eating “junk” food by raising taxes and limiting marketing can be helpful, she and several other experts said. 

Expanding nutrition labels also makes it easier for people to identify unhealthy food. At the end of June, Canada announced that as of Jan. 1, 2026, food high in saturated fat, sugars and sodium must carry a label on the front of the packaging. 

In Chile, similar front-of-package labeling led people to purchase 24% fewer sugary drinks over 18 months, and more than one-third of Chileans said the labels encouraged them to change their eating habits.

Ted Kyle, founder of ConscienHealth

But the COVID-19 pandemic provided a stark reminder that people are resistant to public health interventions, said Ted Kyle, founder of ConscienHealth and former chair of the Obesity Action Coalition, a 75,000-member nonprofit that works to empower people living with obesity.

Public health measures don’t always work, either. “For the past four decades, we have implemented a lot of public health policies based on what we presumed would work, and it has turned out it doesn’t,” he said.

There was the low-fat craze and then the push to eliminate added sugar from the diet. Sugar consumption has declined dramatically since 2000, yet the prevalence of obesity has continued to climb. 

“No one thing that we consume uniquely causes weight gain. It’s the totality of what we consume,” Kyle said.

For his part, Clark said every hospital in the country could be offering personalized programs such as Healthy Me to help people like Brown learn and practice healthier habits.

The obesity epidemic, he said, “isn’t going to be solved at the individual level.”

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.

As part of our ongoing commitment to help our patients live their best life we are sharing the full USA Today series on “Rethinking Obesity”. The following is #2 in the series.

ILLUSTRATION BY TRACIE KEETON/USA TODAY; AND GETTY IMAGES

Karen Weintraub USA TODAY

Published 5:00 AM EDT Jul. 26, 2022 Updated 6:58 AM EDT Jul. 27, 2022

Editor’s note: Part 2 of a six-part USA TODAY series examining America’s obesity epidemic.

Tigress Osborn is fat, and she’s OK with that. 

What she’s not OK with is how she and others with excess weight are treated as if they’re lazy, stupid and sick.

“We consider fat a part of human body diversity,” said Osborn, chair of the nonprofit National Association to Advance Fat Acceptance.

She insists on using the word “fat” rather than the more politically correct “person with obesity,” which she believes characterizes people with extra pounds as abnormal or unhealthy.

Many of the problems people blame on obesity might instead be the fault of something else, she said. 

Take COVID-19. Research found obesity played a role in 30% of severe cases of the disease. But, Osborn suggested, what if the story is really that fat people waited too long to seek medical care because they’re so used to being poorly treated by the health care system? Or maybe fat people who exercise or follow a certain diet have a different risk profile, but the message is just “all fat people are at risk.”

“It’s impossible for us to know whether some of the things that are blamed on fat are caused by weight stigma or other forms of oppression,” she said, citing anti-poverty bias and racism.

Every facet of society – including the medical community – has failed fat people, Osborn and others said. 

Despite decades fighting America’s obesity epidemic, it’s only gotten worse. To try to understand why, USA TODAY spoke with more than 50 experts for this six-part series, which explores emerging science and evolving attitudes toward excess weight.

Researchers have focused on what’s wrong with being fat, rarely exploring why some people remain healthy regardless of excess weight. Doctors have told those with extra pounds they need to lose weight but haven’t offered them a realistic method for doing so. 

In 2005, U.S. Surgeon General Richard Carmona declared obesity a bigger threat to America than terrorists, but government has done little to rein in food marketing, reduce demand by increasing taxes or adding the kind of nutrition labels shown to decrease “junk food” consumption in other countries. 

The law offers little protection. It remains legal in 49 states to fire people simply for their size.

And stigma against excess weight remains in every corner of life even as 42% of Americans fit the medical definition for having obesity. (Obesity is defined as a body mass index – a measure of height and weight – of 30 or above. A 5-foot-5 woman would be considered to have obesity if she weighed more than 180 pounds.) 

“We know that shaming people to lose weight doesn’t work,” said Osborn, 47, a full-time advocate for fat people’s rights. It hasn’t for the 40 years of the declared obesity epidemic or decades of research before that. Yet weight bias continues.

The medical community leaves little doubt that carrying extra pounds can lead to serious health problems. Many types of cancer are linked to obesity. So is heart, liver and kidney disease. People with obesity run an 80% higher risk of developing diabetes than those without it. 

In 2013, the American Medical Association defined obesity as a disease itself. They wanted to finally bring attention to the idea that people are not to blame for their excess pounds, that fat people are not lazy or dumb, just suffering from an illness. 

But Osborn is tired of being defined as sick when she’s not.  

She points out that “being fat and having a health challenge is not the same thing as having a health challenge that is created by being fat.” 

Researchers could learn a lot, she said, by looking at people with excess weight who don’t develop diabetes.  

“When fat people don’t have the problems we think are caused by fat, we dismiss them as an anomaly,” she said. ”There is no money to be made in telling people they’re fine the way they are.” 

The assumption of poor health can have serious consequences.

Before having surgery last summer, Osborn needed a cardiologist’s clearance. After asking what she had done to lose weight, the cardiologist glanced at her EKG and said it suggested she’d had a heart attack.  

Osborn freaked out. Her surgery nearly canceled, she was scheduled for further testing and prescribed a drug that made her feel sick for weeks. 

The operation went fine, and when seeing a different cardiologist afterward, she asked about the supposed heart attack. “Oh no,” he told her. “Those kinds of readings happen all the time when an electrode isn’t placed properly.” He took her off the medication. 

“It was very clear to me that that all would have gone very differently if I had walked into that office not looking like I look,” Osborn said. 

“Not everything going on in (a fat person’s) body is because of their fat. And what the doctor assumed was going on in my fat body wasn’t even going on.” 

Many of the studies that tie health problems to excess weight don’t adequately consider other possible causes of those problems, said Ragen Chastain, an advocate, researcher, speaker and author of  ”The Weight And Healthcare Newsletter.”

For instance, yo-yo dieting, practiced by people desperate to lose pounds but destined to regain them, has been shown to cause some of the health problems otherwise attributed to excess weight. 

“Well-intentioned people have been duped,” Chastain said, by the assumption that all weight gain is bad and weight loss good.  

When people don’t lose weight with lifestyle changes, the assumption is it’s because they’re not trying hard enough, which is then used to stigmatize them even further, Chastain said.

Research shows people can be heavy without being sick.  

“There’s a subgroup of people with obesity but without indicators of poor health where I wonder what the rationale would be for treating them,” said Kevin Hall, an obesity researcher at the National Institutes of Health.  

He noted they might run a higher risk for health complications in the long run. But people with very little body fat face many of the same health risks. “Body fat has a reason,” Hall said.

Glenn Gaesser has been arguing for more than a quarter century that fitness does a far better job of predicting health than weight. 

Sedentary people of “normal” weight have worse health outcomes than fat people who exercise regularly, he said. 

Technically, fitness is measured by oxygen use while on a treadmill, so it’s too complicated to be widely adopted, said Gaesser, a professor of exercise physiology in the College of Health Solutions at Arizona State University. 

But most people can reach at least minimal fitness by moderately exercising 150 minutes a week, or briskly exercising for 75 minutes a week. “The biggest benefit comes from getting people from a ‘couch potato’ status to some level of activity,” he said. “It’s not like getting ready to run a marathon.” 

Exercising improves the health of virtually every major cell type in the body, he said, including fat cells. There’s clearly something biological about fitness. In mice, transplanting fat tissue from fit animals into sedentary ones improved the recipient’s metabolic health.

Size does not determine risk for people with good cardiovascular fitness, Gaesser and a colleague concluded in a 2021 article. Most heart disease risks associated with obesity can be improved with exercise, independent of weight loss. And it’s yo-yo dieting, not simply excess weight that poses serious heart health risks, they concluded. 

“If we just try to focus on the behaviors and encourage those people to engage in more physical activity, their health would improve,” Gaesser said. 

With COVID-19, the apparent higher risk of infection and disease severity might have been more about the patients’ fitness levels than their weight, Gaesser said, citing a 2020 study that concluded as much. “It wasn’t the fatness that was the predictor, it was the unfitness,” he said. 

Although having obesity can make exercise more challenging at first, Gaesser said, his research and experience suggest people of any size, even with a very high weight-to-height ratio, “can improve their fitness level just as much as anyone else.” 

With so many Americans carrying extra pounds, it seems logical that society would be getting more accepting of heavier people.  

But it isn’t, according to Rebecca Puhl, who has studied the subject for decades.

The public perception is that shaming people for their size will provoke them to lose weight. “We see the opposite,” said Puhl, deputy director of the Rudd Center for Food Policy & Health at the University of Connecticut.

Some advertisers have evolved, offering plus-sized models, which Puhl supports. But “we still have very stringent societal ideals of thinness,” she said, and people who violate those ideals are considered lazy and lacking in willpower. 

Shame and stigma cause psychological and emotional distress, anxiety and low self-esteem, all of which can lead to disordered eating and extra pounds, she said. People of all races face weight stigma, though racism compounds the ill effects of weight prejudice. 

Rebecca Puhl, Rudd Center for Food Policy & Health at the University of Connecticut

“Weight stigma itself is a public health issue,” Puhl said. “We need to shift societal attitudes that are strongly ingrained and have been for decades.” 

In survey data across nations, more than half of those with obesity point to family members and doctors as the biggest sources of “fat shaming.” 

Historically, weight stigma wasn’t “on the radar” for doctors or medical students, she said. But in 2020, more than 100 medical organizations committed to ending it. “There’s a recognition that we need to address this.” 

Now, some of the stigma is coming from the other side as well, with people getting blasted on social media and elsewhere for going public with their attempts to lose weight. 

Ted Kyle takes issue with both the people who contend obesity is a crisis and with those who say it poses no problem at all.

Research has clearly established that obesity can undermine health. But that doesn’t justify policing other people’s weight, said Kyle, founder of ConscienHealth, which promotes sound approaches to health and weight.

Obesity is a long-term health problem; stigma and bias do their damage in the short term, he said.

“When you tell someone their health, their body is a disaster, it’s not helpful. It does cause immediate harm,” said Kyle, also a former chair of the Obesity Action Coalition, a 75,000-member nonprofit advocacy organization.

“The media and public health needs to stop catastrophizing obesity.” 

There’s no question excess weight increases the risk for disease, but Kyle doesn’t see it as a crisis that can be resolved quickly. The language of emergency reinforces bias against large people, he said.

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Science hasn’t yet figured out how to solve obesity, at least not at the population level.

“All the while when we’ve been pursuing food and physical-activity-based solutions, the rate of obesity keeps rising,” he said. “We don’t know how to blunt the rise in obesity because we don’t know precisely what the factors are (that are causing it).”

The type of food people eat may play a role, along with stress, additives and a host of other factors.

At the individual level, Kyle said, obesity medicine specialists have made a lot of progress in helping people lose weight, but many of those approaches aren’t covered by insurance – at least not without the kind of lobbying that is difficult for all but the most advantaged patients to muster.

Osborn said she understands why people opt for weight loss medications or surgery if their doctor regularly tells them they’ll die without it. But counseling patients on how to be healthy at any size would be safer and less stigmatizing, she said. 

“People living in a fat-phobic culture are going to resort to things that will help them move away from that oppression,” Osborn said. “They’re making a tough choice in a culture that’s telling them their body is hate-able.”  

Fat people, Osborn said, “just want to live our best lives.” 

Contact Karen Weintraub at kweintraub@usatoday.com.

Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.