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by with Ragen Chastain
Examining the intersections of weight science, weight stigma, and healthcare and what evidence, ethics, and lived experience teach us about healthcare and public health best practices for higher-weight people. weightandhealthcare.substack.com
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- 1 weeks ago9 min
GLP-1 Study is an EPIC Fail Part 2 - Analysis
In Part 1 we started discussing the study Two Years After Stopping GLP-1s, Most Patients Sustain at Least Some Weight Loss by Bartelt et al. which I identified as possibly the worst, and definitely among the top 3 worst, studies I’ve ever analyzed.In part 1 we talked about the platform (Epic Research), the researchers, and the basic methodology for reporting. Today we’re going to get into the analysis. Remember that there are two sources, the first is the actual article, the second is what I am calling the supplementary materials that is a pdf that is linked (though not at all clearly) in the article.We’ll compare the claims made in the article to the data shown in the supplementary materials. I think as we get into this it may be helpful (and maybe just a bit comforting) to remember that this was not published in a peer reviewed journal - it’s Epic publishing Epic’s research on Epic’s website.We’ll begin with the most basic claim: “we studied 188,722 patients who stopped using a GLP-1 medication after being on it for at least 90 days and who lost at least 5 pounds while on it.”You might be thinking “wait - in Part 1 you said the study population was 323,782, what happened to the other 135,060 people? Let’s go on this journey together. We’ll start by looking at their data. In the supplementary materials, Table 1: Characteristics of the Study Population looks like this:So they say in the article that they studied 188,722 patients but the very first line of the supplementary materials chart about the study population says that the total number of patients was 323,782. But it gets a bit weirder, if you add up all the participants in the different age categories you get 323,750, 32 short. If you add up the totals across the drug groups you do get 188,722, if you add up the participants in the weight loss category you get 323,782. If you add up the diabetic status you get 323,782. What is going on here? Maybe they originally looked at 323,782 records of which only 188,722 were not excluded for some reason, and maybe 32 of the participants did not have an age on their electronic health record? At least the number of people across the drug groups in the supplementary materials chart matches the number of people they claim to have studied but this is, in the absolute more charitable description, an extremely confusing way to present this data.In part 1 we discussed the fact that the inclusion criteria were not particularly stringent but the biggest issue, to me, is that the researchers appear to have just done calculations with whatever data they happened to have, but reported it and drew conclusions as if they had consistent data on all participants.For each of the three drug groups (semaglutide, liraglutide, tirzepatide), they present an interactive graph that shows “the proportion of patients by amount of weight regained or lost after stopping [liraglutide/semaglutide/tirzepatide].”Let’s dig in.In the article we find Figure 1 - Proportion of Patients by Weight Change After Stopping Semaglutide we can see in the lower left “n=139,972 patients.”But if you look at the supplementary materials you find Table 2 Proportion of Patients by Weight Change After Stopping Semaglutide. This is the table from which they are drawing the data for Figure 1.The final column of the supplemental table is “patients” and the number in that column represents the number of the original 139,972 patients who had taken (and subsequently stopped taking) semaglutide for which the researchers had a weight at each month of their calculation. At month 1, the researchers had a weight for 68,754 of the patients and this number trends steadily downward until month 24 when they only had weights for 2,650 of the original 139,972 patients. At literally no point does Figure 1 in the original article give data for the n=139,972 patients the label claims.In the liraglutide group the graph in the article says n = 23,377. The supplementary tables show that in month 1 they had weights for 11,580. That steadily declined until month 24 they had weights for 1,268 of the population.In the tirzepatide group, the article says n= 25,373 patients. At month 1 they had weights for 12,909 patients which steadily declined until at at month 24 they only had a weight for 145 people (that is not a typo, they were doing the two year calculation upon which they drew their bold conclusions with only one hundred and forty five of the original 25k+ people represented!)This is such a bonkers way to do this that I actually emailed them, using the semaglutide table as an
- 2 weeks ago9 min
GLP-1 Study is an EPIC Fail Part 1 - Authors and Methodology
Every month, paid subscribers can participate in an Ask Me Anything and the study I’m writing about today was brought to my attention during the June AMA. It is, if not the worst, one of the top 3 worst studies I have ever analyzed so strap in because we are going for an EPIC ride. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
- 2 weeks ago12 min
Case Study - Using New GLP-1 Article for Patient Advocacy
Some of you may know that I’m a Board Certified Patient Advocate. I don’t currently do a lot of individual advocacy because my speaking schedule doesn’t allow for the necessary time availability so I typically either work on complex or emergency cases, or on cases that are not strictly timebound - most of these are people who are dealing with a BMI-based denial of care, meaning that their healthcare is being held hostage for a weight loss ransom. This is one of those situations and I am, as always, sharing this story with permission and anonymously by request. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
- 3 weeks ago8 min
New Study: Weighing and Blood Pressure Part 2 - Limitations, Recommendations, and Conclusions
In part 1 we began discussing the study ““Please step on the scale”: The experience of being weighed promotes sustained systolic blood pressure level” by Incollingo Rodriguez, Nunes, & Kirschner, published in 2026 in the Stigma and Health Journal.The study sought to determine the impact of weighing in a medical appointments on blood pressure, cortisol, and perceived stress. In part 1 we looked at the participants, the intervention, and the baseline findings. In part 2 we’ll consider the limitations, recommendations, and conclusions. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
- 3 weeks ago12 min
New Study: Weighing and Blood Pressure Part 1 - Study Basics
I recently spoke at the Association for Weight and Size Inclusive Medicine’s Spring Scientific Assembly. Speakers were grouped into blocks and this study was presented by the lead author, Angela C. Icollingo Rodriguez in the same block as me and I think it’s an important area of study. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
- 4 weeks ago12 min
Reader Question - What is Going On With Medicare and GLP-1 Diet Drugs?
I’ve received a bunch of reader questions that can be summarized as what the hell is going on with GLP-1s and Medicare? Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
- Jun 24, 202616 min
GLP-1s and Cancer Part 4 - Three Studies
In Part 1 we talked about the basics of the studies around GLP-1s and cancer. In part 2 we looked at a study of relatively early data around breast cancer. In part 3 we began discussing a Guardian article that made broad, unsubstantiated claims about these drugs and cancer. Today, in the final part of this series, we’ll take a look at the three studies the Guardian author quotes. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
- Jun 20, 20268 min
GLP-1s and Cancer Part 3 - The Guardian Article
In part 1 we discussed the basics around the current studies considering possible impacts of GLP-1s on cancer (if you haven’t read part 1 yet you might want to as I will refer to the things discussed in that post.) In part 2 we looked at a study that explored correlation between GLP-1 use and cis women with breast cancer. Today we’re going to look at a Guardian Article that many of you asked me to discuss. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe
About Weight and Healthcare
Examining the intersections of weight science, weight stigma, and healthcare and what evidence, ethics, and lived experience teach us about healthcare and public health best practices for higher-weight people. weightandhealthcare.substack.com
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