1. Depression

Obesity is closely linked to Major Depressive Disorder, often due to biological and social factors.

What you can do:

• Start with small, consistent movement (even 10-minute walks improve mood)

• If you experience limited mobility, spend 10 minutes outside in the sunlight each day. Consider adding chair exercises if mobility permits.

• Seek therapy (especially CBT) to actively engage in emotional and mental well-being practices, identify patterns, understand trauma, and take action steps to improve mental health factors.

• Ask a doctor about treatment options. Treatment options are advancing, and eligibility for coverage is improving for qualified diagnosed conditions.

• Focus on progress, not perfection. Small, incremental daily changes. It takes time to develop consistency.

2. Anxiety

Weight-related worries and social pressure can increase anxiety levels.

What you can do:

• Practice breathing techniques (like 4-7-8 breathing). Anxiety increases as we hold our breath. Breathing properly can reduce acute stress factors.

• Limit social media that triggers comparison. Refraining from comparing yourself to others who are on their health journey may negatively affect how you feel about your own.

• Gradually expose yourself to situations you avoid. Exposure therapy is an effective way to increase your window of tolerance.

• Try mindfulness or meditation apps such as Calm, Insight Timer, or Headspace.

3. Low Self-Esteem

Negative body image can reduce confidence and self-worth.

What you can do:

• Challenge negative self-talk (“Would I say this to a friend?”)

• Wear clothes that fit comfortably now that you feel good in. Consider meeting with a color stylist to find your color palette and define your style.

• Set non-scale goals (strength, energy, stamina). Weight loss is not a goal; it’s an outcome. Setting goals that do not reflect weight can shift your focus toward consistency of habits rather than pounds lost.

• Surround yourself with supportive people. If you have family members who are critical of your health, set boundaries for yourself about the time and energy you give to those relationships.

4. Social Isolation

Fear of judgment may lead to withdrawing from others. Active engagement with people who make you feel loved, supported, and seen is the most valuable ally in your life. Engaging in advocacy efforts will help you feel empowered, in charge, and ready for change in the systems that have hurt your health in the past.

What you can do:

• Start small: meet one trusted person at a time.

• Join low-pressure environments (walking groups, hobby clubs)

• Consider online communities for support. The Obesity Action Coalition is a great organization to join for research-based, sound, scientific medical content, community engagement, advocacy efforts, and knowledge to take with you to your medical appointments to get the care you need.

• Remind yourself: avoidance increases anxiety over time. Small steps toward improved social interactions will create a community that you can trust.

5. Body Image Distortion

Some people develop distorted perceptions aligned with Body Dysmorphic Disorder. Actively improving your body acceptance and self-love practices, and acknowledging your efforts to increase self-awareness while decreasing self-sabotage, will help drive lasting change.

What you can do:

• Limit mirror checking or body-checking behaviors

• Focus on what your body can do, not just how it looks

• Work with a therapist trained in body image issues

• Avoid constant comparison (especially online)

6. Emotional Eating Cycles

Emotional eating can overlap with Binge Eating Disorder. Journaling to identify cycles can support your work with your therapist.

What you can do:

• Identify triggers (stress, boredom, sadness) through self-check-ins throughout your day. Notice how you feel at times and rate from 1-10 your emotional response to stressful situations. Develop strategies to reduce stressful interactions.

• Replace eating with alternative coping tools (e.g., walking, journaling, calling someone). Find an alternative go-to before you reach for a snack outside of planned mealtimes. If you still feel the urge to eat, keep appropriate, healthy snacks around to ensure you’re making food choices that align with your goals.

• Keep regular meal patterns to reduce urges. I can not stress enough the importance of regulating your hunger signaling by consistently eating on a schedule. Your body will not register hunger until 30-60 minutes after you have needed to eat. If you eat at specific times each day, your body will adjust to that schedule (most of the time!).

• Seek professional help if binge cycles feel uncontrollable. A licensed therapist (Licensed Psychologist, LPC, LCSW, LMHC, LMFT, etc.) with training in eating disorders may be helpful to gain further insight and intervention in your treatment plan.

7. Chronic Stress

Obesity can increase stress from health concerns and societal pressure.

What you can do:

• Build a daily stress-reduction routine (exercise, music, time outside). You are in charge of how you spend your time engaging in self-care.

• Improve sleep consistency. (See #8 for more information on sleep.)

• Practice saying no to overwhelming commitments. If you don’t want to go, don’t force it. Being around people who stress you out will contribute to the exhaustion you’ll experience after the event. It’s okay to say “No” when situations don’t work for you.

• Try relaxation techniques (progressive muscle relaxation, breathing). See #2 for more on relaxation.

8. Sleep Disturbances

Conditions like Obstructive Sleep Apnea can disrupt rest and worsen mood.

What you can do:

• Get evaluated for sleep apnea if you snore or feel exhausted. If prescribed, use your C-PAP or Bi-PAP machine regularly.

• Stick to a consistent sleep schedule and aim for at least 7 hours of solid sleep. Avoid oversleeping by waking up consistently to start your day.

• Avoid screens 1 hour before bed to decrease blue light exposure.

• Reduce caffeine late in the day to avoid disrupting sleep schedules.

9. Cognitive Effects

Obesity may affect memory, focus, and mental clarity.

What you can do:

• Exercise regularly (boosts brain function)

• Eat foods that support brain health (omega-3s, whole foods)

• Stay mentally active (reading, puzzles, learning)

• Prioritize sleep and hydration

10. Stigma and Discrimination

Weight bias can impact opportunities and self-worth.

What you can do:

• Build a strong support system

• Practice assertiveness in difficult situations

• Limit time around people who reinforce negativity

• Follow body-positive or realistic health-focused communities

💡 Final Thought

You don’t have to fix everything at once. The most effective approach is to start small and build momentum—even one positive habit can begin to improve both mental and physical health.

I paused.

Is it?

As therapists, we’re trained in modalities, interventions, evidence-based practices. We talk about treatment plans and measurable goals. But what we don’t talk about enough is the relationship itself—the steady, evolving, human bond that becomes a container for someone’s life.

I’ve been with my own therapist for five years. I can’t imagine not having that biweekly check-in—a sacred pause to reflect, to process, to recalibrate. My therapist reminds me of my goals when I forget them. When I drift. When I quietly start ignoring the direction I once said I wanted to go.

When you find the right therapist, you don’t want to leave.

Another client said to me recently, “I can’t see going to anyone else. You know all my history. You’ve been with me through the worst and best parts of my life. You tell me when I need to step back, take care of myself, and stop putting so much pressure on myself to be everything to everyone.”

That’s what rapport builds. That’s what time builds. When someone knows your patterns, your grief, your defenses, your dreams—they can see what you cannot see in the middle of chaos. They can say gently, “This isn’t you,” or “You’re doing it again,” or “You need rest.”

Yes, long-term therapy has significance.

When life becomes too heavy to lift alone, your therapist helps you see clearly. The relationship often matters more than any specific intervention. Research supports that the therapeutic alliance is one of the strongest predictors of positive outcomes—and in lived experience, that rings true. Trust is built slowly. It allows someone to say, “I’m not okay,” in their grief, sadness, anxiety, stress, mania, or overwhelm—and know they will be met with steadiness.

I feel deeply privileged that so many people trust me with their mental and emotional well-being. Not everyone gets to that place. Sometimes they didn’t find the right fit. Sometimes they left before the work had time to show progress. Sometimes they simply weren’t ready.

And sometimes—if I’m honest—I am reminded that I am human in the relationship too.

Recently, I took planned time off. During the opening night of the first Carnival weekend, I broke my nose face-planting the sidewalk while excitedly telling a colleague about the “Joys of Mardi Gras in New Orleans.” Days later, my mother had a heart attack. An email came through from a client over the weekend. Normally, I reply within 24 hours—that’s my protocol. But this time, I didn’t. I needed to check out. When I did respond, it wasn’t my usual thoughtful, thorough reply. I assumed we would process it in session.

The client then canceled their upcoming appointments.

My inner critic was immediate and sharp:
You didn’t follow your own rule. You didn’t show up. You dropped the ball. (I tell myself, trust the process, they will come back if you are meant to be their therapist.)

The rational part of me countered:
You were on planned time off. You had a broken nose. Your mother had a heart attack. Practice the boundaries you preach. Give yourself grace.

Still, I wondered. If I had responded more quickly, more fully—would they have stayed? I don’t know. I may never know.

What I do know is this: I cannot be everything to everyone all the time.

The long game of therapy is this—if someone is ready, they’ll come back. And if they don’t, that doesn’t negate the work we did or the growth that happened. Over the last few years, I’ve intentionally stepped back from voluntary obligations to create more space in my life. Space to breathe. Space to live. Space to be human.

Therapists need room too.

And in that spirit of reclaiming space and joy, I’ve decided to rekindle something that has always lit me up: Mardi Gras.

Mardi Gras is about community. It’s about culture. It’s about connection. It builds friendships across organizations, across the city, across the state. Joining a krewe is stepping into shared creativity and shared celebration.

As a Float Lieutenant, I get to plan events, craft, connect people, and celebrate our traditions. I’m especially excited about the reformation of the Krewe of ALLA—the fifth-oldest krewe in New Orleans. It’s a historic organization entering a new chapter.

We’ve taken the “Opening Night” spot for DEEP GRAS on the Wednesday before Fat Tuesday—an incredible way to kick off Carnival week. ALLA truly is the “Krewe of ALL!” If you’ve ever wanted to ride in a Mardi Gras parade on the Uptown route, this is one of the most affordable opportunities to do it.

Register before April 1st for the early bird membership fee of $500
($250 due at sign-up, $250 due on or before April 1st). Select Group: Unknown and type in Referral: Nanette Wilson. You’ll get assigned to my float once I’m set up again on the back in. (Though, by the time you read this, it might be updated.)

You can bring your own throws or purchase a package—flexible, accessible, and community-driven.

Therapy teaches us that relationships matter. That joy matters. That boundaries matter. That we are allowed to hold both responsibility and celebration.

So yes—sometimes you stay with a therapist for twelve years.
Sometimes you step back and give yourself grace.
And sometimes you join a krewe and throw beads into a crowd of strangers who feel like family.

If you’ve been looking for community, I’d love to see you join me.

As for Mom, she’s healing and taking her medication. My nose is mending too—and I’m slowly accepting that being human means I’m not invincible; sometimes I have to pause, walk to the ER because getting an Uber is impossible, get the stitches, tend to what hurts, and then return—steadier, softer, and still committed to showing up.

Also, compartmentalizing my life is impossible. I am the work that I do, the passions I bring to the table, and the culture I love. So, no, I won’t even try to divide my life into nice, neat little parts. I’m here for the whole picture. I will show up as me for my clients, my community, and the people who want to join me to experience everything this life has to offer. We must learn to live fully, completely, and embrace all the parts of ourselves to find JOY.

Friday night, on the walk back to the hotel, I was excitedly recounting all the interesting Carnival happenings when I face-planted on the uneven sidewalks near Lafayette Square. Starting off the 2026 Carnival season with a broken nose, bruises on both knees, and three stitches in my upper lip was not how I planned to kick things off.

I bring this up because Mardi Gras is not for the faint of heart, and a positive attitude or a “can-do” spirit doesn’t always carry you through the tough moments. While my outlook has helped me navigate many challenges, it’s resilience—fortitude, perseverance, humility, gratitude, and compassion—that I lean on most when circumstances beyond my control come crashing in.

I could have been upset, crying, frustrated, and annoyed with myself. Instead, I humbly reminded myself, “I have all my teeth.” When I picked myself up, pulled my hand away from my mouth, and realized I hadn’t destroyed my entire face, I felt overwhelming relief. Despite the embarrassment and my clumsiness, I walked away with a broken nose, bruised knees, a swollen lip, and a deep gash. It could have been so much worse. A bad attitude would have only made the situation more miserable.

I surprised more than a few people by showing up to the meeting the very next day. I don’t think they realized there’s a particular Mardi Gras resilience factor that only locals understand: the party—and the purpose—must go on. I didn’t put boots on the ground for three months just to skip a meeting I had waited years to attend in New Orleans.

After three months of planning and praying for solid attendance—especially given the timing with the first weekend of Mardi Gras—the outcome exceeded all expectations. It was the highest attendance of a Your Weight Matters Regional Meeting to date.

Nearly 100 people showed up to learn about the disease of obesity and the science behind the treatments available to address it seriously. That’s the real win.

If you’re interested in learning more, you can find upcoming dates around the country at www.yourweightmatters.com

For many people, stepping on a scale isn’t just a measurement.
It’s an emotional event.

It can stir up grief. Shame. Fear. Pressure. Old stories. Old wounds.
And sometimes it happens so fast we don’t even realize what’s going on until we’re already flooded.

Two moments that stuck with me

The first happened at home.

My partner and I were having a conversation about accountability—one that felt grounded and hopeful. He’s been making diligent efforts toward changing his eating behaviors, and I’ve watched him stay consistent in a way that deserves real credit. He’s also lost quite a bit of weight over the last two years, which made what happened next catch me completely off guard.

In a casual tone, I suggested we check out the InBody scale at our local vitamin shop so he could see his weight distribution and get a baseline.

He immediately rejected it.

No hesitation. No curiosity. Just an immediate “no.”

His avoidance took me aback. I genuinely thought he would want to know where he stands so he could set a baseline for his progress. But his reaction told me something important:

Even when progress is happening… the scale can still feel unsafe.

The second moment happened with a client.

They were sharing a story about a conversation with their partner, who casually said:

“Just get on the scale, so you know where you are!”

My client began to cry as they told me.

And I felt my heart sink.

Not because I didn’t understand what the partner meant—on the surface, it sounds practical. But because I understood exactly what my client felt.

I could feel the shared pain of weight-related frustration that so many of us carry from years of trying, tracking, restricting, “being good,” “starting over,” and never feeling like we’ve done enough.

And in that moment, I flashed back to my partner’s reaction, too.

Same trigger. Same emotional charge. Different people. Same wound.

Why “weighing in” is rarely just a number

Diet culture has done something sneaky.

It has taken the complexity of health—your habits, your energy, your sleep, your stress, your hormones, your metabolism, your strength, your nourishment—and reduced “success” down to one number.

And the scale becomes the judge.

The scale becomes the scoreboard.

The scale becomes the thing that tells you whether you “deserve” to feel proud.

But you are more than a number.
And that number doesn’t define who you are or what you’re doing to improve your health.

The hardest part is that sometimes you can do everything right and still not see the results you expected.

I lived with that frustration for many years.

I knew I wasn’t getting the results that my behavior should have produced. I was trying. I was consistent. I was doing what I thought I was supposed to do. And still… my progress didn’t match my effort.

Later, I learned about metabolic dysfunction—and suddenly, so much of my story made sense.

Not because I lacked discipline.
Not because I didn’t “want it enough.”
Not because I wasn’t trying.

But because my body needed a different kind of support.

The scale can’t measure your effort

The scale can’t measure:

• how many times you chose yourself this week

• how hard it was to show up and you did it anyway

• how much your relationship with food is healing

• the strength you’re building

• the inflammation you’re reducing

• the habits you’re practicing

• the nervous system regulation you’re learning

• the resilience you’re developing

And yet, we give it the power to determine how we feel about ourselves.

No wonder so many people avoid it.

Avoidance isn’t laziness.
Avoidance is often protection.

A different way to look at “baseline”

When working with clients, I often recommend starting by getting a baseline—not because I believe the scale is the ultimate truth, but because I want them to understand something crucial:

It’s not all fat.

Your body is made up of:

• bone

• muscle

• water mass

• fat tissue

And when you don’t think you’re losing, an impedance measure can sometimes show you the quality of the work you’re doing.

Because the quality of weight loss is far more important than the pounds lost.

You can be losing fat and gaining muscle.
You can improve hydration and reduce inflammation.
You can be getting stronger while the scale stays stubborn.

And when all you have is one number, it’s easy to assume you’re failing.

Sometimes the data isn’t there to punish you.
Sometimes it’s there to give you a fuller picture.

And sometimes—especially if you’ve had a long history of weight trauma—the most supportive choice is to wait.

You always have the option not to weigh

Let me say that again, clearly:

You always have the option not to weigh.

You can choose to wait until you feel ready.
You can choose to measure later.
You can choose to focus on behavior, strength, consistency, and internal progress first.

Yes—you won’t know where you started.

But you may feel safer when you do measure.
And that matters.

Because health isn’t just physical. It’s emotional and psychological, too.

And a number that sends you spiraling isn’t “accountability.”
It’s self-sabotage dressed up as motivation.

A note about medical settings: you can refuse

Despite recommendations to healthcare facilities, I still see scales in hallways rather than in private rooms.

And I want you to know this:

A nurse or tech should always ask permission before weighing you.

If you don’t feel comfortable, you can refuse to be weighed and still move forward with your medical appointment.

You can say:

• “I’m not weighing today.”

• “I’d rather not know my weight.”

• “Can we skip that?”

• “I’m okay being weighed, but I don’t want to see or hear the number.”

Exercise your right of refusal.

You are not being difficult.
You are being discerning.

Compassion changes the conversation

Here’s what I’ve learned, both personally and professionally:

Most people don’t need more pressure.
They need more compassion.

They need to know that their progress counts even when the scale doesn’t reflect it.
They need to feel safe enough to keep going.
They need to trust that their body isn’t betraying them—it’s communicating.

And sometimes the bravest thing you can do isn’t “just get on the scale.”

Sometimes the bravest thing you can do is ask:

“What would support me right now?”

Because compassion for yourself isn’t optional.
It’s foundational.

“I slipped up.”
“I think I stretched my pouch.”
“I can’t stop grazing.”
“I’m living on slider foods.”
“I ruined everything.”

And every time, I want to pause and say this clearly:

What you’re describing isn’t a moral failure. It’s not laziness. It’s not a lack of willpower.
More often than not, what I’m hearing is metabolic dysfunction—and a body still fighting hard to defend its highest weight.

Because here’s the truth that doesn’t get said enough:

Surgery helps. But surgery doesn’t fix everything.

The “Stretched Pouch” Fear Is Often the Wrong Target

Many people assume that weight regain (or stalled weight loss) must mean they’ve eaten too much volume and physically “stretched” something.

But what I see more commonly is something different:

Patients aren’t struggling most with volume.
They’re struggling with hunger—the kind that doesn’t feel negotiable.

And hunger isn’t just a feeling. It’s chemistry.

Hunger Hormones Don’t Care About Your Motivation

If you’re dealing with elevated ghrelin (the primary hunger hormone), your brain is receiving a persistent message:

Eat. Now.

So if you wait until you feel hungry before you eat, you’re already behind.

That hunger tends to drive a predictable pattern:

• you eat faster

• you eat more

• you eat less intentionally

• you reach for foods that go down easily

Not because you’re “out of control.”

Because your body is doing what it was designed to do: protect you from starvation.
The problem is—your body is treating weight loss like a threat.

Slider Foods: Not the Enemy, But a Clue

Let’s talk about the foods that show up in almost every story of struggle:

• ice cream

• popcorn

• chips

• crackers

• candy

• sugary coffee drinks

• snacky “little bites” all day long

These are often called slider foods because they slide right through the pouch with very little resistance.

And they tend to lead to grazing—eating repeatedly, almost automatically, with minimal satisfaction.

The issue isn’t that these foods are “bad.”
The issue is that they are often:

• easy to eat quickly

• easy to eat while distracted

• low in protein

• low in fiber

• not filling enough to shut off hunger signals

So you keep eating—not because you’re weak, but because your body is still searching for enough.

Protein and Fiber Still Matter (More Than Ever)

We forget this when we’re overwhelmed, exhausted, and just trying to get through the day:

Protein and fiber are the anchors of sustainable weight loss.

They help with:

• satiety (feeling full)

• blood sugar stability

• cravings

• energy

• muscle maintenance

When people tell me they feel like they’re “failing,” what I often find is that they’re simply stuck in a loop where:

Their hunger hormones are loud, and their food choices aren’t giving their body what they need to quiet them.

Movement Isn’t Punishment—It’s Metabolic Support

The other missing piece is often movement, not as punishment, but as physiology.

Increasing movement and building strength helps create what I call a metabolic machine—a body that can burn fuel more efficiently and maintain weight loss with less struggle over time.

Strength training matters because it supports:

• lean muscle mass

• resting metabolic rate

• insulin sensitivity

• long-term weight stability

And importantly: it builds confidence.

Not the “I’m finally disciplined” kind.

The “my body is capable” kind.

The Missing Link: Behavioral Health Support

Here’s where the conversation gets real.

Most people don’t struggle because they don’t know what to do.
They struggle because they’re trying to do it alone, with no real support.

And without behavioral health support, what creeps in fast is the most toxic narrative of all:

“I failed surgery.”

That story doesn’t help you change.
It only adds shame—and shame is gasoline on the fire.

Comprehensive obesity care should include therapy that understands:

• the science of obesity

• the biology of hunger

• the mental load of weight stigma

• the emotional coping patterns that develop over time

Because yes—sometimes the eating isn’t about hunger alone.

Sometimes it’s about survival.

Many of us have coped with work stress, burnout, grief, and overload by dissociating while eating.
Not because we don’t care.

Because we’re trying to get through something.

Start Here: Go Back to Your Surgeon

If you feel stuck, the first step isn’t self-punishment.

It’s support.

Go back to your bariatric surgeon or obesity medicine team and ask about current medication options that may help address the underlying issue: metabolic dysfunction.

Because for many patients, the missing piece isn’t effort.

It’s treatment.

Obesity drives overeating.
Hunger hormones drive behavior.
And the biology often has to be addressed alongside the behavior.

You’re Not Noncompliant. You’re Not Broken. You’re Human.

If you’re reading this and quietly wondering if you “ruined” your results, please hear me:

You didn’t fail surgery.

You’re experiencing a chronic, relapsing, biologically-driven disease that requires long-term care.

And you deserve care that includes:

• medical support - a board-certified obesity medicine specialist

• nutrition support - a registered dietitian who works with this population

• movement support - a trained exercise specialist who is trained to work with larger bodies

• behavioral health support - a licensed therapist who understands obesity from a scientific perspective (not a HAES-aligned therapist who doesn’t believe in the comprehensive management of obesity treatment)

• and zero shame

Not blame. Not lectures. Not “just try harder.”

A plan. A team. A path forward.

If you needed a sign to start again, this is it.

Not from a place of punishment.
From a place of compassion and strategy.

Your body isn’t the enemy.
Your hunger isn’t a character flaw.
And you are not alone in this.

You’re not failing.

You’re adjusting.

And you can absolutely get back on track.

I can turn on counseling mode at a moment’s notice. I live in that mode at least 25 hours a week—sometimes more—so when a friend, a colleague in another area of healthcare, or even an acquaintance asks, “What’s therapy actually like?” my answer is usually pretty simple.

“I’ll start with a question.”

How are you feeling today?
What’s on your mind?
Is there something specific you want to explore in this session, or should we let the conversation flow and see what comes up?

Tell me what matters right now, in this moment.
What’s been stressing you out?
What’s been making you sad?
How have you been feeling lately?
What are you looking forward to—or dreading—this coming week?

And just like that, we’re at the heart of the work.

Even when a client comes in saying, “I don’t really know what I want to talk about today,” those opening questions almost always lead us to the core issues they’re there to explore. I don’t expect my clients to prepare for sessions. That’s not their job—it’s mine.

After 20 years as a therapist, with specializations in ADHD, obesity and weight management, WLS and GLP-1 treatment, eating disorders, substance use, grief, trauma, depression, anxiety, career concerns, family systems, relationships, and the general messiness of being human, I’ve learned something important:

People don’t need to come in with a script.
They need someone who knows how to listen.

The Tools (and the Timing)

Over two decades, my professional toolbox has grown to include cognitive behavioral therapy, dialectical behavior therapy, acceptance and commitment therapy, rational emotive behavior therapy, solution-focused interventions, crisis management, co-occurring disorder treatment planning, somatic therapy, neurofeedback, and more.

But here’s the thing: therapy isn’t about rigidly sticking to one modality.

These are tools, not rules.

I access them in real time, based on what the client needs in that moment. Sometimes that means challenging a thought pattern. Sometimes it means grounding in the body. Sometimes it means slowing way down. Sometimes it means laughing. Sometimes it means sitting quietly with something uncomfortable.

I do assign homework occasionally—but I’m realistic. Most people don’t do homework. I name that upfront and keep it simple:

• Practice the skill we talked about today

• Notice when a certain feeling shows up

• Try one healthy thought reframe when you catch yourself spiraling

That’s usually it.

If someone is genuinely motivated, I might send a worksheet, journal prompts, or a between-session task I truly believe they’ll engage with. Therapy works best when it fits into real life—not when it becomes another thing to feel guilty about.

The Deeper Work Comes With Time

Over the course of treatment, something shifts.

I get to know my clients—not just how they present, but how they protect themselves. I begin to notice what they avoid. I can gently call out what isn’t being said. That’s not intuition alone—that’s relational therapy, built on trust and time.

Reading people is a skill.
Knowing people takes patience.

When someone tells their story to someone who truly wants to hear it, trust forms. And from that place, it becomes my job to help make sense of the story—to challenge thoughts, feelings, and behaviors in a way that brings insight into why someone isn’t doing the things they say they want to do… and why avoidance keeps showing up instead.

A Real Moment From the Therapy Room

Here’s a case in point.

A client may want to talk about their trauma, but they won’t bring it up until they’re ready. And that’s exactly how it should be. My role isn’t to force the door open—it’s to gently check in, with tact and care, and notice when readiness appears.

Recently, I had a session with a client who is also a therapist. (I have a few of those—does that make me a grandtherapist? I digress.)

We spent most of the session talking about recent life developments. Then, about ten minutes before the session ended—as often happens—she brought up her trauma.

She was ready.

I gave those minutes everything I had.

When she finished describing what had been triggered, I asked one simple question:

“Who in your life exhibited those same behaviors that are now being triggered in your relationship?”

Bingo.

With five minutes left, I said, “What’s been missing in processing this trauma with your partner may be speaking directly about how you feel—and identifying the reassurances you need to build trust.”

With one minute to spare, I gave her a focused assignment:

• Write out what you’ve been avoiding discussing with your spouse

• Identify what would make things better

• Name how you want to move forward with clear, solution-focused intentions

We established a weekly check-in with her partner. We set goals around equalizing household labor—something deeply connected to what she witnessed in her family of origin. A clear direction was set to transform old trauma imprints into present-day productivity and connection.

That’s therapy.

In Closing

Every session looks different.

If you’ve never been to therapy, try it.
If you’ve been to therapy and didn’t like it, try someone else.
Go to a support group.
Go to an AA meeting.

Have some therapeutic experience that offers reflection and insight.

You might be surprised by what it opens up—and how it gently reshapes the direction of your mind, your relationships, and your life.

And if nothing else, you’ll learn this:

You don’t have to have it all figured out before you walk in.
That’s what therapy is for.

Mental health professionals are trained to lead with empathy. We are taught to listen deeply, to suspend judgment, to believe in the humanity of the person in front of us—even when their stories are chaotic, painful, or frightening. Compassion is not just a value in this field; it is a requirement.

But sometimes we forget that kindness, care, and compassion can carry consequences.

When a person is deeply dysregulated, unstable, or intent on causing harm, our openness does not automatically equal safety. The murder of Rebecca White is a devastating reminder of that truth. It forces us to confront something uncomfortable but necessary: we must protect ourselves, even as we commit to caring for others.

This is not a failure of compassion. It is an act of responsibility.

Listening to the Gut That Keeps Us Alive

In my own work, I have only ever declined to work with a client once—because I had a gut feeling I could not ignore. I didn’t want to be alone in my office with them in the evening, with no one else around. There was no dramatic incident, no overt threat. Just a quiet, insistent voice in my body saying this isn’t safe.

For those of us in helping professions, intuition is often dismissed as unscientific or unprofessional. But our nervous systems are data collectors. They register subtle cues long before our conscious minds catch up. Listening to that information is not a

weakness—it is wisdom.

Rebecca White should still be alive. And honoring her means we talk honestly about boundaries, safety protocols, and the right to say no—without shame.

Carrying the Weight of a World in Crisis

Lately, the emotional load feels heavier than usual.

We are practicing in a world that feels perpetually on fire. War. Violence. Political unrest. Collective grief layered on top of personal trauma. We are asked to hold space for clients’ pain while simultaneously trying to process our own reactions to the same horrors.

There are days when I sit with clients and silently wonder: How do we even begin to approach this much suffering?

Presence can feel inadequate when the tragedies keep accumulating. Compassion can feel fragile when the light is hard to find. Even peaceful protest—finding our voices in the darkness—requires energy many of us are running low on.

And yet, we show up.

Compassion With Eyes Wide Open

Compassion does not mean ignoring risk.
It does not mean sacrificing ourselves.
It does not mean absorbing endless harm in the name of care.

True compassion includes discernment. It includes systems of protection. It includes acknowledging that some individuals need more containment, more structure, or different levels of care than we can safely provide in a one-on-one setting.

We can grieve Rebecca White and still say: this must change.

Change in how we assess risk.
Change in how we support clinicians.
Change in how institutions respond when professionals raise safety concerns.

Caring for others should not require gambling with our lives.

Where Hope Still Lives

Despite all of this—despite the grief, the fear, the exhaustion—I still believe in hope.

Not the naïve kind that pretends things are fine.
But the kind that insists on imagining something better anyway.

Hope lives in conversations like this one.
Hope lives in collective acknowledgment that the system must do better.
Hope lives in clinicians refusing to normalize harm as “part of the job.”

Rebellions are built on hope.

And sometimes rebellion looks quiet: a boundary set, a door locked, a voice speaking up, a professional saying I matter too.

We can honor compassion and prioritize safety.
We can grieve deeply and demand change.
We can hold the darkness without becoming consumed by it.

For Rebecca.
For those of us still doing this work.
For the possibility that the future of mental health care can be both humane and safe.

Image Note: REBELLIONS ARE BUILT ON HOPE. To bring the light back in, I proudly embrace the joys of Mardi Gras. This image is from the 2026 Krewe of Chewbacchus parade, which took place this weekend. The signs to protest ICE raids, the murder of Renee Good and Alex Pretti, and all the other victims who have been unlawfully detained and imprisoned by the current administration deserve for us to fight for their human rights. There are so many injustices in the world. Find your voice. Use your voice. Take action by trusting that democracy dies in darkness.

You’ve had a long day.
The kind that drains you before you even walk through the door.

You come home, and your partner hasn’t done anything around the house. No dishes. No laundry folded. No visible effort to meet you halfway. And suddenly the mental tally starts running—because you’re the one keeping track of everything.

Cleaning.
Laundry.
Meals.
Kids.
Appointments.
Emotional labor.
And somehow, you’re also supposed to take care of yourself.

Your frustration simmers. Your shoulders are tight. Your nervous system is fried.

So you do what works.

You sit down in front of the TV. You grab a bag of something—salty, crunchy, sweet—and you graze. You check out. For a few minutes, the noise quiets. The overwhelm softens. Your body exhales.

This isn’t a lack of willpower.
It’s a coping mechanism.

One your nervous system learned because it provided relief.

But here’s where it gets interesting—and where shame has led us astray for far too long.

What If This Isn’t “Bad Habits”… but a Pattern of Safety?

That moment of eating isn’t random. It’s not you “failing.” It’s your body responding to discomfort and overload.

Food becomes a tool for dissociation—just for a moment—when life feels too loud. And over time, moments become patterns. Patterns become habits. Habits become default responses.

And maybe what’s turning on “fat storage mode” isn’t just the calories themselves—but the context in which they’re consumed.

Because your body isn’t just tracking food.
It’s tracking safety.

This Might Have Started Long Before Adulthood

For many of us, this story didn’t begin on a couch after a long workday.

It began in childhood.

Maybe you were given a treat to quiet your frustration instead of a real meal. Maybe emotional discomfort was soothed with sugar rather than acknowledged with connection. Maybe your needs were minimized, rushed, or postponed.

Your nervous system learned something important in those moments:

Relief comes from food when my needs aren’t met.

So when stress shows up later in life—when you’re overwhelmed, unseen, overextended—your body remembers.

And here’s the part we don’t talk about enough:
Your metabolism remembers, too.

When your nervous system is in overload, your body may not prioritize burning fuel. Instead, it may store it—just in case. Because from a biological standpoint, unresolved stress can signal scarcity, not abundance.

A switch flips.
Burning pauses.
Storing begins.

Not because your body is broken—but because it’s trying to protect you.

We Are Not All Wired the Same

There is so much happening beneath the surface of our lives—down to the molecular level—that we cannot see.

No two people experience stress the same way.
No two nervous systems respond identically.
No two bodies process fuel under pressure in the same manner.

One child under stress might become hyperactive—burning through stored energy quickly. Another might go dormant—conserving energy instead. One adult might lose their appetite under pressure, while another feels an almost magnetic pull toward food.

From the outside, the results may look similar—or wildly different.

This is why obesity cannot be reduced to character flaws or simple math. We still don’t fully understand why one person develops the disease of obesity while another, with seemingly similar habits, does not.

But what we do know is more than we ever have.

The New Science Is Changing the Conversation

We now understand far more about:

• Metabolism

• Gut hormones

• Insulin signaling

• Stress physiology

• The connection between mental health and metabolic health

Your body is not working in isolation. Your brain, gut, hormones, and nervous system are in constant communication. Chronic stress can alter how hunger signals are perceived. Emotional overload can disrupt satiety cues. Repeated nervous system activation can change how fuel is stored and used.

This isn’t an excuse.
It’s an explanation.

And explanations create space for compassion.

Maybe the Question Isn’t “Why Can’t I Stop Eating?”

Maybe the better question is:

“What is my body trying to regulate right now?”

Because when we address the nervous system—when we create safety, support, and regulation—behavior often changes without force.

Not through restriction.
Not through punishment.
But through understanding.

You don’t need more discipline.
You need more safety.

And your body has been trying to tell you that all along.

• You don’t need celebrities to validate obesity science—you’ve been living the evidence in your own body.

• The real harm wasn’t just bad guidance; it was shame-based blame that fuels anxiety, depression, disordered eating, and avoidance of care.

• Obesity is biological + adaptive, not a character flaw—and there are no permanent fixes, only ongoing care (treatment, nutrition, movement, and behavior support) with no guaranteed outcome.

• Obesity medicine is also a big business, so you must vet treatments like a consumer and a patient, not a follower.

• Research matters, but your nervous system matters too: any “solution” that increases obsession, panic, rigidity, or self-hatred is not health.

You are the expert in yourself. You have the right to choose your engagement, boundaries, pace, and treatment options—without proving your worth through suffering.

There’s a particular kind of exhaustion that comes from being told the truth late.

Not because the truth is new—

But because it confirms what you’ve been living through.

When a celebrity releases a book on obesity, and suddenly the world is ready to listen, it creates this strange emotional whiplash. On one hand: relief. Finally, a big microphone is saying, “It’s biology.” On the other hand: grief. Why did we need a celebrity to say it before people stopped treating fat bodies like moral failures?

Let me be clear: I’m not mad at Oprah. I’m mad at the system that taught us to distrust patients and worship authority. I’m mad at the cultural conditioning that only believes people with larger bodies after a famous person narrates what we already know.

And I’m especially mad at what that delay costs people mentally.

Because this isn’t just about metabolism.

It’s about shame.

It’s about anxiety.

It’s about the quiet despair of trying “everything” and still being blamed.

So this is a Substack not about the science you’ve already heard—set points, ghrelin, leptin, GLP-1/GIP, endocrine disruption, and “food noise.”

You’ve heard it. You’ve lived it.

This is about what comes next:

How to protect your mental health in the obesity discourse.

How to stop letting celebrity narratives (or even clinician narratives) override your lived reality.

How to vet treatments without surrendering your autonomy.

How to remember that you are allowed to choose what you invest in.

Because you are not a before-and-after photo.

You are a whole person.

1) The celebrity problem isn’t Oprah. It’s authority addiction.

Celebrity health books don’t spread information. They spread permission.

They tell the public:

“It’s okay to believe this now.”

That’s the part that should make us furious—not at the celebrity, but at the fact that your pain wasn’t enough evidence until it was narrated by someone famous.

We’ve built a world where fat people can say:

• “I eat normally and still gain weight.”

• “Dieting made me worse.”

• “I’m exhausted and hungry all the time.”

• “My body is fighting me.”

…and people respond like it’s a confession.

But when a celebrity says:

• “Obesity is metabolic dysfunction.”

• “Hunger hormones matter.”

• “Bodies defend weight.”

Suddenly it’s “scientific.”

That’s not progress.

That’s status-based truth.

And status-based truth is a direct threat to mental health because it trains you to think:

“If the right person says it, then I’m valid.”

“If they don’t, then I’m not.”

You don’t need permission to be real.

2) The most dangerous lie wasn’t “eat less, move more.”

It was “if it doesn’t work, it’s your fault.”

Let’s name what we’ve endured.

For decades, the dominant obesity narrative wasn’t just simplistic. It was psychologically violent.

It built an entire moral framework where:

• weight loss = virtue

• weight gain = failure

• hunger = weakness

• cravings = lack of discipline

• regain = proof you didn’t want it badly enough

And then society added the finishing touch: public humiliation as motivation.

But shame does not produce long-term changes in health behaviors.

Shame produces:

• obsessive monitoring

• disordered eating

• anxiety around food and medical appointments

• avoidance of care

• depression

• self-loathing disguised as “motivation”

• the belief that you must be punished to deserve support

That’s not a “mindset issue.”

That’s a predictable trauma response.

If you’ve spent years feeling like your body is a courtroom and you’re always on trial, it makes sense that your mental health is tired.

3) You are allowed to stop chasing “the permanent solution.”

Here’s the agony that most obesity conversations avoid:

There is no permanent fix.

Not because you’re doomed.

Because biology is adaptive.

Your body is not static. It’s constantly adjusting to:

• calorie availability

• stress levels

• sleep debt

• inflammation

• hormonal signaling

• medication changes

• aging

• environment

• and yes—genetic predisposition

Even with:

• consistent nutrition

• consistent movement

• consistent treatment

• consistent support

There are still no guarantees.

If that statement makes you feel despair, I want to gently offer this:

The despair isn’t caused by reality.

It’s caused by the expectation that reality should be different.

We were sold a fantasy:

“If you find the right program, the right macro split, the right medication, the right mindset… you will finally be fixed.”

That fantasy keeps people spending money and blaming themselves.

Reality is harder.

But it’s also kinder.

Reality says:

You don’t need to be fixed.

You need sustainable care.

You need options.

You need support that respects your autonomy.

4) Obesity medicine is a business. That doesn’t make it evil—just untrustworthy by default.

This part matters.

Because it’s possible to hold both truths at once:

1. Obesity is real biology, not personal failure.

2. The system built around treating it is incentivized to keep you consuming care.

That doesn’t mean your doctor is a villain.

It means you must understand the environment they work within.

There are entire industries attached to:

• medications

• therapy/coaching (These two are similar but different, but I’ll get to that in another post.)

• supplements

• meal plans

• “metabolic resets”

• bariatric pipelines

• continuous glucose monitors sold like personality upgrades

• wellness programs rebranded as “lifestyle medicine”

And because obesity is chronic and complex, it becomes an endlessly renewable market.

So yes:

Obesity medicine can be both helpful and predatory.

That’s why you must learn to vet information like your wellbeing depends on it—because it does.

5) How to vet obesity treatments without giving up your autonomy

Here are the guiding questions I want you to keep:

A) “What is the mechanism—and what are the tradeoffs?”

If someone promises a treatment, they should be able to clearly explain:

What changes in the body

What it doesn’t change

What side effects are common

What long-term data exists

What happens when you stop

If they can’t explain tradeoffs, they’re selling.

B) “What kind of evidence is this?”

Not all “science” is equal.

Things to trust more:

• randomized controlled trials (especially long-term)

• systematic reviews and meta-analyses

• multi-site studies

• outcomes beyond weight: mental health, eating behavior, metabolic markers, quality of life

Things to be cautious with:

• influencer summaries

• “Doctor explains” threads with no sources

• single small studies

• mouse studies presented as human truth

• anything that uses fear and urgency

C) “Does this respect my nervous system?”

This is a mental-health filter most people never use.

If a plan spikes:

• hypervigilance

• food obsession

• shame spirals

• anxiety

• rigid rules

• all-or-nothing thinking

…it is not a health intervention.

It is self-harm dressed as discipline.

D) “Does this require me to distrust myself?”

Any provider or program that implies:

• Your hunger is wrong

• Your body is lying

• Your needs are inconvenient

• Your questions are resistance

…is not safe.

6) You are the expert in yourself. Full stop.

This is the part I wish the world would understand.

No doctor lives in your body.

No celebrity lives in your mind.

No “evidence-based” program understands your trauma history, your fatigue threshold, your financial limits, your sensory preferences, your chronic stress load, your medication interactions, your cultural context, or how hard it is to exist in public without being evaluated.

• You can respect medical expertise without surrendering your authority.

• Here’s what patient expertise looks like:

• You are the expert in your hunger and satiety signals.

• You are the expert in what restriction does to your mind.

• You are the expert in what you can sustainably maintain.

• You are the expert in the difference between motivation and self-punishment.

• You are the expert in what you can afford—financially and emotionally.

And here’s your permission slip:

You have the right to choose:

• your engagement level

• your pace

• your “why”

• your boundaries

• your methods

• your treatment preferences

• your stopping point

• your definition of success

You do not owe anyone the performance of trying harder.

7) The most radical truth: genetics aren’t rewritten by willpower.

It bears repeating:

There are no quick fixes.

No gimmicks.

No fads.

You cannot hack your way out of genetic predisposition.

You can treat.

You can support.

You can care for your body with consistency.

But you cannot punish it into becoming someone else’s ideal.

And if you take nothing else from this, take this:

Your body is not broken because it adapts.

Your body is not failing because it resists weight loss.

Your body is not immoral because it’s hungry.

Your body is doing what bodies do: survive.

Closing: your mental health is part of the treatment plan

If this conversation about obesity doesn’t include mental health, it’s incomplete.

Because the deepest wound for so many people isn’t the weight.

It’s the decades of being treated like:

• You’re lying

• You’re lazy

• You’re “noncompliant”

• You’re a problem to solve

• You’re evidence of failure

And you are none of those things.

You’re a person living in a body that deserves respect.

And you don’t need a celebrity to prove it.

As a therapist, I appreciate Dr. Kevin’s thoughtful exploration of the psychological dimensions of GLP-1 medications. His caution about unintended mental and emotional effects is an important contribution to a conversation that is often dominated by weight-loss outcomes alone. Where I see things a bit differently is at the intersection of lived experience, pleasure regulation, behavior change, and therapeutic engagement.

In my clinical work, I’ve observed that many clients who begin GLP medications experience not psychological blunting or destabilization, but an increase in impulse control, groundedness, and intentionality. Clients who previously struggled with emotional dysregulation, behavioral frustration, anxiety, irregular patterns, or even self-harm often describe a new internal steadiness. Mood regulation improves. Anxiety softens. Harm-reduction behaviors emerge where impulsivity once dominated.

One area that deserves more nuance in this discussion is pleasure-seeking behavior. Many of my clients do not lose the capacity for pleasure on GLP medications; rather, their relationship to pleasure shifts. Before treatment, pleasure was often driven by urgency—dopamine-seeking behaviors that temporarily soothed distress but led to regret, shame, or loss of control. Food, spending, substances, scrolling, or risky behaviors were not about joy so much as nervous system survival.

What I see clinically is that GLP medications often reduce compulsive pleasure-seeking without eliminating pleasure itself. Clients describe fewer urges to chase relief and a greater ability to notice subtler, more sustaining forms of satisfaction. They enjoy food more slowly. They move their bodies with less resistance. They report feeling pleasure that is integrated rather than dysregulated. This distinction matters. The reduction of compulsive reward-seeking can feel unfamiliar—and sometimes unsettling at first—but it often opens space for healthier, values-aligned sources of enjoyment.

These shifts rarely occur in isolation. When GLP medications are paired with therapy, something deeper happens: clients begin to see—often for the first time—how biology, reward pathways, and behavior interact, sometimes working together and sometimes against one another. That insight alone can be profoundly relieving. Longstanding shame gives way to curiosity. “Why has this always been so hard for me?” becomes “How does my nervous system actually work?” The real work of developing coping skills takes on greater meaning when you understand the biological struggles that once accompanied weight loss.

When patients are engaged in learning about hormones, nutrition, behavioral health, and movement—not as moral imperatives, but as tools for emotional regulation and nervous system support—they don’t become passive recipients of a medication. They become active participants in their own care. About a month into treatment, many begin putting previously missing pieces together. Movement feels more accessible. Thoughts feel clearer. Decisions around health feel less reactive and more values-driven.

From my perspective, this is not psychological numbing—it’s psychological capacity. The medication doesn’t replace agency; it often creates the conditions for agency to emerge. Clients who once felt hijacked by cravings, impulses, or pleasure-seeking that no longer served them now have enough internal space to pause, reflect, and choose differently. That space is where therapy can do its most meaningful work.

Of course, GLP medications are not a panacea, and they are not appropriate for everyone. Ongoing assessment, informed consent, and mental health screening remain essential. But I worry that focusing primarily on potential psychiatric risk—especially framed as “loss of pleasure”—without equal attention to potential psychiatric benefit risks oversimplifies a complex biopsychosocial process. Even as recently as last week, the FDA requested the removal of Suicidal Behavior and Ideation Warning from Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA) Medications.

What I see, again and again, is not people becoming less themselves—but more themselves. More regulated. More curious. More capable of experiencing pleasure without compulsion. They don’t just lose weight; they gain insight. And often, they become seekers of success in areas of life that once felt permanently out of reach.

That, to me, is a psychological outcome worth taking seriously.

That first surgical experience forced me to pause and reconsider what it truly meant to have a “tool” for weight loss. While surgery helped me see that change was possible, it was my deeper understanding of metabolic health and mental health that ultimately guided me toward my current work in obesity advocacy, education, and people-centered mental health care. That understanding continues to inform how I approach treatment—thoughtfully, compassionately, and with respect for the complexity of obesity as a disease.

On that day, seventeen years ago, I was filled with hope for my health. My primary motivation was prevention. I grew up watching my mother finger-prick my grandmother every morning before giving her insulin for type 1 diabetes. I knew both of my grandmothers had struggled with weight throughout their lives. I understood that my maternal grandmother’s type 2 diabetes—later insulin-dependent—was the result of a lifelong battle with obesity. Those experiences shaped my fears, my awareness, and my resolve.

The superficial desire for thinness was there, of course, but it was never the driving force. I wanted long-term health. I wanted to live differently. Yes, I wanted to wear the beautiful clothes I designed as a fashion student during my undergraduate years, but it was my experience of fat shaming and weight bias—particularly while interning in New York City—that became a true catalyst for change. When things didn’t work out in NYC, I chose to pursue a master’s degree in mental health counseling, rooted in my own lifelong struggles with weight. I had come to understand that my body had often been a barrier to connection, and I didn’t want weight—or obesity—to define me or anyone else.

Nearly four years after receiving an adjustable gastric band, during a pivotal weekend in my life, I thought I was coming down with the flu. Instead, I landed in the emergency room with a suspected band slippage. The following day, I underwent emergency surgery to have the band removed. I didn’t have insurance at the time, so there was no revision—only removal of the device that had helped me lose 150 pounds in less than four years. I left the hospital physically and emotionally depleted, after being stuck there for five days due to a hurricane lockdown.

Over the next fourteen months, I gained approximately five pounds per month. No matter what I did—working out, eating low-carb as instructed—it felt impossible to maintain the weight loss I had achieved. The speed at which the weight returned was disorienting and devastating.

The years that followed were challenging, even after a revision to sleeve gastrectomy in 2013 and eventually gastric bypass in 2015. Because my insurance did not cover bariatric surgery, I traveled to Mexico. There, I met one of the most compassionate and dedicated physicians I’ve ever known, Dr. Elias Ortiz. His team took exceptional care of both me and my mother, and over time we formed a lasting friendship. His commitment to obesity care—and the supportive community he built around his patients—has changed thousands of lives. Despite the geographic distance, his team remains deeply engaged with patients years after surgery, demonstrating what continuity of care truly looks like.

While my path has taken many turns, one of the most impactful experiences has been my involvement with the Obesity Action Coalition’s Your Weight Matters National Conventions. Through these experiences, I’ve traveled, built lifelong friendships, and advocated nationally and internationally for the recognition and treatment of obesity as a disease—one that must include mental health care as a core component. Weight and mental health cannot be separated. Ignoring how these worlds collide has caused harm for decades.

Too often, we were told we must be doing something wrong, while biology was dismissed and bias filled the gaps. As I learned more, the importance of this work became unmistakable: we must confront and change the attitudes that continue to harm people living with obesity.

The assumption that behavior alone drives weight gain is simply false. The last place judgment and shame should exist is in a doctor’s office. It has become my mission to help clinicians and patients have more open, honest, and compassionate conversations about weight management. Blaming patients erodes trust and destroys rapport. We now know far more about metabolic health, and we have an obligation to do better. Asking for help is hard enough—I never want to make it harder for someone to speak openly about their struggles.

Even now, the last four years of GLP treatment interventions furthered my personal journey to health improvement. I continue to advocate for myself and others to reach these medical interventions to improve health conditions for all people who want the opportunity to live longer, correcting the genetic and biological defaults of a lifetime of difficulties with metabolic syndrome. We all deserve to choose the way we pursue treatment, and the pharmaceutical industry should not gatekeep interventions by imposing financial constraints. Everyone deserves access to care, and everyone deserves to decide how they want to improve their health on their terms without going into debt. As someone who paid out of pocket for surgical intervention and emergency surgery, I can attest to the years it took to pay off my debts to the hospital and how my own financial life suffered due to their lack of access to care.

As I’ve grown as a clinician, I’ve also had to reflect on my own missteps. I wasn’t always as compassionate as I should have been, and my enthusiasm for science-based treatments wasn’t always received the way I intended. My openness about my own journey may have even discouraged some people from pursuing care. We are all learning in real time, and we all have room to improve how we talk about weight and health.

Along the way, I found Pilates—a practice that transformed my relationship with movement. Getting started was difficult, but once I found something that resonated, I committed fully. I’m currently completing my comprehensive Pilates teacher certification, and my clinical orientation has expanded to include somatic interventions. This evolution feels natural and necessary.

This journey has shaped me in countless ways, and I know it isn’t over. There is no final destination—only integration, growth, and a continued commitment to reaching people in ways that honor their humanity. These past seventeen years have been challenging, humbling, and transformative. They’ve helped me find myself—and continue to guide who I am becoming.

It makes me sad when people are mean.

I’m not saying that as some fragile sentiment. I’m saying it because I genuinely don’t understand why cruelty has become a personality trait — especially in conversations about bodies, health, and obesity.

I try hard to be kind. Always.

And when someone misunderstands me, I don’t come out swinging. I do my best to slow down, explain my point more clearly, and even express empathy if I unintentionally hurt someone’s feelings.

I don’t believe in humiliation as a teaching tool.
I don’t believe in “gotcha” culture.
And I definitely don’t believe in attacking people because you disagree with them.

But I need to say this plainly:

The shaming, the stigma, the passive-aggressive comments, and the bullying?
They’re hurtful.

And yes — it’s giving mean girl energy.

If you want to disagree with me, that’s fine.

But being cruel to yourself and stigmatizing others does not make you smart, superior, or morally correct.

It just makes you mean.

Do better.
Listen to learn.
Be curious.
Be kind.

Because the hostility I see isn’t “advocacy.”
It’s not “protecting people.”
It’s not “helping.”

It’s bullying.

And I’m not interested in participating.

Let’s Start With This:

Describing Someone as “Fat” Isn’t Who They Are

This is important:

Fat isn’t an identity. It’s a biological tissue.

People aren’t “a fat.”
People are human beings — with lives, families, nervous systems, stories, goals, trauma, dreams, and worth.

That’s why I use people-first language:

• ✅ You have fat.

• ❌ You are not fat.

Some people act like this is semantics. It’s not.

Language shapes dignity. And stigma shapes outcomes.

And here’s the other reality that too many people avoid because it disrupts their comfort:

Having excess fat is usually not a moral failing.

It is often the result of metabolic dysfunction and a modern environment that is literally engineered to impair our biology.

Obesity isn’t simply “too many calories.” It’s often driven by:

• Genetic and metabolic factors

• A body that doesn’t metabolize efficiently

• A food supply full of food-like substances that hijack reward pathways

• Environmental endocrine disruptors that impair hormones

• Insulin resistance that increases cravings

• Excess ghrelin (the hunger hormone)

• Leptin resistance or deficiency (satiety signaling issues)

• Gut hormone disruption and impaired signaling

• Chronic cellular inflammation affecting the brain, appetite, mood, and behavior

This is not just willpower.

It’s brain + gut wiring.
It’s hormone signaling.
It’s inflammation.
It’s biology.

And the worst part?

When the body is dysregulated, people blame themselves.

Self-blame becomes shame.
Shame becomes silence.
Silence becomes suffering.

That’s not healthcare.
That’s a punishment system.

My Message Has Never Been “You Must Change”

Let me be crystal clear:

Nobody is saying you must change.

I will never tell anyone what to do with their body.

What I fight for is choice.

I fight for every person’s right to access healthcare treatment if they want it — just like with any other disease. I fight for people to receive medical care without being mocked, dismissed, or moralized.

I believe we all deserve the option to become healthier versions of ourselves if that’s what we want.

And if you don’t?

That is your choice. Completely.

But what I don’t understand is this:

• Why are people so quick to shame those who do want treatment?

• Why is it suddenly “wrong” to pursue health?

• Why is it suddenly “bad” to seek medical care?

That’s not body positivity.

That’s control.

I’m Not the Villain for Sharing Science

It honestly shocks me how hostile people get when I present research.

We now have decades of evidence showing that obesity is complex and biologically driven. We have medications that genuinely help metabolic dysfunction. We have treatments that reduce suffering. We have interventions that improve insulin regulation, appetite signaling, and long-term outcomes.

And yet some people respond to science with contempt — as if knowledge itself is an attack.

If facts trigger rage, the issue is not facts.

My Story:

I Am a Person Affected by Obesity (And I Still Am)

Here’s the part that makes the cruelty extra wild:

I am a person affected by obesity.
I always have been.
I still am.

I have lost 200 pounds — and it took me 20 years to learn how to maintain that loss while living with severe metabolic dysfunction.

It took:

• Trial and error

• Effort

• Agony

• Years of learning

• Medical treatment

• A willingness to advocate for myself when the world tried to convince me I was “just lazy.”

I sought treatment at 30.

And I say this without exaggeration:

I would have been dead by 47 if I had not pursued treatment.

This is what people don’t understand when they’re busy making snarky comments from the sidelines:

For some of us, treatment isn’t about vanity.

It’s about survival.

It’s hard every day.

But in all the years I lived in that body — the one the world loved to judge — the first thing I always knew was this:

We should be kind.

Because you never know what someone is carrying.
And you never know what it took them to keep going.

If You’re Angry at This Post, Ask Yourself Why

If you feel activated by me saying:

• “Obesity is metabolic dysfunction.”

• “Language matters”

• “People deserve treatment options.”

• “Don’t shame those who want to improve their health.”

Then I’m going to say this gently:

Your opinion isn’t supported by the data.

You’re allowed to feel however you feel — but facts don’t change because they offend someone.

And also?

You don’t get to call yourself compassionate while weaponizing shame.

The End of This Conversation Is Simple

✌️ You are not your body fat.
✌️ You are human.
✌️ Your metabolism can be dysfunctional — and that is not a character flaw.
✌️ You deserve kindness.
✌️ You deserve choice.
✌️ You deserve healthcare if you want it.

I wish you a long and happy life.

But if you’re going to be in community with others, I’m asking you to do one thing:

Be kind to yourself.
And be kind to others.

Because bullying doesn’t make you righteous.

It just makes you cruel.

And we can do better.

During the pandemic, when the world shut down, and the familiar rhythms of New Orleans went quiet, I did something that surprised even me: I brought people together to join a krewe. It was unfortunate when there were no parades in 2021, no crowds pressed shoulder to shoulder, no brass bands spilling joy into the streets. What there was—was isolation. Anxiety. A profound sense of loss. Like so many others, I felt unmoored. And so, I reached for the thing New Orleans has always offered in times of uncertainty: collective creative culture.

I called out to social media to gather on my carport to craft. Friends and strangers gathered—first cautiously, then more confidently—to glue, glitter, create, and dream. What started as an attempt to keep Mardi Gras alive during an uncertain year quickly became something far more meaningful. Friendships formed. Trust deepened. Our little float krewe became a lifeline. Those relationships have shaped my life ever since.

Looking back now, it’s clear to me: Mardi Gras is not just a celebration. It is a mental health intervention hiding in plain sight. It’s a unique opportunity to find your joy in the city that care forgot, though it is a central tenet in our organizational purpose: most, if not all, of our non-profit groups fundraise for important causes throughout the year, and volunteer hours are plentiful when you look deeper into the purpose of our social aid and pleasure clubs.

As a therapist, I often find myself recommending that my clients find their place in the community of vibrant opportunities for self-expression through the dance troupes, music ensembles, float krewes, and culture crafting that takes place all year round. It’s an expressive therapeutic experience that is naturally New Orleans. Every event, parade, or krewe party is an opportunity to find identity and self-expression through creative costuming. Connection is healing, and we all can find a place in the revelry.

The Social Architecture of Mardi Gras

Mardi Gras in New Orleans is often described in terms of spectacle—beads, floats, music, excess. But beneath the surface is an intricate social structure that fosters belonging and purpose.

Krewes are communities. Float builds are collaborative laboratories. The dance troupe rehearsed for months. Musical ensembles practice weekly. Costuming circles gather around kitchen tables and warehouses alike. These are not solitary activities; they are deeply social, embodied, and interdependent.

Mental health research consistently shows that social connection, creative expression, and shared purpose are among the strongest protective factors against depression, anxiety, and loneliness. Mardi Gras weaves all three together.

When you commit to a krewe, you commit to others showing up. When you build a float, you build it together. When you dance or play music in the streets, you synchronize your body with the bodies around you. This kind of engagement regulates the nervous system, strengthens social bonds, and reinforces identity—not as an individual alone, but as part of something larger.

Crafting as Care

There is something quietly radical about crafting together.

In a culture that prizes productivity and speed, the slow, tactile nature of costume-making and float-building offers a different rhythm. Hands busy. Minds focused. Conversations flow without pressure. People who might never otherwise meet—across age, profession, background—find themselves laughing over glue guns and fabric scraps.

Crafting creates space for vulnerability without requiring it. You don’t have to “talk about your feelings” to feel better. You just have to show up, make something, and be witnessed.

During the pandemic, this mattered enormously. The act of creating beauty in a moment of global fear was stabilizing. It reminded us that joy could still be built, piece by piece.

Music, Movement, and Regulation

Music and dancing are central to Mardi Gras—and central to mental health.

Rhythm regulates. Movement discharges stress. Dancing in a group increases oxytocin, lowers cortisol, and strengthens emotional resilience. Brass bands, drumlines, and dance troupes don’t just entertain; they attune communities.

When you march or dance with others, your breathing tends to align. Your steps align. Your nervous system aligns. This collective regulation is especially powerful in a city that has endured repeated trauma—from storms to systemic inequities to a global pandemic.

Mardi Gras doesn’t erase those realities, but it offers a counterbalance: a way to metabolize them together.

Shifting Away From Alcohol, Toward Art

In recent years, there has been a noticeable shift within many Mardi Gras spaces: declining alcohol use and an increasing emphasis on artistry, wellness, and intentional participation.

This matters.

While alcohol has long been part of carnival culture, excessive use can undermine the very mental health benefits Mardi Gras offers. As more people choose moderation—or abstention altogether—they are finding deeper connection in the creative and social aspects of the season.

People stay longer at crafting nights. Conversations go deeper. Rehearsals become more focused. Friendships become more sustainable.

Art becomes the anchor, not intoxication.

This shift improves social health factors across the board: increased reliability, emotional availability, safety, and inclusivity. It opens Mardi Gras to people who may have previously felt excluded or overwhelmed. It makes the culture stronger, not weaker.

Mardi Gras as Collective Medicine

What I learned during the pandemic—and continue to learn every season since—is that Mardi Gras works because it is participatory. You don’t just consume it; you co-create it.

That co-creation builds meaning. Meaning builds resilience.

In a time when loneliness is described as a public health crisis, New Orleans offers a model the rest of the world could learn from: invest in communal art, protect spaces for shared creativity, and honor joy as essential—not optional.

For me, it started with inviting people to a table to craft. It grew into friendships, chosen family, and a renewed sense of purpose. And it reminded me that mental health doesn’t always come from therapy rooms or prescriptions—sometimes it comes from glue, glitter, music, and the radical act of showing up for one another.

Mardi Gras doesn’t just happen to us.

It heals us—because we make it together.

Weight bias is not a neutral social phenomenon. It is a learned behavior, reinforced by medical systems, media narratives, and cultural myths about morality and body size. And while conversations about weight are often framed as necessary for health, the way those conversations are conducted frequently does more harm than good.

The Alienation of Weight Bias

People in larger bodies are routinely treated as problems to be solved rather than people to be supported. This alienation shows up early and often:

• Delayed or avoided medical care due to fear of judgment

• Diagnostic overshadowing, where symptoms are dismissed as “just weight”

• Social exclusion that reinforces shame, isolation, and internalized stigma

Weight bias doesn’t simply hurt feelings. It creates structural barriers to care. When people expect humiliation in clinical settings, they avoid them. When they avoid care, conditions worsen. This cycle is not accidental — it is the predictable outcome of stigma.

Behavior Blaming in Medical Care

One of the most damaging manifestations of weight bias is behavior blaming — the assumption that body size is solely the result of personal choices and moral failure.

In practice, this looks like:

• Providers attributing unrelated symptoms to weight without investigation

• Recommending weight loss before addressing pain, fatigue, or metabolic markers

• Framing health exclusively around compliance, discipline, and willpower

This approach ignores decades of research showing that body weight is influenced by genetics, environment, trauma, medications, stress, socioeconomic factors, and access to care. Behavior blaming oversimplifies complex biology and places the burden of “fixing” health entirely on the individual — often without adequate tools or support.

People-First language matters here. A person living with obesity is not an “obese person.” The distinction reinforces that health conditions do not define identity, and that dignity is not contingent on body size.

The Mental Health Cost of HAES Absolutism

The Health at Every Size (HAES) framework emerged as a corrective to weight stigma — and in many ways, it has been an important one. It challenged harmful dieting culture, emphasized body respect, and pushed back against shame-based health messaging.

However, when HAES is applied rigidly or ideologically, it can have unintended mental health and medical consequences.

For some individuals:

• Being told that weight is never relevant can feel invalidating when physical discomfort or metabolic conditions are present

• Pressure to “fully accept” one’s body at all times can silence grief, frustration, or desire for change

• Dismissing intentional health-oriented weight change as inherently disordered can increase confusion and distress

• Denying the individual’s desire for change and invalidating medical treatment can further distance patients and providers from improvement of comorbidities

Mental health suffers when people are forced into false binaries: acceptance or harm, weight focus or stigma, care or compliance. Humans are more nuanced than that.

A compassionate, evidence-based approach allows for body respect and health-directed change, without shame.

What Positive Treatment Actually Looks Like

Moving beyond fat shaming requires more than kinder language — it requires better systems.

In Medical Care

• Use neutral, People-First language and ask permission before discussing weight

• Address presenting symptoms first, not last

• Focus on measurable health outcomes (blood pressure, mobility, sleep, pain, labs) rather than weight alone

• Collaborate with patients on realistic, individualized goals

In Mental Health Care

• Treat weight stigma itself as a source of chronic stress and trauma

• Screen for depression, anxiety, and disordered eating across all body sizes

• Support autonomy — people are allowed to want change, stability, or acceptance at different times

In Exercise and Movement

• Reframe movement as functional, accessible, and adaptable

• Emphasize strength, balance, endurance, posture, form, and quality of life

• Remove punitive language around “burning off” food or bodies

In Dietetics and Nutrition

• Shift away from moralized food rules

• Focus on nourishment, consistency, and metabolic health

• Meet people where they are — culturally, financially, and emotionally

Health improves when care is collaborative, not coercive.

A Call for Better Conversations

Fat shaming rhetoric often claims urgency — that stigma is necessary because “health is at stake.” But stigma has never produced better health outcomes. Respect, access, and evidence-based care do.

If we want fewer complications, better engagement, and improved quality of life, we must stop mistaking shame for accountability.

Join the Conversation: Your Weight Matters Regional Meeting

These issues deserve thoughtful, multidisciplinary dialogue — and that’s exactly what the Your Weight Matters Regional Meeting offers.

📍 New Orleans, Louisiana
📅 February 7, 2026

This regional meeting brings together healthcare professionals, advocates, and community members to explore compassionate, science-driven approaches to weight and health — without stigma, absolutism, or blame.

Whether you work in medicine, mental health, nutrition, or advocacy, or you are navigating these issues personally, your voice belongs in the room.

Because weight always matters — but people matter more.

Weight, Without Shame: Why This Conversation Matters

Fat shaming has never improved health outcomes — but it has successfully driven people away from care.

For people living in larger bodies, weight bias often shows up as dismissal, behavior blaming, and moral judgment in spaces meant to support health. These experiences don’t just harm trust in healthcare systems; they contribute to anxiety, depression, and delayed treatment.

At the same time, oversimplified responses — including rigid interpretations of Health at Every Size — can unintentionally silence people who want nuanced, individualized conversations about health, body respect, and change. When complexity is replaced with ideology, mental health suffers.

We need better conversations.

That means:

• People-First language that centers dignity

• Medical care that treats symptoms before assumptions

• Mental health support that acknowledges weight stigma as real stress

• Movement that builds function and confidence, not punishment

• Nutrition guidance rooted in nourishment, not shame

This work requires collaboration across medicine, mental health, nutrition, fitness, and advocacy — and it requires spaces where difficult topics can be discussed with compassion and evidence.

It’s an entire orchestral arrangement your body writes like a magnum opus—sound, sight, smell, taste, memory, emotion—each with its own dial, each wired into a speaker we call the brain. And when those dials are turned all the way up, the experience isn’t just hunger. It’s a symphony of sensation that can overwhelm, soothe, seduce, or silence us.

For most of my life, I thought food noise meant a lack of willpower. I was wrong. It was never just noise—it was amplification and complex biological melody of instruments, some out of tune and completely unaware of each other.

I experience food the way I experience music. Deeply. Emotionally. Viscerally.

When Pleasure Has a Volume Knob

Cheese dip and cheesecake are not the same experience.
They don’t hit the same frequencies in the body.

There’s a word for this: hedonisia—the pursuit of pleasure through eating. But that pleasure isn’t shallow or indulgent by default. It’s layered. It’s emotional. It’s cultural. It’s neurological.

Food has been comfort.
Food has been joy.
Food has been enrichment.
Food has been curiosity.

And sometimes, food has been the only instrument loud enough to drown out fear, loneliness, grief, or chaos.

Music, Sensation, and the Body

I love music. Choir music. Rhythm. Harmony. The emotional swell of a song that reaches into your chest and rearranges something inside you.

I’ve often wondered: What does life feel like for someone who hates music?
It feels like disdain—like living disconnected from joy.

Food has worked the same way for me. I don’t just taste it—I feel it. Almost like synesthesia, where sensation bleeds into emotion, memory into desire. That sensitivity is not a flaw. But without safety, it becomes overwhelming.

The Nervous System Has a Melody

The vagus nerve is the rhythm section of the body—delivering information from body to brain and back again. When the rhythm is steady, the melody flows.

But anxiety, depression, and chronic stress disrupt that flow.

In persistent states of worry, chaos, and confusion, I sought food—not just to soothe pain, but to regulate my nervous system. Food wasn’t the problem. It was the strategy.

Control, Culture, and Moral Soundtracks

Restriction and indulgence are competing frequencies.

Just like music genres—reggae, classical, R&B, hip-hop, gospel—our cultural and religious contexts shape how we eat, celebrate, and control our bodies.

In my evangelical and Pentecostal upbringing, food and body size were moralized.
Gluttony was sin.
Fasting was virtue.
The Daniel fast became repentance.

Weight loss was holiness. Hunger was discipline.

This theology promoted self-harm disguised as devotion. It cultivated shame, self-hatred, poor body image, and worthlessness tied directly to size.

When resistance finally came, it came as extreme bingeing—followed by more blame and more shame. The noise only got louder.

Exercise Is the Drumline

Movement is not punishment.
It’s percussion.

Exercise is the drumline that brings cadence back to the body. The heart beats more efficiently. The body remembers rhythm. Harmony returns—not because of control, but because of connection.

Breaking Down Emotional Eating

We can eat for any reason if we don’t name the emotion underneath.

Fear.
Loneliness.
Grief.
Joy.
Excitement.

The work isn’t asking, “Why do I want food?”
The work is asking, “What energy does my body need right now?”

Can I feel this emotion without numbing it?
Can I eat and feel at the same time—without guilt or shame?
Can I allow my body to experience life in safety and security?

I am learning that emotions don’t require suppression. They require presence.

Loneliness has been one of the loudest instruments in my life. Food filled space when connection felt unreachable. Faith promised belonging but delivered judgment. Silence became heavy.

Talking about this—naming it—is liberation.

Advocacy and education free us from moral failure narratives. They give us language where there was only shame.

Turning the Volume Down, Not the Music

As I move into a new year, I’m not trying to silence the symphony.

I’m learning to:

Turn down shame

Adjust the dials of restriction and indulgence

Choose safety over punishment

Let my body feel without fear

This isn’t about control.
It’s about listening differently.

And for the first time, the music feels like it might belong to me.

A Call to Tune Our Inner Voice

What if the work ahead is not about muting the body, but about changing the song we sing to it?

What if we practiced praising our bodies—not for how they look, but for how they carry us, heal, adapt, and keep showing up? What if we celebrated improvements in our health the way we celebrate a good melody—small shifts, better timing, deeper breath, steadier rhythm?

This is an invitation to tend to your internal choir.

To notice the voices that shame, rush, moralize, and distract—and gently soften them. Not with force. Not with silence. But with compassion. With curiosity. With truth.

To sing words of safety instead of punishment.
To harmonize effort with rest.
To honor movement as rhythm, nourishment as fuel, and pleasure as part of being alive.

A body-positive, health-centered future doesn’t demand perfection—it asks for presence. It asks us to listen for hope beneath the noise and to tune our inner voice toward kindness, resilience, and possibility.

May we learn to sing with our bodies instead of against them.
May we praise progress without comparison.
And may the music we make inside ourselves guide us toward a healthier future—one softened note at a time.

Pick Your Song: Four Options for Reflection Questions:

What would change if the voice guiding your health sounded more like praise than punishment?

Which internal voice is loudest in your relationship with food and your body—and what might happen if you softened it?

If your body were a song, what words would you want it to hear as it moves toward healing?

What does it look like for you to honor your body as worthy of care, kindness, and hope—right now, as it is?

And sometimes, food has been the only instrument loud enough to drown out fear, loneliness, grief, or chaos.

Music, Sensation, and the Body

I love music. Choir music. Rhythm. Harmony. The emotional swell of a song that reaches into your chest and rearranges something inside you.

I’ve often wondered: What does life feel like for someone who hates music?
It feels like disdain—like living disconnected from joy.

Food has worked the same way for me. I don’t just taste it—I feel it. Almost like synesthesia, where sensation bleeds into emotion, memory into desire. That sensitivity is not a flaw. But without safety, it becomes overwhelming.

The Nervous System Has a Melody

The vagus nerve is the rhythm section of the body—delivering information from body to brain and back again. When the rhythm is steady, the melody flows.

But anxiety, depression, and chronic stress disrupt that flow.

In persistent states of worry, chaos, and confusion, I sought food—not just to soothe pain, but to regulate my nervous system. Food wasn’t the problem. It was the strategy.

Control, Culture, and Moral Soundtracks

Restriction and indulgence are competing frequencies.

Just as music genres—reggae, classical, R&B, hip-hop, gospel—shape how we eat, celebrate, and control our bodies, our cultural and religious contexts do the same.

In my evangelical and Pentecostal upbringing, food and body size were moralized.
Gluttony was a sin.
Fasting was a virtue.
The Daniel fast became repentance.

Weight loss was holiness. Hunger was discipline.

This theology promoted self-harm disguised as devotion. It cultivated shame, self-hatred, poor body image, and worthlessness tied directly to size.

When resistance finally came, it came as extreme bingeing—followed by more blame and more shame. The noise only got louder.

Exercise Is the Drumline

Movement is not punishment.
It’s percussion.

Exercise is the drumline that brings cadence back to the body. The heart beats more efficiently. The body remembers rhythm. Harmony returns—not because of control, but because of connection.

Breaking Down Emotional Eating

We can eat for any reason if we don’t name the emotion underneath.

Fear.
Loneliness.
Grief.
Joy.
Excitement.

The work isn’t asking, “Why do I want food?”
The work is asking, “What energy does my body need right now?”

Can I feel this emotion without numbing it?
Can I eat and feel at the same time—without guilt or shame?
Can I allow my body to experience life in safety and security?

I am learning that emotions don’t require suppression. They require presence.

Loneliness has been one of the loudest instruments in my life—a food-filled space when the connection felt unreachable. Faith promised belonging but delivered judgment. Silence became heavy.

Talking about this—naming it—is liberation. Advocacy and education free us from narratives of moral failure. They give us language where there was only shame.

Turning the Volume Down, Not the Music

As I move into a new year, I’m not trying to silence the symphony.

I’m learning to:

Turn down shame

Adjust the dials of restriction and indulgence

Choose safety over punishment

Let my body feel without fear

This isn’t about control.
It’s about listening differently.

And for the first time, the music feels like it might belong to me.

A Call to Tune Our Inner Voice

What if the work ahead is not about muting the body, but about changing the song we sing to it?

What if we practiced praising our bodies—not for how they look, but for how they carry us, heal, adapt, and keep showing up? What if we celebrated improvements in our health the way we celebrate a good melody—small shifts, better timing, deeper breath, steadier rhythm?

This is an invitation to tend to your internal choir.

To notice the voices that shame, rush, moralize, and distract—and gently soften them. Not with force. Not with silence. But with compassion. With curiosity. With truth.

To sing words of safety instead of punishment.
To harmonize effort with rest.
To honor movement as rhythm, nourishment as fuel, and pleasure as part of being alive.

A body-positive, health-centered future doesn’t demand perfection—it asks for presence. It asks us to listen for hope beneath the noise and to tune our inner voice toward kindness, resilience, and possibility.

May we learn to sing with our bodies instead of against them.
May we praise progress without comparison.
And may the music we make inside ourselves guide us toward a healthier future—one softened note at a time.

Pick Your Song: Four Options for Reflection Questions:

What would change if the voice guiding your health sounded more like praise than punishment?

Which internal voice is loudest in your relationship with food and your body—and what might happen if you softened it?

If your body were a song, what words would you want it to hear as it moves toward healing?

What does it look like for you to honor your body as worthy of care, kindness, and hope—right now, as it is?

Nothing about obesity—or treating it—is easy.

Obesity is a highly complex metabolic disease, and the struggles individuals face are deeply personal and biologically diverse. No two people develop metabolic dysfunction in the same way, because no two people have lived the same life, eaten the same foods, experienced the same stressors, or had the same behaviors every single day since birth. Right?

Yet we continue to frame obesity as a failure of willpower rather than what it is: a chronic, multifactorial disease.

Obesity Is Not a Single Metabolic Problem

Obesity does not stem from a single “metabolic issue” or a fixed set of factors. It arises from a web of interacting influences—genetic, physiological, hormonal, environmental, and behavioral.

While diet and exercise play important roles in body weight regulation, they are not the sole—or even primary—drivers for many people. Metabolic health is far more nuanced than society has led us to believe.

When clinicians evaluate metabolic health, they consider a wide range of factors. A central framework often used is Metabolic Syndrome, which is diagnosed when at least three of the following five markers are present:

• Elevated blood glucose
  High blood sugar levels that can lead to insulin resistance and type 2 diabetes.

• Elevated triglycerides
  High levels of circulating fat in the blood.

• Low HDL (“good”) cholesterol
  Insufficient protective cholesterol levels.

• Elevated blood pressure
  Increased force of blood against artery walls.

• Central obesity / large waist circumference
  Excess visceral fat stored around internal organs.

These are the clinical markers—but they are not the full story.

The Underlying Biology Is Vast and Complex

Beyond these diagnostic criteria lies a much broader and more complicated metabolic reality. Contributing mechanisms include:

• Hormonal dysregulation
  Imbalances in hormones such as insulin, leptin, and adiponectin that regulate hunger, satiety, and fat storage.

• Chronic inflammation
  Visceral fat releases pro-inflammatory signals that disrupt metabolic function throughout the body.

• Ectopic fat accumulation
  Fat stored in organs like the liver, pancreas, and skeletal muscle—where it does not belong.

• Genetic predisposition
  Numerous genes influence energy balance, appetite regulation, insulin sensitivity, and fat distribution.

In short: while there are five key markers used to diagnose metabolic conditions, the number of underlying biological and physiological factors involved in obesity is extensive and deeply individualized.

And the impact of obesity doesn’t stop at physical health.

The Psychological and Social Toll of Obesity

Obesity affects nearly every domain of life—especially mental health, relationships, and social belonging.

There is a bidirectional relationship between obesity and mental health, one that is significantly worsened by pervasive weight stigma and bias. Importantly, research shows that stigma-induced psychological stress—not body weight alone—is a major driver of poor mental health outcomes.

This stress contributes to social isolation, avoidance of healthcare, and worsening physical disease.

Common Mental Health Impacts Include:

• Depression and anxiety
  Individuals with obesity have an estimated 18%–55% higher risk of developing depression or anxiety disorders.

• Low self-esteem and poor body image
  Cultural obsession with thinness fuels shame and self-criticism.

• Disordered eating and maladaptive coping
  Emotional eating, binge-eating disorder, and extreme weight-control behaviors often emerge as responses to psychological distress.

• Reduced quality of life
  Physical limitations combined with emotional burden significantly impair daily functioning and life satisfaction.

• Social isolation
  Fear of judgment leads to withdrawal from relationships, activities, and community.

• Increased risk of substance use and suicidality
  Weight stigma is linked to higher rates of substance use disorders and suicidal thoughts and behaviors.

Weight Stigma Is Not Harmless—It Is Actively Harmful

Weight stigma (negative beliefs and stereotypes) and weight bias (discriminatory actions) inflict measurable psychological and physiological damage.

Key consequences include:

• Chronic stress activation
  Experiences—or even anticipation—of discrimination trigger prolonged cortisol elevation, which promotes further fat storage and worsens metabolic health.

• Internalized stigma
  When people absorb messages that they are lazy or lack discipline, mental health outcomes worsen—even when BMI is controlled for.

• Avoidance of healthcare
  Fear of judgment leads many individuals to delay or avoid medical care, screenings, and preventative services.

• Worsened health behaviors
  Contrary to popular belief, stigma does not motivate change. It increases avoidance of physical activity and promotes emotional eating as a coping mechanism.

• Discrimination in everyday life
  Bias affects employment, education, healthcare, and social relationships—resulting in lower wages, fewer opportunities, and social exclusion.

Research increasingly suggests that weight stigma itself is a greater contributor to psychological distress than obesity alone.

The Bottom Line

Obesity is not a moral failing.
Treatment is not a shortcut.
And there is no “easy way out.”

What is easy is blaming individuals for a disease shaped by biology, environment, and social inequity.

If we truly care about health, we must move beyond shame-based narratives and start treating obesity—and the people living with it—with the complexity, dignity, and compassion they deserve.

But lately, I’ve felt myself waking up again.

My dad was my rock—calm, steady, fiercely loving. He was also a devoted public servant: an FBI Federal Agent, a sheriff, and a protector of national security across DOE, OPM, and Customs and Border Protection. He served his country quietly, humbly, and with deep conviction. I think of him every day.

I’ve also realized how much I stopped talking about the issues that matter most to me. Divorce had pulled me into survival mode. I lost my way in the world even as I found my way back to the love of my life—a partner who supports me in ways I know would make my dad smile.

And now, as I try to reclaim my voice, I’m confronting the cracks in the systems around us—systems my father spent his life trying to strengthen. Our immigration crisis breaks my heart. Our healthcare system continues to put profit over people. Families are being harmed by policies that should protect them, and patients are being denied timely care by processes that could be fixed with simple, humane reforms.

There’s no reason a prior authorization for a covered medication should take more than 48 hours—except that insurance companies profit from the delay. There’s no justification for asking doctors to override their clinical judgment in favor of cheaper alternatives. We can do better. We must do better.

And through all of this, I hear my father’s lessons echoing:
Seek justice over ego.
Lead with compassion.
Do good without needing credit.

I carry those lessons into my work in mental health every day. I’m not perfect—none of us are—but I’m committed to honoring the legacy he left behind: one built on service, integrity, and the belief that one person can make a difference.

Thank you for being here, for reading, and for being part of this conversation. There’s so much work ahead, but I’m finally finding my voice again.

In my enthusiasm, I shared the event without offering context about what the Obesity Action Coalition (OAC) actually does—its work to improve healthcare access, expand treatment coverage for obesity, and fight weight bias across every setting of our lives. I should have taken the time to frame that clearly.

Instead, my excitement may have been received as an assumption, an evaluation, or an offer of help that wasn’t welcomed. If you felt hurt, I am truly sorry. That was never my intention.

Why This Work Matters to Me

My passion for advocacy comes from lived experience. I grew up with teasing, bullying, name-calling, and years of not being taken seriously about my own health. Too often, doctors assumed every concern I had stemmed from weight—even when it wasn’t remotely related. That pattern of dismissal has shaped countless others’ experiences as well.

The work I do now aims to change that narrative.

If you received my invitation and felt upset or judged, I hope you will feel comfortable talking to me about it. Understanding often comes from conversation, and I welcome the chance to clear the air.

And if you’re even a little curious about the work we do—and how advocacy can help reshape systems that have failed so many—I hope you’ll consider attending or simply learning more.

Curiosity Is the First Step Toward Social Change

Anyone who knows me knows that my goal is to end weight bias and obesity stigma. The shame we internalize—often before we’re even aware it’s happening—is profoundly damaging. Even well-intentioned conversations about weight can feel like an attack because we’ve been conditioned to expect judgment.

If you’d like to learn more, please take a moment to explore:

• Obesity Action Coalition:

https://www.obesityaction.org

• Stop Weight Bias Campaign:

https://stopweightbias.com

The mission is not to push treatment. It’s to eliminate shame, expand compassion, and support choice—including the choice not to pursue treatment.

A Note on HAES and Treatment Choice

Since we’re on the subject of weight bias, I want to address Health at Every Size (HAES). The movement has grown significantly, and while it offers important critiques of stigma and discrimination, it often leaves no room for those who want treatment for obesity.

I frequently see clinicians describe themselves as “HAES-aligned.” I am not—and here’s why:

If someone seeks support, guidance, or treatment options, rejecting metabolic surgery or obesity medications outright is not meeting them where they are.
Our role—clinically and interpersonally—is to listen, inform, educate, and support. Not to shame someone for exploring evidence-based treatments for a chronic disease.

Choice matters. Autonomy matters. Compassion matters.

My Journey, For Context

I think many people who received my invitation haven’t seen the advocacy work I do, the conferences I attend, or the conversations I have behind the scenes. They may not know I’ve undergone “weight loss surgery” three times, navigated complications, and struggled with insurance coverage for medications that help manage my disease.

They may also not know how much personal work it took to unlearn internalized bias—my old belief that obesity came down to “eat less, move more,” and that my struggle was simply laziness or lack of willpower. I believed that 20 years ago. I know better now.

I don’t post before-and-after photos. I don’t sell quick fixes. There are no gimmicks in what I do. Advocacy is real work. Emotional work. And sometimes, exhausting work—especially when trying to help people stop blaming themselves for something we now understand as a complex, chronic disease.

Obesity Is a Chronic Disease—Not an Identity

Obesity is something you are affected by, not something you are.
Treating it is challenging enough without the added weight of stigma.

Society’s perceptions are deeply unfair, and the narrative must change. The internalized shame, the self-blame, and the silence harm people every single day. Many of us have lived for years under the belief that our struggle is our fault. It isn’t.

There is hope—not just in treatment options, but in improving coverage and pushing for equitable access. There is hope in education, advocacy, and community.

A Final Mea Culpa—and an Invitation

Unprompted conversations about weight do feel like an attack, especially when someone is living with unresolved pain. Emotional wounds shape reactions. I understand that.

My invitation came from passion, not judgment—but intentions don’t erase impact. So again: I’m sorry for any hurt caused.

If you’re open to it, I would love the opportunity to talk, clarify, and rebuild understanding.

And if you’re even slightly interested in learning more—about bias, about stigma, about the science of obesity—please join us in that conversation. Curiosity truly is the first step toward lasting change.

Here’s to more compassion, more understanding, and a healthier narrative for all of us in the year ahead.

Just because you experience something in a certain way doesn’t mean everyone else will.

We each live inside our own nervous system, our own biology, our own history. Yet so often, people cling to a single-minded, black-and-white worldview—as if their path is the path, their body is the body, their experience is the universal truth. This kind of dichotomous thinking doesn’t just limit empathy; it leads straight to cognitive dissonance and the delusion that your way is the only way.

Newsflash: Not everyone is you.
Not everyone experiences the world from your vantage point.

And nowhere is this more painfully obvious—and more urgently misunderstood—than in the conversation around obesity.

Obesity Isn’t a Choice. It’s a Disease.

It’s time we expand our collective consciousness and acknowledge what decades of research have already made clear:

Obesity is not a moral failing. It’s not a lack of willpower. It’s not solved by “just eating less.”
It is a complex, chronic disease with biological, genetic, metabolic, behavioral, hormonal, and environmental determinants.

Yes—the calories-in/calories-out myth has been debunked.
And yes—some of us live with medical conditions that are not curable, but absolutely treatable.

If someone had told me 17 years ago that my life, career, and purpose would be to help people understand this truth, I would’ve pushed back. I would’ve retreated to the shame-fueled narrative that shaped the first 30 years of my life. I absorbed every painful message society threw at me: that my body was my fault, that if I just “put the fork down,” everything would magically fix itself.

Treatment Takes Discipline—No Matter What It Looks Like

Whether someone chooses behavioral changes, medication, surgery, or a combination of all three, discipline and determination are required. None of it is the “easy way out”—that phrase should be retired permanently.

Today, we understand so much more about how obesity medications improve cardiometabolic function and reduce inflammation in chronic disease states. They help real people with real biology—not “lazy willpower-deficient humans,” because that person doesn’t exist.

And yet, even with great medications, some people are non-responders.
That’s because not all obesity is the same, and not all metabolic dysfunction presents in the same way. This is why new medications continue to go through clinical trials. This is why science keeps evolving. This is why we need options.

Just like there are multiple types of bariatric surgery.

Because guess what?
Not every surgery works for every person.

(Ask me how I learned that particular lesson.)

Your Biology Is Not Everyone’s Biology

Maybe your body responds beautifully to changes in nutrition, movement, or lifestyle. If so—great! Truly.

But that’s your biology.

Not everyone’s biology operates the same way. Some of us were handed metabolic dysfunction that does not respond to traditional interventions—medical or non-medical. Some of us require more advanced or multiple forms of treatment. Some of us are still waiting for therapies that are currently in development.

This isn’t a character flaw. It’s physiology.

The Heart of It All: Compassion

If we could collectively expand our understanding—even just a little—to recognize that human beings are not carbon copies of one another, we could transform not just how we talk about obesity, but how we treat one another.

Compassion begins where assumptions end.
And the sooner we stop insisting everyone else’s body should behave like our own, the faster we can move toward a world rooted in respect, dignity, and actual science.

Not everyone is like you.
Not everybody responds the same.
And that’s exactly why empathy matters.

These experiences are not harmless teasing. They are acts of cruelty that can shape a person’s sense of worth, safety, and identity for years.

What Weight Bias Really Looks Like

Weight bias often goes unrecognized because it is so normalized. People may feel entitled to comment on someone’s body or eating habits, making assumptions about character, willpower, or intelligence. For many, the stigma arrives long before any health concerns ever do.

Weight bias shows up in many hurtful ways:

• Name-calling that reduces a person to a slur rather than acknowledging their humanity

• Animal noises such as oinking or mooing, intended to degrade and humiliate

• Laughing, pointing, or mimicking someone’s movements or appearance

• Unwanted comments or “advice” about weight, diet, or exercise

• Invasive, inappropriate behavior—from staring to touching to photographing without consent

• Social exclusion, where people are left out of activities, conversations, or opportunities

• Institutional discrimination, including bias in schools, healthcare, and the workplace

To the person on the receiving end, these actions send one devastating message: You don’t belong.

The Emotional Pain Beneath the Harassment

The impacts of weight-based bullying extend far beyond the moment of humiliation. Many individuals carry emotional scars that last for decades. The harm is often cumulative, built from hundreds of small degradations that others barely notice but that land with heavy force.

People who experience weight stigma often describe:

• Shame, sometimes so deep it becomes part of their self-image

• Anxiety in social situations, public spaces, or anywhere they may be judged

• Isolation, withdrawing from friends, school, work events, or physical activities

• Fear of seeking healthcare, worrying they’ll be blamed or dismissed

• Depression, hopelessness, and decreased self-esteem

• Internalized bias, believing negative stereotypes about themselves

These emotional injuries can be just as damaging as any physical health concern—sometimes more so.

Why This Harm Is Often Overlooked

People affected by obesity are frequently told their suffering is “their fault,” as if weight alone justifies mistreatment. But no one deserves abuse. No one deserves judgment. And no one deserves to have their humanity reduced to a stereotype.

Despite widespread awareness about bullying, weight-based harassment is still commonly dismissed as humor, tough love, or motivation. In reality, weight stigma does not lead to healthier habits or improved well-being. Instead, it is associated with worse mental health, increased stress, disordered eating, and avoidance of physical activity.

Blame does not make people healthier. Compassion does.

A Call to Challenge Weight Bias—Together

Reducing obesity stigma begins with recognizing the humanity of each person, regardless of their size. It means shifting from criticism to understanding, from assumptions to empathy. And it requires all of us to call out bullying when we see it.

Here’s how we can help create change:

• Challenge fat-shaming jokes or comments, even subtle ones

• Avoid making assumptions about a person’s lifestyle, abilities, or health based on their weight

• Listen when someone describes their experiences with stigma

• Support body-inclusive environments, including seating, equipment, and clothing options

• Use respectful, person-first language, such as “people affected by obesity”

• Encourage kindness, not commentary, when it comes to bodies

Everyone deserves dignity. Everyone deserves to be treated with respect.

Healing and Hope

For those who have experienced bullying, name-calling, or other forms of weight-based mistreatment, the journey toward emotional healing can be long. But it begins with acknowledging the truth: What happened to you was not your fault. It was not deserved. And it should never have happened.

Your worth is not defined by your weight.

Ending obesity stigma is not only possible—it’s essential. When we challenge prejudice and replace shame with compassion, we help build a world where every person, in every body, can feel seen, valued, and safe.