As a physician assistant who has followed the science for a life time, I have to disagree with "Mike the health and nutrition coach." We have well over 100 years of studies showing the same thing over and over again. Diets don't work. Full stop. Frankly, I believe that any doctor who prescribes a diet should have their license revoked. It's like giving an Rx for a drug that's been revoked by the FDA because it never works AND it makes 80% (or more) worse. Much worse. There are some key points here.First, we are not cars. We are not ruled by physics like "calories in = calories out." We are in fact, highly diverse biochemical organisms which have evolved to survive in highly diverse environments. Really, if we were all the same then you could test a drug on one person and if it worked. You're done! No further testing needed. But it DOES NOT work that way. Exposed to the same environment/ food /drug etc. one body will respond one way and another a very different way. This is to be expected. After all, as humans we can survive in the arctic or the desert. Reasonable to expect some diversity. Next, we are animals first. If we don't eat, we don't live. Therefore, you can expect that we will have a drive to eat. And since humans have survived both famines and abundance to quite successfully populate the world you can expect 3 things. One, redundant biochemical drives to eat. It is a biological necessity. Two, variable expressions of the drives to eat. Three, multiple potential areas for metabolic failure of the human regulatory system. We know from studies of women in Finland during "the hungry winter" that periods of food deprivation in women can lead to epigenetic activation of weight retaining "thrifty" genes. And that this can translate into increased metabolic syndrome down MULTIPLE generations!We know we are being inundated by a variety of "obesogenic" chemicals such as bisphenol and phthalates that chemists and health providers alike are deeply concerned about.Humans have a fantastic innate desire to know why things are the way they are. We want answers. When we have incomplete information we formulate the best answer we can with what we have. Unfortunately, once we’ve “figured it out” we don’t like to let an idea go even in the face of enormous evidence that it’s wrong. You know the world is flat right? You know the earth is 6,000 years old right? You know that ulcers are caused by stress and type-A personality? (Oops, actually caused by H. pylori.) You know that women’s health issues are caused by female hysteria? (Oops, need to do some tests for endometriosis, polycystic ovarian syndrome etc…) And of course voluminous adiposity is caused by “life style!” Just ignore all the evidence to the contrary. Because since we don’t have the answers that make sense yet, we’re not going to let go of an old idea that everyone KNOWS is right. The earth is flat.Interestingly, we are finally now coming to understand a few of the metabolic pathways of body weight regulation. I’m deeply grateful to the researchers who did recognize that something more must be going on and who then pursued a better understanding. It’s all so late in coming, but glad we’re getting there. Up until now it has been one of the greatest failures of western medicine. But doctors are just as vulnerable to fat bias as the culture they grew up within.So, now we have Ozempic, Mounjaro, etc. and they confront us with a truth. There are probably as many causes of body mass dysregulation as there are causes of menstrual irregularities. Fatness is a symptom of various underlying metabolic imbalances in the multifold and complex mechanisms of satiety and drives to eat. But for many of us with fluffy adiposity, the normal body hormone in these drugs given by a weekly injection, suddenly changes our body’s weight regulation. I’m taking Mounjaro. I’ve gone from 5’2” and #295 to 5’4” and #242…okay so I didn’t actually get taller! Making sure you’re paying attention. I’m eating all the time, and my metabolic clinic is adamant that I not diet in anyway. They even want me to eat in the middle of the night if I wake up hungry! Why? Because they want to bring down my neuropeptide-Y and ghrelin. Those are hungry hormones that are elevated with food restriction. They also want my adiponectin to go up. That’s a satisfaction hormone that also helps protect the heart. A lot of this is experimental. Not because we don’t know the hormones, but because we don’t have much experience practicing real medicine with obesity. And just to be clear, Mounjaro is not the only medication I’m taking nor are those tests the only things we are monitoring. It’s complex business. But truth be told, we know enough to get started helping people. We just need primary care doctors to take this on like they did hypertension. It should be the bread and butter of medical practice.Now to the political and social aspects of bigness. I agree with Ms. Nolan that bias, righteousness, and scapegoating have formed the basis for many science and societal beliefs about fat. And I believe that fighting that bias both internalized and inflicted is critical to the emotional wellbeing of we grands. But, and it’s a big BUT, there are 2 important truths that we must acknowledge. If we fail to face them, we will shut out many who need our support.First, some people want to not be fat because it’s uncomfortable. I’m not talking about chairs that don’t fit. I’m saying that walking around all day long carrying #120 pack on your back is hard! I have bad ankles and knees from before I got really fat. They hurt. Before I lost weight on Mounjaro, I’d given up on taking my kids hiking on my favorite trails in Kings Canyon. Now, I’ve been out on several tough hikes, and I’m plotting for a trip to one of those trails. I just want to be able to move and go again in a way that, despite great effort, had become impossible.Second, it is absolutely true that some people who are fat have excellent health makers. It is true that some people who are skinny do not have good health markers. It is also true that a very large percentage of persons with a lot of fat will move into worsening metabolic syndrome and eventually diabetes. Despite my herculean efforts to prevent this outcome, it is now mine. And now fully reversed with the lost weight and Mounjaro etc..If you insist that fatted people only want to lose weight due to internalization of societal bias, then you shut out those of us who are happy to give the finger to that bias, but who are also suffering from the effects of our excess adiposity. Yes, those who diet are just making themselves worse. But we need to tap that compassion you spoke of. Some who are fat suffer physically and cling to hope for less of a load to carry. Even knowing what I know, I found it quite frightening to fully commit to intuitive eating. To ditch the diets, and diet police in my head. Ultimately, it was fantastically liberating! What a waste of years of energy and thought I spent on all those years of tracking every bite! Makes me furious that I felt the need to squander so much life industry on an absolutely futile effort. But my understanding of the social and political discrimination of fat bias in all its many forms, does not mean that I’m physically comfortable in my fat. I’m glad to be getting rid of some of it, and in doing so have greatly improved my physical wellbeing.Don’t deny people the right to not want to be carrying around excess adiposity. That is a legitimate feeling separate from issues of bias and discrimination.