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Chasing Stigma Through the Ages, Part 6

Pat Hartman September 10, 2026 No Comments

Let’s keep going with Erving Goffman for a while, because that man was incredibly tuned in to issues that are exactly as vital (if not more so!) now as they were six decades ago when “Stigma: Notes on the Management of Spoiled Identity” was published. What an incredible find!

Note these incontestable facts about what has happened since then:

Science has advanced to an unimaginable extent.
Academic papers containing millions of words have been published.
Entire institutions dedicated to this exact issue have been built and staffed, and have established formidable reputations for themselves.
Billions of dollars have been spent on research and theories and programs and methods and trials and the education of new generations of scientists and doctors.
Thousands of brilliant professionals have devoted their careers to figuring out how to stop obesity from being such a curse.

And yet, meanwhile, grownups who were not even born yet when Goffman articulated his ideas have spent their entire lives regretting how an extra-large body has impacted their lives. All over the world, countries that did not even use to know the meaning of the word “obesity” are now drowning in tons of it. Entire professions that did not yet exist when Goffman did his work are dedicated to making sure that people all over the planet consume tons of stuff whose intent and purpose is to destroy them. That stuff, incredibly, is unquestioningly accepted as food.

Further, we do not want our current babies and kindergarteners to be the next generation made miserable by obesity… Which they are in serious danger of becoming, because no matter how much science has progressed in the meantime, human nature has not improved by one iota. And we need Erving Goffman today, because the threat of obesity is hanging over our children worse than it has over any previous generation since people were invented.

A wide range of interests

Goffman’s sympathy did not extend only to the obese. He empathized with people stigmatized for other reasons, too. A woman unable to conceive a child, for instance, might be pushed aside and totally disregarded. A person of either sex who was born with a facial deformity might be shunned and avoided throughout life.

Depending on geography, education, religious faith, “political correctness,” and dozens of other variables, there are plenty of circumstances all around the globe right now that cause individuals to be “othered.” They might be shunned, or barely tolerated, or made to feel their difference in a number of ways.

What it all boils down to is that, just like in almost any society that has ever existed, certain individuals are deemed unacceptable. Goffman’s book concentrated on…

[…] the issue of “mixed contacts” — the moments when stigmatized and normal are in the same “social situation,” that is, in one another’s immediate physical presence, whether in a conversation-like encounter or in the mere co-presence of an unfocused gathering. The very anticipation of such contacts can of course lead normals and the stigmatized to arrange life so as to avoid them. Presumably this will have larger consequences for the stigmatized, since more arranging will usually be necessary on their part.

Looking back in history, Victor Hugo’s 1831 novel The Hunchback of Notre Dame is perhaps the prime fictitious example of a character who is “othered” by physical circumstances.

An interesting side note is that in the late 1950s, just before Goffman’s non-fiction work on stigma was published, Lawrence Durrell wrote a series of novels known as the Alexandria Quartet, which caused a sensation in the realm of literary fiction. Two of the characters suffer from facial deformities that strongly influence their personalities and activities.

One is landowner Narouz Hosnani, described as jealous, frustrated, and fanatically religious. Despite his cleft lip and palate (surgically uncorrectable at the time), he is an impressive orator who also enjoys killing wild animals with a whip, and murders a human by forcing a hatpin into his skull.

Another Durrell character is Leila, whose famously beautiful face is “melted” by smallpox. Despite also being a very intelligent woman who speaks several languages, she has no choice but to wear a heavy black veil and live reclusively in a country house with a tame snake as companion.

Even today, many people who have been taught that they are unacceptably different catch on quickly, and do society a favor by self-isolating, to whatever extent is possible. What are the results of such categorization? Goffman wrote,

Lacking the salutary feed-back of daily social intercourse with others, the self-isolate can become suspicious, depressed, hostile, anxious, and bewildered.

Of course, those are not the only negative results. A person who is “othered” may feel insecure, inferior, jealous, disrespected, shunned, deficient, unwanted, undesirable, hopeless, and unfixable.

Your responses and feedback are welcome!

Source: “Stigma: Notes on the Management of Spoiled Identity,” WordPress.com, 1963
Image by jovemVoodo/Pixabay

Semaglutide Trials Show Promising Results

Tatyana Meshcheryakova September 9, 2026 No Comments

GLP-1 medications have transformed obesity treatment for many adults and adolescents. Now, new research suggests these drugs may also benefit younger children with obesity — even as their rapidly increasing use raises important questions about safety, access, and long-term care.

Results from Novo Nordisk’s late-stage STEP Young trial found that 40.4% of children ages 6 to younger than 12 who received semaglutide were no longer classified as having obesity after 68 weeks, assuming they fully followed the prescribed treatment.

Semaglutide is the active ingredient in Wegovy, a once-weekly injectable medication used for chronic weight management. Wegovy is currently approved in the United States for adults and adolescents ages 12 and older with obesity, but not for children younger than 12.

The STEP Young trial compared once-weekly semaglutide injections with a placebo. Every participant also received lifestyle support throughout the study, including guidance on a reduced-calorie diet and increased physical activity.

According to Novo Nordisk, the trial met its primary goal by demonstrating a greater reduction in body mass index, or BMI, after 68 weeks among children receiving semaglutide compared with those receiving a placebo.

Martin Holst Lange, Novo Nordisk’s chief scientific officer, said:

We are encouraged by the positive STEP Young results and semaglutide’s potential to help children living with obesity who need medical treatment, alongside lifestyle changes, to better manage their obesity.

The company also reported that semaglutide’s overall safety and tolerability were consistent with findings from clinical trials involving adolescents and adults. However, additional study details and longer-term monitoring will be important for understanding how treatment may affect children as they grow and develop.

The trial results arrive as GLP-1 use among children younger than 12 is already increasing in the United States. A separate study led by researchers at NYU Langone Health found that GLP-1 prescribing among children ages 8 to 11 with obesity and without diabetes was 310 times higher in June 2026 than when prescribing began in 2019. More than 20,000 children in this age group received GLP-1 prescriptions during the study period. The study results were published in Pediatrics earlier this month.

Despite that rapid growth, the overall percentage of young children receiving these medications remains low. Prescriptions are still less common among children ages 8 to 11 than among adolescents ages 12 to 17.

Lead investigator Babak J. Orandi, M.D., Ph.D., said:

Our study offers the first national overview in young children of the use of GLP-1 drugs to fight the obesity epidemic in the United States and shows that while the absolute numbers of children under the age of 12 receiving GLP-1 treatment is still low, GLP-1 use is accelerating rapidly.

Researchers examined electronic health records from Epic Cosmos, a national database containing information from more than 300 million patients across thousands of hospitals and health clinics.

Nearly 94% of the young children prescribed GLP-1 medications had severe obesity. Approximately 65% also had at least one obesity-related health condition, such as high blood pressure, elevated cholesterol, or sleep apnea. About one-quarter had prediabetes.

These findings suggest that physicians have generally been prescribing the medications to children facing significant health risks rather than using them as a routine weight-loss intervention.

GLP-1 medications can support weight loss by reducing appetite, slowing digestion and improving blood sugar regulation. For children with severe obesity, treatment may also help reduce the likelihood of developing diabetes, liver disease, cardiovascular problems and other chronic conditions later in life.

Dr. Orandi described careful GLP-1 use as “a valuable tool in confronting the obesity epidemic among young Americans.” He also emphasized the need to monitor treated children over time to ensure the medications remain safe and effective.

The NYU Langone study also identified a potential socioeconomic divide. Young children with obesity living in higher-income communities were 55% more likely to receive GLP-1 medications than children living elsewhere.

The medications can be costly, and insurance coverage varies considerably. Families with stronger insurance benefits, greater financial resources or easier access to pediatric specialists may therefore be better positioned to obtain treatment.

Co-senior author Allan B. Massie, Ph.D., said,

Physicians and health policymakers alike have a responsibility to ensure, as use of GLP-1 medications continues to rise, that all young children with obesity who need these drugs have access to them.

Addressing this disparity will become increasingly important if clinical trials support expanding GLP-1 approvals to younger age groups.

The STEP Young results are promising, but they do not mean semaglutide is appropriate for every child with obesity. Treatment decisions should consider the child’s overall health, obesity severity, related medical conditions, developmental needs, and family circumstances.

Medication is also not presented as a replacement for nutrition, physical activity, or ongoing medical care. In the STEP Young trial, semaglutide was used alongside structured lifestyle changes.

Further research will be needed to answer several key questions, including how long children may need treatment, whether weight returns after medication is discontinued, and how extended use could affect growth, development, and long-term health.

For now, the two studies point to a rapidly evolving area of pediatric medicine. GLP-1 medications may eventually offer an important option for younger children with severe obesity, but their growing use will require careful prescribing, long-term monitoring, and equitable access to qualified medical care.

Your responses and feedback are welcome!

Source: “Novo Nordisk says semaglutide cut obesity rates in young children in trial,” Reuters, 9/7/26
Source: “Novo Nordisk STEP Young phase 3 data: 40.4% of children living with obesity achieved a BMI below the obesity threshold with semaglutide and lifestyle modification,” GlobeNewswire, 9/7/26
Source: “GLP-1 Use Among Young Children With Obesity in US Remains Rare but Is Rising Rapidly,” NYU Langone Health, 9/4/26
Image by Vanessa Loring/Pexels

Chasing Stigma Through the Ages, Part 5

Pat Hartman September 8, 2026 No Comments

Is the title of this series intended to carry a double meaning? Absolutely! It’s about how, for centuries, bias has been inflicted on and felt by humans who bring out a negative reaction in others. When a person is automatically, perpetually criticized at first sight, it is unlikely to be because they prefer Canadian maple syrup to the sort harvested in the USA, or because they like a piano solo better than a drum solo. Those differences cannot be ascertained by a mere glance.

But obesity can easily be spotted, and anyone who is considered by others to be too physically large is a target waiting to happen. Too many people feel entitled to comment out loud, either to the obese person or to bystanders. Depending on their age, upbringing, and degree of basic humanity, random strangers may feel compelled to voice their disapproval. Even familiar folks, friends and relatives, might be perfectly comfortable dishing out criticism.

In another sense, the title is a reminder that obesity is not a problem that growing older will solve. The opposite, in fact. A 7-year-old child whose body size attracts ridicule and censure is statistically likely to still be in that situation at age 18 and 21 and 35… And possibly even at retirement age and beyond.

Random circumstances and determining factors

Naturally, all these numbers are dependent on variables, like the person’s genetics and gender; their position in society, and particularly in the economic spectrum; the degree of obesity they start out with in childhood; and of course any treatment that might have been attempted or successfully completed.

It goes without saying that statistics will differ according to year and location, but it is probably fair to say that there is a 50% to 70% likelihood that the obese child will still be obese at 18… And a slightly higher chance that they will still be obese at age 25.

And what about the remainder of adulthood? Will an obese child still be that way on her or his deathbed? There are too many variables to really say anything solid about that likelihood. Just to complicate matters, someone might lose weight in later years for causes unconnected to their earlier excess of it; and some of the reasons are not good: aging, starvation, illness, a wasting disease, or treatment for a medical condition.

This needs to be kept in mind

Still, in general, the longer the state of childhood obesity endures, the more likely the individual is to continue into adulthood as an obese person. The longer the condition is allowed to persist, the more difficult it is to shake off, and the less likely a return to non-obesity will become.

Overall, the general prognosis does not look good. Of course, we are now raising a whole generation of young people whose fate will be determined by the absence or presence of the radical weight-loss drugs that even many children now have access to, and it will take many years, and a whole lot of science, to discover how that turns out.

The same doubts can be expressed about the adults who are currently involved with the revolutionary drugs. As of yet, there is no way to know what sort of shape a 30-year-old will be in 20 years from now, although a number of possibilities are of course on the table. Can the meds, like the training wheels of a bicycle, be left behind? Or is the patient, determined not to return to obesity, destined to a lifetime of these medications as surely as someone with diabetes is tied to insulin forever?

Call to action

The general point here is, any grownup responsible for a child or children really needs to be aware that childhood obesity is unlikely to “just go away.” The particular point is, don’t doom your kids to a lifetime of being the butt of other people’s jokes. We can’t all bequeath to our children a trust fund or a townhouse, or even a secondhand car. In the wake of certain tragedies, some caregivers can’t even hand down the simpler things like an album of family photos or grandma’s engagement ring.

But we can all take an active interest in figuring out the very best way, in our own unique case, to help our own particular children avoid lifelong obesity. If your circle happens to include a child who could benefit from such an advantage, here is one starting point: Check out BrainWeighve.

Your responses and feedback are welcome!

Source: “Predicting obesity in young adulthood from childhood and parental obesity,” NIH.gov, 09/25/97
Image by Brainweighve

Chasing Stigma Through the Ages, Part 4

Pat Hartman September 3, 2026 No Comments

Author Erving Goffman has more to tell us about the inner lives of people who carry around too many pounds. Since one of these people could be a beloved child of yours or mine, it just might be useful to check out Goffman’s insights about this matter, especially the parts that involve interactions with strangers.

In recent years, out there in the world, a lot of attention has been focused on one particular way in which a child can be damaged. Sadly, that is not the only possible way. Although less immediately traumatic (and less punishable by law) than inappropriate contact, the focusing of negative attention on a child’s weight can cause significant harm.

A random stranger can do damage in a minute that will reverberate for years, causing emotional pain and influencing behavior. For instance,

The stigmatized individual can also attempt to correct his condition indirectly by devoting much private effort to the mastery of areas of activity ordinarily felt to be closed on incidental and physical grounds to one with his shortcoming.

A person who is unable to shed fat might adapt to it in a way that seems good-natured and healthy. As parallel examples, Goffman mentions a wheelchair basketball team, or “the blind person who becomes expert at skiing and mountain climbing.” There is nothing wrong with such an adaptation, except that in the case of a dangerously overweight person, it might only signify avoidance which, if it could be overcome, would illustrate that the same amount of energy, differently applied, could actually have solved the obesity problem instead.

Multiple possibilities

Whether the physical fact is a facial scar, hilariously prominent ears, or obesity, some very odd psychological effects may ensue:

The stigmatized individual is likely to use his stigma for “secondary gains,” as an excuse for ill success that has come his way for other reasons… It is the “hook” on which the patient has hung all inadequacies, all dissatisfactions, all procrastinations and all unpleasant duties of social life…

Just as effectively as a facial scar, morbid obesity can be used as an excuse to avoid competitive situations and other types of challenges. It can be manipulated into a reason to ignore normal social responsibilities, or provide a plausible excuse for the person’s refusal to become emotionally involved. If a miracle comes along, like a way to pay for bariatric surgery, a whole new landscape of problems might open up.

In ways either recognized or unacknowledged, the severe medical handicap might have functioned as a screen that always served to hide some other problems:

He is unprepared to cope with this situation without the support of a “handicap,” and he may turn to the less simple, but similar, protection of the behavior patterns of neurasthenia, hysterical conversion, hypochondriasis or the acute anxiety states.

Strange as it may seem, to undergo successful weight-loss surgery, and follow it up with all the right moves, may not be the end of the story. The transformation might not even last very long. Some folks feel anxiety and/or depression. Objectively, the body might be lookin’ good, but the sad truth is that’s a stranger in the mirror. And the world might be just as full of strangers as it ever was.

It works both ways

Friends who enjoyed the company of one of those jolly fat people with the legendary sense of humor might now be confronted with an unfamiliar human who is anxious, depressed, confused, and bummed out because now, s/he no longer even has the coping mechanism of eating food for comfort. The formerly overweight person might not have realized there would be so much loose skin. The miraculous weight-loser might feel like s/he went to a whole lot of trouble and expense just to wind up feeling more alienated than before.

If alcohol use was not a problem previously, it might be now, because the body absorbs substances differently. If the patient already had a lover or spouse, that partner might undergo unexpected emotional impact, and the whole relationship may have to be renegotiated. Children might feel uncomfortable with their greatly changed mom or dad. If the patient had been unattached, s/he might have expected to find someone quickly, and feel unjustly rejected. If suicide had never been “on the table” before, it might now look like a viable alternative.

What is going on here?

Why are we even bringing up such depressing scenarios?

As a way of reminding ourselves that going through life vulnerable to any sort of stigma can be a miserable existence. To remind ourselves that we certainly do not want to inflict any of this misery on our children, and that there are ways to avoid having obese children.

Not to be too obvious, but this is a good place for a reminder. If it seems that this sort of trouble might be brewing at home, it might be helpful to have a look at Brainweighve.

You’re welcome!

Source: “Stigma: Notes on the Management of Spoiled Identity,” WordPress.com, 1963
Images by Tumisu, trtasfiq/Pixabay

Are Pediatric GLP-1 Prescriptions Moving Faster Than the Evidence?

Tatyana Meshcheryakova September 2, 2026 No Comments

The rapid rise of glucagon-like peptide-1 (GLP-1) receptor agonists has transformed the treatment of obesity. Medications such as semaglutide (Wegovy), tirzepatide (Zepbound and Mounjaro), and liraglutide (Saxenda) have demonstrated an ability to produce significant weight loss in adults, making them some of the most consequential pharmaceutical developments in obesity medicine in decades. Increasingly, however, these medications are being prescribed to children and adolescents.

That expansion raises important questions. How strong is the long-term safety evidence in developing children? What are the potential consequences of altering appetite, digestion, body composition, and other physiological systems during childhood? And are medications being used to manage childhood obesity without adequately addressing the environmental and lifestyle factors contributing to it?

These questions deserve careful consideration as GLP-1 medications become a larger part of pediatric medicine.

In January 2023, the American Academy of Pediatrics published its Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. The recommendations represented a significant shift toward more intensive treatment of childhood obesity. The guideline supported consideration of pharmacotherapy in pediatric patients, including off-label treatment in some younger children, while also recommending evaluation for bariatric surgery for certain adolescents beginning at age 13.

Its release also came shortly after the FDA expanded approval of GLP-1 therapy for adolescents. Questions about potential conflicts of interest subsequently emerged.

According to a July 2025 BMJ investigation, GLP-1 drug manufacturers provided approximately $2 million in corporate sponsorship to the AAP between 2012 and 2024. Investigators also identified pharmaceutical-industry payments to 10 of the 27 members of the guideline-writing committee and 17 of 77 members of the organization’s national leadership.

Those financial relationships were reportedly not disclosed within the guideline or its accompanying technical report. Financial relationships do not by themselves demonstrate that a clinical recommendation is incorrect. They do, however, make transparency particularly important when recommendations could substantially increase medication use among children.

Since the release of the guidelines, prescribing has increased substantially. The figures include:

A 38% increase in pediatric GLP-1 prescriptions during the first year following the guideline.
A reported 700% increase for two particular GLP-1 medications.
CDC data showing approximately a 300% increase in adolescent obesity-medication prescribing between 2020 and 2023.
Semaglutide accounting for approximately 57% of adolescent obesity prescriptions, with the majority going to adolescents with severe obesity.

Although only a small percentage of adolescents with obesity currently receive these medications, the speed at which prescribing is increasing makes the quality and duration of pediatric safety evidence increasingly important.

GLP-1 receptors are not confined to the digestive system. They are found throughout the body, including in the cardiovascular system. Clinical trials have documented small increases in heart rate among patients taking GLP-1 receptor agonists.

There is also a more indirect cardiovascular concern. Nausea, vomiting, and diarrhea — well-recognized side effects of GLP-1 drugs — can cause dehydration and significant electrolyte abnormalities. This may be especially relevant in younger patients because pediatric prescribing information for Mounjaro reports a higher incidence of vomiting and abdominal pain among children than adults.

One of the less frequently discussed issues surrounding GLP-1 medications is body composition. When a patient loses weight, not all of the lost weight comes from body fat. This issue may carry different implications for children than for adults.

Childhood and adolescence are critical periods for building muscle and achieving peak bone mass. Researchers therefore need to understand whether prolonged pharmacologically-induced weight loss could affect skeletal development, muscle development, or long-term body composition.

There is also the issue of what happens when treatment ends. Loss of metabolically active lean tissue may be one of several factors contributing to weight regain after discontinuation, potentially making GLP-1 therapy a long-term treatment rather than a temporary intervention.

Perhaps the largest unanswered question involves the widespread distribution of GLP-1 receptors themselves. They are found in the brain, gastrointestinal tract, pancreas, heart, kidneys, lungs, thyroid, blood vessels, adipose tissue, immune cells, and bone. Researchers continue to investigate exactly what those receptors do in each organ system and how prolonged pharmacological activation may affect them.

Interest in GLP-1 medications as potential treatments for conditions such as neurodegenerative disease further demonstrates that their biological effects extend well beyond blood-sugar control and appetite regulation. That does not mean these additional effects are necessarily harmful. It means that the biological picture is more complex than appetite suppression alone — and that long-term pediatric research is especially important.

The duration and size of existing pediatric trials remain significant limitations. The pediatric approval of Mounjaro for type 2 diabetes relied on a 30-week study involving 99 pediatric participants. The longest pediatric weight-loss study referenced lasted 68 weeks. Neither timeframe can establish what may happen over many years of treatment with respect to growth, puberty, bone density, neurodevelopment, reproductive development, or other long-term outcomes.

The debate surrounding pediatric GLP-1 prescribing ultimately involves a larger question: What is driving childhood obesity in the first place?

Childhood obesity develops within a complicated environment involving food quality and availability, highly processed diets, refined carbohydrates, sedentary behavior, screen time, sleep, socioeconomic conditions, genetics, family habits, environmental exposures, and numerous other influences.

GLP-1 drugs may help reduce appetite and body weight, but they do not directly change that broader environment. That distinction matters.

For some children and adolescents with severe obesity or related metabolic disease, pharmacotherapy may ultimately prove to have an appropriate place alongside nutrition, physical activity, behavioral care, family support, and treatment of related medical conditions. But medication should not prevent clinicians, families, researchers, or policymakers from confronting the circumstances contributing to the rise in childhood obesity.

The central concern surrounding pediatric GLP-1 prescribing is not whether these medications can produce weight loss. The available evidence shows that they can. The larger question is whether enough is known about what prolonged treatment does to a developing body.

Children are not simply smaller adults. Their bones are developing. Their muscles are growing. Their endocrine systems are changing. Their brains and reproductive systems are maturing.

Let’s close with the words of the pediatrician and the author of the article we’ve used as one of the sources for this post, Dr. Michelle Perro:

Underlying this is a more fundamental question. Childhood obesity is a symptom of an altered food environment: ultra-processed foods, GMOs and their associated pesticides, refined carbohydrates, seed oils, endocrine-disrupting chemicals, and a sedentary, screen-based childhood. Pharmacologic appetite suppression addresses none of these. It intervenes downstream of the pathology while leaving the causes intact.

A therapeutic approach that treats the symptom while ignoring the etiology and that commits a child to indefinite medication without long-term safety data does not meet the standard of care to which pediatric patients are entitled.

Your responses and feedback are welcome!

Source: “GLP-1 Receptor Agonists in Pediatric Patients: An Evidence Review and Cautionary Analysis,” GMOScience.org, 8/27/26
Source: “Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity,” Pediatrics, 1/3/23
Image by Gustavo Fring/Pexels

Chasing Stigma Through the Ages, Part 3

Pat Hartman September 1, 2026 No Comments

Here is the sort of fact that AI proves its singular brand of genius by identifying: In modern written English, the verb “stigmatize” occurs only once in every million words.

In real life, the act of stigmatizing occurs a million times every second. Yes, that is only a figure of speech, not officially verified. But an aware parent is all too likely to discover that when their kid is stigmatized, one incident per year is too many.

We don’t want a child to cry because another six-year-old decided that it’s lame to bring an apple in your home-packed lunchbox, and made an issue out of it. Nor do we want a 14-year-old to contemplate suicide because some teenage idiot mocked his haircut. Humiliating one’s peers is a favorite sport of kids, and learning how to avoid being targeted is an important life skill.

To stigmatize a fellow human being is to brand, label, mark, stamp, defame, denounce, and disgrace… All things that a decent parent does not want done to a daughter or son, no more than they would want that child to be shot, drowned, or set on fire. Acknowledging his expertise on the subject, we stick for a while longer with author Erving Goffman:

By definition, of course, we believe the person with a stigma is not quite human. On this assumption we exercise varieties of discrimination, through which we effectively, if often unthinkingly, reduce his life chances.

Tragically, even some parents exist who practice types of discrimination against their own overweight offspring, and effectively reduce those children’s odds of ever achieving various life benefits, including mental health. Those parents are of course welcome on this page, with the understanding that they need more help than can be found here, and with the hope that they recognize the sad fact and seek that help.

Sticks and stones may break my bones…

“[b]ut words will never hurt me.” For centuries, parents have repeated that old saying to their children, with little effect. Goffman, of course, mentions the obvious: the cruel propensity for inventing rude nouns and adjectives to characterize the stigmatized people. In our particular area of interest, we have seen how even the professionals who are trained and paid to care most about their clients have been capable of using, and even coining, terminology that can easily be read as offensive.

But of course, it goes further than verbal insults. Humans have always had a wonderful talent for explaining the world by constructing mythologies, origin stories, legends, doctrines, lore, and folk tales to explain the various universal phenomena of everyday life. Goffman wrote,

We construct a stigma-theory, an ideology to explain his inferiority and account for the danger he represents… We tend to impute a wide range of imperfections on the basis of the original one, and at the same time to impute some desirable but undesired attributes, often of a supernatural cast, such as “sixth sense,” or “understanding…”

That last remark is striking because, of course, it is true of fat people, who are rumored to be gifted with an extraordinary sense of humor. On the downside, however, this is countered by the large number of associated negative stereotypes that are so familiar, there is no need to list them here. Goffman wrote,

Shame becomes a central possibility, arising from the individual’s perception of one of his own attributes as being a defiling thing to possess, and one he can readily see himself as not possessing… In some cases it will be possible for him to make a direct attempt to correct what he sees as the objective basis of his failing.

Obesity is famous for being — unlike blindness, for instance — a handicap that a person can get rid of just by taking control and doing what’s necessary to shed 50 or 250 pounds. Many people have done exactly that, and still come out on the other side with problems.

Or, they were unable to succeed in the first place, often because of insufficient knowledge and preparation. The author cites “[…] the stigmatized person’s exposure to fraudulent servers selling speech correction, skin lighteners, body stretchers, youth restorers, cures through faith….” or, in this case, shady peddlers of methods and medicines that somehow just never seem to work out.

Here is Goffman’s take on one way in which “happily ever after” can be an elusive outcome:

Where such repair is possible, what often results is not the acquisition of fully normal status, but a transformation of self from someone with a particular blemish into someone with a record of having corrected a particular blemish.

Who wants to spend the rest of their life being introduced with the footnote, “You’re not gonna believe this, but Howard used to weigh more than 400 pounds!”

Of course, it’s still preferable to the alternative.

Your responses and feedback are welcome!

Source: “Stigmatize,” OED.com, undated
Source: “Stigmatize,” Thesaurus.com, undated
Source: “Stigma: Notes on the Management of Spoiled Identity,” WordPress.com, 1963
Image by diegartenprofis/Pixabay

Chasing Stigma Through the Ages, Part 2

Pat Hartman August 27, 2026 No Comments

“Stigma: Notes on the Management of Spoiled Identity” is a golden oldie, a work published years ago (more than 60 of them) that makes so many excellent points, the question arises: “What else about that subject could possibly have been thought or said since then?”

The author Erving Goffman seems to have pretty much said it all, with an enviable expertise in the art of seeing and articulating multiple aspects and angles of a topic — and the concept of stigmatization gave him plenty of raw material to work with.

The author noted that certain individuals and groups seem to possess an immunity to stigma. Whatever is thought or said about them, they simply don’t care. The Roma are an obvious example of people who have done their own thing for centuries, oblivious to the opinions of the world. Whether critics have admitted it or not, they have been unable to avoid feeling respect, right alongside the hate.

Inescapable truth

The ugly fact is that stigmatization carries many associations and can manifest in innumerable ways. One is the identifier, the outward sign. If nature neglected to provide the identifier (for instance, a different color of skin), humans have obligingly figured out how to supply the lack. In ancient society, law dictated that the good people should restrain a transgressor, and brand his or her face with an ineradicable mark, as a warning to the normies who deem themselves acceptable.

In practical terms, belonging to a certain race is something that cannot, in any case, be changed. This factor provides society with a group of people who can be looked down on, and treated differently. To separate and “other” those problematic folks, the righteous majority does not even need to take the trouble to heat up a branding iron. The stigma of shame does not need to be added. It arrives as part of the package.

Cruel nature

What happened when a child was born with a birthmark? Did the leader gasp and warn the rest of the people that such a mutant should immediately be smothered? The reactions of different societies to such challenges are the story of civilization, which in many places and over the course of millennia, seems not to have progressed much.

What happens now when a person shows up with purple hair? The range of tolerance can vary. When an individual goes so far out of their way to be so confoundingly different, some would want that rebel thrown in jail, for reasons they may not have examined. Others, astonished that anyone could feel so strongly about the issue, shrug and say “It’s no skin off my nose.”

When a person is different due to an accident of nature, Goffman reminds us,

Shame becomes a central possibility, arising from the individual’s perception of one of his own attributes as being a defiling thing to possess, and one he can readily see himself as not possessing.

Someone born with a facial birthmark, or a gigantic nose, or an allergy to sunlight, or a preference for same-sex partners, isn’t trying to make trouble. They didn’t do that on purpose. They didn’t ask to be different, and certainly never intended to make others uncomfortable or upset in their presence. And yet, a certain proportion of fellow humans will make it their business — nay, their mission — to be sure the divergent person feels uncomfortable and unacceptable.

A tricky exam

If asked to name the most powerful destructive force on earth, most people would probably answer, “a nuclear bomb,” while a certain proportion would say “shame.” Millions of people feel the pain of shame, mostly generated by factors they can’t control, like having been born with a facial birthmark. This is the secret door to understanding the phenomenon of fat-phobia, the condition that causes a human (who might be a perfect darling in every other way) to fear and/or hate humans who are overweight.

Even someone who might feel compassion for the person with a facial birthmark, or stretch their mind and heart far enough to understand that another person could not help being gay — even someone who is that far advanced will let themselves freely hate a morbidly obese person on the grounds that they didn’t have to be that way.

That person let themselves get fat, made themselves get fat, and does not care one single bit how uncomfortable the sight of their corpulent body makes others feel. Therefore, that person deserves to experience every bit of shame that can possibly be piled on them, from every direction, day and night, for the rest of their disgusting life.

This, Moms and Dads, is one of the very excellent reasons why we would rather not have our kids become overweight.

Your responses and feedback are welcome!

Source: “Stigma: Notes on the Management of Spoiled Identity,” WordPress.com, 1963
Images by Conmongt and Tumisu/Pixabay

Is Obesity Reversible?

Tatyana Meshcheryakova August 26, 2026 No Comments

Obesity may affect the body differently at age 15 than it does at age 45. New research from Duke University School of Medicine suggests that adolescents retain a level of metabolic flexibility that is largely diminished by adulthood.

The study, published in the Journal of Clinical Investigation, found that although teenagers with obesity show early biological signs associated with metabolic disease, their bodies may still be able to adapt to the strain of excess weight. This resilience could make adolescence an especially important time for treatment.

By demonstrating that the biology of obesity changes with age, the findings point to a potential window in which obesity-related metabolic damage may be slowed, prevented, or possibly reversed before it becomes deeply established. John Rawls, Ph.D., a professor of molecular genetics and microbiology and member of the Duke Microbiome Center, said:

For a long time, medicine has tended to treat adolescents as little adults… But teenagers are still growing, building muscle and bone, and using energy in ways that are very different from adults. We wanted to understand how those differences shape obesity.

Why this research matters

Nearly one in five children in the United States has obesity. Without effective intervention, most children with obesity will continue to have obesity as adults, according to study co-author Sarah Armstrong, M.D., a pediatrician and medical weight management specialist at Duke Health.

The transition from adolescence to adulthood does not occur at exactly the same time for everyone. It generally takes place during the late teenage years and early 20s for women and during the early to mid-20s for men.

Researchers are now looking more closely at when the long-term health effects of obesity become biologically embedded. Understanding that timeline could help healthcare providers identify when treatment is most likely to alter a young person’s future health.

Teenagers’ gut microbiomes behave differently

The Duke research team examined two biological systems frequently connected to obesity: the microbiome and the metabolome. The gut microbiome is the community of bacteria and other microorganisms living within the digestive tract. The metabolome includes the chemicals produced as the body and its microbes break down food, generate energy, and carry out other essential processes.

Researchers first analyzed gut microbes collected from 287 teenagers participating in the Pediatric Obesity Microbiome and Metabolism Study. They confirmed that the microbiomes of adolescents with obesity differed in composition from those of teenagers at a healthy weight.

Jessica McCann, Ph.D., a senior research associate in molecular genetics and microbiology, then transplanted microbiome samples from adolescents with and without obesity into germ-free mice. In adult obesity research, transferring gut microbes associated with obesity can sometimes cause recipient mice to gain additional weight. That did not happen when the Duke researchers used microbiota collected from teenagers with obesity.

The result suggests that obesity-related changes in the microbiome are already beginning during adolescence, but those microbes may not yet be contributing to disease in the same way they often do in adults. Dr. McCann said:

This suggests there’s a developmental window in which the microbiome becomes involved in obesity… The relationship between the host and the microbiome may still be developing during adolescence, which means there may be an opportunity to change its trajectory.

In other words, the adolescent microbiome may be changing, but its relationship with the rest of the body has not necessarily become fixed. That could leave room for treatments that influence the microbiome before harmful patterns become more firmly established.

Early warning signs

Working with the Duke Molecular Physiology Institute, the research team also investigated how adolescents process nutrients. Adults with obesity frequently have elevated levels of branched-chain amino acids. They may also have higher levels of related substances called branched-chain keto acids, or BCKAs. Elevated BCKAs have been linked to insulin resistance and type 2 diabetes.

The adolescents in the Duke study displayed a different metabolic pattern. Their branched-chain amino acid levels were elevated, but their BCKA levels remained comparatively low.

The elevated amino acids may represent an early warning sign. However, the relatively low BCKA levels suggest that the teenagers’ bodies were still adapting to the metabolic pressure associated with excess weight. According to Dr. McCann,

The metabolome is showing early signs of disease progression, but it’s also showing evidence of adaptive plasticity.

This adaptive plasticity may help explain why obesity during adolescence is not biologically identical to obesity in adulthood. Teenagers’ bodies are still developing and may remain more capable of adjusting how they use and process nutrients.

A critical opportunity for obesity treatment

The findings strengthen the case for addressing obesity early rather than waiting until adulthood or until related conditions, such as insulin resistance, have fully developed. “The evidence increasingly supports intervening as early as possible,” said Dr. Armstrong, a professor of pediatrics at Duke.

During this period of metabolic flexibility, adolescents may be more responsive to weight-management strategies involving nutrition, physical activity, medication, or future microbiome-based therapies. The research does not suggest that one treatment will work for every teenager. Instead, it highlights the possibility that timing and individual biology may influence which approaches are most effective.

The study also challenges the idea that adolescent obesity should simply be managed using adult treatment models. Early biological warning signs do not necessarily mean that long-term metabolic disease is inevitable. By recognizing adolescence as a unique developmental stage, healthcare providers may have an important opportunity to intervene before temporary metabolic strain becomes a lasting health burden.

Your responses and feedback are welcome!

Source: “Study finds that obesity in adolescence may be more reversible than previously thought,” MedicalXPress, 8/24/26
Source: “Branched chain amino acid metabolism and microbiome in adolescents with obesity during weight loss therapy,” JCI, 7/15/26
Image by CDC/Pexels

Chasing Stigma Through the Ages

Pat Hartman August 25, 2026 No Comments

Because some truths are eternal, today’s post refers to a work published six decades ago, whose roots go back centuries. Written by Erving Goffman, its title is “Stigma: Notes on the Management of Spoiled Identity,” and its subject is one that concerns us because if our children grow up to be unacceptably obese according to the standards of the time and place, stigma is what they will face daily throughout their lives.

The word itself has a complicated origin, intertwined with not only punitive laws but with the Christian religion. Stigmata are wounds or scars that spontaneously appear on the body of a saint or other particularly holy individual, in locations (hands, feet, torso) commemorating the violence inflicted on Jesus during the crucifixion.

But no…

What we are talking about here is the other meaning, the intentionally inflicted wounds that served as warning labels, signaling to others that they should avoid a stranger because of potential trouble. The presence of those scars meant, “To help this escaped slave could get you imprisoned,” or “While this sinner did not do something bad enough for a sentence of execution, he was convicted of a serious crime, so steer clear.” It’s where the expression “He’s a marked man” came from — there would be a literal mark, usually on the face, the meaning of which was clear to the general public.

One of the points made by Goffman’s work is that “shifts have occurred in the kinds of disgrace that arouse concern.” To be stigmatized, a person no longer needs to be a fugitive or a convict — or to be held down and branded with a hot iron. A body that is too big, according to the standards of the time and place, is enough to signify that a person’s “social identity” is one that decent, upstanding, right-minded citizens might (and probably should) be repelled by. Because of this expectation, it is easy to “read” the stranger as worthy of blame for being dangerous, evil, or at the very least, weak.

The author’s extensive study of the subject causes him to occasionally throw in a phrase like,

A stigma, then, is really a special kind of relationship between attribute and stereotype.

How does this relationship manifest itself, out in the world?

The term stigma and its synonyms conceal a double perspective: does the stigmatized individual assume his differentness is known about already or is evident on the spot, or does he assume it is neither known about by those present nor immediately perceivable by them?

Then, in many instances, another if/then factor becomes apparent. Even in the case of obvious differentness, like skin color or obesity — does anybody really care? If they don’t, then the interaction or the relationship can move on to more relevant points.

But just in case

In reaction to a stigmatized individual, the author points out, we let our prejudiced mental stereotypes take over — “transforming them into normative expectations, into righteously presented demands.” Those demands can show up in many guises. For instance, if the morbidly obese stranger is gracious enough to make a little joke like, “Gee, I hope I don’t break your chair,” we might feel inclined to give that person a pass (at least temporarily) because they have bowed to our automatic revulsion by acknowledging how disgusting they are.

Our mental filing cabinet registers that gesture of surrender and makes a note: “At least she knows her place in the hierarchy of worthiness.” The overweight individual can mollify and (temporarily, anyway) neutralize our disgust by confessing to their inadequacy. A fat teenager can become acceptable and even popular within a friend group by frequently insulting himself and saving everybody else the effort.

Acceptance, even grace

A stigmatized person who bows to, and often acknowledges, the group’s stereotypes can earn forgiveness. In their subconscious minds, the others are doing the person a favor by granting a temporary pass into the human race. Of course, the trouble with a temporary pass is that it can be revoked at any time.

We are only on Page 5, and Goffman is just getting started. Here are a few more points:

By definition, of course, we believe the person with a stigma is not quite human. On this assumption we exercise varieties of discrimination…

We construct a stigma-theory, an ideology to explain his inferiority and account for the danger he represents…

We use specific stigma terms…

We tend to impute a wide range of imperfections on the basis of the original one…

Obviously, even the most limited and un-intellectually inclined “normal” individuals can generate sufficient insults, pranks, slurs, putdowns, slights, taunts, and sneers to make anyone’s life miserable. But wait, there is more:

Further, we may perceive his defensive response to his situation as a direct expression of his defect, and then see both defect and response as just retribution for something he or his parents or his tribe did, and hence a justification of the way we treat him.

When persecutors with a few more brain cells, material resources, and additional free time become involved, they have the means to concoct entire theoretical constructs and mythologies and old wives’ tales to justify the mistreatment of some particular type of person. Not only that, but they can accrue enough power and influence to affect the scientific fundamentals, and even the religious institutions and the legal underpinnings of a society, to the detriment of a chosen group.

(To be continued…)

Your responses and feedback are welcome!

Source: “Stigma: Notes on the Management of Spoiled Identity,” WordPress.com, 1963
Image by Tumisu/Pixabay

Words, Feelings, and Healthcare Professionals

Pat Hartman August 20, 2026 No Comments

A few years ago, someone noticed that while research had been done to determine how overweight people felt about the names that friends, relatives, and strangers chose to call them, nobody had really looked at patients’ emotional response to the terminology used by healthcare professionals. To make this inquiry involved surveying almost 3,000 adults (2,911 actually), of whom well over half (1,963) were actually overweight or obese. Others were the parents of children with weight problems, and all were asked to express their opinions about the relevant vocabulary.

The researchers chose 22 common English words and phrases, and here they all are:
Overweight, obese, higher weight, weight problem, unhealthy weight, weight, heavy, chubby, fat, extremely obese, large, plus size, curvy, big, BMI, high BMI, morbidly obese, very overweight, extra large, obesity, super obese, excess weight.

As it turned out, the great majority of respondents found “weight” and “unhealthy weight” to be the least offensive terms. Many people preferred references to the BMI number, despite the fact that it has become much less respected as a meaningful standard.

The reported reactions are complicated:

The term “BMI” may be perceived positively and thus preferred by people within the healthy weight range, while people living with overweight or obesity may consider the term BMI to represent a perceived threat, and do not prefer its use. Further research is required to explore these differences in the preference based on the word “BMI”.

Grownups do not want themselves or their children to be described as super-obese, extremely obese, extra-large, or even fat. And chubby? Forget it. Nobody thinks that word is softer or less offensive than any of the others.

Hurt feelings

Respondents reported their emotional states when offensive terminology is used. Not surprisingly, the feelings inspired by various rejected terms included sadness, anger, disgust, contempt, and several other negative states. The researchers discovered that parents react differently to certain words used by healthcare professionals in relation to the grownups themselves, versus when describing their children. The report duly observed that “HCPs working with adults and children should note these subtle nuances.”

They also suggested that clothing manufacturers might get a clue and stop using some of their accustomed descriptors. Young customers particularly do not want to hear “extra-large,” nor do they care for “super obese” or even the seemingly inoffensive “chubby.”

Fine distinctions

The findings included some noteworthy details. For instance, the word “obese” by itself inspires sadness, while more descriptive adjectives added to it, like “extremely” and “morbidly,” stir up feelings of disgust.

The researchers found this interesting because in other studies, when normal-weight participants are asked what, exactly, it is about heavy people that they find so objectionable, they tend to use the word “disgust” a lot. They often report how that emotion is responsible for their negative emotions, including weight bias, negativity, and extreme prejudice. One captivating detail is described here:

Interestingly, evidence suggests that although some parents might be upset by HCPs using the words “overweight” or “obese”, these terms would be concerning enough to motivate them to make changes.

Many of the results suggested that there are still more layers of meaning to sort through before coming to any definitive conclusions. For instance, advice has been offered to use “person-first language,” for example “person living with obesity” — but that construction apparently does not reduce patients’ hostility toward the term “obesity” itself. The consensus is that professionals need to show more compassion, and the best available advice so far seems to be this:

HCPs should use “weight” when discussing body weight with both adults and children. Given that “weight” was the uniformly preferred term across all BMI categories, and elicited the least negative emotional response… HCPs are advised to use weight neutral terms and ask people for their preferred weight-related terms, as not all terms are uniformly accepted.

(Note to any reader who looks up the document discussed here: The authors consistently use the word “adverb” when they mean “adjective.” But they are not English majors. The scientific aspects of their material are presumed to have passed inspection by many knowledgeable eyes.)

Your responses and feedback are welcome!

Source: “Preferences and emotional response to weight-related terminology used by healthcare professionals to describe body weight in people living with overweight and obesity,” Wiley.com, 06/09/21
Image by rhuf/Pixabay

Chasing Stigma Through the Ages, Part 6

A wide range of interests

Semaglutide Trials Show Promising Results

Chasing Stigma Through the Ages, Part 5

Random circumstances and determining factors

This needs to be kept in mind

Call to action

Chasing Stigma Through the Ages, Part 4

Multiple possibilities

It works both ways

What is going on here?

Are Pediatric GLP-1 Prescriptions Moving Faster Than the Evidence?

Chasing Stigma Through the Ages, Part 3

Sticks and stones may break my bones…

Chasing Stigma Through the Ages, Part 2

Inescapable truth

Cruel nature

A tricky exam

Is Obesity Reversible?

Why this research matters

Teenagers’ gut microbiomes behave differently

Early warning signs

A critical opportunity for obesity treatment

Chasing Stigma Through the Ages

But no…

But just in case

Acceptance, even grace

Words, Feelings, and Healthcare Professionals

Hurt feelings

Fine distinctions

Profiles: Kids Struggling with Weight

The Book

About Dr. Robert A. Pretlow

Presentations