Diabetes and obesity: what physicians say, in their own words

Last updated September 20, 2026.

Read together, the 198 KevinMD posts on diabetes and obesity say one thing consistently: telling patients to eat less and move more did not work, and the physicians writing have spent fifteen years arguing about what to say instead. They agree that insulin should not cost what it costs, that BMI misclassifies a third of the people it labels, and that physicians are biased against the patients they are trying to help. They do not agree on whether obesity is a disease, whether fat acceptance is health or harm, or whether the new drugs are the answer or a distraction. GLP-1 or Ozempic appears in 0 percent of posts in 2020 to 2022 and 34 percent since 2025; stigma, shame, or bias in 8 percent before 2013 and 9 percent since 2025. Where physicians disagree, both sides are on this page under their own names.

This page is a maintained record of what physicians, dietitians, bariatric surgeons, and patients have written about diabetes and obesity on KevinMD.com, a physician-authored publication founded in 2004 by Kevin Pho, MD, a board-certified internal medicine physician in Nashua, New Hampshire. It draws on 198 essays and podcast transcripts with diabetes, insulin, obesity, weight loss, BMI, bariatric, sugar, diet, or nutrition in the title, published between August 2005 and September 2026 by 134 named contributors, 124 of the posts bylined by physicians and 15 of them podcast episodes with transcripts. Of the 198, 76 were published from 2023 onward and 28 in 2026 alone, the most of any year. Every claim is attributed to a named author with the month it was published, quoted in the author’s own words, and linked to the original.

This record is about the diseases and the arguments over them. The GLP-1 drugs have their own record, GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words, and posts about them were routed there; childhood obesity is also on the Children’s health: what pediatricians say, in their own words record; heart disease on the Heart disease: what physicians say, in their own words record. Patients, dietitians, physical therapists, and students are cited at the same weight as physicians and identified as such. Each section opens with a direct answer, then what named authors have said, in the order they said it. Where authors cite figures, the source is named alongside the author and the figures are theirs as of the date they wrote. Contributors who sell services into this subject are identified where they are cited. This is physician opinion and experience, not clinical guidance.

What do physicians say about diabetes care and the price of insulin?

The diabetes posts on KevinMD move from prevention, a 2010 account of the Diabetes Prevention Program, to price: by 2016 an internist asked why a drug that has been around for decades costs what it does, by 2019 a family physician described a patient with an A1c of 14 who could afford the pills but not the insulin, and in 2026 the posts argue that strict targets harm the elderly and that sliding-scale insulin is a 1934 idea. Insulin appears in 21 percent of posts before 2013 and 47 percent since 2025.

Erin Marcus, MD, an internist, wrote in January 2010 that “The study, called the Diabetes Prevention Program, included more than 3,000 adults, all of whom were overweight,” in “How to prevent diabetes with diet and exercise.” Vipan Nikore, MD, an internist, wrote in January 2014 that “DKA is a life-threatening condition that diabetics often face when their body is unable to uptake enough glucose,” in “Pizza or insulin: What does our society value more?” Peter Ubel, MD, a physician and behavioral scientist, wrote in June 2016 that “There has been a steady supply of insulin on the market for more than a half-century,” in “What’s behind the rising cost of insulin?” Therese Zink, MD, MPH, a family physician, wrote in April 2019 that “He purchased his diabetes pills because they’re cheap, but he couldn’t afford the insulin,” in “The obscene price of insulin: This is what happens when health care is for profit.” Rushi Nagalla, a student, wrote in December 2022 that “High insulin prices force approximately nine million Americans to balance their wallet and well-being,” in “Don’t blame Big Pharma for insulin’s problems.” George James, a medical student, wrote in February 2026 that “our health care system treats diabetes as if all adults are metabolically and functionally the same,” in “Geriatric diabetes management: Why strict A1c targets can harm seniors.” Michael Duben, MD, a physician, wrote in August 2026 that “Premeal insulin dose and premeal blood glucose have nothing to do with each other, hyperglycemia correction notwithstanding,” in “Sliding scale insulin is a 1934 idea in a 2026 hospital.”

Is obesity a disease? What physicians say about blame, bias, and BMI.

Physicians on KevinMD agree on the bias and disagree on the diagnosis. A hospitalist who has been obese her adult life told doctors in 2017 to stop fat shaming and in 2018 refused to sign off on fat acceptance; a pediatrician says BMI wrongly labels a third of children; two physicians say obesity is not a disease to be cured but a risk factor for risk factors; a physical therapist says BMI misclassifies a third of adults. BMI appears in 12 percent of posts in 2013 to 2016 and 13 percent since 2025.

Maggie Mahar, a health journalist, wrote in March 2012 that, as the myth goes “if our obese neighbors would just put down their forks and get on a treadmill, the pounds would melt away,” in “Fat kills, and 2 other obesity myths.” Roy Benaroch, MD, a pediatrician, wrote in April 2014 that obesity in the long run isn’t good, but “we can’t even agree on what ‘obesity’ is,” in “Should BMI be used to measure obesity in children?” Jenny Hartsock, MD, a hospitalist, wrote in August 2017 that “Obese patients are often treated rudely and are not given the same level of medical care as non-obese patients,” in “Doctors must stop fat shaming their patients.” Jenny Hartsock, MD, a hospitalist, wrote in October 2018 that “I would never tell myself or any patient to accept that their body is destined to be obese,” in “Don’t sign off on fat acceptance. Don’t normalize obesity.” Rami Bailony, MD, a physician who founded an obesity clinic, wrote in October 2019 that “our response as a medical community thus far has lacked urgency,” in “The physician’s role in the fat-shaming epidemic.” Merideth C. Norris, DO, a family physician, wrote in July 2021 that “Obese children have scores on the Quality of Life Index similar to children undergoing chemotherapy,” in “Be someone who sees the person beyond the BMI.” Judy Butler and Adriane Fugh-Berman, MD, a pharmacologist and a physician, wrote in April 2023 that “obesity isn’t a disease to be cured,” and that ‘Obesity is just a risk factor for more important risk factors’, in “Why weight loss drugs are not the answer to obesity.” Natasha Agbai, MD, a pediatrician, wrote in June 2023 that research reveals “approximately one-third of children falling within the BMI percentile range of 85th to 94th exhibit normal adiposity levels,” in “Breaking free from BMI’s limitations for fair and effective care.” Maureen McBeth, PT, a physical therapist, wrote in February 2026 that “When used alone, BMI has been found to misclassify up to 34 percent of the general population as obese,” in “Beyond BMI: Why weight management must look inside the body.” Howard Smith, MD, a physician, wrote in April 2026 that “Obesity, the predispositions for obesity, and the medical consequences of obesity are a major, if not the major, contributing factors,” in “The evolving standard of medical weight loss and obesity treatment.”

What do physicians say about diets, sugar, and keto?

The diet posts on KevinMD are a fifteen-year argument in which the preventive medicine physician who wrote most often says the diet wars are stupidity, a nephrologist warns about keto, a physical therapist raised in rural Nigeria calls the debates an elite pastime born of food glut, and in 2026 a nutrition researcher says ultra-processed is not one category. Keto or low-carb appears in 12 percent of posts in 2013 to 2016 and 11 percent since 2025.

David L. Katz, MD, a preventive medicine physician, wrote in July 2014 that a meta-analysis indicates “a high intake of saturated fat is as bad as a high intake of sugar, as well as vice versa,” in “Stupidity is worse for us than either sugar or saturated fat.” Albert Fuchs, MD, an internist, wrote in September 2014 that “Many people are passionate about their favorite diet, but there is very little data comparing different diets to each other,” in “Low-fat or low-carb diets: Interpreting results of the new study.” Shivam Joshi, MD, a nephrologist, wrote in July 2018 that not all the evidence supports the enthusiasm “leading the diet to straddle the increasingly blurred lines between faddist snake oil and sanctified medical therapy,” in “A physician’s warning on the keto diet.” Michelle Housel, MD, a physician, wrote in March 2021 that every diet led her to the same conclusion: “extreme dietary restrictions are not sustainable,” in “Reimagining diet: Why cheating brings the win.” Jillian Rigert, MD, DMD, a physician and dentist, wrote in March 2022 that “I studied the rules of diet culture and tried to combine them all: I came up empty,” in “When it comes to diet culture, it’s time to end the abuse.” Mukaila Kareem, DPT, a physical therapist, wrote in July 2023 that as someone raised in rural Nigeria he believes “the diet debates are out-of-touch elite pastimes born out of food glut in Western societies,” in “The ketogenic diet: a historical perspective and survival consequences.” Hana Kahleova, MD, PhD, MBA, a physician and nutrition researcher, wrote in April 2026 that “Processing alone is not the primary driver of disease risk,” in “Rethinking nutrition policy on ultra-processed food.”

What do physicians say about bariatric surgery?

Bariatric surgery is the smallest section of this record and the one with the widest range of voices: a psychiatrist who supported patients choosing it in 2013, a bariatric surgeon who cited a 70 percent long-term recurrence rate, a surgeon who spends most of a first visit building trust, a patient who lost 218 pounds and her ability to walk, and a physician who has treated 10,000 bariatric patients and says the problem is protein. Bariatric appears in 12 percent of posts in 2013 to 2016 and 17 percent since 2025.

Sara Stein, MD, a psychiatrist, wrote in May 2013 that “Bariatric surgeries are not without risk, and don’t always work,” in “What Angelina Jolie and bariatric surgery patients have in common.” Franchell Hamilton, MD, a bariatric surgeon, wrote in March 2023 citing relapse rates from diet and medication over 90 percent and a “post-bariatric surgery recurrence rate long-term above 70 percent,” in “Unlocking the secret to successful weight loss: Curiosity is the key.” Stephanie Mojica, a patient, wrote in March 2026 that after three years of severely limited mobility “I can finally say that I regret having surgery,” in “I lost 218 pounds and my ability to walk: a bariatric surgery regret.” Kevin Huffman, DO, a physician who sells bariatric nutrition products, wrote in April 2026 that “Only a minority of bariatric patients reach the recommended minimum of 60 grams per day,” in “Why bariatric patients struggle with protein and how to fix it.”

What do physicians say about prevention, lifestyle, and nutrition training?

On prevention the physicians on KevinMD confess more than they prescribe: a cardiologist in 2012 asked what it means that diet and exercise did not change heart attacks in Type 2 diabetes, an internist stopped telling patients to lose weight in 2016, and a family physician in 2018 confessed he was taught little to nothing about nutrition. The remedies since 2020 are nutrition counseling in primary care and a national strategy on hunger. Exercise appears in 28 to 56 percent of posts in every period.

Wes Fisher, MD, a cardiologist, wrote in November 2012 asking what if, for people with Type II diabetes “diet and exercise don’t affect the incidence of heart attack, stroke, or hospital admission for angina,” in “Should we reconsider the benefits of exercise and weight loss?” Alberto Hazan, MD and Jordana Haber, MD, emergency physicians, wrote in December 2015 that “An exercise program is a good start, but it doesn’t go far enough,” in “Telling patients to diet and exercise isn’t enough. Here’s what you can do instead.” Elisabeth Poorman, MD, an internist, wrote in October 2016 that “Many doctors agree we need to change how we approach obesity, but are divided about how,” in “This doctor stopped telling patients to lose weight. Here’s why.” Eric Madrid, MD, a family physician, wrote in November 2018 that “I was taught little to nothing about nutrition and true disease prevention,” in “Doctors need to learn more about nutrition.” Melinda Mesmer, MD, a physician, wrote in October 2020 that “When doctors aren’t formally educated about nutrition, it shouldn’t surprise us that it’s rarely addressed in clinical visits,” in “Put nutrition counseling in primary care.” Karla Lester, MD, a pediatrician who sells weight coaching, wrote in July 2022 that “The diet industry’s complex myth that obesity is caloric and its built-in failure and shame model are to blame,” in “Fat acceptance is a human acceptance movement.”

What do physicians disagree about?

On fat acceptance, Jenny Hartsock, MD, cannot sign off on normalizing obesity and Karla Lester, MD, calls it a human acceptance movement. On whether obesity is a disease, Judy Butler and Adriane Fugh-Berman, MD, say it is a risk factor for risk factors and Howard Smith, MD, calls it the major contributing factor to most conditions that plague American society. On diets, David L. Katz, MD, a preventive medicine physician, wrote in June 2014 of the Paleo argument that “There are so many things wrong with this combination of tortured logic, revisionist history, and wishful thinking,” in “You’re doing it wrong: The Paleo diet.” On diet and exercise, Erin Marcus, MD, described a patient who avoided diabetes for eleven years and Wes Fisher, MD, asked what it means that they did not change heart attacks. On the new drugs, the argument is on the GLP-1 record. The record does not resolve these; it dates them.

What would fix it? What physicians propose.

Asked what would fix diabetes and obesity care, physicians on KevinMD propose calorie counts that were written into health reform, weight management medicalized and taught in medical school, nutrition counseling in primary care, an end to weight bias inside health systems, a better measure than BMI, and nutrition policy that gets past processing absolutism.

Danielle Ofri, MD, PhD, an internist, wrote in May 2010 of the calorie-count provision that “I’m rooting for health care reform to work, on all its levels,” in “Calorie counts in health reform is significant for patients.” Elisabeth Poorman, MD, an internist, wrote in October 2016 that we need to get serious and “stop pretending that telling patients to lose weight without giving them the tools to do so is an acceptable intervention,” in “This doctor stopped telling patients to lose weight. Here’s why.” Melinda Mesmer, MD, a physician, wrote in October 2020 that “One of the best solutions to rising obesity and non-communicable disease rates lie in primary care,” in “Put nutrition counseling in primary care.” Kevin Seely, a medical student, wrote in June 2021 that “we must medicalize weight management, displacing it from the discretion of nonprofessionals and pseudoscience,” in “The need for a standardized approach to weight loss in medicine.” Samantha Malley, FNP-C, a nurse practitioner, wrote in July 2025 that “Health systems also need to address their role in weight bias and stigma,” in “Why doctors must stop ignoring unintentional weight loss in patients with obesity.” Hana Kahleova, MD, PhD, MBA, a physician and nutrition researcher, wrote in April 2026 that “Nutrition policy must evolve beyond processing absolutism,” in “Rethinking nutrition policy on ultra-processed food.”

How has the diabetes and obesity conversation changed since 2005?

The record starts with Kevin Pho’s short commentaries, 10 of them, counted here but not cited, and with 4 board-review case questions, counted but not cited. The 2010 to 2015 posts are prevention, soda taxes, celebrity diets, and the low-fat versus low-carb trial, with David Katz’s essays the most frequent. The 2016 to 2019 posts turn to insulin prices, fat shaming, and keto. The record thins in the pandemic years and doubles after 2022, and its subjects since 2023 are BMI, weight stigma, bariatric surgery, insulin resistance reframed, and the drugs, which are argued on the GLP-1 record and mentioned in 34 percent of the 2025 and 2026 posts here. AI is mentioned in 17 percent.

Two things did not change. Exercise is named in 28 to 56 percent of posts in every period. And the physicians who write best about obesity are the ones who describe their own.

Term 2005 to 2012 (39 posts) 2013 to 2016 (40 posts) 2017 to 2019 (18 posts) 2020 to 2022 (25 posts) 2023 to 2024 (29 posts) 2025 to 2026 (47 posts)
Insulin 21 percent 12 percent 33 percent 20 percent 24 percent 47 percent
BMI 28 percent 12 percent 28 percent 28 percent 24 percent 13 percent
Stigma, shame, or bias 8 percent 10 percent 22 percent 36 percent 24 percent 9 percent
Disease (obesity as) 0 percent 0 percent 6 percent 0 percent 3 percent 0 percent
Sugar or soda 38 percent 45 percent 39 percent 16 percent 38 percent 47 percent
Keto or low-carb 8 percent 12 percent 22 percent 12 percent 7 percent 11 percent
Bariatric 8 percent 12 percent 6 percent 8 percent 24 percent 17 percent
GLP-1 or Ozempic 0 percent 0 percent 0 percent 0 percent 52 percent 34 percent
Ultra-processed 0 percent 0 percent 0 percent 8 percent 10 percent 9 percent
Exercise 56 percent 48 percent 28 percent 36 percent 38 percent 47 percent
AI 0 percent 0 percent 0 percent 4 percent 17 percent 17 percent

Term frequencies are the share of posts in each period whose text contains the term at least once, computed on the September 20, 2026 corpus of 198 posts with one stored expression per term.

The KevinMD diabetes and obesity corpus by the numbers

These figures describe the set of KevinMD posts this page draws on. They are counts of what KevinMD has published, not clinical data.

Measure Value
Posts in the corpus 198
Published 2023 or later 76
Published in 2026 (through September) 28
Named contributors 134
Posts bylined by physicians (MD or DO) 124
Podcast episodes with transcripts 15
Posts bylined by nurses 4
Kevin Pho’s early commentaries, counted but not cited 10
Board-review case questions, counted but not cited 4
Posts not indexed, counted but not cited 9
Most frequent contributors David L. Katz, MD (9); Peter Ubel, MD (4); John Mandrola, MD (3); Jillian Rigert, MD, DMD (3); Marc Arginteanu, MD (3)
Title matches routed or excluded 98: 14 GLP-1 posts to the GLP-1 record, 84 with the subject thin in the text

How this page was built and how it is updated

The corpus was assembled from title searches for diabetes, insulin, obesity, overweight, weight loss, BMI, bariatric, metabolic syndrome, prediabetes, sugar, soda, fat, calorie, nutrition, diet, A1c, and glucose. Figurative uses were excluded. GLP-1 posts were routed to the GLP-1 record, and posts whose text mentioned the subject fewer than six times were excluded. Term frequencies were computed against the full text of each post. Posts are counted whether or not they are indexed; citations on this page are limited to posts that are indexed and can be verified at the link. 9 posts in the corpus are not indexed; they are counted but not cited. Board-review case questions are counted but not cited. Quotations are taken verbatim from the original posts and were checked against the source text by script. Author credentials are as they appeared in the byline at publication; where the byline gave none, the credential is the one the post itself states. Patients, a journalist, a neuroscientist, physical therapists, nurses, and students are cited at the same weight as physicians and identified as such. Contributors who sell services into this subject are identified where they are cited: Karla Lester, MD, sells weight coaching; Rami Bailony, MD, founded an obesity clinic; Kevin Huffman, DO, sells bariatric nutrition products. Every source is linked in the sentence that cites it, and the full list appears at the end of the page. The closest archives are the Endocrinology tag and the Conditions and Diseases category. Related records: GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words, Heart disease: what physicians say, in their own words, Children’s health: what pediatricians say, in their own words, Primary care: what physicians say, in their own words, and Aging and dementia: what physicians say, in their own words.

This page is updated as new diabetes and obesity essays are published on KevinMD. When it is updated, the date at the top changes, the counts in the tables are recomputed, and new named claims are added to the relevant section. Nothing is removed unless the original post is removed. An author who believes a quotation on this page misrepresents them can write to Kevin Pho and the page will be corrected.

To cite this page: Pho K. Diabetes and obesity: what physicians say, in their own words. KevinMD.com. Updated September 20, 2026. https://kevinmd.com/diabetes-and-obesity

The 38 KevinMD posts cited on this page, in order of publication