Weighted Wisdoms

10/13/2026

Your body can change faster than your mind can recognize it.

After substantial weight loss, excess skin can bring real discomfort, rashes, and frustration. Wanting reconstructive surgery is understandable.

But sometimes the urgency carries more: the hope that one more procedure will finally make you feel at home in your body. The fear of regain. The expectation that reaching a certain weight would mean feeling like a different person.

Those feelings deserve space in the conversation, too.

In the final installment of “The Diagnosis We Keep Missing,” I explore body image, expectations, and what I call maintenance confidence—the trust that develops as we learn to live with and care for a changed body.

My own waiting period was personal, not a prescription for anyone else. This conversation is about making room for physical needs and emotional readiness in the same care plan.

Before the next intervention, we need to ask:
“How is the person doing, inside the body we changed?”

Read “When the Body Changes Faster Than the Mind”:
https://nanetteadamslpc.substack.com/p/when-the-body-changes-faster-than

Part 4 of The Diagnosis We Keep Missing

10/10/2026

You don’t have to earn the right to be cared for. 💚

This World Mental Health Day, remember: you can be grateful for your life and still feel overwhelmed. You can be the person everyone relies on and still need support. You can look “fine” and be carrying something heavy.

You don’t need to wait until everything falls apart to say, “I’m having a hard time.”

You deserve compassion, connection, and care—including on the days when getting through the day is all you can manage.

Share this as a reminder to someone you love. Yourself included.

10/09/2026

10/08/2026

Maintenance isn’t punishment. It’s consistent care.

10/05/2026

“I’m addicted to sugar.”

It sounds like a diagnosis. And when a patient says it with enough conviction, it's tempting to treat it like one.

But what happens when the real problem is binge eating disorder — and the prescription is more restriction?

No sugar.
No bread.
No “trigger foods.”
No exceptions.

Then the inevitable slip becomes a “relapse,” shame increases, and the patient walks away even more convinced that she simply lacks willpower.

The pull toward hyperpalatable food is real. Reward circuitry is real. Cravings are real.

But **“food addiction” is not a DSM-5-TR diagnosis**, and treating food like a substance that must be eliminated can be a poor fit when binge eating is the underlying problem.

In my latest Substack, I unpack the difference between validating a patient’s experience and choosing the right treatment target — including why regular eating, flexible structure, affect regulation, and work on all-or-nothing thinking may be more useful than another list of forbidden foods.

Read the full piece on Substack. https://nanetteadamslpc.substack.com/p/rethinking-binge-eating-food-addiction

10/02/2026

There is no finish line.

That may be one of the most important things I’ve learned about long-term obesity care and life after bariatric surgery.

In 2017, I was 175 pounds down and struggling to walk to the IFSO conference center in London. I thought I was exhausted. What I didn’t know yet was that I was iron deficient and anemic.

Nine years later, walking to sessions at the International Bariatric Club Congress at Oxford felt completely different. I had energy. I was moving. I felt motivated.

What changed wasn’t willpower.

A medical barrier had finally been treated.

This year brought another course correction. After losing muscle mass, I recommitted to three short Pilates sessions a week, increased my attention to protein, and returned to consistent tracking. Ninety days later, I had lost 7.7 pounds of fat and gained 2.6 pounds of muscle.

For me, maintenance isn’t standing still.

It’s noticing. Learning. Adjusting. Repairing. Beginning again when I need to.

And the right change isn’t always the biggest one. Sometimes it’s simply the change you are actually ready to make.

My new Substack article, There Is No Finish Line, explores what long-term maintenance really looks like—including the medical, emotional, financial, and behavioral barriers that can be mistaken for a lack of motivation.

What is one small change you are ready for right now?

And is there something standing in the way that has nothing to do with effort?

https://nanetteadamslpc.substack.com/p/there-is-no-finish-line

If you haven’t reached maintenance yet, here is what I wish someone had told me: there is no endpoint.

09/29/2026

New boundaries rarely feel good at first.

Maybe it's saying "no thank you" to the second helping. Maybe it's asking family to stop commenting on your plate, your body, or your medication. Maybe it's leaving the party earlier than you used to.

It can feel awkward, and some people may push back. That doesn't mean you did something wrong. It means you're asking the people in your life to adjust to you taking care of yourself in a new way.

Discomfort is often the sound of change, not a sign of a mistake.

What's one boundary you're working on right now? I'd love to hear. 💬

09/28/2026

What if the behavior we keep trying to correct is actually the symptom we should be investigating?

In obesity care, patients are often asked to change portion sizes, food choices, meal frequency, and exercise habits. But when eating feels genuinely out of control, we need to ask a different question:

What disrupted this patient’s regulatory capacity — and when?

Metabolic signaling. Trauma. Chronic stress. Grief. Depression. Family dynamics around food and body. Years of restrictive dieting.

These aren’t simply background details. They may be part of the etiology.

And when we treat the behavior without understanding what is driving it, we risk missing eating disorders and disordered eating patterns in the very patients whose symptoms have already been attributed to their weight.

GLP-1 medications have made this especially important. When patients describe the “food noise” suddenly becoming quieter, that experience should challenge assumptions we’ve made about willpower and control.

Medication can quiet the signal.

But the clinical work still has to ask what the signal was responding to.

My latest in Weighted Wisdoms:

The Diagnosis We Keep Missing


https://nanetteadamslpc.substack.com/p/the-diagnosis-we-keep-missing