Medical & Educational Disclaimer

MEDICAL & EDUCATIONAL DISCLAIMER Changing Image 20/20 is based on the author's personal experiences, reflections, and coaching perspective and is provided for educational and informational purposes only.

This book is not intended to provide medical,

psychological, mental health, nutritional, or other professional healthcare advice, diagnosis, or treatment. It should not be used as a substitute for care or guidance from a qualified healthcare professional.

Any discussion of the author's experiences with obesity, weight management, bariatric surgery,

medications, grief, emotional wellbeing, or other health-related matters reflects her individual experience. It should not be interpreted as a recommendation that any reader pursue,

discontinue, or change a particular treatment,

medication, procedure, or course of care.

Health needs and circumstances vary from person to person. Readers should consult an appropriately qualified healthcare professional regarding questions about their individual health, symptoms,

medications, treatment options, or medical decisions.

The reflective exercises, coaching concepts, and personal-development tools in this book are

intended to support self-reflection and personal growth. They are not a substitute for professional medical or mental health care.

MEDICAL & SCIENTIFIC REFERENCES The book is primarily a lived-experience and coaching narrative.

The references below support the medical or scientific statements that appear in the manuscript. Personal medical decisions described in the text are the author's experience and are not presented as medical advice.

Obesity as a chronic disease (Chapter 9)

American Diabetes Association Professional Practice Committee for Obesity. Screening, Diagnosis, Evaluation, and Staging of Obesity in Adults: Standards of Care in Overweight and Obesity—2026. BMJ Open Diabetes Research & Care.

2026;13(Suppl 1):e006247. doi:10.1136/bmjdrc-2026-006247.

Relevance: Supports the manuscript's statement that obesity is a chronic disease and that ongoing, person-centered clinical care may be appropriate.

Obesity as a chronic, relapsing disease and long-term care (Chapters 6 and 9)

Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192(31):E875–E891.

doi:10.1503/cmaj.191707.

Relevance: Describes obesity as a complex, progressive, relapsing chronic disease and discusses evidence-informed treatment including nutrition, physical activity, psychological interventions,

pharmacotherapy, and surgery.

GLP-1/GIP-based treatment for chronic weight management (Chapters 6 and 9)

U.S. Food and Drug Administration. FDA Approves New Medication for Chronic Weight Management. November 8, 2023.

Zepbound (tirzepatide) is a GIP and GLP-1 receptor agonist approved for chronic weight management in specified adults.

Relevance: Supports the manuscript's general reference to GLP-1/GIP-based treatment under medical care. Treatment selection, risks, benefits, and eligibility require individualized clinical guidance.

Weight-management medication decisions should be individualized (Chapters 6 and 9)

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Prescription Medications to Treat Overweight & Obesity.

Relevance: Explains that medication choice should be made with a health care professional and should consider benefits, side effects, current health conditions, other medications, family history, and cost.

Bariatric surgery, nutrition,

supplements, and follow-up care (Chapters 6, 8, and 9)

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Types of Weight-loss Surgery; Weight-loss Surgery Side Effects; Potential Candidates for Weight-loss Surgery.

Relevance: Supports the manuscript's references to postoperative dietary guidance, vitamin/mineral supplementation, recovery, and ongoing medical follow-up after metabolic/bariatric surgery.

Long-term care after metabolic/bariatric surgery (Chapters 6, 8, and 9)

American Society for Metabolic and Bariatric Surgery (ASMBS).

Life After Bariatric Surgery. Updated February 2021.

Relevance: Describes long-term nutrition, vitamin/mineral supplementation, physical activity, medication considerations,

and regular follow-up with health care providers after bariatric surgery.

Bereavement and health context (Chapter 3)

Stroebe M, Schut H, Stroebe W. Health outcomes of bereavement. The Lancet. 2007;370(9603):1960–1973.

doi:10.1016/S0140-6736(07)61816-9.

Relevance: Reviews associations between bereavement and physical and mental health. The manuscript deliberately does not claim that grief caused the author's weight regain.

Grief and physical/somatic health evidence (Chapter 3)

Cunningham J, Shevlin M, Cerda C, McElroy E. ICD-11 Prolonged Grief Disorder, Physical Health, and Somatic Problems: A Systematic Review. Clinical Psychology in Europe.

2025;7(1):e14351. doi:10.32872/cpe.14351.

Relevance: Provides contemporary review evidence on associations between prolonged grief disorder and

physical/somatic health outcomes; it does not establish that grief causes weight gain in an individual.

Reference links https://pmc.ncbi.nlm.nih.gov/articles/PMC13266248/

https://pmc.ncbi.nlm.nih.gov/articles/PMC7828878/

https://www.fda.gov/news-events/press-announcements/fda-appro ves-new-medication-chronic-weight-management

https://www.niddk.nih.gov/health-information/weight-managemen t/prescription-medications-treat-overweight-obesity

https://www.niddk.nih.gov/health-information/weight-managemen t/bariatric-surgery

https://asmbs.org/patients/life-after-bariatric-surgery/

https://pubmed.ncbi.nlm.nih.gov/18068517/

https://pubmed.ncbi.nlm.nih.gov/40177338/