tag:theconversation.com,2011:/us/topics/overweight-1879/articlesOverweight – The Conversation2024-03-17T08:42:31Ztag:theconversation.com,2011:article/2242862024-03-17T08:42:31Z2024-03-17T08:42:31ZAlmost 50% of adult South Africans are overweight or obese. Poverty and poor nutrition are largely to blame<p><a href="https://www.who.int/health-topics/malnutrition#tab=tab_1">Malnutrition</a>, in all its forms, includes undernutrition (wasting, stunting, underweight), inadequate vitamins or minerals, overweight and obesity. </p>
<p>South Africa has undergone a nutritional transition over the past 30 years characterised by the <a href="https://www.researchgate.net/publication/378313186_National_Food_and_Nutrition_South_Africa">triple burden</a> of malnutrition: households are simultaneously experiencing undernutrition, hidden hunger, and overweight or obesity due to nutrient-poor diets.</p>
<p>Results of the first in-depth, nationwide <a href="https://www.researchgate.net/publication/378313186_National_Food_and_Nutrition_South_Africa">study</a> into food and nutrition since 1994, the National Food and Nutrition Security Survey, found almost half the adult population of South Africa were overweight or obese. </p>
<p>While there was sufficient food to feed everyone through domestic production and imports, many families and individuals went to bed on empty stomachs.</p>
<p>Due to <a href="https://www.gov.za/news/media-statements/statistics-south-africa-quarterly-labour-force-survey-quarter-three-2023-14#:%7E:text=The%20official%20unemployment%20rate%20was,the%20second%20quarter%20of%202023.">high unemployment figures</a>, families relied on social grants to buy basic food items. Many tended to buy food with little nutritional value to avoid hunger. </p>
<p>The survey, conducted by the Human Sciences Research Council, was commissioned by the Department of Agriculture, Land Reform and Rural Development to map hunger and malnutrition hotspots in the country. </p>
<p>Data was collected from more than 34,500 households between 2021 and 2023. Close to 100 indicators were used to compile the report. </p>
<h2>Overweight or obese: what’s the difference?</h2>
<p>Carrying excess weight poses a number of health risks. It increases the dangers of high blood pressure, high triglyceride levels, coronary heart disease, stroke, type 2 diabetes, osteoarthritis, sleep apnoea, and respiratory problems.</p>
<p>People are <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight#:%7E:text=For%20adults%2C%20WHO%20defines%20overweight,than%20or%20equal%20to%2030">overweight</a> if their body mass index, a measure of body fat based on height and weight, is greater than 25. </p>
<p><a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight#:%7E:text=For%20adults%2C%20WHO%20defines%20overweight,than%20or%20equal%20to%2030">Obese</a> adults have a body mass index greater than 30.</p>
<h2>Key facts</h2>
<p>Some of the significant findings were:</p>
<ul>
<li><p>69% of obese adults lived in food insecure households where families had little dietary choices and were forced to eat food with little nutritional value. </p></li>
<li><p>More than two-thirds (67.9%) of females were either overweight or obese. There were higher incidences of obesity among women than men.</p></li>
<li><p>Adults aged 35 to 64 years had a significantly greater prevalence of obesity than younger age groups. This could be explained by differences in <a href="https://faseb.onlinelibrary.wiley.com/doi/full/10.1096/fj.202101930R">metabolism</a> and the fact that youngsters are more active than adults. </p></li>
<li><p>KwaZulu-Natal reported a higher prevalence of obesity (39.4%) compared to the other provinces. More research is needed to explore this finding and whether cultural factors are behind this.</p></li>
</ul>
<p>The survey period overlapped with the tail-end of COVID-19. Focus group discussions took place in all districts where data was collected to assess the effects of the pandemic. </p>
<p>The survey found that the swift responses by government through various relief programmes significantly reduced the exposure of families to extreme poverty and food insecurity during this period.</p>
<h2>Moving forward</h2>
<p>Obesity is a global problem. A <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02750-2/fulltext">new study</a> released by the Lancet showed that, in 2022, more than 1 billion people in the world were living with obesity. </p>
<p>Worldwide, obesity among adults had more than doubled since 1990, and had quadrupled among children and adolescents (5 to 19 years of age). </p>
<p>The Human Sciences Research Council made the following recommendations to help address malnutrition in South Africa: </p>
<ul>
<li><p>focus on areas with high levels of malnutrition</p></li>
<li><p>encourage families to produce their own food to supplement social grants</p></li>
<li><p>invest in food banks at fruit and vegetable markets strategically located close to vulnerable households</p></li>
<li><p>help extremely poor households survive seasonal hunger</p></li>
<li><p>launch campaigns to educate the public on the benefits of consuming nutrient-rich foods and dietary diversity.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/research-shows-shocking-rise-in-obesity-levels-in-urban-africa-over-past-25-years-90485">Research shows shocking rise in obesity levels in urban Africa over past 25 years</a>
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</em>
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<img src="https://counter.theconversation.com/content/224286/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thokozani Simelane does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>South Africa’s national survey of food and nutrition security identifies the areas most in need.Thokozani Simelane, Professor of Practice, Human Sciences Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2255672024-03-12T23:31:26Z2024-03-12T23:31:26ZAn apple cider vinegar drink a day? New study shows it might help weight loss<figure><img src="https://images.theconversation.com/files/581225/original/file-20240312-16-pgd6kq.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5742%2C3819&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/glass-healthy-cloudy-fermented-apple-cider-1133317064">Shutterstock</a></span></figcaption></figure><p>Made from fermented apples and naturally high in acetic acid, apple cider vinegar has been popular in recent years for its <a href="https://www.healthline.com/nutrition/6-proven-health-benefits-of-apple-cider-vinegar#blood-sugar">purported health benefits</a> – from antibacterial properties to antioxidant effects and potential for helping manage blood sugars. </p>
<p>Its <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136602/">origins as a health tonic</a> stretch much further back. Hippocrates used it to treat wounds, fever and skin sores.</p>
<p>An experimental <a href="https://nutrition.bmj.com/content/early/2024/01/18/bmjnph-2023-000823">study</a>, released today, looks into whether apple cider vinegar could be effective for weight loss, reduce blood glucose levels and reduce blood lipids (cholesterol and triglycerides). </p>
<p>The results suggest it could reduce all three – but it might not be as simple as downing an apple cider vinegar drink a day.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-apple-cider-vinegar-really-a-wonder-food-86551">Is apple cider vinegar really a wonder food?</a>
</strong>
</em>
</p>
<hr>
<h2>What did they do?</h2>
<p>A group of scientists in Lebanon did a double-blinded, randomised, clinical trial in a group of overweight and obese young people aged from 12–25 years. </p>
<p>Researchers randomly placed 30 participants in one of four groups. The participants were instructed to consume either 5, 10 or 15ml of apple cider vinegar diluted into 250ml of water each morning before they ate anything for 12 weeks. A control group consumed an inactive drink (a placebo) made (from lactic acid added to water) to look and taste the same. </p>
<p>Typically this sort of study provides <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124652/#:%7E:text=Both%20systems%20place%20randomized%20controlled,less%20risk%20of%20systematic%20errors.">high quality evidence</a> as it can show cause and effect – that is the intervention (apple cider vinegar in this case) leads to a certain outcome. The study was also double-blinded, which means neither the participants or the scientists involved with collecting the data knew who was in which group.</p>
<h2>So, what did they find?</h2>
<p>After a period of three months apple cider vinegar consumption was linked with significant falls in body weight and body mass index (BMI). On average, those who drank apple cider vinegar during that period lost 6–8kg in weight and reduced their BMI by 2.7–3 points, depending on the dose. They also showed significant decreases in the waist and hip circumference.</p>
<p>The authors also report significant decreases in levels of blood glucose, triglycerides, and cholesterol in the apple cider groups. This finding echoes <a href="https://link.springer.com/article/10.1186/s12906-021-03351-w">previous studies</a>. The placebo group, who were given water with lactic acid, had much smaller decreases in weight and BMI. There were also no significant decreases in blood glucose and blood lipids. </p>
<p>From animal studies, it is thought the acetic acid in apple cider vinegar may affect the expression of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136602/">genes involved in burning fats for energy</a>. The new study did not explore whether this mechanism was involved in any weight loss.</p>
<h2>Is this good news?</h2>
<p>While the study appears promising, there are also reasons for caution. </p>
<p>Firstly, study participants were aged from 12 to 25, so we can’t say whether the results could apply to everyone.</p>
<p>The statistical methods used in the study don’t allow us to confidently say the same amount of weight loss would occur again if the study was done again.</p>
<p>And while the researchers kept records of the participants’ diet and exercise during the study, these were not published in the paper. This makes it difficult to determine if diet or exercise may have had an impact. We don’t know whether participants changed the amount they ate or the types of food they ate, or whether they changed their exercise levels. </p>
<p>The study used a placebo which they tried to make identical in appearance and taste to the active treatment. But people may still be able to determine differences. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308085/">Researchers may ask participants</a> at the end of a study to guess which group they were in to test the integrity of the placebo. Unfortunately this was not done in this study, so we can’t be certain if the participants knew or not.</p>
<p>Finally, the authors do not report whether anyone dropped out of the study. This could be important and influence results if people who did not lose weight quit due to lack of motivation.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="open glass of liquid with cloudy substance at bottom, surrounded by apples" src="https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Is that you mother? The enzymes in apple cider vinegar might be health-giving.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fresh-apples-bowl-raw-unfiltered-organic-257388970">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/turns-out-the-viral-sleepy-girl-mocktail-is-backed-by-science-should-you-try-it-222151">Turns out the viral 'Sleepy Girl Mocktail' is backed by science. Should you try it?</a>
</strong>
</em>
</p>
<hr>
<h2>Any other concerns?</h2>
<p>Apple cider vinegar is acidic and there are concerns it may erode tooth enamel. This can be a problem with any acidic beverages, including fizzy drinks, <a href="https://theconversation.com/lemon-water-wont-detox-or-energise-you-but-it-may-affect-your-body-in-other-ways-180035">lemon water</a> and orange juice.</p>
<p>To minimise the risk of <a href="https://theconversation.com/health-check-whats-eating-your-teeth-37096">acid erosion</a> some dentists recommend the following after drinking acidic drinks: </p>
<ul>
<li>rinsing out your mouth with tap water afterwards</li>
<li>chewing sugar-free gum afterwards to stimulate saliva production</li>
<li>avoiding brushing your teeth immediately after drinking because it might damage the teeth’s softened top layer</li>
<li>drink with a straw to minimise contact with the teeth.</li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman holds glass of water and has full cheeks" src="https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rinsing with water could prevent acid damaging your teeth.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-rinsing-gargling-while-using-mouthwash-644616745">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/apple-cider-vinegar-is-drinking-this-popular-home-remedy-bad-for-your-teeth-a-dentist-explains-197297">Apple cider vinegar: is drinking this popular home remedy bad for your teeth? A dentist explains</a>
</strong>
</em>
</p>
<hr>
<h2>Down the hatch?</h2>
<p>This study provides us with some evidence of a link between apple cider vinegar and weight loss. But before health professionals can recommend this as a weight loss strategy we need bigger and better conducted studies across a wider age range. </p>
<p>Such research would need to be done alongside a controlled background diet and exercise across all the participants. This would provide more robust evidence that apple cider vinegar could be a useful aid for weight loss. </p>
<p>Still, if you don’t mind the taste of apple cider vinegar then you could try drinking some for weight loss, alongside a <a href="https://www.eatforhealth.gov.au/">healthy balanced and varied dietary intake</a>. This study does not suggest people can eat whatever they like and drink apple cider vinegar as a way to control weight. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/great-time-to-try-pickling-135052">Great time to try: pickling</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/225567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.</span></em></p>Researchers gave people in the study 5, 10 or 15ml doses of apple cider vinegar and found they lost more weight than those taking a placebo. But the findings need a closer look.Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172872024-02-04T19:09:37Z2024-02-04T19:09:37ZHow much weight do you actually need to lose? It might be a lot less than you think<figure><img src="https://images.theconversation.com/files/572339/original/file-20240131-15-eetcro.jpg?ixlib=rb-1.1.0&rect=81%2C0%2C5381%2C3260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/overweight-woman-drink-water-during-morning-1079331911">Flotsam/Shutterstock</a></span></figcaption></figure><p>If you’re one of the <a href="https://www.finder.com.au/new-years-resolutions-statistics">one in three</a> Australians whose New Year’s resolution involved losing weight, it’s likely you’re now contemplating what weight-loss goal you should actually be working towards. </p>
<p>But type “setting a weight loss goal” into any online search engine and you’ll likely be left with more questions than answers.</p>
<p>Sure, the many weight-loss apps and calculators available will make setting this goal seem easy. They’ll typically use a body mass index (BMI) calculator to confirm a “healthy” weight and provide a goal weight based on this range.</p>
<p>Your screen will fill with trim-looking influencers touting diets that will help you drop ten kilos in a month, or ads for diets, pills and exercise regimens promising to help you effortlessly and rapidly lose weight. </p>
<p>Most sales pitches will suggest you need to lose substantial amounts of weight to be healthy – making weight loss seem an impossible task. But the research shows you don’t need to lose a lot of weight to achieve health benefits. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-you-be-overweight-and-healthy-182219">Can you be overweight and healthy?</a>
</strong>
</em>
</p>
<hr>
<h2>Using BMI to define our target weight is flawed</h2>
<p>We’re a society fixated on numbers. So it’s no surprise we use measurements and equations to score our weight. The most popular is BMI, a measure of our body weight-to-height ratio. </p>
<p>BMI classifies bodies as underweight, normal (healthy) weight, overweight or obese and can be a useful tool for weight and health screening. </p>
<p>But it shouldn’t be used as the single measure of what it means to be a healthy weight when we set our weight-loss goals. This is <a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">because</a> it: </p>
<ul>
<li><p>fails to consider two critical factors related to body weight and health – body fat percentage and distribution</p></li>
<li><p>does not account for significant differences in body composition based on gender, ethnicity and age.</p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1520959736476274690"}"></div></p>
<h2>How does losing weight benefit our health?</h2>
<p>Losing just 5–10% of our body weight – between 6 and 12kg for someone weighing 120kg – can significantly improve our health in four key ways.</p>
<p><strong>1. Reducing cholesterol</strong></p>
<p>Obesity increases the chances of having too much low-density lipoprotein (LDL) cholesterol – also known as bad cholesterol – because carrying excess weight changes how our bodies produce and manage lipoproteins and triglycerides, another fat molecule we use for energy.</p>
<p>Having too much bad cholesterol and high triglyceride levels is not good, narrowing our arteries and limiting blood flow, which increases the risk of heart disease, heart attack and stroke.</p>
<p>But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987606/">research</a> shows improvements in total cholesterol, LDL cholesterol and triglyceride levels are evident with just 5% weight loss.</p>
<p><strong>2. Lowering blood pressure</strong></p>
<p>Our blood pressure is considered high if it reads more than 140/90 on at least two occasions. </p>
<p>Excess weight is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">linked to</a> high blood pressure in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">several ways</a>, including changing how our sympathetic nervous system, blood vessels and hormones regulate our blood pressure.</p>
<p>Essentially, high blood pressure makes our heart and blood vessels work harder and less efficiently, damaging our arteries over time and increasing our risk of heart disease, heart attack and stroke. </p>
<figure class="align-center ">
<img alt="Older man takes his blood pressure at home" src="https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Losing weight can lower your blood pressure.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hypertension-older-age-senior-black-man-2066841269">Prostock-studio/Shutterstock</a></span>
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</figure>
<p>Like the improvements in cholesterol, a 5% weight loss <a href="https://onlinelibrary.wiley.com/doi/10.1002/oby.21358">improves</a> both systolic blood pressure (the first number in the reading) and diastolic blood pressure (the second number). </p>
<p>A <a href="https://www.ahajournals.org/doi/10.1161/01.hyp.0000094221.86888.ae">meta-analysis of 25 trials</a> on the influence of weight reduction on blood pressure also found every kilo of weight loss improved blood pressure by one point.</p>
<p><strong>3. Reducing risk for type 2 diabetes</strong></p>
<p>Excess body weight is the primary manageable risk factor for type 2 diabetes, particularly for people carrying a lot of visceral fat around the abdomen (belly fat).</p>
<p>Carrying this excess weight can cause fat cells to release pro-inflammatory chemicals that disrupt how our bodies regulate and use the insulin produced by our pancreas, leading to high blood sugar levels. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-i-actually-target-areas-to-lose-fat-like-my-belly-205203">Can I actually target areas to lose fat, like my belly?</a>
</strong>
</em>
</p>
<hr>
<p>Type 2 diabetes can lead to serious medical conditions if it’s not carefully managed, including damaging our heart, blood vessels, major organs, eyes and nervous system.</p>
<p><a href="https://www.nejm.org/doi/full/10.1056/nejmoa012512">Research</a> shows just 7% weight loss reduces risk of developing type 2 diabetes by 58%.</p>
<p><strong>4. Reducing joint pain and the risk of osteoarthritis</strong></p>
<p>Carrying excess weight can cause our joints to become inflamed and damaged, making us more prone to osteoarthritis. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/21425246/">Observational studies</a> show being overweight doubles a person’s risk of developing osteoarthritis, while obesity increases the risk fourfold.</p>
<p>Small amounts of weight loss alleviate this stress on our joints. <a href="https://pubmed.ncbi.nlm.nih.gov/15986358/">In one study</a> each kilogram of weight loss resulted in a fourfold decrease in the load exerted on the knee in each step taken during daily activities.</p>
<figure class="align-center ">
<img alt="Man on bathroom scales" src="https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Losing weight eases stress on joints.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-feet-on-scale-bathroom-1030174888">Shutterstock/Rostislav_Sedlacek</a></span>
</figcaption>
</figure>
<h2>Focus on long-term habits</h2>
<p>If you’ve ever tried to lose weight but found the kilos return almost as quickly as they left, you’re not alone.</p>
<p>An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/">analysis</a> of 29 long-term weight-loss studies found participants regained more than half of the weight lost within two years. Within five years, they regained more than 80%.</p>
<p>When we lose weight, we take our body out of its comfort zone and trigger its survival response. It then counteracts weight loss, triggering several <a href="https://pubmed.ncbi.nlm.nih.gov/25896063/">physiological responses</a> to defend our body weight and “survive” starvation. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">What's the 'weight set point', and why does it make it so hard to keep weight off?</a>
</strong>
</em>
</p>
<hr>
<p>Just as the problem is evolutionary, the solution is evolutionary too. Successfully losing weight long-term comes down to:</p>
<ul>
<li><p>losing weight in small manageable chunks you can sustain, specifically periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight </p></li>
<li><p>making gradual changes to your lifestyle to ensure you form habits that last a lifetime.</p></li>
</ul>
<p>Setting a goal to reach a healthy weight can feel daunting. But it doesn’t have to be a pre-defined weight according to a “healthy” BMI range. Losing 5–10% of our body weight will result in immediate health benefits.</p>
<p><em>At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.</em></p><img src="https://counter.theconversation.com/content/217287/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Nick Fuller works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program.</span></em></p>Weight loss can seem like an impossible, unachievable task. But you don’t need to lose a lot of weight to start noticing the health benefits.Nick Fuller, Charles Perkins Centre Research Program Leader, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2215142024-02-01T21:21:20Z2024-02-01T21:21:20ZHow dieting, weight suppression and even misuse of drugs like Ozempic can contribute to eating disorders<figure><img src="https://images.theconversation.com/files/572540/original/file-20240131-15-o0m6p8.jpg?ixlib=rb-1.1.0&rect=147%2C78%2C6271%2C4030&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Although semaglutide drugs like Ozempic are indicated to treat Type 2 diabetes, they are increasingly prescribed off-label because of their observed effectiveness at inducing weight loss.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/how-dieting-weight-suppression-and-even-misuse-of-drugs-like-ozempic-can-contribute-to-eating-disorders" width="100%" height="400"></iframe>
<p>Up to 72 per cent of women and 61 per cent of men are dissatisfied with their weight or <a href="https://doi.org/10.1016/j.eatbeh.2014.04.010">body image</a>, according to a U.S. study. Globally, millions of people <a href="https://doi.org/10.1111%2Fobr.12466">attempt to lose weight</a> every year with the hope that weight loss will have positive effects on their body image, health and quality of life. </p>
<p>However, these motivated individuals often struggle to maintain new diets or exercise regimens. The rise of medications such as semaglutides, like <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101298">Ozempic</a> or <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101765">Wegovy</a>, <a href="https://www.cbc.ca/news/health/ozempic-weight-loss-1.6772021">might be viewed as an appealing “quick fix”</a> alternative to meet weight loss goals. </p>
<p>Research led by our team and others suggests that such attempts to lose weight often do more harm than good, and even increase the risk of <a href="https://osf.io/9stq2">developing an eating disorder</a>.</p>
<h2>Weight loss and eating disorders</h2>
<p>Eating disorders are <a href="https://doi.org/10.1002/eat.20589">serious mental health conditions</a> primarily characterized by extreme patterns of under- or over-eating, concerns about one’s shape or body weight or other behaviours intended to influence body shape or weight such as exercising excessively or self-inducing vomiting. </p>
<p>Although once thought to only affect young, white adolescent girls, eating disorders do not discriminate; eating disorders can develop in people of <a href="https://doi.org/10.1002/erv.2553">any age, sex, gender or racial/ethnic background</a>, with an estimated <a href="https://nedic.ca/general-information/">one million Canadians</a> suffering from an eating disorder at any given time. Feb. 1 to 7 is <a href="https://nedic.ca/edaw/">National Eating Disorders Awareness Week</a>.</p>
<p>As a clinical psychologist and clinical psychology graduate student, our research has focused on how eating disorders develop and what keeps them going. Pertinent to society’s focus on weight-related goals, our research has examined associations between weight loss and eating disorder symptoms.</p>
<h2>Eating disorders and ‘weight suppression’</h2>
<p>In eating disorders research, the state of maintaining weight loss is referred to as “weight suppression.” Weight suppression is typically defined as the difference between a person’s current weight and their highest lifetime weight (excluding pregnancy). </p>
<p>Despite the belief that weight loss will improve body satisfaction, we found that in a sample of over 600 men and women, weight loss had no impact on women’s negative body image and was associated with increased body dissatisfaction in <a href="https://doi.org/10.1016/j.bodyim.2023.01.011">men</a>. Importantly, being more weight suppressed has been associated with the <a href="https://doi.org/10.1093/ajcn/nqaa146">onset of eating disorders</a>, including anorexia nervosa and bulimia nervosa. </p>
<p><a href="https://doi.org/10.1007/s11920-018-0955-2">One proposed explanation</a> for the relationship between weight suppression and eating disorders is that maintaining weight loss becomes increasingly difficult as body systems that <a href="https://doi.org/10.3945/ajcn.110.010025">reduce metabolic rate and energy expenditure, and increase appetite</a>, are activated to promote weight gain.</p>
<p>There is growing awareness that <a href="https://doi.org/10.1136/bmj.g2646">weight regain is highly likely following conventional diet programs</a>. This might lead people to engage in more and more extreme behaviours to control their weight, or they might shift between extreme restriction of food intake and episodes of overeating or binge eating, the characteristic symptoms of bulimia nervosa.</p>
<h2>Ozempic and other semaglutide drugs</h2>
<p>Semaglutide drugs like Ozempic and Wegovy are part of a class of drug called <a href="https://pdf.hres.ca/dpd_pm/00067924.PDF">glucagon-like peptide-1 agonists (GLP-1As)</a>. These drugs work by mimicking the hormone GLP-1 to interact with neural pathways that signal satiety (fullness) and slow stomach emptying, leading to reduced food intake. </p>
<figure class="align-center ">
<img alt="A white plate with a weight scale in it, with knife and fork, against an orange background" src="https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Popular weight-loss methods, whether they involve pills or ‘crash diets,’ often mimic symptoms of eating disorders.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Although GLP-1As are indicated to treat Type 2 diabetes, <a href="https://www.cbc.ca/news/canada/london/ozempic-off-label-1.6884141">they are increasingly prescribed off-label</a> or being <a href="https://www.bbc.com/news/health-67414203">illegally purchased</a> without a prescription because of their observed effectiveness at inducing weight loss. Although medications like Ozempic do often lead to weight loss, the rate of weight loss may <a href="https://doi.org/10.1001/jama.2021.3224">slow down or stop over time</a>.</p>
<p>Research by Lindsay Bodell, one of the authors of this story, and her colleagues on weight suppression may help explain why effects of semaglutides diminish over time, as <a href="https://doi.org/10.1016/j.physbeh.2019.112565">weight suppression is associated with reduced GLP-1 response</a>. This means those suppressing their weight could become less responsive to the satiety signals activated by GLP-1As. </p>
<p>Additionally, weight loss effects are only seen for as long as the medication is taken, meaning those who take these drugs to achieve some weight loss goal are <a href="https://doi.org/10.1111/dom.14725">likely to regain most, if not all, weight lost</a> when they stop taking the medication.</p>
<h2>Risks of dieting and weight-loss drugs</h2>
<p>The growing market for off-label weight loss drugs is concerning, because of the exacerbation of <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">weight stigma</a> and the serious <a href="https://doi.org/10.1016/j.jand.2022.01.004">health risks</a> associated with unsupervised weight loss, including developing eating disorders. </p>
<p>Researchers and health professionals are already raising the alarm about the use of GLP-1As in children and adolescents, due to concerns about their possible <a href="https://doi.org/10.1017/cts.2023.612">impact on growth and development</a>.</p>
<p>Moreover, popular weight-loss methods, whether they involve pills or “crash diets,” often mimic symptoms of eating disorders. For example, intermittent fasting diets that involve long periods of fasting followed by short periods of food consumption may mimic and <a href="https://doi.org/10.1016/j.eatbeh.2022.101681">increase the risk of developing binge eating problems</a>. </p>
<p>The use of diet pills or laxatives to lose weight has been found to increase the risk of <a href="https://doi.org/10.2105/AJPH.2019.305390">being diagnosed with an eating disorder in the next one to three years</a>. Drugs like Ozempic may also be <a href="https://doi.org/10.1002/eat.24109">misused by individuals already struggling with an eating disorder</a> to suppress their appetite, compensate for binge eating episodes or manage fear of weight gain. </p>
<p>Individuals who are already showing signs of an eating disorder, such as limiting their food intake and intense concerns about their weight, may be most at risk of spiralling from a weight loss diet or medication into an eating disorder, <a href="https://doi.org/10.1002/eat.24116">even if they only lose a moderate amount of weight</a>.</p>
<p>People who are dissatisfied with their weight or have made multiple attempts to lose weight often feel pressured to try increasingly drastic methods. However, any diet, exercise program or weight-loss medication promising a quick fix for weight loss should be treated with extreme caution. At best, you may gain the weight back; at worst, you put yourself at risk for much more serious eating disorders and other health problems.</p><img src="https://counter.theconversation.com/content/221514/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samantha Withnell receives funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Lindsay Bodell receives (or has previously received) funding from the Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Brain Canada Foundation, and Banting Research Foundation. </span></em></p>The demand for off-label weight loss drugs like Ozempic is concerning, because of the impact on weight stigma and the health risks of unsupervised weight loss, including developing eating disorders.Samantha Withnell, PhD Candidate, Clinical Psychology, Western UniversityLindsay Bodell, Assistant Professor of Psychology, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2077102023-12-07T13:27:48Z2023-12-07T13:27:48ZWhat does weight-inclusive health care mean? A dietitian explains what some providers are doing to end weight stigma<figure><img src="https://images.theconversation.com/files/563736/original/file-20231205-19-fz1zo3.jpg?ixlib=rb-1.1.0&rect=25%2C37%2C8326%2C4632&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People living in larger bodies face constant discrimination and negative messages about their body weight.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/overweight-people-royalty-free-illustration/1454557526?adppopup=true">smartboy10/DigitalVision Vectors via Getty Images</a></span></figcaption></figure><p>Weight-inclusive health care means a focus on <a href="https://doi.org/10.1002/ncp.10885">better health with no weight loss required</a>. </p>
<p>This includes practices such as eating for overall well-being rather than for the number of calories. It may also include prioritizing activities to reduce stress, avoiding smoking, drinking less alcohol and striving to be physically active in enjoyable ways.</p>
<p>A weight-inclusive approach to health seeks to undo the harms caused by weight stigma.</p>
<p>People with larger bodies often experience <a href="https://www.health.harvard.edu/blog/weight-stigma-as-harmful-as-obesity-itself-202206022755">weight stigma</a> as discrimination, prejudice, negative stereotypes and judgments from others – including their own doctors and other health care providers. More than 40% of U.S. adults across a range of body sizes report <a href="https://doi.org/10.1038%2Fs41366-021-00814-5">experiencing weight stigma</a> in their day-to-day lives. </p>
<p>Avoiding this stigma is likely a major driver behind the great lengths people in the U.S. go to in order to lose weight. Market data shows that Americans spent some <a href="https://www.researchandmarkets.com/reports/5556414/the-u-s-weight-loss-market-2022-status-report">US$72.6 billion</a> on weight loss products and programs in 2021. In addition, weight loss efforts start early, with nearly half of all high school students in the U.S. reporting that they <a href="https://www.cdc.gov/mmwr/volumes/67/ss/ss6708a1.htm?s_cid=ss6708a1_w">have tried to lose weight</a>.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=ARa5g-oAAAAJ&hl=en">nutrition epidemiologist</a> and <a href="https://faculty.txst.edu/profile/2327984">registered dietitian</a> studying the consequences of weight stigma and working to develop weight-inclusive nutrition interventions. </p>
<p>Initially my private practice and research approach were <a href="https://doi.org/10.1177/2158244018772888">weight-centered</a>. A weight-centered approach focuses on weight loss to achieve health and is widely accepted in health care settings across the world. After over a decade of work in public health nutrition, I have witnessed how, in my view, the weight-centered approach harms individuals and communities. So I have shifted to using a <a href="https://doi.org/10.1002/ncp.10885">weight-inclusive approach</a> in practice and research.</p>
<h2>Overturning the ‘lower weight equals better health’ dogma</h2>
<p>There is an extensive body of research and <a href="https://doi.org/10.1093/heapro/daaa018">public health messaging</a> indicating that <a href="https://www.who.int/health-topics/obesity#tab=tab_1">higher body weight has links</a> with <a href="https://theconversation.com/obesity-in-children-is-rising-dramatically-and-it-comes-with-major-and-sometimes-lifelong-health-consequences-202595">many long-term health concerns</a>, such as high blood pressure and Type 2 diabetes. </p>
<p>As a result, there is a pervasive misconception that a weight-inclusive approach disregards the patient’s health concerns. However, proponents of weight-inclusive care argue that a weight-inclusive approach <a href="http://dx.doi.org/10.1155/2014/983495">minimizes health problems</a> by destigmatizing weight status and promoting health equity. They also acknowledge that there are links between <a href="http://dx.doi.org/10.1155/2014/983495">both higher and lower body weight</a> and various health concerns. </p>
<p>The dogma that lower weight is synonymous with better health is being questioned by public health researchers and health care providers. Scientists and clinicians are calling for a <a href="https://experts.nau.edu/en/publications/the-consequences-of-a-weight-centric-approach-to-healthcare-a-cas">paradigm shift</a> away from a <a href="https://theconversation.com/bmi-alone-will-no-longer-be-treated-as-the-go-to-measure-for-weight-management-an-obesity-medicine-physician-explains-the-seismic-shift-taking-place-208174">weight-centered focus on weight status and body mass index, or BMI</a>, as indicators of health. </p>
<p>Advocacy groups like the Association for Size Diversity and Health have long been promoting the <a href="https://asdah.org/health-at-every-size-haes-approach/">Health at Every Size</a> approach. This weight-inclusive approach affirms a socially just definition of health and advocates for equitable health care regardless of weight status. More recently, the American Medical Association released a statement outlining the <a href="https://www.ama-assn.org/delivering-care/public-health/ama-use-bmi-alone-imperfect-clinical-measure">harms and shortcomings of using BMI</a> as a clinical measurement.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/v4OPDjI0Uf4?wmode=transparent&start=2" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The effects of weight stigma include chronic stress, depression, social isolation, low self-esteem and higher blood pressure.</span></figcaption>
</figure>
<h2>The evidence supporting weight-inclusive care</h2>
<p>Substantial research shows that behaviors such as stopping smoking and drinking less alcohol can prevent disease and <a href="https://doi.org/10.1111/sipr.12062">support overall long-term health, regardless of body weight</a>. For example, a systematic review of one clinical trial and 152 observational peer-reviewed studies reported that a <a href="https://doi.org/10.1001/jamanetworkopen.2021.22277">diet high in nutrient-rich foods</a> with low or moderate alcohol consumption is associated with reduced risk of death for everyone.</p>
<p>Another example: One of my own clients with high cholesterol said that focusing on weight loss over their lifetime had left them stuck in a cycle of weight loss and weight regain, disordered eating, inconsistent and extreme exercise habits and body image concerns. After adopting weight-inclusive practices such as eating more fiber-rich foods and being more physically active, instead of focusing on losing weight, their cholesterol levels returned to normal. </p>
<p>Both the weight-inclusive approach and the weight-centered approach can include diet changes, increasing physical activity and reducing stress as key components to manage and prevent diseases. However, the weight-inclusive approach works to end weight stigma and acknowledges that factors such as socioeconomic status, culture and <a href="https://theconversation.com/fixing-the-global-childhood-obesity-epidemic-begins-with-making-healthy-choices-the-easier-choices-and-that-requires-new-laws-and-policies-207975">access to food and health care</a> – collectively called the <a href="https://health.gov/healthypeople/priority-areas/social-determinants-health">social determinants of health</a> – have huge impacts on a person’s body weight, shape and size. Even if a person could adhere to strict dieting and exercise routines, there will always be <a href="https://doi.org/10.1155%2F2016%2F3753650">structural, political and other factors</a> affecting health and weight that the individual can’t control.</p>
<p>What’s more, evidence indicates that people who lose weight generally don’t have better long-term health and <a href="https://theconversation.com/bmi-alone-will-no-longer-be-treated-as-the-go-to-measure-for-weight-management-an-obesity-medicine-physician-explains-the-seismic-shift-taking-place-208174">fail to keep those pounds off</a>. </p>
<h2>Finding weight-inclusive health care</h2>
<p>There are several things that people can look for in a <a href="https://doi.org/10.1002/ncp.10885">weight-inclusive health care practice</a>.</p>
<p>Look for health care providers who:</p>
<ul>
<li>Make weight checks optional for routine visits.</li>
<li>Treat patient symptoms rather than telling them to lose weight.</li>
<li>Provide patients in larger bodies the same treatment as those in thinner bodies with similar health concerns.</li>
<li>Use measures other than BMI, such as lab results, to diagnose health concerns.</li>
<li>Ask permission before discussing weight with patients.</li>
</ul>
<p>For additional resources on weight-inclusive care, check out the <a href="https://haeshealthsheets.com/">Health at Every Size Health Sheets</a>. Consider examining your own weight bias by taking an online test focused on <a href="https://implicit.harvard.edu/implicit/">implicit associations around weight</a>.</p><img src="https://counter.theconversation.com/content/207710/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Butler receives funding from the American Society for Nutrition Foundation and the National Pork Board. Lauren Butler is owner of Combined Nutrition Solutions, LLC. in Atlantic Beach, FL and currently leads the Food Freedom Research Team at Texas State University. </span></em></p>Research shows that focusing strictly on weight loss is not only ineffective in the long term, it can even be harmful and counterproductive.Lauren Butler, Assistant Professor of Nutrition, Texas State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2134462023-09-20T21:28:41Z2023-09-20T21:28:41ZObesity is a dangerous disease that shares key features with cancer<figure><img src="https://images.theconversation.com/files/549385/original/file-20230920-19-5q8kcd.jpg?ixlib=rb-1.1.0&rect=3851%2C14%2C5663%2C4180&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Obesity is itself a disease, in addition to contributing to the onset and progression of other conditions such as diabetes, heart attack and stroke.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/obesity-is-a-dangerous-disease-that-shares-key-features-with-cancer" width="100%" height="400"></iframe>
<p>Although obesity has been <a href="https://doi.org/10.1038/ijo.2008.247">recognized as a disease by the World Health Organization (WHO)</a> since 1948, its identity as a disease may not be widely perceived the same way as other health conditions. </p>
<p>People living with obesity are less <a href="https://doi.org/10.1007/s13679-021-00444-y">likely to receive dedicated care for that condition</a>, in contrast to patients with other diseases, such as cancer. However, obesity and cancer have several similarities. This is of <a href="https://www.worldobesityday.org/">global crucial importance</a>, given the dramatic increase in numbers of affected adults and children, <a href="https://data.worldobesity.org/country/canada-36/">including in Canada</a>.</p>
<h2>Obesity is a disease</h2>
<p>Like cancer, or other medically recognized diseases, obesity should be seriously considered as such by public opinion. Not only is obesity itself a disease, but it can also contribute to the onset and progression of <a href="https://doi.org/10.1177/2042018820934955">cancer and other diseases</a>, such as <a href="https://doi.org/10.1155/2018/3407306">diabetes, atherosclerosis, heart attack and stroke</a>.</p>
<p>The disease of obesity affects people in several ways:</p>
<p><strong>Mechanically:</strong> Obesity imposes an excessive <a href="https://www.health.harvard.edu/pain/why-weight-matters-when-it-comes-to-joint-pain">pressure on the bones and the joints</a>, as well as internal organs. It can also <a href="https://www.sleepfoundation.org/sleep-apnea/weight-loss-and-sleep-apnea">potentially cause airway obstruction</a> that can lead to obstructive sleep apnea.</p>
<p><strong>Biologically:</strong> <a href="https://doi.org/10.3389/fimmu.2022.907750">Obesity can lead to osteoarthritis</a>, for example, and it presents with <a href="https://doi.org/10.1172/JCI92035">inflammation</a> and <a href="https://doi.org/10.3390/ijms21103570">dysregulated secretions</a> by dysfunctional fat tissue cells. </p>
<p>Obesity can also result in <a href="https://doi.org/10.1172/JCI81507%22%22">abnormal fat deposits on vital organs</a>, which seriously alters the whole organism’s <a href="https://www.britannica.com/science/homeostasis">homeostasis</a>, or biological stability.</p>
<p><strong>Psychologically:</strong> <a href="https://doi.org/10.1111/scs.12756">Patients with obesity may face difficulties in accomplishing daily activities</a>; even simple things such as tying their shoelaces may be a challenge. This is further worsened by <a href="https://doi.org/10.1016/j.eclinm.2022.101464">social media’s deep influence</a> and promotion of a presumed “ideal” unrealistic body shape image, which stigmatizes patients with obesity. </p>
<p>There is also evidence that obesity is accompanied by <a href="https://doi.org/10.1007/s12272-019-01138-9">brain inflammation</a> and increased risk of mental health conditions such as major <a href="https://doi.org/10.1038/s41380-018-0017-5">depressive disorder</a> and <a href="https://doi.org/10.1007/s40211-019-0302-9">anxiety</a>.</p>
<h2>Common characteristics of obesity and cancer</h2>
<figure class="align-center ">
<img alt="Illustration with two human figures representing cancer and obesity flanking a list of common factors: Metastatic, Recurrent, Progressive and Multifactorial" src="https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=503&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=503&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=503&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=633&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=633&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=633&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">As a disease, obesity shares many common features with cancer.</span>
<span class="attribution"><span class="source">(Besma Boubertakh, using Biorender.com and Mindthegraph.com)</span></span>
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<p>Obesity shares several major features with cancer:</p>
<p><strong>Multifactorial grounds:</strong> Both diseases present no single known cause, which can make prevention and treatment challenging. </p>
<p>Obesity is not simply due to individual lifestyles of high-calorie consumption or low levels of physical exercise, since the balance between energy intake and expenditure can be tipped in either direction by <a href="https://doi.org/10.1007/s00261-012-9862-x">genetics, the environment as well as other factors that are not completely understood</a>.</p>
<p><strong>Metastasis:</strong> <a href="https://doi.org/10.3390/cells11121872">Like cancer, obesity can involve metastases</a>, meaning that the disease can spread to other parts of the body. </p>
<p>In the case of obesity, this takes the form of ectopic fat deposits, which occur when adipose (fat) tissue cannot store all of the excess <a href="https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/in-depth/triglycerides/art-20048186">triglycerides</a>, a type of lipid, or fat. Triglycerides then accumulate beyond their normal locations, including around organs. In obesity, fat can be deposited on the heart, the liver, in blood vessels and <a href="https://doi.org/10.1113/jphysiol.2012.239491">even the brain</a>. These deposits can alter vital organ function and have devastating effects on an individual’s health.</p>
<p><strong>Progressive development and stages:</strong> <a href="https://doi.org/10.1155/2015/619734">Obesity</a>, like <a href="https://doi.org/10.1038/s41568-020-00300-6">cancer,</a> can develop progressively to reach advanced harmful stages. One of the reasons why people may consider obesity as a less serious illness than cancer is that they may pay more attention to the stages of cancer. </p>
<p>In fact, both obesity and cancer might advance progressively in the absence of proper diagnosis and intervention. However, deaths that originate in obesity are most often attributed to potential consequent diseases (such as cardiovascular ischemic events or even cancer) and neglect the pivotal impact of obesity.</p>
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<img alt="A red yo-yo with a measuring tape instead of a string" src="https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549432/original/file-20230920-29-30f3tt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Many people with obesity struggle to control weight regain following weight loss, a phenomenon often called ‘yo-yo’ effect. However, recurrence is a better term that should replace yo-yo, since it more seriously emphasizes that obesity is far from a game.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p><strong>Recurrence:</strong> Those who recover from obesity can experience recurrence of the disease. A good example is seen in <em>The Biggest Loser</em> TV series. <a href="https://www.health.harvard.edu/diet-and-weight-loss/lessons-from-the-biggest-loser">Contestants who lost weight</a> on the show <a href="https://doi.org/10.1002/oby.21538">later regained it</a>.</p>
<p>Obesity recurrence is often referred to as “yo-yo” effect. However, “recurrence” is a better term that should replace yo-yo, since it more seriously emphasizes that obesity is far from a game. In fact, certain patients struggle deeply to curb uncontrollable weight regain.</p>
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Read more:
<a href="https://theconversation.com/the-obesity-epidemic-is-fuelled-by-biology-not-lack-of-willpower-209121">The obesity epidemic is fuelled by biology, not lack of willpower</a>
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<p>As illustrated by the tale of the Emperor’s New Clothes, people’s perceptions can be erroneous. Often, perceptions of obesity do not reflect its serious threats to health. Obesity is scientifically proven to be a disease, and internationally recognized as one. The mirroring of its features with cancer reveals its inherent morbid potential.</p>
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<img alt="Illustration of a tailor, and a king in his underwear looking in a mirror" src="https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549437/original/file-20230920-25-zab88z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">We need to heed the lesson from the tale of the Emperor’s New Clothes, and recognize the reality of things: obesity is not simply a discomfort but a real disease.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Obesity is a disease because it can cause deterioration of several aspects of health. <a href="https://www.who.int/about/governance/constitution">WHO defines health</a> as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity.” </p>
<p>Even though obesity shares numerous morbidity characteristics with cancer, it does not get the same society-wide recognition as a disease, and people with obesity may be less likely to get the help and treatment they need. There is an urgent need to reshape the way obesity is viewed.</p><img src="https://counter.theconversation.com/content/213446/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors receive funding from the Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health (CERC-MEND; Chairholder Prof. Vincenzo Di Marzo).</span></em></p><p class="fine-print"><em><span>Cristoforo Silvestri receives funding from the Canada First Research Excellence Fund through Sentinelle Nord of Université Laval.</span></em></p>Obesity is a disease that shares several characteristics with cancer, but does not get the same society-wide recognition of its disease status, so people with obesity are less likely to get treatment.Besma Boubertakh, Doctoral student, molecular medicine, Université LavalCristoforo Silvestri, Assistant Professor, Faculty of Medicine, Université LavalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2111902023-09-11T02:20:22Z2023-09-11T02:20:22ZThe body mass index can’t tell us if we’re healthy. Here’s what we should use instead<p>We’ve known for some time the <a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">body mass index (BMI) is an inaccurate measuring stick</a> for assessing someone’s weight and associated health. But it continues to be the go-to tool for medical doctors, population researchers and personal trainers.</p>
<p>Why is such an imperfect tool still being used, and what should we use instead?</p>
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Read more:
<a href="https://theconversation.com/is-bmi-a-good-way-to-tell-if-my-weight-is-healthy-we-asked-five-experts-96985">Is BMI a good way to tell if my weight is healthy? We asked five experts</a>
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<h2>First, what is BMI?</h2>
<p>BMI is an internationally recognised screening method for sorting people into one of four weight categories: underweight (BMI less than 18.5), normal weight (18.5 to 24.9), overweight (25.0 to 29.9) or obese (30 or greater).</p>
<p>It’s a value <a href="https://www.cdc.gov/healthyweight/assessing/bmi/index.html">calculated</a> by a measure of someone’s mass (weight) divided by the square of their height.</p>
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Read more:
<a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">Using BMI to measure your health is nonsense. Here's why</a>
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<h2>Who invented BMI?</h2>
<p>Belgian mathematician <a href="https://www.britannica.com/biography/Adolphe-Quetelet">Lambert Adolphe Jacques Quetelet</a> (1796-1874) devised the BMI in 1832, as a mathematical model to chart the average Western European man’s <a href="https://pubmed.ncbi.nlm.nih.gov/17890752/">physical characteristics</a>.</p>
<p>It was initially called the <a href="https://www.msdmanuals.com/en-au/professional/multimedia/clinical-calculator/body-mass-index-quetelets-index">Quetelet Index</a> and was never meant to be used as a medical assessment tool. The Quetelex Index was renamed the “body mass index” in 1972.</p>
<h2>What’s wrong with the BMI?</h2>
<p>Using a mathematical formula to give a full picture of someone’s health is just not possible.</p>
<p>The BMI <a href="https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html">does not measure excess body fat</a>, it just measures “excess” weight. It does not distinguish between excess body fat or bone mass or musculature, and does not interpret the distribution of fat (which <em>is</em> a <a href="https://www.health.harvard.edu/staying-healthy/abdominal-fat-and-what-to-do-about-it">predictor</a> of health, including type 2 diabetes, metabolic disorders, and heart disease).</p>
<p>It also cannot tell the difference between social variables such as sex, age, and ethnicity. Given Quetelet’s formula used only Western European men, the findings are not appropriate for many other groups, including non-European ethnicities, post-menopausal women and pregnant women.</p>
<p>The medical profession’s <a href="https://pubmed.ncbi.nlm.nih.gov/37432007/">overreliance on BMI</a> may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930234/">harming patients’ health</a> as it ignores much of what makes us healthy and focuses only on mass.</p>
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Read more:
<a href="https://theconversation.com/renaming-obesity-wont-fix-weight-stigma-overnight-heres-what-we-really-need-to-do-209224">Renaming obesity won't fix weight stigma overnight. Here's what we really need to do</a>
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<h2>What should we use instead?</h2>
<p>Rather than seeing BMI as the primary diagnostic test for determining a person’s health, it should be used in conjunction with other measures and considerations.</p>
<p>Since researchers know belly fat around our vital organs carries the most <a href="https://www.bmj.com/content/370/bmj.m3324">health risk</a>, <a href="https://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/how-to-measure-body-fatness/">waist circumference</a>, waist-to-hip ratio or waist-to-height ratio offer more accurate measurements of health.</p>
<p><strong>Waist circumference</strong>: is an effective measure of fat distribution, particularly for athletes who carry less fat and more muscle. It’s most useful as a predictor of health when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027970/">combined with the BMI</a>. Waist circumference should be less than 94cm for men and 80cm for women for <a href="https://www.heartfoundation.org.au/bundles/your-heart/waist-measurement">optimal health</a>, as measured from halfway between the bottom of your ribs and your hip bones.</p>
<p><strong>Waist-to-hip ratio</strong>: calculates the proportion of your body fat and how much is stored on your waist, hips, and buttocks. It’s the waist measurement divided by hip measurement and according to the World Health Organisation it should be <a href="https://apps.who.int/iris/bitstream/handle/10665/44583/9789241501491_eng.pdf;jsessionid=A119D165CFFF5E7B5BDBD51D9DD25684?sequence=1">0.85 or less for women, and 0.9 or less in men</a> to reduce health risks. It’s especially beneficial in predicting health outcomes in <a href="https://link.springer.com/article/10.1007/s40200-021-00882-4">older people</a>, as the ageing process alters the body proportions on which BMI is founded. This is because fat mass increases and muscle mass decreases with age.</p>
<p><strong>Waist-to-height ratio</strong>: is height divided by waist circumference, and it’s <a href="https://www.nice.org.uk/news/article/keep-the-size-of-your-waist-to-less-than-half-of-your-height-updated-nice-draft-guideline-recommends">recommended</a> a person’s waist circumference be kept at less than half their height. Some studies have found this measure is <a href="https://bmjopen.bmj.com/content/6/3/e010159">most strongly correlated</a> with health predictions.</p>
<p>Body composition and body fat percentage can also be calculated through <a href="https://www.youtube.com/watch?v=a1A9m0wO17g">skinfold measurement tests</a>, by assessing specific locations on the body (such as the abdomen, triceps or quadriceps) with skin callipers.</p>
<p>Additional ways to gauge your heart health include asking your doctor to monitor your cholesterol and blood pressure. These more formal tests can be combined with a review of lifestyle, diet, physical activity, and family medical history. </p>
<h2>What makes us healthy apart from weight?</h2>
<p>A diet including whole grains, low fat protein sources such as fish and <a href="https://en.wikipedia.org/wiki/Legume">legumes</a>, eggs, yoghurt, cheese, milk, nuts, seeds, and plenty of fresh fruit and vegetables <a href="https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-healthy-diet/art-20047702">reduces our risk</a> of heart and vessel disease.</p>
<p>Limiting <a href="https://www.foodstandards.gov.au/consumer/generalissues/Pages/processed-foods.aspx">processed food</a> and sugary snacks, as well as <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/healthy+living/healthy+eating/healthy+eating+tips/eat+less+saturated+and+trans+fats">saturated and trans fats</a> can help us with weight management and ward off diet-related illnesses.</p>
<p>Being physically active most days of the week improves general health. This <a href="https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians">includes</a> two sessions of strength training per week, and 2.5 to five hours of moderate cardio activity or 1.25 to 2.5 hours of vigorous cardio activity.</p>
<p>Weight is just one aspect of health, and there are much better measurements than BMI.</p><img src="https://counter.theconversation.com/content/211190/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachael Jefferson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The BMI does not distinguish between excess body fat, bone mass or musculature. It also does not interpret the distribution of fat, which is a predictor of health.Rachael Jefferson, Lecturer in Human Movement Studies (Health and PE) and Creative Arts, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2107092023-08-01T20:14:54Z2023-08-01T20:14:54ZWhen Christmas comes so do the kilos. New research tracks Australians’ yo-yo weight gain<figure><img src="https://images.theconversation.com/files/540344/original/file-20230801-17-eiwjzq.jpg?ixlib=rb-1.1.0&rect=26%2C0%2C5964%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-bare-feet-weight-scale-bathroom-785794792">Shutterstock</a></span></figcaption></figure><p>As we revel in much-cherished festive occasions and weekly get-togethers, Australians are unwittingly bearing an increasingly heavy cost – an expanding waistline. </p>
<p>Our new <a href="https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2807660">study</a> offers a new perspective on this. We asked 375 adults aged 18 to 65 years to wear a fitness tracker and weigh themselves, preferably daily but at least weekly. The research, published in JAMA Open Network, uncovers the subtle yet significant weight gain patterns of everyday Australians. </p>
<p>When we compare this new research with patterns from the northern hemisphere, it suggests it’s holidays and festive occasions – not just cooler weather – that drives weight gain. Australians show a yo-yo pattern of weight fluctuation that’s associated with poor weight control and poorer health overall. </p>
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Read more:
<a href="https://theconversation.com/the-last-5-kilos-really-are-the-hardest-to-lose-heres-why-and-what-you-can-do-about-it-195725">The last 5 kilos really are the hardest to lose. Here’s why, and what you can do about it</a>
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<h2>A global concern</h2>
<p>Obesity is a major health concern worldwide. In Australia, an alarming <a href="https://www.aihw.gov.au/getmedia/f8618e51-c1c4-4dfb-85e0-54ea19500c91/20700.pdf.aspx?inline=true">two-thirds of adults are now overweight or obese</a>. On a global stage, we have some of the highest rates of excess weight and obesity – with OECD data ranking us 8th highest out of the 41 OECD countries based on the most recent <a href="https://www.oecd-ilibrary.org/social-issues-migration-health/overweight-or-obese-population/indicator/english_86583552-en">data</a>. </p>
<p>People who are overweight or have obesity are at <a href="https://pubmed.ncbi.nlm.nih.gov/28489290/">an increased risk</a> of preventable chronic diseases such as heart disease, type 2 diabetes, certain cancers and depression and anxiety. </p>
<p>Recognising and understanding the factors that contribute to weight gain are the crucial first steps towards developing effective interventions. To explore this complex issue, we embarked on an in-depth exploration of how the weight of Australian adults fluctuates over a year. What we found was intriguing when compared to overseas studies.</p>
<h2>Happy holidays and weighty weekends</h2>
<p>Firstly, we noted a prominent weight gain during festive periods. Easter, a time of chocolate eggs and hot cross buns, saw a an average gain of about 244g (0.29% of average participant body weight). The Australian summer months associated with Christmas and New Year, feasts and festivities, had an even larger average increase of approximately 546g (0.65% of average participant body weight). </p>
<p>We also found a weekly cycle, with weight peaking on the weekend, when many people are likely letting their hair down after a busy work week and may be drinking and eating more. </p>
<p>While our study used total body weight, measured using scales, there are other options for tracking body composition. These include waist circumference, skin fold or bioelectric impedence. But these require differing levels of expertise to use. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/540346/original/file-20230801-234597-n1srym.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="man measures own waist with tape measure" src="https://images.theconversation.com/files/540346/original/file-20230801-234597-n1srym.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540346/original/file-20230801-234597-n1srym.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540346/original/file-20230801-234597-n1srym.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540346/original/file-20230801-234597-n1srym.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540346/original/file-20230801-234597-n1srym.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540346/original/file-20230801-234597-n1srym.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540346/original/file-20230801-234597-n1srym.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Learning more about what time of year we gain weight can help target health messages.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-overweight-man-measuring-waist-205314403">Shutterstock</a></span>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-indulged-over-the-holidays-if-im-healthy-the-rest-of-the-time-does-it-matter-195643">I've indulged over the holidays. If I'm healthy the rest of the time, does it matter?</a>
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<h2>How our weight pattern yo-yos</h2>
<p>Seasonal variations were the most striking. </p>
<p>Unlike our counterparts in <a href="https://pubmed.ncbi.nlm.nih.gov/32353079/">Europe</a> and the <a href="https://pubmed.ncbi.nlm.nih.gov/16340952/">United States</a>, who typically gain weight in winter and lose it in summer, Australians follow a more complex cycle. </p>
<p>Our study, the first to look at to examine changes in weight across a full calendar year in any southern hemisphere country, found Australians are heaviest in summer and lightest in autumn. Weight progressively increases in winter and early spring, only to dip at the end of spring. This pattern, akin to a yo-yo, diverges from the trends observed in the northern hemisphere, where winter overlaps with the common festive periods.</p>
<p>Frequent and significant weight cycling is problematic. It’s not just about the numbers on the scale; it’s the associated health risks that are concerning. Weight cycling, like “yo-yo dieting”, is linked to <a href="https://pubmed.ncbi.nlm.nih.gov/25614199/">poor metabolic health</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/27773644/">long-term weight gain</a>. </p>
<p>Small weight increases can add up each year. Those gains increase the risk of preventable chronic illness. In our study, approximately a quarter of participants finished the year 2% or more heavier than when they started – an average increase of 1.7kg.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1643497445069041664"}"></div></p>
<h2>A fresh opportunity</h2>
<p>Mapping these “temporal hot spots” presents a unique opportunity to develop more targeted and effective interventions. The periods of weight gain identified in our study (weekends, festive periods and specific seasons) provide key points on the calendar where we could try to curb unhealthy weight fluctuations.</p>
<p>How do we use this information? A great first step would be to concentrate public health campaigns and personal weight management strategies on specific times of year.</p>
<p>Awareness campaigns before and during Christmas and winter could highlight the risks of obesity and provide tips for maintaining a balanced diet, moderate drinking, and staying active amid the festivities. Encouraging regular physical activity during colder months could also help offset seasonal weight gain.</p>
<p>Ultimately, messaging should focus on encouraging sustainable habits like healthy eating, regular exercise, and holistic wellbeing, rather than suggest drastic, short-term fixes. Our study offers an additional tool for creating weight-gain prevention strategies. </p>
<p>As we learn more about the social, cultural and behavioural influences on weight gain, we can tailor our interventions to be more effective.</p>
<p>It’s clear that our love for celebrations comes at a cost. But, armed with new insight, we can still enjoy these beloved traditions while also keeping our health in check. After all, good health is a gift in itself. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/exercise-is-even-more-effective-than-counselling-or-medication-for-depression-but-how-much-do-you-need-200717">Exercise is even more effective than counselling or medication for depression. But how much do you need?</a>
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<img src="https://counter.theconversation.com/content/210709/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carol Maher receives funding from the Medical Research Future Fund, the National Health and Medical Research Council, the National Heart Foundation, the SA Department for Education, the SA Department for Innovation and Skills, the SA Office for the Early Years, Healthway, Hunter New England Local Health District, the Central Adelaide Local Health Network, LeapForward and EML.</span></em></p><p class="fine-print"><em><span>Ty Ferguson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Researchers asked more than 350 adults to weigh themselves daily or weekly. They found a yo-yo pattern of weight gain over festive periods and cooler months.Ty Ferguson, Research Associate, University of South AustraliaCarol Maher, Professor, Medical Research Future Fund Emerging Leader, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2091212023-07-23T12:37:43Z2023-07-23T12:37:43ZThe obesity epidemic is fuelled by biology, not lack of willpower<figure><img src="https://images.theconversation.com/files/538592/original/file-20230720-27-qvsftl.jpg?ixlib=rb-1.1.0&rect=222%2C138%2C4711%2C3107&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For many people, trying to lose excess fat is very difficult without help. Effective treatment is available when obesity affects health.
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/the-obesity-epidemic-is-fuelled-by-biology-not-lack-of-willpower" width="100%" height="400"></iframe>
<p>Since the time a human first used a tool to make life easier, increased weight has been inevitable.</p>
<p>From that day the amazing and rapid progress of human achievement has been on a parallel trajectory with the growing availability of calories and the health and social consequences — initially positive — that have come with it.</p>
<p>Through most of human history, <a href="https://doi.org/10.1146%2Fannurev-nutr-080508-141048">our species has had to cope with food scarcity</a>. Scrounging enough calories to stay alive was a struggle, and our ability to compete and survive sometimes meant enduring long breaks between scarce meals.</p>
<p>When food was abundant, our bodies stored excess energy in the form of fat to draw upon when food was not available.</p>
<h2>Ancient metabolism in a modern world</h2>
<p>Human ingenuity allowed our predecessors to harness fire, create weapons for hunting and invent farming. Our brains enabled our species to develop an easier, more comfortable life and a steady supply of food to support population growth.</p>
<p>As human progress continued, our ancestors learned to domesticate and use animals. Later, they invented machines to move ourselves and our belongings from place to place, and life became even easier.</p>
<figure class="align-center ">
<img alt="evolution silhouettes beginning with an ape, morphing into humans carrying fire or spears, and eventually to person pushing a grocery cart" src="https://images.theconversation.com/files/538774/original/file-20230721-23892-afrwop.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538774/original/file-20230721-23892-afrwop.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=282&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538774/original/file-20230721-23892-afrwop.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=282&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538774/original/file-20230721-23892-afrwop.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=282&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538774/original/file-20230721-23892-afrwop.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=355&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538774/original/file-20230721-23892-afrwop.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=355&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538774/original/file-20230721-23892-afrwop.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=355&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Our metabolism remains calibrated for a hard, uncomfortable life where every bite had to be earned through strenuous physical effort, and our brains are still telling us to eat more than we need.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Today, mountains of calorie-rich (and often nutritionally poor) food and lakes of sugary beverages are readily available in much of the world. It’s no longer necessary to leave home — or even stand up — to access this cornucopia.</p>
<p><a href="https://obesitycanada.ca/guidelines/science/">Our biology has not yet caught up to our progress</a>, though. Our metabolism remains calibrated for a hard, uncomfortable life where every bite had to be earned through strenuous physical effort, and our brains are still telling us to eat more than we need.</p>
<p><a href="https://doi.org/10.2174%2F138920211795677895">Polygenic obesity — the inherited predisposition to consume and store calories</a> — is the inevitable outcome of our primal instincts colliding with amazing, man-made abundance. It’s also what makes it so hard to lose excess fat and keep it off.</p>
<h2>The brain’s role in obesity</h2>
<p>From our clinical work and our research in obesity we know that while some people can carry extra weight and be truly healthy, others suffer serious health consequences, <a href="https://doi.org/10.3390/ijms20092358">including diabetes, high blood pressure, cancer and arthritis.</a>
For far too long society has treated obesity as a personal failing while in reality it’s a <a href="https://obesitycanada.ca/guidelines/science/">biological, physiological, environmental, chronic disease</a>.</p>
<p>The fact is that for many, trying to lose excess fat is very difficult without help. The brain wants us to eat as much as we can because it thinks it’s helping us survive, and it has the power to overwhelm our best intentions. </p>
<p>Despite the prevalent view that people with large bodies should <a href="https://theconversation.com/its-time-to-bust-the-calories-in-calories-out-weight-loss-myth-199092">simply eat less and move more</a>, it’s nearly impossible to fight our genetic heritage or other factors that are not within our control. </p>
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<img alt="A chalk drawing of a brain, half of which is filled in with different types of food" src="https://images.theconversation.com/files/538591/original/file-20230720-25-6r6648.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/538591/original/file-20230720-25-6r6648.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=278&fit=crop&dpr=1 600w, https://images.theconversation.com/files/538591/original/file-20230720-25-6r6648.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=278&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/538591/original/file-20230720-25-6r6648.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=278&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/538591/original/file-20230720-25-6r6648.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=349&fit=crop&dpr=1 754w, https://images.theconversation.com/files/538591/original/file-20230720-25-6r6648.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=349&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/538591/original/file-20230720-25-6r6648.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=349&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The brain wants us to eat as much as we can because it thinks it’s helping us survive, and it has the power to overwhelm our best intentions.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Our body defends its weight vigorously. It changes levels of leptin and insulin, which regulate appetite. <a href="https://obesitycanada.ca/guidelines/science/">Whenever we lose weight by restricting calories, hormones compel our brains to signal increased hunger and decreased fullness and they slow our metabolism in an effort to retain body fat</a>.</p>
<p>This makes it difficult to reduce weight and keep it off through diet and exercise alone. </p>
<p>In the meantime, another part of our brain, which regulates reward and pleasure, is also working to make us eat more. </p>
<p>The pleasure of eating food is <a href="https://doi.org/10.1016%2Fj.neuron.2011.02.016">driven by naturally occurring neurochemicals like dopamine, opioids and cannabinoids</a>, to help with survival and energy storage. People living with obesity may have a genetic predisposition toward a heightened reward system associated with food. Glossy packaging, aggressive marketing (<a href="https://www.apa.org/topics/obesity/food-advertising-children">often targeting children</a>), delicious but nutrient-poor foods, drive-through windows and online delivery services all enable this. </p>
<h2>Effective treatment</h2>
<p>Just as human progress brought us problematic obesity, it may also help resolve it. </p>
<p>That begins with accepting that <a href="https://obesitycanada.ca/guidelines/weightbias/">polygenic obesity is a disease and not a matter of willpower</a>. Rather than blaming and shaming one another for our size, we should be more understanding and educate ourselves about obesity, to help take stigma and judgment out of the equation.
<a href="https://doi.org/10.2105%2FAJPH.2009.159491">Society sends damaging messages about weight, especially through popular culture</a>, so we want to make this very clear: our weight doesn’t define who we are, and it does not define how healthy we are.</p>
<p>It’s important to recognize that when obesity does impair one’s health, it needs treatment, and effective treatment is available. <a href="https://doi.org/10.1503/cmaj.191707">Canada’s 2020 clinical practice guidelines</a> are based on three pillars: bariatric surgery, medication and cognitive psychotherapy. </p>
<p>Psychotherapy is critical to the effectiveness of surgery or medication, or both. Behavioural therapy can resolve questions such as: Why am I eating the way I do? What is my relationship with food? Where did that come from?</p>
<p>These pillars are the primary interventions that have been shown repeatedly to be able to help people with obesity improve their health while reducing their weight and keeping it off in the long run.</p>
<p>We need less judgment and more science. Progress is possible if we work for it.</p><img src="https://counter.theconversation.com/content/209121/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Megha Poddar is the Medical Director of the Medical Weight Management Centre of Canada. She has participated in the development and delivery of continued medical education with pharmaceutical companies who have obesity medications including Novo Nordisk and Eli Lilly. </span></em></p><p class="fine-print"><em><span>Sean Wharton is the medical director of The Wharton Medical Clinic and the lead authour of the Canadian Obesity Guidelines.
He has received funding from CIHR, Mitacs, Novo Nordisk, Bausch Health Canada Inc., Eli Lilly, and Boehringer Ingelheim. </span></em></p>Despite the prevalent view that people with large bodies should simply eat less and move more, it’s nearly impossible to fight our genetic heritage or other factors that are not within our control.Megha Poddar, Assistant (Adjunct) professor, Deptartment of Internal Medicine, McMaster UniversitySean Wharton, Adjunct professor, Department of Medicine, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2081742023-06-26T12:21:51Z2023-06-26T12:21:51ZBMI alone will no longer be treated as the go-to measure for weight management – an obesity medicine physician explains the seismic shift taking place<figure><img src="https://images.theconversation.com/files/533803/original/file-20230623-5599-r64fub.jpg?ixlib=rb-1.1.0&rect=64%2C83%2C4214%2C3188&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Body mass index has been the standard measure to classify obesity and overweight for decades. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/text-on-digital-weighing-scale-persons-looking-down-royalty-free-image/1076583812?adppopup=true">kaipong/iStock via Getty Images</a></span></figcaption></figure><p>Amid the buzz around <a href="https://theconversation.com/drugs-that-melt-away-pounds-still-present-more-questions-than-answers-but-ozempic-wegovy-and-mounjaro-could-be-key-tools-in-reducing-the-obesity-epidemic-205549">weight loss drugs</a> and rising rates of <a href="https://www.who.int/activities/controlling-the-global-obesity-epidemic">obesity worldwide</a>, many health care professionals are questioning one of the key measures that has long been used to define obesity. </p>
<p>On June 14, 2023, the American Medical Association adopted a new policy, calling on doctors to <a href="https://www.ama-assn.org/delivering-care/public-health/ama-use-bmi-alone-imperfect-clinical-measure">deemphasize the role of body mass index</a>, or BMI, in clinical practice. </p>
<p>The statement by the AMA, the <a href="https://www.ama-assn.org/about#:">nation’s largest association</a> representing physicians, signals a significant shift in how clinicians regard BMI as a measure of general health. With <a href="https://www.cdc.gov/nchs/data/databriefs/db360-h.pdf#:">over 40% of Americans</a> having obesity as defined by BMI, a movement away from BMI could have broad implications for patient care.</p>
<p>As a board-certified <a href="https://www.ncbi.nlm.nih.gov/myncbi/scott.hagan.1/bibliography/public/">obesity medicine physician with a research interest</a> in patient-centered obesity care, I have written before about my concerns over use of <a href="https://doi.org/10.1007/s11606-022-07821-w">BMI as a measure of health</a>. The AMA’s policy statement creates an important opportunity to review the current use of BMI in health care settings and to consider what the future holds for the assessment of the health risks of elevated body weight.</p>
<h2>BMI basics</h2>
<p><a href="https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm">Body mass index is a measurement</a> taken by dividing body weight in kilograms by height in meters squared. The metric was developed to estimate a normal body weight <a href="https://doi.org/10.1016/0021-9681(72)90027-6">depending on an individual’s height</a>, given that taller people tend to weigh more. </p>
<p>It rose to prominence for clinicians in the 1990s following the World Health Organization’s adoption of the metric as the <a href="https://pubmed.ncbi.nlm.nih.gov/8594834/">official screening index for obesity</a>. </p>
<p>Research has consistently shown that BMI at a population level <a href="https://doi.org/10.1177/193229680800200623">correlates strongly with body fat percentage</a> and risk for <a href="https://www.cdc.gov/healthyweight/effects/index.html">serious health conditions</a>. The index is easy to measure and inexpensive to calculate, allowing its wide implementation in health care settings.</p>
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<h2>Major limitations</h2>
<p>Because of that ample body of evidence from previous decades, one of the long-standing assumptions in the use of BMI as a measure of general health is that it <a href="https://doi.org/10.1136/jech.25.1.42">accurately predicts an individual’s body fat percentage</a> and, therefore, the potential health risks of elevated weight. </p>
<p>However, while BMI may have strong correlations with the amount of body weight composed of body fat in studies of averages of large groups of people, it does not directly measure body fat for an individual. Therefore, people with the same BMI may have substantially different body fat percentage based on a variety of factors such as <a href="https://doi.org/10.1046/j.1467-789x.2001.00031.x">age, muscle mass, sex and race</a>. In an example from <a href="https://doi.org/10.1038/ijo.2008.11">one large study</a>, adults with a BMI of 25 had a body fat percentage ranging from 14% to 35% for men, and 26% to 42% for women.</p>
<p>Ultimately, BMI cannot provide doctors with precise information about the portion of body weight composed of body fat, nor can it tell us how that fat is distributed in the body. But this distribution is important because research has shown that fat stored around the internal organs has <a href="https://doi.org/10.1136/bmj.m3324">significantly higher health risks</a> than that distributed in the extremities.</p>
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<figcaption><span class="caption">You can’t tell if someone is healthy just by looking at their body weight, and using BMI alone to determine if someone is healthy can be misleading.</span></figcaption>
</figure>
<p>Further, just as a variety of health factors may affect the accuracy of BMI to predict how much body fat someone has, health outcomes <a href="https://doi.org/10.1016/s2213-8587(21)00088-7">such as developing diabetes</a> at a specific BMI can vary substantially based on factors such as a person’s race, sex, age and <a href="https://doi.org/10.1001/jama.282.16.1547">physical fitness level</a>.</p>
<p>Finally, a significant number of adults <a href="https://doi.org/10.1001/archinte.168.15.1617">may have metabolically healthy obesity</a>, defined as having a BMI above 30 without having high blood pressure, blood sugar or cholesterol. Adults with metabolically healthy obesity <a href="https://doi.org/10.7326/0003-4819-159-11-201312030-00008">have significantly lower health risks</a> associated with a high BMI and therefore may not benefit from weight loss.</p>
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<figcaption><span class="caption">The American Medical Association says the data determining body mass index does not include considerations for genetics, muscle mass or racial differences.</span></figcaption>
</figure>
<p>Although research in the 1970s suggested that any BMI above a normal (18.5-24.9) range <a href="https://doi.org/10.1056/nejm199509143331101">shortened life expectancy</a>, <a href="https://doi.org/10.1001/jama.2012.113905">some modern studies</a> suggest that BMI in the overweight (25-29.9) to class 1 obesity (30-34.9) range <a href="https://doi.org/10.1001/jama.2016.4666">does not raise risk for early death</a>.</p>
<p>The potentially lower risk of death in modern studies for people with higher body weight might be explained by <a href="https://doi.org/10.1001/jama.293.15.1868">improved treatment of conditions</a> such as high cholesterol and blood pressure, common contributors to shortened life expectancy for people with a BMI over 30.</p>
<h2>Using BMI to guide recommendations for weight loss</h2>
<p>Clinicians commonly use BMI as the metric to decide whether to recommend weight loss, drawing from recommendations such as those released by the United States Preventive Services Task Force, an independent, national panel of health care experts that writes <a href="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations">guidelines on preventive health</a>. The task force recommends <a href="https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/obesity-in-adults-interventions">lifestyle-based weight loss programs</a> such as diet and exercise for adults with a BMI above 30, or above 25 if they have other obesity-associated health conditions such as high blood pressure or high blood sugar. Its members cite the potential for lifestyle-based weight loss interventions to reduce obesity-related health risks as justification for the recommendation.</p>
<p>However, in their 2018 evidence review for these guidelines, task force researchers found <a href="https://doi.org/10.1001/jama.2018.7777">no significant improvements in cardiovascular events</a>, mortality or health-related quality of life in studies comparing those who received a lifestyle-based or medication-based weight loss intervention, or both, versus those who did not. </p>
<p>The only specific health outcome that was prevented was developing diabetes. Whether newer, more effective weight loss medications, <a href="https://theconversation.com/ozempic-helps-people-lose-weight-but-who-should-be-able-to-use-it-196794">such as Ozempic</a>, will lead to long-term health benefits <a href="https://classic.clinicaltrials.gov/ct2/show/NCT03574597">remains to be seen</a>.</p>
<p>Part of the reason that the evidence for health benefits of weight loss interventions is so poor is that <a href="https://doi.org/10.1210/er.2017-00111">body weight is regulated by a complicated hormonal system</a>. An adult trying to lose weight with diet and exercise <a href="https://doi.org/10.1056/nejmoa1105816">will face indefinite increases in hunger</a> and <a href="https://doi.org/10.1056/nejm199503093321001">reductions in daily calories burned</a> as the body attempts to correct weight back to baseline. As a result, even in the optimal setting of clinical trials, the task force found that only 1 in 8 adults would sustain clinically meaningful weight loss of at least 5% of their prior body weight.</p>
<h2>Alternatives for assessing weight and health</h2>
<p>With the shift away from BMI, the AMA recommends alternative measures that clinicians can use for the assessment of the health risks of an elevated body weight. A variety of measures are suggested, including <a href="https://www.omnicalculator.com/health/bai">body adiposity index</a>, <a href="https://www.omnicalculator.com/health/relative-fat-mass">relative fat mass</a>, <a href="https://www.omnicalculator.com/health/waist-hip-ratio#:">waist-to-hip ratio</a> and waist circumference. </p>
<p>These measures attempt to better characterize fat distribution in the body, given the increased health risks of fat stored around the internal organs. They require additional measurements in a clinic visit. Given the prevalence of <a href="https://doi.org/10.1038/s41574-022-00686-3">anti-fat bias in health care settings</a>, patients may find such measurements to be stigmatizing. Further, while these measurements may <a href="https://doi.org/10.1016/s0140-6736(05)67663-5">better predict health risks</a> of elevated weight, evidence for using these measurements to improve health outcomes is lacking.</p>
<p>In acknowledging the limitations in using BMI as a general measure of health or as a tool to assess the need for obesity treatment, the AMA has taken an important step toward diminishing the role of BMI in clinical practice. Further research is needed to identify the best ways to assess the health risks of elevated body weight.</p><img src="https://counter.theconversation.com/content/208174/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Scott Hagan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Overreliance on BMI as a measure of weight and health has deepened inequities and led to inaccuracies and overgeneralizations.Scott Hagan, Assistant Professor of Medicine, School of Medicine, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2058272023-05-18T04:11:45Z2023-05-18T04:11:45ZThe WHO says we shouldn’t bother with artificial sweeteners for weight loss or health. Is sugar better?<figure><img src="https://images.theconversation.com/files/526747/original/file-20230517-23-dlv1zx.jpg?ixlib=rb-1.1.0&rect=40%2C16%2C5422%2C3620&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/white-pink-blue-brown-sugar-bags-1023556240">Shutterstock</a></span></figcaption></figure><p>This week, the World Health Organization (WHO) <a href="https://www.who.int/news/item/15-05-2023-who-advises-not-to-use-non-sugar-sweeteners-for-weight-control-in-newly-released-guideline">advised</a> that “non-sugar sweeteners should not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases” such as diabetes and heart disease.</p>
<p>Artificial sweeteners are either natural compounds or synthesised compounds that taste sweet like sugar – and are are <a href="https://www.foodstandards.gov.au/consumer/additives/SiteAssets/Pages/Steviol-glycosides-%28960%29-%28intense-sweetener%29%20%28stevia%29/SteviolGlycosideRiskAssessment_April2023.pdf">up to 400 times</a> sweeter by weight – but provide no or negligible energy. As a comparison, sugar has 17kj (or four calories) per gram, so one teaspoon of sugar would have 85 kilojoules.</p>
<p>Several types of artificial sweeteners are <a href="https://www.foodstandards.gov.au/consumer/additives/pages/sweeteners.aspx">used in Australia</a>. Some are synthetic, others are extracted from foods such as monk fruit and the stevia plant. </p>
<p>So, what do the new WHO guidelines mean for people who have switched to artificial sweeteners for health reasons? Should they just go back to sugar?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/food-and-drinks-are-getting-sweeter-even-if-its-not-all-sugar-its-bad-for-our-health-187605">Food and drinks are getting sweeter. Even if it's not all sugar, it's bad for our health</a>
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</em>
</p>
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<h2>Promoted for weight loss</h2>
<p>As a practising clinical dietitian in the 1990s, I remember when artificial sweeteners began to appear in processed foods. They were promoted as a way of substituting sugar into food products that may lead to weight loss. </p>
<p>A can of sugar-sweetened soft drink contains on average about 500kj. Theoretically, the substitution of one sugar-sweetened can of soft drink with an artificially sweetened can of soft drink every day would reduce your weight by about 1kg per month. </p>
<p>But research over the past few decades shows this doesn’t hold up. </p>
<h2>What’s the new advice based on?</h2>
<p>The WHO has based its recommendation on a <a href="https://theconversation.com/how-do-we-know-what-works-systematic-research-reviews-5979">systematic review</a> it has <a href="https://www.who.int/publications/i/item/9789240073616">conducted</a>. Its objective was to provide evidence-based guidance on the use of artificial sweeteners in weight management and for disease prevention. </p>
<p><a href="https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/ncd-mortality">Weight management</a> is important, given obesity increases the risk of diseases such as diabetes and certain types of cancer, which are the <a href="https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/ncd-mortality">leading cause</a> of death globally.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1658164337758855168"}"></div></p>
<p>The <a href="https://www.who.int/publications/i/item/9789240073616">WHO’s systematic review</a> included data from different types of studies, which give us different information:</p>
<ul>
<li><p>50 were randomised controlled trials (when scientists intervene and make changes – in this case to the diet – while keeping everything else constant, to see the impact of that change)</p></li>
<li><p>97 were prospective cohort studies (when scientists observe a risk factor in a large group of people over a period of time to see how it impacts an outcome – without intervening or make any changes)</p></li>
<li><p>47 were case-control studies (another type of observational study that follows and compares two groups of otherwise matched people, aside from the risk factor of interest).</p></li>
</ul>
<p>Randomised controlled trials provide us with causal data, allowing us to say the intervention led to the change we saw. </p>
<p>Prospective cohort and case-control only give us associations or links. We can’t prove the risk factors led to a change in the outcomes – in this case, weight – because other risk factors that scientists haven’t considered could be responsible. But they give great clues about what might be happening, particularly if we can’t do a trial because it’s unethical or unsafe to give or withhold specific treatments. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="person puts sweetener in cup of tea" src="https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/526746/original/file-20230517-19-1nqed9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The WHO review looked at different types of studies investigating artificial sweeteners.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/N2n01mhpbmg">Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The WHO’s systematic review looked at body fatness, non-communicable diseases and death. </p>
<p>For body fatness, the randomised controlled trials showed those consuming more artificial sweeteners had slightly lower weight – an average of 0.71kg – than those consuming less or no artificial sweeteners. </p>
<p>But the cohort studies found higher intakes of artificial sweeteners were associated with a higher BMI, or body mass index (0.14 kg/m2) and a 76% increased likelihood of having obesity.</p>
<p>The prospective cohort studies showed for higher intakes of artificial sweetened beverages there was a 23% increase in the risk of type 2 diabetes. If artificial sweeteners were consumed as a tabletop item (that the consumer added to foods and drinks) there was a 34% increase in the risk of diabetes.</p>
<p>In people with diabetes, artificial sweeteners did not improve or worsen any clinical indicators used to monitor their diabetes such as fasting blood sugar or insulin levels.</p>
<p>Higher intakes of artificial sweeteners were associated with an increased risk of type 2 diabetes, cardiovascular disease and death in the long-term prospective observational studies that followed participants for an average of 13 years. </p>
<p>But artificial sweeteners were not associated with differences in overall cancer rates or premature death from cancer. </p>
<p>Overall, while the randomised controlled trials suggested slightly more weight loss in people who used artificial sweeteners, the observational studies found this group tended to have an increased risk of obesity and poorer health outcomes.</p>
<h2>Does the review have any shortcomings?</h2>
<p>The WHO’s advice has led to <a href="https://www.sciencemediacentre.org/expert-reaction-to-new-who-guideline-which-advises-not-to-use-non-sugar-sweeteners-for-weight-control-or-to-reduce-the-risk-of-noncommunicable-diseases/">some criticism</a> because the randomised controlled trials did show some weight loss benefit to using artificial sweeteners, albeit small. </p>
<p>However the WHO clearly states its advice is based on the multiple research designs, not just randomised controlled trials. </p>
<p>Additionally, the WHO assessed the quality of the studies in the review to be of “low or very low certainty”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sweeteners-may-be-linked-to-increased-cancer-risk-new-research-179709">Sweeteners may be linked to increased cancer risk – new research</a>
</strong>
</em>
</p>
<hr>
<h2>Are they unsafe?</h2>
<p>This advice is not suggesting artificial sweeteners are unsafe or should be banned. The WHO’s scientific review was not about chemical or safety issues.</p>
<h2>So are we better off having sugar instead?</h2>
<p>The answer is no. </p>
<p>In 2015, the WHO released <a href="https://www.who.int/publications/i/item/9789241549028">guidelines on added sugar intake</a> to reduce the risk of excess weight and obesity. Added sugars are found in processed and ultra-processed foods and drinks such as soft drinks, fruits drinks, sports drinks, chocolate and confectionery, flavoured yoghurt and muesli bars. </p>
<p>It recommended people consume no more 10% of total energy intake, which is about 50 grams (ten teaspoons), of sugar per day for an average adult who needs 8,700kj a day. </p>
<p>The WHO’s recommendation is in line with the <a href="https://www.eatforhealth.gov.au/food-essentials/how-much-do-we-need-each-day/recommended-number-serves-adults">Australian Dietary Guidelines</a>, which recommends no more than three serves of discretionary foods per day, if you need the extra energy. However it’s best to get extra energy from the core food groups (grains, vegetable, fruit, dairy and protein group) rather than discretionary foods. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/8-everyday-foods-you-might-not-realise-are-ultra-processed-and-how-to-spot-them-197993">8 everyday foods you might not realise are ultra processed – and how to spot them</a>
</strong>
</em>
</p>
<hr>
<h2>So what do I drink now?</h2>
<p>So if artificial and sugar in drinks are not advised for weight loss, what can you drink? </p>
<p>Some options include water, kombucha with no added sugar, tea or coffee. Soda and mineral water flavoured with a small amount of your favourite fruit juice are good substitutes. </p>
<p>Milk is also a good option, particularly if you’re not currently meeting you calcium requirements.</p><img src="https://counter.theconversation.com/content/205827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.</span></em></p>Here’s what the new WHO guidelines mean for people who have switched to artificial sweeteners for health reasons.Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2025952023-05-05T12:14:19Z2023-05-05T12:14:19ZObesity in children is rising dramatically, and it comes with major – and sometimes lifelong – health consequences<figure><img src="https://images.theconversation.com/files/524166/original/file-20230503-24-l7rhni.jpg?ixlib=rb-1.1.0&rect=22%2C33%2C7326%2C4869&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Knowing how to talk to kids about healthful eating is key.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/xtd3zYWxEs4">MI PHAM/Unsplash</a></span></figcaption></figure><p>In the past two decades, <a href="https://doi.org/10.1542/peds.2021-053708">children have become more obese</a> and have developed obesity at a younger age. A 2020 report found that <a href="https://www.cdc.gov/obesity/data/childhood.html#">14.7 million</a> children and adolescents in the U.S. live with obesity. </p>
<p>Because <a href="https://childhoodobesityfoundation.ca/what-is-childhood-obesity/complications-childhood-obesity/">obesity is a known risk factor</a> for <a href="https://www.mayoclinic.org/diseases-conditions/childhood-obesity/symptoms-causes/syc-20354827">serious health problems</a>, its <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a3.htm">rapid increase during the COVID-19 pandemic</a> raised alarms.</p>
<p>Without intervention, many obese <a href="https://doi.org/10.1111/obr.12334">adolescents will remain obese</a> as adults. Even before adulthood, some children will have serious health problems beginning in their preteen years.</p>
<p>To address these issues, in early 2023, the American Academy of Pediatrics released its <a href="https://www.aap.org/en/news-room/news-releases/aap/2023/american-academy-of-pediatrics-issues-its-first-comprehensive-guideline-on-evaluating-treating-children-and-adolescents-with-obesity/">first new obesity management guidelines</a> in 15 years.</p>
<p>I am a <a href="https://www.scvmc.org/find-provider-result?field_specialties_target_id=536&field_spoken_language_target_id=All&title=&field_gender_target_id=All&sort_bef_combine=field_last_name_value_ASC">pediatric gastroenterologist</a> who sees children in the largest public hospital in California, and I have witnessed a clear trend over the last two decades. Early in my practice, I only occasionally saw a child with a complication of obesity; now I see multiple referrals each month. Some of these children have severe obesity and several health complications that require multiple specialists.</p>
<p>These observations prompted my reporting for the <a href="https://centerforhealthjournalism.org/2023/03/06/pandemic-made-childhood-obesity-even-worse-how-can-we-help-children-most-risk">California Health Equity Fellowship</a> at the University of Southern California. </p>
<p>It’s important to note that not all children who carry extra weight are unhealthy. But evidence supports that obesity, especially severe obesity, requires further assessment.</p>
<h2>How obesity is measured</h2>
<p>The <a href="https://www.who.int/health-topics/obesity#tab=tab_1">World Health Organization defines obesity</a> as “abnormal or excessive fat accumulation that presents a risk to health.” </p>
<p>Measuring fat composition requires specialized equipment that is not available in a regular doctor’s office. Therefore most clinicians use body measurements to screen for obesity. </p>
<p>One method is body mass index, or BMI, a calculation based on a child’s height and weight compared to age- and sex-matched peers. BMI doesn’t measure body fat, but when <a href="https://www.cdc.gov/healthyweight/assessing/bmi/index.html">BMI is high</a>, it correlates with total body fat.</p>
<p>According to the <a href="https://doi.org/10.1542/peds.2022-060640">American Academy of Pediatrics</a>, a child qualifies as overweight at a BMI between the <a href="https://www.cdc.gov/growthcharts/clinical_charts.htm">85th and 95th percentile</a>. Obese is defined as a <a href="https://www.cdc.gov/obesity/basics/childhood-defining.html">BMI above the 95th percentile</a>. Other screens for obesity include <a href="https://www.nccor.org/nccor-tools/a-guide-to-methods-for-assessing-childhood-obesity/">waist circumference and skin-fold thickness</a>, but these methods are less common. </p>
<p>Because many children exceeded the limits of existing growth charts, in 2022 the Centers for Disease Control and Prevention introduced <a href="https://www.cdc.gov/growthcharts/extended-bmi.htm">extended growth charts</a> for severe obesity. Severe obesity occurs when a child reaches the 120th percentile or has a BMI over 35. For instance, a 6-year-old boy who is 48 inches tall and is 110 pounds would meet criteria for severe obesity because his BMI is 139th percentile.</p>
<p><a href="https://doi.org/10.1161/cir.0b013e3182a5cfb3">Severe obesity</a> carries a heightened risk of liver disease, cardiovascular disease and metabolic problems such as diabetes. As of 2016, almost <a href="https://doi.org/10.1542%2Fpeds.2017-3459">8% of children ages 2 to 19 had severe obesity</a>.</p>
<p>Other health problems associated with severe obesity include <a href="https://doi.org/10.1155%2F2012%2F134202">obstructive sleep apnea</a>, <a href="https://orthoinfo.aaos.org/en/diseases--conditions/slipped-capital-femoral-epiphysis-scfe">bone and joint problems</a> that can cause early arthritis, <a href="https://doi.org/10.5527%2Fwjn.v4.i2.223">high blood pressure</a> and <a href="https://doi.org/10.1159/000492826">kidney disease</a>. Many of these problems occur together.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/ZpbZ33Dc53E?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">More and more children are developing diseases that have traditionally only been seen in adults.</span></figcaption>
</figure>
<h2>How obesity affects the liver</h2>
<p>The liver disease associated with obesity is called nonalcoholic <a href="https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash-children#">fatty liver disease</a>. To store excess dietary fat and sugar, the liver’s cells fill with fat. Excess carbohydrates in particular get processed into substances similar to the <a href="https://doi.org/10.3945%2Fan.112.002998">breakdown products of alcohols</a>. Under the microscope, a pediatric fatty liver looks similar to a liver with alcohol damage.</p>
<p>Occasionally children with fatty liver are not obese; however, the <a href="https://doi.org/10.1002/cld.1027">greatest risk factor for fatty liver</a> is obesity. At the same BMI, Hispanic and Asian children are more susceptible to fatty liver disease than Black and white children. Weight reduction or reducing the consumption of fructose, a naturally occurring sugar and common food additive – even without significant weight loss – improves fatty liver.</p>
<p>Fatty liver is the most common chronic liver disease in children and adults. In Southern California, <a href="https://doi.org/10.1542%2Fpeds.2020-0771">pediatric fatty liver doubled</a> from 2009 to 2018. The disease can progress rapidly in children, and <a href="https://doi.org/10.1136/gut.2008.171280">some will have liver scarring</a> after only a few years. </p>
<p>Although few children currently require liver transplants for fatty liver, it is the most <a href="https://doi.org/10.1097/mcg.0000000000000925">rapidly increasing reason for transplantation in young adults</a>. Fatty liver is the second-most common reason for liver transplantation in the U.S., and it will be the <a href="https://liverfoundation.org/about-your-liver/facts-about-liver-disease/fatty-liver-disease/">leading cause in the future</a>.</p>
<figure class="align-center ">
<img alt="A light micrograph image of fatty liver, with large vacuoles of triglyceride fat accumulated inside liver cells." src="https://images.theconversation.com/files/524456/original/file-20230504-17-zbul98.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524456/original/file-20230504-17-zbul98.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524456/original/file-20230504-17-zbul98.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524456/original/file-20230504-17-zbul98.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524456/original/file-20230504-17-zbul98.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524456/original/file-20230504-17-zbul98.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524456/original/file-20230504-17-zbul98.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A light micrograph image of fatty liver, with large vacuoles of triglyceride fat inside liver cells.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/light-micrograph-of-a-fatty-liver-royalty-free-image/851075118?phrase=fatty+liver&adppopup=true">Dr_Microbe/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>Links between obesity and diabetes</h2>
<p><a href="https://doi.org/10.1016/S2213-8587(14)70032-4">Fatty liver is implicated</a> in <a href="https://www.nhlbi.nih.gov/health/metabolic-syndrome">metabolic syndrome</a>, a group of conditions that cluster together and increase the risk of cardiovascular disease and diabetes.</p>
<p>In a telephone interview, Dr. Barry Reiner, a pediatric endocrinologist, voiced his concerns to me about obesity and diabetes.</p>
<p>“When I started my practice, I had never heard of type 2 diabetes in children,” says Reiner. “Now, depending on which part of the U.S., between a quarter and a third of new cases of diabetes are type 2.”</p>
<p><a href="https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/symptoms-causes/syc-20353011">Type 1 diabetes</a> is an autoimmune disease previously called juvenile-onset diabetes. Conversely, <a href="https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193">type 2 diabetes</a> was historically considered an adult disease. </p>
<p>However, type 2 diabetes is increasing in children, and obesity is the <a href="https://www.endocrine.org/news-and-advocacy/news-room/2017/childhood-obesity-quadruples-risk-of-developing-type-2-diabetes">major risk factor</a>. While both types of diabetes have genetic and lifestyle influences, type 2 is more modifiable through diet and exercise. </p>
<p>By 2060, the number of people under 20 with type 2 diabetes will <a href="https://doi.org/10.2337/dc22-0945">increase by 700%</a>. Black, Latino, Asian, Pacific Islander and Native American/Alaska Native children will have more type 2 diabetes diagnoses than white children. </p>
<p>“The seriousness of type 2 diabetes in children is underestimated,” says Reiner. He added that many people express a misconception that type 2 diabetes is a mild, slow-moving disease.</p>
<p>Reiner pointed to an important study showing that type 2 diabetes acquired in childhood <a href="https://www.adameetingnews.org/live-updates/session-coverage/today2-study-youth-onset-type-2-diabetes-more-severe-than-adult-onset-disease">can rapidly progress</a>. As early as 10 to 12 years after their childhood diagnosis, patients developed nerve damage, kidney problems and vision damage. By 15 years after diagnosis, at an average age of 27, almost <a href="https://doi.org/10.1056/NEJMoa2100165">70% of the patients had high blood pressure</a>.</p>
<p>Most patients had more than one complication. Although rare, a few patients experienced heart attacks and strokes. When people with childhood onset diabetes became pregnant, 24% delivered premature infants, over <a href="https://www.marchofdimes.org/peristats/reports/united-states/prematurity-profile#">double the rate in the general population</a>.</p>
<h2>Heart health</h2>
<p>Cardiovascular changes associated with obesity and severe obesity can also increase a child’s lifetime chance of heart attacks and strokes. Carrying extra weight at 6 to 7 years old can result in higher blood pressure, cholesterol and artery stiffness by <a href="https://doi.org/10.1542/peds.2019-3666">11 to 12 years of age</a>. Obesity <a href="https://doi.org/10.1093/eurheartj/ehv089">changes the structure of the heart</a>, making the muscle thicken and expand. </p>
<p>Although still uncommon, more people in their 20s, 30s and 40s <a href="https://doi.org/10.1161/STROKEAHA.119.024156">are having strokes</a> and <a href="https://www.acc.org/about-acc/press-releases/2019/03/07/08/45/heart-attacks-increasingly-common-in-young-adults">heart attacks</a> than a few decades ago. Although many factors may contribute to heart attack and stroke, obesity adds to that risk.</p>
<h2>Talk about being healthy, not focusing on weight</h2>
<p>Venus Kalami, a registered dietitian, spoke with me about the environmental and societal influences on childhood obesity.</p>
<p>“Food, diet, lifestyle and weight are often a proxy for something greater going on in someone’s life,” says Kalami.</p>
<p>Factors beyond a child’s control, including <a href="https://med.stanford.edu/news/all-news/2018/04/pediatric-obesity-depression-connected-in-the-brain.html">depression</a>, <a href="https://doi.org/10.1542/peds.2021-055571">access to healthy food</a> and <a href="https://doi.org/10.1210/endrev/bnac005">walkable neighborhoods</a>, contribute to obesity.</p>
<p>Parents may wonder how to help children without introducing shame or blame. First, conversations about weight and food should be age appropriate.</p>
<p>“A 6-year-old does not need to be thinking about their weight,” says Kalami. She adds that even preteens and teenagers should not be focusing on their weight, though they likely already are. </p>
<p>Even <a href="https://doi.org/10.1542/peds.2016-1649">“good-natured” teasing</a> is harmful. Avoid diet talk, and instead discuss health. Kalami recommends that adults explain how healthy habits can improve mood, focus or kids’ performance in a favorite activity.</p>
<p>“A 12-year-old isn’t always going to know what is healthy,” Kalami said. “Help them pick what’s available and make the best choice, which may not be the perfect choice.”</p>
<p>Any weight talk, either criticism or compliments for weight loss, may backfire, she adds. Praising a child for their weight loss can reinforce a negative cycle of disordered eating. Instead, cheer the child’s better health and good choices.</p>
<p>Dr. Muneeza Mirza, a pediatrician, recommends that parents model healthful behavior.</p>
<p>“Changes should be made for the whole family,” says Mirza. “It shouldn’t be considered a punishment for that kid.”</p><img src="https://counter.theconversation.com/content/202595/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christine Nguyen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The American Academy of Pediatrics has recently released new obesity management guidelines in order to help address the growing obesity crisis in children.Christine Nguyen, 2023 California Health Equity Fellow, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2025652023-03-29T10:43:07Z2023-03-29T10:43:07ZShedding pounds might benefit your heart even if some weight is regained – new study<figure><img src="https://images.theconversation.com/files/517864/original/file-20230328-28-v9juj0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-bare-feet-weight-scale-bathroom-785794792">Rostislav Sedlacek/Shutterstock</a></span></figcaption></figure><p>Programmes to help people lose weight through changes to their diet, exercise or both, are mainstays of weight management. Despite their widespread use, many people worry that after the programmes end they will regain the weight they lost – or more - removing the health benefits.</p>
<p>To understand the effects of this, we brought together <a href="https://www.bmj.com/content/374/bmj.n1840">249 studies including 60,000 adults who were overweight or living with obesity</a>. We compared the half who joined programmes to lose weight through diet or exercise, or both, with the half who had no support (or less support than offered on these programmes). We assessed what happened to people’s weight after the programmes ended, and what this meant for their physical and mental health.</p>
<p>As expected, people lost weight during the programmes. There was a lot of variability, but, on average, people weighed 5kg less at the end of the programme than they did at the start. In most studies of weight loss programmes, <a href="https://pubmed.ncbi.nlm.nih.gov/27028279/">people who don’t receive support (those in the “control group”) also lose weight</a> - these are people who not only want to lose weight, but have volunteered to be in a study to help them lose weight, which means they are highly committed. For this reason, we use these “control groups” as a way to test the effect of the programme itself. On average, people assigned to a programme lost 2kg more than people in the control groups. </p>
<p>People who had been assigned to a diet and exercise programme gradually regained weight when the programme ended. Typically, it took at least five years to regain the weight that was lost during the weight loss programme - few studies followed people for more than five years. Some studies stopped at a point where people still hadn’t regained all the weight they had lost.</p>
<p>We showed that weight loss <a href="https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.122.009348">led to improvements in risk factors</a> for heart disease, including high blood pressure, high cholesterol, blood glucose and type 2 diabetes. On average, these reductions were small, but translated across a population, would lead to significant reductions in disease. </p>
<p>Later, as weight was regained, these improvements ebbed away. But even five years, later some benefits were still apparent. There was some evidence that the chances of developing diabetes or having a heart problem were reduced. But most trials didn’t follow people for long enough to be certain. There is <a href="https://bmjopen.bmj.com/content/8/9/e020584">some evidence</a> that short-term reduction in risk factors can lead to long-term reductions in disease incidence.</p>
<p>On average, people who went on diet and exercise programmes <a href="https://dom-pubs.onlinelibrary.wiley.com/doi/full/10.1111/dom.14895">improved their quality of life</a>, but around two years after the programme ended, their quality of life was similar to people who did not go on a programme.</p>
<figure class="align-center ">
<img alt="A man taking his own blood pressure reading." src="https://images.theconversation.com/files/517890/original/file-20230328-3398-otahkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/517890/original/file-20230328-3398-otahkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/517890/original/file-20230328-3398-otahkx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/517890/original/file-20230328-3398-otahkx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/517890/original/file-20230328-3398-otahkx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/517890/original/file-20230328-3398-otahkx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/517890/original/file-20230328-3398-otahkx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Weight loss led to improvements in blood pressure.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hypertension-older-age-senior-black-man-2066841269">Prostock-studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>Forty-seven studies also looked at the <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/cob.12575">effect of these programmes on mental health</a>. Overall, there was no evidence that these programmes made anxiety or depression worse, either during the programme or after it ended. There was some evidence that anxiety and depression might be improved, particularly in programmes that combined diet and exercise, rather than ones that focused on diet alone. We need more studies to be sure about these findings.</p>
<p>We also looked at whether anything made people more or less likely to regain weight. There was a lot of variation in how much weight was lost and how quickly weight was regained. On average, <a href="https://www.bmj.com/content/374/bmj.n1840">the more weight people lost through diet and exercise programmes</a>, the quicker they regained it after the programme ended. However, this faster rate of weight regain did not wipe out the initial weight loss for at least five years. </p>
<p>Programmes that paid people to lose weight tended to lead to faster weight regain once the payments stopped than for people who did not receive any financial incentives. Programmes that continued to be available outside of the study were linked to less weight regain. This might be because people could keep attending the programme for as long as they wanted, or engage with it again when they started regaining weight. This included weight management programmes provided in the community.</p>
<p>In our review, we didn’t look at weight regain after using other weight loss methods, like medications. There is <a href="https://pubmed.ncbi.nlm.nih.gov/35441470/">some evidence</a> from individual studies that weight regain after weight-loss medication is stopped may be faster than after diet and exercise programmes.</p>
<h2>Benefits still accrue, despite weight regain</h2>
<p>Weight regain isn’t inevitable, but it is very common. Some people keep off most of the weight they lose in the long term, but it’s hard to predict who this will be. No one sets out on a weight loss attempt wanting to regain weight, but our genes and the environment we live in make it harder for some people to keep off weight than others.</p>
<p>Nonetheless, our findings provide some reassurance that taking part in a diet and exercise programme to lose weight can benefit people’s health – even if they put the weight back on. Increasingly, obesity is thought of as a chronic, relapsing condition – one that may need repeated periods of treatment to reduce health risks in the long term.</p><img src="https://counter.theconversation.com/content/202565/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jamie Hartmann-Boyce has received funding from the British Heart Foundation and the National Institute for Health and Care Research to support the work covered in this article. She has received funding from Cancer Research UK, Cochrane, the University of Oxford, and the World Health Organization for other work. The views expressed are those of the authors and not of the funding bodies.</span></em></p><p class="fine-print"><em><span>Paul Aveyard receives funding from the National Institute for Health Research and the British Heart Foundation for research. He is paid by the University of Oxford and the NHS for his work as a medical researcher. He is an investigator on a publicly funded trial where Nestle have donated total diet replacement products to NHS patients to support the trial.. </span></em></p><p class="fine-print"><em><span>Susan Jebb conducts research studies funded by the National Institute for Health Research and holds a research grant from the Novo Nordisk Foundation. She is Chair of the UK Food Standards Agency. The views expressed are those of the authors and do not necessarily reflect the views of these organisations.</span></em></p>Permanent weight loss is hard to achieve. But the good news is: there are still benefits to temporary weight loss.Jamie Hartmann-Boyce, Associate Professor and Director of Evidence-Based Healthcare DPhil Programme, University of OxfordPaul Aveyard, Professor of Behavioural Medicine, University of OxfordSusan Jebb, Professor of Diet and Population Health, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952632023-01-26T13:24:11Z2023-01-26T13:24:11ZPeople blame and judge parents for children’s heavier weights<figure><img src="https://images.theconversation.com/files/503477/original/file-20230106-10808-bsbh5r.jpg?ixlib=rb-1.1.0&rect=237%2C1%2C721%2C537&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Would you hold the mother responsible for her daughter's weight?</span> <span class="attribution"><span class="source">Courtesy of Steve Neuberg, Arizona State University, and Jaimie Krems, Oklahoma State University</span></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Americans stigmatize parents of heavier children, specifically <a href="https://doi.org/10.1177/09567976221124951">blaming them for their children’s weights</a>, according to experiments conducted by <a href="https://scholar.google.com/citations?user=CpXzPwgAAAAJ&hl=en&oi=ao">our</a> <a href="https://scholar.google.com/citations?user=ofYV4l0AAAAJ&hl=en&oi=ao">team</a> <a href="https://scholar.google.com/citations?user=qiWqHHYAAAAJ&hl=en&oi=ao">of</a> <a href="https://scholar.google.com/citations?user=brp7lrcAAAAJ&hl=en&oi=ao">psychologists</a>.</p>
<p>The more a person views parents as responsible for a child’s excess weight, the more likely they are to <a href="https://doi.org/10.1111/cob.12202">view such parents as bad parents</a> who are lazy, overindulgent and incompetent.</p>
<p>Our findings corroborate what parents of children with higher weights have reported for years: that other people – friends, other parents, strangers or <a href="https://www.nytimes.com/2023/01/20/well/family/childhood-obesity-guidelines.html">even their pediatricians</a> – <a href="https://doi.org/10.1111/cob.12202">might blame them, dislike them and think they are poor parents</a>. </p>
<h2>Why it matters</h2>
<p>In the U.S., <a href="https://www.hsph.harvard.edu/obesity-prevention-source/obesity-trends-original/global-obesity-trends-in-children">about 1 in 3 children</a> have body mass indexes that would be categorized as overweight or obese. The number has <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7037a3.htm?s_cid=mm7037a3_w">grown during the COVID-19 pandemic</a>, meaning an increasing number of parents face stigma on account of their child’s weight.</p>
<p>This <a href="https://doi.org/10.1016/j.acap.2021.09.019">parental weight stigma</a> is just beginning to receive serious scientific attention but could have major effects on parents, children and families. </p>
<p>For example, <a href="https://www.washingtonpost.com/blogs/on-parenting/post/ohio-mom-loses-custody-of-obese-son-should-the-government-penalize-parents-of-obese-children/2011/11/28/gIQA1v665N_blog.html">family courts</a> <a href="https://www.cbsnews.com/news/five-year-olds-removal-from-family-spotlights-obesity-intervention/">across the U.S.</a> and <a href="https://www.theguardian.com/society/2021/mar/10/two-teenagers-placed-in-foster-care-after-weight-loss-plan-fails">internationally</a> have removed children with obesity from parental custody in large part due to their children’s weights. Family separation can have massive <a href="https://socialchangenyu.com/review/the-harm-of-child-removal/">negative effects on children</a>. <a href="https://doi.org/10.1177/09567976221124951">Our work</a> suggests that if judges react as our study participants did, they may view parents of heavier children as being bad parents simply because their children are heavier. </p>
<p>In reality, <a href="https://www.ncbi.nlm.nih.gov/sites/books/NBK19935/">weight is not solely</a> <a href="https://doi.org/10.1093/bmb/ldx022">under personal control</a>. In fact, <a href="https://doi.org/10.1016/j.jada.2006.12.013">dieting can</a> <a href="https://doi.org/10.1093/emph/eow031">cause weight gain</a>. Excess weight arises from a <a href="https://www.ncbi.nlm.nih.gov/sites/books/NBK19935/">complex interplay of genes, environment, diet and activity</a>. </p>
<p>Psychologists also know that <a href="https://psycnet.apa.org/record/2005-16248-000">weight stigma is associated with pervasive negative consequences</a>, including bullying, ignorant comments and feelings of painful invisibility – as well as diminished educational and <a href="https://doi.org/10.1037/a0020860">economic opportunities</a> and <a href="https://doi.org/10.1177/0956797615601103">worse medical outcomes importantly not simply due to one’s weight</a>. Experiencing weight stigma, insidiously, <a href="https://doi.org/10.1038/s41591-020-0803-x">might itself facilitate weight gain</a> and cause other negative effects.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A child's feet standing on a digital scale." src="https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505658/original/file-20230120-24-qchj1f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Everyone loses in the blame game.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/childs-foot-on-fashionable-digital-scale-royalty-free-image/892826582">roman023/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<h2>What still isn’t known</h2>
<p>If people blame and stigmatize parents of children with higher weights, what effects does it have on parents, on their children and on the parent-child interactions that are so important for healthy development? </p>
<p>We do not yet know, for example, if heavier children are aware people stigmatize their parents. If so, these children might not only be ashamed of their size, but also might erroneously feel responsible for how people treat their parents.</p>
<h2>How we do our work</h2>
<p>For this research, published in the journal Psychological Science, we ran <a href="https://doi.org/10.1177/09567976221124951">three experiments with over 1,000 U.S. participants</a> – about 75% white and 25% other races/ethnicities – over the course of 2022. </p>
<p>We randomly assigned participants to view one of four line drawings depicting a mother or father next to an 8-year-old daughter or son. We also included a short description of the parent and child. </p>
<p>In two of the line drawings and descriptions, the child was described and depicted as “healthy”-weight. In the other two, the child was depicted and described as having “obesity.” The parents were always depicted and described as being healthy-weight. This allowed us to conclude that study participants’ reactions to parents were due to their children’s weights, not the parents’.</p>
<p>We asked participants a few short questions about how good or bad a parent they thought the adult was. Participants also answered questions about what they believed influenced the child’s weight (as well as their academic performance and athleticism, to help obscure the focus of the study). Participants were given 100 “responsibility points” to allot to four factors that could be behind the child’s weight: parent behavior, child behavior, genetic factors and societal factors. </p>
<p><iframe id="wQDu1" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/wQDu1/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>As expected, people who viewed the child with obesity assigned more responsibility points to parent behavior and saw that parent as a worse parent. We found parent and child gender made little difference, <a href="https://doi.org/10.1016/j.acap.2021.09.019">consistent with other work</a>. </p>
<p>This is <a href="https://doi.org/10.1056/NEJMp1206519">consistent with previous research</a> showing people blame parents for children’s obesity more than people blame society or the kids themselves. </p>
<p>We also tested whether providing alternative explanations for the child’s weight would decrease the amount of blame parents received for it. When we told participants the child had a thyroid condition that caused her excess weight, they stigmatized the mother less, holding her less responsible.</p>
<p>Next, our team is exploring how parents’ own weight, income and race/ethnicity influences the stigma directed toward them on account of their child’s excess weight.</p><img src="https://counter.theconversation.com/content/195263/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While excess weight arises from a complex interplay of genes, environment, diet and activity, new research finds Americans hold parents responsible for excess weight in their kids.Jaimie Arona Krems, Assistant Professor of Psychology, Oklahoma State UniversityDevanshi Patel, Ph.D. Candidate in Clinical Psychology, Oklahoma State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1966342023-01-08T13:26:53Z2023-01-08T13:26:53ZType 2 diabetes in young people puts their eyes at risk<figure><img src="https://images.theconversation.com/files/501160/original/file-20221214-15950-g5r5q3.jpg?ixlib=rb-1.1.0&rect=5%2C7%2C989%2C654&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When it comes to eye care, regular visits to the optometrist or ophthalmologist can detect the early signs of diabetic damage.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Sixteen-year-old Karl is seen for the first time in my optometry practice. He was referred to me for a fluctuating vision problem. During his examination, I saw signs suggesting he may have diabetes, which could have explained the fluctuating vision. This suspicion became a reality when his family doctor confirmed the diagnosis. Karl’s world was turned upside down.</p>
<p>As an optometrist, I invite you to dive into a reality that should concern us all.</p>
<h2>What is diabetes?</h2>
<p>Diabetes is an insidious disease. Its symptoms <a href="https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/symptoms-causes/syc-20355318">(thirst, need to urinate often, fatigue, weight loss, darker skin areas on the neck and underarms)</a> often go unnoticed, at least in the early stages of the disease.</p>
<p>Diabetes affects the lives of <a href="https://data.worldbank.org/indicator/SH.STA.DIAB.ZS?locations=XU">one in 14 people in Canada (7 per cent) and one in 10 in North America (10 per cent)</a>.</p>
<p>Two types of diabetes can be diagnosed:</p>
<ul>
<li><p><a href="https://www.diabete.qc.ca/en/understand-diabetes/all-about-diabetes/types-of-diabetes/type-1-diabetes/">Type 1</a>, which is insulin-dependent and develops when the body cannot produce the insulin needed to metabolize the sugars we ingest and which feed our tissues</p></li>
<li><p><a href="https://www.canada.ca/en/public-health/services/diseases/type-2-diabetes.html">Type 2</a>, which develops when insulin is produced, but in insufficient quantities. Sometimes the insulin that is produced is ineffective in doing its job.</p></li>
</ul>
<p>Type 1 diabetes is usually associated with the development of the disease in childhood and adolescence. Type 2, the most common, usually develops later in life, <a href="https://www.diabete.qc.ca/en/understand-diabetes/all-about-diabetes/types-of-diabetes/">often after age 50</a>.</p>
<h2>A counter-intuitive diagnosis, but not a rare one</h2>
<p>From this definition, it would have been logical to conclude that Karl was affected by Type 1 diabetes, the course and treatment of which are well controlled by physicians. However, in his case, and after the required testing, his doctor identified Type 2 diabetes. This diagnosis is counter-intuitive and poses significant challenges. The speed of onset, the initial severity of the disease and the mechanisms of resistance, or of reduced insulin secretion, may be different in patients who develop the disease at a younger age <a href="https://pubmed.ncbi.nlm.nih.gov/15735201/">than in adults</a>.</p>
<p>In addition, treatment options, involving trial and error, become more complex due to the much longer duration of this type of disease when it starts at a young age. Both major and minor changes <a href="https://pubmed.ncbi.nlm.nih.gov/12090830/">that affect the blood vessels in the Type 2 diabetic patient</a> can have serious consequences that are difficult to predict since the course of treatment can continue for 40 to 60 years.</p>
<p>However, Karl’s situation is not exceptional. <a href="https://www.thelancet.com/pdfs/journals/landia/PIIS2213-8587(17)30186-9.pdf">More and more young people and adolescents</a>, especially those who are <a href="https://pubmed.ncbi.nlm.nih.gov/12241736/">overweight, obese, and sedentary</a>, are affected by Type 2. Almost 75 per cent of them have <a href="https://www.cdc.gov/diabetes/basics/type2.html">parents or siblings with diabetes</a>.</p>
<p>While at first sight, this confirms genetics as a risk factor for developing the disease, in this specific case, it was more a consequence of <a href="https://www.cdc.gov/diabetes/basics/type2.html">poor lifestyle habits, especially dietary habits, and lack of physical activity</a>, which are often shared by the whole family.</p>
<h2>Impact on vision</h2>
<p>The fact that Karl developed Type 2 diabetes earlier, rather than later in life also puts him at a higher risk of developing eye complications. An <a href="https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2786928">article</a> about this topic recently caught my attention. This study looked at the records of 1,362 people with diabetes living in Minnesota, so, in North America and then extrapolate to Canada. The data was compiled between 1970 and 2019, which also allows us to measure the evolution of the situation over the last decades.</p>
<p>The results are astonishing: young people with Type 2 diabetes (compared to Type 1 diabetics of the same age) are 88 times more likely to develop retinopathy (abnormal blood vessels and/or hemorrhages in the retina). In addition, the risk of this retinopathy becoming “proliferative,” and therefore threatening to vision, is increased 230 times. There is also a 49-fold increase in the risk of fluid accumulation in the retina (macular edema) and a 243-fold increase in the risk of developing a mature cataract at a young age. The latter requires surgery which is riskier in young people than in the case of age-related senile cataracts.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="photograph of a fundus" src="https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500479/original/file-20221212-113662-60amw4.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vascular and metabolic complications of diabetes visible on the fundus (hemorrhages, exudates).</span>
<span class="attribution"><span class="source">(Langis Michaud)</span>, <span class="license">Fourni par l'auteur</span></span>
</figcaption>
</figure>
<p>What should we remember from this? That the major problems, which often require surgical interventions to save vision, occur much more rapidly in young Type 2 diabetics than in those affected by Type 1. These patients must therefore be followed more closely. Indeed, almost one in two Type 2 patients will develop some form of retinopathy within one to eight years of diagnosis. In comparison, one in three Type 1 diabetics will develop retinopathy between six and 10 years following diagnosis.</p>
<h2>Significant repercussions</h2>
<p>Already having increased significantly in the last 10 years, the prevalence (number of cases) of Type 2 diabetes in young people is predicted to <a href="https://pubmed.ncbi.nlm.nih.gov/23173134/">quadruple by 2050</a>. This prediction is most alarming for health professionals, but also for policymakers and managers of public health agencies. The lifetime cost of direct medical care for a single diabetic patient aged 25-44 years was <a href="https://pubmed.ncbi.nlm.nih.gov/23953350/">US$125,000 in 2013</a>. These costs have since increased and many more dollars need to be added to cover the period between 15 and 25 years, which is not taken into account. Indeed, if 20 per cent of the youth population develops diabetes by 2050, millions (perhaps billions?) of health-care dollars will have to be spent on their care by our governments.</p>
<p>The long-term quality of life of people with diabetes is also reduced. <a href="https://pubmed.ncbi.nlm.nih.gov/30345893/">Another study</a>, this time of young people with Type 1 diabetes, shows that their disease has a negative impact on their life. They have to devote a lot of time to their care (missing activities with their friends). And the burden of their disease on their relatives weighs heavily on their shoulders. The fear of hypoglycemia (lack of sugar that can lead to coma) or of developing serious complications of the disease also affects them. Achieving autonomy is more difficult for these adolescents, and their quality of life is proportional to the freedom they can or cannot exercise.</p>
<h2>Eat well, exercise and visit your optometrist</h2>
<p>Type 1 diabetes is difficult to prevent, mainly because we don’t know all the reasons why it occurs and to proactively screen for it. The situation is different for Type 2 diabetes, which is strongly associated with unhealthy lifestyle in young people. Eating a healthy diet, exercising regularly, and combating sedentary lifestyles, including limiting screen leisure time (to less than two hours per day), are good ways to avoid or delay the onset of diabetes in young people. Screen time is also associated with <a href="https://pubmed.ncbi.nlm.nih.gov/28288985/">insulin resistance</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/31270831/">obesity</a> in young people. In other words, healthy lifestyles must be encouraged and especially shared within the family unit.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="young children ride bikes" src="https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500780/original/file-20221213-16037-bsk51g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Healthy habits are good ways to avoid or delay the onset of diabetes in young people.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>As far as eyes are concerned, regular visits to the optometrist or ophthalmologist can detect early signs of diabetic complications <a href="https://guidelines.diabetes.ca/cpg/chapter30">(signs are seen in up to 30 per cent of patients shortly after diagnosis)</a>. These health professionals can also detect other oculo-visual problems arising from the disease, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518369/">loss of ability to focus up close (accommodation), partial paralysis of certain muscles of the eye resulting in double vision, delayed healing of surface corneal changes, dry eye or glaucoma</a>. Testing should be done <a href="https://guidelines.diabetes.ca/cpg/chapter30">at the time of medical diagnosis of diabetes</a>, or in anyone with a high-risk profile (heredity, obesity, sedentary lifestyle).</p>
<p>Since healthy lifestyle habits are an integral part of the treatment of the disease, it is not too late for Karl to enjoy a happier future. But it is important not to neglect regular follow-ups by his medical doctor and frequent visits to his family optometrist.</p><img src="https://counter.theconversation.com/content/196634/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Langis Michaud ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>The risk of developing eye complications is high in young people with Type 2 diabetes, which is increasingly affecting children and adolescents, especially those who are more sedentary.Langis Michaud, Professeur Titulaire. École d'optométrie. Expertise en santé oculaire et usage des lentilles cornéennes spécialisées, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1962432022-12-16T14:25:40Z2022-12-16T14:25:40ZGPs don’t give useful weight-loss advice – new study<figure><img src="https://images.theconversation.com/files/501319/original/file-20221215-15-z95ckr.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C4977%2C3303&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Have you tried eating less and moving more?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-female-doctor-senior-male-patient-280364663">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>The advice general practitioners give to patients with obesity in the UK was found to be “highly varied, superficial and often lacked an apparent evidence base”, according to a <a href="https://academic.oup.com/fampra/advance-article/doi/10.1093/fampra/cmac137/6849537?login=true">new study</a> from the University of Oxford.</p>
<p>GPs in the UK are in a trusted position as guides and managers of health in their communities. Expectations of them are often high: they are the personal advisers, taking stock of their patients’ physical and mental health, and delivering tailored advice and treatments.</p>
<p>A formidable test of general practice in the last 50 years has been the rise in obesity. Not an illness in itself and not a new phenomenon, but a significant potential threat to health. </p>
<p>It is widely known that corpulence does not yield easily to diet or exercise. In 1865, William Banting, an English undertaker and coffin maker, <a href="https://www.gutenberg.org/cache/epub/57545/pg57545-images.html">published a combination of these two strategies</a> to help reduce the stoutness of English Victorians. William Osler, a professor of medicine at Oxford University, in 1892 elaborated further on ideal foods and physical activity in <a href="https://en.wikipedia.org/wiki/The_Principles_and_Practice_of_Medicine">The Principles and Practice of Medicine</a>. Both pointed out that these approaches worked slowly, requiring considerable motivation to be effective.</p>
<p>Globally, the number of obese children and adults <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">remains very high</a>, and progress in prevention and treatment has been slow. Many separate approaches are needed to optimise our diets, our food supplies and ourselves. </p>
<p>Current guidelines in the UK encourage GPs to talk to obese patients about their weight and discuss ways to lose weight. <a href="https://www.sciencedirect.com/science/article/pii/S0140673616318931">Evidence shows</a> that even brief conversations can lead to weight loss. </p>
<p>In this latest study, published in the journal Family Practice, the researchers analysed 159 audio recordings of consultations between GPs and obese patients in which doctors gave brief (up to 30 seconds) weight-loss advice. The recordings were made between 2013 and 2014 across 137 GP surgeries.</p>
<p>Word analysis of these conversations provided surprising results. If the patients had followed the advice given in most of the consultations, they would not have lost weight.</p>
<p>The most frequent advice was essentially “eat less and do more”. Only 30 patients were given personalised advice, that is, where GPs “took into account patients’ capacity to follow the advice, such as a patient’s limited physical mobility and the implications on this for exercise”. </p>
<p>In half the interviews (78 instances), GPs also advise patients to access further support, such as a follow-up appointment or referral to a gym. </p>
<p>The advice provided by GPs in the recordings was not always accurate. Many elements of advice included, for instance, the idea that small behavioural changes could result in a large loss of weight. Banting showed this to be a myth back in the early 19th century. </p>
<figure class="align-center ">
<img alt="Woman doing sit ups in a gym." src="https://images.theconversation.com/files/501515/original/file-20221216-27-q0pir7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501515/original/file-20221216-27-q0pir7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501515/original/file-20221216-27-q0pir7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501515/original/file-20221216-27-q0pir7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501515/original/file-20221216-27-q0pir7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501515/original/file-20221216-27-q0pir7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501515/original/file-20221216-27-q0pir7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">GPs recommended gym prescriptions in just 4 consultations.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fat-woman-dieting-fitness-portrait-obese-1893029500">Oleggg/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Things have improved since 2014</h2>
<p>In 2014, few GPs were well-trained in this area of counselling. The more specialised areas of motivational counselling and setting realistic weight-loss goals for patients were also difficult. So although patients would prefer to speak to a GP about their weight, those GPs felt underqualified to do so. </p>
<p>Developing and improving advice given to patients since 2014 has featured increasingly in primary care education and guidelines from the UK’s National Institute for Health and Care Excellence. </p>
<p>New systems are being deployed, such as the use of social prescribing that permit a GP to recommend various “community referrals” such as prescribing a gym membership. This shared responsibility between those with greater expertise is powerful, reduces stigma and encourages independence in those who are overweight or obese. </p>
<p>These approaches have been reinforced by Public Health England’s campaign to help people make healthier choices - this includes the free <a href="https://www.nhs.uk/better-health/lose-weight/">NHS Weight Loss Plan</a> app. </p>
<p>Advice concerning health and weight is particularly valuable – and <a href="https://www.sciencedirect.com/science/article/pii/S0140673616318931">it works</a>. Improving it can only support the very difficult job of tackling obesity. This long, slow journey requires all of us to be participants.</p><img src="https://counter.theconversation.com/content/196243/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Colin Michie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>GPs’ advice on weight loss for people with obesity is often ‘superficial’, but things have improved in recent years.Colin Michie, Deputy Lead, School of Medicine, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1962952022-12-15T19:07:37Z2022-12-15T19:07:37ZYour tendency to overindulge these holidays could relate to your ‘eating personality’. Which type are you?<figure><img src="https://images.theconversation.com/files/500896/original/file-20221214-17-kq7mqq.jpg?ixlib=rb-1.1.0&rect=55%2C33%2C7293%2C4241&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/santa-claus-having-delicious-snack-600w-2063217185.jpg">Shutterstock</a></span></figcaption></figure><p>Holidays are a time when lots of us tend to overindulge in food and drink, and many people <a href="https://www.nejm.org/doi/full/10.1056/nejm200003233421206">gain weight</a>. Once gained, weight is difficult to lose, and it is likely that much of the holiday weight gain will <a href="https://www.nejm.org/doi/10.1056/NEJMc1602012">stay with us</a>.</p>
<p>Overindulgence might happen for some people around relaxed and positive family gatherings, especially if COVID has limited travel and family occasions in recent years. For others, holiday gatherings hold the potential for conflict and emotional challenges and that can lead to having more to eat and drink. For some people it will be a sad and lonely period, without family or significant others around, and food might seem comforting. </p>
<p>Holiday gatherings are typically social, featuring foods that are delicious, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5687574/">energy-dense</a> and plentiful. It can be challenging to resist the temptations on offer. Yet some people overindulge, but others do not. Why? </p>
<p>Research tells us how different “eating personalities” influence our tendency to overdo it at the festive buffet. </p>
<h2>Eating personalities</h2>
<p>The various combinations of our eating behaviours (our usual ways of behaving and thinking about food) interact with each other as “eating personalities”. </p>
<p>Technically, eating personalities (or <a href="https://pubmed.ncbi.nlm.nih.gov/28043857/">eating phenotypes</a>) refer to habitual patterns of eating behaviours and thoughts that are the result of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5994376/">interactions</a> between our genetic makeup, individual characteristics and the environment. </p>
<p>Eating personalities affect how we eat (such as how fast), what we eat (healthy or unhealthy foods), how much we eat in different situations, and importantly, why we overeat. Eating personalities are apparent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8740295/">even in infants</a> and continue to evolve and change over our lifetime. They also inform how we select specific <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4267530">weight-loss strategies</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500895/original/file-20221214-22-srnvx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="cutting turkey at the table" src="https://images.theconversation.com/files/500895/original/file-20221214-22-srnvx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500895/original/file-20221214-22-srnvx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500895/original/file-20221214-22-srnvx0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500895/original/file-20221214-22-srnvx0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500895/original/file-20221214-22-srnvx0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500895/original/file-20221214-22-srnvx0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500895/original/file-20221214-22-srnvx0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">For some it’s the pudding, for others it’s the turkey that’s hard to turn down.</span>
<span class="attribution"><a class="source" href="https://images.pexels.com/photos/5848011/pexels-photo-5848011.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Our eating personalities could include: </p>
<ul>
<li><p>how we respond to prompts for overeating, such as the presence of tempting foods or drinks at a buffet lunch, and whether we sometimes lose control </p></li>
<li><p>how desirable or appealing or rewarding we find different foods or drinks. It might be a glossy chocolate cake for one person but crispy roast potatoes for another</p></li>
<li><p>whether we notice and respond to internal signals of fullness</p></li>
<li><p>our tendency to serve large portions and eat until the plate is clean</p></li>
<li><p>whether we are able to wait until we start feeling hungry again to begin eating, rather than being guided by the clock or a tempting snack</p></li>
<li><p>our capacity to stick to longer-term goals in the presence of tempting foods or drinks</p></li>
<li><p>how fast we eat and whether we tend to maintain this pace or slow down during the course of eating</p></li>
<li><p>whether we are “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137864/">emotional eaters</a>” who eat when we feel down or to celebrate success.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mukbang-eatwithme-and-eating-disorders-on-tiktok-why-online-food-consumption-videos-could-fuel-food-fixations-194809">Mukbang, #EatWithMe and eating disorders on TikTok: why online food consumption videos could fuel food fixations</a>
</strong>
</em>
</p>
<hr>
<h2>5 ideas for eating according to your personality</h2>
<p>Research <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2792381">published</a> this year, based on a randomised clinical trial with 217 adults, indicates that knowing your eating personality can help identify strategies to manage food intakes and weight. A second recent <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4267530">study of 165</a> people supports these findings. </p>
<p>Matching strategies to your particular eating personality traits could help you manage or avoid overindulgence. </p>
<p><strong>1. The overeater</strong></p>
<p>If eating when you’re not actually hungry is a component of your eating personality, improving awareness of hunger versus other triggers for eating <a href="https://uhs.berkeley.edu/sites/default/files/wellness-hungersatietyscale.pdf">when you feel full</a>, and developing skills in responding to these cues before deciding to eat, <a href="https://www.sciencedirect.com/science/article/pii/S0031938420303322">could help</a>. </p>
<p><strong>2. The food admirer and impulsive eater</strong></p>
<p>If high attraction to food is a factor, and you have difficulty resisting, acknowledging the attractiveness of food cues and practising using avoidance, distraction or resistance strategies <a href="https://www.sciencedirect.com/science/article/pii/S0031938420303322#bib0175">may be effective</a>.</p>
<p><strong>3. The emotional eater</strong></p>
<p>People who recognise they eat for emotional reasons might try <a href="https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss/art-20047342">other strategies</a> such as mindfulness, walking or listening to music to work through their feelings. </p>
<p><strong>4. The plate cleaner</strong></p>
<p>If resisting food is hard once it’s on your plate, choosing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6088523/#:%7E:text=Offering%20large%20portions%20of%20high,and%20ultimately%20positive%20energy%20balance.">smaller portions</a> could help, along with developing awareness of fullness cues, or selecting some food but saving some for later in a separate location. Some young children do this naturally, spreading holiday chocolates or treats over days or weeks. </p>
<p><strong>5. The speed eater</strong></p>
<p>If eating quickly means you tend to eat too much, pay greater attention to your <a href="https://pubmed.ncbi.nlm.nih.gov/24388483/">eating speed</a> during the meal and attempt to slow down by interspersing eating with other things like chatting or drinking water.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500889/original/file-20221214-14-lmxifa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="gingerbread men falling out of a bowl" src="https://images.theconversation.com/files/500889/original/file-20221214-14-lmxifa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500889/original/file-20221214-14-lmxifa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500889/original/file-20221214-14-lmxifa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500889/original/file-20221214-14-lmxifa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500889/original/file-20221214-14-lmxifa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500889/original/file-20221214-14-lmxifa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500889/original/file-20221214-14-lmxifa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Eating patterns and responses are highly individualised.</span>
<span class="attribution"><a class="source" href="https://images.unsplash.com/photo-1575993051801-d5a7940d78a2?ixlib=rb-4.0.3&ixid=MnwxMjA3fDB8MHxwaG90by1wYWdlfHx8fGVufDB8fHx8&auto=format&fit=crop&w=872&q=80">Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-i-work-with-people-with-eating-disorders-i-see-many-rules-around-good-and-bad-foods-but-eating-is-never-that-simple-188803">When I work with people with eating disorders, I see many rules around 'good' and 'bad' foods – but eating is never that simple</a>
</strong>
</em>
</p>
<hr>
<h2>Acknowledging the challenges</h2>
<p>It is a common experience to have tried, and sometimes failed, to temper food intakes during holiday periods and celebrations. </p>
<p>Food is a central part of holiday celebrations – it provides social and cultural connection, and is a source of enjoyment. However, if avoiding overindulgence is a priority for your <a href="https://theconversation.com/im-not-overweight-so-why-do-i-need-to-eat-healthy-foods-90436">health and wellbeing</a>, it is worth exploring your eating personality. This is a path to a better understanding of overindulgence, and possibly to strategies for moderating what you eat and how much, during the holiday period and beyond. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/step-away-from-the-table-why-you-keep-eating-when-youre-full-170649">Step away from the table – why you keep eating when you're full</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/196295/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Georgie Russell is affiliated with the Nutrition Society of Australia and the Australian and New Zealand Obesity Society. </span></em></p><p class="fine-print"><em><span>Alan Russell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Do you feel the need to clean your plate? Does a bowl of salty chips seem completely irresistible? Understanding your ‘eating personality’ could stop you eating or drinking too much these holidays.Georgie Russell, Senior Lecturer, Institute for Physical Activity and Nutrition (IPAN), Deakin UniversityAlan Russell, Emeritus Professor of Education, Flinders UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1952872022-12-13T19:52:51Z2022-12-13T19:52:51ZWhat Taylor Swift’s ‘Anti-Hero’ controversy can tell us about fatphobia in feminist politics<figure><img src="https://images.theconversation.com/files/499101/original/file-20221205-26-y57tja.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3600%2C2457&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Taylor Swift was accused of fatphobia over her 'Anti-Hero' music video.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Taylor Swift recently <a href="https://www.nbcnews.com/think/opinion/taylor-swift-should-not-remove-fatphobic-scene-anti-hero-video-rcna54617">removed a scene</a> from her music video, <a href="https://www.youtube.com/watch?v=b1kbLwvqugk"><em>Anti-Hero</em></a>, after several <a href="https://www.vice.com/en/article/gvzx94/fat-positive-activists-explain-what-its-really-like-to-be-fat">fat positivity activists</a> across social media accused the <a href="https://twitter.com/fatfabfeminist/status/1583523413221867520">scene of being fatphobic</a>. </p>
<p>In the scene, Swift’s two selves, the real her and her “anti-hero” character, are in a bathroom. As Swift’s real self stands on a weighting scale, her anti-hero persona peers downward and the word “FAT” appears on the scale. Swift’s face appears disgusted. The scene earned <a href="https://www.bbc.com/news/entertainment-arts-63414044">considerable backlash online</a>. </p>
<p>In response to the video, fat positive therapist <a href="https://twitter.com/theshirarose/status/1583500955818942470?s=20&t=c8ETpLI4xoWvF_vCOR4R0g">Shira Rosenbluth</a> posted on Twitter:</p>
<blockquote>
<p>Taylor Swift’s music video, where she looks down at the scale where it says “fat,” is a shitty way to describe her body image struggles. Fat people don’t need to have it reiterated yet again that it’s everyone’s worst nightmare to look like us.</p>
</blockquote>
<h2>White celebrity feminism</h2>
<p>As white feminist scholars committed to anti-racist and decolonial practices who work on divisions within feminist politics as they appear in art practices, this is far from an isolated incident of one artist. It reveals divisions about fat positivity within <a href="https://www.simonandschuster.ca/books/White-Feminism/Koa-Beck/9781982134426">white feminism</a>. </p>
<p>White feminism is not just an identity, it is a structure. As women’s studies scholar <a href="https://www.boldtypebooks.com/titles/kyla-schuller/the-trouble-with-white-women/9781645036883/">Kyla Schuller</a> writes, it “attracts people of all sexes, races, sexualities and class backgrounds, though straight white middle-class women have been its primary architects.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Taylor Swift wearing white on a weighting scale in a bathroom. Her alter-ego looks down at the scale." src="https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=605&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=605&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=605&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=760&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=760&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499109/original/file-20221205-21-rmkq69.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=760&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Scene from Taylor Swift’s music video ‘Anti-Hero’. The video was edited to remove the word ‘fat’ after Swift was accused of fatphobia.</span>
<span class="attribution"><a class="source" href="https://www.youtube.com/watch?v=b1kbLwvqugk">(YouTube/Taylor Swift)</a></span>
</figcaption>
</figure>
<p>Fat activists have worked to take <a href="https://www.penguinrandomhouse.ca/books/197420/fat-so-by-marilyn-wann/9780898159950">power away from the term “fat”</a> and use it as a neutral descriptor. Swift does not believe she is fat, but is illustrating internalized fatphobic messages. According to Swift, fame and public scrutiny of her body was <a href="https://www.buzzfeednews.com/article/annehelenpetersen/taylor-swift-miss-americana-disordered-eating-body-image">a major contributor to her eating disorder</a>.</p>
<p>Some have raised concerns that Swift’s removal of the scene from the video <a href="https://www.rollingstone.com/music/music-news/taylor-swift-anti-hero-video-fat-controversy-1234619554/">watered down</a> her feminist message. But how does removing the term “fat” water down a specifically feminist message unless fat is seen to be a feminist issue? </p>
<p>This suggests that fat becomes a feminist issue only in the context of the harms of eating disorders from a white woman’s perspective, within market-friendly celebrity feminism. </p>
<p>Fat activists are criticizing Swift’s video and response for reproducing a depoliticized and individualistic strain of feminism that <a href="https://theconversation.com/how-neoliberalism-colonised-feminism-and-what-you-can-do-about-it-94856">ignores the racial, colonial, ableist and socioeconomic problems</a> behind issues such as eating disorders.</p>
<p>Swift has been able to deflect criticism with the support of fans and media writers who have jumped to her defence to protect her image. </p>
<h2>Erasure of others’ experiences</h2>
<p><a href="https://twitter.com/Stoppp_looking/status/1585481003820515330?s=20&t=fnbDCVDMktV5VWSOIRbrhA">Online responses</a> to fat activist critique is telling. Swift’s defenders dismiss and demonize fat activists, aligning them with stereotypes of <a href="https://rowman.com/ISBN/9780739114872/The-Embodiment-of-Disobedience-Fat-Black-Womens-Unruly-Political-Bodies">fat women as unruly</a>. </p>
<p>As feminist scholar <a href="https://doi.org/10.1177/1367549420985852">Alison Phipps</a> argues, white feminism is an identity deeply invested in victimization, suffering and injury. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1584963631271538688"}"></div></p>
<p>Swift’s silence and her angry defenders reveal a complicity in reproducing <a href="https://nyupress.org/9781479886753/fearing-the-black-body/">white supremacist fatphobia</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A book cover featuring a naked fat black woman." src="https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=930&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=930&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=930&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1169&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1169&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498759/original/file-20221202-11-x9twvi.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1169&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Body is Not an Apology by Sonya Renee Taylor.</span>
<span class="attribution"><span class="source">(Penguin Random House)</span></span>
</figcaption>
</figure>
<p>The rhetoric erases the fatphobia experienced by <a href="https://www.marieclaire.com/celebrity/lizzo-kanye-west-body-shaming/">Black women</a> and other racialized people. As author <a href="https://www.penguinrandomhouse.com/books/565139/the-body-is-not-an-apology-second-edition-by-sonya-renee-taylor/">Sonya Renee Taylor writes</a>, “From LGBTQIA bodies, to fat bodies, to women’s bodies, we live under systems that force us to judge, devalue, and discriminate against the bodies of others.”</p>
<p>White feminism upholds the idea that <a href="https://www.publicaffairsbooks.com/titles/andi-zeisler/we-were-feminists-once/9781610397735/">feminism is about individual empowerment</a>, letting artists off the hook of answering for the injustices reiterated in their art. Moments like this come up <a href="https://theconversation.com/mask-or-no-mask-stop-using-fat-people-in-political-cartoons-176631">regularly in feminist politics</a> and rejecting a fat activist critique is a missed opportunity for coalition. It reinforces the power of white feminism to gatekeep. </p>
<h2>Feminism and eating disorders</h2>
<p>This division between feminism and fat activism often revolves around conceptualizing the harms of eating disorders. <a href="https://www.ucpress.edu/book/9780520240544/unbearable-weight">Feminists have argued that eating disorders do not exist in a social or cultural vaccuum</a>, but this argument has stopped short at fat acceptance. Fat positivity requires grappling with how our culture is obsessed with thinness, and how it reviles fatness as a way of enforcing and <a href="https://doi.org/10.18574/nyu/9780814728758.003.0007">maintaining bodily hierarchies</a>.</p>
<p>Swift’s video echoes many <a href="https://www.youtube.com/watch?v=uJOQOVAoQ9g">other white feminist artists who work out their bad body feelings in public as a way of processing harms of a negative body image</a>. </p>
<p>A running theme in Swift’s work is to <a href="https://doi.org/10.1080/07494467.2021.1976586">mock media misogyny</a>. Since distancing herself from authentic country storytelling, she has moved to a pop persona that <a href="https://doi.org/10.1080/19392397.2019.1630160">relishes in her “zany” flaws</a> and talks about the “real person” underneath the persona to remain relatable. Here, fatphobia is a personal flaw rather than a <a href="https://doi.org/10.1007/978-3-030-95935-7_6">systemic social issue</a>. </p>
<p>White feminist responses to fat activist critique reveal the limits of fat positivity in feminism. Women’s studies professor <a href="https://digitalcommons.uri.edu/jfs/vol1/iss1/13/">Talia Welsh articulates how mainstream feminism is of two minds</a>:</p>
<blockquote>
<p>[The feminist] ability to reject the demonization of fat in one context and to accept fat’s negative status in another is based in the idea that one view of fat (the bad one) arises from sexism and that the other (the good one) arises from a concern about health. It is wrong to equate a woman’s value with her looks, but it is acceptable to encourage that same woman to lose weight if it would augment her health. </p>
</blockquote>
<p>Swift’s permission to express fatphobia in terms of it being detrimental to her health upholds her victim status, thereby centring a thin woman’s pain in discussing fatphobia. </p>
<p>The message received is: feeling positive about one’s body is good, but that good has limits, it is only for those with thin bodies. </p>
<p>Swift has no doubt been the target of beauty culture’s critique, but that culture cannot be divorced from its <a href="https://nyupress.org/9781479886753/fearing-the-black-body/">capitalist, colonial and white supremacist roots</a>. In identifying fatphobia as primarily about women’s looks, Swift and others obscure the <a href="https://www.penguinrandomhouse.com/books/670607/belly-of-the-beast-by-dashaun-harrison/">structural and material oppression experienced by fat people</a></p>
<p>These divisions in feminism will continue so long as white feminism claims fatphobia as its issue to both define and individually resist.</p><img src="https://counter.theconversation.com/content/195287/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>By only discussing fatphobia in the context of eating disorders, Taylor Swift illustrates how deeply individualized and depoliticized white feminism is.Kristin Rodier, Assistant Professor of Philosophy, Athabasca UniversityHeather McLean, Assistant Professor, Environmental Studies and Human Geography, Athabasca UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1954782022-11-30T20:40:06Z2022-11-30T20:40:06ZOverweight women may be at highest risk of long COVID – new research<figure><img src="https://images.theconversation.com/files/498026/original/file-20221129-16-q5ijr9.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5237%2C3494&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pair-female-feet-standing-on-bathroom-193998131">Rostislav_Sedlacek/Shutterstock</a></span></figcaption></figure><p>While hundreds of thousands of people are still getting COVID <a href="https://www.worldometers.info/coronavirus/">every day</a> across the globe, reassuringly, the number of people dying as a result of the infection has dropped significantly thanks to effective vaccines and treatments.</p>
<p>Yet for many people, the consequences of COVID continue well beyond the initial infection, in the form of long COVID. We wanted to understand what factors might make people more or less susceptible to ongoing symptoms. In <a href="https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0001188">a new study</a> we found that women who are overweight are at highest risk of developing long COVID.</p>
<p>Long COVID can include symptoms such as fatigue, shortness of breath, palpitations, “brain fog” (for example, problems with concentration or memory) and many others. These symptoms can be debilitating and affect a person’s quality of life significantly.</p>
<p>The term long COVID <a href="https://www.nice.org.uk/guidance/ng188/resources/covid19-rapid-guideline-managing-the-longterm-effects-of-covid19-pdf-51035515742">encompasses</a> both “ongoing symptomatic COVID-19” (symptoms four to 12 weeks after infection) and “<a href="https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1">post COVID syndrome</a>” (symptoms which continue for 12 weeks or more). Our research focused on the latter.</p>
<p>We surveyed people in Norfolk, England, who had tested positive for COVID at least 12 weeks prior. From a total of 1,487 participants who completed the online questionnaire, 774 respondents (52%) said they were experiencing at least one long COVID symptom. The most commonly reported symptoms were anxiety (32%), general pain or discomfort (28%), fatigue (25%), insomnia (22%) and cognitive impairment (20%). </p>
<p>It’s possible such a large proportion of participants in our study reported long COVID symptoms partly because of a bias in the recruitment process. People with symptoms may have been more inclined to respond to the survey.</p>
<p>But the main element of our study was in comparing those who did report symptoms with those who didn’t. We explored what factors might make people more or less likely to develop long COVID by looking at participants’ medical records. We took into account factors including body mass index (BMI), sex, medication use, other health conditions, and whether the person lived in a deprived area or not.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/six-common-covid-myths-busted-by-a-virologist-and-a-public-health-expert-188396">Six common COVID myths busted by a virologist and a public health expert</a>
</strong>
</em>
</p>
<hr>
<p>We found that women and people with high BMI had an increased risk of developing long COVID compared with men and people with normal or low BMI respectively. So women with high BMI were at greatest risk.</p>
<p>We also observed a trend suggesting that older people may be more likely to get long COVID, but our study didn’t include enough patients to confirm this (we didn’t reach statistical significance). However, this observation is supported in <a href="https://www.nature.com/articles/s41467-022-30836-0">other studies</a>.</p>
<p>Other studies have similarly shown that women are <a href="https://pubmed.ncbi.nlm.nih.gov/35054108/">at greater risk</a> of developing long COVID. The reasons for this are unclear, though scientists have hypothesised that <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(21)00228-3/fulltext">female sex hormones</a> may play a role.</p>
<figure class="align-center ">
<img alt="A woman wearing a mask with a doctor." src="https://images.theconversation.com/files/498240/original/file-20221130-26-b742hb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498240/original/file-20221130-26-b742hb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498240/original/file-20221130-26-b742hb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498240/original/file-20221130-26-b742hb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498240/original/file-20221130-26-b742hb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498240/original/file-20221130-26-b742hb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498240/original/file-20221130-26-b742hb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We don’t fully understand why women are more likely to develop long COVID.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-patient-doctor-pregnancy-lab-test-1948581340">Andrey_Popov/Shutterstock</a></span>
</figcaption>
</figure>
<p>Meanwhile, research has also identified high BMI and obesity as <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(22)00127-8/fulltext">risk factors</a> for long COVID. </p>
<p>We don’t know exactly why this might be, but some have suggested that because obesity leads to more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9034853/">inflammation</a> in the body, people who are obese take longer to get rid of the virus, in turn predisposing them to long COVID. Linked to that, we know people who are obese have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711810/pdf/fnut-07-597600.pdf">weaker immune systems</a>, which not only puts them at higher risk of poor outcomes from the initial infection, but also makes clearing the virus more difficult.</p>
<h2>Protecting yourself</h2>
<p>One limitation of our study is that it was only in one area of England. More research will be needed to capture wider trends, particularly in ethnic minority groups. Our study also looked at people who developed long COVID from an infection in 2020, before COVID vaccines became available. So it would be good to replicate similar research now.</p>
<p>Recent <a href="https://www.bmj.com/content/377/bmj-2021-069676">studies</a> have actually shown that people who have been vaccinated are <a href="https://www.gov.uk/government/news/ukhsa-review-shows-vaccinated-less-likely-to-have-long-covid-than-unvaccinated">significantly less likely</a> to develop long COVID. Given this, and since COVID vaccination reduces the severity of a COVID infection in the first instance, people should go out and get vaccinated if they’re not up to date. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-cases-of-severe-long-covid-appear-to-be-dropping-and-vaccination-is-probably-key-187825">New cases of severe long COVID appear to be dropping – and vaccination is probably key</a>
</strong>
</em>
</p>
<hr>
<p>It seems almost impossible not to catch COVID nowadays, in most countries at least, given the vast majority of protective measures have gradually disappeared. But day to day, keeping <a href="https://pubmed.ncbi.nlm.nih.gov/34357885/">physically active</a> and maintaining a healthy diet before any COVID infection could also go some way to protecting against the worst and ongoing effects of the virus.</p><img src="https://counter.theconversation.com/content/195478/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new study of people in England sought to understand what factors make people more or less susceptible to developing long COVID.Vassilios Vassiliou, Professor of Cardiac Medicine, University of East AngliaVasiliki Tsampasian, Cardiology SpR & NIHR Academic Clinical Fellow, University of East AngliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1945022022-11-14T10:44:38Z2022-11-14T10:44:38ZOver 12% of South African adults have diabetes - education is critical to achieve good outcomes<figure><img src="https://images.theconversation.com/files/494927/original/file-20221112-29604-1ypgsq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Type 2 diabetes mostly affects adults of a certain age.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>Over <a href="https://www.up.ac.za/tshwane-insulin-project-tip/news/post_2937261-world-diabetes-day-up-insulin-project-acknowledges-crucial-role-of-nurses-in-managing-the-disease">12%</a> of adults in South Africa have diabetes. Since 2019, researchers at the University of Pretoria have been working on the <a href="https://www.up.ac.za/diabetes-research-centre/article/3107624/tshwane-insulin-programme-tip">Tshwane Insulin Project</a>. The project consists of delivering training workshops on comprehensive diabetes and hypertension management in primary care. The researchers also provide technical assistance to healthcare professionals to improve diabetes care. The Conversation Africa spoke to project manager Dr Patrick Ngassa Piotie about what diabetes is and why it’s so difficult to manage.</em></p>
<hr>
<h2>What is diabetes?</h2>
<p>Diabetes mellitus, or <a href="https://www.who.int/news-room/fact-sheets/detail/diabetes">diabetes</a>, refers to a group of conditions that affect how the body uses blood glucose (sugar). Diabetes occurs when the pancreas is no longer <a href="https://www.idf.org/aboutdiabetes/what-is-diabetes.html">able to make insulin</a>, or when the body cannot make good use of the insulin it produces. This leads to elevated glucose levels in the blood. Over time, high blood glucose levels cause damage to the body and the failure of various organs.</p>
<p>There are different types of diabetes. Type 2 is the most common. It accounts for 90% of all cases. With type 2, the body is still able to produce insulin but can’t use it correctly. Type 2 diabetes mostly affects adults of a certain age, who are overweight, don’t exercise, and have a family history of diabetes.</p>
<p>Type 1 diabetes can develop at any age, but it occurs most frequently in children and adolescents. With type 1 diabetes, the pancreas produces very little to no insulin. This means people who have type 1 diabetes need insulin daily to maintain blood glucose levels. </p>
<p>Lastly, there’s diabetes that occurs during pregnancy – gestational diabetes. It affects both mother and child, but usually disappears after pregnancy.</p>
<p>Pre-diabetes is a reversible condition. It happens when blood glucose levels are higher than normal, but <a href="https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444">not high enough to be called diabetes</a>. It can lead to diabetes unless measures such as lifestyle modifications are taken to prevent it.</p>
<p>The symptoms of diabetes are linked to the high levels of sugar in the blood. They include feeling tired and weak, feeling more thirsty than usual, urinating often, or losing weight without trying. Other symptoms such as blurry vision, recurring infections or slow-healing sores are signs of an advanced stage of the disease.</p>
<h2>How is it managed?</h2>
<p>This depends on the type of diabetes. For example, people with type 1 diabetes need daily insulin injections. The management of type 2 diabetes consists of adopting a healthy lifestyle including increased physical activity and healthy diet. However, type 2 diabetes is a progressive disease. This means that, as the condition progresses, people with type 2 diabetes will need oral drugs and/or insulin to keep their blood glucose levels under control.</p>
<p>Managing diabetes is not just about keeping the blood glucose levels within normal ranges. Often, people with diabetes and healthcare professionals must control the blood pressure and cholesterol levels as well. In addition, a key aspect of managing diabetes is to prevent complications by protecting target organs such as the kidneys and the heart, or the feet.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/technology-and-home-visits-can-help-south-africans-with-diabetes-cope-with-insulin-186000">Technology and home visits can help South Africans with diabetes cope with insulin</a>
</strong>
</em>
</p>
<hr>
<p>At the <a href="http://www.diabetes.up.ac.za">University of Pretoria Diabetes Research Centre</a>, we have developed an acronym that summarises our approach to good diabetes care: the <a href="https://www.up.ac.za/media/shared/856/ZP_Resources/living-with-diabetes_starting-insulin.zp225902.pdf">four “Bs” and four “Cs”</a> or 4Bs 4Cs.</p>
<p>The 4Bs are critical elements to control diabetes:</p>
<ul>
<li><p>Blood pressure control</p></li>
<li><p>Blood glucose control</p></li>
<li><p>Blood cholesterol control</p></li>
<li><p>Breathe air, don’t smoke</p></li>
</ul>
<p>The 4Cs are important tests that people with diabetes should receive every year:</p>
<ul>
<li><p>Check eyes, with a diabetic eye screening – a specific test to check for eye problems caused by diabetes</p></li>
<li><p>Check mouth, by going to the dentist</p></li>
<li><p>Check kidneys, with a laboratory test</p></li>
<li><p>Check feet, with a simple easy-to-do foot exam.</p></li>
</ul>
<p>To manage diabetes, healthcare professionals need the full participation of people with diabetes and their families. That is why it’s important that people with diabetes and their families receive <a href="https://www.semdsa.org.za/">diabetes education</a>. People with diabetes must be <a href="https://worlddiabetesday.org/about/theme/">equipped</a> with the skills to navigate self-management decisions and activities. </p>
<h2>What are the main challenges in managing the condition?</h2>
<p>In South Africa, most people with diabetes rely on the public health system for care. This system is overburdened, overstretched and under-resourced. These systemic challenges have an impact on the delivery of diabetes care, despite the availability of diabetes medication – including insulin – free of charge at primary care clinics.</p>
<p>Healthcare professionals often don’t have time for diabetes education because of long queues and congested health facilities. As a result, people with diabetes <a href="https://pubmed.ncbi.nlm.nih.gov/28156143/">don’t receive the education they need</a>. This, in turn, means people don’t have a good understanding of their condition, which affects their ability to adopt appropriate self-management behaviours, and to adhere to their medication.</p>
<p>Research conducted in South Africa has consistently shown that healthcare workers <a href="https://pubmed.ncbi.nlm.nih.gov/32242428/">don’t comply with diabetes management guidelines</a>. They also fail to implement the recommended processes of care such as measurements of body mass index, waist circumference or weight.</p>
<p>Having paper-based medical records instead of electronic medical records is an additional barrier. The medical records are often lost or misplaced. In a context where healthcare professionals rotate often between departments, it becomes difficult to preserve patient history and to ensure continuity of care. A paper-based system makes it difficult to implement structured diabetes care.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-research-shows-gaps-in-south-africas-diabetes-management-programme-160275">Our research shows gaps in South Africa's diabetes management programme</a>
</strong>
</em>
</p>
<hr>
<p>South African <a href="https://pubmed.ncbi.nlm.nih.gov/35532128/">studies</a> have found that screening for diabetes-related complications is lacking. For example, healthcare professionals are <a href="https://www.diabetessa.org.za/challenges-facing-sa-in-the-fight-against-diabetic-retinopathy/">not able to screen patients for eye problems</a> caused by diabetes. Diabetic eye screening requires a specific camera that is not available in most clinics and community health centres. </p>
<h2>How can these be addressed?</h2>
<p><a href="https://guidelines.diabetes.ca/cpg">Diabetes care</a> should be structured, evidence-based and facilitated by a multidisciplinary team trained in diabetes management.</p>
<p>South Africa’s health system should be strengthened. Investments are needed to improve the delivery of diabetes care. There is a pressing need for the continuous training of healthcare professionals in diabetes management.</p>
<p>Because of the heavy workload on primary care nurses and doctors, allied healthcare workers, community health workers and health promoters should be trained to carry out non-clinical duties like diabetes education and support.</p>
<p>The recognition and integration of diabetes educators within the public healthcare system should be a priority. This will ensure that diabetes education becomes systematic and consistent. It should be repeated at regular intervals. Families of people living with diabetes should also be involved and receive diabetes education because their support is crucial.</p>
<p>Technology, digital health solutions and telehealth can improve the delivery of quality diabetes care. Clinical information systems such as electronic medical records and electronic patient registries can have a positive impact on evidence-based diabetes care. Those systems should be introduced as a matter of urgency.</p>
<h2>What are some of the key lessons from the Tshwane Insulin Project so far?</h2>
<p>The use of digital health, enhancing the role played by community health workers and following patients proactively are some of the <a href="https://pubmed.ncbi.nlm.nih.gov/34733467/">innovations that were introduced</a>.</p>
<p>Most healthcare professionals are eager to embrace change and new knowledge. And people with diabetes and their families were appreciative of the education they were receiving. They qualified it as life changing.</p>
<p>Improving diabetes care and outcomes in South Africa will require a strong will and unwavering support from the health authorities, the introduction of clinical information systems, the use of technology and digital solutions, advocacy and accountability.</p><img src="https://counter.theconversation.com/content/194502/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrick Ngassa Piotie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Improving diabetes care in South Africa requires strong will and support from health authorities, introduction of clinical information systems, the use of technology and digital solutions.Patrick Ngassa Piotie, Project Manager, University of Pretoria Diabetes Research Centre, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1937182022-11-03T19:00:57Z2022-11-03T19:00:57ZIs child obesity really going to shorten lives?<figure><img src="https://images.theconversation.com/files/493169/original/file-20221102-12-kspvcc.jpg?ixlib=rb-1.1.0&rect=43%2C0%2C4875%2C2641&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-young-children-running-towards-camera-289559627">Shutterstock</a></span></figcaption></figure><p>Rising life expectancy is one of the great success stories. If you were born in 1870, you’d expect to live until you were 30. But if you were born today, you’d <a href="https://ourworldindata.org/life-expectancy">expect</a> to live to 72, and the UN predicts it will continue to rise to 82 years by 2100. <a href="https://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4102.0Main+Features10Mar+2011#:%7E:text=During%201881%2D1890%2C%20the%20average,83.9%20years%20for%20newborn%20girls">Australian</a> life expectancy is currently 84.</p>
<p>There is the occasional blip – world wars, famines, pandemics (even COVID seems to have knocked a year or so off life expectancy <a href="https://www.nature.com/articles/s41562-022-01450-3">globally</a>) – but over time, it just goes marching on.</p>
<p>That’s why I was surprised to read a <a href="https://hw.qld.gov.au/wp-content/uploads/2022/10/HWQld_Impact-of-Obesity-on-Life-Expectancy-in-Queensland_October-2022.pdf">report from Health and Wellbeing Queensland</a>, a government agency, suggesting life expectancy would fall by 0.6-4.1 years for children born in Queensland next year. According to the report, the problem is obesity.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1587606666631061504"}"></div></p>
<p>While being overweight and obese increases your risk of serious diseases, it doesn’t mean children born in Queensland or the rest of Australia will have a shorter life expectancy. </p>
<h2>Child obesity isn’t rising much, but we get heavier as we age</h2>
<p>The proportion of children who are obese and overweight in Australia rose very rapidly from about 1970, but <a href="https://pubmed.ncbi.nlm.nih.gov/19823187/">plateaued at about 25%</a> in the mid-1990s, and has remained thereabouts pretty much ever since. </p>
<p>But the likelihood of becoming overweight or obese increases throughout the lifespan, or at least until deep old age. So as the current crop of kids age, they get heavier. When I was 40, 55% of my cohort were overweight or obese. By the time I was 60, it was 75%.</p>
<h2>Life expectancy and obesity have both increased</h2>
<p>Obesity <a href="https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity/health-risks">increases the risk</a> of the major killer diseases: heart disease, stroke, diabetes, and cancer — and many other conditions. </p>
<p>So, the Health and Wellbeing Queensland report argues, we can expect a tsunami of obesity-related deaths in the future, even without an increase in current levels of childhood obesity.</p>
<p>At first blush, this sounds plausible.</p>
<p>But life expectancy has been increasing in countries where obesity has been increasing for decades. The obesity-related reduction in life expectancy previously <a href="https://click.endnote.com/viewer?doi=10.1155%2F2012%2F107989&token=WzMzNTQ0ODAsIjEwLjExNTUvMjAxMi8xMDc5ODkiXQ.OO78w18iQk5KASiZCC7c_gYdVUo">predicted</a> hasn’t happened. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/obesitys-paradoxical-impact-on-trends-in-life-expectancy-7981">Obesity's paradoxical impact on trends in life expectancy</a>
</strong>
</em>
</p>
<hr>
<h2>Obesity is associated with a higher risk of death but being moderately overweight isn’t</h2>
<p>A slew of <a href="https://pubmed.ncbi.nlm.nih.gov/23511854/">studies</a> involving <a href="https://pubmed.ncbi.nlm.nih.gov/23280227/">millions of people</a> have found, rather counter-intuitively, that although slightly overweight people are more likely to get heart disease and diabetes, or suffer strokes, they live longer. </p>
<p>These studies find that life expectancy is greatest at a body mass index (BMI) of about 27: pretty much in the middle of the overweight range. </p>
<p>However, obesity (BMI of 30 or more) is consistently associated with a higher risk of premature death.</p>
<figure class="align-center ">
<img alt="Woman on scales" src="https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493186/original/file-20221103-16-uevbir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Our weight tends to increase as we age.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-photo-woman-legs-stepping-on-1947168976">Shutterstock</a></span>
</figcaption>
</figure>
<h2>So what’s the problem with the report?</h2>
<p>First, the report assumes “business as usual” – that is, childhood obesity levels will remain high, and the risk of disease and death associated with a given level of fatness won’t change. </p>
<p>But business is never as usual. Medical treatments improve, diet and activity change. </p>
<p>In fact, several studies have found that the level of fatness associated with the lowest risk of death has been increasing over time.</p>
<p>One <a href="https://jamanetwork.com/journals/jama/fullarticle/2520627">Danish study</a> found that in a cohort from 1977, the lowest risk of death occurred at a BMI of 24. By 1992, it was 25, and by 2008 it was 27. This probably reflects better medical treatment of people who are overweight or obese. </p>
<p>So by the time these children reach adulthood, even if they remain obese, their chance of dying prematurely will be less than it is today.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/obesity-has-become-the-new-normal-but-its-still-a-health-risk-118829">Obesity has become the new normal but it's still a health risk</a>
</strong>
</em>
</p>
<hr>
<h2>Some data underpinning the modelling are questionable</h2>
<p>There’s a second problem with this report. To estimate how much being overweight or obese increases the risk of death, the report relies on a <a href="https://www.sciencedirect.com/science/article/pii/S0140673609603184">2009 study</a> by an Oxford University-based group called The Prospective Studies Collaboration. </p>
<p>In contrast to the studies mentioned above, this study found the risk of death was lowest at a BMI of about 23-24. </p>
<p>However, the study relied in part on self-reported height and weight, and people tend to underestimate their BMI (we all think we’re a little taller and a little leaner than we really are). </p>
<p>This bias means that in these studies based on self-report, the lowest risk of death actually occurs at a higher BMI, rather than the reported 23-24.</p>
<p>This methodological flaw (and others) have been <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/jcsm.12378?fbclid=IwAR3us6e4MNq8-tsZ3SAM1o2u_EEPlluE8x3NircHqCdKAFpjfXn_YZbngHU&">pointed out</a> in relation to a different study using a similar methodology.</p>
<p>Another issue is that as we age, the BMI associated with the lowest risk of death increases. <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30288-2/fulltext">One British study</a> found that under the age of 50, the “least lethal” BMI is about 23. By the age of 80, it is closer to 28. </p>
<p>So that as people age, higher levels of fatness carry less risk. This may be because fat provides a nutritional reserve, or cushioning from falls, or because older people get better medical care. </p>
<figure class="align-center ">
<img alt="Woman walks on trail with poles" src="https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493191/original/file-20221103-19-vkzy1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The studies on life expectancy aren’t what you’d expect.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/overweight-woman-walking-on-forest-trail-1756682804">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Separating science from activism</h2>
<p>Finally, it troubles me that the report is openly activist in its intent. </p>
<p>The executive summary states that “to build social licence” for changes such as sugar taxes and advertising bans:</p>
<blockquote>
<p>people need to accept the gravity of the situation and believe that maintaining healthy weight for children is not solely a parental responsibility.</p>
</blockquote>
<p>This conclusion is nowhere justified by this report. The report doesn’t analyse factors driving obesity at all. It merely makes a mathematical projection of life expectancy. </p>
<p>Predictions about life expectancy arise from time to time, and we should always be wary about taking them at face value. As US baseballer Yogi Berra <a href="https://www.economist.com/letters-to-the-editor-the-inbox/2007/07/15/the-perils-of-prediction-june-2nd">said</a>, “It’s tough to make predictions, especially about the future.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australia-is-dragging-its-feet-on-healthy-eating-in-5-years-weve-made-woeful-progress-192393">Australia is dragging its feet on healthy eating. In 5 years we've made woeful progress</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/193718/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Olds has received funding from the ARC and NHMRC, as well as SA Health.</span></em></p>A new report predicts child obesity could reduce Australian life expectancy by more than four years. Here’s why you should be a little skeptical.Tim Olds, Professor of Health Sciences, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1892362022-09-28T14:37:10Z2022-09-28T14:37:10ZObesity is on the rise among South African women – a risk to maternal and child health<figure><img src="https://images.theconversation.com/files/484034/original/file-20220912-12-v49dqu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Obesity in adults has <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">nearly tripled</a> between 1975 and 2016 across the world. The World Health Organization <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">estimated</a> that by 2016, about 1.9 billion adults worldwide were overweight. More than 650 million of these adults were obese. These represent about 39% and 13% of the world’s adult population, respectively. </p>
<p>Women bear a disproportionately higher burden of obesity. In 2016, it was <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">estimated</a> that 15% of the world’s women and 11% of men were obese. </p>
<p>Overweight and obesity are burgeoning health issues in sub-Saharan Africa – particularly South Africa, with a significantly high burden of overweight and obesity.</p>
<p>In our <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12601-6">recent research</a> we looked at the prevalence of overweight and obesity among women of childbearing age in South Africa. Earlier studies published in <a href="https://hsrc.ac.za/uploads/pageNews/72/SANHANES-launch%20edition%20(online%20version).pdf">2013</a>, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0107471">2014</a> and <a href="https://dhsprogram.com/pubs/pdf/FR337/FR337.pdf">2019</a> (including a government report) show the prevalence of overweight and obesity at one single point in time. But there is a dearth of studies looking at trend data on overweight and obesity prevalence among women of childbearing age, including socioeconomic determinants.</p>
<p>Obesity leads to a number of <a href="https://www.ajol.info/index.php/ijmbr/article/view/133171">maternal and child health problems</a>. These include infertility, miscarriage, babies having congenital abnormalities and other adverse obstetric outcomes. Women who are super-obese experience <a href="https://www.ajol.info/index.php/sajog/article/view/108616/98414">more pregnancy complications</a> (hypertension, pre-eclampsia and surgical complications) than those who are morbidly obese. Noncommunicable diseases associated with obesity are among the <a href="http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S0256-95742016000500013">top causes of death</a> in the country. </p>
<h2>Overweight and obesity</h2>
<p><a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12601-6">Our study</a> looked at nationally representative data on the prevalence and determinants of overweight and obesity in South African women aged 15 to 49 who were not pregnant. It covered the period 1998 to 2017.</p>
<p>The study found a rise in the prevalence of overweight (from 51.3% to 60%) and obesity (from 24.7% to 35.2%) between 1998 and 2017.</p>
<p>There are a number of factors behind the rising trend of overweight and obesity in women of childbearing age in South Africa. These include rapid economic development since the new democracy in 1994, urbanisation, and the increased number of women in the labour force. </p>
<p>Working women tend to have low-energy expending jobs. And mobility is less energy-intensive because of shorter commutes and the use of motorised transport. Long working hours make it difficult for many women to prepare healthy meals. In addition, processed food is more widely accessible. Also, the wider living environment may act as a barrier to physical activity. High crime levels in communities can lead to safety concerns that prevent women from being physically active.</p>
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Read more:
<a href="https://theconversation.com/young-women-in-soweto-say-healthy-living-is-hard-heres-why-118198">Young women in Soweto say healthy living is hard. Here's why</a>
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<p>Factors associated with being overweight and obese were: increased age; self-identifying with the black African population group; higher educational attainment; residing in an urban area; and belonging to wealthier socioeconomic quintiles. Current smokers had decreased odds of being overweight and obese.</p>
<p>The prevalence of obesity in South Africa is high relative to that documented in other countries (except for urban Egypt). Rates of overweight and obesity documented in the <a href="https://link.springer.com/content/pdf/10.1007%2Fs10995-008-0340-6.pdf">US</a>, <a href="https://www.cambridge.org/core/services/aop-cambridge-core/content/view/84DE7B5E812AA66BB028039B058C6E69/S1368980004000618a.pdf/div-class-title-anthropometry-of-women-of-childbearing-age-in-morocco-body-composition-and-prevalence-of-overweight-and-obesity-div.pdf">Morocco</a> and <a href="https://bmjopen.bmj.com/content/7/10/e017344">urban sub-Saharan Africa</a> vary between 10% and 32%. </p>
<p>Our findings show that South Africa is off-track with meeting targets it set in 2013 for reducing overweight and obesity levels. The initial goal was to get levels down <a href="https://extranet.who.int/ncdccs/Data/ZAF_B3_NCDs_STRAT_PLAN_1_29_1_3%5B2%5D.pdf">10 percentage points by 2020</a>.</p>
<p>Given that by <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12601-6">2017</a> the levels of overweight and obesity were still at 60% and 35.2%, respectively, it is clear from this research that more needs to be done. </p>
<h2>Recommendations</h2>
<p>The current tax on sugar-sweetened beverages is an example of the government’s commitment to fighting obesity in South Africa. However, the rising prevalence of overweight and obesity among women of childbearing age reported in this research means the government needs to complement this tax with other interventions. </p>
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Read more:
<a href="https://theconversation.com/new-research-shows-south-africas-levy-on-sugar-sweetened-drinks-is-having-an-impact-158320">New research shows South Africa's levy on sugar-sweetened drinks is having an impact</a>
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<p>The government should run sensitisation and awareness-raising campaigns and programmes targeting certain groups of women. There is a need to focus on women who are older, who self-identify as black African, with higher educational attainment, who live in urban areas, and who are relatively wealthy. </p>
<p>In addition, the interests of the food industry that contribute to the rise in overweight and obesity need to be regulated. And investments must be made by the government to promote healthy lifestyles and safety in urban communities. At an individual level, women need to have healthy lifestyles and be physically active. This will help to reverse or restrain the rise in overweight and obesity.</p><img src="https://counter.theconversation.com/content/189236/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mweete D. Nglazi received funding from the South African Medical Research Council (SAMRC) through its Division of Research Capacity Development under the National Health Scholarship Programme from funding received from the Public Health Enhancement Fund/South African National Department of Health. The content hereof is the author’s sole responsibility and does not necessarily represent the official views of the SAMRC. The funder had no role in writing the article.</span></em></p><p class="fine-print"><em><span>John Ele-Ojo Ataguba does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Obesity leads to a number of maternal and child health problems.Mweete D. Nglazi, PhD graduate, University of Cape TownJohn Ele-Ojo Ataguba, Senior Lecturer in the Health Economics Unit, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1887682022-09-13T15:09:04Z2022-09-13T15:09:04ZObesity costs South Africa billions. We did the sums<figure><img src="https://images.theconversation.com/files/479882/original/file-20220818-22-qz382c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Quantifying the financial costs of overweight and obesity is important for national policy. </span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Globally, it is widely <a href="https://www.mdpi.com/1660-4601/14/4/435">acknowledged</a> that obesity-related conditions and their complications add hugely to healthcare costs and productivity losses. In turn this adds a large burden on individuals, their families and on governments.</p>
<p>One estimate suggests that of the total health expenditure on the continent, <a href="https://s3-eu-west-1.amazonaws.com/wof-files/970_-_WOF_Missing_the_2025_Global_Targets_Report_ART.pdf">9% is attributed</a> to dealing with people who are overweight and obese. </p>
<p>We conducted <a href="https://www.tandfonline.com/doi/full/10.1080/16549716.2022.2045092">research</a> to calculate the cost of obesity to South Africa’s health system. Our aim was to estimate the direct healthcare costs associated with the treatment of weight-related conditions based on public-sector tariffs.</p>
<p>Based on our calculations overweight and obesity are costing South Africa’s health system R33 billion (US$1.9bn) a year. This represents 15.38% of government health expenditure and is equivalent to 0.67% of GDP. Annual per person cost of overweight and obesity is R2,769.</p>
<p>Among the most expensive conditions to manage were diabetes and cardiovascular diseases. </p>
<p>Our analysis shows that overweight and obesity impose a huge financial burden on the public healthcare system in South Africa. It suggests an urgent need for preventive, population-level interventions to reduce overweight and obesity rates. The reduction will lower the incidence, prevalence, and healthcare spending on noncommunicable diseases.</p>
<p>Quantifying the financial costs of overweight and obesity also gives national policy-makers a sense of the scale of the cost to the state, those of managing their diseases, and the costs to the community.</p>
<h2>Scale of the problem</h2>
<p>Half of all adults in South Africa are overweight (23%) or obese (27%). And the World Obesity Federation anticipates an additional 10% increase (37%) <a href="https://www.worldobesityday.org/assets/downloads/World_Obesity_Atlas_2022_WEB.pdf">in obesity among adults by 2030</a>. Overweight and obesity hugely increase the risk of noncommunicable diseases. This burden contributes to the country’s high prevalence of diabetes, or example. An estimated 11% of people older than 15 had diabetes in 2021. This is much higher than Nigeria’s prevalence of <a href="https://worldpopulationreview.com/country-rankings/diabetes-rates-by-country">4%</a>. </p>
<p>Around 12 million people suffer from weight-related diseases for which they receive treatment in the public sector. These include diabetes, hypertension, cardiovascular disease, arthritis and some cancers. </p>
<p>This does not include the numerous undiagnosed people with diabetes and hypertension who are not on treatment. Nor does it include people being treated in the private sector.</p>
<p>These noncommunicable diseases cause life-altering illness, disabilities, and premature death.</p>
<h2>What we found</h2>
<p>Our research calculated the cost of obesity starting at age 15. In doing our calculations we looked at the following: cancers , cardiovascular diseases , diabetes , musculoskeletal disorders , respiratory diseases and digestive diseases. </p>
<p>We costed each in detail and used the prevalence of those diseases to measure the cost to the system, taking account of healthcare use patterns.</p>
<p>In South Africa, the biggest share of the R33-billion (US$1.9 billion) annual cost comes from treating diabetes (R19,86-billion). Cardiovascular disease (ZAR 8,87-billion) had the second biggest share. These costs are, in turn, mainly driven by the cost of medication and hospitalisation. Diabetes and hypertension-related conditions are among South Africa’s top-ten causes of death. Digestive diseases, such as gallstones and diseases of the gallbladder, contribute the least (R395-million).</p>
<p>Diabetes (95%) and arthritis (58%) are the diseases that are mostly caused by overweight and obesity. </p>
<p>Overall, 53% of total healthcare costs of managing and treating these diseases in the public sector was attributable to the overweight and obesity problem. South Africa shares this dubious distinction with other high- and middle-income countries such as Brazil, South Korea, Thailand and Colombia. <a href="https://data.worldobesity.org/economic-impact/countries/#ZA">Our results are similar to the World Obesity Federation’s estimate of R36bn</a>.</p>
<p>We also warn that the R33-billion is an underestimation of the economic cost. We used public-sector tariffs, which we calculated as 60% of private sector costs. We also excluded costs such as clinical screening and the treatment of comorbidities, such as amputations as well as potential costs for the undiagnosed. </p>
<p>And our findings don’t include the indirect costs of productivity losses resulting from absenteeism. We also didn’t consider premature death as a result of overweight- and obesity-related diseases.</p>
<h2>Next steps</h2>
<p>Putting a health problem in monetary terms may create a sense of urgency to find ways to reduce future expenditure on the direct costs of healthcare, and to reduce future losses to the state from the consequences of illness and premature death, including the knock-on effects of worsening poverty as a result.</p>
<p>This is particularly problem in a setting such as South Africa, which already has a drastically under-resourced public-health system, <a href="https://worldpopulationreview.com/country-rankings/unemployment-by-country">shockingly high unemployment</a>, and <a href="https://www.hst.org.za/publications/South%20African%20Health%20Reviews/SAHR_NO_BlankPages_3_8_Artifacts_07052021.pdf">both under- and over-nutrition crises that are aggravated by obesogenic environments</a> and poverty-driven food choices.</p>
<p>Until now, no detailed country-specific information on the economic cost of overweight and obesity in sub-Saharan Africa has existed. Based on our research, South Africa’s burden is even higher than the African or global averages: <a href="https://www.hst.org.za/publications/South%20African%20Health%20Reviews/SAHR_NO_BlankPages_3_8_Artifacts_07052021.pdf">15.38%</a>of overall government health budget, which equates to <a href="https://www.statssa.gov.za/publications/P0441/P04414thQuarter2020.pdf">0.67%</a> of GDP.</p>
<p>Unless rapid steps are taken to decrease obesity and overweight, the health system will buckle under this strain, and the planned National Health Insurance scheme will not succeed in producing equity in health services.</p>
<p>The opportunity costs of overweight and obesity – and the diseases they often bring with them – are both personal and national. It is difficult to quantify the personal disability in monetary terms – the benefits of vastly improved quality of life are priceless.</p><img src="https://counter.theconversation.com/content/188768/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Micheal Boachie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Lowering obesity and overweight rates will lift the burden on healthcare spending.Micheal Boachie, Senior Researcher, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1846772022-07-01T11:45:46Z2022-07-01T11:45:46ZCOVID vaccines work well for people of all body weights – but underweight and obesity remain risk factors for severe disease<figure><img src="https://images.theconversation.com/files/471926/original/file-20220630-14-mct6bu.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5468%2C3653&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/jakarta-indonesiafebruary-2021-number-elderly-people-1921817720">Wulandari Wulandari/Shutterstock</a></span></figcaption></figure><p>Since the pandemic began, more than <a href="https://coronavirus.jhu.edu/map.html">6 million</a> people have died from COVID around the world. The good news is that we now have a wide range of <a href="https://www.nhs.uk/conditions/coronavirus-covid-19/self-care-and-treatments-for-coronavirus/treatments-for-coronavirus/">treatments</a> as well as highly effective <a href="https://covid19.trackvaccines.org/agency/who/">vaccines</a> which have helped reduce the number of severe COVID cases. </p>
<p>Still, <a href="https://www.nature.com/articles/s41586-020-2521-4">some people</a> are more likely to get very sick or die from COVID than others. Our research, carried out before vaccines became available, showed that <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00089-9/fulltext">obesity</a> is one of the factors that increases a person’s risk of being hospitalised or dying from COVID. We have now followed this up <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00158-9/fulltext">with a new study</a> looking at how body weight affects the uptake and effectiveness of COVID vaccines, and discovered that being underweight can also be a risk factor for severe disease.</p>
<p>Obesity is measured using the <a href="https://www.nhs.uk/conditions/obesity/#:%7E:text=For%20most%20adults%2C%20a%20BMI,means%20you're%20severely%20obese">body mass index</a> (BMI). This is calculated by dividing a person’s weight in kilograms by their height in meters, squared. A person with a BMI below 18.5 is considered underweight, in the range of 18.5–25 is considered healthy weight, above 25 is considered to be overweight, and above 30 is considered obese.</p>
<p>These early findings on the people most at risk were used to support policies that prioritised certain groups of people for vaccination. This included people with a <a href="https://www.gov.uk/government/publications/covid-19-vaccination-care-home-and-healthcare-settings-posters/covid-19-vaccination-first-phase-priority-groups">BMI of 40 or above</a>.</p>
<p>Other research from before the COVID pandemic has shown that people with obesity are <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11736-2">less likely</a> to take up seasonal flu vaccines. There’s also evidence to suggest that <a href="https://www.nature.com/articles/ijo2017131">some vaccines work less well</a> in people with obesity, although we don’t fully understand the reasons for this. </p>
<h2>What we did</h2>
<p>In our new study, published in The Lancet Diabetes & Endocrinology, we used anonymous health records from more than 9 million people aged 18 and older in England. Our data covered the period from December 8 2020 (the date the first COVID vaccine was administered in the UK) until November 17 2021. During this time, 566,461 people out of the 9 million tested positive for COVID, of which 32,808 were admitted to hospital and 14,389 died.</p>
<p>To investigate vaccine effectiveness across different body weights, we looked at the risk of severe COVID outcomes (such as hospitalisation and death) across the full BMI range. Within BMI groups, we compared people who were vaccinated with people of the same age, sex and other characteristics who hadn’t been vaccinated. </p>
<p>We found COVID vaccines were highly effective against severe outcomes in all BMI categories, especially after the second and third doses. After the second dose, vaccinated people in healthy weight, overweight or obesity groups were almost 70% less likely to be hospitalised as a result of COVID than their unvaccinated counterparts. Similarly, vaccinated people in the healthy weight, overweight and obesity groups were around 60%–74% less likely to die from COVID than unvaccinated people with the same BMI.</p>
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Read more:
<a href="https://theconversation.com/covid-vaccines-for-children-under-five-what-parents-need-to-know-183994">COVID vaccines for children under five: what parents need to know</a>
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<p>Our results indicate that COVID vaccines may be slightly less effective in people who are underweight. Vaccinated people who were underweight were around 50% less likely to be hospitalised and around 40% less likely to die than their unvaccinated counterparts. Of course, this still represents a good level of protection.</p>
<p>People who were underweight were also the least likely to get vaccinated in the first instance, and this was true across all age groups. The proportion of fully vaccinated people was highest among people who were overweight and obese. In our study, fully vaccinated meant having received two or three doses, as not everyone was eligible yet for a booster at the end of our study period.</p>
<p><strong>Uptake of vaccination by age and BMI</strong></p>
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<img alt="A chart showing the uptake of COVID vaccination by age group and BMI." src="https://images.theconversation.com/files/471616/original/file-20220629-20-x31m2v.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471616/original/file-20220629-20-x31m2v.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=326&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471616/original/file-20220629-20-x31m2v.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=326&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471616/original/file-20220629-20-x31m2v.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=326&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471616/original/file-20220629-20-x31m2v.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=410&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471616/original/file-20220629-20-x31m2v.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=410&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471616/original/file-20220629-20-x31m2v.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=410&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00158-9/fulltext">Adapted from The Lancet Diabetes & Endocrinology</a>, <span class="license">Author provided</span></span>
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<p>We also looked at the risk of severe COVID outcomes only among the people who had been vaccinated with at least one dose. Although vaccination massively reduced the likelihood of severe COVID, people who were underweight and those with obesity remained at greater risk of hospitalisation or death from COVID than people of a healthy weight. This was <a href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(21)00089-9/fulltext">also the case</a> before vaccines were rolled out.</p>
<p><strong>Risk of COVID hospitalisation and death after two vaccine doses by BMI</strong></p>
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<img alt="Two figures with curves showing the increasing risk of hospitalisation (left) and death (right) with increasing BMI, after two doses of COVID vaccine." src="https://images.theconversation.com/files/471607/original/file-20220629-12-qe8rs4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/471607/original/file-20220629-12-qe8rs4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=221&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471607/original/file-20220629-12-qe8rs4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=221&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471607/original/file-20220629-12-qe8rs4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=221&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471607/original/file-20220629-12-qe8rs4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=278&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471607/original/file-20220629-12-qe8rs4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=278&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471607/original/file-20220629-12-qe8rs4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=278&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00158-9/fulltext">Adapted from The Lancet Diabetes & Endocrinology</a>, <span class="license">Author provided</span></span>
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<p>The associations became less significant among those who had received a third dose. But as only a limited number of people were eligible for the third dose by the end of the study period, we’ll need further research to better understand the effect of boosters.</p>
<p>The data also didn’t allow us to explore any differences between the different COVID vaccines, or to assess the influence of different COVID variants.</p>
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Read more:
<a href="https://theconversation.com/inflammation-the-key-factor-that-explains-vulnerability-to-severe-covid-144768">Inflammation: the key factor that explains vulnerability to severe COVID</a>
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<p>People who have two doses of a COVID vaccine receive a high level of protection against severe outcomes, regardless of their body weight. Given the slight reduction in vaccine effectiveness in people who are underweight, targeted efforts may be needed in this group to increase vaccine uptake. </p>
<p>Even though severe outcomes were much rarer after vaccination, people in the underweight and obese groups were at significantly higher risk compared to people of a healthy weight. </p>
<p>Public health strategies to help people achieve and maintain a healthy weight have many benefits. One important one may be to help reduce the burden of severe COVID.</p><img src="https://counter.theconversation.com/content/184677/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nerys M Astbury currently receives funding from NIHR Biomedical Research Centre Oxford, NIHR School of Primary Care Research, Diabetes Research and Wellness Foundation & Diabetes UK and is currently elected as a trustee of the Association for the Study of Obesity (ASO).</span></em></p><p class="fine-print"><em><span>Carmen Piernas received funding from the NIHR Applied Research Collaborations - Oxford (UK) during the conduct of this study. She is currently a Ramon y Cajal fellow at the University of Granada (Spain), funded by the Spanish State Plan for Scientific and Technical Research and Innovation 2017-2020 (RYC2020-028818-I).
This study was supported by Health Data Research UK (HDRUK) in partnership with the Office for National Statistics and funded by UK Research and Innovation. It was also supported by the NIHR Oxford Biomedical Research Centre (BRC) and the NIHR Oxford and Thames Valley Applied Research Collaboration. </span></em></p>A new study looked at the health records of more than 9 million people in England to assess whether body weight influenced the uptake and effectiveness of COVID vaccines.Nerys M Astbury, Senior Researcher, Diet and Obesity, University of OxfordCarmen Piernas, University Research Lecturer, Nutrition, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1833472022-06-17T00:05:20Z2022-06-17T00:05:20ZFatBlaster Max has just been banned. Why? Here’s everything you need to know about diet supplements<figure><img src="https://images.theconversation.com/files/467942/original/file-20220609-14-qhuwdk.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C6006%2C3998&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Australia’s regulator has <a href="https://www.tga.gov.au/media-release/fatblaster-max-cancelled-tga-alleged-breaches-therapeutic-goods-legislation">banned FatBlaster Max</a>, an over-the-counter pill that claimed (with no evidence) to be able to help you lose weight.</p>
<p>FatBlaster Max can no longer be purchased, after the Therapeutic Goods Administration (TGA) found the company behind the pills registered the medicine with no mention of weightloss properties and failed to produce any evidence substantiating its advertised claim it led to weight loss.</p>
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<img alt="" src="https://images.theconversation.com/files/469384/original/file-20220617-23-k3i7lt.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/469384/original/file-20220617-23-k3i7lt.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=792&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469384/original/file-20220617-23-k3i7lt.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=792&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469384/original/file-20220617-23-k3i7lt.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=792&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469384/original/file-20220617-23-k3i7lt.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=995&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469384/original/file-20220617-23-k3i7lt.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=995&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469384/original/file-20220617-23-k3i7lt.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=995&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">FatBlaster Max is no longer available.</span>
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</figure>
<p>The ban has put over-the-counter weightloss pills back in the spotlight, shining light on an unregulated area that is immensely popular. <a href="https://pubmed.ncbi.nlm.nih.gov/17324663/">Studies</a> show one in seven people have tried an over-the-counter weightloss pill, undoubtedly enticed by their promises of helping people lose weight easily and rapidly.</p>
<p>But do over-the-counter weightloss pills really work? Here’s everything you need to know about the weightloss supplements currently claiming a big share of Australia’s billion-dollar weight-loss industry.</p>
<h2>What exactly are over-the-counter weightloss pills?</h2>
<p>Broadly speaking, over-the-counter pills are anything you buy from a pharmacist without a prescription, like cold and flu remedies and paracetamol. Some over-the-counter medications are also available at retailers like supermarkets, service stations and health food stores.</p>
<p>Over-the-counter weightloss pills are essentially dietary and herbal supplements marketed and sold with claims of assisting with weight loss.</p>
<p>The important distinction between over-the-counter weightloss pills and weightloss medications prescribed by a doctor is that prescription weightloss drugs – like all pharmaceutical drugs – must go through clinical trials and provide Australia’s drug regulator with evidence of their effectiveness and safety.</p>
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Read more:
<a href="https://theconversation.com/fat-blaster-drug-can-give-you-weight-loss-to-die-for-28330">'Fat blaster' drug can give you weight loss to die for</a>
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<p>Worryingly, the distributors of over-the-counter diet pills and supplements are not required to produce any evidence of their products’ efficacy and safety before they hit the <a href="https://onlinelibrary.wiley.com/doi/10.5694/j.1326-5377.2008.tb01498.x">Australian market</a>. The TGA only requires them to hold, but not necessarily make freely available, evidence substantiating their claims.</p>
<h2>How do over-the-counter weightloss pills help you lose weight?</h2>
<p>Over-the-counter weightloss pills usually claim to have several herbal or natural ingredients that help you lose weight in one of four ways:</p>
<ol>
<li><p>by suppressing your appetite or making you feel full using ingredients like a tropical fruit called <em>Garcinia cambogia</em> or glucomannan, a dietary fibre made from the root of the konjac plant</p></li>
<li><p>by speeding up your metabolism and your body’s ability to burn fat using components like the herb <em>Ephedra sinica</em> or a fatty acid (conjugated linoleic acid) found in meat and dairy products</p></li>
<li><p>by blocking your body’s ability to digest things like carbohydrates and fat using <em>Phaseolus vulgaris</em> (also known as the common bean) or a variety of green tea leaf called <em>Camellia sinensis</em></p></li>
<li><p>by absorbing fat in the foods you eat, relying on ingredients like chitosan, a product created using the shells of crustaceans and insects.</p></li>
</ol>
<h2>Do these weightloss pills work?</h2>
<p>In a word: no.</p>
<p>Most advertising for over-the-counter weightloss pills and dietary supplements will proudly claim a product’s results are backed by “clinical trials” and “scientific evidence”, but the reality is a host of independent studies don’t support these claims.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/467964/original/file-20220609-22-mr92dr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pills in woman's hand" src="https://images.theconversation.com/files/467964/original/file-20220609-22-mr92dr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467964/original/file-20220609-22-mr92dr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467964/original/file-20220609-22-mr92dr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467964/original/file-20220609-22-mr92dr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467964/original/file-20220609-22-mr92dr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467964/original/file-20220609-22-mr92dr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467964/original/file-20220609-22-mr92dr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Independent studies don’t support claims of weight loss from over-the-counter pills.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/33976376/">Two</a> recent <a href="https://pubmed.ncbi.nlm.nih.gov/31984610/">studies</a> by the University of Sydney examined data from more than 120 placebo-controlled trials of herbal and dietary supplements for weight loss, including products featuring the ingredients described above. None of the supplements provided clinically meaningful weight loss.</p>
<h2>If they don’t work, why are they allowed to be sold?</h2>
<p>Given there are few to no checks and even less accountability when compared to prescription weightloss drugs, the researchers’ findings should come as no surprise.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/31984610/">Recent studies</a> suggest weightloss supplement companies have conducted very few high-quality studies. Many trials are too small, poorly designed and don’t accurately report the composition of the supplements being investigated. This is because there are no guidelines currently covering how these types of trials should be conducted.</p>
<p>The good news is the Australian regulator is taking some action on the claims made by distributors of these weightloss supplements, with the TGA recently banning the sale of FatBlaster Max.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/science-or-snake-oil-do-the-enduring-hydroxycut-weight-loss-products-work-62492">Science or Snake Oil? Do the enduring Hydroxycut weight-loss products work?</a>
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<p>While the reality is the most likely thing to be damaged by over-the-counter weightloss pills is your hip pocket, the TGA’s action also serves as an important reminder that the <a href="https://pubmed.ncbi.nlm.nih.gov/26448674/">safety</a> of over-the-counter weightloss supplements can never be <a href="https://casereports.bmj.com/content/2015/bcr-2015-210303.abstract">guaranteed</a>. </p>
<p>Several products have been banned from sale around the world after causing serious health problems. This includes the TGA and America’s Food and Drug Administration banning dietary supplements containing <a href="https://www.nccih.nih.gov/health/ephedra">ephedra</a> in 2018, when supplements containing this stimulant herb were associated with cases of heart attack, seizure, stroke and sudden death.</p>
<p>Real harm is also caused by the over-the-counter weightloss industry feeding on people’s desire for a quick fix to achieve rapid weight loss.</p>
<p>The reality is there is no wonder pill. </p>
<p>Losing weight and achieving lasting results comes down to: following evidence-based care from health-care professionals and making meaningful changes to your diet, exercise and lifestyle that you can sustain for life.</p>
<hr>
<p>A spokesperson for FatBlaster said the company is disappointed with the TGA’s decision and it is evaluating options for next steps.</p>
<p>It said the TGA’s requirements had changed during the years that FatBlaster Max Tablets have been on the market and the company has taken great care to update all packaging, advertising and claims to ensure compliance with these requirements. </p>
<p>The listing cancellation does not impact the wider FatBlaster range.</p>
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<p><em>The original version of this article included a tweet from another media outlet that depicted an old version of the FatBlaster Max packaging.</em></p><img src="https://counter.theconversation.com/content/183347/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Nick Fuller works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program.</span></em></p>With FatBlaster Max recently banned from sale, it’s a good time to look at what diet pills actually contain, and whether they work.Nick Fuller, Charles Perkins Centre Research Program Leader, University of SydneyLicensed as Creative Commons – attribution, no derivatives.