tag:theconversation.com,2011:/au/topics/diabetes-612/articlesDiabetes – The Conversation2024-03-28T12:18:54Ztag:theconversation.com,2011:article/2232392024-03-28T12:18:54Z2024-03-28T12:18:54ZWhat is sugar and what would happen if I stopped eating it? A scientist explains<p>The world has declared a time-out on sugar consumption. The harmful link between disease and dietary sugar was recently outlined in a <a href="https://pubmed.ncbi.nlm.nih.gov/37019448/">comprehensive assessment</a> of published studies. </p>
<p>Recognising this link between widely consumed food and disease is essential in marshalling forces to <a href="https://www.who.int/tools/elena/interventions/free-sugars-adults-ncds">change harmful outcomes</a>. These include coronary heart disease, obesity, type 2 diabetes, tooth decay and some cancers. For over a decade, <a href="https://www.researchgate.net/profile/Grace-Jones-10#publications">my research</a> has focused on the mechanisms by which fructose intake plays into disease. </p>
<p>A growing number of African countries have joined the worldwide efforts to reduce sugar intake. For instance, in an attempt to address obesity, diabetes and other non-communicable diseases, South Africa introduced a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9597050/#:%7E:text=South%20Africa%20became%20the%20first,implemented%20on%201%20April%202018.&text=Referred%20to%20as%20the%20Health,billions%20of%20rands%20in%20revenues.">tax on sugar-sweetened drinks</a> in 2018. </p>
<p>It’s hard to avoid sugar when it’s become a normal part of diets and when we celebrate special times with sweet treats. But being more aware of what sugar is and how it can affect our health is the first step.</p>
<h2>What is sugar?</h2>
<p>Sugar is a class of naturally occurring sweet-tasting molecules found in fruits, vegetables, plants and the milk of mammals. It can be extracted from these natural sources and concentrated in processed foods. </p>
<p>The sweet-tasting molecules in sucrose (table sugar) are glucose and fructose. </p>
<p>Sucrose is a disaccharide. This is a molecule made of two simple sugars – glucose and fructose – in a 1:1 ratio and chemically bound. Sucrose is used in many processed foods.</p>
<p>High fructose corn syrup, also used in processed foods, is a mixture of the monosaccharides glucose and fructose. Usually the combination is 45% glucose and 55% fructose. </p>
<p>Sucrose and high fructose corn syrup are more concentrated in processed foods than in fruits and vegetables. </p>
<p>Both are considered added sugars when they are <a href="https://ift.onlinelibrary.wiley.com/doi/abs/10.1111/1541-4337.12151">added to foods and drinks</a>. Besides the sweet taste, they may be <a href="https://www.sciencedaily.com/releases/2015/08/150818131807.htm#:%7E:text=Sugar%20aids%20in%20the%20fermentation,reducing%20water%20activity%20in%20foods">added</a> for colour and texture, as a preservative or to aid fermentation. </p>
<p>There are other natural sugars found in the foods we eat. Lactose, or milk sugar, is a disaccharide made of two simple sugars – glucose and galactose – in a 1:1 ratio. It’s found in mammals’ milk and produced naturally to provide nutrition to offspring, and in other dairy products, such as cheese and ice cream. </p>
<p>Honey, made from nectar by honeybees, is primarily a mixture of glucose and fructose monosaccharides with some maltose, sucrose and other carbohydrates. Maltose, which is found in breakfast cereals and breads, is a disaccharide of two glucose molecules. </p>
<p>Naturally occurring sugars are made by plants, bees or mammals based on their needs. </p>
<p>The human body needs glucose as a fuel for every cell, especially brain cells. That’s one of the reasons why we need a stable blood glucose level throughout the day and night.</p>
<p>The way our bodies use fructose is different. It can be turned into glucose, used as fuel, or processed into fats, called triglycerides. Excessive fructose in our diets can lead to <a href="https://pubmed.ncbi.nlm.nih.gov/29408694/">increases</a> in blood triglycerides, liver fat, blood glucose, body mass index and insulin resistance (where the body cannot easily remove glucose from the bloodstream). </p>
<p>Increases in these markers can lead to an increased risk for metabolic dysfunction, type 2 diabetes and non-alcoholic fatty liver disease (or metabolic dysfunction-associated steatotic liver disease). </p>
<p>Because of the difference in how the body uses glucose and fructose, and evidence that a higher consumption of sugar leads to worse health outcomes, we must be mindful of the added sugar we eat.</p>
<h2>What would happen if we quit eating sugar?</h2>
<p>A group of scientists performed a study and published a set of research papers that detailed <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.21371">exactly what happened</a> when over 40 children (aged eight to 18) stopped eating sugar and fructose for 10 days. The participants didn’t stop eating bread, hotdogs or snacks. They stopped eating fructose. These studies found <a href="https://pubmed.ncbi.nlm.nih.gov/28579536/">significant reductions</a> in:</p>
<ul>
<li><p>newly made triglycerides (or fats)</p></li>
<li><p>fasting blood glucose</p></li>
<li><p>blood pressure</p></li>
<li><p>fat stored on organs, including the liver</p></li>
<li><p>AST, which is a marker of liver function</p></li>
<li><p>insulin resistance, as their cells were better able to remove glucose from the bloodstream</p></li>
<li><p>body mass index.</p></li>
</ul>
<p>The participants also reported feeling better and were better behaved.</p>
<p>The World Health Organization has made <a href="https://iris.who.int/bitstream/handle/10665/149782/9789241549028_eng.pdf?sequence=1">recommendations</a> for adults and children to reduce their sugar intake to about 58 grams, or 14 teaspoons, per day or between 5% and 10% of total caloric intake. </p>
<p>This is not a lot of sugar. </p>
<p>Consider that a 300ml bottle of Coca-Cola or 240ml cup of sugarcane juice contain about <a href="https://www.coca-cola.com/ke/en/brands/brand-coca-cola/product-coca-cola-original#accordion-d588759a1d-item-8b5bb499cf">30 grams</a> of sugar. One piece of mandazi, a popular deep-fried Kenyan wheat snack, has about <a href="https://www.nutritionix.com/i/nutritionix/mandazi-1-small-piece-3-diameter/5c4f552f21b2c9e80f1748f2">4 grams</a> of sugar, or about 6% of the WHO’s recommended intake contained in each small piece.</p>
<h2>What can I do to lower my sugar intake to recommended levels?</h2>
<p>First, keep track of everything you eat during a typical day, what you eat, when you eat and how much you eat. Secondly, give yourself a star for the fresh vegetables and whole fruits you eat, and identify the foods that have added sugars. </p>
<p>Now, set an attainable goal that details one thing you can change to either:</p>
<p>1) increase the whole fruits or vegetables you eat or </p>
<p>2) decrease the amount of added sugar that you eat each day. </p>
<p>This way, you can be mindful of the added sugar you consume and adjust what you eat accordingly.</p><img src="https://counter.theconversation.com/content/223239/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grace Marie Jones receives funding from The National Institutes of Health (US). </span></em></p>A higher consumption of sugar leads to worse health outcomes, so we need to be mindful of the added sugar we eat.Grace Marie Jones, Associate Professor, College of Osteopathic Medicine, Touro UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2259882024-03-20T14:18:51Z2024-03-20T14:18:51ZDehydration: how it happens, what to watch out for, what steps to take<p><em><a href="https://pubmed.ncbi.nlm.nih.gov/33636649/">Dehydration</a> is a big issue during unusually <a href="https://theconversation.com/kenyas-had-unusually-hot-weather-an-expert-unpacks-what-could-be-causing-it-224348">hot weather</a> and outbreaks of diseases such as <a href="https://theconversation.com/whats-behind-the-worldwide-shortage-of-cholera-vaccines-for-starters-theyre-only-made-by-one-company-224891">cholera</a> that lead to life-threatening diarrhoea. Anastasia Ugwuanyi is a family physician and clinical educator at the University of the Witwatersrand. We asked her four questions designed to be useful in avoiding or managing dehydration.</em></p>
<h2>What causes dehydration?</h2>
<p>Dehydration can be defined as loss of intracellular body water. To understand the causes it’s important to set out some basic information about our bodies in relation to water physiology. Water contributes 55% to 65% of total body mass. Most of this is in <a href="https://www.healthline.com/health/body-water-percentage#body-water-charts">lean tissue</a>. The other third is extracellular.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/18519109/">Dehydration</a> can be either water loss or salt and water loss. The body’s “water ecosystem” is regulated by responses to salt and water levels. Organs such as the brain, skin, gastrointestinal tract and kidneys are involved in water regulation.</p>
<p>Water in the body ecosystem is useful to maintain certain functions. These include:</p>
<ul>
<li><p>transporting nutrient, biological and chemical materials around</p></li>
<li><p>part of the support system in joints, including the spine</p></li>
<li><p>an environment for the normal chemical processes of the body to function.</p></li>
</ul>
<p>Dehydration can be caused by several factors that tilt the regulatory mechanisms to a water loss mode. These can include:</p>
<ul>
<li><p>environmental or external causes such as heat waves (climate change factors) </p></li>
<li><p>droughts and long-standing water deprivation</p></li>
<li><p>reduced fluid intake – in elderly people, children or people with certain mental health challenges</p></li>
<li><p>municipal shortages affecting availability or access to potable drinking water</p></li>
<li><p>increased fluid loss through urinating excessively such as in conditions like diabetes</p></li>
<li><p>increased loss of fluids from diarrhoea</p></li>
<li><p>increased loss of fluids from sweating or hyperventilating.</p></li>
</ul>
<h2>How do you know if you’re dehydrated?</h2>
<p>Shifts of between 5% and 10% loss of body water are symptomatic especially among very old and very young people. Signs to look out for include: headaches, fatigue or lassitude, confusion that cannot be immediately explained, a dry mouth (not immediately explainable), skin that’s dry when you pinch it and sluggish in the normal elastic return, sunken eyes and in infants sunken fontanelles, no tears when crying particularly in children, concentrated urine – deep amber to dark, and decreased frequency of urination as the body switches to conservation.</p>
<p>Other signs to watch out for include <a href="https://www.cdc.gov/disasters/extremeheat/warning.html#text">heat exhaustion symptoms</a>. These indicate that the cardiovascular system is taking a hit. Here the signs can include: cold, clammy skin; unusually heavy sweating; weak, fast pulse; dizziness; muscle cramps; nausea. </p>
<h2>What happens to your body when you’re dehydrated?</h2>
<p>Several of our body’s systems are affected by dehydration. Effects of dehydration depend on the amount of loss, and for how long one has been dehydrated.</p>
<p>What happens is also a function of the level of dehydration. <a href="https://www.msdmanuals.com/professional/pediatrics/dehydration-and-fluid-therapy-in-children/dehydration-in-children">Dehydration is classified from mild to severe depending on the percentage body weight of water lost</a>. In children and infants it’s particularly problematic because water makes up a bigger part of their body mass. </p>
<p>With a significant loss, symptoms include a drop in blood pressure that affects circulation dynamics and signs of decompensation – systems not being able to cope (think of an overheating car engine).</p>
<p>The cardiovascular system, gastro-intestinal system, renal system, central nervous system, skin and outer layer of your body, musculoskeletal system, are all adversely affected by dehydration depending on the level of total body water lost.</p>
<p>The effects of dehydration on the body can include: weight loss, constipation, delirium, renal failure, greater propensity for respiratory infections and urinary infections, hearts attacks and seizures <a href="https://pubmed.ncbi.nlm.nih.gov/16248421/#:%7E:text=Dehydration%2C%20which%20increases%20blood%20viscosity,cause%20an%20increase%20in%20viscosity.">as a result of blood thickening</a></p>
<p>These effects are all more debilitating in very old people and those with existing conditions like diabetes.</p>
<h2>How can you stop dehydration?</h2>
<p>To stop dehydration, it is important to consider every aspect of water demand and supply.</p>
<p>Environmental: Access to potable water supply always is a collective responsibility of government and the community. This can range from reporting and repairing municipality water supply leaks and breaks, to maintaining the water purification and supply distribution networks.</p>
<p>Personal: Don’t wait until you are thirsty before you drink. Thirst is your body saying you are becoming dehydrated. For every kilogram of body weight, drink about 30-35 millilitres (3 tablespoons) of water daily, especially in hot weather. </p>
<p>Be mindful of the signs of dehydration in yourself, or in the elderly, children, or incapacitated family or friends. Check that with simple steps such as <a href="https://www.rehydrate.org/ors/made-at-home.htm">replacement therapies</a> made up of water, salt and sugar. </p>
<p>Be deliberate about drinking more water during physical activity, and when ill. Every home has salt, sugar and water. Knowing how to make this or having the prepackaged oral rehydration therapy at home is essential. There are a number of good guides to <a href="https://www.cdc.gov/healthywater/pdf/global/posters/11_229310-j_ors_print-africa.pdf">making homemade salt-sugar-water solution </a> for treating dehydration before seeking medical help.</p>
<p>Create a habit of drinking water intentionally as opposed to cold drinks and beers that have water but are high in calories. These worsen dehydration.</p>
<p>Make sure you have extra fluids before, during and after exercise to maintain the right balance of water and salts during exercise.</p>
<p>Keep cool in hot weather by wearing breathable clothes, taking a swim or cooling showers if there are no water restrictions. Water jets are available in some public places to help with cooling during particularly hot weather.</p>
<p>Lastly, there are several smart devices with health apps that can assist with tracking water intake.</p><img src="https://counter.theconversation.com/content/225988/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anastasia Ugwuanyi belongs to the South African Association of Family Physicians.</span></em></p>About 60% of the human body is made up of water. Excessive water loss can be fatal.Anastasia Ugwuanyi, Senior clinical educator, department of family medicine, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2222452024-03-19T12:26:43Z2024-03-19T12:26:43ZHow much stress is too much? A psychiatrist explains the links between toxic stress and poor health − and how to get help<figure><img src="https://images.theconversation.com/files/579438/original/file-20240303-22-dk7t8p.jpg?ixlib=rb-1.1.0&rect=0%2C12%2C8348%2C5957&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Toxic stress increases the risks for obesity, diabetes, depression and other illnesses.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/depressed-man-covering-face-amidst-orange-rays-royalty-free-image/1227304528?phrase=stress+&adppopup=true">Klaus Vedfelt/Digital Vision via Getty Images</a></span></figcaption></figure><p>COVID-19 taught most people that the line between tolerable and toxic stress – defined as persistent demands that lead to disease – varies widely. But some people will age faster and die younger from toxic stressors than others. </p>
<p>So how much stress is too much, and what can you do about it?</p>
<p>I’m a <a href="https://researchdirectory.uc.edu/p/wulsinlr">psychiatrist specializing in psychosomatic medicine</a>, which is the study and treatment of people who have physical and mental illnesses. My research is focused on people who have psychological conditions and medical illnesses as well as those whose stress exacerbates their health issues.</p>
<p>I’ve spent my career studying mind-body questions and training physicians to treat mental illness in primary care settings. My <a href="https://www.cambridge.org/core/books/toxic-stress/677FA62B741540DBDB53E2F0A52A74B1">forthcoming book</a> is titled “Toxic Stress: How Stress is Killing Us and What We Can Do About It.” </p>
<p>A 2023 study of stress and aging over the life span – one of the first studies to confirm this piece of common wisdom – found that four measures of stress all speed up the pace of biological aging in midlife. It also found that persistent high stress ages people in a comparable way to the <a href="https://doi.org/10.1097/PSY.0000000000001197">effects of smoking and low socioeconomic status</a>, two well-established risk factors for accelerated aging. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/yiglpsqv5ik?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Children with alcoholic or drug-addicted parents have a greater risk of developing toxic stress.</span></figcaption>
</figure>
<h2>The difference between good stress and the toxic kind</h2>
<p>Good stress – a demand or challenge you readily cope with – is good for your health. In fact, the rhythm of these daily challenges, including feeding yourself, cleaning up messes, communicating with one another and carrying out your job, helps to regulate your stress response system and keep you fit. </p>
<p>Toxic stress, on the other hand, wears down your stress response system in ways that have lasting effects, as psychiatrist and trauma expert Bessel van der Kolk explains in his bestselling book “<a href="https://www.penguinrandomhouse.com/books/313183/the-body-%20keeps-the-score-by-bessel-van-der-kolk-md/">The Body Keeps the Score</a>.” </p>
<p>The earliest effects of toxic stress are often persistent symptoms such as headache, fatigue or abdominal pain that interfere with overall functioning. After months of initial symptoms, a full-blown illness with a life of its own – such as migraine headaches, asthma, diabetes or ulcerative colitis – may surface. </p>
<p>When we are healthy, our stress response systems are like an orchestra of organs that miraculously tune themselves and play in unison without our conscious effort – a process called self-regulation. But when we are sick, some parts of this orchestra struggle to regulate themselves, which causes a cascade of stress-related dysregulation that contributes to other conditions.</p>
<p>For instance, in the case of diabetes, the hormonal system struggles to regulate sugar. With obesity, the metabolic system has a difficult time regulating energy intake and consumption. With depression, the central nervous system develops an imbalance in its circuits and neurotransmitters that makes it difficult to regulate mood, thoughts and behaviors. </p>
<h2>‘Treating’ stress</h2>
<p>Though stress neuroscience in recent years has given researchers like me <a href="https://doi.org/10.1097/PSY.0000000000001051">new ways to measure and understand stress</a>, you may have noticed that in your doctor’s office, the management of stress isn’t typically part of your treatment plan. </p>
<p>Most doctors don’t assess the contribution of stress to a patient’s common chronic diseases such as diabetes, heart disease and obesity, partly because stress is complicated to measure and partly because it is difficult to treat. In general, doctors don’t treat what they can’t measure. </p>
<p>Stress neuroscience and epidemiology have also taught researchers recently that the chances of developing serious mental and physical illnesses in midlife rise dramatically when people are exposed to trauma or adverse events, especially during <a href="https://www.cdc.gov/violenceprevention/aces/ace-brfss.html">vulnerable periods such as childhood</a>. </p>
<p>Over the past 40 years in the U.S., the alarming rise in <a href="https://www.cdc.gov/diabetes/health-equity/diabetes-by-the-numbers.html">rates of diabetes</a>, <a href="https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf">obesity</a>, depression, PTSD, <a href="https://www.cdc.gov/nchs/products/databriefs/db433.htm">suicide</a> and addictions points to one contributing factor that these different illnesses share: toxic stress. </p>
<p>Toxic stress increases the risk for the onset, progression, complications or early death from these illnesses. </p>
<h2>Suffering from toxic stress</h2>
<p>Because the definition of toxic stress varies from one person to another, it’s hard to know how many people struggle with it. One starting point is the fact that about 16% of adults report having been exposed to <a href="https://www.cdc.gov/violenceprevention/aces/fastfact.html">four or more adverse events in childhood</a>. This is the threshold for higher risk for illnesses in adulthood.</p>
<p>Research dating back to before the COVID-19 pandemic also shows that about 19% of adults in the U.S. have <a href="https://doi.org/10.7249/TL221">four or more chronic illnesses</a>. If you have even one chronic illness, you can imagine how stressful four must be. </p>
<p>And about 12% of the U.S. population <a href="https://blogs.worldbank.org/opendata/introducing-second-edition-world-banks-global-subnational-atlas-poverty">lives in poverty</a>, the epitome of a life in which demands exceed resources every day. For instance, if a person doesn’t know how they will get to work each day, or doesn’t have a way to fix a leaking water pipe or resolve a conflict with their partner, their stress response system can never rest. One or any combination of threats may keep them on high alert or shut them down in a way that prevents them from trying to cope at all. </p>
<p>Add to these overlapping groups all those who struggle with harassing relationships, homelessness, captivity, severe loneliness, living in high-crime neighborhoods or working in or around noise or air pollution. It seems conservative to estimate that about 20% of people in the U.S. live with the effects of toxic stress.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/WuyPuH9ojCE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Exercise, meditation and a healthy diet help fight toxic stress.</span></figcaption>
</figure>
<h2>Recognizing and managing stress and its associated conditions</h2>
<p>The first step to managing stress is to recognize it and talk to your primary care clinician about it. The clinician may do an assessment involving a <a href="https://doi.org/10.1097/PSY.0000000000001051">self-reported measure of stress</a>. </p>
<p>The next step is treatment. Research shows that it is possible to retrain a dysregulated stress response system. This approach, <a href="https://lifestylemedicine.org/">called “lifestyle medicine</a>,” focuses on improving health outcomes through changing high-risk health behaviors and adopting daily habits that help the stress response system self-regulate.</p>
<p>Adopting these lifestyle changes is not quick or easy, but it works. </p>
<p>The <a href="https://www.cdc.gov/diabetes/prevention/index.html">National Diabetes Prevention Program</a>, the <a href="https://www.ornish.com/">Ornish “UnDo” heart disease program</a> and the <a href="https://www.ptsd.va.gov/understand_tx/tx_basics.asp">U.S. Department of Veterans Affairs PTSD program</a>, for example, all achieve a slowing or reversal of stress-related chronic conditions through weekly support groups and guided daily practice over six to nine months. These programs help teach people how to practice personal regimens of stress management, diet and exercise in ways that build and sustain their new habits.</p>
<p>There is now strong evidence that it is possible to treat toxic stress in ways that improve health outcomes for people with stress-related conditions. The next steps include finding ways to expand the recognition of toxic stress and, for those affected, to expand access to these new and effective approaches to treatment.</p><img src="https://counter.theconversation.com/content/222245/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lawson R. Wulsin received funding in 2010 from the Veterans Administration support a secondary analysis of data from the Framingham Heart Study, which was published and contributed in part to the substance of this article. </span></em></p>No one can escape stress, but sometimes it takes a physical and emotional toll that translates to disease and other health effects. The good news is that there are new approaches to treating it.Lawson R. Wulsin, Professor of Psychiatry and Family Medicine, University of Cincinnati Licensed as Creative Commons – attribution, no derivatives.tag: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>
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<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>
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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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<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/2239092024-03-04T13:26:22Z2024-03-04T13:26:22ZSouth Africa has more than 4 million people living with diabetes – many aren’t getting proper treatment<p>Diabetes is a chronic condition that affects how the body turns food into energy. </p>
<p>In South Africa there has been a notable <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199430/">rise in the prevalence of type 2 diabetes</a> in recent years, due to changing diets. People are consuming more processed foods, sugary drinks and high-calorie meals. </p>
<p>Other factors are the lack of physical activity and high levels of obesity. </p>
<p><a href="https://theconversation.com/over-12-of-south-african-adults-have-diabetes-education-is-critical-to-achieve-good-outcomes-194502">Type 2 diabetes</a> is the most common form, making up 90% of cases. With this type, the body produces insulin but can’t use it effectively. It typically affects overweight adults with a family history of the condition.</p>
<p>Approximately one in nine South African adults have diabetes, totalling around <a href="https://diabetesatlas.org/data/en/country/185/za.html">4.2 million individuals</a>. </p>
<p>Diabetes is also the leading cause of death <a href="https://www.statssa.gov.za/publications/P03093/P030932017.pdf">among women</a> in the country. </p>
<p>As public health specialists and clinicians focusing on diabetes, we <a href="https://www.tandfonline.com/doi/full/10.1080/16089677.2024.2311497">researched</a> the standard of primary care that people living with type 2 diabetes receive in South Africa. </p>
<p>We found that the management of diabetes falls short of optimal standards, putting individuals at risk of the many side effects associated with diabetes.</p>
<h2>What we found and why it matters</h2>
<p>We examined 479 medical records of individuals diagnosed with type 2 diabetes across 23 primary healthcare facilities in the Tshwane district of Gauteng province. </p>
<p>The majority of patients were women. Patients had been living with diabetes for an average of 5.5 years. The average age was 58 years.</p>
<p>When it comes to managing diabetes, there are targets for blood glucose, blood pressure and cholesterol. We used guidelines set out by the <a href="https://www.semdsa.org.za/for-members/guidelines">Society for Endocrinology, Metabolism and Diabetes South Africa</a> for this study. </p>
<p>Our audit found a significant number of patients with type 2 diabetes were not receiving adequate treatment. </p>
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<strong>
Read more:
<a href="https://theconversation.com/over-12-of-south-african-adults-have-diabetes-education-is-critical-to-achieve-good-outcomes-194502">Over 12% of South African adults have diabetes - education is critical to achieve good outcomes</a>
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<p>Only 23% of patients met the glucose target. This meant more than 70% of the patients were at risk of serious health complications.</p>
<p>Patients attended clinic visits regularly, yet they experienced prolonged periods of <a href="https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/hyperglycaemia-high-blood-sugar/">hyperglycaemia</a> (high blood sugar levels).</p>
<p>We also found that healthcare providers often displayed <a href="https://diabetes.medicinematters.com/quality-of-life/type-2-diabetes/tackling-clinical-inertia-the-role-of-patient-engagement/15918202">clinical inertia</a>. In other words, they failed to set targets or to initiate or adjust treatment to achieve these goals. They delayed starting or changing a patient’s treatment plan, even when it was clear the current plan wasn’t working well.</p>
<p>Factors contributing to clinical inertia included a uniform treatment approach not suited to all patients, limited treatment options and an inadequately equipped healthcare system. </p>
<p>Given the absence of comprehensive surveillance systems like <a href="https://link.springer.com/article/10.1007/s00592-020-01576-8">diabetes registries</a>, studies serve as the primary source of information regarding the implementation and quality of diabetes care in South Africa. </p>
<p>Our results aligned with various studies conducted across South Africa, including one about <a href="https://doi.org/10.1016/j.pcd.2014.05.002">a decade ago within the same district</a>.</p>
<p>A more recent study of 116,726 patients in <a href="https://doi.org/10.1016/j.pcd.2022.05.011">Cape Town</a> found three-quarters of participants had poor glycaemic control as blood sugar levels were not being managed well.</p>
<p>These consistent findings highlight the extra effort needed to overcome clinical inertia to improve diabetes care in South Africa.</p>
<h2>High cost of poor treatment</h2>
<p>For poorly managed patients, diabetes can lead to <a href="https://www.who.int/news-room/fact-sheets/detail/diabetes">severe health complications</a>, such as nerve damage, kidney issues, heart disease, stroke, vision impairment and mental health disorders.</p>
<p>For society as a whole, suboptimal diabetes care places a strain on the healthcare system and contributes to higher healthcare costs. </p>
<p>Another consequence is <a href="https://link.springer.com/article/10.1007/s11892-019-1124-7">loss of productivity</a> due to absenteeism from work and even disability, which has an <a href="http://www.samj.org.za/index.php/samj/article/view/13330/9830">economic impact on the country</a>.</p>
<h2>Ways forward</h2>
<p>Monitoring the quality of diabetes care and evaluating the effectiveness of therapies and treatment in clinical practice is a challenge in South Africa. </p>
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Read more:
<a href="https://theconversation.com/diabetes-is-a-ticking-time-bomb-in-sub-saharan-africa-149766">Diabetes is a ticking time bomb in sub-Saharan Africa</a>
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<p>New strategies could include: </p>
<ul>
<li><p>adopting individualised patient-centred management with access to a wider choice of glucose-lowering drugs </p></li>
<li><p>addressing clinical inertia and the failure to intensify therapy when indicated </p></li>
<li><p>building a health system that caters for the needs of South Africans with diabetes.</p></li>
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<p>Inadequate treatment for the country’s many people living with diabetes has devastating consequences, not just for individuals and their families, but for the country’s health system at large.</p><img src="https://counter.theconversation.com/content/223909/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Rheeder received research funding from Eli Lilly Global health partnerships (2019-2023)</span></em></p><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>Healthcare workers in South Africa aren’t always well equipped to treat diabetes. This has devastating consequences for patients.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/2153112024-02-09T16:50:23Z2024-02-09T16:50:23ZYour unique smell can provide clues about how healthy you are<figure><img src="https://images.theconversation.com/files/574043/original/file-20240207-19-o4ehc8.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5291%2C3516&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/happy-calm-teen-girl-enjoying-good-1325627765">fizkes/Shutterstock</a></span></figcaption></figure><p>Hundreds of chemicals stream from our bodies into the air every second. These chemicals release into the air easily as they have high vapour pressures, meaning they boil and turn into gases at room temperature. They give clues about who we are, and how healthy we are. </p>
<p>Since ancient Greek times, we’ve known that we smell differently when we are unwell. While we rely on blood analysis today, ancient Greek physicians used smell to diagnose maladies. If they took a whiff of your breath and described it as <em>fetor hepaticus</em> (meaning bad liver), it meant you could be headed for liver failure.</p>
<p>If a person’s whiff was sweet or fruity, physicians thought this meant that sugars in the digestive system were not being broken down, and that person had probably diabetes. Science has since shown the ancient Greeks were right – liver failure and <a href="https://tisserandinstitute.org/human-volatilome/">diabetes</a> and many <a href="https://link.springer.com/article/10.1007/s00216-023-04986-z">other diseases</a> including infectious diseases give your breath a distinctive smell.</p>
<p>In 1971, <a href="https://www.nobelprize.org/prizes/peace/1962/pauling/facts/">Nobel Laureate chemist Linus Pauling</a> <a href="https://edu.rsc.org/feature/breath-analysis/2020106.article#:%7E:text=The%20'modern%20era'%20of%20breath,in%20an%20average%20breath%20sample.">counted 250 different</a> gaseous chemicals in breath. These gaseous chemicals are called volatile organic compounds or VOCs. </p>
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<p>Since Pauling’s discovery, other scientists have <a href="https://link.springer.com/article/10.1007/s40291-023-00640-7">discovered hundreds more VOCs</a> in our breath. We have learned that many of these VOCs have distinctive odours, but some have no odour that our noses can perceive. </p>
<p>Scientists believe that whether a VOC <a href="https://tisserandinstitute.org/human-volatilome/">has an odour</a> that our noses can detect or not, they can reveal information about how healthy someone is.</p>
<p>A Scottish man’s Parkinson’s disease onset was <a href="https://www.bbc.co.uk/news/uk-scotland-47627179">identified by his wife</a>, retired nurse Joy Milner, after she was convinced the way he smelled had changed, years before he was diagnosed in 2005. This discovery has <a href="https://www.manchester.ac.uk/discover/news/smell-of-skin-could-lead-to-early-diagnosis-for-parkinsons/">led to research programmes</a> involving Joy Milner to identify <a href="https://www.scientificamerican.com/article/a-supersmeller-can-detect-the-scent-of-parkinsons-leading-to-an-experimental-test-for-the-illness/">the precise smell</a> of this disease. </p>
<p>Dogs can <a href="https://www.nature.com/articles/d41586-022-01629-8">sniff out more diseases</a> than humans because of their more <a href="https://www.understandinganimalresearch.org.uk/news/the-science-of-sniffs-disease-smelling-dogs%20-%20I%20think%20the%20previous%20nature%20link%20has%20more%20credibility%20for%20here%20also">sophisticated olfactory talents</a>. But technological techniques, like <a href="https://www.britannica.com/science/mass-spectrometry">analytical tool mass spectrometry</a>, picks up even more subtle changes in VOC profiles that are being linked to <a href="https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(20)30100-6/fulltext">gut</a>, <a href="https://www-sciencedirect-com.dcu.idm.oclc.org/science/article/pii/S0165993618305168">skin</a> and <a href="https://err.ersjournals.com/content/28/152/190011">respiratory</a> diseases as well as neurological diseases like Parkinson’s. Researchers believe that one day some diseases will be diagnosed simply by breathing into a device. </p>
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<h2>Where do VOCs come from?</h2>
<p>Breath is not the only source of VOCs in the body. They are also emitted from skin, urine and faeces. </p>
<p>VOCs from skin are the result of millions of skin glands removing metabolic waste from the body, as well as waste generated by bacteria and other microbes that live on our skin. Sweating produces extra nutrients for these bacteria to metabolise which can result in particularly odorous VOCs. Odour from sweat only makes up a fraction of the scents from VOCs though.</p>
<p><a href="https://www.nature.com/articles/nrmicro.2017.157">Our skin</a> and also our gut microbiomes are made up from a delicate balance of these microbes. Scientists think <a href="https://journals.lww.com/co-gastroenterology/abstract/2015/01000/the_gut_microbiome_in_health_and_in_disease.12.aspx">they influence our health</a>, but we don’t yet understand a lot about how this relationship works. </p>
<p>Unlike the gut, the skin is relatively easy to study – you can collect skin samples from living humans without having to go deep into the body. <a href="https://www-sciencedirect-com.dcu.idm.oclc.org/science/article/pii/S1471492221002087">Scientists think</a> skin VOCs can offer insights into how the microbiome’s bacteria and the human body work together to maintain our health and protect us from disease.</p>
<p>In my team’s laboratory, <a href="https://iopscience.iop.org/article/10.1088/1752-7163/abf20a">we are investigating</a> whether the skin VOC signature can reveal different attributes of the person it belongs to. These signals in skin VOC signatures are probably how dogs distinguish between people by smell. </p>
<p>We are at a relatively early stage in this research area but we have shown that you can tell males from females based on how acidic the VOCs from skin are. We use mass spectrometry to see this as the average human nose is not sophisticated enough to detect these VOCs. </p>
<p>We can also predict a person’s age with reasonable accuracy to within a few years from their skin VOC profile. This is not surprising considering that oxidative stress in our bodies increases as we age.</p>
<p><a href="https://www.metabolismjournal.com/article/S0026-0495(00)80077-3/pdf">Oxidative stress</a> happens when your antioxidant levels are low and causes irreversible damage to our cells and organs. <a href="https://pubs.acs.org/doi/10.1021/jasms.3c00315">Our recent research</a> found by-products of this oxidative damage in skin VOC profiles. </p>
<p>Not only are these VOCs responsible for personal scent – they are used by plants, insects and animals as a communication channel. Plants are in a <a href="https://www.nature.com/articles/s41598-017-10975-x">constant VOC dialogue</a> with other organisms including pollinators, herbivores, other plants and their natural enemies such as harmful bacteria and insects. VOCs used for this back and forth dialogue are known as pheromones. </p>
<h2>What has science shown about love pheromones?</h2>
<p>In the animal kingdom, there is good evidence VOCs can act as aphrodisiacs. Mice for example have microbes which contribute to a particularly <a href="https://www.sciencedirect.com/science/article/pii/S0960982212012687">smelly compound called trimethylamine</a>, which allows mice to verify the species of a potential mate. <a href="https://www.sciencedirect.com/science/article/abs/pii/S0093691X21003083">Pigs</a> and <a href="https://www.nature.com/articles/4381097a">elephants</a> have sex pheromones too. </p>
<p>It is possible that humans also produce VOCs for attracting the perfect mate. Scientists have yet to fully decode skin – or other VOCs that are released from our bodies. But evidence for human love pheromones so far is <a href="https://www.science.org/content/article/do-human-pheromones-actually-exist">controversial at best</a>. <a href="https://www.newscientist.com/article/dn3835-colour-vision-ended-human-pheromone-use/">One theory suggests</a> that they were lost about 23 million years ago when primates developed full colour vision and started relying on their enhanced vision to choose a mate.</p>
<p>However, we believe that whether human pheromones exist or not, skin VOCs can reveal who and how we are, in terms of things like ageing, nutrition and fitness, fertility and even stress levels. This signature probably contains markers we can use to monitor our health and diagnose disease.</p><img src="https://counter.theconversation.com/content/215311/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aoife Morrin receives funding from Science Foundation Ireland.</span></em></p>The science of smell is an exciting area of research.Aoife Morrin, Associate Professor of Analytical Chemistry, Dublin City UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2145432024-02-08T13:38:26Z2024-02-08T13:38:26ZBreastfeeding benefits mothers as much as babies, but public health messaging often only tells half of the story<figure><img src="https://images.theconversation.com/files/558172/original/file-20231107-19-cjfj8i.jpg?ixlib=rb-1.1.0&rect=23%2C23%2C7961%2C5303&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Breastfeeding lowers the risk of diabetes as well as breast and ovarian cancers for mothers.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/smiling-mom-holding-her-baby-boy-in-her-arms-while-royalty-free-image/1370476365?phrase=black+mothers+breastfeeding&adppopup=true">Goodboy Picture Company/E+ via Getty Images</a></span></figcaption></figure><p>Four babies are born <a href="https://www.theworldcounts.com/populations/world/births">every second in the world</a>, and there are only two options for their first food at birth: human milk or formula. </p>
<p>Global and U.S. health authorities agree, however, that human milk provides the optimal nutrition for infants. The World Health Organization and the American Academy of Pediatrics <a href="https://www.who.int/health-topics/breastfeeding#tab=tab_2">recommend exclusive breastfeeding</a> for the <a href="https://doi.org/10.1542/peds.2022-057988">first six months of an infant’s life</a>. Following the introduction of solid foods, these organizations recommend continued breastfeeding up to two years and beyond. </p>
<p>Human milk can be given to infants directly through breastfeeding or by pumping or expressing human milk into a cup or bottle. The health benefits of breastfeeding and human milk for infants stem from its composition, which includes <a href="https://www.aap.org/en/patient-care/newborn-and-infant-nutrition/newborn-and-infant-breastfeeding/">vitamins, minerals and antibodies</a> that can prompt its composition to change over time to meet the growing infant’s needs. The dynamic nature of human milk leads to commonly known benefits, such as <a href="https://doi.org/10.1111/apa.13151">lower risks of ear</a> and <a href="https://doi.org/10.1111/apt.14291">gastrointestinal infections among infants</a> who are breastfed. </p>
<p>However, there are other benefits for infants that many people aren’t aware of, as well as for the breastfeeding mother and society.</p>
<p>We are women’s health scholars with combined professional expertise in <a href="https://sc.edu/study/colleges_schools/nursing/faculty-staff/riversj.php">maternal obstetrics nursing</a> and <a href="https://sc.edu/study/colleges_schools/nursing/faculty-staff/feldert.php">public health</a>. Together, we co-founded <a href="https://www.instagram.com/mochamamasmilk/">Mocha Mamas Milk</a>, a research and support initiative focused on improving <a href="https://doi.org/10.1177/01939459211045431">breastfeeding among Black families in South Carolina</a>, a <a href="https://www.cdc.gov/mmwr/volumes/66/wr/mm6627a3.htm">state where just 55.1% of Black infants are breastfed</a>, compared with 75.2% of white infants. </p>
<p>Human milk is personalized medicine that can benefit both the mother and infant. We are personally and professionally passionate about this because many people are not aware that some of these benefits can save lives and reduce persistent health disparities.</p>
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<figcaption><span class="caption">Breast milk provides benefits to the infant that no other food source can.</span></figcaption>
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<h2>Lesser-known benefits of breastfeeding for infants</h2>
<p>One significant benefit of breastfeeding not widely known by the public is its ability to lower the risk of <a href="https://www.childrenshospital.org/conditions/sudden-infant-death-syndrome-sids#">sudden infant death syndrome</a>, or SIDS. SIDS, sometimes referred to as “crib death,” is the unexplained death of a baby, usually under 1 year of age. </p>
<p>Some risk factors include stomach- or side-lying sleep, low birth weight, sleeping on a soft surface or overheating. A large analysis of studies found that infants who received any human milk for at least two months had nearly a <a href="https://doi.org/10.1542/peds.2017-1324">50% lower risk of SIDS</a>. </p>
<p>This reduction is notable for two reasons. First, the reduction in risk occurs about 60 days following birth, which is several months before the six-month exclusive breastfeeding guideline is met. Second, the protection from SIDS was the same for infants who were exclusively breastfed compared to infants who may have received formula in addition to any breastfeeding. </p>
<p>In addition, breastfeeding can <a href="https://doi.org/10.1016%2Fj.pcl.2012.09.008">significantly protect premature infants</a> – those <a href="https://www.who.int/news-room/fact-sheets/detail/preterm-birth">born before 37 weeks of pregnancy</a> – from developing a condition called <a href="https://www.ncbi.nlm.nih.gov/books/NBK513357/#">necrotizing enterocolitis</a>, an inflammation of the intestines that <a href="https://doi.org/10.3390/nu12051322">can be fatal</a>. While this condition is rare in full-term infants, it <a href="https://doi.org/10.1097%2FNNR.0000000000000483">occurs in 5% to 15% of preterm infants</a>.</p>
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<h2>Benefits for mom, too</h2>
<p>Breastfeeding also provides important benefits for the mother, such as reducing <a href="https://doi.org/10.1001/jama.294.20.2601">risks of diabetes</a> and <a href="https://doi.org/10.1016/s0140-6736(02)09454-0">breast</a> and <a href="https://doi.org/10.1001/jamaoncol.2020.0421">ovarian cancers</a>. Breastfeeding for any length of time compared to never is associated with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855244">10% decrease in hormone receptor-negative breast cancers</a>, which are more common in younger women. These cancers cannot be treated with hormonal therapy and <a href="https://www.cancer.org/cancer/types/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-hormone-receptor-status.html">often grow faster</a> than the more commonly diagnosed hormone receptor-positive breast cancers. </p>
<p>The reduction in risk from breastfeeding is even greater for Black women, who are more likely to be diagnosed with these hormone receptor-negative breast cancers and <a href="https://doi.org/10.1158/1055-9965.EPI-20-1784">have worse prognoses and fewer treatment options</a>. Any way of reducing the risk for Black women is critically important because, compared to white women, Black women are 40% more likely to die from breast cancer, <a href="https://www.cancer.org/research/acs-research-news/breast-cancer-death-rates-are-highest-for-black-women-again.html">yet 4% less likely to be diagnosed </a> with the disease.</p>
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<figcaption><span class="caption">Tisha Felder explains the vision behind Mocha Mamas Milk to help improve the way that Black mothers think about breastfeeding. Figures presented in the 2021 film were from the National Immunization Survey, 2011–2015.</span></figcaption>
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<p>There is also growing research suggesting the positive impact of breastfeeding on a mother’s mental health. One possible reason for this is that <a href="https://www.yourhormones.info/hormones/oxytocin/">oxytocin</a> – often <a href="https://www.health.harvard.edu/mind-and-mood/oxytocin-the-love-hormone">called the “love hormone” because of its association with bonding</a> – plays a <a href="https://doi.org/10.1016%2Fj.ijnss.2019.09.009">role in the maternal-infant bonding process</a>. </p>
<p>After delivery, the release of oxytocin causes human milk to flow – a process called the <a href="https://www.ncbi.nlm.nih.gov/books/NBK148970/#">letdown reflex</a> – and initiate breastfeeding. This release of milk can satisfy the new baby and leave the mom with “warm and fuzzy” feelings toward her baby. Research also suggests that breastfeeding can <a href="https://doi.org/10.1017/s0033291713001530">reduce the risk of depression </a>. A 2021 study also found that the longer a woman breastfed, <a href="https://doi.org/10.1111/phn.12969">the lower her risk for postpartum depression</a>. </p>
<h2>Closing racial gaps</h2>
<p>Despite the benefits of breastfeeding to both infants and mothers, few U.S. families are able to sustain breastfeeding over time. The Centers for Disease Control and Prevention 2022 Breastfeeding Report Card – the latest data that is currently available – shows that more than 80% of infants start out receiving human milk, yet just over a quarter of them <a href="https://www.cdc.gov/breastfeeding/pdf/2022-Breastfeeding-Report-Card-H.pdf">are exclusively breastfed through six months</a>.</p>
<p>Black infant-mother pairs not only have the lowest breastfeeding rates in South Carolina, but they also have the lowest rates nationally, compared to other U.S. racial and ethnic groups. More recent data from the National Vital Statistics System of U.S. infants born in 2020 and 2021, shows that <a href="https://www.cdc.gov/pcd/issues/2023/23_0199.htm">only 74.5% of Black infants were breastfed</a>, compared with non-Hispanic Asian infants (90.1%), non-Hispanic white infants (84.0%) and Hispanic infants (86.8%), based on analysis of birth records collected by the CDC. </p>
<p>Black infants are also more likely <a href="https://www.ncbi.nlm.nih.gov/books/NBK513376/">to die from SIDS</a> and to be born prematurely. So <a href="https://www.contemporarypediatrics.com/view/breastfeeding-least-2-months-provides-sids-protection">increasing breastfeeding among Black families</a> could lead to saving significantly more Black infant lives. </p>
<p>The Southeast U.S. is where the <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7021a1.htm?s_cid=mm7021a1_w">widest racial gaps in breastfeeding exist</a>. In addition, infants living in Southern states are <a href="https://doi.org/10.1038%2Fs41372-022-01535-x">less likely to achieve national goals for breastfeeding</a> at 6 or 12 months old compared to infants living in other regions of the country.</p>
<h2>Removing barriers to breastfeeding</h2>
<p>Reducing barriers is critical to closing racial and geographic gaps in breastfeeding and allowing U.S. mothers and their infants the opportunity to benefit from the life-saving qualities of human milk. Studies show that addressing work-related barriers by making investments in paid family leave, for example, could <a href="https://doi.org/10.1016/j.ehb.2023.101308">increase exclusive breastfeeding rates by 15%</a>. </p>
<p>The U.S. is one of the only countries in the world that <a href="https://www.worldpolicycenter.org/policies/is-paid-leave-available-for-both-parents-of-infants">does not provide national paid family leave</a>. </p>
<p>Workplaces that support breastfeeding breaks and provide safe and clean spaces for expressing and storing human milk are also <a href="https://www.unicef.org/sites/default/files/2019-07/UNICEF-policy-brief-family-friendly-policies-2019.pdf">important in promoting breastfeeding</a>. Given that U.S. women’s labor force participation rates are <a href="https://www.bls.gov/opub/ted/2023/labor-force-participation-rate-for-people-ages-25-to-54-in-may-2023-highest-since-january-2007.htm">at a record high</a>, the importance of reducing barriers in the workplace cannot be overstated.</p>
<p>The U.S. Agency for International Development estimates that every U.S. dollar invested in breastfeeding <a href="https://www.usaid.gov/global-health/resources/fact-sheets/breastfeeding#">yields $35 in economic returns</a>.</p>
<p>Societal investments in breastfeeding-friendly workplace policies will not only yield cost savings and extend breastfeeding rates, but they will shift the burden of breastfeeding from simply being an individual choice to being a public health priority.</p><img src="https://counter.theconversation.com/content/214543/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tisha Felder receives funding from the Patient Centered Research Outcomes Institute (PCORI) and National Institutes of Health (NIH).</span></em></p><p class="fine-print"><em><span>Joynelle Jackson receives funding from Patient Centered Research Outcomes Institute (PCORI). </span></em></p>Some states, especially in the Southeastern US, have large disparities in breastfeeding among racial groups, making clear the need to lower barriers for breastfeeding in the workplace and elsewhere.Tisha Felder, Associate Professor of Behavioral Sciences, University of South CarolinaJoynelle Jackson, Associate Professor of Nursing, University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2219502024-01-26T17:58:04Z2024-01-26T17:58:04ZIs diabetes remission really as hard to achieve as a new study suggests?<figure><img src="https://images.theconversation.com/files/571619/original/file-20240126-23-wfibhz.jpg?ixlib=rb-1.1.0&rect=50%2C70%2C6710%2C4267&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/world-diabetes-day-awareness-concept-diabetic-1832275786">siam pukkato/Shutterstock</a></span></figcaption></figure><p>In 2017, a <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33102-1/fulltext">landmark study</a> was published in The Lancet showing that type 2 diabetes could be reversed by diet alone. </p>
<p>The <a href="https://www.directclinicaltrial.org.uk/">Direct study</a>, as it is known, seemed to change everything. With an intensive weight-loss programme and support throughout the study, 46% of participants were able to put their diabetes in remission after one year. </p>
<p>This has led to <a href="https://www.england.nhs.uk/diabetes/treatment-care/low-calorie-diets/">“path to remission”</a> diabetes remission programmes being rolled out across the NHS. But how likely is it that this treatment will work outside of the carefully controlled environment of a clinical trial?</p>
<p>A new study from <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004327">Hong Kong</a> suggests that remission of type 2 diabetes is far less common in the real world. This led to headlines suggesting remission from type 2 diabetes was rare (occurring in 6% of people in the study), and expert media comments that it was <a href="https://www.healthline.com/health-news/only-6-of-people-can-achieve-type-2-diabetes-remission-via-weight-loss">“a little bit depressing”</a>.</p>
<p>We have known about cases of type 2 diabetes going into remission, or glucose levels going back to normal, since <a href="https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/572819">the 1960s</a>. These observations were first made decades before the first internationally agreed definition of what remission is. </p>
<h2>Remission finally defined</h2>
<p>In 2021, type 2 diabetes remission was defined as an HbA1c (a measure of average glucose levels in blood over two to three months) of <a href="https://www.diabetes.org.uk/about-us/news-and-views/remission-new-definition">less than 48 mmol/mol or 6.5%</a> for at least three months without taking any diabetes drugs. </p>
<p>So, is it true that this method of achieving remission is less likely in the messy world outside of clinical trials where people aren’t carefully selected for likeness to each other and where researchers aren’t fussing over participants? </p>
<p>It seems that remission may be harder to attain and sustain in the real-world setting, but the news is perhaps not quite as gloomy as the Hong Kong study suggests. </p>
<p>Also, it might depend on how patients are cared for in the real world. For example, Dr David Unwin, a UK-based GP, has helped <a href="https://nutrition.bmj.com/content/6/1/46">20% of his type 2 diabetes patients</a> achieve remission by advising them on the type of low-carbohydrate diet to follow and offering one-to-one support over the phone.</p>
<p>It should be noted, though, that achieving remission is <a href="https://onlinelibrary.wiley.com/doi/10.1111/jhn.12938">easier for some</a>, namely men, people who lose more than 15kg of body weight, and people who have been diagnosed with type 2 diabetes fairly recently. However, this shouldn’t discourage people who don’t meet these criteria. Any weight loss and improvement in diabetes control will improve a person’s health and should always be encouraged.</p>
<p>And weight loss doesn’t have to be achieved through something as radical as the “total diet replacement” – usually milkshakes – that many clinical trials use. <a href="https://onlinelibrary.wiley.com/doi/10.1111/jhn.12938">Our review </a> found that it is possible to achieve remission with low carbohydrate diets, and, to a lesser extent, with Mediterranean and vegan diets. </p>
<p>The key is to find a diet that people will stick with in the long run.</p>
<figure class="align-center ">
<img alt="Greek salad" src="https://images.theconversation.com/files/571623/original/file-20240126-31-76fn8s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571623/original/file-20240126-31-76fn8s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571623/original/file-20240126-31-76fn8s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571623/original/file-20240126-31-76fn8s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571623/original/file-20240126-31-76fn8s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571623/original/file-20240126-31-76fn8s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571623/original/file-20240126-31-76fn8s.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 for remission doesn’t have to be meal-replacement drinks.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/caprese-italian-mediterranean-salad-tomato-mozzarella-291753935">Marian Weyo/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Why the Hong Kong patients failed</h2>
<p>Unlike the Direct trial and the previously mentioned UK GP’s programme, the Hong Kong data was not a programme aimed at achieving remission. And, of course, you are unlikely to achieve something if you do not plan to do it.</p>
<p>Changing diet and lifestyle in a supportive environment could have been what was missing in the Hong Kong study. The researchers only reported data on clinical checks that the people with type 2 diabetes had.</p>
<p>The chances of remission are increased in people who lose a substantial <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9284579/">amount of weight</a>, whether through <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8311476/">bariatric surgery</a> or <a href="https://onlinelibrary.wiley.com/doi/10.1111/jhn.12938">diet</a>. These interventions were not supported and were therefore uncommon in the Hong Kong data.</p>
<p>If this new study proves one thing, it’s that it’s not enough to merely monitor people with type 2 diabetes. To achieve remission, they need advice, support and encouragement – both initially and in the long term.</p><img src="https://counter.theconversation.com/content/221950/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Duane Mellor is a member of the British Dietetic Association, including membership of the Diabetes Specialist Interest Group committeee and Professional Committee. </span></em></p><p class="fine-print"><em><span>Srikanth Bellary has received honoraria and speaker fees from Astrazeneca, Eli Lilly, Boehringer Ingelheim.</span></em></p><p class="fine-print"><em><span>Craig 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>A new study from Hong Kong shows that reversing type 2 diabetes is much harder than clinical trials suggest. However, all is not lost.Duane Mellor, Lead for Evidence-Based Medicine and Nutrition, Aston Medical School, Aston UniversityCraig Russell, Lecturer, Pharmacy, Aston UniversitySrikanth Bellary, Clinical Associate Professor, Diabetes and Endocrinology, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2207562024-01-09T20:18:23Z2024-01-09T20:18:23ZWhy don’t fruit bats get diabetes? New understanding of how they’ve adapted to a high-sugar diet could lead to treatments for people<figure><img src="https://images.theconversation.com/files/568452/original/file-20240109-23-jjo6l0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2376%2C1442&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fruit bats have honed their sweet tooth through adaptive evolution.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/fruit-bat-feeding-in-a-tree-royalty-free-image/1293525000">Keith Rose/iStock via Getty Images Plus</a></span></figcaption></figure><p>People around the world eat too much sugar. When the body is unable to process sugar effectively, leading to excess glucose in the blood, this can result in diabetes. According to the World Health Organization, diabetes became the <a href="https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death">ninth leading cause of death</a> in 2019.</p>
<p>Humans are not the only mammals that love sugar. Fruit bats do, too, eating up to <a href="https://dem.ri.gov/sites/g/files/xkgbur861/files/programs/bnatres/fishwild/outreach/critter-kits/bat-ex-benefits.pdf">twice their body weight</a> in sugary fruit a day. However, unlike humans, fruit bats thrive on a sugar-rich diet. They can <a href="https://doi.org/10.1007/s00360-019-01242-8">lower their blood sugar faster</a> than bats that rely on insects as their main food source.</p>
<p>We are a team of <a href="https://www.menlo.edu/about/find-an-expert/wei-gordon/">biologists</a> and <a href="https://scholar.google.com/citations?user=kkrPGvcAAAAJ&hl=en">bioengineers</a>. Determining how fruit bats evolved to specialize on a high-sugar diet sent us on a quest to approach diabetes therapy from an unusual angle – one that sent us all the way to Lamanai, Belize, for the <a href="https://www.batcon.org/belize-bat-a-thon/">Belize Bat-a-thon</a>, an annual gathering where researchers collect and study bats.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/568470/original/file-20240109-29-2hgb6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people wearing face masks, one with a headlamp and one holding a small bat up to the camera" src="https://images.theconversation.com/files/568470/original/file-20240109-29-2hgb6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/568470/original/file-20240109-29-2hgb6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568470/original/file-20240109-29-2hgb6j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568470/original/file-20240109-29-2hgb6j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568470/original/file-20240109-29-2hgb6j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568470/original/file-20240109-29-2hgb6j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568470/original/file-20240109-29-2hgb6j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Authors Nadav Ahituv, left, and Wei Gordon.</span>
<span class="attribution"><span class="source">Wei Gordon</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>In our <a href="https://doi.org/10.1038/s41467-023-44186-y">newly published research</a> in Nature Communications, we and colleagues <a href="https://netbiolab.org/w/People:SB_Baek">Seungbyn Baek</a> and <a href="https://scholar.google.com/citations?user=H4jO_DQAAAAJ&hl=en">Martin Hemberg</a> used a technology that analyzes the DNA of individual cells to compare the unique metabolic instructions encoded in the genome of the Jamaican fruit bat, <em>Artibeus jamaicensis</em>, with those in the genome of the insect-eating big brown bat, <em>Eptesicus fuscus</em>. </p>
<p><a href="https://doi.org/10.1038/nature11247">Approximately 2% of DNA</a> is composed of genes, which are segments of DNA that contain the instructions cells use to create certain traits, such as a <a href="https://doi.org/10.1016/j.acthis.2020.151503">longer tongue in fruit bats</a>. The other 98% are segments of DNA that regulate genes and determine the presence and absence of the traits they encode.</p>
<p>To understand how fruit bats evolved to consume so much sugar, we wanted to identify the genetic and cellular differences between bats that eat fruit and bats that eat insects. Specifically, we looked at the genes, regulatory DNA and cell types in two significant organs involved in metabolic disease: the pancreas and the kidney. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/568363/original/file-20240109-25-d0snov.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Four male *Artibeus jamaicensis* and four male *Eptesicus fuscus* bats were put in a fast then fed fruit or worms, respectively, or no meal before analyzing the cells and genes of their kidney and pancreas." src="https://images.theconversation.com/files/568363/original/file-20240109-25-d0snov.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568363/original/file-20240109-25-d0snov.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=244&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568363/original/file-20240109-25-d0snov.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=244&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568363/original/file-20240109-25-d0snov.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=244&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568363/original/file-20240109-25-d0snov.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=306&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568363/original/file-20240109-25-d0snov.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=306&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568363/original/file-20240109-25-d0snov.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=306&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This flowchart outlines the authors’ study methodology.</span>
<span class="attribution"><a class="source" href="https://doi.org/10.1038/s41467-023-44186-y">Wei Gordon, created with BioRender.com/Nature Communications</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1038/s41580-020-00317-7">The pancreas</a> regulates blood sugar and appetite by secreting hormones like insulin, which lowers your blood sugar, and glucagon, which raises your blood sugar. We found Jamaican fruit bats have <a href="https://doi.org/10.1038/s41467-023-44186-y">more insulin-producing and glucagon-producing cells</a> than big brown bats, along with regulatory DNA that primes fruit bat pancreatic cells to initiate production of insulin and glucagon. Together these two hormones work to keep blood sugar levels balanced even when the fruit bats are eating large amounts of sugar.</p>
<p><a href="https://doi.org/10.1093%2Fndt%2Fgfx027">The kidney</a> filters metabolic waste from the blood, maintains water and salt balance and regulates blood pressure. Fruit bat kidneys need to be equipped to remove from their bloodstreams the large amounts of water that come from fruit while retaining the low amounts of salt in fruit. We found Jamaican fruit bats have adjusted the compositions of their kidney cells in accordance with their diet, <a href="https://doi.org/10.1038/s41467-023-44186-y">reducing the number of urine-concentrating cells</a> so their urine is more diluted with water compared with big brown bats.</p>
<h2>Why it matters</h2>
<p>Diabetes is one of the most expensive chronic conditions in the world. The <a href="https://doi.org/10.2337/dci23-0085">U.S. spent US$412.9 billion</a> in 2022 on direct medical costs and indirect costs related to diabetes.</p>
<p>Most approaches to developing new treatments for diabetes are based on traditional laboratory animals such as mice because they are easy to reproduce and study in a lab. But outside the lab, there exist mammals like fruit bats that have actually evolved to withstand high sugar loads. Figuring out how these mammals deal with high sugar loads can help researchers identify new approaches to treat diabetes.</p>
<p>By applying new cell characterization technologies on these <a href="https://theconversation.com/e-coli-is-one-of-the-most-widely-studied-organisms-and-that-may-be-a-problem-for-both-science-and-medicine-206045">nonmodel organisms</a>, or organisms researchers don’t usually use for research in the lab, we and a growing body of researchers show that nature could be leveraged to develop novel treatment approaches for disease. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/QIBMyj8ebRU?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The authors disentangle a fruit bat from a net during the Belize Bat-a-thon.</span></figcaption>
</figure>
<h2>What still isn’t known</h2>
<p>While our study revealed many potential therapeutic targets for diabetes, more research needs to be done to demonstrate whether our fruit bat DNA sequences can help understand, manage or cure diabetes in humans.</p>
<p>Some of our fruit bat findings may be unrelated to metabolism or are specific only to Jamaican fruit bats. There are <a href="https://www.britannica.com/animal/Old-World-fruit-bat">close to 200 species</a> of fruit bats. Studying more bats will help researchers clarify which fruit bat DNA sequences are relevant for diabetes treatment. </p>
<p>Our study also focused only on bat pancreases and kidneys. Analyzing other organs involved in metabolism, such as the liver and small intestine, will help researchers more comprehensively understand fruit bat metabolism and design appropriate treatments.</p>
<h2>What’s next</h2>
<p>Our team is now testing the regulatory DNA sequences that allow fruit bats to eat so much sugar and checking whether we can use them to better regulate how people respond to glucose.</p>
<p>We are doing this by <a href="https://www.youtube.com/watch?v=Cv59sjupd1Y&t=77s">swapping the regulatory DNA sequences</a> in mice with those of fruit bats and testing their effects on how well these mice manage their glucose levels.</p>
<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><img src="https://counter.theconversation.com/content/220756/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wei Gordon receives funding from NSF. </span></em></p><p class="fine-print"><em><span>Nadav Ahituv is a cofounder and on the scientific advisory board of Regel Therapeutics and also received funding from BioMarin Pharmaceutical Incorporate.
Funding for this research was supported by the National Human Genome Research Institute grant R01HG012396.
</span></em></p>Fruit bats can eat up to twice their body weight in fruit a day. But their genes and cells evolved to process all that sugar without any health consequences − a feat drug developers can learn from.Wei Gordon, Assistant Professor of Biology, Menlo CollegeNadav Ahituv, Professor, Department of Bioengineering and Therapeutic Sciences; Director, Institute for Human Genetics, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2194412023-12-28T09:20:09Z2023-12-28T09:20:09ZSix ways to look after your eyes in 2024<figure><img src="https://images.theconversation.com/files/564923/original/file-20231211-27-7cymn4.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C6523%2C4342&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/portrait-mature-man-fitting-o-1832804689">Inside Creative House/Shutterstock</a></span></figcaption></figure><p>The World Health Organization estimates that <a href="https://www.who.int/news/item/09-10-2003-up-to-45-million-blind-people-globally---and-growing">over 80%</a> of all vision impairment around the world can be prevented and even cured. Reducing the risk of eye diseases involves adopting a combination of lifestyle changes, protective measures, and regular eye care. Here are six ways to look after your eyes in 2024. </p>
<h2>1. Have regular eye tests</h2>
<p>Many eye diseases don’t have symptoms – at least, initially. <a href="https://www.nhs.uk/conditions/glaucoma/#:%7E:text=Glaucoma%20is%20a%20common%20eye,not%20diagnosed%20and%20treated%20early.">Glaucoma</a>, for example, will cause irreversible damage to the eye if not picked up early enough as it damages the peripheral visual field to start with. People tend not to notice and merely compensate for this loss of peripheral vision by moving their heads more. </p>
<p>Eye disease linked to diabetes also causes irreversible damage to the eyes without much noticeable vision loss as it damages the <a href="https://www.nhs.uk/conditions/diabetic-retinopathy/#:%7E:text=Diabetic%20retinopathy%20is%20a%20complication,it%20could%20threaten%20your%20sight.">small blood vessels</a> in the eye. </p>
<p>Going for an eye test with a qualified optometrist will enable them to detect eye diseases and refer you to a specialist if needed. Early detection of changes in the eye due to diabetes will reduce the <a href="https://diabetesjournals.org/clinical/article/27/4/140/1721/Diabetic-Retinopathy-Screening-Updatelink">risk of blindness by 60-90%</a>. </p>
<p>And a visit to the optometrist does not necessarily mean you have to fork out for expensive new glasses if your vision hasn’t changed. People in the UK qualify for <a href="https://www.nhs.uk/nhs-services/opticians/free-nhs-eye-tests-and-optical-vouchers/">free NHS eye tests</a> if they are over 60 or under 18 years, have a family history of glaucoma, or receive certain state benefits. </p>
<h2>2. Check your eyes at home</h2>
<p>As most of us use both eyes at the same time, it can be difficult to know if one is not seeing so well. Try covering each eye every week and look at a number plate in the distance to make sure both eyes are seeing well. </p>
<p>Differences between the two eyes will affect your depth perception, which then ends up with you not being able to judge how far a person is when driving. </p>
<p><a href="https://www.nhs.uk/conditions/age-related-macular-degeneration-amd/">Age-related macular degeneration</a> usually affects one eye earlier than the other. And the “wet” type – caused by tiny blood vessels at the back of the eye leaking fluid – needs to be treated as soon as possible to avoid any further damage. </p>
<p>Use graph paper held at a near distance, wearing near glasses if you need them, and if lines appear to be wavy or missing, seek an appointment with your optometrist. </p>
<h2>3. Protect your eyes from mechanical and UV damage</h2>
<p>Ultraviolet light can damage the macula, the most central and important part of the eye. Make sure you wear good quality sunglasses that block 100% of UVA and UVB rays to protect your eyes from harmful ultraviolet radiation. </p>
<p>If you are a DIY enthusiast, it’s really important to wear safety goggles. In the summer, gardening accidents, such as getting caught in the eye with a twig when pruning are quite frequent and can cause permanent damage.</p>
<p>Playing squash and other sports without adequate protection can also cause permanent damage. A squash ball is just a bit smaller than the orbit of the eye and this can cause a lot of damage to the soft tissues within the eye as the orbital wall cannot stop the ball’s entry into the eye. </p>
<figure class="align-center ">
<img alt="Woman wearing sunglasses" src="https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564933/original/file-20231211-15-nslvhc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Wear good-quality sunglasses.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-shot-stylish-young-woman-sunglasses-459775861">Jacob Lund/Shutterstock</a></span>
</figcaption>
</figure>
<h2>4. Reduce digital eye strain</h2>
<p>Excessive exposure to computers and smartphones can lead to eyestrain. While eyestrain does not normally cause permanent damage or affect your glasses prescription, it can be very uncomfortable. </p>
<p>Most people forget to blink when they are working on screens, and this leads to dry eyes. To reduce this discomfort, try consciously blinking more often during screen time. </p>
<p>It helps keep your eyes moist and reduces that tired, dry feeling. You can set a reminder on your phone for blinking exercises where you forcibly blink at least ten times every hour. </p>
<p>Regular breaks will not only give your eyes a rest but will also give your back a rest, too. Remember the <a href="https://www.rnib.org.uk/your-eyes/how-to-keep-your-eyes-healthy/eye-safety/#:%7E:text=Taking%20frequent%20breaks%20from%20the,cause%20you%20to%20need%20spectacles.">20-20-20 rule</a>: every 20 minutes, take a 20-second break, and look at something 20 feet away.</p>
<h2>5. Have a good diet</h2>
<p>While many of us know that vitamin A from carrots is good for the eyes, our eyes need <a href="https://www.medicalnewstoday.com/articles/326758">more than vitamin A</a> to function healthily. </p>
<p>Vitamin C found in citrus fruits, strawberries, bell peppers and broccoli helps protect the eyes from oxidative damage as does vitamin E found in nuts, seeds, spinach and fortified cereals. </p>
<p>Green leafy vegetables have been shown to reduce the risk of macular damage, which is the <a href="https://www.cdc.gov/visionhealth/resources/features/macular-degeneration.html#:%7E:text=AMD%20is%20a%20major%20cause,to%2088%20million%20in%202050.">leading cause of blindness</a> in the elderly. </p>
<p>A healthy diet is also linked to good control of diabetes, and poor control of diabetes will lead to a much higher risk of blindness from diabetic-related eye disease. </p>
<h2>6. Quit smoking and be more active</h2>
<p>Smoking is a significant risk factor for most systemic diseases in the body <a href="https://www.fda.gov/tobacco-products/health-effects-tobacco-use/how-smoking-can-contribute-vision-loss-and-blindness">including the eyes</a>. Smoking increases the risk of macular degeneration and cataracts. Quitting can be tough, but your eyes will appreciate it in the long run. </p>
<p>Exercise is not only important for the rest of the body but also for the eyes. Outdoor activity is a <a href="https://www.sciencedirect.com/science/article/pii/S0161642007013644?via%3Dihub">significant protective factor</a> against the progression of myopia (shortsightedness) in children. </p>
<p>Physical activity increases blood circulation to the eyes, which is essential for delivering oxygen and nutrients to the eyes and removing waste products. It has also been linked to reducing the risk of <a href="https://www.sciencedirect.com/science/article/pii/S0002939417302180?via%3Dihub">age-related macular degeneration</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/29610523/">diabetic retinopathy and glaucoma</a>. </p>
<p>Physical activity is also essential for controlling diabetes, which reduces the risk of blindness in patients with this condition. It is important to note that physical activity is not just about joining a gym. It can involve free activities, including brisk walking, which would be a wonderful opportunity to spend time with family and reduce the progression of myopia in our children.</p><img src="https://counter.theconversation.com/content/219441/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span><a href="mailto:shahina.pardhan@aru.ac.uk">shahina.pardhan@aru.ac.uk</a> receives funding from various NHS bodies, Charities and EU. </span></em></p>Your eyes are your windows on the world. Here’s how to stop them getting smudgy.Shahina Pardhan, Professor of Optometry, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2183292023-12-11T13:13:00Z2023-12-11T13:13:00ZHow cinnamon, nutmeg and ginger became the scents of winter holidays, far from their tropical origins<figure><img src="https://images.theconversation.com/files/564556/original/file-20231208-29-lo8tej.jpg?ixlib=rb-1.1.0&rect=38%2C0%2C5075%2C3879&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nutmeg, ginger, cinnamon and other gingerbread spices.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/gingerbread-spices-on-slate-star-anise-cinnamon-royalty-free-image/1297922082">Almaje/iStock via Getty Images</a></span></figcaption></figure><p>Regardless of how you celebrate end-of-year holidays, food is probably central to your winter festivities. And a trio of spices – cinnamon, nutmeg and ginger – feature in many dishes and drinks and are an unmistakable part of the scent profile we associate with the holiday season.</p>
<p>As a <a href="https://soilcrop.tamu.edu/people/desalvio-serina/">plant scientist</a>, I was curious to know how these spices, grown in the tropics, became so closely associated with the Northern Hemisphere’s winter holidays. Just as <a href="https://theconversation.com/cranberries-can-bounce-float-and-pollinate-themselves-the-saucy-science-of-a-thanksgiving-classic-216326">cranberries’ fall harvest</a> makes them a natural choice for Thanksgiving, I thought that perhaps the seasonality of spice harvest had something to do with their use during the winter months.</p>
<p>However, this doesn’t appear to be the case. When it comes to growing spices, producers are playing the long game. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/ygnzhWrML_4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Spices are prized commodities that have fueled global trade, exploration and conquest for centuries.</span></figcaption>
</figure>
<h2>Growing holiday spices</h2>
<p>Take ginger, which features in both sweet and savory recipes in many cuisines worldwide. Ginger roots take between eight and 10 months to fully mature. The plants can be <a href="https://agrilifeextension.tamu.edu/library/gardening/ginger/">harvested at any time of year</a> if they are mature and haven’t been exposed to cold or wind. </p>
<p>That timing is important because harvesting ginger means uprooting the whole plant to get to the rhizomes growing underground. Rhizomes function like <a href="https://www.canr.msu.edu/news/plant-science-at-the-dinner-table-ginger">underground stems</a>, storing nutrients for the plant to help it survive the winter. Once cold weather signals to the plant to dip into its underground supply of nutrients, the quality of the harvested ginger will decline significantly.</p>
<p>Nutmeg comes from grinding seeds of the <em>Myristica fragrans</em> tree, an evergreen that’s <a href="https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/nutmeg">native to Indonesia</a>. The trees start flowering in their sixth year, but peak production comes when they are closer to 20 years old. </p>
<p>Workers harvest fruit from the trees, which typically grow to heights of <a href="https://www.missouribotanicalgarden.org/PlantFinder/PlantFinderDetails.aspx?taxonid=282832&isprofile=1&basic=Myristica%20fragrans">10 to 30 feet</a> (3 to 10 meters), using long poles to knock the fruits down. For spice production, the fruits then are dried in the sun. </p>
<p>Nutmeg comes from grinding the inner seed kernels; its <a href="https://www.thespicehouse.com/blogs/news/what-is-mace">sister spice, mace</a>, comes from grinding the tissue that envelopes the seeds. Since this plant yields two spices, the long wait for the trees to mature is worthwhile for producers.</p>
<p>Cinnamon is made from the bark of two trees: <em>Cinnamomum verum</em> for cinnamon sticks, and <em>Cinnamomum cassia</em> for ground cinnamon. The two types have different textures and flavor profiles, but both are made from the outermost layer of the trees’ bark. Production typically starts after a tree is 2 years old.</p>
<p><a href="https://www.smithsonianmag.com/smart-news/heres-how-cinnamon-harvested-valley-indonesia-180955063/">Peeling bark from cinnamon tree branches</a> is easiest after <a href="https://doi.org/10.1007/978-3-030-54426-3_7">heavy rainfalls</a>, which soften the bark, so harvests typically happen after monsoon seasons. The same effect can be achieved outside of monsoon season by soaking branches in buckets of water.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564557/original/file-20231208-31-1xol8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man in a t-shirt scrapes long shreds of bark from a branch." src="https://images.theconversation.com/files/564557/original/file-20231208-31-1xol8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564557/original/file-20231208-31-1xol8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=412&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564557/original/file-20231208-31-1xol8m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=412&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564557/original/file-20231208-31-1xol8m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=412&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564557/original/file-20231208-31-1xol8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564557/original/file-20231208-31-1xol8m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564557/original/file-20231208-31-1xol8m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A Sri Lankan farmer peels freshly harvested cinnamon sticks. Sri Lanka is the world’s largest exporter of cinnamon, responsible for 80% of production.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sri-lankan-farmer-peels-freshly-harvested-cinnamon-sticks-news-photo/146590450">Buddhika Weerasinghe/Getty Images</a></span>
</figcaption>
</figure>
<h2>What makes a spice ‘warm’?</h2>
<p>Cinnamon, ginger and nutmeg all are widely described as “warm” spices, which probably has less to do with where they come from and more with <a href="https://www.piedmont.org/living-real-change/the-healthiest-winter-spices">how they affect our bodies</a>. </p>
<p>In the same way that mint can “taste” cold due to its <a href="https://doi.org/10.1111/j.1748-1716.1951.tb00824.x">menthol content</a>, cinnamon’s warm taste is attributed to <a href="https://pubchem.ncbi.nlm.nih.gov/compound/Cinnamaldehyde#section=Structures">a compound called cinnamaldehyde</a>, which gives the spice its distinctive taste and smell. This chemical tricks our nervous system when we eat it by triggering the same pathway that perceives warmth, much as <a href="https://www.houstonmethodist.org/blog/articles/2020/sep/how-to-cool-your-mouth-down-after-eating-spicy-food/#">capsaicin in peppers</a> triggers feelings of pain.</p>
<p>Cinnamaldehyde also helps <a href="https://www.sciencedirect.com/topics/chemistry/cinnamaldehyde">decrease blood glucose levels</a>, so enjoying some cinnamon tea after a big Christmas dinner can help stop your blood sugar from spiking. Cinnamon has been used for thousands of years in traditional medicine across Asia for its antibacterial properties and as a <a href="http://dx.doi.org/10.4103/0974-8490.157990">digestive aid</a>. </p>
<p>Christopher Columbus’ first voyage west across the Atlantic sought to find a <a href="https://www.cabinet.ox.ac.uk/cinnamon-peppercorns-nutmeg-and-cloves-0">direct route to Asia to purchase cinnamon</a> and other spices directly where they were grown.<br>
Indeed, the spice trade can be seen as a <a href="https://www.bbc.com/future/bespoke/made-on-earth/the-flavours-that-shaped-the-world/">microcosm for the story of globalization</a>, with all of its associated benefits and harms.</p>
<h2>Spicing up our health and digestive systems</h2>
<p>Ginger and nutmeg don’t trick our nervous systems into feeling warm, but they both contain a myriad of compounds that aid in digestion and can fend off viral and bacterial infections. Ginger is an excellent <a href="http://dx.doi.org/10.4137/IMI.S36273">anti-nausea agent</a> because of a compound called gingerol, which increases <a href="https://www.hopkinsmedicine.org/health/wellness-and-prevention/ginger-benefits#">gut mobility</a>. This means food doesn’t linger in the gut as long, which cuts down on gas production and keeps us from feeling bloated and sick.</p>
<p>Ginger was first used for food purposes in the <a href="https://www.pbs.org/food/the-history-kitchen/history-gingerbread/#">Middle Ages</a> as a way of masking the taste of preserved meats, which were mainly consumed in the winter months surrounding holidays. Unlike most spices, it can be used for cooking in many forms – fresh, dried and ground, candied or pickled. Each version offers a different level of ginger’s signature bite.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/wNJxrbgmaow?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Gingerbread, which typically is flavored with multiple spices including ground ginger, has existed in various forms for centuries.</span></figcaption>
</figure>
<p>Like cinnamon, nutmeg is another anti-diabetic. It has been shown to both decrease blood glucose levels and <a href="http://dx.doi.org/%2010.5603/FM.a2019.0052">increase serum insulin</a>. Insulin helps regulate how sugars are stored in our bodies by moving glucose out of our bloodstream and into cells, where it can be accessed later when we need an energy boost. So cinnamon can help ensure that all those holiday baked goods are put to use energetically, whether that’s right now or later. </p>
<p>Nutmeg seeds produce many natural compounds, some of which have the potential to <a href="https://doi.org/10.1016/B978-0-12-375688-6.10098-2">fight pathogenic bacteria</a>. During the 1600s, doctors believed nutmeg could be effective at warding off the bubonic plague, and many people wore it tied around their necks. This belief likely came from nutmeg’s <a href="https://doi.org/10.1016/j.exppara.2021.108104">insecticidal qualities</a>, which would have helped keep fleas carrying the plague off people sporting a nutmeg necklace. </p>
<p>The sights and sounds of the winter holidays are distinctive, but nothing is as all-encompassing and nostalgic as the smells and tastes. Understanding how we have evolved traditions surrounding food, and the science behind those foods, can help us further appreciate their role in the season of celebrations.</p><img src="https://counter.theconversation.com/content/218329/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Serina DeSalvio 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>Spices have been prized commodities for centuries. Today, ‘warm’ flavors boost our health and spirits in fall and winter.Serina DeSalvio, Ph.D. Candidate in Genetics and Genomics, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2169782023-12-07T22:50:53Z2023-12-07T22:50:53ZCould visiting a museum be the secret to a healthy life?<figure><img src="https://images.theconversation.com/files/557354/original/file-20231016-28-1a079n.jpg?ixlib=rb-1.1.0&rect=5%2C1%2C986%2C655&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Does the simple fact of being in contact with art have any specific effects?</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>It’s Saturday morning. You are barely awake, with a cup of coffee in your hand, and your gaze wanders to the window. It’s raining. So you make up your mind. This afternoon, you will go to a museum.</p>
<p>But what if, without realizing it, you just made a good decision for your health?</p>
<p>That’s the hypothesis put forward by the <a href="https://www.medecinsfrancophones.ca/a-propos/lassociation/">Association des Médecins francophones du Canada</a> in 2018, when it launched the <a href="https://www.mbam.qc.ca/en/news/museum-prescriptions/">museum prescriptions program</a> in partnership with the Montreal Museum of Fine Arts. The project, now completed, has enabled thousands of patients to get a doctor’s prescription to visit a museum, either on their own or accompanied. The aim of the prescription was to promote the recovery and well-being of patients with chronic illnesses (hypertension, diabetes), neurological conditions, cognitive disorders or mental health problems. The decision to write the prescription was left to the discretion of the doctor.</p>
<p>Five years in, this pioneering initiative has inspired other innovative projects. So we are now seeing an increasing number of museum-based wellness activities ranging from <a href="https://museumlondon.ca/yoga-at-the-museum">museum yoga</a> to <a href="https://agakhanmuseum.org/programs/mindfulness-and-education-sessions">guided meditations</a> with works of art, as well as the practice of <a href="https://www.gallery.ca/magazine/your-collection/the-art-of-slow-looking-a-painting-by-jean-paul-riopelle?_gl=1*ys4kk2*_ga*MTY5MjQ1NTg3Mi4xNjk5NTUxNTQ3*_ga_83BW334MD2*MTY5OTU1MTU0Ni4xLjAuMTY5OTU1MTU0Ni4wLjAuMA..">slow contemplation</a> or “slow looking.” </p>
<p>There’s no shortage of possibilities, and they all help to reinforce the same idea, that art is good for us.</p>
<h2>Beyond first impressions</h2>
<p>These initiatives have recently made headlines in national media on both sides of the Atlantic, in <a href="https://www.radiofrance.fr/franceculture/museotherapie-je-crois-que-nous-sommes-dans-un-moment-de-bouillonnement-2414180">France</a> and <a href="https://www.cbc.ca/news/canada/montreal/montreal-museum-fine-arts-medecins-francophone-art-museum-therapy-1.4859936">Canada</a>, and are gaining in visibility in the general public. Because of the popularity of these activities, more and more claims are being made that a visit to the museum can have “powerful anti-stress properties,” be a “miracle cure for stress,” or have other “incredible benefits.”</p>
<p>Talk about enthusiasm!</p>
<p>Yet, as a certified neuroscientist, I can’t help but wonder why, given the extraordinarily relaxing effects that are being claimed, crowds aren’t flocking to our museums every day. </p>
<p>And that gives us all the more reason to look at the scientific reports and studies that have recently been published on the subject.</p>
<h2>Is art good for you? From intuition to observation</h2>
<p>In 2019, the World Health Organization published an extensive report compiling evidence on the role of arts and cultural activities <a href="https://apps.who.int/iris/handle/10665/329834">in promoting health and well-being</a>. The authors of this report attempted to move away from the sweeping claim that the benefits of art could constitute a universal solution to health problems, like a type of home remedy. </p>
<p>Instead, they encourage new, more precise and rigorous approaches to looking at the question, based on observation of the psychological, physiological and behavioural responses induced by certain specific components of artistic activity (aesthetic engagement, sensory stimulation, physical activity, etc.).</p>
<h2>Actor or spectator?</h2>
<p>What’s specific about a museum visit is that it is a so-called receptive artistic activity – in other words, it is not about producing art (painting, drawing, composing). It does, however, have the advantage of being accessible and already well established in our collective habits, making it a good candidate for health prevention.</p>
<p>The question is whether art exposure, alone, is enough to reap its benefits. In other words, does the simple fact of being in contact with art have specific effects?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/554091/original/file-20231016-15-yh6rw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman in a museum" src="https://images.theconversation.com/files/554091/original/file-20231016-15-yh6rw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/554091/original/file-20231016-15-yh6rw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/554091/original/file-20231016-15-yh6rw2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/554091/original/file-20231016-15-yh6rw2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/554091/original/file-20231016-15-yh6rw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/554091/original/file-20231016-15-yh6rw2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/554091/original/file-20231016-15-yh6rw2.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">Could exposure to art lead to healthier aging?</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Healthier consumers of culture</h2>
<p>Research has been carried out in England on samples of several thousand individuals whose long-term health indicators were monitored, and who were asked for 10 years to report on their habits in terms of <a href="https://www.elsa-project.ac.uk">cultural and artistic activities</a>.</p>
<p>This research shows that individuals who regularly (every two or three months, or more) visit cultural venues (theatres, opera houses, museums, galleries) have a 50 per cent lower risk of <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/cultural-engagement-and-cognitive-reserve-museum-attendance-and-dementia-incidence-over-a-10year-period/0D5F792DD1842E97AEFAD1274CCCC9B9">dementia</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429253/">depression</a>, and a 40 per cent lower risk of developing a <a href="https://academic.oup.com/psychsocgerontology/article/75/3/571/5280637">geriatric frailty syndrome</a> (age-related decline in health and loss of functional independence).</p>
<p>Does that mean that exposure to art could lead to healthier aging?</p>
<p>Perhaps, but whether cultural involvement is the cause of the improvement in health markers observed in these studies, has yet to be confirmed. To do this, cohort studies and <a href="https://cihr-irsc.gc.ca/e/48952.html">randomized controlled trials</a> are required. However, this type of study has yet to be done.</p>
<h2>In search of the active ingredients</h2>
<p>There is one other question, and it’s a big one! It’s the question of <em>why</em>.</p>
<p>Why would art, and visual art in particular, do me good? What happens in my body when I encounter a work of art, and how does this contact transform me and help to keep me healthier – if this is the case?</p>
<p>This was the question Mikaela Law, a psychology researcher at the University of Auckland in New Zealand, and her colleagues asked in 2021. They <a href="https://bmjopen.bmj.com/content/11/6/e043549.abstract">reviewed the scientific literature</a> for studies on the physiological response to the visual arts and its effect on self-reported stress. </p>
<p>Some of the studies listed in her work show that contact with artwork can lower blood pressure, heart rate and the cortisol secreted in saliva. Such changes reflect a reduction in the body’s state of guardedness, also called stress. This change appears to be perceived by the individual, reflected by the reduction in the stress he or she feels after exposure.</p>
<p>Other studies, on the other hand, have observed no effects. </p>
<p>So, if contact with visual art is likely to bring about physical and psychological relaxation for the viewer, it may not be a sufficient condition for improved health.</p>
<p>This conclusion invites us to qualify our conclusions and reflect more deeply on what happens at the moment of an encounter with a work that might condition its effects on an individual’s psyche.</p>
<p>Today is Saturday…</p>
<p>You’ve decided you’re going to the museum. </p>
<p>This decision will likely be good for your health. </p>
<p>It’s also likely to depend on the museum you choose, and how you visit it. </p>
<p>However one thing’s certain: going to a museum means you will greatly increase your chances of having a pleasant day!</p><img src="https://counter.theconversation.com/content/216978/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emma Dupuy works in partnership with the Montreal Museum of Fine Arts and has received funding from MITACS, the Université de Montréal and the Fonds de Recherche du Québec.</span></em></p>Can a trip to a museum help cure mental dullness? Here’s what the science has to say.Emma Dupuy, Postdoctoral researcher, cognitive neuroscience, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2160792023-12-01T00:35:56Z2023-12-01T00:35:56ZWhich blood sugar monitor is best?<figure><img src="https://images.theconversation.com/files/562346/original/file-20231129-26-lamare.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C998%2C520&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/close-diabetic-girl-sitting-on-bed-2260361181">Shutterstock</a></span></figcaption></figure><p>Monitoring the level of glucose (sugar) in your blood is <a href="https://theconversation.com/explainer-what-is-diabetes-11842">vital</a> if you have diabetes. You get results in real time, which allows you to adjust your medications, exercise and food accordingly.</p>
<p>Because blood glucose levels fluctuate throughout the day, monitoring improves glucose control and reduces the risks of <a href="https://www.diabetesaustralia.com.au/managing-diabetes/hypo-hyperglycaemia/">complications</a> from hypoglycaemia (low blood glucose) and hyperglycaemia (high glucose levels).</p>
<p>But the <a href="https://www.diabetesaustralia.com.au/diabetes-technology/">type and range</a> of blood glucose monitors has increased in recent years. Here are the two main options, with their pros and cons.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-diabetes-11842">Explainer: what is diabetes?</a>
</strong>
</em>
</p>
<hr>
<h2>Finger prick tests</h2>
<p>The first blood glucose monitors were the finger prick tests, which were developed <a href="https://diabetesjournals.org/compendia/article/2018/1/1/144616/Introduction-History-of-Glucose-Monitoringase">over 50 years ago</a> and are still in use today. These rely on you pricking your finger and placing a drop of blood on a strip, which you insert into a handheld meter.</p>
<p>Meters available in Australia must meet <a href="https://www.iso.org/standard/54976.html">international standards</a> for accuracy. There are many approved meters and strips subsidised <a href="https://www.diabetesaustralia.com.au/resources/ndss/">under the</a> <a href="https://www.health.gov.au/our-work/national-diabetes-services-scheme-ndss">National Diabetes Services Scheme</a>.</p>
<p>If you have type 2 diabetes and need infrequent testing (mostly people who are not taking insulin) these devices may be suitable.</p>
<p>However, it can be unpleasant or impractical to prick your finger several times a day, especially if you require more frequent monitoring.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/562348/original/file-20231129-29-5px7h6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman sitting on sofa, taking finger prick test for blood sugar levels" src="https://images.theconversation.com/files/562348/original/file-20231129-29-5px7h6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/562348/original/file-20231129-29-5px7h6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/562348/original/file-20231129-29-5px7h6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/562348/original/file-20231129-29-5px7h6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/562348/original/file-20231129-29-5px7h6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/562348/original/file-20231129-29-5px7h6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/562348/original/file-20231129-29-5px7h6.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">Finger prick testing with a handheld device is suitable for some people.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-woman-checking-blood-sugar-level-1995438632">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-psychological-support-can-help-people-living-with-diabetes-10647">How psychological support can help people living with diabetes</a>
</strong>
</em>
</p>
<hr>
<h2>Continuous glucose monitoring</h2>
<p><a href="https://jdrf.org.au/living-with-t1d/continuous-glucose-monitors/">Continuous glucose monitoring</a> has transformed glucose testing over the past 20 years or so, particularly for people who need insulin injections or use an insulin pump. </p>
<p>These systems use sensors you usually stick on to your arm or abdomen. The sensor has a tiny needle that pierces the skin to measure glucose levels under the skin (subcutaneous glucose) every few minutes. The reading is then transmitted to a device, such as a smartphone or receiver. These systems also need to meet <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6501529/">international standards</a> for accuracy.</p>
<p>Because the glucose level under the skin is not exactly the same as the blood glucose level, an algorithm transforms this into a blood glucose reading. </p>
<p>These systems provide real-time glucose information and have become increasingly accurate and user friendly over time. All have alarms to alert the wearer to dangerously low or high glucose levels. These alarms bring peace of mind to users and carers who fear the consequences of severe hypos, particularly during the night or during activities, such as driving.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/flash-glucose-monitoring-the-little-patches-that-can-make-managing-diabetes-a-whole-lot-easier-117249">Flash glucose monitoring: the little patches that can make managing diabetes a whole lot easier</a>
</strong>
</em>
</p>
<hr>
<p>But there is a time lag between subcutaneous glucose and blood glucose of a few minutes that means continuous monitoring is always running a bit behind.</p>
<p>Applying pressure to the sensor (for example, sleeping on it) can affect its accuracy, as can various medications or supplements such as vitamin C or paracetamol. </p>
<p>You also cannot use these devices straight away. There’s a one to two hour warm-up period after applying them to the skin.</p>
<p>Then there’s the cost. <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/new-cgm-device-for-australians-with-diabetes">Since 2022</a>, all people with type 1 diabetes have had subsidised access to continuous monitoring under the National Diabetes Services Scheme. But there is no such subsidy for people with type 2 diabetes, who have to pay around A$50 a week for their systems.</p>
<h2>Other options</h2>
<p>The sensors for the continuous monitoring systems last for one to two weeks, depending on the system; then you have to apply a new sensor. But there are implantable devices <a href="https://www.ascensiadiabetes.com/eversense/">in development</a> that will last six months. These are not yet available in Australia.</p>
<p>Other devices based on watches that are widely advertised are not approved glucose monitors. There is <a href="https://www.theverge.com/2023/3/18/23618649/noninvasive-blood-glucose-monitoring-wearables-smartwatches">no scientific evidence</a> supporting their accuracy. </p>
<p>Whichever device you use or are considering, it is important you do so with your treating medical practitioner, specialist or diabetes nurse educator.</p>
<hr>
<p><em>More information about blood glucose monitors is available from <a href="https://www.diabetesaustralia.com.au/diabetes-technology/">Diabetes Australia</a> and <a href="https://australianprescriber.tg.org.au/articles/blood-glucose-monitoring-devices-current-considerations.html">Australian Prescriber</a>.</em></p><img src="https://counter.theconversation.com/content/216079/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Neale Cohen consults to Abbott. He has received research funding from Ypsomed, the Juvenile Diabetes Research Foundation, National Health and Medical Research Council, and Diabetes Australia. He has had speaking engagements with Roche and Medtronic. The companies mentioned are manufacturers of insulin pumps, continuous glucose monitoring systems and glucose meters.</span></em></p>There are two main types, with pros and cons for each. One thing’s certain though. Don’t rely on your watch to monitor your blood sugar levels.Neale Cohen, Head of Diabetes Clinics, Baker Heart and Diabetes InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2167872023-11-14T13:25:49Z2023-11-14T13:25:49ZInsulin injections could one day be replaced with rock music − new research in mice<figure><img src="https://images.theconversation.com/files/558688/original/file-20231109-21-ic46x7.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2120%2C1414&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Turns out pop songs and movie soundtracks are key to a new system to deliver insulin.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cheering-audience-at-music-concert-royalty-free-image/1384296998">Sammyvision/Moment via Getty Images</a></span></figcaption></figure><p>More than <a href="https://www.cdc.gov/diabetes/basics/diabetes.html">37 million people</a> in the U.S. have diabetes. According to the American Diabetes Association, <a href="https://www2.diabetes.org/newsroom/press-releases/2022/american-diabetes-association-announces-support-for-insulin-act-at-senate-press-conference">8.4 million Americans</a> needed to take insulin in 2022 to lower their blood sugar. Insulin, however, is <a href="https://doi.org/10.1111/jphp.12852">tricky to deliver</a> into the body orally because it is a protein easily <a href="https://theconversation.com/many-drugs-cant-withstand-stomach-acid-a-new-delivery-method-could-lead-to-more-convenient-medications-183421">destroyed in the stomach</a>.</p>
<p>While researchers are developing <a href="https://www.acs.org/pressroom/presspacs/2023/january/another-step-toward-an-insulin-tablet.html">pills that resist digestion</a> in the stomach and <a href="https://samueli.ucla.edu/smart-insulin-patch/">skin patches</a> that monitor blood sugar and automatically release insulin, the most reliable way currently to take insulin is through frequent injections.</p>
<p>I am a professor of <a href="https://medicine.iu.edu/faculty/13502/sullivan-william">pharmacology and toxicology</a> at Indiana University School of Medicine, where my colleagues and I study drug delivery systems. Researching innovative new ways to get medications into the body can improve how well patients respond to and comply with treatments. An easier way to take insulin would be music to the ears of many people with diabetes, especially those who aren’t fans of needles.</p>
<p>In a recent study in <a href="https://doi.org/10.1016/S2213-8587(23)00153-5">The Lancet Diabetes & Endocrinology</a>, researchers engineered cells to release insulin in response to specific sound waves: the music of the band Queen. Though it still has a long way to go, this new system may one day replace the insulin injection with a dose of rock ’n’ roll.</p>
<h2>What is diabetes?</h2>
<p><a href="https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444">Diabetes is a chronic disease</a> that arises when the body fails to make enough insulin or respond to insulin. <a href="https://my.clevelandclinic.org/health/articles/22601-insulin">Insulin is a hormone</a> the pancreas makes in response to the rise in sugar concentration in the blood when the body digests food. This crucial hormone gets those sugars out of the blood and into muscles and tissues where it is used or stored for energy.</p>
<p>Without insulin, <a href="https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631">blood sugar levels remain high</a> and cause symptoms that include frequent urination, thirst, blurry vision and fatigue. Left untreated, this hyperglycemia can be life-threatening, causing organ damage and a diabetic coma. According to the U.S. Centers for Disease Control and Prevention, diabetes is the <a href="https://www.cdc.gov/diabetes/basics/diabetes.html">No. 1 cause</a> of kidney failure, lower-limb amputations and adult blindness, making it the eighth most common cause of death in the U.S.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Q6rLXPJ6j_I?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Diabetes results when the body either doesn’t produce enough insulin or is no longer responsive to it.</span></figcaption>
</figure>
<p>Treating diabetes is straightforward: When the body is lacking insulin, give it more insulin. Scientists have <a href="https://www.vox.com/2019/4/3/18293950/why-is-insulin-so-expensive">mastered how to make the hormone</a>, but direct injection is the only effective way to get it into the body. Diabetic patients usually have to carry insulin vials and needles wherever they go. Considering that <a href="https://theconversation.com/over-half-of-adults-unvaccinated-for-covid-19-fear-needles-heres-whats-proven-to-help-161636">many people fear needles</a>, this may not be an ideal way to manage the disease.</p>
<p>This challenge has sparked researchers to look into new ways to deliver insulin more easily.</p>
<h2>What is cellular engineering?</h2>
<p>Cells are the basic unit of life. Your body is composed of <a href="https://pubmed.ncbi.nlm.nih.gov/35832316/">hundreds of different types of cells</a> that carry out specialized functions. In some diabetic patients, the pancreatic beta cells that make insulin have malfunctioned or died. What if there were a way to replace these defective cells with new ones that could produce insulin on demand?</p>
<p>That’s where cellular engineering comes in. <a href="https://doi.org/10.1126/science.adf8627">Cellular engineering</a> involves genetically modifying a cell to perform a specific function, like producing insulin. <a href="https://medlineplus.gov/genetics/gene/ins/">Installing the gene that makes insulin</a> into cells is not difficult, but controlling when the cell makes it has been a challenge. Insulin should be made only in response to high blood sugar levels following a meal, not at any other time.</p>
<p>Scientists have been exploring the idea of using <a href="https://www.britannica.com/science/ion-channel">ion channels</a> – proteins embedded in a cell’s membrane that regulate the flow of ions such as calcium or chloride – like a remote-controlled device to activate cellular activity. Cells with specific types of ion channel in their membranes can be <a href="https://doi.org/10.1126/science.abb9122">activated in response to certain stimuli</a>, such as light, electricity, magnetic fields or mechanical stimulation. Such ion channels exist naturally as sensory devices to help cells and organisms respond to light, magnetism, touch or sound. For example, <a href="https://doi.org/10.1016/j.neuron.2018.07.033">hair cells in the inner ear</a> have mechanosensitive ion channels that respond to sound waves. </p>
<h2>Combining cellular engineering with Queen</h2>
<p>Bioengineering professor <a href="https://scholar.google.com/citations?user=Re5ypoQAAAAJ&hl=en">Martin Fussenegger</a> of ETH Zurich, a university in Basel, Switzerland, led a recent study that used a mechanosensitive ion channel as a remote control to signal cells to <a href="https://doi.org/10.1016/S2213-8587(23)00153-5">make insulin in response to specific sound waves</a>.</p>
<p>These “MUSIC-controlled, insulin-releasing cells” – MUSIC is short for music-inducible cellular control – were cultured in the lab next to loudspeakers. His team tested a variety of musical genres of different intensities and speeds.</p>
<p>Among the songs they played were pop songs like Michael Jackson’s “Billie Jean,” Queen’s “We Will Rock You” and the Eagles’ “Hotel California”; classical pieces such as Beethoven’s “Für Elise” and Mozart’s “Alla Turca”; and movie themes such as Soundgarden’s “Live To Rise,” which was featured in “The Avengers,” a Marvel film. They found that pop music heavy in low bass and movie soundtracks were better able to trigger insulin release compared with classical music, and cells were able to release insulin within minutes of exposure to the song.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/558690/original/file-20231109-27-tjh26u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of person injecting insulin into upper arm" src="https://images.theconversation.com/files/558690/original/file-20231109-27-tjh26u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558690/original/file-20231109-27-tjh26u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558690/original/file-20231109-27-tjh26u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558690/original/file-20231109-27-tjh26u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558690/original/file-20231109-27-tjh26u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558690/original/file-20231109-27-tjh26u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558690/original/file-20231109-27-tjh26u.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">Many people with diabetes have to take frequent insulin injections to control their blood sugar levels.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/taking-an-insulin-shot-at-home-royalty-free-image/1426368585">Caíque de Abreu/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>In particular, they found that the Queen song “<a href="https://www.youtube.com/watch?v=-tJYN-eG1zk">We Will Rock You</a>” most faithfully mimicked the rate of insulin release in normal pancreatic beta cells.</p>
<p>The team then implanted the MUSIC-controlled, insulin-releasing cells into diabetic mice. Listening to the Queen song for 15 minutes once a day returned the amount of insulin in their blood to normal levels. Blood sugar levels returned to normal as well. In contrast, mice that were not exposed to the song remained hyperglycemic.</p>
<h2>Could music make insulin in people?</h2>
<p>Despite these promising results, much more research is needed before this musical approach to producing insulin can be considered for human use.</p>
<p>One concern is the possibility of making too much insulin, which can also cause <a href="https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685">health problems</a>. Fussenegger’s study found that talking and background noise such as the racket made by airplanes, lawn mowers or firetrucks did not trigger the insulin production system in mice. The music also needed to be played close to the abdomen where the MUSIC-controlled, insulin-releasing cells were implanted.</p>
<p>In an email, Fussenegger explained that extensive clinical trials must be performed to ensure efficacy and safety of the technique and to determine how long the cellular implants can last. As with introducing any foreign material into the body, <a href="https://medlineplus.gov/ency/article/000815.htm">tissue rejection</a> is also a concern.</p>
<p>Cellular engineering may one day provide a much-needed alternative to frequent injections of insulin for the millions of people with diabetes around the world. In the future, different cell types could be engineered to release other drugs in the body more conveniently.</p><img src="https://counter.theconversation.com/content/216787/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Sullivan receives funding from the National Institutes of Health.</span></em></p>Researchers successfully treated diabetes in mice by engineering cells to make insulin in response to the music of Queen.Bill Sullivan, Professor of Pharmacology & Toxicology, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2164562023-10-30T16:15:23Z2023-10-30T16:15:23ZDiabetes is South Africa’s second biggest killer disease: hiking the sugar tax would help<p><a href="https://www.macrotrends.net/countries/ZAF/south-africa/death-rate">Death rates in South Africa</a> have declined slightly during the past few years. But the country faces a steady rise in both death and disability caused by <a href="https://www.statssa.gov.za/?p=16729#:%7E:text=In%20South%20Africa%2C%20deaths%20due,males%20and%2069%20for%20females.">increases</a> in non-communicable diseases such as diabetes and cancer.</p>
<p>According to the <a href="https://ncdalliance.org/">NCD Alliance</a>, a civil society network, non-communicable diseases <a href="https://ncdalliance.org/why-ncds/NCDs">cause 71% of deaths</a> globally. Of these deaths <a href="https://www.afro.who.int/countries/south-africa/publication/acting-against-non-communicable-diseases-south-africa-investing-healthier-future">85% occur in low and middle income countries</a>. </p>
<p>In South Africa, according to <a href="https://www.statssa.gov.za/?p=16729#:%7E:text=In%20South%20Africa%2C%20deaths%20due,males%20and%2069%20for%20females.">Statistics South Africa</a>, there was an increase of 58% in deaths from non-communicable diseases from 1997 to 2018. <a href="https://www.statssa.gov.za/?p=16729">Diabetes is the second leading cause of death</a> in South Africa after tuberculosis. </p>
<p>Diabetes affects <a href="https://www.up.ac.za/faculty-of-health-sciences/news/post_2972065-our-research-shows-gaps-in-south-africas-diabetes-management-programme#:%7E:text=In%20South%20Africa%2C%20diabetes%20affects,89%2C834%20people%20died%20of%20diabetes.">12%</a> of the adult population, wreaking massive damage to individuals’ health and livelihoods, and to the national fiscus. The direct cost of diabetes to South Africa’s health system is <a href="https://www.wits.ac.za/news/latest-news/opinion/2022/2022-09/obesity-costs-south-africa-billions-we-did-the-sums.html">R2.7 billion</a> (US$150 million) – and that is only for those patients who are diagnosed. It does not factor in the indirect costs of loss of jobs and income. </p>
<p>If all cases were diagnosed and treated, PRICELESS SA, a research unit based at the School of Public Health at the University of the Witwatersrand, estimates this would cost R21.8 billion (US$1.2 billion) a year, rising to R35 billion (US$1.9 billion) in real terms by 2030.</p>
<p>Finance minister Enoch Godongwana will table the <a href="https://www.treasury.gov.za/comm_media/press/2023/2023091101%20MEDIA%20ADVISORY-MEDIUM%20TERM%20BUDGET%20POLICY%20STATEMENT%20DATE.pdf">medium-term budget</a> policy statement this week. Based on our <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30304-1/fulltext">research</a> and the experience elsewhere in the world, we believe Godongwana has an opportunity to improve both South Africa’s fiscal health and its public health in one swift, effective action: by increasing the Health Promotion Levy, better known as the “sugar tax” on beverages.</p>
<h2>Why the urgency?</h2>
<p>Most South Africans with diabetes are either diagnosed very late, by which time they are much sicker, or are not diagnosed at all. The SA Demographic Health Survey data from 2016, the most recent study, <a href="https://pubmed.ncbi.nlm.nih.gov/35236427/">found that 67% of all men and women were “pre-diabetic”</a> and suggested that a “large portion” of South Africans remained undiagnosed, and therefore untreated.</p>
<p>Untreated or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8383848/">badly controlled diabetes</a> can result in amputations, kidney failure and blindness. Many of these same individuals also have high blood pressure and end up with stroke as a result of brain haemorrhage. </p>
<p>Obesity is known to be linked to diabetes – and rates of <a href="https://pubmed.ncbi.nlm.nih.gov/34986330/#:%7E:text=The%20accumulation%20of%20an%20excessive,prevalence%20of%20type%202%20diabetes.">obesity and overweight</a> people, too, are increasing relentlessly. Current rates of obesity in South Africa are 11% among men (with another 20.3% overweight), and 41% among women (with another 26.6% overweight). At this rate it is expected that <a href="https://s3-eu-west-1.amazonaws.com/wof-files/World_Obesity_Atlas_2022.pdf#page=25">50%</a> of South African women will be obese by 2030. </p>
<p>Both obesity and diabetes are known to be triggered by <a href="https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/how-much-sugar-is-too-much#:%7E:text=Men%20should%20consume%20no%20more,32%20grams">over-consumption</a> of sugar. <a href="https://pubmed.ncbi.nlm.nih.gov/31054268/">Liquid sugar</a> is known to be particularly harmful and has no nutritional value. This is why the public health recommends at least a 20% tax on sugary beverages. </p>
<p>The Health Promotion Levy should also include 100% fruit juices in the list of products subject to the tax.</p>
<h2>Sugar tax</h2>
<p>In 2018, in an attempt to address South Africa’s obesity, diabetes and other non-communicable diseases, National Treasury imposed a tax on sugar-sweetened beverages, known as the <a href="https://www.sars.gov.za/customs-and-excise/excise/health-promotion-levy-on-sugary-beverages/">Health Promotion Levy</a>. It equates to 2.1 cents per gram of sugar above a 4 gram threshold per 100 millilitres – which amounts to a levy of approximately 11% on the price.</p>
<p>As of June 2022, the sugar tax alone had raised more than R10 billion (US$750 million) in revenues that went directly to the treasury. Only R24 million (US$1.3 million) in 2019/2020 and R14 million (US$0.7 million) in 2020/2021 was allocated to expenditure on <a href="https://knowledgehub.health.gov.za/system/files/elibdownloads/2023-04/National%252520health%252520promotion%252520policy%252520and%252520strategy%2525202015%252520-%2525202019.pdf">“health promotion”</a>. </p>
<p>But the South African sugar industry fought the sugar tax from the outset. The tax started out at a lower rate than originally planned: it was designed to be <a href="https://www.who.int/news/item/11-10-2016-who-urges-global-action-to-curtail-consumption-and-health-impacts-of-sugary-drinks">20%</a> in line with World Health Organization recommendations, but was slashed to 11% because of sugar industry <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747348/">pressure</a> during a prolonged public consultation period. The already ailing industry alleged it would cause further job losses. </p>
<p>In reality, other global sugar market realities are the cause of declines in local sugar production and jobs. For example <a href="https://www.namc.co.za/wp-content/uploads/2017/09/Document-3-Legislative-environment.pdf">distorted global prices</a> are below South Africa’s cost of production. This predated the introduction of the sugar tax. </p>
<p>The South African government has not increased the sugar levy from its initial 11% in the five years since it started. It has put previously planned increases on hold. In the <a href="https://www.gov.za/speeches/minister-enoch-godongwana-2023-budget-speech-22-feb-2023-0000">February 2023 budget speech</a> the minister again imposed a two-year moratorium on the Health Promotion Levy, not even allowing for an inflation-related increase. In real terms, the sugar tax has effectively been reduced.</p>
<p>The South African Sugarcane Growers’ Association has <a href="https://apps.fas.usda.gov/newgainapi/api/Report/DownloadReportByFileName?fileName=South%20African%20Sugar%20Industry%20Crushed%20by%20Not%20So%20Sweet%20Tax_Pretoria_South%20Africa%20-%20Republic%20of_3-5-2019">expressed concern</a> at the prospect of an increase in the levy, fearing negative impacts on the sugar industry. Yet research from PRICELESS, analysing data from the <a href="https://www.statssa.gov.za/publications/P0211/P02112ndQuarter2019.pdf">South African Quarterly Labour Force Survey</a> from January 2008 to June 2019, shows that the sugar levy has had little effect on sugar-industry employment.
Even at its current weaker-than-ideal rate, the tax has reduced consumers’ consumption of sugary beverages by about 2g per capita per day, separate <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30304-1/fulltext">research</a> led by PRICELESS SA scientists shows. </p>
<h2>Government could turn the tide</h2>
<p>To reverse South Africa’s fatal diabetes trend and pour additional, much-needed billions into public funds, the government should increase the rate of the Health Promotion Levy to the 20% endorsed by the WHO. </p>
<p>Early detection and treatment is key to reducing the disabling effects of diabetes and the cost to the state. Therefore better diagnosis in the public health system should be prioritised – and funded from Health Promotion Levy revenues. </p>
<p>The fact that the Health Promotion Levy has already yielded more than R10 billion to the treasury is testament to its revenue potential. The win-win consequences of raising the levy seem indisputable.</p><img src="https://counter.theconversation.com/content/216456/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Goldstein receives funding from the Bloomberg Foundation and UK research foundations (UKRI and NIHR) as well as the IDRC. </span></em></p><p class="fine-print"><em><span>Karen Hofman 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>Diabetes affects about 12% of South Africa’s adult population.Karen Hofman, Professor and Programme Director, SA MRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandSusan Goldstein, Associate Professor in the SAMRC Centre for Health Economics and Decision Science - PRICELESS SA (Priority Cost Effective Lessons in Systems Strengthening South Africa), University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2117882023-10-05T15:50:14Z2023-10-05T15:50:14ZMedicine or food? People with diabetes in Liberia sometimes have to choose between the two<p>Diabetes is on the rise globally. Since the 1980s the number of people living with the disease has quadrupled from 108 million to <a href="https://idf.org/about-diabetes/diabetes-facts-figures/">537 million</a>.</p>
<p>This dramatic increase is largely due to the rise in <a href="https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-causes/syc-20351193">type 2 diabetes</a> and its associated risk factors such as being overweight or obese. </p>
<p>For many years, diabetes was considered a disease of affluence and thought to be rare in sub-Saharan Africa. This is no longer the case. Today <a href="https://diabetesatlas.org/idfawp/resource-files/2022/01/IDF-Atlas-Factsheet-2021_AFR.pdf">24 million people</a> – one in 22 adults in the region – have diabetes and rates are rapidly increasing.</p>
<p>In Liberia, one of the <a href="https://databankfiles.worldbank.org/public/ddpext_download/poverty/987B9C90-CB9F-4D93-AE8C-750588BF00QA/AM2020/Global_POVEQ_LBR.pdf">poorest nations</a> in sub-Saharan Africa, it is reported that an estimated <a href="https://diabetesatlas.org/data/en/region/2/afr.html">2.1%</a> of its population of 5.2 million are living with diabetes. More than half of them are <a href="https://diabetesatlas.org/data/en/country/112/lr.html">undiagnosed</a>, underscoring the grave burden of diabetes in the country. </p>
<p>Available research on diabetes in Liberia excludes people’s voices and stories. It is not rooted in people’s lived experiences. As a result, the research findings seldom lead to change. </p>
<p>The goal of our <a href="https://publi.ludomedia.org/index.php/ntqr/article/view/785">study</a> was to understand people’s lived experiences with diabetes in Liberia. We used a photovoice method, providing 10 Liberian adults with cameras to take photographs representing their lives. Through discussing the meaning of their photographs, we gained insights into local assets and needs.</p>
<p>Participants were recruited from Redemption Hospital in Monrovia. Due to COVID-19 restrictions, we partnered with Adventist University of West Africa to help facilitate interviews.</p>
<p>Our study identified two major challenges: food insecurity and healthcare neglect. </p>
<h2>Worrying about the next meal</h2>
<p>Participants shared stories about worrying about obtaining food, compromising the quality of food they ate, skipping meals and <a href="https://publi.ludomedia.org/index.php/ntqr/article/view/785">experiencing hunger</a>. They were often forced to choose between food and medication. </p>
<p>Not taking medication regularly for diabetes can lead to dangerous consequences like severe <a href="https://www.ncbi.nlm.nih.gov/books/NBK279340/#:%7E:text=Hyperglycemia%20occurs%20when%20blood%20sugar,blood%2Dsugar%2Dlowering%20medication">hypoglycemia or hyperglycemia</a>, coma and sometimes death. </p>
<p>One of the participants who was diagnosed with diabetes four years ago had <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/diabetic-retinopathy">diabetic retinopathy</a>, a common complication of diabetes that leads to vision loss. </p>
<p>He had been unable to work since his diagnosis and relied entirely on his sisters for financial help and the kindness of friends in his community. </p>
<p>During periods of extreme financial hardship, the 30-year-old experienced hunger. </p>
<blockquote>
<p>When I don’t have money, I don’t eat.</p>
</blockquote>
<p>If people like him survive the short-term consequences of hunger, repeated experiences of hunger can also place people living with diabetes at risk for long-term consequences such as <a href="https://hms.harvard.edu/news-events/publications-archive/brain/sugar-brain">cognitive impairment</a>. </p>
<p>Participants also reported concerns about the limited food options that healthcare providers recommended for their diet. They were generally advised to avoid staple foods with <a href="https://www.medicalnewstoday.com/articles/high-glycemic-index-foods">high glycemic indexes</a> such as white rice and <a href="https://liberiainfo.co/prd/liberian-cuisine/">cassava dumboy</a> that raise the blood sugar quickly and to replace them with foods like bulgur wheat and green plantain, as they provided better blood glucose control. </p>
<p>It was not always possible to adhere to these recommendations as foods like bulgur wheat and green plantain were far more expensive.</p>
<h2>Back of the queue</h2>
<p>Liberia’s <a href="https://cja.org/where-we-work/liberia/">14-year civil war</a> coupled with the <a href="https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease">Ebola outbreak</a> left a devastating impact on the country’s healthcare system. </p>
<p>As a result the country faces unique challenges in combating diabetes because of the country’s <a href="https://static1.squarespace.com/static/55d4de6de4b011a1673a40a6/t/5be085804d7a9c6daef842ea/1541440897071/Liberia+NCDI+Poverty+Commission+Report+FINAL.pdf">limited health infrastructure</a>, which neglects people living with chronic illnesses.</p>
<p>In 2018, only about 22% of publicly funded healthcare facilities could provide <a href="https://static1.squarespace.com/static/55d4de6de4b011a1673a40a6/t/5be085804d7a9c6daef842ea/1541440897071/Liberia+NCDI+Poverty+Commission+Report+FINAL.pdf">diagnosis</a> and management of diabetes. This makes it very difficult, for example, to get basic diabetes care such as testing, medication and diabetes education. </p>
<p>Participants on the research attested to this. One voiced his frustration with the local hospital and the lack of supplies and resources allocated to people living with diabetes. He was particularly disappointed that his local hospital was routinely out of medications: </p>
<blockquote>
<p>Sometimes at the hospital, they don’t have all the medicine. Yeah, so the whole frustrating part is when you get there, and the medicine not there, you have to pay for your prescription. With the prescription, he can just write it for me, and I will try to get it, because I want to be treated. They give you prescription, then you go to the drug store. </p>
</blockquote>
<p>Participants also shared how their religious faith helped them cope and sustain hope of living with diabetes. Their transcendent hope persisted despite hardship. </p>
<h2>The way forward</h2>
<p>Our findings demonstrate the need to improve the health and quality of life of people living with diabetes in Liberia. </p>
<p>Based on our findings, we recommended the following:</p>
<ul>
<li><p>Increased prioritisation and resourcing of diabetes management. This would involve allocation of adequate resources for screening, diagnostic testing, medications, diabetes supplies and diabetes education. </p></li>
<li><p>Integrated diabetes centres to facilitate ongoing care. To the best of our knowledge, there is currently no public or private diabetes centre in Liberia.</p></li>
<li><p>Community food programmes with healthy options. These should include community gardens and food banks.</p></li>
</ul><img src="https://counter.theconversation.com/content/211788/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nothing to disclose</span></em></p><p class="fine-print"><em><span>Danielle Macdonald, Paulina Bleah, and Pilar Camargo-Plazas 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>People with diabetes in Liberia face a vicious cycle of hunger and neglect that can sometimes spiral out of control and put their lives in danger.Paulina Bleah, Nurse Practitioner, PhD Nursing Student, Queen's University, OntarioDanielle Macdonald, Assistant Professor, Queen's University, OntarioPilar Camargo-Plazas, Associate Professor, Queen's University, OntarioRosemary Wilson, Associate Director/Associate Professor of Nursing, Queen's University, OntarioLicensed 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">
<figcaption>
<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>
</figcaption>
</figure>
<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>
<figure class="align-center ">
<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">
<figcaption>
<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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</figure>
<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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<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<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>
<figure class="align-center ">
<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">
<figcaption>
<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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</figure>
<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/2099252023-08-21T13:01:08Z2023-08-21T13:01:08ZThe order in which you acquire diseases could affect your life expectancy – new research<figure><img src="https://images.theconversation.com/files/542634/original/file-20230814-15-6ly3wb.jpg?ixlib=rb-1.1.0&rect=47%2C0%2C5310%2C3497&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Almost two-thirds of UK adults aged 65 and over possess two or more long-term health conditions.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/elderly-couple-tourists-sea-resort-1596444508">EvgL/Shutterstock</a></span></figcaption></figure><p><a href="https://doi.org/10.1016/S0140-6736(12)60240-2">More than 25%</a> of adults in the UK have two or more long-term health conditions. This increases to 65% for people older than 65 years, and to almost 82% for those aged 85 or older. </p>
<p><a href="https://doi.org/10.1016/S2468-2667(23)00098-1">Our study</a> assessed how a number of multiple long-term health conditions (<a href="https://www.nhs.uk/mental-health/conditions/psychosis/overview/">psychosis</a>, diabetes and congestive heart failure) develop over time, and what effect this can have on life expectancy. We chose these conditions because, together, they can lead to substantial reductions in how long someone lives.</p>
<p>We analysed the development of these conditions over a 20-year period for more than 1.6 million adults aged 25 and over. We used data held within the <a href="https://saildatabank.com/">SAIL databank</a>, which provides secure access to routinely collected anonymous health and administrative records for the population of Wales.</p>
<p>We also worked with patients and the public from across the UK to understand their experience of living with multiple long-term conditions. </p>
<p>Using statistical models, we examined the order and timing of developing psychosis, diabetes and congestive heart failure in patients of the same age, sex and area-level deprivation – and the related impact on their life expectancy. </p>
<h2>The impact of disease order</h2>
<p>We found that the order in which people developed these diseases had an important impact on their life expectancy. People who developed diabetes, psychosis and congestive heart failure, in that order, had the largest loss in life expectancy (approximately 13 years, on average).</p>
<p>People who developed the same conditions in a different order were less affected. So, for example, a 50-year-old man in an area of average deprivation could experience a difference in his life expectancy of more than 10 years, depending on the order in which he developed the three diseases. </p>
<p>Our research also identified that people who first developed diabetes, then psychosis and finally congestive heart failure carried a higher risk of developing the next long-term health condition, or dying within five years of their last diagnosis. </p>
<p>However, the development of further conditions is not always life-limiting. For example, people diagnosed with psychosis and diabetes – in any order – had a higher life expectancy than those diagnosed with psychosis alone. While this was a surprising finding, we expect people with diabetes to have more regular contact with health professionals through diabetic clinics, for example, which may improve their overall health. </p>
<p>Our study also found that congestive heart failure on its own, and in combination with psychosis (in any order), had a similar effect on life expectancy to the “worst case” combination of diabetes, psychosis and congestive heart failure (in that order). </p>
<figure class="align-center ">
<img alt="An empty bed in a hospital surrounded with medical equipment" src="https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542796/original/file-20230815-25-8wyoa2.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">The application of this research could lead to improved outcomes for the NHS.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/national-health-service-uk-19th-march-608498993">Imran Khan's Photography/Shutterstock</a></span>
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</figure>
<p>This is the first study to examine how the order of developing multiple long-term conditions affects a person’s life expectancy. This research could be used to inform patients, healthcare providers and decision-makers on the appropriate identification of diseases and management of patient care. In turn, this could lead to improved outcomes for patients and the NHS. </p>
<p>Our research also helps to support healthcare delivery by looking at the factors that may increase a person’s risk of developing disease, as well as identifying potential opportunities for disease screening and earlier intervention.</p>
<h2>Applying our research</h2>
<p>Future research could evaluate the impact of screening programmes and interventions in delaying the development of further long-term conditions and extending life.</p>
<p>However, it is important to note that our research used information from routinely collected health records, which are not always accurate – some diagnoses may be missing or delayed. Also, diagnoses are not always accurately described. These are all important factors in being able to accurately estimate the impact of multiple long-term conditions on life expectancy. </p>
<p><a href="https://phenotypes.healthdatagateway.org/">Further research funded by Health Data Research UK</a>, the national institute for health data science, aims to harmonise how this data is collected and reported. Over time, this will improve the quality of information obtained from routinely collected health records for research. </p>
<p>While our study examined the development of one group of multiple long-term conditions, this approach could be replicated for any other combination of conditions – including the development of long-term health conditions following COVID-19 infection (known as long COVID), and the impact this has on quality of life.</p>
<p>Those living with multiple long-term conditions often experience increased use of healthcare services and medications, as well as greater difficulty with day-to-day tasks. This leads to a reduced quality of life as well as reduced life expectancy. </p>
<p>Our research has shown that the combination of long-term conditions and order in which you develop them may both have a substantial impact on your life expectancy. However, this relationship can be complex, and the development of further disease does not always reduce life expectancy.</p><img src="https://counter.theconversation.com/content/209925/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rhiannon Owen receives funding from the Academy of Medical Sciences (AMS), Health and Care Research Wales (HCRW), Heath Data Research UK (HDRUK), Medical Research Council (MRC), and the National Institute for Health and Care Research (NIHR). She is affiliated with the National Institute for Health and Care Excellence (NICE). </span></em></p>People who developed diabetes, psychosis and congestive heart failure, in that order, experienced the largest reduction in life expectancyRhiannon Owen, Professor of Statistics, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2116612023-08-20T12:12:20Z2023-08-20T12:12:20ZOzempic, the ‘miracle drug,’ and the harmful idea
of a future without fat<figure><img src="https://images.theconversation.com/files/543325/original/file-20230817-27-jyg5rx.jpeg?ixlib=rb-1.1.0&rect=42%2C77%2C2030%2C1345&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Following news of Ozempic's ability to help its users lose weight, it did not take long for fat-haters to surface.</span> <span class="attribution"><a class="source" href="https://affecttheverb.com/disabledandhere/">(Justin Katigbak/Disabled And Here)</a></span></figcaption></figure><p>The headlines squeal with delight: <a href="https://www.nytimes.com/2019/09/10/well/eat/seeking-an-obesity-cure-researchers-turn-to-the-gut-microbiome.html">Latest wonder drug will “cure” obesity</a>.</p>
<p>We’ve encountered these headlines before. Time and <a href="https://www.forbes.com/sites/ericmack/2018/12/06/new-discovery-may-soon-allow-you-to-eat-whatever-you-want-without-gaining-weight/">again</a>, dubious and ineffective solutions for obesity gain prominence. Pills, tonics, elixirs, Zumba, Noom and now Ozempic. </p>
<p>The latest wonder drug is a semaglutide drug invented to help diabetics regulate blood glucose levels, but has the notable side-effect of severe weight loss — for which it is prescribed off-label. It has been heralded by many to culminate in the elimination of fat bodies.</p>
<p>The fatphobia that undergirds such a proclamation isn’t new.</p>
<p>What makes this moment different from the others, however, is the dangerous rhetoric in which it is lodged. This rhetoric elevates the banal and commonplace fat-shaming that fat people must endure and resist to an unprecedented level. </p>
<p>Even before this, fat people have been seen as having disposable lives not worth saving. For example, during the height of the COVID-19 pandemic amid fears of bed shortages for COVID patients, the Ontario government drew up draft triage protocols that prioritized people assumed to be more likely to survive COVID-19. </p>
<p>The move sparked an outcry <a href="https://archdisabilitylaw.ca/wp-content/uploads/2020/04/April-8-2020-Open-Letter-Ontarios-COVID-19-Triage-Protocol-PDF.pdf">from hundreds of organizations</a>, led by ARCH Disability Law Centre. Given the history of discrimination experienced by fat people in environments that are supposed to provide care, <a href="https://nobodyisdisposable.org/open-letter/">fat communities also mobilized globally</a> to sound an alarm about the potential for discrimination against them. </p>
<h2>Fat-haters</h2>
<p>Following news of Ozempic’s ability to help its users lose weight, it did not take long for fat-haters to surface.</p>
<p>Two weeks ago, <em>National Post</em> columnist Barbara Kay <a href="https://nationalpost.com/opinion/ozempic-will-spell-the-death-of-the-push-to-turn-obesity-into-an-identity-issue">proclaimed the death of obesity politics</a> (a.k.a. the fat liberation movement). The arrival of these drugs, she wrote, will lead to the conquering of obesity once and for all, putting an end to fat activism. </p>
<p>Ozempic is being likened to what eyeglasses are to near- or far-sighted people. But, its promise of a fat-free future is unsustainable. </p>
<p>It is steeped in fat-hatred that could further damage our relationships to our bodies and food.</p>
<h2>The language of the ‘miracle cure’</h2>
<p>Let’s start with language.</p>
<p>The <a href="https://www.economist.com/leaders/2023/03/02/new-drugs-could-spell-an-end-to-the-worlds-obesity-epidemic">language used around Ozempic is about ending the so called “obesity epidemic.”</a> The very description is laced with the idea of eradicating fat people. </p>
<p>First, Ozempic does not cure obesity. Certain users of the drug have lost significant weight, but they will need to take this costly medication in perpetuity. </p>
<p>If you come off the drug or if the drug changes, you will, <a href="https://slate.com/technology/2015/03/diets-do-not-work-the-thin-evidence-that-losing-weight-makes-you-healthier.html#:%7E:text=In%20reality%2C%2097%20percent%20of,and%20downright%20deceptive%20at%20worst.">just like 97 per cent of all dieters</a>, gain that weight back and more. </p>
<p>Also, restricting or suppressing caloric intake — or your body’s natural urges — is dangerous. These urges can come back with a vengeance after being quieted down for so long in the form of the <a href="https://doi.org/10.1097%2FMCO.0b013e328365b9be">ghrelin hormone</a>, which increases one’s appetite. </p>
<p>Ozempic could drop one from the requisite weight associated with the danger zones of obesity or morbid obesity. Yet, in a world marked by scientific uncertainty, the promise of “a cure” as a magic elixir is the ultimate expression of science vanquishing the bad enemy.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/listen-widespread-use-of-ozempic-for-weight-loss-could-change-how-we-view-fatness-206457">Listen: Widespread use of Ozempic for weight loss could change how we view fatness</a>
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</em>
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<h2>Then there is the other ‘O’ word: Obesity</h2>
<p>Obesity talk pervades society. </p>
<p>The latest news is that medications to address obesity, like Ozempic and other semaglutide drugs at higher doses, are transforming health as we know it.</p>
<p>Governments are intent on stamping out obesity. Individuals are exhorted to do everything in their power to avoid becoming or being “obese.” This, even though the measure of obesity, the Body Mass Index (BMI), is widely regarded as a flawed measure of health. </p>
<p>Pressure is mounting for governments to provide these medications as part of a universal basket of health care. Social media is abuzz with Ozempic talk and the hashtag #Ozempic has garnered a staggering 1.2 billion views on TikTok. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/543479/original/file-20230818-23-4ki3st.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543479/original/file-20230818-23-4ki3st.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=750&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543479/original/file-20230818-23-4ki3st.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=750&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543479/original/file-20230818-23-4ki3st.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=750&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543479/original/file-20230818-23-4ki3st.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=943&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543479/original/file-20230818-23-4ki3st.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=943&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543479/original/file-20230818-23-4ki3st.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=943&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">Social media and fat-positive activist, Remi Bader, opened up about using Ozempic and then getting off of it and gaining twice the weight back.</span>
<span class="attribution"><span class="source">@RemiBader/Instagram</span></span>
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</figure>
<h2>Distorted picture of side-effects</h2>
<p>The crusaders are half right. Ozempic is indeed transforming how we understand health. </p>
<p>The bad news is that it paints a grossly distorted picture of patients whose lives will be purportedly transformed if only they could shed that weight. While initial concerns were expressed that these injections are for diabetes only and should not be used strictly for weight loss, those concerns seem to have dissipated. Ozempic manufacturer Novo Nordisk is warning <a href="https://www.cbc.ca/news/health/shortage-of-diabetes-weight-loss-drug-ozempic-expected-in-canada-says-manufacturer-1.6940626">a shortage of the drug is expected in Canada</a>. </p>
<p>One notable side-effect of Ozempic <a href="https://www.cbc.ca/news/health/health-canada-review-diabetes-weight-loss-1.6921759">is reportedly suicidal ideation</a>. However, when you are in the midst of an obesity epidemic, side-effects are, well, secondary. </p>
<h2>The message in the marketing of Ozempic</h2>
<p>What other messages can we read from the marketing of Ozempic? Highly visible ads have appeared in such places as the exterior of <a href="https://www.blogto.com/city/2023/06/toronto-has-basically-just-turned-giant-ad-ozempic/">Toronto streetcars and behind home plate at Blue Jays games</a>, <a href="https://globalnews.ca/news/9779972/ozempic-ads-canada-concerns/">drawing criticism from some doctors and medical ethics experts</a>. </p>
<p><a href="https://www.theguardian.com/lifeandstyle/2023/jun/08/ozempic-weight-loss-body-positivity">Journalist Rachel Pick argued recently in the <em>Guardian</em></a> that the use of these drugs for weight loss encourages a myopic view of self: “It does not ask us to work on how we regard and treat others, it only asks us to feel better about ourselves. It is purely self-love, with an emphasis on the ‘self’: the ultimate exercise in navel-gazing.”</p>
<h2>Obesity biopolitics: selling ‘fat-free futures’</h2>
<p>Drugs such as Ozempic can be understood as a form of “pre-emptive obesity biopolitics,” a term used by United Kingdom geographer, <a href="https://doi.org/10.1111/j.1475-5661.2009.00363.x">Bethan Evans</a>, to describe policy interventions that seek in the present to prevent fat futures. </p>
<p>Noom, the cognitive behavioural therapy-powered weight-loss company, has similar aspirations of helping what they <a href="https://www.inanna.ca/product/fat-studies-in-canada-remapping-the-field-in-canada/">call pre-chronic patients</a>, candidates in waiting. </p>
<p>All of these approaches seek to create new markets of anxious consumers obsessed with their weight. Everyone can hop on the bandwagon that tramples over fat people in the pursuit of wealth and market share, even if it means pushing unrealistic and unattainable beauty and size ideals. </p>
<p>Although <em>Post</em> columnist Kay was quick to celebrate the so-called end of “obesity politics” occasioned by the arrival of Ozempic, perhaps we are instead witnessing the dawn of a politics engaged in contesting fatphobia and fat hatred in all of its forms. </p>
<p>A future without fat is a dystopian aspiration. And it’s one that fails to acknowledge the essential role fat plays in our bodies and in the body politic.</p>
<p><em>This is an updated version of an article originally published on Aug. 20, 2023. It clarifies the usage and marketing of Ozempic.</em></p>
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<p class="fine-print"><em><span>Michael Orsini receives funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Fady Shanouda 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 messaging around Ozempic being a miracle cure is not only a lie, it has kicked up a new level of fatphobia.Fady Shanouda, Assistant Professor, Critical Disability Studies, Carleton UniversityMichael Orsini, Professor, Institute of Feminist and Gender Studies | School of Political Studies, L’Université d’Ottawa/University of OttawaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2059192023-08-14T20:00:06Z2023-08-14T20:00:06Z1 in 6 women are diagnosed with gestational diabetes. But this diagnosis may not benefit them or their babies<figure><img src="https://images.theconversation.com/files/539721/original/file-20230727-18363-k1nhbm.jpg?ixlib=rb-1.1.0&rect=115%2C49%2C5390%2C3615&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/depressed-pregnant-woman-worried-about-her-2210916539">Shutterstock</a></span></figcaption></figure><p>When Sophie was pregnant with her first baby, she had an <a href="https://www.ncbi.nlm.nih.gov/books/NBK279331/#:%7E:text=Oral%20glucose%20tolerance%20tests%20(OGTT,enough%20by%20the%20body's%20cells.)">oral glucose tolerance</a> blood test. A few days later, the hospital phoned telling her she had gestational diabetes.</p>
<p>Despite having only a slightly raised glucose (blood sugar) level, Sophie describes being diagnosed as affecting her pregnancy tremendously. She tested her blood glucose levels four times a day, kept food diaries and had extra appointments with doctors and dietitians. </p>
<p>She was advised to have an induction because of the risk of having a large baby. At 39 weeks her son was born, weighing a very average 3.5kg. But he was separated from Sophie for four hours so his glucose levels could be monitored. </p>
<p>Sophie is not alone. About <a href="https://www.aihw.gov.au/reports/diabetes/diabetes/contents/how-many-australians-have-diabetes/gestational-diabetes">one in six</a> pregnant women in Australia are now diagnosed with gestational diabetes. </p>
<p>That was not always so. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827530/">New criteria</a> were developed in 2010 which dropped an initial screening test and lowered the diagnostic set-points. Gestational diabetes diagnoses have since <a href="https://www.aihw.gov.au/reports/diabetes/diabetes/contents/how-many-australians-have-diabetes/gestational-diabetes">more than doubled</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=487&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=487&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536691/original/file-20230710-23-v8weyw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=487&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Gestational diabetes rates more than doubled after the threshold changed.</span>
<span class="attribution"><span class="source">AIHW</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>But <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2204091">recent</a> <a href="https://pubmed.ncbi.nlm.nih.gov/33704936/">studies</a> cast doubt on the ways we diagnose and manage gestational diabetes, especially for women like Sophie with only mildly elevated glucose. Here’s what’s wrong with gestational diabetes screening.</p>
<h2>The glucose test is unreliable</h2>
<p>The test used to diagnose gestational diabetes – the oral glucose tolerance test – has poor reproducibility. This means subsequent tests may give a different result.</p>
<p>In a <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2214956">recent Australian trial</a> of earlier testing in pregnancy, one-third of the women initially classified as having gestational diabetes (but neither told nor treated) did not have gestational diabetes when retested later in pregnancy. That is a problem. </p>
<p>Usually when a test has poor reproducibility – for example, blood pressure or cholesterol – we repeat the test to confirm before making a diagnosis. </p>
<p>Much of the increase in the incidence of gestational diabetes after the introduction of new diagnostic criteria was due to the switch from using two tests to only using a single test for diagnosis.</p>
<figure class="align-center ">
<img alt="Pregnant woman cooks dinner with her child" src="https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540334/original/file-20230801-157556-lb9vkv.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">Women with only mildly elevated glucose levels are being diagnosed with gestational diabetes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/black-pregnant-woman-cooking-her-daughter-2019300152">Shutterstock</a></span>
</figcaption>
</figure>
<h2>The thresholds are too low</h2>
<p>Despite little evidence of benefit for either women or babies, the current Australian criteria diagnose women with only mildly abnormal results as having “gestational diabetes”. </p>
<p>Recent studies have shown this doesn’t benefit women and may cause harms. A <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2204091">New Zealand trial</a> of more than 4,000 women randomly assigned women to be assessed based on the current Australian thresholds or to higher threshold levels (similar to the pre-2010 criteria). </p>
<p>The trial found no additional benefit from using the current low threshold levels, with overall no difference in the proportion of infants born large for gestational age. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sixteen-pound-baby-born-in-brazil-heres-what-increases-the-risk-of-giving-birth-to-a-giant-baby-198423">Sixteen-pound baby born in Brazil: here's what increases the risk of giving birth to a giant baby</a>
</strong>
</em>
</p>
<hr>
<p>However, the trial found several harms, including more neonatal hypoglycaemia (low blood sugar in newborns), induction of labour, use of diabetic medications including insulin injections, and use of health services. </p>
<p>The study authors also looked at the subgroup of women who were diagnosed with glucose levels between the higher and lower thresholds. In this subgroup, there was some reduction in large babies, and in shoulder problems at delivery. </p>
<p>But there was also an increase in small babies. This is of concern because being small for gestational age can also have consequences for babies, including long-term health consequences.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=349&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=349&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=349&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=438&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=438&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540643/original/file-20230802-29-1dw2rw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=438&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">NEJM</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Testing too early</h2>
<p>Some centres have begun testing women at higher risk of gestational diabetes earlier in the pregnancy (between 12 and 20 weeks).</p>
<p>However, a <a href="https://pubmed.ncbi.nlm.nih.gov/37144983/">recent trial</a> showed no clear benefit compared with testing at the usual 24–28 weeks: possibly fewer large babies, but again matched by more small babies.</p>
<p>There was a reduction in transient “respiratory distress” – needing extra oxygen for a few hours – but not in serious clinical events. </p>
<h2>Impact on women with gestational diabetes</h2>
<p>For women diagnosed using the higher glucose thresholds, dietary advice, glucose monitoring and, where necessary, insulin therapy has been shown to reduce complications during delivery and the post-natal period. </p>
<p>However, current models of care can also cause harm. Women with gestational diabetes are often denied their preferred model of care – for example, midwifery continuity of carer. In rural areas, they may have to transfer to a larger hospital, requiring longer travel to antenatal visits and moving to a larger centre for their birth – away from their families and support networks for several weeks. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-you-at-risk-of-being-diagnosed-with-gestational-diabetes-it-depends-on-where-you-live-112515">Are you at risk of being diagnosed with gestational diabetes? It depends on where you live</a>
</strong>
</em>
</p>
<hr>
<p>Women say the diagnosis often dominates their antenatal care and their whole <a href="https://pubmed.ncbi.nlm.nih.gov/32028931/">experience of pregnancy</a>, reducing time for other issues or concerns. </p>
<p>Women from culturally and linguistically diverse communities <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-03981-5">find it difficult</a> to reconcile the advice given about diet and exercise with their own cultural practices and beliefs about pregnancy.</p>
<p>Some women with gestational diabetes <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-2745-1">become</a> extremely anxious about their eating and undertake extensive calorie restrictions or disordered eating habits.</p>
<figure class="align-center ">
<img alt="Woman stands in garden looking at her pregnant belly" src="https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540324/original/file-20230801-241351-uvur05.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">Some pregnant women become extremely anxious after being diagnosed with gestational diabetes.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/gYnEka3-tCI">Unsplash/Jordan Bauer</a></span>
</figcaption>
</figure>
<h2>Time to reassess the advice</h2>
<p>Recent evidence from both randomised controlled trials and from qualitative studies with women diagnosed with gestational diabetes suggest we need to reassess how we currently diagnose and manage gestational diabetes, particularly for women with only slightly elevated levels.</p>
<p>It is time for a review to consider all the problems described above. This review should include the views of all those impacted by these decisions: women in childbearing years, and the GPs, dietitians, diabetes educators, midwives and obstetricians who care for them.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/had-gestational-diabetes-here-are-5-things-to-help-lower-your-future-risk-of-type-2-diabetes-114298">Had gestational diabetes? Here are 5 things to help lower your future risk of type 2 diabetes</a>
</strong>
</em>
</p>
<hr>
<p><em>This article was co-authored by maternity services consumer advocate Leah Hardiman.</em></p><img src="https://counter.theconversation.com/content/205919/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Glasziou receives funding from an NHMRC Investigator grant.</span></em></p><p class="fine-print"><em><span>Jenny Doust receives funding from NHMRC and MRFF. </span></em></p>About one in six pregnant women in Australia are now diagnosed with gestational diabetes. Rates have more than doubled since the thresholds for diagnosis were changed.Paul Glasziou, Professor of Medicine, Bond UniversityJenny Doust, Clinical Professorial Research Fellow, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2097352023-08-08T21:47:06Z2023-08-08T21:47:06ZCan physical activity boost our resilience to rising temperatures?<figure><img src="https://images.theconversation.com/files/540843/original/file-20230802-25-wjb3ec.jpeg?ixlib=rb-1.1.0&rect=8%2C0%2C1905%2C1276&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The number of days of extreme heat is set to increase in the years ahead. An active lifestyle can help reduce the impact on your health. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Climate change, a high prevalence of chronic diseases and alarming levels of physical inactivity are three of the central challenges we face in the 21st century. </p>
<p>The increased frequency, duration and intensity of heat waves is one of the undeniable signs that climate change is well underway. According to the various climate scenarios, by the end of the century <a href="https://www.nature.com/articles/nclimate3322">between half and three-quarters of the world’s population will be exposed to lethal heat for more than 20 days per year</a>. </p>
<p>The future impact of extreme heat events will depend on the extent of climate change, but also on our ability to adapt to it by becoming less sensitive and vulnerable to heat, and therefore more resilient. As researchers in physical activity science and environmental physiology, we are assessing how adopting an active lifestyle can make us better equipped to cope with rising global temperatures.</p>
<h2>How can the human body combat heat?</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/532038/original/file-20230614-6008-evbd3c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532038/original/file-20230614-6008-evbd3c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532038/original/file-20230614-6008-evbd3c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532038/original/file-20230614-6008-evbd3c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532038/original/file-20230614-6008-evbd3c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532038/original/file-20230614-6008-evbd3c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532038/original/file-20230614-6008-evbd3c.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 child enjoys water jets in Montréal during a heat wave.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>When exposed to heat, <a href="https://journals.lww.com/acsm-essr/Fulltext/2019/04000/Regulation_of_Body_Temperature_by_Autonomic_and.9.aspx">the body deploys several responses to try to dissipate it</a>. The first is conscious and depends on behavioural decisions we make to minimize exposure, such as seeking a cool place, switching on a fan or reducing our physical activity. </p>
<p>Secondly, if these strategies are not sufficient, the brain activates physiological responses that are beyond our control; blood vessels in the skin dilate to increase the blood supply and sweat glands increase their activity to excrete more sweat. </p>
<p>So it’s not surprising that any factor that affects these responses can alter the body’s ability to react adequately to heat exposure.</p>
<h2>Who are the most vulnerable groups?</h2>
<p>Although heat affects us all, evidence shows that <a href="https://www.canada.ca/en/health-canada/services/climate-change-health/populations-risk.html">certain groups of people are more sensitive to it, which increases their vulnerability</a>. </p>
<p>A number of individual factors including age, pre-existing health problems such as cardiovascular disease and Type 2 diabetes, the use of certain medications (anticholinergic drugs, beta blockers, antidepressants and diuretics, among others), being overweight or obese, having low functional and cognitive abilities and low cardiorespiratory fitness <a href="https://www.sciencedirect.com/science/article/pii/S0140673621012083">are all associated with reduced heat tolerance and a greater risk of developing heat-related health problems</a>. This is reflected in public health figures since <a href="https://www.cmaj.ca/content/182/10/1053.short">these factors are associated with an increased risk of hospitalization or death during an extreme heat event</a>. </p>
<p>This finding can be explained by the fact that several of these conditions are associated with two physiological responses:</p>
<ul>
<li><p>reduced voluntary and autonomous heat dissipation capacities, which increase the stress imposed on the body;</p></li>
<li><p>reduced physiological potential, which reduces the body’s ability to cope.</p></li>
</ul>
<p>Together, these two conditions increase the likelihood that the stress placed on the body will reach and exceed the body’s physiological potential, increasing the risk of developing heat-related health problems.</p>
<h2>How can regular physical activity improve resilience to heat?</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541144/original/file-20230804-18285-t9qc82.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/541144/original/file-20230804-18285-t9qc82.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541144/original/file-20230804-18285-t9qc82.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=342&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541144/original/file-20230804-18285-t9qc82.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=342&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541144/original/file-20230804-18285-t9qc82.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=342&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541144/original/file-20230804-18285-t9qc82.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=430&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541144/original/file-20230804-18285-t9qc82.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=430&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541144/original/file-20230804-18285-t9qc82.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=430&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="attribution"><span class="source">Created with BioRender.com</span></span>
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<p>Interestingly, of the many risk factors for developing heat-related health problems, several can be avoided by adopting a healthy, active lifestyle. In fact, doing regular physical activity throughout one’s life could mean being better equipped to cope with rising global temperatures:</p>
<ol>
<li><p>By bringing about a number of physiological adaptations that increase heat dissipation capacity (increased sweat production) and the body’s physiological potential (increased cardiovascular reserve), thereby increasing heat tolerance and helping to meet the increased demands placed on the cardiovascular system during heat stress;</p></li>
<li><p>By limiting the decline in cardiorespiratory fitness and thermoregulatory functions associated with obesity, chronic disease and the use of certain medications. Regular physical activity can also help to limit cognitive and functional decline, enabling people to maintain their independence, an important protective factor against heat;</p></li>
<li><p>By slowing the decline in cardiovascular function and thermoregulatory functions inherent in aging;</p></li>
<li><p>By contributing to improved mental well-being, which could help people cope with the stress associated with extreme heat episodes.</p></li>
</ol>
<p>Physical activity could therefore make an important contribution to our ability to adapt to rising global temperatures, increasing our individual and community resilience.</p>
<p>However, it is important to note that a number of other risk factors are not directly modifiable by a healthy and active lifestyle, including certain mental health disorders, low socio-economic status and limited access to cool or air-conditioned places, among others. It is also well established that people who engage in intense to moderate physical activity during heat episodes are at greater risk of developing heat-related health problems (agricultural workers, construction workers, restaurant workers, etc.).</p>
<h2>Is the next generation sufficiently equipped to meet this challenge?</h2>
<p>In Canada, the <a href="https://www.canada.ca/en/public-health/services/childhood-obesity/childhood-obesity.html">prevalence of obesity among five- to 17-year-olds has almost tripled in the last 30 years</a>. Currently, <a href="https://www.canada.ca/en/public-health/services/reports-publications/health-promotion-chronic-disease-prevention-canada-research-policy-practice/vol-37-no-11-2017/adherence-24hour-movement-guidelines-10-17-year-old-canadians.html">more than nine out of 10 young people do not meet Canada’s 24-hour exercise guidelines</a>. The same is true worldwide. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/532039/original/file-20230614-18-xsmcof.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532039/original/file-20230614-18-xsmcof.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532039/original/file-20230614-18-xsmcof.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532039/original/file-20230614-18-xsmcof.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532039/original/file-20230614-18-xsmcof.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532039/original/file-20230614-18-xsmcof.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532039/original/file-20230614-18-xsmcof.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">Younger generations are less active than those who came before them. They risk being more vulnerable to extreme heat.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In Québec, recent figures paint a picture that is more than alarming: a <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2022.1056484/full">15 per cent decrease in cardiorespiratory capacity and a 30 per cent decrease in functional capacity in young people</a> compared with their elders who underwent the same tests in the 1980s. Worse still, the researchers observed that among 15- to 17-year-olds, <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2022.1056484/full">six out of 10 boys and seven out of 10 girls have a cardiorespiratory capacity that will expose them to cardiometabolic health problems in the future</a>. </p>
<p>Such trends suggest that today’s young people may be less and less equipped to tolerate heat, while they will be increasingly exposed to it. From a public health point of view, this is alarming. Maintaining regular physical activity and adequate fitness throughout their lives could make young people <a href="https://www.tandfonline.com/doi/full/10.1080/23328940.2022.2102375">better equipped to meet these challenges</a>.</p><img src="https://counter.theconversation.com/content/209735/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Les auteurs ne travaillent pas, ne conseillent pas, ne possèdent pas de parts, ne reçoivent pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'ont déclaré aucune autre affiliation que leur organisme de recherche.</span></em></p>Many heat-related health problems can be avoided by adopting a healthy, active lifestyle. But the younger generation is less active than previous generations, and therefore more vulnerable.Thomas Deshayes, Chercheur postdoctoral en sciences de l'activité physique, Université de MontréalJulien Periard, Research professor, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2088322023-07-19T12:24:41Z2023-07-19T12:24:41ZGlobal diabetes cases on pace to soar to 1.3 billion people in the next 3 decades, new study finds<figure><img src="https://images.theconversation.com/files/537560/original/file-20230714-21-ha7ae5.jpg?ixlib=rb-1.1.0&rect=0%2C51%2C6845%2C4300&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Aging and obesity are likely to be the two primary drivers of the expected rise in diabetes. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/glycemia-test-royalty-free-image/1336828471?phrase=diabetes&adppopup=true">fotograzia/Moment via Getty Images</a></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>The number of people living with diabetes worldwide is on pace to more than double in the next three decades, for a total of 1.3 billion people by 2050. That is one of the key findings from our <a href="https://doi.org/10.1016/S0140-6736(23)01301-6">study on the global burden of diabetes</a> recently published in The Lancet.</p>
<p>We analyzed and synthesized all available epidemiological data on diabetes burden – defined as health decline due to diabetes captured through the number of cases, disease severity and deaths. Our study included more than 27,000 data sources to produce estimates of diabetes prevalence, disability and deaths for 204 countries and territories from 1990 through 2021. Using a modeling tool that takes into account sociodemographic factors and obesity, we projected diabetes prevalence out to 2050. </p>
<p>We also estimated the <a href="https://doi.org/10.1186/1478-7954-1-1">proportion of diabetes disability and death</a> attributable to specific risk factors related to obesity, diet, physical activity, environment or occupation, tobacco use and alcohol use.</p>
<p>This analysis is part of the larger <a href="https://www.healthdata.org/gbd">Global Burden of Diseases, Injuries, and Risk Factors Study</a>, which has quantified health decline due to hundreds of diseases, injuries and risk factors since 1990. Thousands of health experts and researchers around the world both contribute to and use estimates from this study, which is continually updated.</p>
<p>Our team projected that every country is expected to experience an increase in diabetes cases by 2050. In the regions that are expected to be hardest hit – including North Africa and the Middle East and Pacific island nations – there are countries where as many as 1 in 5 people could be living with diabetes in 2050 if current trends continue. Among older adults in these regions, diabetes prevalence is expected to be even higher.</p>
<p>While both <a href="https://www.cdc.gov/diabetes/basics/diabetes.html">type 1 and type 2 diabetes</a> are characterized by high levels of blood sugar, also known as glucose, <a href="https://www.cdc.gov/diabetes/basics/type2.html">type 2</a> is a largely preventable disease that occurs due to gradual insulin resistance and is commonly diagnosed among adults. <a href="https://www.cdc.gov/diabetes/basics/type1.html">Type 1</a>, on the other hand, is an autoimmune disease where the body cannot produce insulin and typically develops during childhood or adolescence.</p>
<p>The vast majority of new diabetes cases in the next three decades are projected to be type 2. We expect the two primary drivers will be aging populations and increases in obesity. In 2021, obesity was the most important risk factor for type 2 diabetes, accounting for more than half of disability and death from the disease.</p>
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<h2>Why it matters</h2>
<p>People living with diabetes are at significantly higher risk of developing and dying from other major diseases, including <a href="https://doi.org/10.1016/S0140-6736(20)30752-2">ischemic heart disease and stroke,</a> and from complications such as <a href="https://www.thinkglobalhealth.org/article/putting-vision-loss-and-aging-focus">vision loss</a> and foot ulcers. This compounds the stress of diabetes on health care systems, requiring more comprehensive screening and management. However, a study found that <a href="https://doi.org/10.1016/s2666-7568(21)00089-1">fewer than 1 in 10 people</a> with diabetes in low- and middle-income countries have access to comprehensive diabetes treatment.</p>
<p>Based on <a href="https://doi.org/10.1186/s40842-016-0039-3">an abundance of research</a>, the two primary drivers of the expected rise in diabetes cases will be aging and obesity. As people age, their bodies’ <a href="https://doi.org/10.1161/CIRCRESAHA.118.312806">ability to regulate blood sugar levels changes</a>.</p>
<p>In addition, studies indicate that <a href="https://doi.org/10.1016/j.amepre.2011.10.026">obesity rates will continue to rise</a>. No program has yet shown <a href="https://doi.org/10.1038/s41574-019-0176-8">sustainable and population-level reductions in obesity</a>. </p>
<p>To reverse this trend in obesity rates, an approach that targets both the behavioral and structural factors related to <a href="https://doi.org/10.1002/oby.20922">maintaining a healthy diet</a> and <a href="https://doi.org/10.1016/j.jada.2005.02.045">getting enough physical activity</a> will be needed.</p>
<h2>What other research is being done</h2>
<p>Our study reports on diabetes trends and risk factors over time by age, sex and geography. However, there are other factors that offer clues to why diabetes disproportionately afflicts certain populations.</p>
<p>Research shows that there are many complex social and economic dynamics at play when it comes to trying to live a healthy lifestyle. <a href="https://doi.org/10.1016/j.diabres.2012.12.005">Low income</a>, <a href="https://doi.org/10.1136/bmjopen-2014-005710">low education level</a> and <a href="https://doi.org/10.1016/S2213-8587(23)00119-5">living in urban areas</a> are all associated with a higher risk of developing type 2 diabetes. Studies also show that <a href="https://diabetesatlas.org/atlas/indigenous-2022/">type 2 diabetes disproportionately affects Indigenous populations</a> across the world, largely owing to colonization and resulting disruptions to traditional ways of life.</p>
<p>The rapid increase in the number of people living with diabetes that we project in our study doesn’t have to become a reality. Understanding how these trends are tied in with how people live is the first step toward changing the course of this disease over the coming decades.</p><img src="https://counter.theconversation.com/content/208832/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>Diabetes rates worldwide have been rising steadily since the early 1990s when these data were first estimated. This trend is only going up.Lauryn Stafford, Fellow in Health Metrics Sciences, University of WashingtonLiane Ong, Lead Research Scientist at the Institute for Health Metrics and Evaluation, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2074602023-07-12T15:18:09Z2023-07-12T15:18:09ZCommon diabetes drug metformin could protect against long COVID<figure><img src="https://images.theconversation.com/files/534052/original/file-20230626-25-dy3ijb.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C6709%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Metformin is a drug commonly taken by patients with type 2 diabetes.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-man-taking-prescription-medicine-home-1768003094">pikselstock/Shutterstock</a></span></figcaption></figure><p>There are no drugs to treat long COVID – a condition that affects around <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/30march2023">2 million people</a> in the UK alone – so you can imagine the excitement when a cheap diabetes drug called metformin was shown to decrease the risk of getting the disease. </p>
<p>The <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(23)00299-2/fulltext">study</a>, published in The Lancet Infectious Diseases, showed that if you give people who are overweight or obese metformin when they are ill with COVID, they are 40% less likely to develop long COVID compared with people who are given a placebo (dummy pill).</p>
<p>We don’t know exactly what causes long COVID, but a variety of biological mechanisms <a href="https://www.science.org/content/article/what-causes-long-covid-three-leading-theories">have been suggested</a>, including an overactive immune response, the virus lingering in certain organs, and thrombosis (clots) causing tissue damage.</p>
<p>Finding a cure is clearly going to be difficult, so a better approach would be to prevent the condition from developing in the first place. Treatment given during the infection may be able to reduce the immune response or help the body eliminate the virus and so lessen its long-term effects. </p>
<h2>What the study did</h2>
<p>In a clinical trial in the US, overweight and obese people aged 30 and over were randomly allocated to receive metformin or a placebo. (Being overweight or obese are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8469321/">known risk factors</a> for long COVID.)</p>
<p>The participants were recruited remotely, for example, through online messaging, and people were selected for the study based on self-reported criteria, including age and weight. The trial did include women who were pregnant or breastfeeding, which is important as these groups are often excluded from drug trials.</p>
<p>Over 1,000 people were given either metformin or an identical placebo pill after testing positive for COVID between December 2020 and January 2022.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-risk-of-diabetes-and-heart-disease-is-higher-after-infection-but-maybe-only-temporarily-186976">COVID: risk of diabetes and heart disease is higher after infection – but maybe only temporarily</a>
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<p>The active drugs and placebos were mailed to patients by courier and treatment was initiated within seven days of COVID symptoms starting. Almost half of the participants began treatment within four days of their symptoms starting.</p>
<p>Participants were instructed to take the pills for two weeks. The researchers followed the participants for ten months to see if they developed long COVID. Participants reported their symptoms monthly via an online survey.</p>
<p>Neither the trial participants nor the researchers knew which treatment a participant had received. This is what’s known as a “double-blind” trial and it’s important for avoiding bias.</p>
<figure class="align-center ">
<img alt="A woman sitting on a couch, holding her head between her hands." src="https://images.theconversation.com/files/534053/original/file-20230626-15-bhfu8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534053/original/file-20230626-15-bhfu8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534053/original/file-20230626-15-bhfu8n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534053/original/file-20230626-15-bhfu8n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534053/original/file-20230626-15-bhfu8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534053/original/file-20230626-15-bhfu8n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534053/original/file-20230626-15-bhfu8n.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">
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<span class="caption">Long COVID affects millions of people around the world.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-sad-woman-broken-heart-sitting-2112452147">Srdjan Randjelovic/Shutterstock</a></span>
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<h2>What the results showed</h2>
<p>The main outcome measure was the report of a doctor’s diagnosis of long COVID. Of the 564 people who received metformin, 35 developed long COVID (6.3%) compared with 58 out of 562 (10.4%) who took a placebo. This equates to a 41% lower risk of long COVID for patients who received metformin.</p>
<p>Those starting treatment earlier, by day four, had lower rates of long COVID compared with those who started treatment later. This lends weight to the proposition that metformin has a protective effect against long COVID.</p>
<p>However, because relatively few people developed long COVID, large numbers of people needed to take metformin to prevent a single case of long COVID. Roughly 24 people would need to take metformin to prevent one case of long COVID.</p>
<p>While metformin is a safe drug – as indicated by many decades of use worldwide for type 2 diabetes as well as its current prescribing <a href="https://www.nhs.uk/conditions/gestational-diabetes/treatment/">in pregnancy</a> to treat gestational diabetes – it’s nevertheless worth weighing up the risks and benefits carefully. Side-effects can include a rash and <a href="https://www.nhs.uk/medicines/metformin/side-effects-of-metformin/">diarrhoea</a>.</p>
<p>Further studies will also be required to determine whether similar benefit is seen in the UK, particularly in people from minority ethnic groups, who were underrepresented in this study (83% of participants were white). </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/long-covid-who-is-at-risk-151797">Long COVID: who is at risk?</a>
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</em>
</p>
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<p>While it’s not clear how exactly metformin might work to protect against long COVID, this study offers a promising glimpse of how we might prevent it from developing in future.</p><img src="https://counter.theconversation.com/content/207460/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Frances Williams receives funding from Versus Arthritis and the Kennedy Trust. </span></em></p>A recent study found that among people who were overweight or obese, taking metformin during a COVID infection reduced the risk of developing long COVID by 40%.Frances Williams, Professor of Genomic Epidemiology and Hon Consultant Rheumatologist, King's College LondonLicensed 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>
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<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>
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<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/2064572023-06-22T17:25:55Z2023-06-22T17:25:55ZListen: Widespread use of Ozempic for weight loss could change how we view fatness<figure><img src="https://images.theconversation.com/files/533549/original/file-20230622-19-53j2i3.jpg?ixlib=rb-1.1.0&rect=20%2C958%2C1943%2C1005&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ozempic, a semaglutide drug being used for weight loss, could impact how society sees fat people. </span> <span class="attribution"><span class="source">(macrovector/Freepik)</span></span></figcaption></figure><iframe height="200px" width="100%" frameborder="no" scrolling="no" seamless="" src="https://player.simplecast.com/325083d9-aeee-49a3-a16e-2ef5bdce4fad?dark=true"></iframe>
<p>It seems like everywhere you look these days, on TikTok, on the sides of buses, in news headlines, you see Ozempic, the drug originally created as a diabetes treatment, but now being used as a weight-loss method.</p>
<p>Ever since it <a href="https://globalnews.ca/news/9618159/ozempic-diabetes-weight-loss-drug-policy/#:%7E:text=Novo%20Nordisk%20actually,yet%20in%20Canada.">arrived in Canada</a>, it’s been in incredibly high demand. </p>
<p>While Ozempic may just be the next in a long line of get-thin-quick fads, it’s already causing a lot of issues, many of which are especially felt by racialized communities.</p>
<p><a href="https://dont-call-me-resilient.simplecast.com/episodes/widespread-use-of-ozempic-for-weight-loss-could-change-the-way-we-view-fatness">In this episode of <em>Don’t Call Me Resilient</em></a>, we are joined by fat and disability studies professor Fady Shanouda, who examines anti-fat bias in medicine. As the use of Ozempic, a drug for diabetes, slams into the mainstream as a weight-loss method, will the drug’s use impact our concept of fatness? And how does fatness intersect with race and class? How might the craze for Ozempic deepen racial and class disparities?</p>
<h2>Higher risk for diabetes</h2>
<p>In the United States and Canada, Black, Indigenous and South Asian communities are at a higher risk of Type 2 diabetes. A <a href="https://news.umanitoba.ca/rate-of-children-diagnosed-with-type-2-diabetes-rises-over-50-over-last-10-years-mchp-study-finds/">recent report</a> revealed that First Nations children in Manitoba are 25 times more likely to be diagnosed with Type 2 diabetes than other children. </p>
<figure class="align-left ">
<img alt="A person with their shirt pulled up and stomach exposed, with an ozempic injection in their right hand" src="https://images.theconversation.com/files/533254/original/file-20230621-21-h6xfhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/533254/original/file-20230621-21-h6xfhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533254/original/file-20230621-21-h6xfhj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533254/original/file-20230621-21-h6xfhj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533254/original/file-20230621-21-h6xfhj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533254/original/file-20230621-21-h6xfhj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533254/original/file-20230621-21-h6xfhj.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 person prepares an Ozempic injection to use to control blood sugar levels.</span>
<span class="attribution"><span class="source">myskin/Shutterstock</span></span>
</figcaption>
</figure>
<p>The cost of Ozempic already puts certain communities at a disadvantage. In Canada, Ozempic costs around <a href="https://www.cbc.ca/news/canada/british-columbia/ozempic-canada-british-columbia-how-it-works-1.6794950">$300 a month</a> and in the U.S., the price is about <a href="https://www.webmd.com/obesity/news/20230503/ozempic-cost-coupons-and-ways-to-save-cash">$1,000 a month</a>. While many rely on health insurance for prescriptions, insurance for the most part does not cover Ozempic for non-diabetic use.</p>
<h2>The racist roots of fighting obesity</h2>
<p>Prof. Shanouda explains how fatness has been negatively associated with Blackness, both historically and currently. These harmful conceptions of fatness influences the treatment of racialized communities in health care. This includes <a href="https://www.newyorker.com/magazine/2023/03/27/will-the-ozempic-era-change-how-we-think-about-being-fat-and-being-thin">frequent misdiagnosis, under-treatment and frequent fat-shaming by doctors</a>.</p>
<blockquote>
<p>I imagine fat people will be asked all the time now: why they continue to be fat and why they’re not on Ozempic. It is presenting us with a supposed solution for a human variation that has existed for all time. There have always been fat people. There will always be fat people. - Fady Shanouda</p>
</blockquote>
<h2>Listen and Follow</h2>
<p>You can listen to or follow <em><a href="https://dont-call-me-resilient.simplecast.com/episodes/listen-to-an-american-canadian-trans-scholar-and-activist-explain-why-trans-rights-are-under-attack">Don’t Call Me Resilient</a></em> on <a href="https://podcasts.apple.com/ca/podcast/dont-call-me-resilient/id1549798876">Apple Podcasts</a>, <a href="https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5zaW1wbGVjYXN0LmNvbS9qZFg0Ql9DOA">Google Podcasts</a>, <a href="https://open.spotify.com/show/37tK4zmjWvq2Sh6jLIpzp7">Spotify</a> or <a href="https://dont-call-me-resilient.simplecast.com">wherever you listen to your favourite podcasts</a>. </p>
<p><a href="mailto:DCMR@theconversation.com">We’d love to hear from you</a>, including any ideas for future episodes. Join The Conversation on <a href="https://twitter.com/ConversationCA">Twitter</a>, <a href="https://www.facebook.com/TheConversationCanada">Facebook</a>, <a href="https://www.instagram.com/theconversationdotcom/">Instagram</a> and <a href="https://www.tiktok.com/@theconversation">TikTok</a> and use #DontCallMeResilient.</p>
<figure class="align-right ">
<img alt="A book cover with an drawing of Sara Baartman, and African women displayed in a zoo in 1800s England, for her body shape" src="https://images.theconversation.com/files/533291/original/file-20230621-21-sf20hh.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/533291/original/file-20230621-21-sf20hh.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533291/original/file-20230621-21-sf20hh.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533291/original/file-20230621-21-sf20hh.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533291/original/file-20230621-21-sf20hh.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533291/original/file-20230621-21-sf20hh.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533291/original/file-20230621-21-sf20hh.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sabrina Strings’s book cover for ‘Fearing the Black Body: The Racial Origins of Fat Phobia’ published by New York University Press.</span>
<span class="attribution"><span class="source">NYU Press</span></span>
</figcaption>
</figure>
<h2>Resources</h2>
<p><a href="https://www.scientificamerican.com/article/the-racist-roots-of-fighting-obesity2/">The Racist Roots of Fighting Obesity
</a> (<em>Scientific American</em>)</p>
<p><a href="https://www.nytimes.com/2023/06/14/health/obesity-drugs-wegovy-ozempic.html">New Obesity Drugs Come With a Side Effect of Shaming </a> (<em>The New York Times)</em></p>
<p><a href="https://news.yahoo.com/where-black-people-fit-ozepmic-140728627.html">Where do Black people fit into the Ozempic conversation?</a></p>
<p><a href="https://nyupress.org/9781479886753/fearing-the-black-body/"><em>Fearing the Black Body: The Racial Origins of Fatphobia</em></a> by Sabrina Strings</p>
<p><a href="https://www.inanna.ca/product/fat-studies-in-canada-remapping-the-field-in-canada/">Fat and Mad Bodies: Under, Out of, and Beyond Control</a> by Fady Shanouda in <em>Fat Studies in Canada: (Re)Mapping the Field</em></p>
<p><a href="https://www.huffpost.com/entry/why-im-nonbinary-but-dont-use-they-them_b_58ac875ee4b05e6b9b192c07">Why I’m Non-Binary But Don’t Use ‘They/Them’</a> by Hunter Ashleigh Shackelford</p>
<p><a href="https://www.press.umich.edu/11700274/queer_nightlife">Jockstraps and Crop Tops: Fat Queer Femmes Dressing for the Night</a> by Caleb Luna in <em>Queer Nightlife</em></p>
<h2>Read more in The Conversation</h2>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ozempic-helps-weight-loss-by-making-you-feel-full-but-certain-foods-can-do-the-same-thing-without-the-side-effects-201870">Ozempic helps weight loss by making you feel full. But certain foods can do the same thing – without the side-effects</a>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/fatblaster-max-has-just-been-banned-why-heres-everything-you-need-to-know-about-diet-supplements-183347">FatBlaster Max has just been banned. Why? Here’s everything you need to know about diet supplements</a>
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Read more:
<a href="https://theconversation.com/is-it-true-the-faster-you-lose-weight-the-quicker-it-comes-back-heres-what-we-know-about-slow-and-fast-weight-loss-198301">Is it true the faster you lose weight the quicker it comes back? Here's what we know about slow and fast weight loss</a>
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</em>
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<img src="https://counter.theconversation.com/content/206457/count.gif" alt="The Conversation" width="1" height="1" />
As the use of Ozempic, a drug for diabetes, slams into the mainstream as a weight-loss method, will the drug’s use impact our concept of fatness? And how does fatness intersect with race and class?Vinita Srivastava, Host + Producer, Don't Call Me ResilientBoké Saisi, Associate Producer, Don't Call Me ResilientKikachi Memeh, Assistant Producer/Student Journalist, Don't Call Me ResilientLicensed as Creative Commons – attribution, no derivatives.