tag:theconversation.com,2011:/nz/topics/obesity-341/articlesObesity – 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/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/2232702024-03-18T12:24:52Z2024-03-18T12:24:52ZFree school meals for all may reduce childhood obesity, while easing financial and logistical burdens for families and schools<figure><img src="https://images.theconversation.com/files/580529/original/file-20240307-16-nylyj3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C683&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">School meal waivers that started with the COVID-19 pandemic stopped with the end of the public health emergency.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/plymouth-ma-a-student-at-plymouth-county-intermediate-news-photo/1242013592">Jonathan Wiggs/The Boston Globe via Getty Images</a></span></figcaption></figure><p>School meals are critical to child health. Research has shown that <a href="https://doi.org/10.3390/nu9090924">school meals can be more nutritious</a> than meals from other sources, such as meals brought from home. </p>
<p>A recent study that one of us conducted found the quality of school meals has steadily improved, especially since the 2010 <a href="https://doi.org/10.1001/jama.2020.9517">Healthy, Hunger-Free Kids Act</a> strengthened nutrition standards for school meals. In fact, by 2017, another study found that school meals provided the <a href="https://doi.org/10.1001/jamanetworkopen.2021.5262">best diet quality</a> of any major U.S. food source.</p>
<p>Many American families became familiar with universal free school meals during the COVID-19 pandemic. To ease the financial and logistical burdens of the pandemic on families and schools, the <a href="https://www.fns.usda.gov/coronavirus">U.S. Department of Agriculture issued waivers</a> that allowed schools nationwide to provide free breakfast and lunch to all students. However, these <a href="https://www.fns.usda.gov/cn/offsite-monitoring-after-phe#">waivers expired</a> by the 2022-23 school year. </p>
<p>Since that time, there has been a substantial increase in schools participating in the <a href="https://www.fns.usda.gov/cn/community-eligibility-provision">Community Eligibility Provision</a>, a federal policy that allows schools in high poverty areas to provide free breakfast and lunch to all attending students. The policy became available as an option for low-income schools nationwide in 2014 and was part of the <a href="https://obamawhitehouse.archives.gov/sites/default/files/Child_Nutrition_Fact_Sheet_12_10_10.pdf">Healthy, Hunger-Free Kids Act</a>. By the 2022-23 school year, <a href="https://frac.org/cep-report-2023">over 40,000 schools</a> had adopted the Community Eligibility Provision, an increase of more than 20% over the prior year.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/wsFvSmkYbVU?wmode=transparent&start=30" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Many families felt stressed when a federal program providing free school meals during the pandemic came to an end.</span></figcaption>
</figure>
<p>We are <a href="https://scholar.google.com/citations?user=ihU7JuoAAAAJ&hl=en">public health</a> <a href="https://scholar.google.com/citations?user=VkqyJPcAAAAJ&hl=en">researchers who</a> study the health effects of nutrition-related policies, particularly those that alleviate poverty. Our newly published research found that the Community Eligibility Provision was associated with a net <a href="https://doi.org/10.1542/peds.2023-063749">reduction in the prevalence of childhood obesity</a>.</p>
<h2>Improving the health of American children</h2>
<p>President Harry Truman <a href="https://www.fns.usda.gov/nslp/nslp-fact-sheet">established the National School Lunch Program</a> in 1946, with the stated goal of protecting the health and well-being of American children. The program established permanent federal funding for school lunches, and participating schools were required to provide free or reduced-price lunches to children from qualifying households. Eligibility is <a href="https://www.fns.usda.gov/cn/fr-020923">determined by income</a> based on federal poverty levels, both of which are <a href="https://www.federalregister.gov/documents/2024/01/17/2024-00796/annual-update-of-the-hhs-poverty-guidelines#">revised annually</a>.</p>
<p>In 1966, the <a href="https://www.fns.usda.gov/cna-amended-pl-111-296">Child Nutrition Act</a> piloted the <a href="https://www.fns.usda.gov/sbp/program-history">School Breakfast Program</a>, which provides free, reduced-price and full-price breakfasts to students. This program was later made permanent through an amendment in 1975.</p>
<p>The <a href="https://www.fns.usda.gov/cn/community-eligibility-provision">Community Eligibility Provision</a> was piloted in several states beginning in 2011 and became an option for eligible schools nationwide beginning in 2014. It operates through the national school lunch and school breakfast programs and expands on these programs.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Gloved hand placing cheese slices on bun slices" src="https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580532/original/file-20240307-22-r2dnw1.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">Various federal and state programs have sought to make food more accessible to children.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/cafeteria-worker-puts-together-sandwiches-for-free-meals-as-news-photo/1213018954">John Moore/Getty Images</a></span>
</figcaption>
</figure>
<p>The policy allows all students in a school to receive free breakfast and lunch, rather than determine eligibility by individual households. Entire schools or school districts are eligible for free lunches if at least 40% of their students are directly certified to receive free meals, meaning their household participated in a means-based safety net program, such as the <a href="https://fns-prod.azureedge.us/sites/default/files/resource-files/NSLPDirectCertification2016.pdf">Supplemental Nutrition Assistance Program</a>, or the child is identified as runaway, homeless, in foster care or enrolled in Head Start. Some states also <a href="https://www.fns.usda.gov/cn/direct-certification-medicaid-demonstration-project">use Medicaid for direct certification</a>.</p>
<p>The Community Eligibility Provision increases school meal participation by <a href="https://doi.org/10.2105/AJPH.2011.300134">reducing the stigma</a> associated with receiving free meals, eliminating the need to complete and process applications and extending access to students in households with incomes above the eligibility threshold for free meals. As of 2023, the eligibility threshold for free meals is 130% of the federal poverty level, which amounts to US$39,000 for a family of four.</p>
<h2>Universal free meals and obesity</h2>
<p>We analyzed whether providing universal free meals at school through the Community Eligibility Provision was associated with lower childhood obesity before the COVID-19 pandemic.</p>
<p>To do this, we measured <a href="https://doi.org/10.1542/peds.2023-063749">changes in obesity prevalence</a> from 2013 to 2019 among 3,531 low-income California schools. We used over 3.5 million body mass index measurements of students in fifth, seventh and ninth grade that were taken annually and aggregated at the school level. To ensure rigorous results, we <a href="https://doi.org/10.1016/j.jeconom.2020.12.001">accounted for differences</a> between schools that adopted the policy and eligible schools that did not. We also followed the same schools over time, comparing obesity prevalence before and after the policy.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Child scooping food from salad bar onto a tray; other children lean against the wall" src="https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=381&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=381&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=381&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=479&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=479&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580530/original/file-20240307-24-swy6q3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=479&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Free school meals may help reduce health disparities among marginalized and low-income children.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/westbrook-middle-school-fifth-grade-student-salem-bukasa-news-photo/469592304">Whitney Hayward/Portland Portland Press Herald via Getty Images</a></span>
</figcaption>
</figure>
<p>We found that schools participating in the Community Eligibility Provision had a <a href="https://doi.org/10.1542/peds.2023-063749">2.4% relative reduction</a> in obesity prevalence compared with eligible schools that did not participate in the provision. Although our findings are modest, even small improvements in obesity levels are notable because effective strategies to reduce obesity at a population level <a href="https://doi.org/10.1038/s41574-019-0176-8">remain elusive</a>. Additionally, because obesity <a href="http://dx.doi.org/10.15620/cdc:106273">disproportionately affects</a> racially and ethnically marginalized and low-income children, this policy could contribute to reducing health disparities.</p>
<p>The Community Eligibility Provision likely reduces obesity prevalence by substituting up to half of a child’s weekly diet with healthier options and simultaneously <a href="https://doi.org/10.1016/j.jhealeco.2022.102646">freeing up more disposable income</a> for low-to-middle-income families. Families receiving free breakfast and lunch save approximately $4.70 per day per child, or $850 per year. For low-income families, particularly those with multiple school-age children, this could result in meaningful savings that families can use for other health-promoting goods or services.</p>
<h2>Expanding access to school meals</h2>
<p>Childhood obesity <a href="https://doi.org/10.1542/peds.2021-053708">has been</a> <a href="https://doi.org/10.1001/jama.2020.14590">increasing over</a> the past several decades. Obesity often <a href="https://doi.org/10.1111/obr.12334">continues into adulthood</a> <a href="https://theconversation.com/obesity-in-children-is-rising-dramatically-and-it-comes-with-major-and-sometimes-lifelong-health-consequences-202595">and is linked</a> to a range of <a href="https://doi.org/10.2105/ajph.2016.303326">chronic health conditions and premature death</a>. </p>
<p>Growing research is showing the benefits of universal free school meals for the health and well-being of children. Along with our study of California schools, other researchers have found an association between universal free school meals and reduced obesity in <a href="https://doi.org/10.1086/723824">Chile</a>, <a href="https://doi.org/10.1016/j.ssmph.2022.101072">South Korea</a> and <a href="https://doi.org/10.1016/j.pubecp.2022.100016">England</a>, as well as among <a href="https://doi.org/10.1002/pam.22175">New York City schools</a> and school districts in <a href="https://doi.org/10.1162/edfp_a_00380">New York state</a>.</p>
<p>Studies have also linked the Community Eligibility Provision to <a href="https://doi.org/10.3368/jhr.57.3.0518-9509R3">improvements in academic performance</a> and <a href="https://doi.org/10.3102/00028312231222266">reductions in suspensions</a>.</p>
<p>While our research observed a reduction in the prevalence of obesity among schools participating in the Community Eligibility Provision relative to schools that did not, obesity increased over time in both groups, with a greater increase among nonparticipating schools.</p>
<p>Universal free meals policies may slow the rise in childhood obesity rates, but they alone will not be sufficient to reverse these trends. Alongside universal free meals, identifying <a href="https://theconversation.com/fixing-the-global-childhood-obesity-epidemic-begins-with-making-healthy-choices-the-easier-choices-and-that-requires-new-laws-and-policies-207975">other population-level strategies</a> to reduce obesity among children is necessary to address this public health issue.</p>
<p>As of 2023, <a href="https://www.americanprogress.org/article/5-states-addressing-child-hunger-and-food-insecurity-with-free-school-meals-for-all/">several states have implemented their own</a> universal free school meals policies. States such as California, Maine, Colorado, Minnesota and New Mexico have pledged to cover the difference between school meal expenditures and federal reimbursements. As more states adopt their own universal free meals policies, understanding their effects on child health and well-being, as well as barriers and supports to successfully implementing these programs, will be critical.</p><img src="https://counter.theconversation.com/content/223270/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Jones-Smith receives funding from the National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Anna Localio 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>Since nutrition standards were strengthened in 2010, eating at school provides many students with healthier food than is available cheaply elsewhere. Plus, reducing stigma increases the number of kids getting fed.Anna Localio, Ph.D. Candidate in Health Services, University of WashingtonJessica Jones-Smith, Associate Professor of Health Systems and Population Health, Epidemiology, University of WashingtonLicensed 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>
<ul>
<li><p>focus on areas with high levels of malnutrition</p></li>
<li><p>encourage families to produce their own food to supplement social grants</p></li>
<li><p>invest in food banks at fruit and vegetable markets strategically located close to vulnerable households</p></li>
<li><p>help extremely poor households survive seasonal hunger</p></li>
<li><p>launch campaigns to educate the public on the benefits of consuming nutrient-rich foods and dietary diversity.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/research-shows-shocking-rise-in-obesity-levels-in-urban-africa-over-past-25-years-90485">Research shows shocking rise in obesity levels in urban Africa over past 25 years</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/224286/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thokozani Simelane does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>South Africa’s national survey of food and nutrition security identifies the areas most in need.Thokozani Simelane, Professor of Practice, Human Sciences Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2255672024-03-12T23:31:26Z2024-03-12T23:31:26ZAn apple cider vinegar drink a day? New study shows it might help weight loss<figure><img src="https://images.theconversation.com/files/581225/original/file-20240312-16-pgd6kq.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5742%2C3819&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/glass-healthy-cloudy-fermented-apple-cider-1133317064">Shutterstock</a></span></figcaption></figure><p>Made from fermented apples and naturally high in acetic acid, apple cider vinegar has been popular in recent years for its <a href="https://www.healthline.com/nutrition/6-proven-health-benefits-of-apple-cider-vinegar#blood-sugar">purported health benefits</a> – from antibacterial properties to antioxidant effects and potential for helping manage blood sugars. </p>
<p>Its <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136602/">origins as a health tonic</a> stretch much further back. Hippocrates used it to treat wounds, fever and skin sores.</p>
<p>An experimental <a href="https://nutrition.bmj.com/content/early/2024/01/18/bmjnph-2023-000823">study</a>, released today, looks into whether apple cider vinegar could be effective for weight loss, reduce blood glucose levels and reduce blood lipids (cholesterol and triglycerides). </p>
<p>The results suggest it could reduce all three – but it might not be as simple as downing an apple cider vinegar drink a day.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-apple-cider-vinegar-really-a-wonder-food-86551">Is apple cider vinegar really a wonder food?</a>
</strong>
</em>
</p>
<hr>
<h2>What did they do?</h2>
<p>A group of scientists in Lebanon did a double-blinded, randomised, clinical trial in a group of overweight and obese young people aged from 12–25 years. </p>
<p>Researchers randomly placed 30 participants in one of four groups. The participants were instructed to consume either 5, 10 or 15ml of apple cider vinegar diluted into 250ml of water each morning before they ate anything for 12 weeks. A control group consumed an inactive drink (a placebo) made (from lactic acid added to water) to look and taste the same. </p>
<p>Typically this sort of study provides <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124652/#:%7E:text=Both%20systems%20place%20randomized%20controlled,less%20risk%20of%20systematic%20errors.">high quality evidence</a> as it can show cause and effect – that is the intervention (apple cider vinegar in this case) leads to a certain outcome. The study was also double-blinded, which means neither the participants or the scientists involved with collecting the data knew who was in which group.</p>
<h2>So, what did they find?</h2>
<p>After a period of three months apple cider vinegar consumption was linked with significant falls in body weight and body mass index (BMI). On average, those who drank apple cider vinegar during that period lost 6–8kg in weight and reduced their BMI by 2.7–3 points, depending on the dose. They also showed significant decreases in the waist and hip circumference.</p>
<p>The authors also report significant decreases in levels of blood glucose, triglycerides, and cholesterol in the apple cider groups. This finding echoes <a href="https://link.springer.com/article/10.1186/s12906-021-03351-w">previous studies</a>. The placebo group, who were given water with lactic acid, had much smaller decreases in weight and BMI. There were also no significant decreases in blood glucose and blood lipids. </p>
<p>From animal studies, it is thought the acetic acid in apple cider vinegar may affect the expression of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136602/">genes involved in burning fats for energy</a>. The new study did not explore whether this mechanism was involved in any weight loss.</p>
<h2>Is this good news?</h2>
<p>While the study appears promising, there are also reasons for caution. </p>
<p>Firstly, study participants were aged from 12 to 25, so we can’t say whether the results could apply to everyone.</p>
<p>The statistical methods used in the study don’t allow us to confidently say the same amount of weight loss would occur again if the study was done again.</p>
<p>And while the researchers kept records of the participants’ diet and exercise during the study, these were not published in the paper. This makes it difficult to determine if diet or exercise may have had an impact. We don’t know whether participants changed the amount they ate or the types of food they ate, or whether they changed their exercise levels. </p>
<p>The study used a placebo which they tried to make identical in appearance and taste to the active treatment. But people may still be able to determine differences. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8308085/">Researchers may ask participants</a> at the end of a study to guess which group they were in to test the integrity of the placebo. Unfortunately this was not done in this study, so we can’t be certain if the participants knew or not.</p>
<p>Finally, the authors do not report whether anyone dropped out of the study. This could be important and influence results if people who did not lose weight quit due to lack of motivation.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="open glass of liquid with cloudy substance at bottom, surrounded by apples" src="https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581231/original/file-20240312-28-rsj49.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Is that you mother? The enzymes in apple cider vinegar might be health-giving.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fresh-apples-bowl-raw-unfiltered-organic-257388970">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/turns-out-the-viral-sleepy-girl-mocktail-is-backed-by-science-should-you-try-it-222151">Turns out the viral 'Sleepy Girl Mocktail' is backed by science. Should you try it?</a>
</strong>
</em>
</p>
<hr>
<h2>Any other concerns?</h2>
<p>Apple cider vinegar is acidic and there are concerns it may erode tooth enamel. This can be a problem with any acidic beverages, including fizzy drinks, <a href="https://theconversation.com/lemon-water-wont-detox-or-energise-you-but-it-may-affect-your-body-in-other-ways-180035">lemon water</a> and orange juice.</p>
<p>To minimise the risk of <a href="https://theconversation.com/health-check-whats-eating-your-teeth-37096">acid erosion</a> some dentists recommend the following after drinking acidic drinks: </p>
<ul>
<li>rinsing out your mouth with tap water afterwards</li>
<li>chewing sugar-free gum afterwards to stimulate saliva production</li>
<li>avoiding brushing your teeth immediately after drinking because it might damage the teeth’s softened top layer</li>
<li>drink with a straw to minimise contact with the teeth.</li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman holds glass of water and has full cheeks" src="https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581235/original/file-20240312-28-1jzy3o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rinsing with water could prevent acid damaging your teeth.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-rinsing-gargling-while-using-mouthwash-644616745">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/apple-cider-vinegar-is-drinking-this-popular-home-remedy-bad-for-your-teeth-a-dentist-explains-197297">Apple cider vinegar: is drinking this popular home remedy bad for your teeth? A dentist explains</a>
</strong>
</em>
</p>
<hr>
<h2>Down the hatch?</h2>
<p>This study provides us with some evidence of a link between apple cider vinegar and weight loss. But before health professionals can recommend this as a weight loss strategy we need bigger and better conducted studies across a wider age range. </p>
<p>Such research would need to be done alongside a controlled background diet and exercise across all the participants. This would provide more robust evidence that apple cider vinegar could be a useful aid for weight loss. </p>
<p>Still, if you don’t mind the taste of apple cider vinegar then you could try drinking some for weight loss, alongside a <a href="https://www.eatforhealth.gov.au/">healthy balanced and varied dietary intake</a>. This study does not suggest people can eat whatever they like and drink apple cider vinegar as a way to control weight. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/great-time-to-try-pickling-135052">Great time to try: pickling</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/225567/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.</span></em></p>Researchers gave people in the study 5, 10 or 15ml doses of apple cider vinegar and found they lost more weight than those taking a placebo. But the findings need a closer look.Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2236672024-03-05T13:29:22Z2024-03-05T13:29:22ZThe Atlantic diet: how it compares to its Mediterranean counterpart – and what benefits it might have<figure><img src="https://images.theconversation.com/files/579168/original/file-20240301-22-1qoqvf.jpg?ixlib=rb-1.1.0&rect=0%2C7%2C4822%2C3203&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Atlantic diet also places an emphasis on fresh, minimally-processed foods.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cod-fish-potato-tomato-cherry-on-562428598">Natalia Mylova/ Shutterstock</a></span></figcaption></figure><p>The Mediterranean diet has long been seen as one of the most beneficial diets out there. It’s been associated with many health benefits, including lower risk of <a href="https://cdt.amegroups.org/article/view/14269/14736">cardiovascular disease</a> and other <a href="https://pubmed.ncbi.nlm.nih.gov/34204683/">chronic diseases</a> (including <a href="https://pubmed.ncbi.nlm.nih.gov/31480794/">cancer</a>), better <a href="https://pubmed.ncbi.nlm.nih.gov/35889954/">sleep</a> and even <a href="https://gut.bmj.com/content/69/7/1218">good gut health</a>.</p>
<p>But a recent study suggests that a slightly modified version of this diet – named the “<a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814624">Atlantic diet</a>” – may also be beneficial for your health. </p>
<p>The Atlantic diet draws inspiration from the traditional eating habits of people living in northwestern Spain and Portugal. Like the Mediterranean diet, it’s characterised by eating local, fresh and minimally processed seasonal foods – such as vegetables, fruits, fish, wholegrain, nuts, beans and olive oil. But unlike the Mediterranean diet, the Atlantic diet also includes moderate amounts of meat and pork products, as well as starchy vegetables such as potatoes.</p>
<p>According to this latest study, the Atlantic diet may reduce the risk of <a href="https://www.heartuk.org.uk/genetic-conditions/metabolic-syndrome">metabolic syndrome</a>. This is the combination of high blood pressure, high blood fat levels, obesity and high blood sugar – all of which can lead to heart disease, stroke and type 2 diabetes.</p>
<p>The researchers conducted what’s known as a secondary analysis. This meant they analysed data from a previous study on the Atlantic diet, the <a href="https://pubmed.ncbi.nlm.nih.gov/27539113/">GALIAT Atlantic Diet study</a>, in order to better understand its effects. This was a six-month randomised clinical trial, which included more than 500 participants who were grouped together by family.</p>
<p>As part of the GALIAT trial, families were placed into two groups. One group followed the Atlantic diet. They were also taught about the diet and given cooking classes to help adhere to it. The second group, who acted as the control group, followed their usual diet and lifestyle. </p>
<p>The study lasted for six months. At the beginning of the study and after six months, researchers collected information on participants’ food intake using a three-day food diary, as well as their physical activity levels, any medications they took and other variables such as weight if they smoked.</p>
<p>In the <a href="https://www.mdpi.com/2072-6643/13/4/1211">initial GALIAT diet study</a>, the researchers found that the Atlantic diet group lost weight – whereas those in the control group gained weight. The Atlantic diet group also saw improvements in their levels of one type of cholesterol – though other types of cholesterol still remained the same. There were also no changes in their blood pressure and blood sugar.</p>
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<img alt="A plate of food with cooked fish and slices of pork or chorizo." src="https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579170/original/file-20240301-28-ls360c.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">The Atlantic diet may also include pork and other types of meat.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/prawn-rice-closeup-traditionnal-spanish-food-106809581">ilolab/ Shutterstock</a></span>
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<p>In the recent secondary analysis of this study, the researchers found that overall, participants who had followed the Atlantic diet had significantly lower risk of developing metabolic syndrome compared to the control group. They also found that following the Atlantic diet lowered risk of obesity, improved waist circumference and levels of cholesterol (specifically high-density lipoprotein).</p>
<p>But though the Atlantic diet had an overall effect on lowering risk of metabolic syndrome, it wasn’t shown to have much effect on specific aspects of metabolic syndrome. Specifically, the researchers did not see any benefit from the Atlantic diet on blood pressure, blood sugar and blood fat levels.</p>
<p>Overall, the study shows that consuming the Atlantic diet may be helpful for managing weight – which may in turn lower risk of some long-term chronic conditions (such as cardiovascular disease). </p>
<h2>Balanced diet</h2>
<p>This is not the first time the effects of the Atlantic diet have been researched. </p>
<p><a href="https://www.atherosclerosis-journal.com/article/S0021-9150(12)00830-1/abstract">Previous studies</a> have shown that the Atlantic diet is associated with lower levels of inflammation, blood fat levels and blood pressure among adults living in Spain. <a href="https://www.mdpi.com/2072-6643/11/4/742">Another study</a> also found that Spanish people who paired the Atlantic diet with regular physical activity had a lower risk of cardiovascular disease, lower cholesterol and lower rates of obesity.</p>
<p>But while research does show some potential benefits in adhering to the Atlantic diet, these results may not hold true for everyone. </p>
<p>First, most studies on the Atlantic diet – including this latest one – only included participants of Spanish or white European descent. This means we don’t know whether the Atlantic diet will be equally beneficial for ethnic groups who are at <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/0470025131.ch2">greater risk of metabolic syndrome</a> – such as people of south Asian, Black African and Caribbean descent.</p>
<p>It’s well established that regularly consuming fruits, vegetables, wholegrains, nuts and fish provides a wide range of essential vitamins, minerals, fibre and antioxidants that are <a href="https://www.who.int/news-room/fact-sheets/detail/healthy-diet">vital for good health</a>. While the Atlantic diet is said to contain plenty of these foods, there’s no clear information from this latest study on portion sizes or what quantity of certain foods participants consumed in order to reduce their risk of metabolic syndrome.</p>
<p>Another thing worth mentioning is that the <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3441-y">GALIAT study gained a lot of media attention at the time</a>. This may have influenced the particpants’ eating and lifestyle habits as a result, making them adhere more strictly to it – making it appear the diet had a greater affect than it actually might in reality.</p>
<p>And, even though participants in both groups had similar characteristics at the start of the study (such as how physically active they were on average, or if they smoked), the researchers were unable to adjust their findings to fully account for all the factors that might influence a person’s risk of developing metabolic syndrome.</p>
<p>The participants in the Atlantic diet group were also provided with the food they needed in order to stick with their diet. But in a real world setting, not everyone can regularly access or afford the kinds of foods the Atlantic diet consists of. This makes it difficult to know whether the findings will still stand outside of a controlled environment. </p>
<p>At the end of the day, the ideal diet to follow for improving metabolic health is one that includes a wide range of foods from each of the main food groups: fruits and vegetables, starchy carbohydrates (opting for wholegrain alternatives where possible), protein, dairy or dairy alternatives and healthy fats that you find accessible, affordable, enjoyable, as well as nourishing.</p><img src="https://counter.theconversation.com/content/223667/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Taibat (Tai) Ibitoye 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 Atlantic diet draws inspiration from the traditional eating habits of people living in Spain and Portugal.Taibat (Tai) Ibitoye, Senior Lecturer in Public Health and Registered Dietitian, University of HertfordshireLicensed 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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<p>
<em>
<strong>
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>
</ul>
<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/2239322024-03-03T07:50:46Z2024-03-03T07:50:46ZBig companies, like Nestlé, are funding health research in South Africa - why this is wrong<p>In 2021, the director of the African Research University Alliance Centre of Excellence in Food Security at the University of Pretoria was <a href="https://www.nestle.com/media/pressreleases/allpressreleases/board-of-directors-agm-2021">appointed</a> to the board of the transnational food corporation Nestlé. </p>
<p>At the time a group of more than <a href="https://www.dailymaverick.co.za/article/2021-11-23-on-board-with-nestle-academics-express-concern-over-conflicts-of-interest/">200 senior academics</a> wrote an open letter,
about conflicts of interest. Nestlé’s portfolio of foods, <a href="https://www.businesstoday.in/latest/corporate/story/60-of-nestles-food-portfolio-unhealthy-says-report-company-on-firefighting-mode-298388-2021-06-01">by its own admission</a>, includes more than 60% that don’t meet the definition of healthy products. </p>
<p>In December last year, the same centre announced it had signed a memorandum of understanding with Nestlé. It signalled their intent to “forge a transformative
partnership” to shape “the future of food and nutrition research and education” and transform “<a href="https://www.futureafrica.science/news-events/all-news/item/UP%20and%20%20Nestl%C3%A9%20forge%20a%20transformative%20partnership">Africa’s food systems</a>”. </p>
<p>This is not an isolated case. </p>
<p>Across African universities, companies with products that are harmful to health fund health-related research and education.</p>
<p>Nestlé, for example, <a href="https://www.nestle.com/about/research-development/news/expertise-sharing-african-students">“shares expertise”</a> with “eight universities in Africa”. </p>
<p>These include the Institute of Applied Science and Technology at the <a href="https://www.ug.edu.gh/news/ug-and-nestl%C3%A9-collaborate-advance-sustainable-and-affordable-%20nutrition">University of Ghana</a> and the <a href="https://www.csrs.ch/en/blog/centre-suisse-de-recherches-scientifiques-and-nestle-take-stock-their-collaboration">Centre Suisse de Recherches Scientifiques</a> in
Côte d’Ivoire. </p>
<p>Activities funded under agreements with universities include internships, seminars and training programmes as well as sponsorships for graduate research students. </p>
<p>In South Africa, Nestlé has funded a prize in paediatrics for final year medical students at the <a href="https://www.wits.ac.za/media/wits-university/students/graduations/2022-graduations/14%20Dec%2014-30%20December_38.pdf#page=23">University of the Witwatersrand</a>. It also funds a two-year paediatric gastroenterology fellowship at <a href="https://www.nestlenutrition-institute.org/education/fellowship/stellenbosch-university">Stellenbosch University.</a></p>
<h2>Bias – even if it’s unconscious</h2>
<p>Financial links between corporations and academic institutions are well known to lead to conflicts of interest.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/28207928/">A 2017 paper</a>, Industry sponsorship and Research Outcome, found that “industry funding leads researchers to favour corporations either consciously or unconsciously”. </p>
<p>Those advising governments and charities on dietary policy warn how “current or past financial or personal associations with interested parties make it difficult <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3393-2">to distinguish subtle, unconscious bias from deliberately concealed impropriety</a>.” </p>
<p>Other research found that of 168 industry-funded studies, <a href="https://www.theguardian.com/lifeandstyle/2016/dec/12/studies-health-nutrition-sugar-coca-cola-marion-nestle">156 (93%) showed biased results</a>, all in favour of industry sponsors. </p>
<p>In 2018 around 13% of research articles published in the top 10 most-cited nutrition journals were <a href="https://pubmed.ncbi.nlm.nih.gov/33326431/">backed by and favourable to the food industry</a>. Such backing is often hidden. </p>
<h2>A growing problem</h2>
<p>The world is facing a pandemic of non-communicable diseases – hypertension, diabetes, cardiovascular diseases, cancer – all linked to the consequences of poor nutrition such as <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">stunting and obesity</a>.</p>
<p>A 2023 Lancet commission reports that <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00590-1/fulltext">“just four industry sectors already account for at least a third of global deaths”</a>, one of which is unhealthy food. </p>
<p>These four industry sectors are expanding their markets in Africa and elsewhere in the global south where the inadequate regulation of the sales and marketing of <a href="https://www.tandfonline.com/doi/full/10.1080/09581596.2021.2019681">unhealthy foods, drinks, alcohol, tobacco</a> and agrichemical products provides opportunities for corporations to exploit.</p>
<h2>Where there’s smoke …</h2>
<p>The most well-known commercial products that harm health are tobacco-related, now widely regulated to decrease harm.</p>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/7609230/">tobacco industry used many tactics to prevent their regulation</a>. They funded research and whole institutions to produce “evidence” to support the industry or sow doubt about the harmful impacts of tobacco. </p>
<p>In 2019 public health academics at the University of Cape Town in South Africa discovered that the psychiatry department had accepted funding from the <a href="https://www.pmi.com/our-transformation/delivering-a-smoke-free-future">Philip Morris Foundation for a Smoke-Free World</a>. </p>
<p>The department subsequently cancelled the contract. This followed <a href="https://mg.co.za/article/2019-10-18-00-big-tobaccos-r1m-for-uct-stubbed-out/">outrage</a> from the broader university community. In 2020, the UCT Council adopted a policy <a href="https://commerce.uct.ac.za/reep/articles/2020-01-30-uct-council-adopts-policy-tobacco-funding">disallowing</a> any employee from accepting funding from the tobacco industry. </p>
<p>In another example scientific research published in <a href="https://pubmed.ncbi.nlm.nih.gov/5339699/">1967</a> implicated saturated fat as the main cause of heart disease. In so <a href="https://pubmed.ncbi.nlm.nih.gov/27802504/">doing it downplayed the role of sugar</a>. It took over 40 years to uncover that this research was paid for by the sugar industry. </p>
<p>The decline in <a href="https://doi.org/10.1038/nature.2017.22816">research funding</a> in South Africa means that academics need to be especially vigilant. We need to protect our higher education institutions from research bias.</p>
<p>It is not enough to simply declare these interests and assume that this will eliminate the conflict of interest.</p>
<p>Instead, public health academics need to develop much more robust systems to manage conflicts of interest at all levels of academia.</p>
<p>Governance structures at universities need mechanisms to respond to initiatives which run counter to public health. </p>
<p>The Department of Paediatrics and Child Health at the University of Cape Town has called for the <a href="https://health.uct.ac.za/department-paediatrics/child-advocacy-campaigns/protect-support-and-promote-breastfeeding">end to sponsorship</a> by infant formula milk companies for education, research or policy development. </p>
<p>An online course and toolkit for research ethics committees on conflict of interest in health research provides some <a href="https://health.uct.ac.za/school-public-health/conflict-interest-health-research">practical guidance</a>.</p>
<p>These and other initiatives point the way forward for universities to be alert to the dangers of these “gift relationships” and to be better equipped to protect their integrity.</p>
<p><em>Lori Lake contributed to this article. She is a Communication and Education Specialist at the Children’s Institute, Department of Paediatrics and Child Health, University of Cape Town.</em></p><img src="https://counter.theconversation.com/content/223932/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Wynberg works for the University of Cape Town, South Africa where she holds a research chair funded by the Department of Science and Innovation and National Research Foundation. She serves on the Boards of Biowatch South Africa, and the Union for Ethical BioTrade. This article is written in her personal capacity and does not represent the views of any of these organisations. No benefit will accrue to any organisation.</span></em></p><p class="fine-print"><em><span>Tanya Doherty receives funding from the South African Medical Research Council. </span></em></p><p class="fine-print"><em><span>Mark Tomlinson and Susan Goldstein 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>Financial links between corporations and health research invariably lead to conflicts of interest.Susan 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 WitwatersrandMark Tomlinson, Professor in the Institute for Life Course Health Research, Department of Global Health, Stellenbosch UniversityRachel Wynberg, Professor and DST/NRF Bio-economy Research Chair, University of Cape TownTanya Doherty, Professor and Chief specialist scientist, South African Medical Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2243012024-02-29T17:37:26Z2024-02-29T17:37:26ZBurning ‘no ball game signs’ won’t fix the obesity epidemic – there are way bigger obstacles<p>Growing up in the 80s as a child with lots of siblings, I played in the street until dark or until we were called for dinner. We had an amazing community of neighbours. However, one elderly neighbour hated us. Every time the football went into her garden, she would confiscate it – and then pop the ball. When she collected over 20 deflated footballs, she would take them down to the police station and complain. To her, at least, free and active children were a pest and a disgrace. </p>
<p>Our neighbour’s one-woman campaign didn’t deter us, though. Only one thing stopped us playing: the shattering of a window and the scream of a parent coming outside to tell us off. (Much harder to do nowadays with most windows being double-glazed.) </p>
<p>On reflection, I was probably part of the last generation of children to play outside regularly. Now in London, the estate I live in is covered with historic signs saying: “No ball games”. </p>
<p>The signs function as a play ban for children. Even during the summer, there are only a couple of rebels who dare to play football on the street. They get my nod and a kick of the ball back when it comes in my direction. </p>
<p>The problem is, many people don’t know that these signs are not enforceable by law: they are simply a request from local housing associations. </p>
<p>Of course, if people are kicking the ball <a href="https://www.askthe.police.uk/view-category/?id=c39ede1e-6ad2-eb11-bacb-000d3ad61986">against someone’s house</a> or out on the streets making noise late at night, it would be considered criminal damage and <a href="https://crimestoppers-uk.org/keeping-safe/community-family/antisocial-behaviour">antisocial behaviour</a> – and quite right. But most of the time the signs are just <a href="https://playingout.net/play-streets/info-for-councils/housing-and-playing-out/">preventing children from playing</a>. </p>
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<p>The <a href="https://www.bbc.co.uk/news/uk-england-london-68365486">London Sport charity</a> has recommended that these signs are removed. I agree - let’s burn them all. But I do think it is simplistic to imagine banning the signs will combat a <a href="https://www.theguardian.com/uk-news/2023/dec/25/england-obesity-report-analysis">national obesity epidemic</a>. </p>
<h2>An unequal playing field</h2>
<p>The <a href="https://www.sportengland.org/news/childrens-activity-levels-recover-pre-pandemic-levels">Active Lives Survey</a> shows that just 47% of children in England are getting the recommended 60 minutes or more of sport and physical activity a day. Removing “No ball games” signs doesn’t mean that the other 53% of children will feel motivated to venture outside and play. </p>
<p>The Active Lives Survey also suggests that boys are more likely to be active than girls. Perhaps boys are still given more activity opportunities. The Lionesses win at the Euros football tournament highlighted the <a href="https://inews.co.uk/sport/football/heard-nothing-girls-access-sport-stalls-government-empty-words-2477343">lack of opportunities</a> for <a href="https://www.footballbeyondborders.org/news/inspiring-a-generation#:%7E:text=The%20report%20found%20that%3A,football%20players%20on%20social%20media">girls in football</a> and <a href="https://www.gov.uk/government/publications/extra-curricular-activities-soft-skills-and-social-mobility/an-unequal-playing-field-extra-curricular-activities-soft-skills-and-social-mobility">inequitable sports curriculums in schools</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/girls-should-get-the-chance-to-play-football-at-school-but-pe-needs-a-major-rehaul-for-all-students-188113">Girls should get the chance to play football at school – but PE needs a major rehaul for all students</a>
</strong>
</em>
</p>
<hr>
<p>Children and young people of black, Asian and other minority ethnicities are <a href="https://www.sportengland.org/news-and-inspiration/childrens-activity-levels-hold-firm-significant-challenges-remain">least likely to be active</a>. Perhaps because <a href="https://www.sportengland.org/funds-and-campaigns/equality-and-diversity?section=race_in_sport_review#a-summary-of-the-findings-14195">racism in sport is alive</a> and kicking? </p>
<p>Attitudes to high-profile athletes reflect systemic inequalities like racism and misogyny. <a href="https://www.lboro.ac.uk/news-events/news/2024/january/online-abuse-aimed-at-athletes-on-the-rise/">Elite sports people continually face</a> racist, homophobic and sexist abuse on and off the pitch. It isn’t surprising that sport isn’t an appealing – <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8934877/">or safe</a> – option for many minority ethnic children. </p>
<h2>Access to sport and physical activity is a social justice issue</h2>
<p>Family affluence <a href="https://www.streetgames.org/2023/01/06/activity-levels-and-affluence-why-it-matters/">is another major factor</a> in children’s activity levels. Those who are less affluent are <a href="https://www.sportengland.org/news-and-inspiration/childrens-activity-levels-hold-firm-significant-challenges-remain#:%7E:text=Family%20affluence,from%20the%20most%20affluent%20families.">less likely to be active</a>. </p>
<p>Access to sport and physical activity is a social justice issue that <a href="https://www.sportengland.org/research-and-data/research/lower-socio-economic-groups">depends on location and financial circumstances</a>. For a child from an economically disadvantaged background, who lives in a high-rise flat with little green space around, the costs and practicalities of participating in sport are prohibitive. For example, a weekend tennis court costs anywhere between £10 and £27, without travel or equipment.</p>
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<p>So, while we can burn all the “No ball games” signs in the country, the real barrier to combating low activity levels in children is social inequality. What really needs to happen to get our children moving?</p>
<h2>Reimagining accessibility to sports facilities for children</h2>
<p>First, we need to <a href="https://lgiu.org/play-in-everyday-life-how-can-we-reimagine-the-places-we-live-to-be-more-playful/">reimagine the spaces in which we live</a>, and <a href="https://thecpsu.org.uk/news/2023-10-breaking-down-barriers-to-make-sport-accessible-blog/">understand the barriers</a> children face. We could start by <a href="https://www.sportengland.org/about-us/uniting-movement/what-well-do/positive-experiences-children-and-young-people">providing positive physical education experiences</a> to young people in school then promote <a href="https://sphr.nihr.ac.uk/research/the-health-inequalities-impact-of-reducing-the-cost-of-local-authority-leisure-facilities/">concessionary rates for community sport</a> and physical activity spaces.</p>
<p>Councils could get on board with under-16s free swimming initiatives at a national level and increase the number of <a href="https://www.mentalhealth.org.uk/explore-mental-health/publications/how-look-after-your-mental-health-using-exercise">women-only swimming sessions</a>. Safe bike routes are essential because, although <a href="https://www.sportengland.org/research-and-data/research/active-travel">active travel is an increasing trend</a>, cyclists need to feel confident to use bikes as a dominant method of travel. </p>
<p>The issue is complex, but at least we’ve got double glazing to protect against footballs – it’s a start.</p><img src="https://counter.theconversation.com/content/224301/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shrehan Lynch 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>It’ll take more than the removal of ‘no ball games’ signs to get children moving. The real barriers to children’s participation in sport are structural: racism, misogyny and classism.Shrehan Lynch, Senior Lecturer in Sport, University of East LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2225982024-02-08T04:07:59Z2024-02-08T04:07:59ZCan kimchi really help you lose weight? Hold your pickle. The evidence isn’t looking great<figure><img src="https://images.theconversation.com/files/573992/original/file-20240207-18-9do2qy.jpg?ixlib=rb-1.1.0&rect=0%2C4%2C998%2C682&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/fermented-preserved-vegetables-food-concept-cabbage-624182348">casanisa/Shutterstock</a></span></figcaption></figure><p>Fermented foods have become popular in recent years, partly due to their <a href="https://pubmed.ncbi.nlm.nih.gov/28945458/#:%7E:text=As%20a%20result%2C%20fermented%20foods,diabetic%20and%20anti%2Datherosclerotic%20activity.">perceived health benefits</a>.</p>
<p>For instance, there is some evidence eating or drinking fermented foods can improve <a href="https://www.tandfonline.com/doi/full/10.1080/10408398.2022.2128032">blood glucose control</a> in people with diabetes. They can <a href="https://www.cambridge.org/core/journals/nutrition-research-reviews/article/impact-of-botanical-fermented-foods-on-metabolic-syndrome-and-type-2-diabetes-a-systematic-review-of-randomised-controlled-trials/27AE60CFFA7C937455C9DA50BD542F78">lower</a> blood lipid (fats) levels and blood pressure in people with diabetes or obesity. Fermented foods can also improve <a href="https://journals.sagepub.com/doi/full/10.1177/02601060221095678">diarrhoea</a> symptoms.</p>
<p>But can they help you lose weight, as a <a href="https://bmjopen.bmj.com/content/14/2/e076650">recent study</a> suggests? Let’s look at the evidence.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-kombucha-and-how-do-the-health-claims-stack-up-87180">What is kombucha and how do the health claims stack up?</a>
</strong>
</em>
</p>
<hr>
<h2>Remind me, what are fermented foods?</h2>
<p><a href="https://www.nature.com/articles/s41575-020-00390-5">Fermented foods</a> are ones prepared when microbes (bacteria and/or yeast) ferment (or digest) food components to form new foods. Examples include yoghurt, cheese, kefir, kombucha, wine, beer, sauerkraut and kimchi.</p>
<p>As a result of fermentation, the food becomes acidic, extending its shelf life (food-spoilage microbes are less likely to grow under these conditions). This makes fermentation one of the earliest forms of food processing.</p>
<p>Fermentation also leads to new nutrients being made. Beneficial microbes (probiotics) digest nutrients and components in the food to produce new bioactive components (postbiotics). These postbiotics are thought to contribute to the health benefits of the fermented foods, alongside the health benefits of the bacteria themselves.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/space-travel-taxes-astronauts-brains-but-microbes-on-the-menu-could-help-in-unexpected-ways-216355">Space travel taxes astronauts' brains. But microbes on the menu could help in unexpected ways</a>
</strong>
</em>
</p>
<hr>
<h2>What does the evidence say?</h2>
<p>A <a href="https://bmjopen.bmj.com/content/14/2/e076650">study</a> published last week has provided some preliminary evidence eating kimchi – the popular Korean fermented food – is associated with a lower risk of obesity in some instances. But there were mixed results.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1752883493049176565"}"></div></p>
<p>The South Korean study involved 115,726 men and women aged 40-69 who reported how much kimchi they’d eaten over the previous year. The study was funded by the World Institute of Kimchi, which specialises in researching the country’s national dish.</p>
<p>Eating one to three servings of any type of kimchi a day was associated with a lower risk of obesity in men.</p>
<p>Men who ate more than three serves a day of cabbage kimchi (baechu) were less likely to have obesity and abdominal obesity (excess fat deposits around their middle). And women who ate two to three serves a day of baechu were less likely to have obesity and abdominal obesity.</p>
<p>Eating more radish kimchi (kkakdugi) was associated with less abdominal obesity in both men and women.</p>
<p>However, people who ate five or more serves of any type of kimchi weighed more, had a larger waist sizes and were more likely to be obese.</p>
<p>The study had limitations. The authors acknowledged the questionnaire they used may make it difficult to say exactly how much kimchi people actually ate.</p>
<p>The study also relied on people to report past eating habits. This may make it hard for them to accurately recall what they ate.</p>
<p>This study design can also only tell us if something is linked (kimchi and obesity), not if one thing causes another (if kimchi causes weight loss). So it is important to look at experimental studies where researchers make changes to people’s diets then look at the results.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-apple-cider-vinegar-really-a-wonder-food-86551">Is apple cider vinegar really a wonder food?</a>
</strong>
</em>
</p>
<hr>
<h2>How about evidence from experimental trials?</h2>
<p>There have been several experimental studies looking at how much weight people lose after eating various types of fermented foods. Other studies looked at markers or measures of appetite, but not weight loss.</p>
<p>One <a href="https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/different-effects-of-whole-milk-and-a-fermented-milk-with-the-same-fat-and-lactose-content-on-gastric-emptying-and-postprandial-lipaemia-but-not-on-glycaemic-response-and-appetite/79DEE4301B2C3190497E058E49ACA758">study</a> showed the stomach of men who drank 1.4 litres of fermented milk during a meal took longer to empty (compared to those who drank the same quantity of whole milk). This is related to feeling fuller for longer, potentially having less appetite for more food.</p>
<p>Another <a href="https://www.scielo.br/j/rn/a/FBWZ7CYwfJN7mxnxWZqvWsS/?lang=en#">study</a> showed drinking 200 millilitres of kefir (a small glass) reduced participants’ appetite after the meal, but only when the meal contained quickly-digested foods likely to make blood glucose levels rise rapidly. This study did not measure changes in weight.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Kefir in jar, with kefir grains on wood spoon" src="https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574006/original/file-20240207-26-rimoto.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">Kefir, a fermented milk drink, reduced people’s appetite.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/milk-kefir-grains-on-wooden-spoon-526635049">Ildi Papp/Shutterstock</a></span>
</figcaption>
</figure>
<p>Another <a href="https://www.sciencedirect.com/science/article/pii/S1871403X21000910?via%3Dihub">study</a> looked at Indonesian young women with obesity. Eating tempeh (a fermented soybean product) led to changes in an appetite hormone. But this did not impact their appetite or whether they felt full. Weight was not measured in this study. </p>
<p>A <a href="https://www.nature.com/articles/ejcn201677">study</a> in South Korea asked people to eat about 70g a day of chungkookjang (fermented soybean). There were improvements in some measures of obesity, including percentage body fat, lean body mass, waist-to-hip ratio and waist circumference in women. However there were no changes in weight for men or women.</p>
<p>A <a href="https://www.sciencedirect.com/science/article/pii/S0924224423000535">systematic review</a> of all studies that looked at the impact of fermented foods on satiety (feeling full) showed no effect. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-much-weight-do-you-actually-need-to-lose-it-might-be-a-lot-less-than-you-think-217287">How much weight do you actually need to lose? It might be a lot less than you think</a>
</strong>
</em>
</p>
<hr>
<h2>What should I do?</h2>
<p>The evidence so far is very weak to support or recommend fermented foods for weight loss. These experimental studies have been short in length, and many did not report weight changes. </p>
<p>To date, most of the studies have used different fermented foods, so it is difficult to generalise across them all. </p>
<p>Nevertheless, fermented foods are still useful as part of a healthy, varied and balanced <a href="https://www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating">diet</a>, particularly if you enjoy them. They are rich in healthy <a href="https://pubmed.ncbi.nlm.nih.gov/28945458/#:%7E:text=As%20a%20result%2C%20fermented%20foods,diabetic%20and%20anti%2Datherosclerotic%20activity.">bacteria, and nutrients</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-trying-to-lose-weight-and-eat-healthily-why-do-i-feel-so-hungry-all-the-time-what-can-i-do-about-it-215808">I’m trying to lose weight and eat healthily. Why do I feel so hungry all the time? What can I do about it?</a>
</strong>
</em>
</p>
<hr>
<h2>Are there downsides?</h2>
<p>Some fermented foods, such as kimchi and sauerkraut, have added salt. The latest kimchi study said the average amount of kimchi South Koreans eat provides about 490mg of salt a day. For an Australian, this would represent about <a href="https://www.eatforhealth.gov.au/nutrient-reference-values/nutrients/sodium">50%</a> of the suggested dietary target for optimal health. </p>
<p>Eating too much salt <a href="https://theconversation.com/remind-me-again-why-is-salt-bad-for-you-179768">increases your risk</a> of high blood pressure, heart disease and stroke. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/remind-me-again-why-is-salt-bad-for-you-179768">Remind me again, why is salt bad for you?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/222598/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.</span></em></p>Fermented foods, such as kimchi, have some health benefits. But helping you lose weight? I’m not convinced.Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172872024-02-04T19:09:37Z2024-02-04T19:09:37ZHow much weight do you actually need to lose? It might be a lot less than you think<figure><img src="https://images.theconversation.com/files/572339/original/file-20240131-15-eetcro.jpg?ixlib=rb-1.1.0&rect=81%2C0%2C5381%2C3260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/overweight-woman-drink-water-during-morning-1079331911">Flotsam/Shutterstock</a></span></figcaption></figure><p>If you’re one of the <a href="https://www.finder.com.au/new-years-resolutions-statistics">one in three</a> Australians whose New Year’s resolution involved losing weight, it’s likely you’re now contemplating what weight-loss goal you should actually be working towards. </p>
<p>But type “setting a weight loss goal” into any online search engine and you’ll likely be left with more questions than answers.</p>
<p>Sure, the many weight-loss apps and calculators available will make setting this goal seem easy. They’ll typically use a body mass index (BMI) calculator to confirm a “healthy” weight and provide a goal weight based on this range.</p>
<p>Your screen will fill with trim-looking influencers touting diets that will help you drop ten kilos in a month, or ads for diets, pills and exercise regimens promising to help you effortlessly and rapidly lose weight. </p>
<p>Most sales pitches will suggest you need to lose substantial amounts of weight to be healthy – making weight loss seem an impossible task. But the research shows you don’t need to lose a lot of weight to achieve health benefits. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-you-be-overweight-and-healthy-182219">Can you be overweight and healthy?</a>
</strong>
</em>
</p>
<hr>
<h2>Using BMI to define our target weight is flawed</h2>
<p>We’re a society fixated on numbers. So it’s no surprise we use measurements and equations to score our weight. The most popular is BMI, a measure of our body weight-to-height ratio. </p>
<p>BMI classifies bodies as underweight, normal (healthy) weight, overweight or obese and can be a useful tool for weight and health screening. </p>
<p>But it shouldn’t be used as the single measure of what it means to be a healthy weight when we set our weight-loss goals. This is <a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">because</a> it: </p>
<ul>
<li><p>fails to consider two critical factors related to body weight and health – body fat percentage and distribution</p></li>
<li><p>does not account for significant differences in body composition based on gender, ethnicity and age.</p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1520959736476274690"}"></div></p>
<h2>How does losing weight benefit our health?</h2>
<p>Losing just 5–10% of our body weight – between 6 and 12kg for someone weighing 120kg – can significantly improve our health in four key ways.</p>
<p><strong>1. Reducing cholesterol</strong></p>
<p>Obesity increases the chances of having too much low-density lipoprotein (LDL) cholesterol – also known as bad cholesterol – because carrying excess weight changes how our bodies produce and manage lipoproteins and triglycerides, another fat molecule we use for energy.</p>
<p>Having too much bad cholesterol and high triglyceride levels is not good, narrowing our arteries and limiting blood flow, which increases the risk of heart disease, heart attack and stroke.</p>
<p>But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987606/">research</a> shows improvements in total cholesterol, LDL cholesterol and triglyceride levels are evident with just 5% weight loss.</p>
<p><strong>2. Lowering blood pressure</strong></p>
<p>Our blood pressure is considered high if it reads more than 140/90 on at least two occasions. </p>
<p>Excess weight is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">linked to</a> high blood pressure in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">several ways</a>, including changing how our sympathetic nervous system, blood vessels and hormones regulate our blood pressure.</p>
<p>Essentially, high blood pressure makes our heart and blood vessels work harder and less efficiently, damaging our arteries over time and increasing our risk of heart disease, heart attack and stroke. </p>
<figure class="align-center ">
<img alt="Older man takes his blood pressure at home" src="https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Losing weight can lower your blood pressure.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hypertension-older-age-senior-black-man-2066841269">Prostock-studio/Shutterstock</a></span>
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</figure>
<p>Like the improvements in cholesterol, a 5% weight loss <a href="https://onlinelibrary.wiley.com/doi/10.1002/oby.21358">improves</a> both systolic blood pressure (the first number in the reading) and diastolic blood pressure (the second number). </p>
<p>A <a href="https://www.ahajournals.org/doi/10.1161/01.hyp.0000094221.86888.ae">meta-analysis of 25 trials</a> on the influence of weight reduction on blood pressure also found every kilo of weight loss improved blood pressure by one point.</p>
<p><strong>3. Reducing risk for type 2 diabetes</strong></p>
<p>Excess body weight is the primary manageable risk factor for type 2 diabetes, particularly for people carrying a lot of visceral fat around the abdomen (belly fat).</p>
<p>Carrying this excess weight can cause fat cells to release pro-inflammatory chemicals that disrupt how our bodies regulate and use the insulin produced by our pancreas, leading to high blood sugar levels. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-i-actually-target-areas-to-lose-fat-like-my-belly-205203">Can I actually target areas to lose fat, like my belly?</a>
</strong>
</em>
</p>
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<p>Type 2 diabetes can lead to serious medical conditions if it’s not carefully managed, including damaging our heart, blood vessels, major organs, eyes and nervous system.</p>
<p><a href="https://www.nejm.org/doi/full/10.1056/nejmoa012512">Research</a> shows just 7% weight loss reduces risk of developing type 2 diabetes by 58%.</p>
<p><strong>4. Reducing joint pain and the risk of osteoarthritis</strong></p>
<p>Carrying excess weight can cause our joints to become inflamed and damaged, making us more prone to osteoarthritis. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/21425246/">Observational studies</a> show being overweight doubles a person’s risk of developing osteoarthritis, while obesity increases the risk fourfold.</p>
<p>Small amounts of weight loss alleviate this stress on our joints. <a href="https://pubmed.ncbi.nlm.nih.gov/15986358/">In one study</a> each kilogram of weight loss resulted in a fourfold decrease in the load exerted on the knee in each step taken during daily activities.</p>
<figure class="align-center ">
<img alt="Man on bathroom scales" src="https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Losing weight eases stress on joints.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-feet-on-scale-bathroom-1030174888">Shutterstock/Rostislav_Sedlacek</a></span>
</figcaption>
</figure>
<h2>Focus on long-term habits</h2>
<p>If you’ve ever tried to lose weight but found the kilos return almost as quickly as they left, you’re not alone.</p>
<p>An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/">analysis</a> of 29 long-term weight-loss studies found participants regained more than half of the weight lost within two years. Within five years, they regained more than 80%.</p>
<p>When we lose weight, we take our body out of its comfort zone and trigger its survival response. It then counteracts weight loss, triggering several <a href="https://pubmed.ncbi.nlm.nih.gov/25896063/">physiological responses</a> to defend our body weight and “survive” starvation. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">What's the 'weight set point', and why does it make it so hard to keep weight off?</a>
</strong>
</em>
</p>
<hr>
<p>Just as the problem is evolutionary, the solution is evolutionary too. Successfully losing weight long-term comes down to:</p>
<ul>
<li><p>losing weight in small manageable chunks you can sustain, specifically periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight </p></li>
<li><p>making gradual changes to your lifestyle to ensure you form habits that last a lifetime.</p></li>
</ul>
<p>Setting a goal to reach a healthy weight can feel daunting. But it doesn’t have to be a pre-defined weight according to a “healthy” BMI range. Losing 5–10% of our body weight will result in immediate health benefits.</p>
<p><em>At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.</em></p><img src="https://counter.theconversation.com/content/217287/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Nick Fuller works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program.</span></em></p>Weight loss can seem like an impossible, unachievable task. But you don’t need to lose a lot of weight to start noticing the health benefits.Nick Fuller, Charles Perkins Centre Research Program Leader, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2215142024-02-01T21:21:20Z2024-02-01T21:21:20ZHow dieting, weight suppression and even misuse of drugs like Ozempic can contribute to eating disorders<figure><img src="https://images.theconversation.com/files/572540/original/file-20240131-15-o0m6p8.jpg?ixlib=rb-1.1.0&rect=147%2C78%2C6271%2C4030&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Although semaglutide drugs like Ozempic are indicated to treat Type 2 diabetes, they are increasingly prescribed off-label because of their observed effectiveness at inducing weight loss.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/how-dieting-weight-suppression-and-even-misuse-of-drugs-like-ozempic-can-contribute-to-eating-disorders" width="100%" height="400"></iframe>
<p>Up to 72 per cent of women and 61 per cent of men are dissatisfied with their weight or <a href="https://doi.org/10.1016/j.eatbeh.2014.04.010">body image</a>, according to a U.S. study. Globally, millions of people <a href="https://doi.org/10.1111%2Fobr.12466">attempt to lose weight</a> every year with the hope that weight loss will have positive effects on their body image, health and quality of life. </p>
<p>However, these motivated individuals often struggle to maintain new diets or exercise regimens. The rise of medications such as semaglutides, like <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101298">Ozempic</a> or <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101765">Wegovy</a>, <a href="https://www.cbc.ca/news/health/ozempic-weight-loss-1.6772021">might be viewed as an appealing “quick fix”</a> alternative to meet weight loss goals. </p>
<p>Research led by our team and others suggests that such attempts to lose weight often do more harm than good, and even increase the risk of <a href="https://osf.io/9stq2">developing an eating disorder</a>.</p>
<h2>Weight loss and eating disorders</h2>
<p>Eating disorders are <a href="https://doi.org/10.1002/eat.20589">serious mental health conditions</a> primarily characterized by extreme patterns of under- or over-eating, concerns about one’s shape or body weight or other behaviours intended to influence body shape or weight such as exercising excessively or self-inducing vomiting. </p>
<p>Although once thought to only affect young, white adolescent girls, eating disorders do not discriminate; eating disorders can develop in people of <a href="https://doi.org/10.1002/erv.2553">any age, sex, gender or racial/ethnic background</a>, with an estimated <a href="https://nedic.ca/general-information/">one million Canadians</a> suffering from an eating disorder at any given time. Feb. 1 to 7 is <a href="https://nedic.ca/edaw/">National Eating Disorders Awareness Week</a>.</p>
<p>As a clinical psychologist and clinical psychology graduate student, our research has focused on how eating disorders develop and what keeps them going. Pertinent to society’s focus on weight-related goals, our research has examined associations between weight loss and eating disorder symptoms.</p>
<h2>Eating disorders and ‘weight suppression’</h2>
<p>In eating disorders research, the state of maintaining weight loss is referred to as “weight suppression.” Weight suppression is typically defined as the difference between a person’s current weight and their highest lifetime weight (excluding pregnancy). </p>
<p>Despite the belief that weight loss will improve body satisfaction, we found that in a sample of over 600 men and women, weight loss had no impact on women’s negative body image and was associated with increased body dissatisfaction in <a href="https://doi.org/10.1016/j.bodyim.2023.01.011">men</a>. Importantly, being more weight suppressed has been associated with the <a href="https://doi.org/10.1093/ajcn/nqaa146">onset of eating disorders</a>, including anorexia nervosa and bulimia nervosa. </p>
<p><a href="https://doi.org/10.1007/s11920-018-0955-2">One proposed explanation</a> for the relationship between weight suppression and eating disorders is that maintaining weight loss becomes increasingly difficult as body systems that <a href="https://doi.org/10.3945/ajcn.110.010025">reduce metabolic rate and energy expenditure, and increase appetite</a>, are activated to promote weight gain.</p>
<p>There is growing awareness that <a href="https://doi.org/10.1136/bmj.g2646">weight regain is highly likely following conventional diet programs</a>. This might lead people to engage in more and more extreme behaviours to control their weight, or they might shift between extreme restriction of food intake and episodes of overeating or binge eating, the characteristic symptoms of bulimia nervosa.</p>
<h2>Ozempic and other semaglutide drugs</h2>
<p>Semaglutide drugs like Ozempic and Wegovy are part of a class of drug called <a href="https://pdf.hres.ca/dpd_pm/00067924.PDF">glucagon-like peptide-1 agonists (GLP-1As)</a>. These drugs work by mimicking the hormone GLP-1 to interact with neural pathways that signal satiety (fullness) and slow stomach emptying, leading to reduced food intake. </p>
<figure class="align-center ">
<img alt="A white plate with a weight scale in it, with knife and fork, against an orange background" src="https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572541/original/file-20240131-25-y3r386.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Popular weight-loss methods, whether they involve pills or ‘crash diets,’ often mimic symptoms of eating disorders.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Although GLP-1As are indicated to treat Type 2 diabetes, <a href="https://www.cbc.ca/news/canada/london/ozempic-off-label-1.6884141">they are increasingly prescribed off-label</a> or being <a href="https://www.bbc.com/news/health-67414203">illegally purchased</a> without a prescription because of their observed effectiveness at inducing weight loss. Although medications like Ozempic do often lead to weight loss, the rate of weight loss may <a href="https://doi.org/10.1001/jama.2021.3224">slow down or stop over time</a>.</p>
<p>Research by Lindsay Bodell, one of the authors of this story, and her colleagues on weight suppression may help explain why effects of semaglutides diminish over time, as <a href="https://doi.org/10.1016/j.physbeh.2019.112565">weight suppression is associated with reduced GLP-1 response</a>. This means those suppressing their weight could become less responsive to the satiety signals activated by GLP-1As. </p>
<p>Additionally, weight loss effects are only seen for as long as the medication is taken, meaning those who take these drugs to achieve some weight loss goal are <a href="https://doi.org/10.1111/dom.14725">likely to regain most, if not all, weight lost</a> when they stop taking the medication.</p>
<h2>Risks of dieting and weight-loss drugs</h2>
<p>The growing market for off-label weight loss drugs is concerning, because of the exacerbation of <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">weight stigma</a> and the serious <a href="https://doi.org/10.1016/j.jand.2022.01.004">health risks</a> associated with unsupervised weight loss, including developing eating disorders. </p>
<p>Researchers and health professionals are already raising the alarm about the use of GLP-1As in children and adolescents, due to concerns about their possible <a href="https://doi.org/10.1017/cts.2023.612">impact on growth and development</a>.</p>
<p>Moreover, popular weight-loss methods, whether they involve pills or “crash diets,” often mimic symptoms of eating disorders. For example, intermittent fasting diets that involve long periods of fasting followed by short periods of food consumption may mimic and <a href="https://doi.org/10.1016/j.eatbeh.2022.101681">increase the risk of developing binge eating problems</a>. </p>
<p>The use of diet pills or laxatives to lose weight has been found to increase the risk of <a href="https://doi.org/10.2105/AJPH.2019.305390">being diagnosed with an eating disorder in the next one to three years</a>. Drugs like Ozempic may also be <a href="https://doi.org/10.1002/eat.24109">misused by individuals already struggling with an eating disorder</a> to suppress their appetite, compensate for binge eating episodes or manage fear of weight gain. </p>
<p>Individuals who are already showing signs of an eating disorder, such as limiting their food intake and intense concerns about their weight, may be most at risk of spiralling from a weight loss diet or medication into an eating disorder, <a href="https://doi.org/10.1002/eat.24116">even if they only lose a moderate amount of weight</a>.</p>
<p>People who are dissatisfied with their weight or have made multiple attempts to lose weight often feel pressured to try increasingly drastic methods. However, any diet, exercise program or weight-loss medication promising a quick fix for weight loss should be treated with extreme caution. At best, you may gain the weight back; at worst, you put yourself at risk for much more serious eating disorders and other health problems.</p><img src="https://counter.theconversation.com/content/221514/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samantha Withnell receives funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Lindsay Bodell receives (or has previously received) funding from the Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, Brain Canada Foundation, and Banting Research Foundation. </span></em></p>The demand for off-label weight loss drugs like Ozempic is concerning, because of the impact on weight stigma and the health risks of unsupervised weight loss, including developing eating disorders.Samantha Withnell, PhD Candidate, Clinical Psychology, Western UniversityLindsay Bodell, Assistant Professor of Psychology, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2190842024-01-10T13:31:56Z2024-01-10T13:31:56ZAs Zepbound dominates headlines as a new obesity-fighting drug, a nutritionist warns that weight loss shouldn’t be the only goal<figure><img src="https://images.theconversation.com/files/568084/original/file-20240105-19-zvx4x7.jpg?ixlib=rb-1.1.0&rect=52%2C30%2C4979%2C3319&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Overall health and well-being are about much more than just weight management.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/anatomical-heart-made-of-felt-textile-in-red-royalty-free-image/1437430537?phrase=healthy+lifestyle&searchscope=image%2Cfilm&adppopup=true">Carol Yepes/Moment via Getty Images</a></span></figcaption></figure><p>If the buzz surrounding a medication could elevate it to celebrity status, then <a href="https://www.zepbound.lilly.com/">Zepbound</a> is reaching Taylor Swift rank. </p>
<p>Zepbound is the newest addition to the weight loss drug arena. In November 2023, it joined the list of obesity-fighting drugs – administered as an injection – to be <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management">approved by the U.S. Food and Drug Administration</a>. </p>
<p>The key to Zepbound’s weight loss potential is its active ingredient, <a href="https://doi.org/10.1056/NEJMoa2206038">tirzepatide</a>. This is the same active ingredient found in the drug <a href="https://www.mounjaro.com/">Mounjaro</a>, which is approved to treat Type 2 diabetes. </p>
<p>The relationship between Zepbound and Mounjaro is similar to two other popular drugs making headlines, <a href="https://www.wegovy.com/">Wegovy</a> and <a href="https://www.ozempic.com/">Ozempic</a>. Both Wegovy and Ozempic contain the active ingredient <a href="https://www.mayoclinic.org/drugs-supplements/semaglutide-subcutaneous-route/description/drg-20406730#">semaglutide</a>, with Ozempic approved for the treatment of Type 2 diabetes and Wegovy approved for the treatment of obesity. </p>
<p>Tirzepatide and semaglutide both mimic the <a href="https://doi.org/10.1007/s005920050116">digestive hormone GLP-1</a>, which is released by the intestines when we eat to stimulate insulin production and help regulate blood sugar. GLP-1 also suppresses appetite while promoting a sensation of fullness. </p>
<p>Weight loss medications are intended to be used in conjunction with lifestyle changes, such as exercise and <a href="https://theconversation.com/fiber-is-your-bodys-natural-guide-to-weight-management-rather-than-cutting-carbs-out-of-your-diet-eat-them-in-their-original-fiber-packaging-instead-205159">a healthy diet</a>. But too often, people view them as a silver bullet for weight loss. And <a href="https://www.kff.org/health-costs/press-release/drugs-used-for-weight-loss-could-cost-americans-much-more-than-people-in-peer-countries/">the high price tag</a> and <a href="https://www.nbcnews.com/health/health-news/insurance-cover-weight-loss-drugs-take-rcna120091">variable insurance coverage</a> for these popular weight loss drugs create a barrier for many people. </p>
<p>I am a registered dietitian and <a href="https://www.fsnhp.msstate.edu/associate.php?id=182">dietetics educator</a>. Whether I am counseling patients, teaching students or working in my community to address food access challenges and healthy eating, I focus on overall well-being. I am passionate about helping people make informed and realistic health decisions based on their circumstances and helping them see opportunities to overcome the barriers they may encounter.</p>
<figure>
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<figcaption><span class="caption">A doctor outlines the differences between Zepbound and other weight loss drugs.</span></figcaption>
</figure>
<h2>Health risks of obesity</h2>
<p>The potential impact of these drugs is staggering, since <a href="https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity#">more than 2 in 5 American adults are obese</a>, according to the National Institutes of Health. </p>
<p>Obesity is not just an American issue, nor is it going away. The <a href="https://www.worldobesity.org/news/one-billion-people-globally-estimated-to-be-living-with-obesity-by-2030">World Obesity Federation</a> estimates that by 2030, 1 in 5 women and 1 in 7 men will be living with obesity worldwide.</p>
<p>Many serious health conditions are associated with obesity, including <a href="https://doi.org/10.1161/CIR.0000000000000973">heart disease</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3066828/">diabetes</a>, <a href="https://doi.org/10.21037/gs.2019.12.03">high blood pressure</a>, <a href="https://doi.org/10.21037/atm-20-4387">stroke</a>, <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/obesity/obesity-fact-sheet#what-is-known-about-the-relationship-between-obesity-and-cancer-">certain cancers</a> and <a href="https://doi.org/10.3389/fimmu.2022.907750">osteoarthritis</a>. By treating obesity, a person can reduce or reverse obesity-related disease and improve both their health and quality of life.</p>
<p>However, long-term weight management depends on a number of complex factors. Meal timing and <a href="https://www.ncbi.nlm.nih.gov/books/NBK232454/">types of foods eaten</a> can affect energy levels, satisfaction and <a href="https://doi.org/10.1371/journal.pone.0174820">hunger levels</a>. A person’s typical schedule, culture and preferences, activity level and health history must be taken into consideration as well. No single “best strategy” for weight management has been identified, and research indicates that strategies for weight loss and maintenance <a href="https://doi.org/10.7570/jomes20065">need to be individualized</a>.</p>
<p>In addition, it is critical to note that <a href="https://doi.org/10.1111/dom.14725">research on the long-term effects</a> of these newer weight loss drugs is limited. The available research has focused specifically on weight loss, heart health and metabolism and has found that <a href="https://www.tctmd.com/news/stopping-tirzepatide-leads-rebound-weight-cardiometabolic-risk#">ongoing use of these new medications</a> is necessary to maintain improvements in weight and related health benefits. </p>
<p>Common side effects and the emotional toll experienced by those who regain weight once they stop taking the drugs are <a href="https://chicago.suntimes.com/well/2023/4/7/23671762/experts-worry-new-weight-loss-medications-carry-longterm-risks">trade-offs that need to be considered</a>. More research is needed to better understand the long-term impact of both direct and indirect health consequences of taking drugs for weight loss.</p>
<h2>It’s not just what you see on the scale</h2>
<p>Throughout my years working as a registered dietitian, I have counseled numerous people about their weight loss goals. I often see a hyperfocus on weight loss, with much less attention being placed on the right nutrients to eat.</p>
<p>Societal standards and <a href="https://doi.org/10.1371/journal.pone.0251566">weight stigma in the health care setting</a> can negatively affect patients’ health and can lead them to obsess about the number on a scale rather than on the health outcome.</p>
<p>Weight loss may be necessary to reduce risks and promote health. But weight loss alone should not be the end goal: Rather, the focus should be on overall health. Tactics to reduce intake and suppress appetite require intention to ensure that the body receives the nutrients it needs to support health.</p>
<p>Additionally, I remind people that <a href="https://www.washingtonpost.com/opinions/2024/01/03/obesity-ozempic-wegovy-weight-loss-health/">long-term results require attention to diet and lifestyle</a>. When a person stops taking a medication, the condition it’s meant to treat can often return. If you stop taking your high blood pressure pills without altering your diet and lifestyle, your blood pressure goes back up. The same effects can happen with medications used to treat cholesterol and obesity.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567792/original/file-20240103-19-3k2s6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Tape measure lying on top of a scale on a white tile background." src="https://images.theconversation.com/files/567792/original/file-20240103-19-3k2s6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567792/original/file-20240103-19-3k2s6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567792/original/file-20240103-19-3k2s6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567792/original/file-20240103-19-3k2s6o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567792/original/file-20240103-19-3k2s6o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567792/original/file-20240103-19-3k2s6o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567792/original/file-20240103-19-3k2s6o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Weight management plans should take into consideration a person’s schedule, lifestyle and health history.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/tape-measure-on-scales-close-up-royalty-free-image/sb10068935i-001">Peter Dazeley/The Image Bank via Getty Images</a></span>
</figcaption>
</figure>
<h2>Nourish your body with nutrients</h2>
<p>Despite the prevalence of obesity and the emergence of newer drugs to treat it, 95% of the world’s population doesn’t get enough of <a href="https://doi.org/10.3390/nu12061735">at least one nutrient</a>. According to one study, nearly one-third of Americans have been found to be at risk of <a href="https://doi.org/10.3390/nu9070655">at least one nutrient deficiency</a>. Additional research indicates that those actively trying to lose weight are more prone to <a href="https://doi.org/10.29333/ejgm/12675">nutrient deficiencies and inadequate intake</a>. </p>
<p>For instance, a decline in iron intake can lead to <a href="https://doi.org/10.1093/jn/nxab064">iron deficiency anemia</a>, which can cause fatigue as well as an increased risk of many conditions. Adequate intake of calcium and Vitamin D <a href="https://doi.org/10.1007/s10195-017-0474-7">reduce the risk of bone fractures</a>, yet many people get less than the recommended amounts of these nutrients. </p>
<p>It is true that a healthy body weight is associated with reduced health risks and conditions. But if a person loses weight in a manner that does not provide their body with adequate nourishment, then they may develop new health concerns. For example, when a person follows a diet that severely restricts carbohydrates, such as the <a href="https://www.ncbi.nlm.nih.gov/books/NBK499830/">ketogenic diet</a>, intake of many vitamins, minerals, <a href="https://www.uclahealth.org/news/what-are-phytochemicals-and-why-should-you-eat-more-them">phytochemicals</a> – or biologically active compounds found in plants – and fiber are reduced. This can increase risk of nutrient deficiencies and <a href="https://doi.org/10.3389/fnut.2021.702802">impair the health of bacteria in our gut</a> that are important for nutrient absorption and immune function.</p>
<p><a href="https://ods.od.nih.gov/HealthInformation/nutrientrecommendations.aspx">Nutrition recommendations</a> set by the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine and the <a href="https://health.gov/our-work/nutrition-physical-activity/dietary-guidelines">Dietary Guidelines for Americans</a> provide guidance and <a href="https://www.nutrition.gov/">resources</a> to help meet nutrient needs to promote health and prevent disease, regardless of the strategy used to lose weight.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/HloP7XR3Y24?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">His transformation began with a wake-up call from the doctor.</span></figcaption>
</figure>
<h2>Optimizing health</h2>
<p>There is no doubt that striving for a healthy body weight can reduce certain health risks and prevent chronic disease. Whether a person strives to maintain a healthy body weight through diet alone or with medications to treat obesity, the following tips can help optimize health while attempting to lose weight.</p>
<ol>
<li><p>Adopt an individualized approach to healthy behaviors that promote weight loss while considering personal preferences, environmental challenges, health conditions and nutrient needs.</p></li>
<li><p>Focus on nutrient-dense foods to ensure the body is getting required nutrients for disease prevention and optimal function. If medications reduce your appetite, it is crucial to maximize the amount of nutrients in the foods you do consume.</p></li>
<li><p>Include <a href="https://theconversation.com/cardio-or-weights-first-a-kinesiologist-explains-how-to-optimize-the-order-of-your-exercise-routine-217431">exercise in your program</a>. Weight loss as a result of reduced calorie intake can decrease both fat and lean body mass, or muscle. An exercise routine that <a href="https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/strength-training/art-20046670">includes strength training</a> will <a href="https://www.forbes.com/health/fitness/benefits-of-strength-training/">help improve muscle strength</a> and preserve muscle during weight loss. </p></li>
<li><p>Seek professional help. If you are uncertain about how to adopt an individualized approach while ensuring adequate intake of essential nutrients, talk to a registered dietitian. They can learn about your individual needs based on preferences, health conditions and goals to make dietary recommendations that support health.</p></li>
</ol>
<p><em>This article has been corrected to clarify that Ozempic is approved for the treatment of Type 2 diabetes and Wegovy is approved for the treatment of obesity.</em></p><img src="https://counter.theconversation.com/content/219084/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mandy Conrad 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>Medications can play an important role in weight management, but not at the expense of overall nutrition. And healthy lifestyle habits are also key.Mandy Conrad, Assistant Clinical Professor in Nutrition and Dietetics, Mississippi State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2145802023-12-26T20:30:36Z2023-12-26T20:30:36ZYou can’t reverse the ageing process but these 5 things can help you live longer<figure><img src="https://images.theconversation.com/files/565071/original/file-20231212-19-m904rz.jpg?ixlib=rb-1.1.0&rect=0%2C437%2C6500%2C3746&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/seniors-enjoying-breakfast-1105683980">Rawpixel.com/Shutterstock</a></span></figcaption></figure><p>At this time of year many of us resolve to prioritise our health. So it is no surprise there’s a <a href="https://digiday.com/marketing/health-food-brands-ramp-up-marketing-efforts-around-consumers-new-years-resolutions/">roaring trade</a> of products purporting to guarantee you live longer, be healthier and look more youthful. </p>
<p>While an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822264/">estimated</a> 25% of longevity is determined by our genes, the rest is determined by what we do, day to day. </p>
<p>There are no quick fixes or short cuts to living longer and healthier lives, but the science is clear on the key principles. Here are five things you can do to extend your lifespan and improve your health.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-you-cant-reverse-ageing-by-injecting-young-blood-and-fasting-but-that-doesnt-stop-people-trying-207038">No, you can't reverse ageing by injecting 'young blood' and fasting. But that doesn't stop people trying</a>
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</p>
<hr>
<h2>1. Eat a predominantly plant-based diet</h2>
<p>What you eat has a huge impact on your health. The evidence overwhelmingly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8210981/#:%7E:text=According%20to%20an%20expansive%20review,13%20Given%20that%20so%20many">shows</a> eating a diet high in plant-based foods is associated with health and longevity. </p>
<p>If you eat more plant-based foods and less meat, processed foods, sugar and salt, you reduce your risk of a range of illnesses that shorten our lives, including heart disease and cancer. </p>
<figure class="align-center ">
<img alt="Delicious Mediterranean serving platter." src="https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=371&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=371&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=371&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=466&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=466&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565062/original/file-20231212-19-nxaeys.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=466&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Mediterranean diet is one of the healthiest and most studied eating patterns.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/tray-of-food-on-white-surface-K47107aP8UU">Louis Hansel/Unsplash</a></span>
</figcaption>
</figure>
<p>Plant-based foods <a href="https://www.nature.com/articles/s41398-019-0552-0">are rich</a> in nutrients, phytochemicals, antioxidants and fibre. They’re also anti-inflammatory. All of this protects against damage to our cells as we age, which helps prevent disease. </p>
<p>No particular diet is right for everyone but one of the most studied and <a href="https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/mediterranean-diet/#:%7E:text=%5B6%5D%20Those%20who%20had%20the,who%20had%20the%20lowest%20adherence.">healthiest</a> is the <a href="https://www.eatingwell.com/article/291120/mediterranean-diet-for-beginners-everything-you-need-to-get-started/">Mediterranean diet</a>. It’s based on the eating patterns of people who live in countries around the Mediterranean Sea and emphases vegetables, fruits, wholegrains, legumes, nuts and seeds, fish and seafood, and olive oil.</p>
<h2>2. Aim for a healthy weight</h2>
<p>Another important way you can be healthier is to try and achieve a healthy weight, as obesity <a href="https://www.healthline.com/health/obesity/how-obesity-affects-body">increases the risk</a> of a number of health problems that shorten our lives.</p>
<p>Obesity puts strain on all of our body systems and has a whole myriad of physiological effects including causing inflammation and hormonal disturbances. These <a href="https://www.ncbi.nlm.nih.gov/books/NBK572076/">increase your chances</a> of a number of diseases, including heart disease, stroke, high blood pressure, diabetes and a number of cancers.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-body-mass-index-cant-tell-us-if-were-healthy-heres-what-we-should-use-instead-211190">The body mass index can't tell us if we're healthy. Here's what we should use instead</a>
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</em>
</p>
<hr>
<p>In addition to affecting us physically, obesity is also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052856/">associated with</a> poorer psychological health. It’s linked to depression, low self-esteem and stress.</p>
<p>One of the biggest challenges we face in the developed world is that we live in an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6817492/">environment</a> that promotes obesity. The ubiquitous marketing and the easy availability of high-calorie foods our bodies are hard-wired to crave mean it’s easy to consume too many calories.</p>
<h2>3. Exercise regularly</h2>
<p>We all know that exercise is good for us – the <a href="https://www.insurancebusinessmag.com/au/news/breaking-news/hcf-reveals-australias-most-popular-new-years-resolutions-for-2023-431665.aspx">most common resolution</a> we make this time of year is to do more exercise and to get fitter. Regular exercise <a href="https://www.who.int/news-room/fact-sheets/detail/physical-activity">protects</a> against chronic illness, lowers your stress and improves your mental health. </p>
<p>While one of the ways exercising helps you is by supporting you to control your weight and lowering your body fat levels, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1402378/#:%7E:text=For%20instance%2C%20routine%20physical%20activity,HDL%5D%20cholesterol%20levels%20and%20decreased">effects</a> are broader and include improving your glucose (blood sugar) use, lowering your blood pressure, reducing inflammation and improving blood flow and heart function.</p>
<figure class="align-center ">
<img alt="Woman with grey hair does yoga outside" src="https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565049/original/file-20231212-27-u1vhzr.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">Do the types of exercise you enjoy.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-in-black-tank-top-and-gray-denim-jeans-sitting-on-green-grass-field-during-daytime-FGQQho5XXn4">Kelly Newton/Unsplash</a></span>
</figcaption>
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<p>While it’s easy to get caught up in all of the hype about different exercise strategies, the evidence <a href="https://www.medicalnewstoday.com/articles/320760">suggests</a> that any way you can include physical activity in your day has health benefits. You don’t have to run marathons or go to the gym for hours every day. Build movement into your day in any way that you can and do things that you enjoy.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cant-afford-a-gym-membership-or-fitness-class-3-things-to-include-in-a-diy-exercise-program-206204">Can't afford a gym membership or fitness class? 3 things to include in a DIY exercise program</a>
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</em>
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<hr>
<h2>4. Don’t smoke</h2>
<p>If you want to be healthier and live longer then don’t smoke or vape. </p>
<p>Smoking cigarettes affects almost every organ in the body and is associated with both a shorter and lower quality of life. There is no safe level of smoking – every cigarette increases your <a href="https://theconthatkills.org.au/?utm_source=googlesearch&utm_medium=search&utm_campaign=theconthatkills23&utm_content=RSA&gclid=Cj0KCQjwqP2pBhDMARIsAJQ0Czrlep6EQHC-8_9xUhpz0h9v2ZglMF-6-k7_65awq8FxVaIL5HRoivwaAqJwEALw_wcB&gclsrc=aw.ds">chances of developing</a> a range of cancers, heart disease and diabetes. </p>
<p>Even if you have been smoking for years, by giving up smoking at any age you can experience <a href="https://www.cdc.gov/tobacco/quit_smoking/how_to_quit/benefits/index.htm">health benefits</a> almost immediately, and you can reverse many of the harmful effects of smoking.</p>
<p>If you’re thinking of switching to vapes as a healthy long term option, <a href="https://theconversation.com/can-vaping-help-people-quit-smoking-its-unlikely-204812">think again</a>. The long term health effects of vaping are not fully understood and they come with their own <a href="https://theconversation.com/no-vapes-arent-95-less-harmful-than-cigarettes-heres-how-this-decade-old-myth-took-off-203039">health risks</a>.</p>
<h2>5. Prioritise social connection</h2>
<figure class="align-center ">
<img alt="Older men play chess outdoors." src="https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565064/original/file-20231212-21-u1vhzr.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">Don’t forget about friendship and socialising.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/two-men-playing-chess-ItphH2lGzuI">Vlad Sargu/Unsplash</a></span>
</figcaption>
</figure>
<p>When we talk about living healthier and longer, we tend to focus on what we do to our physical bodies. But one of the most important discoveries over the past decade has been the recognition of the importance of spiritual and psychological health. </p>
<p>People who are lonely and socially isolated have a much higher risk of dying early and are <a href="https://healthnews.com/longevity/healthspan/social-connection-and-longevity/#:%7E:text=One%20of%20the%20biggest%20benefits,the%20following%20factors%20and%20influences.">more likely</a> to suffer from heart disease, stroke, dementia as well as anxiety and depression. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-you-part-of-a-social-group-making-sure-you-are-will-improve-your-health-81996">Are you part of a social group? Making sure you are will improve your health</a>
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<p>Although we don’t fully understand the mechanisms, it’s likely due to both behavioural and biological factors. While people who are more socially connected are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150158/">more likely</a> to engage in healthy behaviours, there also seems to be a more direct physiological effect of loneliness on the body. </p>
<p>So if you want to be healthier and live longer, build and maintain your connections to others.</p><img src="https://counter.theconversation.com/content/214580/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hassan Vally 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>Don’t believe the hype about products claiming they can help you live longer. Here are five lifestyle changes to prioritise instead.Hassan Vally, Associate Professor, Epidemiology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2158082023-12-10T19:07:34Z2023-12-10T19:07:34ZI’m trying to lose weight and eat healthily. Why do I feel so hungry all the time? What can I do about it?<p>Benjamin Franklin, one of the founding fathers of the United States, famously said nothing is certain except death and taxes. But I think we can include “you’ll feel hungry when you’re trying to lose weight” as another certainty. </p>
<p>The reason is basic biology. So how does this work – and what can you do about it?</p>
<h2>Hormones control our feelings of hunger</h2>
<p>Several hormones play an essential role in regulating our feelings of hunger and fullness. The most important are ghrelin – often called the hunger hormone – and leptin.</p>
<p>When we’re hungry, <a href="https://pubmed.ncbi.nlm.nih.gov/11739476/">ghrelin</a> is released by our stomach, lighting up a part of our brain called the hypothalamus to tell us to eat. </p>
<p>When it’s time to stop eating, hormones, including <a href="https://pubmed.ncbi.nlm.nih.gov/8717038/">leptin</a>, are released from different organs, such as our gut and fat tissue, to signal to the brain that we’re full.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/chemical-messengers-how-hormones-make-us-feel-hungry-and-full-35545">Chemical messengers: how hormones make us feel hungry and full</a>
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<h2>Dieting disrupts the process</h2>
<p>But when we change our diet and start losing weight, we disrupt how these <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766925/">appetite hormones function</a>. </p>
<p>This triggers a process that stems from our hunter-gatherer ancestors. Their bodies developed this mechanism as a survival response to adapt to periods of deprivation and protect against starvation. </p>
<p>The levels of hormones <a href="https://pubmed.ncbi.nlm.nih.gov/23126426/">managing our hunger increase</a>, making us feel hungrier to tell us to eat more, while the ones responsible for signalling we’re full decrease their levels, intensifying our feelings of hunger.</p>
<p>We end up increasing our calorie consumption so we eat more to regain the weight we lost. </p>
<p>But worse, even after the kilos creep back on, <a href="https://pubmed.ncbi.nlm.nih.gov/22029981/">our appetite hormones don’t restore</a> to their normal levels – they keep telling us to eat more so we put on a little extra fat. This is our body’s way of preparing for the next bout of starvation we will impose through dieting. </p>
<p>Fortunately, there are things we can do to manage our appetite, including:</p>
<h2>1. Eating a large, healthy breakfast every day</h2>
<p>One of the easiest ways to manage our feelings of hunger throughout the day is to eat most of our food earlier in the day and taper our meal sizes so dinner is the smallest meal.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32073608/">Research</a> shows a low-calorie or small breakfast leads to increased feelings of hunger, specifically appetite for sweets, across the course of the day. </p>
<figure class="align-center ">
<img alt="Man spreads avocado" src="https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563857/original/file-20231206-16-2c5mdc.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">Prioritise breakfast over dinner.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/soft-focus-shot-man-having-delicious-759322450">Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://www.cell.com/cell-metabolism/fulltext/S1550-4131(22)00344-8">Another study</a> found the same effect. Participants went on a calorie-controlled diet for two months, where they ate 45% of their calories for breakfast, 35% at lunch and 20% at dinner for the first month, before switching to eat their largest meal in the evening and their smallest in the morning. Eating the largest meal at breakfast resulted in decreased hunger throughout the day.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/32073608/">Research</a> also shows we burn the calories from a meal 2.5-times more efficiently in the morning than the evening. So emphasising breakfast over dinner is good not just for hunger control, but also weight management.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-we-eat-breakfast-like-a-king-lunch-like-a-prince-and-dinner-like-a-pauper-86840">Should we eat breakfast like a king, lunch like a prince, and dinner like a pauper?</a>
</strong>
</em>
</p>
<hr>
<h2>2. Prioritising protein</h2>
<p>Protein helps contain feelings of hunger. This is because protein-rich foods such as lean meats, tofu and beans suppress the appetite-stimulating ghrelin and stimulate another hormone called <a href="https://www.sciencedirect.com/science/article/pii/S1550413106002713">peptide YY</a> that makes you feel full. </p>
<p>And just as eating a breakfast is vital to managing our hunger, what we eat is important too, with <a href="https://pubmed.ncbi.nlm.nih.gov/24703415/">research</a> confirming a breakfast containing protein-rich foods, such as eggs, will leave us feeling fuller for longer. </p>
<p>But this doesn’t mean just eating foods with protein. Meals need to be balanced and include a source of protein, wholegrain carb and healthy fat to meet our dietary needs. For example, eggs on wholegrain toast with avocado.</p>
<h2>3. Filling up with nuts and foods high in good fats and fibre</h2>
<p>Nuts often get a bad rap – thanks to the misconception they cause weight gain – but nuts can help us manage our hunger and weight. The filling fibre and good fats found in nuts take longer to digest, meaning our hunger is satisfied for longer. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/12791613/">Studies</a> suggest you can include up to 68 grams per day of nuts without affecting your weight. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-will-eating-nuts-make-you-gain-weight-108491">Health check: will eating nuts make you gain weight?</a>
</strong>
</em>
</p>
<hr>
<p>Avocados are also high in fibre and heart-healthy monounsaturated fats, making them another excellent food for managing feelings of fullness. This is backed by a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6567160/">study</a> confirming participants who ate a breakfast incorporating avocado felt more satisfied and less hungry than participants who ate a meal containing the same calories but with lower fat and fibre content. </p>
<p>Similarly, eating foods that are high in soluble fibre – such as <a href="https://pubmed.ncbi.nlm.nih.gov/24820437/">beans</a> and vegetables – make us feel fuller. This type of fibre attracts water from our gut, forming a gel that slows digestion. </p>
<figure class="align-center ">
<img alt="Couple cook together" src="https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563854/original/file-20231206-25-s2excn.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">Fibre helps us feel fuller for longer.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-man-and-a-woman-preparing-food-in-a-kitchen-hQocGyy0unQ">Sweet Life/Unsplash</a></span>
</figcaption>
</figure>
<h2>4. Eating mindfully</h2>
<p>When we take time to really be aware of and enjoy the food we’re eating, we slow down and eat far less. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/28718396/">review</a> of 68 studies found eating mindfully helps us better recognise feelings of fullness. Mindful eating provides our brain enough time to recognise and adapt to the signals from our stomach telling us we’re full.</p>
<p>Slow down your food consumption by sitting at the dinner table and use smaller utensils to reduce the volume of food you eat with each mouthful.</p>
<h2>5. Getting enough sleep</h2>
<p>Sleep deprivation disturbs our <a href="https://www.sciencedirect.com/science/article/abs/pii/S1389945708700133">appetite hormones</a>, increasing our feelings of hunger and <a href="https://www.nature.com/articles/ncomms3259">triggering cravings</a>. So aim to get at least seven hours of uninterrupted sleep a night.</p>
<p>Try switching off your devices <a href="https://journals.sagepub.com/doi/full/10.1177/1477153515584979">two hours before bed</a> to boost your body’s secretion of sleep-inducing hormones like melatonin.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-our-brain-needs-sleep-and-what-happens-if-we-dont-get-enough-of-it-83145">Why our brain needs sleep, and what happens if we don’t get enough of it</a>
</strong>
</em>
</p>
<hr>
<h2>6. Managing stress</h2>
<p>Stress increases our <a href="https://pubmed.ncbi.nlm.nih.gov/18568078/">body’s production of cortisol</a> and triggers food cravings.</p>
<p>So take time out when you need it and set aside time for stress-relieving activities. This can be as simple as getting outdoors. A <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00722/full">2019 study</a> found sitting or walking outdoors at least three times a week could reduce cortisol levels by 21%. </p>
<figure class="align-center ">
<img alt="Person walks in house, next to grey dog" src="https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563849/original/file-20231206-23-4atw7u.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">Take time out to reduce your stress levels.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/gray-dog-looking-at-the-person-qqpfqFwAyDQ">Evieanna Santiago/Unsplash</a></span>
</figcaption>
</figure>
<h2>7. Avoiding depriving ourselves</h2>
<p>When we change our diet to lose weight or eat healthier, we typically restrict certain foods or food groups. </p>
<p>However, this <a href="https://pubmed.ncbi.nlm.nih.gov/18568078/">heightens activity</a> in our mesocorticolimbic circuit – the reward system part of the brain – often resulting in us craving the foods we’re trying to avoid. Foods that give us pleasure release feel-good chemicals called endorphins and learning chemicals called dopamine, which enable us to remember – and give in to – that feel-good response.</p>
<p>When we change our diet, activity in our hypothalamus – the clever part of the brain that regulates emotions and food intake – <a href="https://pubmed.ncbi.nlm.nih.gov/18568078/">also reduces</a>, decreasing our control and judgement. It often triggers a psychological response dubbed the “what-the-hell effect”, when we indulge in something we think we shouldn’t feel guilty about and then go back for even more.</p>
<p>Don’t completely cut out your favourite foods when you go on a diet or deprive yourself if you’re hungry. It will take the pleasure out of eating and eventually you’ll give into your cravings. </p>
<p><em>At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.</em></p><img src="https://counter.theconversation.com/content/215808/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Nick Fuller works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program.</span></em></p>When we change our diet, we disrupt our appetite hormones. Here’s how it works – and how small changes to our diet can help us feel fuller for longer.Nick Fuller, Charles Perkins Centre Research Program Leader, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2077102023-12-07T13:27:48Z2023-12-07T13:27:48ZWhat does weight-inclusive health care mean? A dietitian explains what some providers are doing to end weight stigma<figure><img src="https://images.theconversation.com/files/563736/original/file-20231205-19-fz1zo3.jpg?ixlib=rb-1.1.0&rect=25%2C37%2C8326%2C4632&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People living in larger bodies face constant discrimination and negative messages about their body weight.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/overweight-people-royalty-free-illustration/1454557526?adppopup=true">smartboy10/DigitalVision Vectors via Getty Images</a></span></figcaption></figure><p>Weight-inclusive health care means a focus on <a href="https://doi.org/10.1002/ncp.10885">better health with no weight loss required</a>. </p>
<p>This includes practices such as eating for overall well-being rather than for the number of calories. It may also include prioritizing activities to reduce stress, avoiding smoking, drinking less alcohol and striving to be physically active in enjoyable ways.</p>
<p>A weight-inclusive approach to health seeks to undo the harms caused by weight stigma.</p>
<p>People with larger bodies often experience <a href="https://www.health.harvard.edu/blog/weight-stigma-as-harmful-as-obesity-itself-202206022755">weight stigma</a> as discrimination, prejudice, negative stereotypes and judgments from others – including their own doctors and other health care providers. More than 40% of U.S. adults across a range of body sizes report <a href="https://doi.org/10.1038%2Fs41366-021-00814-5">experiencing weight stigma</a> in their day-to-day lives. </p>
<p>Avoiding this stigma is likely a major driver behind the great lengths people in the U.S. go to in order to lose weight. Market data shows that Americans spent some <a href="https://www.researchandmarkets.com/reports/5556414/the-u-s-weight-loss-market-2022-status-report">US$72.6 billion</a> on weight loss products and programs in 2021. In addition, weight loss efforts start early, with nearly half of all high school students in the U.S. reporting that they <a href="https://www.cdc.gov/mmwr/volumes/67/ss/ss6708a1.htm?s_cid=ss6708a1_w">have tried to lose weight</a>.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=ARa5g-oAAAAJ&hl=en">nutrition epidemiologist</a> and <a href="https://faculty.txst.edu/profile/2327984">registered dietitian</a> studying the consequences of weight stigma and working to develop weight-inclusive nutrition interventions. </p>
<p>Initially my private practice and research approach were <a href="https://doi.org/10.1177/2158244018772888">weight-centered</a>. A weight-centered approach focuses on weight loss to achieve health and is widely accepted in health care settings across the world. After over a decade of work in public health nutrition, I have witnessed how, in my view, the weight-centered approach harms individuals and communities. So I have shifted to using a <a href="https://doi.org/10.1002/ncp.10885">weight-inclusive approach</a> in practice and research.</p>
<h2>Overturning the ‘lower weight equals better health’ dogma</h2>
<p>There is an extensive body of research and <a href="https://doi.org/10.1093/heapro/daaa018">public health messaging</a> indicating that <a href="https://www.who.int/health-topics/obesity#tab=tab_1">higher body weight has links</a> with <a href="https://theconversation.com/obesity-in-children-is-rising-dramatically-and-it-comes-with-major-and-sometimes-lifelong-health-consequences-202595">many long-term health concerns</a>, such as high blood pressure and Type 2 diabetes. </p>
<p>As a result, there is a pervasive misconception that a weight-inclusive approach disregards the patient’s health concerns. However, proponents of weight-inclusive care argue that a weight-inclusive approach <a href="http://dx.doi.org/10.1155/2014/983495">minimizes health problems</a> by destigmatizing weight status and promoting health equity. They also acknowledge that there are links between <a href="http://dx.doi.org/10.1155/2014/983495">both higher and lower body weight</a> and various health concerns. </p>
<p>The dogma that lower weight is synonymous with better health is being questioned by public health researchers and health care providers. Scientists and clinicians are calling for a <a href="https://experts.nau.edu/en/publications/the-consequences-of-a-weight-centric-approach-to-healthcare-a-cas">paradigm shift</a> away from a <a href="https://theconversation.com/bmi-alone-will-no-longer-be-treated-as-the-go-to-measure-for-weight-management-an-obesity-medicine-physician-explains-the-seismic-shift-taking-place-208174">weight-centered focus on weight status and body mass index, or BMI</a>, as indicators of health. </p>
<p>Advocacy groups like the Association for Size Diversity and Health have long been promoting the <a href="https://asdah.org/health-at-every-size-haes-approach/">Health at Every Size</a> approach. This weight-inclusive approach affirms a socially just definition of health and advocates for equitable health care regardless of weight status. More recently, the American Medical Association released a statement outlining the <a href="https://www.ama-assn.org/delivering-care/public-health/ama-use-bmi-alone-imperfect-clinical-measure">harms and shortcomings of using BMI</a> as a clinical measurement.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/v4OPDjI0Uf4?wmode=transparent&start=2" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The effects of weight stigma include chronic stress, depression, social isolation, low self-esteem and higher blood pressure.</span></figcaption>
</figure>
<h2>The evidence supporting weight-inclusive care</h2>
<p>Substantial research shows that behaviors such as stopping smoking and drinking less alcohol can prevent disease and <a href="https://doi.org/10.1111/sipr.12062">support overall long-term health, regardless of body weight</a>. For example, a systematic review of one clinical trial and 152 observational peer-reviewed studies reported that a <a href="https://doi.org/10.1001/jamanetworkopen.2021.22277">diet high in nutrient-rich foods</a> with low or moderate alcohol consumption is associated with reduced risk of death for everyone.</p>
<p>Another example: One of my own clients with high cholesterol said that focusing on weight loss over their lifetime had left them stuck in a cycle of weight loss and weight regain, disordered eating, inconsistent and extreme exercise habits and body image concerns. After adopting weight-inclusive practices such as eating more fiber-rich foods and being more physically active, instead of focusing on losing weight, their cholesterol levels returned to normal. </p>
<p>Both the weight-inclusive approach and the weight-centered approach can include diet changes, increasing physical activity and reducing stress as key components to manage and prevent diseases. However, the weight-inclusive approach works to end weight stigma and acknowledges that factors such as socioeconomic status, culture and <a href="https://theconversation.com/fixing-the-global-childhood-obesity-epidemic-begins-with-making-healthy-choices-the-easier-choices-and-that-requires-new-laws-and-policies-207975">access to food and health care</a> – collectively called the <a href="https://health.gov/healthypeople/priority-areas/social-determinants-health">social determinants of health</a> – have huge impacts on a person’s body weight, shape and size. Even if a person could adhere to strict dieting and exercise routines, there will always be <a href="https://doi.org/10.1155%2F2016%2F3753650">structural, political and other factors</a> affecting health and weight that the individual can’t control.</p>
<p>What’s more, evidence indicates that people who lose weight generally don’t have better long-term health and <a href="https://theconversation.com/bmi-alone-will-no-longer-be-treated-as-the-go-to-measure-for-weight-management-an-obesity-medicine-physician-explains-the-seismic-shift-taking-place-208174">fail to keep those pounds off</a>. </p>
<h2>Finding weight-inclusive health care</h2>
<p>There are several things that people can look for in a <a href="https://doi.org/10.1002/ncp.10885">weight-inclusive health care practice</a>.</p>
<p>Look for health care providers who:</p>
<ul>
<li>Make weight checks optional for routine visits.</li>
<li>Treat patient symptoms rather than telling them to lose weight.</li>
<li>Provide patients in larger bodies the same treatment as those in thinner bodies with similar health concerns.</li>
<li>Use measures other than BMI, such as lab results, to diagnose health concerns.</li>
<li>Ask permission before discussing weight with patients.</li>
</ul>
<p>For additional resources on weight-inclusive care, check out the <a href="https://haeshealthsheets.com/">Health at Every Size Health Sheets</a>. Consider examining your own weight bias by taking an online test focused on <a href="https://implicit.harvard.edu/implicit/">implicit associations around weight</a>.</p><img src="https://counter.theconversation.com/content/207710/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Butler receives funding from the American Society for Nutrition Foundation and the National Pork Board. Lauren Butler is owner of Combined Nutrition Solutions, LLC. in Atlantic Beach, FL and currently leads the Food Freedom Research Team at Texas State University. </span></em></p>Research shows that focusing strictly on weight loss is not only ineffective in the long term, it can even be harmful and counterproductive.Lauren Butler, Assistant Professor of Nutrition, Texas State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2174132023-11-15T12:15:57Z2023-11-15T12:15:57ZMounjaro has been authorised for weight loss in the UK – here’s how it compares to Wegovy<figure><img src="https://images.theconversation.com/files/559336/original/file-20231114-21-it77q9.jpg?ixlib=rb-1.1.0&rect=58%2C38%2C6497%2C4260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mounjaro has already been approved in the UK to manage type 2 diabetes.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/basra-iraq-september-14-2023-photo-2367391483">Mohammed_Al_Ali/ Shutterstock</a></span></figcaption></figure><p>The type 2 diabetes drug tirzepatide (better known by its brand name Mounjaro) has recently been authorised by the UK’s medicines regulation authority for use in <a href="https://www.gov.uk/government/news/mhra-authorises-diabetes-drug-mounjaro-tirzepatide-for-weight-management-and-weight-loss">weight loss and weight management</a>. The decision was made on the same day the US Food and Drug Administration (FDA) approved a version of tirzepatide called Zepbound for <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management">weight management</a>.</p>
<p>At the moment, Mounjaro has only been authorised for weight management in people who are obese, or those who are overweight and have weight-related health problems (such as high blood pressure or pre-diabetes). The drug is to be used in combination with lifestyle changes to aid in weight loss.</p>
<h2>How does tirzepatide work?</h2>
<p>The active ingredient in Mounjaro (which is prescribed for diabetes treatment) is tirzepatide. The tirzepatide formulation for obesity will be given another name. Tirzepatide works in a similar way as semaglutide, which is the active ingredient in Ozempic and Wegovy. </p>
<p>Both semaglutide and tirzepatide are drugs that are modelled on naturally occurring gut hormones called incretins. Incretins are produced by the gut in response to eating. They have a <a href="https://pubmed.ncbi.nlm.nih.gov/29364588/">range of effects</a>, including slowing emptying of food from the stomach and increasing insulin levels. </p>
<p>These effects are useful for controlling blood sugar levels in people with diabetes, which is why both drugs have already been licensed to manage type 2 diabetes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/mounjaro-type-2-diabetes-drug-more-effective-than-ozempic-to-launch-in-the-uk-heres-what-you-need-to-know-213195">Mounjaro: type 2 diabetes drug more effective than Ozempic to launch in the UK — here’s what you need to know</a>
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<p>But the reason incretin hormones have garnered so much interest for weight management is because they also produce a sense of fullness after a meal. They do this by signalling to a brain region called the hypothalamus. The hypothalamus then passes the signal on to other areas of the brain, leading to a person feeling full.</p>
<p>Drugs that mimic the action of incretins may cause weight loss because they make a person <a href="https://www.sciencedirect.com/science/article/pii/S1550413118301797">feel full</a> – making them want to eat less.</p>
<h2>How is Mounjaro different from Wegovy?</h2>
<p>There are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020673/">several types</a> of naturally occurring incretin hormones – including glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). </p>
<figure class="align-center ">
<img alt="A person holds a prescription vial of Saxenda." src="https://images.theconversation.com/files/559337/original/file-20231114-23-zykp4t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559337/original/file-20231114-23-zykp4t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559337/original/file-20231114-23-zykp4t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559337/original/file-20231114-23-zykp4t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559337/original/file-20231114-23-zykp4t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559337/original/file-20231114-23-zykp4t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559337/original/file-20231114-23-zykp4t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Saxenda was the first GLP-1 drug approved for obesity.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/basra-iraq-july-6-2023-photo-2328366277">Mohammed_Al_Ali/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Drugs that act on GLP-1 receptors have been very successful in treating diabetes since their launch in 2006. In 2020, Saxenda (liraglutide) was the first GLP-1 receptor drug approved to <a href="https://www.nice.org.uk/guidance/ta664">manage obesity</a>. The most recent addition to the family of medicines that act on GLP-1 receptors has been semaglutide, which has been licensed to both manage type 2 diabetes (Ozempic) and obesity (Wegovy). </p>
<p>What makes tirzepatide different is that it acts not just on the body’s GLP-1 receptors, but also on its GIP receptors. This makes tirzepatide a “dual incretin”. Both GLP-1 and GIP release insulin. It’s thought that the two work together, which is why tirzepatide may lead to a greater therapeutic effect. </p>
<h2>Is tirzepatide more effective than semaglutide?</h2>
<p>Based on data the data we have so far from clinical trials, it appears tirzepatide may lead to greater weight loss when compared to semaglutide.</p>
<p>Trials have shown that a once-weekly injection of 2.4 mg of semaglutide in people who are overweight or obese can lead to an <a href="https://www.nature.com/articles/s41591-022-02026-4#Sec2">average loss of 15% body weight</a> which persisted for the 104 weeks of medication use.</p>
<p>In comparison, <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2206038">clinical trials</a> of tirzepatide have shown that in people who are obese, a once-weekly injection of the lowest dose of tirzepatide (5mg) leads to a 15% loss of body weight after just 72 weeks. Even more impressively, a once-weekly injection of the highest dose of tirzepatide (20mg) is shown to lead to approximately 20% body weight loss. </p>
<p>Over one-third of participants using tirzepatide achieved weight loss of 25% or more. This is impressive – and greater than the amount of weight loss seen with semaglutide. This degree of weight loss is comparable to that achieved by <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001925#sec022">gastric band surgery</a>.</p>
<h2>Other considerations</h2>
<p>Patients who are prescribed Mounjaro will be given a one-weekly injection of 2.5mg for four weeks to begin with. After this, the patient’s doctor may then decide to <a href="https://www.gov.uk/government/news/mhra-authorises-diabetes-drug-mounjaro-tirzepatide-for-weight-management-and-weight-loss">increase their dosage</a> in 5mg increments every four weeks or so, up to a maximum 15mg dosage.</p>
<p>As with other incretin drugs, tirzepatide comes with <a href="https://www.gov.uk/government/news/mhra-authorises-diabetes-drug-mounjaro-tirzepatide-for-weight-management-and-weight-loss">potential side effects</a>. The most commonly reported ones are constipation, diarrhoea, nausea and vomiting. </p>
<p>Another important consideration with all incretin drugs is that the effects only last as long as the drug is being used. <a href="https://pace-cme.org/2023/10/16/discontinuation-of-dual-gip-and-glp-1-receptor-agonist-leads-to-weight-regain-in-people-with-obesity-or-overweight/">Any weight lost</a> while using the drug may be <a href="https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.14725">fully regained</a> within a year of stopping it. Maintaining a healthy lifestyle may help mitigate weight regain somewhat after stopping the drug. </p>
<p>Mounjaro is due to become available early in 2024. It’s authorisation for weight management will be welcome news for many who have struggled to lose weight in the past and those who have weight-related health problems. </p>
<p>What remains to be seen is whether there will be enough supply of tirzepatide to meet demand, which has been an <a href="https://www.diabetes.org.uk/about_us/news/our-response-serious-supply-issues-drugs-people-living-type-2-diabetes#:%7E:text=The%20company%20that%20makes%20semaglutide,clinicians%20on%20what%20to%20do.">issue with semaglutide</a> over the past year.</p><img src="https://counter.theconversation.com/content/217413/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Martin Whyte 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>People who are obese, as well as those who are overweight and have weight-related issues, may soon be able to ask their doctor for a prescription.Martin Whyte, Associate Professor of Metabolic Medicine, University of SurreyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2052032023-10-31T19:18:21Z2023-10-31T19:18:21ZCan I actually target areas to lose fat, like my belly?<figure><img src="https://images.theconversation.com/files/555196/original/file-20231023-17-dj2vz1.jpg?ixlib=rb-1.1.0&rect=16%2C74%2C5481%2C3585&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/full-male-runs-on-treadmill-gym-1456626641">Shutterstock</a></span></figcaption></figure><p>Spend some time scrolling social media and you’re all-but-guaranteed to see an ad promising to help you with targeted fat loss. These ads promote a concept known as “spot reduction”, claiming you can burn fat in a specific body area, usually the belly, with specially designed exercises or workouts. </p>
<p>It’s also common to see ads touting special diets, pills and supplements that will blast fat in targeted areas. These ads – which often feature impressive before and after photos taken weeks apart – can seem believable. </p>
<p>Unfortunately, spot reduction is another weight-loss myth. It’s simply not possible to target the location of fat loss. Here’s why. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">Using BMI to measure your health is nonsense. Here's why</a>
</strong>
</em>
</p>
<hr>
<h2>1. Our bodies are hardwired to access and burn all our fat stores for energy</h2>
<p>To understand why spot reduction is a myth, it’s important to understand how body fat is stored and used.</p>
<p>The fat stored in our bodies takes the form of triglycerides, which are a type of lipid or fat molecule we can use for energy. Around 95% of the dietary fats <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/triglycerides">we consume are triglycerides</a>, and when we eat, our bodies also convert any unused energy consumed into triglycerides.</p>
<p>Triglycerides are stored in special fat cells called adipocytes, and they’re released into our bloodstream and transported to adipose tissue – tissue we more commonly refer to as body fat.</p>
<p>This body fat is found all over our bodies, but it’s primarily stored as subcutaneous fat under our skin and as visceral fat around our internal organs.</p>
<p>These fat stores serve as a vital energy reserve, with our bodies mobilising to access stored triglycerides to provide energy during periods of prolonged exercise. We also draw on these reserves when we’re dieting and fasting.</p>
<figure class="align-center ">
<img alt="Person does button up on tight jeans" src="https://images.theconversation.com/files/555199/original/file-20231023-21-rf34fu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555199/original/file-20231023-21-rf34fu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555199/original/file-20231023-21-rf34fu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555199/original/file-20231023-21-rf34fu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555199/original/file-20231023-21-rf34fu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555199/original/file-20231023-21-rf34fu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555199/original/file-20231023-21-rf34fu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The fat stores we use for energy come from everywhere on our bodies, not just the belly.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-trying-put-on-tight-light-1521248603">Shutterstock</a></span>
</figcaption>
</figure>
<p>However, contrary to what many spot-reduction ads would have us think, our muscles can’t directly access and burn specific fat stores when we exercise. </p>
<p>Instead, they use a process called lipolysis to convert triglycerides into free fatty acids and a compound called glycerol, which then travels to our muscles via our bloodstream.</p>
<p>As a result, the fat stores we’re using for energy when we exercise come from everywhere in our bodies – not just the areas we’re targeting for fat loss. </p>
<p>Research reinforces how our bodies burn fat when we exercise, confirming spot reduction is a weight-loss myth. This includes a randomised <a href="https://pubmed.ncbi.nlm.nih.gov/25766455/">12-week clinical trial</a> which found no greater improvement in reducing belly fat between people who undertook an abdominal resistance program in addition to changes in diet compared to those in the diet-only group. </p>
<p>Further, <a href="https://www.termedia.pl/A-proposed-model-to-test-the-hypothesis-of-exerciseinduced-localized-fat-reduction-spot-reduction-including-a-systematic-review-with-meta-analysis,129,45538,0,1.html">a 2021 meta-analysis</a> of 13 studies involving more than 1,100 participants found that localised muscle training had no effect on localised fat deposits. That is, exercising a specific part of the body did not reduce fat in that part of the body.</p>
<p><a href="https://www.mdpi.com/1660-4601/18/7/3845">Studies</a> purporting to show spot-reduction benefits have small numbers of participants with results that aren’t clinically meaningful. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-exercise-help-you-lose-weight-198292">Does exercise help you lose weight?</a>
</strong>
</em>
</p>
<hr>
<h2>2. Our bodies decide where we store fat and where we lose it from first</h2>
<p>Factors outside of our control influence the areas and order in which our bodies store and lose fat, namely:</p>
<ul>
<li><p>our genes. Just as DNA prescribes whether we’re short or tall, genetics plays a significant role in how our fat stores are managed. Research shows our genes can account for <a href="https://pubmed.ncbi.nlm.nih.gov/24632736/">60% of where fat is distributed</a>. So, if your mum tends to store and lose weight from her face first, there’s a good chance you will, too</p></li>
<li><p>our gender. Our bodies, by nature, have distinct fat storage characteristics <a href="https://pubmed.ncbi.nlm.nih.gov/11706283/">driven by our gender</a>, including females having more fat mass than males. This is primarily because the female body is designed to hold fat reserves to support pregnancy and nursing, with women tending to lose weight from their face, calves and arms first because they impact childbearing the least, while holding onto fat stored around the hips, thighs and buttocks</p></li>
<li><p>our age. The ageing process triggers changes in muscle mass, metabolism, and hormone levels, which can impact where and how quickly fat is lost. Post-menopausal <a href="https://theconversation.com/is-menopause-making-me-put-on-weight-no-but-its-complicated-198308">women</a> and middle-aged <a href="https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/sex-differences-in-fat-storage-fat-metabolism-and-the-health-risks-from-obesity-possible-evolutionary-origins/00950AD6710FB3D0414B13EAA67D4327">men</a> tend to store visceral fat around the midsection and find it a stubborn place to shift fat from. </p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-menopause-making-me-put-on-weight-no-but-its-complicated-198308">Is menopause making me put on weight? No, but it's complicated</a>
</strong>
</em>
</p>
<hr>
<h2>3. Over-the-counter pills and supplements cannot effectively target fat loss</h2>
<p>Most advertising for these pills and dietary supplements – including products claiming to be “the best way to lose belly fat” – will also proudly claim their product’s results are backed by “clinical trials” and “scientific evidence”.</p>
<p>But the reality is a host of independent studies don’t support these claims. </p>
<p>This includes two recent studies by the University of Sydney that examined data from more than 120 placebo-controlled trials of <a href="https://pubmed.ncbi.nlm.nih.gov/31984610/">herbal</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/33976376/">dietary</a> supplements. None of the supplements examined provided a clinically meaningful reduction in body weight among overweight or obese people.</p>
<figure class="align-center ">
<img alt="Woman takes diet pill" src="https://images.theconversation.com/files/555202/original/file-20231023-29-7dt3ul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555202/original/file-20231023-29-7dt3ul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555202/original/file-20231023-29-7dt3ul.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555202/original/file-20231023-29-7dt3ul.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555202/original/file-20231023-29-7dt3ul.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555202/original/file-20231023-29-7dt3ul.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555202/original/file-20231023-29-7dt3ul.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">Supplements won’t help you target ares weight-loss either.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-woman-taking-tablet-glass-water-1498026977">Shutterstock</a></span>
</figcaption>
</figure>
<h2>The bottom line</h2>
<p>Spot reduction is a myth – we can’t control where our bodies lose fat. But we can achieve the results we’re seeking in specific areas by targeting overall fat loss. </p>
<p>While you may not lose the weight in a specific spot when exercising, all physical activity helps to burn body fat and preserve muscle mass. This will lead to a change in your body shape over time and it will also help you with long-term weight management. </p>
<p>This is because your metabolic rate – how much energy you burn at rest – is determined by how much muscle and fat you carry. As muscle is more metabolically active than fat (meaning it burns more energy than fat), a person with a higher muscle mass will have a faster metabolic rate than someone of the same body weight with a higher fat mass. </p>
<p>Successfully losing fat long term comes down to losing weight in small, manageable chunks you can sustain – periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight.</p>
<p>It also requires gradual changes to your lifestyle (diet, exercise and sleep) to ensure you form habits that last a lifetime.</p>
<hr>
<p>
<em>
<strong>
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>
</strong>
</em>
</p>
<hr>
<p><em>At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.</em></p><img src="https://counter.theconversation.com/content/205203/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nick Fuller works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program.</span></em></p>Ads for targeted fat loss, especially
for belly fat, are everywhere on social media. But is there any evidence to support this type of ‘spot reduction’?Nick Fuller, Charles Perkins Centre Research Program Leader, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2077232023-10-10T21:43:33Z2023-10-10T21:43:33ZWhat is the OMAD diet? Is one meal a day actually good for weight loss? And is it safe?<figure><img src="https://images.theconversation.com/files/551627/original/file-20231003-26-odr3p8.jpg?ixlib=rb-1.1.0&rect=152%2C26%2C5838%2C3449&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-bare-feet-weight-scale-bathroom-785794792">Shutterstock</a></span></figcaption></figure><p>What do British Prime Minister <a href="https://www.sciencefocus.com/the-human-body/one-meal-a-day-diet-omad">Rishi Sunak</a> and singer <a href="https://theconversation.com/one-meal-a-day-diet-popular-with-celebrities-could-do-more-harm-than-good-heres-why-203086">Bruce Springsteen</a> have in common?</p>
<p>They’re among an ever-growing group of public figures touting the benefits of eating just one meal a day.</p>
<p>As a result, the one meal a day (OMAD) diet is the latest attention-grabbing weight loss trend. Advocates claim it leads to fast, long-term weight loss success and better health, including delaying the ageing process. </p>
<p>Like most weight-loss programs, the OMAD diet makes big and bold promises. Here’s what you need to know about eating one meal a day and what it means for weight loss.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">What's the 'weight set point', and why does it make it so hard to keep weight off?</a>
</strong>
</em>
</p>
<hr>
<h2>The OMAD diet explained</h2>
<p>Essentially, the OMAD diet is a type of intermittent fasting, where you fast for 23 hours and consume all your daily calories in one meal eaten within one hour.</p>
<p>The OMAD diet rules are presented as simple and easy to follow:</p>
<ol>
<li><p>You can eat whatever you want, provided it fits on a standard dinner plate, with no calorie restrictions or nutritional guidelines to follow. </p></li>
<li><p>You can drink calorie-free drinks throughout the day (water, black tea and coffee). </p></li>
<li><p>You must follow a consistent meal schedule, eating your one meal around the same time each day.</p></li>
</ol>
<figure class="align-center ">
<img alt="Plate of chicken and veggies, next to a cup of dried fruit" src="https://images.theconversation.com/files/551622/original/file-20231003-25-n2lo07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551622/original/file-20231003-25-n2lo07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551622/original/file-20231003-25-n2lo07.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551622/original/file-20231003-25-n2lo07.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551622/original/file-20231003-25-n2lo07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551622/original/file-20231003-25-n2lo07.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551622/original/file-20231003-25-n2lo07.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The one meal a day diet significantly restricts your calorie intake.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/ZjEeMnDiq00">Ella Olsson/Unsplash</a></span>
</figcaption>
</figure>
<p>Along with creating a calorie deficit, resulting in weight loss, advocates believe the OMAD diet’s extended fasting period <a href="https://www.frontiersin.org/articles/10.3389/fphys.2021.771944/full">leads to physiological changes</a> in the body that promote better health, including boosting your metabolism by triggering a process called ketosis, where your body burns stored fat for energy instead of glucose. </p>
<h2>What does the evidence say?</h2>
<p>Unfortunately, research into the OMAD diet is limited. Most studies have examined its impact on <a href="https://www.cell.com/cell-metabolism/pdf/S1550-4131(18)30512-6.pdf">animals</a>, and the <a href="https://pubmed.ncbi.nlm.nih.gov/35087416/">primary study</a> with humans involved 11 lean, young people following the OMAD diet for a mere 11 days.</p>
<p>Claims about the OMAD diet typically rely on research into intermittent fasting, rather than on the OMAD diet itself. There is <a href="https://www.cfp.ca/content/66/2/117.short">evidence</a> backing the efficacy of intermittent fasting to achieve weight loss. However, <a href="https://www.nature.com/articles/s41574-022-00638-x">most studies</a> have focused on short-term results only, typically considering the results achieved across 12 weeks or less.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-it-matter-what-time-of-day-i-eat-and-can-intermittent-fasting-improve-my-health-heres-what-the-science-says-203762">Does it matter what time of day I eat? And can intermittent fasting improve my health? Here's what the science says</a>
</strong>
</em>
</p>
<hr>
<p>One <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2114833">longer-term study from 2022</a> randomly assigned 139 patients with obesity to either a calorie-restricted diet with time-restricted eating between 8am and 4pm daily, or to a diet with daily calorie restriction alone for 12 months.</p>
<p>After 12 months, both groups had lost around the same weight and experienced similar changes in body fat, blood sugar, cholesterol and blood pressure. This indicates long-term weight loss achieved with intermittent fasting is not superior and on a par with that achieved by traditional dieting approaches (daily calorie restriction).</p>
<h2>So what are the problems with the OMAD diet?</h2>
<p><strong>1. It can cause nutritional deficiencies and health issues.</strong></p>
<p>The OMAD diet’s lack of nutritional guidance on what to eat for that one meal a day raises many red flags. </p>
<p>The meals we eat every day should include a source of protein balanced with wholegrain carbs, vegetables, fruits, protein and good fats to support <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071223/">optimum health, disease prevention and weight management</a>.</p>
<figure class="align-center ">
<img alt="Woman shops for groceries" src="https://images.theconversation.com/files/551625/original/file-20231003-15-4yrdir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551625/original/file-20231003-15-4yrdir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551625/original/file-20231003-15-4yrdir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551625/original/file-20231003-15-4yrdir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551625/original/file-20231003-15-4yrdir.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551625/original/file-20231003-15-4yrdir.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551625/original/file-20231003-15-4yrdir.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">We’re likely to miss out on key nutrients if we eat one meal a day.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-in-green-shirt-looking-at-her-grocery-list-8422685/">Kampus Production/Pexels</a></span>
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<p>Not eating a balanced diet will result in nutritional deficiencies that can result in poor immune function, fatigue and a decrease in bone density, leading to osteoporosis. </p>
<p>Fasting for 23 hours a day is also likely to lead to extreme feelings of hunger and uncontrollable cravings, which may mean you consistently eat foods that are not good for you when it’s time to eat. </p>
<p><strong>2. It’s unlikely to be sustainable.</strong></p>
<p>You might be able to stick with the OMAD diet initially, but it will wear thin over time. </p>
<p>Extreme diets – especially ones prescribing extended periods of fasting – aren’t enjoyable, leading to feelings of deprivation and social isolation during meal times. It’s hard enough to refuse a piece of office birthday cake at the best of times, imagine how this would feel when you haven’t eaten for 23 hours!</p>
<p>Restrictive eating can also lead to an unhealthy relationship with food, making it even harder to achieve and maintain a healthy weight. </p>
<p><strong>3. Quick fixes don’t work.</strong></p>
<p>Like other popular intermittent fasting methods, the OMAD diet appeals because it’s easy to digest, and the results appear fast. </p>
<p>But the OMAD diet is just another fancy way of cutting calories to achieve a quick drop on the scales. </p>
<p>As your weight falls, things will quickly go downhill when your <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766925/">body activates its defence mechanisms</a> to defend your weight loss. In fact, it will regain weight – a response that stems from our hunter-gatherer ancestors’ need to survive periods of deprivation when food was scarce.</p>
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<em>
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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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<h2>The bottom line</h2>
<p>Despite the hype, the OMAD diet is unsustainable, and it doesn’t result in better weight-loss outcomes than its predecessors. Our old habits creep back in and we find ourselves fighting a cascade of physiological changes to ensure we regain the weight we lost.</p>
<p>Successfully losing weight long-term comes down to:</p>
<ul>
<li><p>losing weight in small manageable chunks you can sustain, specifically periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight</p></li>
<li><p>making gradual changes to your lifestyle to ensure you form habits that last a lifetime.</p></li>
</ul>
<p><em>At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.</em></p><img src="https://counter.theconversation.com/content/207723/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Nick Fuller works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program.</span></em></p>Like most weight-loss programs, the OMAD diet makes bold promises – and comes with risks.Nick Fuller, Charles Perkins Centre Research Program Leader, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2122522023-09-28T12:27:49Z2023-09-28T12:27:49ZTracking daily step counts can be a useful tool for weight management – an exercise scientist parses the science<figure><img src="https://images.theconversation.com/files/548376/original/file-20230914-15-88rlo1.jpg?ixlib=rb-1.1.0&rect=12%2C12%2C8621%2C5730&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Step counts have an inconsistent relationship with weight loss.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/overweight-mature-woman-does-sports-to-take-care-of-royalty-free-image/1471869441?phrase=step+counts+body+fat&adppopup=true">Jose carlos cerdeno martinez/Moment via Getty Images</a></span></figcaption></figure><p>Over the last decade, smartphones have become ubiquitous not just for sending texts and staying abreast of news, but also for monitoring daily activity levels. </p>
<p>Among the most common, and arguably the most meaningful, tracking method for daily physical activity is step counting. </p>
<p>Counting steps is far more than a fad: The U.S. Department of Health and Human Services dedicated a sizable portion of its <a href="https://health.gov/our-work/nutrition-physical-activity/physical-activity-guidelines/current-guidelines/scientific-report">most recent physical activity guidelines</a> to documenting the relationship between daily step counts and several chronic diseases. </p>
<p>Unfortunately, the guidelines have little to say about how step counts might be used to aid in weight management, an outcome of critical importance given the <a href="https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity">high rates of overweight and obesity</a> in the U.S. </p>
<p>In the early 1980s, fewer than 14% of adults in the U.S. were <a href="https://www.ncbi.nlm.nih.gov/books/NBK44656/">classified as having obesity</a>. Today, just over 40 years later, the prevalence of obesity is greater than <a href="https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity">40% in the adult population</a>, and current trends suggest that <a href="https://doi.org/10.1056/NEJMsa1909301">almost half of adults in the U.S. will be obese by 2030</a>. </p>
<p>I am a <a href="https://scholar.google.com/citations?user=CLsN-g0AAAAJ&hl=en">professor of exercise science</a> at Kennesaw State University, and our lab has been conducting <a href="https://doi.org/10.23736/s0022-4707.21.12038-9">studies examining relationships among step counts</a> and a number of health outcomes. </p>
<p>While the <a href="https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity">evidence is clear</a> that increasing numbers of adults are living in a chronic energy surplus that leads to weight gain, a key question is – why? What has changed so dramatically since 1980 that could explain why obesity rates have tripled? </p>
<p>Although the American diet is likely a key contributor, a wealth of research points to a reduction in physical activity as a major culprit behind the expanding waist lines – and step counts are an excellent indicator of physical activity. </p>
<p><iframe id="91ZN6" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/91ZN6/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Step counts may – or may not – lead to weight loss</h2>
<p>A number of recent studies have looked at whether increasing step counts can lead to weight loss over a certain period of time. One large-scale study called a meta-analysis concluded that increasing physical activity by way of step counts was effective for <a href="https://doi.org/10.1370%2Fafm.761">attaining modest weight loss</a>. However, many if not most studies examining the effect of <a href="https://journals.lww.com/acsm-msse/fulltext/1999/11001/physical_activity_in_the_treatment_of_the.10.aspx">exercise on weight loss report modest outcomes</a>, with results that are variable and often disappointing. </p>
<p>That may be in part because the step count targets used in many weight management studies are most often set in an arbitrary manner, such as targeting 10,000 steps per day. Or, if they’re individualized at all, they’re based on initial behavioral characteristics, like adding a given number of steps to what a person is already accumulating in a typical day. Rarely, if ever, are the step targets in research studies based on any physical attributes of the participants. </p>
<p>My team’s research has compiled weight, body fat percentages and average step counts for large numbers of adults between 19 and 40 years of age. From that data, we have identified a way to determine specific step count goals based on key physical attributes – namely, baseline body weight and composition, and the desired body composition. </p>
<p>When it comes to health, it is important to remember that body weight does not tell the whole story. In fact, body composition is much more predictive of health status than body weight. Someone who weighs more than another person may be in better health if they have more muscle mass and a lower percentage of body fat than the other person who weighs less but has a higher proportion of body fat.</p>
<h2>Parsing the numbers</h2>
<p>We have used our data to develop a model that predicts average daily step counts per unit of fat mass from body fat percentage. We believe that this model can be used to determine how much people would need to walk to achieve a specific amount of weight and body fat reduction. </p>
<p>Take, for instance, a man who weighs 175 pounds (80 kilograms), of which 25% is fat. Our model suggests that he walks an average of 10,900 steps a day. Then consider another man who weighs 220 pounds (100 kilograms), of which 20% is fat. Although they have different amounts of lean mass, both men have about 44 pounds (20 kilograms) of fat. So our model predicts that the heavier man walks an average of 15,300 steps a day. In other words, the heavier person has a lower percentage of body fat and walks more to maintain that leaner body composition. </p>
<p>A person’s body fat percentage is every bit as important as their weight. That’s because how much muscle you have affects <a href="https://doi.org/10.1111/obr.12257">how hungry you get</a>, as well as how many calories you burn. Muscle mass requires energy to maintain, and this requirement leads to increased appetite, which means taking in more calories. In this example, the heavier man probably eats more than the lighter man in order to maintain his lean muscle mass, and he must walk more to maintain his lower body fat percentage.</p>
<p>If you want to lose body fat, and therefore weight, you basically have two choices: You can eat less, or you can move more. Eating less means you’ll be hungry a lot, and that’s uncomfortable, unpleasant and, for most people, not sustainable. Moving more, on the other hand, can allow you to eat until you’re full and keep body fat off – or even lose it. </p>
<p>Therefore, we wanted to know how much a person who eats until they’re full might have to move to offset the calories they’re eating.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/LtELVwC7mGw?wmode=transparent&start=41" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">It’s easy to add in extra steps – for example, park a little farther from the grocery store or take an extra trip to the mailbox.</span></figcaption>
</figure>
<h2>Step counts for weight loss</h2>
<p>Currently, our model applies to young adults, but we are now collecting data for middle-aged and older adults too. To use this model, you need to first have your body composition determined, a service that is being offered by increasing numbers of fitness centers and medical practices. With our model, you must determine your body weight and fat weight in kilograms – to do this, simply divide your weight in pounds by 2.2. </p>
<p>With this information in hand, our model can provide a step count target that is specific to a person’s current body weight and body fat percentage, and their goal for fat loss and weight reduction. </p>
<p>For example, our model predicts that a woman weighing 155 pounds (70 kilograms) with 30% body fat currently accumulates an average of about 8,700 steps per day. If she wants to lose about 10 pounds and reach a body fat percentage around 25%, she could consult the model and discover that people who maintain that body composition accumulate an average of about 545 steps per kilogram of fat per day. Since she currently has about 46 pounds (21 kilograms) of fat, her goal would be to accumulate a total of 11,450 steps per day. </p>
<p>While that may seem at first glance to be a sizable increase in daily steps, most people can accumulate 1,000 steps in 10 minutes or less. So even with a comfortable pace, this additional daily dose of walking would take fewer than 30 minutes. Furthermore, steps can be accumulated throughout the day, with longer or more frequent trips, or both, to restrooms, vending machines and the like. </p>
<p>While steps certainly can be accumulated in dedicated walking sessions, such as a 15-minute walk during lunch hour and another 15-minute walk in the evening, they can also be accumulated in shorter, more frequent bouts of activity. </p>
<p>Researchers have learned a great deal in the past 70 years about appetite and energy expenditure: Appetite imposes a drive for food based largely on our fat-free mass, no matter how active or inactive we are, and we must accumulate enough physical activity to counter the calories that we take in through our diet if we want to maintain an energy balance – or exceed our intake to lose weight.</p>
<p><em>Editor’s note: An incorrect equation representing the relationship between step counts relative to body composition has been removed from the chart of this article.</em></p><img src="https://counter.theconversation.com/content/212252/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Current patent pending for step count model (application #17/733275).</span></em></p>Reduction in physical activity over the last few decades is one of the main culprits in rising obesity rates.Bob Buresh, Professor of Exercise Science, and Director of the Exercise Physiology Lab, Kennesaw State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2134462023-09-20T21:28:41Z2023-09-20T21:28:41ZObesity is a dangerous disease that shares key features with cancer<figure><img src="https://images.theconversation.com/files/549385/original/file-20230920-19-5q8kcd.jpg?ixlib=rb-1.1.0&rect=3851%2C14%2C5663%2C4180&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Obesity is itself a disease, in addition to contributing to the onset and progression of other conditions such as diabetes, heart attack and stroke.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/obesity-is-a-dangerous-disease-that-shares-key-features-with-cancer" width="100%" height="400"></iframe>
<p>Although obesity has been <a href="https://doi.org/10.1038/ijo.2008.247">recognized as a disease by the World Health Organization (WHO)</a> since 1948, its identity as a disease may not be widely perceived the same way as other health conditions. </p>
<p>People living with obesity are less <a href="https://doi.org/10.1007/s13679-021-00444-y">likely to receive dedicated care for that condition</a>, in contrast to patients with other diseases, such as cancer. However, obesity and cancer have several similarities. This is of <a href="https://www.worldobesityday.org/">global crucial importance</a>, given the dramatic increase in numbers of affected adults and children, <a href="https://data.worldobesity.org/country/canada-36/">including in Canada</a>.</p>
<h2>Obesity is a disease</h2>
<p>Like cancer, or other medically recognized diseases, obesity should be seriously considered as such by public opinion. Not only is obesity itself a disease, but it can also contribute to the onset and progression of <a href="https://doi.org/10.1177/2042018820934955">cancer and other diseases</a>, such as <a href="https://doi.org/10.1155/2018/3407306">diabetes, atherosclerosis, heart attack and stroke</a>.</p>
<p>The disease of obesity affects people in several ways:</p>
<p><strong>Mechanically:</strong> Obesity imposes an excessive <a href="https://www.health.harvard.edu/pain/why-weight-matters-when-it-comes-to-joint-pain">pressure on the bones and the joints</a>, as well as internal organs. It can also <a href="https://www.sleepfoundation.org/sleep-apnea/weight-loss-and-sleep-apnea">potentially cause airway obstruction</a> that can lead to obstructive sleep apnea.</p>
<p><strong>Biologically:</strong> <a href="https://doi.org/10.3389/fimmu.2022.907750">Obesity can lead to osteoarthritis</a>, for example, and it presents with <a href="https://doi.org/10.1172/JCI92035">inflammation</a> and <a href="https://doi.org/10.3390/ijms21103570">dysregulated secretions</a> by dysfunctional fat tissue cells. </p>
<p>Obesity can also result in <a href="https://doi.org/10.1172/JCI81507%22%22">abnormal fat deposits on vital organs</a>, which seriously alters the whole organism’s <a href="https://www.britannica.com/science/homeostasis">homeostasis</a>, or biological stability.</p>
<p><strong>Psychologically:</strong> <a href="https://doi.org/10.1111/scs.12756">Patients with obesity may face difficulties in accomplishing daily activities</a>; even simple things such as tying their shoelaces may be a challenge. This is further worsened by <a href="https://doi.org/10.1016/j.eclinm.2022.101464">social media’s deep influence</a> and promotion of a presumed “ideal” unrealistic body shape image, which stigmatizes patients with obesity. </p>
<p>There is also evidence that obesity is accompanied by <a href="https://doi.org/10.1007/s12272-019-01138-9">brain inflammation</a> and increased risk of mental health conditions such as major <a href="https://doi.org/10.1038/s41380-018-0017-5">depressive disorder</a> and <a href="https://doi.org/10.1007/s40211-019-0302-9">anxiety</a>.</p>
<h2>Common characteristics of obesity and cancer</h2>
<figure class="align-center ">
<img alt="Illustration with two human figures representing cancer and obesity flanking a list of common factors: Metastatic, Recurrent, Progressive and Multifactorial" src="https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=503&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=503&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=503&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=633&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=633&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548475/original/file-20230915-23-edvy8n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=633&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<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">
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<span class="caption">Many people with obesity struggle to control weight regain following weight loss, a phenomenon often called ‘yo-yo’ effect. However, recurrence is a better term that should replace yo-yo, since it more seriously emphasizes that obesity is far from a game.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p><strong>Recurrence:</strong> Those who recover from obesity can experience recurrence of the disease. A good example is seen in <em>The Biggest Loser</em> TV series. <a href="https://www.health.harvard.edu/diet-and-weight-loss/lessons-from-the-biggest-loser">Contestants who lost weight</a> on the show <a href="https://doi.org/10.1002/oby.21538">later regained it</a>.</p>
<p>Obesity recurrence is often referred to as “yo-yo” effect. However, “recurrence” is a better term that should replace yo-yo, since it more seriously emphasizes that obesity is far from a game. In fact, certain patients struggle deeply to curb uncontrollable weight regain.</p>
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Read more:
<a href="https://theconversation.com/the-obesity-epidemic-is-fuelled-by-biology-not-lack-of-willpower-209121">The obesity epidemic is fuelled by biology, not lack of willpower</a>
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<p>As illustrated by the tale of the Emperor’s New Clothes, people’s perceptions can be erroneous. Often, perceptions of obesity do not reflect its serious threats to health. Obesity is scientifically proven to be a disease, and internationally recognized as one. The mirroring of its features with cancer reveals its inherent morbid potential.</p>
<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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<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/2135132023-09-15T13:57:29Z2023-09-15T13:57:29ZWhy taxing ‘junk food’ to tackle obesity isn’t as simple as it seems<p>Former prime minister Tony Blair has <a href="https://www.thetimes.co.uk/article/blair-calls-for-tax-on-junk-food-times-health-commission-2gd7hhh69">called for</a> more taxes on junk food to tackle the UK’s obesity crisis. This includes extending sugar taxes beyond just soft drinks, as well as taxing food that is high in salt and fat. Blair also called for restrictions on advertising unhealthy food.</p>
<p>The former PM believes this is the only way to save the NHS. “We’ve got to shift from a service that’s treating people when they’re ill to a service that is focused on wellbeing, on prevention, on how people live more healthy lives,” he told The Times Health Commission.</p>
<p>But is it as simple as that? A levy on sugary drinks was introduced in the UK in 2018 which led to drinks makers reformulating their products so they contained less sugar. A year later, the British public was <a href="https://www.medrxiv.org/content/10.1101/2023.06.26.23291902v1">consuming less sugar</a>. However, sugar consumption had been falling in Britain before the levy was introduced. Once this was factored into the analysis, there was no significant fall in sugar consumption. </p>
<p>Denmark experimented with a fat tax and it had similar underwhelming results. It was hailed as a world-leading public health policy when it was introduced in October 2011 but was abandoned 15 months later. </p>
<p>According to one survey, <a href="https://www.iea.org.uk/sites/default/files/publications/files/The%20Proof%20of%20the%20Pudding.pdf">only 7% of Danes</a> reduced the amount of butter, cream and cheese they bought. A different survey found that 80% did not change their food shopping habits at all.</p>
<p>However, whether or not levies on unhealthy food work is difficult to determine. Advocates for these programmes tend to highlight positive effects based on data modelling rather than actual changes in people’s weight and health. Detractors, on the other hand, quickly challenge such policies as being the enactment of the “nanny state”.</p>
<h2>Where and what to tax?</h2>
<p>Although the UK’s sugar tax led to drinks being reformulated to have less sugar, it also had some unintended consequences. For example, sugary drinks called slushies needed to have glycerol (E422) added to them to maintain their slush (artificial sweeteners failed to produce the required “slush”). </p>
<p>While this is safe for most older children and adults, the <a href="https://www.food.gov.uk/news-alerts/news/not-suitable-for-under-4s-new-industry-guidance-issued-on-glycerol-in-slush-ice-drinks">Food Standards Agency</a> identified a possible risk of <a href="https://www.foodstandards.gov.scot/news-and-alerts/glycerol-in-slush-ice-drinks">glycerol intoxication</a> in smaller children and suggested sales should be restricted to children five years old and older. </p>
<p>Another unintended consequence is making the poor poorer by raising the price of food. If taxes or levies are extended beyond drinks and sugar to include all food high in fat, salt and sugar, the cost of this reformulation is likely to be passed on to the consumer.</p>
<p>With the current cost of living crisis, this is simply not acceptable to politicians or many of the public. If such levies are introduced, they need to be a smarter version of the soft drinks industry levy. It should drive food producers to change the food they produce, making less healthy ingredients cost more while making it more profitable to grow and supply healthier food.</p>
<h2>What is ‘junk’ food?</h2>
<p>The next challenge is to identify which food to tax. </p>
<p>Blair suggested “junk food”, which he defined as high in fat, salt and sugar - often called <a href="https://www.gov.uk/government/publications/restricting-promotions-of-products-high-in-fat-sugar-or-salt-by-location-and-by-volume-price/restricting-promotions-of-products-high-in-fat-sugar-or-salt-by-location-and-by-volume-price-implementation-guidance">HFSS foods</a>. It is these foods that can no longer be advertised on <a href="https://evidence.nihr.ac.uk/alert/advertising-ban-was-linked-to-lower-purchases-of-unhealthy-food-and-drink/#:%7E:text=In%20February%202019%2C%20the%20transport,bus%20stops%2C%20and%20railway%20stations.">Transport for London</a> sites. </p>
<p>This has been hailed as a success. These restrictions on advertising are estimated to have <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003915">significantly decreased</a> the average amount of HFSS foods households buy each week. </p>
<p>This <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-022-01331-y">data</a> was then used to claim that this change reduced the number of people with obesity by <a href="https://www.lshtm.ac.uk/newsevents/news/2022/junk-food-advertising-restrictions-prevent-almost-100000-obesity-cases-and#:%7E:text=Restrictions%20for%20junk%20food%20advertising,Behavioural%20Nutrition%20and%20Physical%20Activity.">100,000</a>. This claim has been <a href="https://onlinelibrary.wiley.com/doi/10.1111/jhn.13155">heavily criticised</a>. It is an estimate, and the change in the number of people who are overweight or obese linked to the advertising ban is unknown. </p>
<p>So, although there may be some merit in tackling advertising, it perhaps needs to be smarter and respond to modern and emerging trends in advertising strategies. The focus on out-of-home advertising, which is the Transport for London approach, does not look at how social media and online advertising linked to cookies and trackers can build a message for potential consumers. Challenging how advertisers link campaigns across media is probably more effective. </p>
<p>An alternative is to focus where advertising is permitted. For example, regulating billboards near schools so that they only show healthy messages may be a more effective solution.</p>
<p>This is before considering the potentially stigmatising language in calling food “junk” food, especially given the message is focused on helping poorer people. Perhaps this is why there has been a move to use terms such as “ultra-processed food”. </p>
<p>Both, however, are slightly subjective. The HFSS definition could include cheese and Greek yoghurt and therefore might suggest that these foods receive an advertising ban. Whereas a fast-food meal with water and carrot sticks – although these may be the least popular meal option – can still be advertised. </p>
<p>When promoting healthier dietary choices, we need to make options like vegetables attractive. This can be difficult for people on low incomes, who might avoid trying new food that might be rejected and wasted. Instead, go for family favourites which might be less healthy but will make sure everyone is full within their budget. </p>
<p>So what are the answers? Perhaps not top-down approaches, such as those proposed by Blair. An example of how our food system can be changed has been set out in the <a href="https://www.birmingham.gov.uk/downloads/download/5219/birmingham_food_system_strategy">Birmingham Food System Strategy</a>. This sets out how small local food businesses make healthier food widely available across the city, as well as provide employment in the city. This sets out a community-led approach that encourages a city-wide food supply that is healthy for people and the planet. </p>
<p>To solve a complex problem you need subtle and connected changes in many areas that are designed with and are acceptable to those with the most to gain, but who are struggling on low incomes.</p><img src="https://counter.theconversation.com/content/213513/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Duane Mellor has provided technical nutrition advice to the slush drinks industry and out of home advertising industry. They are also a member of the British Dietetic Association.</span></em></p>Tony Blair has called on ministers to tighten food regulation, including adding levies to foods high in fat, salt and sugar.Duane Mellor, Lead for Evidence-Based Medicine and Nutrition, Aston Medical School, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2048112023-09-12T20:09:46Z2023-09-12T20:09:46ZWhat can you do to speed up your metabolism?<figure><img src="https://images.theconversation.com/files/546284/original/file-20230905-23-oi6es0.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C6720%2C4446&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Our metabolism is the force inside our bodies that mysteriously decides whether to convert the food we eat into a burst of energy, or extra kilos on the scales. </p>
<p>A “slow” or “sluggish” metabolism is often the first thing we blame when we struggle to lose weight. </p>
<p>As a result, a <a href="https://www.grandviewresearch.com/industry-analysis/weight-loss-supplements-market-report">US$33 billion</a> industry offers thousands of products promising to speed up our metabolic rate for weight-loss success. </p>
<p>But rather than reaching for a supplement, there are things you can do to speed your metabolism up. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ever-wonder-how-your-body-turns-food-into-fuel-we-tracked-atoms-to-find-out-211047">Ever wonder how your body turns food into fuel? We tracked atoms to find out</a>
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<h2>What is metabolism and how does it work?</h2>
<p>Metabolism is the term describing all the chemical reactions in our bodies that keep us alive. It provides the energy needed for essential functions like breathing and digestion.</p>
<p>When we refer to metabolism in the context of our weight, we’re actually describing our basal metabolic rate – the number of calories the body burns at rest, determined by how much muscle and fat we have.</p>
<p>Many factors can affect your metabolism, including gender, age, weight and lifestyle. It naturally slows down <a href="https://www.hindawi.com/journals/jobe/2019/8031705/">as we age</a> and becomes dysfunctional <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/">after dieting</a>. </p>
<h2>Why does our metabolism slow with age?</h2>
<p>As our bodies age, they stop working as efficiently as before. Around the age of 40, our muscle mass starts <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431367/">naturally declining</a>, and the ratio of body fat to muscle increases.</p>
<p>Because muscle mass helps determine the body’s metabolic rate, this decrease in muscle means our bodies start to burn fewer calories at rest, decreasing our metabolic rate.</p>
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<img alt="Fit man looks at smartwatch" src="https://images.theconversation.com/files/546287/original/file-20230905-19-6vzs81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546287/original/file-20230905-19-6vzs81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546287/original/file-20230905-19-6vzs81.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546287/original/file-20230905-19-6vzs81.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546287/original/file-20230905-19-6vzs81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546287/original/file-20230905-19-6vzs81.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546287/original/file-20230905-19-6vzs81.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">Muscle mass helps determine the body’s metabolic rate.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/smart-watch-on-sporty-african-man-2069217704">Shutterstock</a></span>
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</figure>
<h2>Why does our metabolism become dysfunctional after dieting?</h2>
<p>When you lose large amounts of weight, you’re likely to have lowered your metabolic rate, and it <a href="https://pubmed.ncbi.nlm.nih.gov/22535969/">doesn’t recover</a> to the level it was pre-dieting – even if you regain weight. </p>
<p>This is because, typically, when we diet to lose weight, we lose both fat and muscle, and the decrease in our calorie-burning muscle mass slows our metabolism. </p>
<p>We can account for the expected decrease in metabolic rate from the decrease in body mass, but even after we regain lost weight our metabolism doesn’t recover. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/27136388/">Research</a> shows that for every diet you attempt, the rate at which you burn food slows by a further 15% that can’t be accounted for. </p>
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<p>
<em>
<strong>
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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<h2>3 ways to speed up our metabolism (and 1 thing to avoid)</h2>
<p><strong>1) Pay attention to what you eat</strong></p>
<p>Consider the types of food you eat because your diet will influence the amount of energy your body expends to digest, absorb and metabolise food. This process is called <a href="https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-1-5">diet-induced thermogenesis</a>, or the thermic effect of food, and it equates to about 10% of our daily energy expenditure.</p>
<p><a href="https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-1-5">Research</a> shows the thermic effect of food is highest for protein-rich foods because our bodies need to use more energy to break down and digest proteins. Eating protein-rich foods will increase your metabolic rate by about 15% (compared to the average of 10% from all foods). In contrast, carbs will increase it 10% and fats by less than 5%.</p>
<figure class="align-center ">
<img alt="Person stands on scales in their living room" src="https://images.theconversation.com/files/546288/original/file-20230905-15-oi6es0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546288/original/file-20230905-15-oi6es0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546288/original/file-20230905-15-oi6es0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546288/original/file-20230905-15-oi6es0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546288/original/file-20230905-15-oi6es0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546288/original/file-20230905-15-oi6es0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546288/original/file-20230905-15-oi6es0.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">If you’re trying to lose weight, aim for balanced meals rather than avoiding whole food groups.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-person-standing-on-a-weighing-scale-7801341/">Pexels/Pavel Danilyuk</a></span>
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<p>But this doesn’t mean you should switch to a protein-only diet to boost your metabolism. Rather, meals should include vegetables and a source of protein, balanced with wholegrain carbs and good fats to support optimum <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071223/">health, disease prevention and weight loss</a>. </p>
<p><strong>2) Get moving</strong></p>
<p>Regular physical activity will boost muscle mass and <a href="https://link.springer.com/article/10.1007/s00125-020-05177-6">speed up your metabolism</a>. Increasing your muscle mass raises your basal metabolic rate, meaning you’ll burn more calories at rest. </p>
<p>You can achieve this by incorporating 30 minutes of physical activity into your daily routine, supplemented with two days of gym or strength work each week.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/does-exercise-help-you-lose-weight-198292">Does exercise help you lose weight?</a>
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</p>
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<p>It’s also important to mix things up, as following the same routine every day can quickly lead to boredom and exercise avoidance.</p>
<p>Neglecting exercise will just as quickly result in a decline in muscle mass, and your lost muscle will slow your metabolism and hamper your efforts to lose weight.</p>
<p><strong>3) Get enough sleep</strong></p>
<p>A growing body of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2929498/">research</a> confirms sleep deprivation can significantly impact your metabolism. </p>
<p>A lack of sleep disturbs the body’s energy balance. This causes our appetite hormones to <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.23616">increase feelings of hunger</a> and trigger food cravings, while altering our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2084401/">sugar metabolism</a> and decreasing our <a href="https://www.sciencedirect.com/science/article/pii/S0002916523129534">energy expenditure</a>. </p>
<p>If you want to boost your metabolism, set yourself a goal of getting <a href="https://www.sleephealthjournal.org/article/S2352-7218(15)00015-7/fulltext">seven hours</a> of uninterrupted sleep each night. </p>
<p>A simple way to achieve this is to avoid screens for at least one hour before bed. Screens are a big sleep disruptor because they suppress melatonin production in the brain, telling us it’s daytime instead of nighttime.</p>
<figure class="align-center ">
<img alt="Woman stretches after waking up" src="https://images.theconversation.com/files/546290/original/file-20230905-23-c77bn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546290/original/file-20230905-23-c77bn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546290/original/file-20230905-23-c77bn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546290/original/file-20230905-23-c77bn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546290/original/file-20230905-23-c77bn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546290/original/file-20230905-23-c77bn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546290/original/file-20230905-23-c77bn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Poor sleep can impact your metabolism.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/kqDEH7M2tGk">Unsplash/Kinga Howard</a></span>
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</figure>
<p><strong>4) Don’t waste your money on diet pills and supplements</strong></p>
<p>Thousands of products promise to activate your metabolism and speed up your weight loss. While some may have ingredients that will boost your metabolism immediately after you take them, such as caffeine and capsaicin (the component which gives chillies their heat), <a href="https://www.nature.com/articles/ijo201682">research</a> confirms the effect is temporary – they don’t support long-term weight loss.</p>
<p>Most products promising to help you speed up your metabolism to help you lose weight don’t offer any scientific evidence to back their efficacy. <a href="https://pubmed.ncbi.nlm.nih.gov/33976376/">Two</a> extensive <a href="https://pubmed.ncbi.nlm.nih.gov/31984610/">reviews</a> published recently examined around 120 studies of weight-loss supplements and found they just don’t work, despite the bold marketing claims.</p>
<p>So leave the pills, potions and powders on the shelf and focus on the things that work. Your metabolism – and your hip pocket – will thank you.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-time-to-bust-the-calories-in-calories-out-weight-loss-myth-199092">It's time to bust the 'calories in, calories out' weight-loss myth</a>
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<p><em>At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can register <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">here</a> to express your interest.</em></p><img src="https://counter.theconversation.com/content/204811/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Nick Fuller works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program.</span></em></p>Our metabolism naturally slows down as we age and becomes dysfunctional after dieting. Here’s what you can do to give yours a boost.Nick Fuller, Charles Perkins Centre Research Program Leader, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2111902023-09-11T02:20:22Z2023-09-11T02:20:22ZThe body mass index can’t tell us if we’re healthy. Here’s what we should use instead<p>We’ve known for some time the <a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">body mass index (BMI) is an inaccurate measuring stick</a> for assessing someone’s weight and associated health. But it continues to be the go-to tool for medical doctors, population researchers and personal trainers.</p>
<p>Why is such an imperfect tool still being used, and what should we use instead?</p>
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Read more:
<a href="https://theconversation.com/is-bmi-a-good-way-to-tell-if-my-weight-is-healthy-we-asked-five-experts-96985">Is BMI a good way to tell if my weight is healthy? We asked five experts</a>
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<h2>First, what is BMI?</h2>
<p>BMI is an internationally recognised screening method for sorting people into one of four weight categories: underweight (BMI less than 18.5), normal weight (18.5 to 24.9), overweight (25.0 to 29.9) or obese (30 or greater).</p>
<p>It’s a value <a href="https://www.cdc.gov/healthyweight/assessing/bmi/index.html">calculated</a> by a measure of someone’s mass (weight) divided by the square of their height.</p>
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Read more:
<a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">Using BMI to measure your health is nonsense. Here's why</a>
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<h2>Who invented BMI?</h2>
<p>Belgian mathematician <a href="https://www.britannica.com/biography/Adolphe-Quetelet">Lambert Adolphe Jacques Quetelet</a> (1796-1874) devised the BMI in 1832, as a mathematical model to chart the average Western European man’s <a href="https://pubmed.ncbi.nlm.nih.gov/17890752/">physical characteristics</a>.</p>
<p>It was initially called the <a href="https://www.msdmanuals.com/en-au/professional/multimedia/clinical-calculator/body-mass-index-quetelets-index">Quetelet Index</a> and was never meant to be used as a medical assessment tool. The Quetelex Index was renamed the “body mass index” in 1972.</p>
<h2>What’s wrong with the BMI?</h2>
<p>Using a mathematical formula to give a full picture of someone’s health is just not possible.</p>
<p>The BMI <a href="https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html">does not measure excess body fat</a>, it just measures “excess” weight. It does not distinguish between excess body fat or bone mass or musculature, and does not interpret the distribution of fat (which <em>is</em> a <a href="https://www.health.harvard.edu/staying-healthy/abdominal-fat-and-what-to-do-about-it">predictor</a> of health, including type 2 diabetes, metabolic disorders, and heart disease).</p>
<p>It also cannot tell the difference between social variables such as sex, age, and ethnicity. Given Quetelet’s formula used only Western European men, the findings are not appropriate for many other groups, including non-European ethnicities, post-menopausal women and pregnant women.</p>
<p>The medical profession’s <a href="https://pubmed.ncbi.nlm.nih.gov/37432007/">overreliance on BMI</a> may be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2930234/">harming patients’ health</a> as it ignores much of what makes us healthy and focuses only on mass.</p>
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<strong>
Read more:
<a href="https://theconversation.com/renaming-obesity-wont-fix-weight-stigma-overnight-heres-what-we-really-need-to-do-209224">Renaming obesity won't fix weight stigma overnight. Here's what we really need to do</a>
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<h2>What should we use instead?</h2>
<p>Rather than seeing BMI as the primary diagnostic test for determining a person’s health, it should be used in conjunction with other measures and considerations.</p>
<p>Since researchers know belly fat around our vital organs carries the most <a href="https://www.bmj.com/content/370/bmj.m3324">health risk</a>, <a href="https://www.hsph.harvard.edu/obesity-prevention-source/obesity-definition/how-to-measure-body-fatness/">waist circumference</a>, waist-to-hip ratio or waist-to-height ratio offer more accurate measurements of health.</p>
<p><strong>Waist circumference</strong>: is an effective measure of fat distribution, particularly for athletes who carry less fat and more muscle. It’s most useful as a predictor of health when <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7027970/">combined with the BMI</a>. Waist circumference should be less than 94cm for men and 80cm for women for <a href="https://www.heartfoundation.org.au/bundles/your-heart/waist-measurement">optimal health</a>, as measured from halfway between the bottom of your ribs and your hip bones.</p>
<p><strong>Waist-to-hip ratio</strong>: calculates the proportion of your body fat and how much is stored on your waist, hips, and buttocks. It’s the waist measurement divided by hip measurement and according to the World Health Organisation it should be <a href="https://apps.who.int/iris/bitstream/handle/10665/44583/9789241501491_eng.pdf;jsessionid=A119D165CFFF5E7B5BDBD51D9DD25684?sequence=1">0.85 or less for women, and 0.9 or less in men</a> to reduce health risks. It’s especially beneficial in predicting health outcomes in <a href="https://link.springer.com/article/10.1007/s40200-021-00882-4">older people</a>, as the ageing process alters the body proportions on which BMI is founded. This is because fat mass increases and muscle mass decreases with age.</p>
<p><strong>Waist-to-height ratio</strong>: is height divided by waist circumference, and it’s <a href="https://www.nice.org.uk/news/article/keep-the-size-of-your-waist-to-less-than-half-of-your-height-updated-nice-draft-guideline-recommends">recommended</a> a person’s waist circumference be kept at less than half their height. Some studies have found this measure is <a href="https://bmjopen.bmj.com/content/6/3/e010159">most strongly correlated</a> with health predictions.</p>
<p>Body composition and body fat percentage can also be calculated through <a href="https://www.youtube.com/watch?v=a1A9m0wO17g">skinfold measurement tests</a>, by assessing specific locations on the body (such as the abdomen, triceps or quadriceps) with skin callipers.</p>
<p>Additional ways to gauge your heart health include asking your doctor to monitor your cholesterol and blood pressure. These more formal tests can be combined with a review of lifestyle, diet, physical activity, and family medical history. </p>
<h2>What makes us healthy apart from weight?</h2>
<p>A diet including whole grains, low fat protein sources such as fish and <a href="https://en.wikipedia.org/wiki/Legume">legumes</a>, eggs, yoghurt, cheese, milk, nuts, seeds, and plenty of fresh fruit and vegetables <a href="https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-healthy-diet/art-20047702">reduces our risk</a> of heart and vessel disease.</p>
<p>Limiting <a href="https://www.foodstandards.gov.au/consumer/generalissues/Pages/processed-foods.aspx">processed food</a> and sugary snacks, as well as <a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/healthy+living/healthy+eating/healthy+eating+tips/eat+less+saturated+and+trans+fats">saturated and trans fats</a> can help us with weight management and ward off diet-related illnesses.</p>
<p>Being physically active most days of the week improves general health. This <a href="https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians">includes</a> two sessions of strength training per week, and 2.5 to five hours of moderate cardio activity or 1.25 to 2.5 hours of vigorous cardio activity.</p>
<p>Weight is just one aspect of health, and there are much better measurements than BMI.</p><img src="https://counter.theconversation.com/content/211190/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachael Jefferson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The BMI does not distinguish between excess body fat, bone mass or musculature. It also does not interpret the distribution of fat, which is a predictor of health.Rachael Jefferson, Lecturer in Human Movement Studies (Health and PE) and Creative Arts, Charles Sturt UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/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>
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<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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<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>
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<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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<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.