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September 22, 2023

How to build a habit in 5 steps, according to science | CNN

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Most of us assume those superachievers who are always able to squeeze in their workout, eat healthy foods, ace their exams and pick their kids up on time must have superhuman self-control. But science points to a different answer: What we mistake for willpower is often a hallmark of habit.

People with good habits rarely need to resist the temptation to laze on the couch, order greasy takeout, procrastinate on assignments or watch one more viral video before dashing out the door. That’s because autopilot takes over, eliminating temptation from the equation. Having established good habits, little to no willpower is required to choose wisely.

Sounds great, right? The only catch is that building good habits takes effort and insight. Thankfully, science offers both guidance on how to begin and strategies to lighten your lift. Here are a few research-backed steps sourced from my book, “How to Change,” that can set you on the path from where you are to where you want to be.

The way you define the goal you hope to turn into a habit does matter. Goals such as “meditate regularly” are too abstract, research has shown. You’ll benefit from being more specific about what exactly you aim to do and how often.

Don’t say “I’ll meditate regularly.” Say, “I’ll meditate for 15 minutes each day.”

Having a bite-size objective makes it less daunting to get started and easier to see your progress.

Now that you have established a specific goal, it’s time to think about what will cue you to follow through. Scientists have proven that you’ll make more progress toward your goal if you decide not just what you’ll do, but when you’ll be cued to do it, as well as where you’ll do it and how you’ll get there.

A plan like “I’ll study Spanish for 30 minutes, five days a week” is OK. But a detailed, cue-based plan like “Every workday after my last meeting, I’ll spend 30 minutes studying Spanish in my office” is much more likely to stick as a habit.

Making this kind of plan reduces the chances you’ll forget to follow through because the when and where in your plan will serve as cues to action that jog your memory. Even better: Put your plan on your calendar so you’ll get a digital reminder. An established, hyperspecific plan also forces you to anticipate and maneuver around obstacles and makes procrastination feel more sinful.

When we set out to build a new habit, most of us overestimate our willpower and set a course for the most efficient path to achieving our end goal. Say you hope to get fit by exercising regularly — you’ll likely look for a workout that can generate quick results such as grinding it out on a treadmill. But research has shown you’ll persist longer and ultimately achieve more if you instead focus on finding ways to make goal pursuit fun.

When it comes to exercise, this might mean going to Zumba classes with a friend or learning how to rock climb. If you’re trying to eat more fruits and vegetables, it might mean swapping doughnut breakfasts for tasty smoothies, which can combine multiple servings of fruits and veggies in one delicious drink. Because you are far more likely to stick with something you enjoy and repetition is key to habit formation, making the experience positive is critical, but it’s often overlooked.

One excellent way to make goal pursuit fun is to try what I call “temptation bundling.” Consider only letting yourself enjoy an indulgence you crave while working toward your goal. For example, only let yourself binge-watch your favorite show while at the gym or enjoy a beloved podcast while cooking healthy meals. My own research shows that temptation bundling improves follow-through; it transforms goal pursuit into a source of pleasure, not pain.

By the time we put a behavior on autopilot, a lot of us fall into fairly consistent routines, tending to exercise, study or take our medication at the same time of day and in the same place. But when you’re in the start-up phase of habit building, contrary to popular opinion, my research suggests it’s important to insert some variability deliberately into your routine.

You’ll still want to have a first best plan — maybe an 8 a.m. meditation session if you’re trying to kick-start a mindfulness habit. But you should also experiment with other ways of getting the job done. Try to mix in a noon session and maybe a 5 p.m. meditation, too.

Successful habit building relies on frequently repeating a behavior, and if your routine becomes too brittle, you’ll follow through less often. A flexible habit means you can still do what you need to even when a wrench is thrown in your first best plans — say, a traffic jam on the way to dropping the kids off at school that gets in the way of your morning meditation.

One way to be flexible that’s proven useful is by giving yourself “emergency reserves.” Emergency reserves are a limited number of get-out-of-jail-free cards for those days when you really can’t squeeze in your 10 minutes of meditation, regular jog or Spanish practice.

It’s more motivating to set a tough goal for yourself — meditating every day, for instance — than an easy one, according to research. But missing multiple subgoals along the way can be discouraging. A couple of emergency reserves each week give you the flexibility to miss a day when a real emergency arises without getting discouraged and abandoning your objective entirely.

This step is obvious but sometimes overlooked. Seek out social support. Social support isn’t just about having cheerleaders and people to hold you accountable — though both can add value, so I’d suggest telling your friends and family about your goals.

We’re strongly influenced by the behaviors of the people around us, evidence shows. Want to start running regularly? You’re probably better off joining an established running club than asking a few friends who aren’t yet in the habit of jogging to get in shape with you. People in the running club have already built the habits you want. You can learn from them about what works and gain friends who will make you feel like a slouch when you slack off.

Good habits are contagious, so try to catch some by hanging out with people who are a little ahead of you on the learning curve. It’s important not to get too crazy — if you try to train with marathoners when you’re just hoping to work up to a 5K, I’ve found it can be discouraging.

But in general, research by myself and others shows that finding people to socialize with and emulating those who have already accomplished what you want to accomplish can make a world of difference. As an added bonus, when you pursue your goals in tandem with people you like, that makes it more fun!

One last thing to keep in mind is that habits can take some time to form. They don’t click overnight. Despite claims that there’s a “magic number” of days it takes to form a habit, my collaborators and I have disproven this myth in our recent research. We all form habits at our own speed, but for simpler and frequently repeated behaviors such as hand sanitizing, we can expect speedier habit formation than for more complex behaviors such as hitting the gym, which, on average, can take months rather than weeks to put on autopilot.

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July 5, 2023

Blueberries have joined green beans in this year’s Dirty Dozen list | CNN

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CNN
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Blueberries, beloved by nutritionists for their anti-inflammatory properties, have joined fiber-rich green beans in this year’s Dirty Dozen of nonorganic produce with the most pesticides, according to the Environmental Working Group, a nonprofit environmental health organization.

In the 2023 Shopper’s Guide to Pesticides in Produce, researchers analyzed testing data on 46,569 samples of 46 fruits and vegetables conducted by the US Department of Agriculture. Each year, a rotating list of produce is tested by USDA staffers who wash, peel or scrub fruits and vegetables as consumers would before the food is examined for 251 different pesticides.

As in 2022, strawberries and spinach continued to hold the top two spots on the Dirty Dozen, followed by three greens — kale, collard and mustard. Listed next were peaches, pears, nectarines, apples, grapes, bell and hot peppers, and cherries. Blueberries and green beans were 11th and 12th on the list.

A total of 210 pesticides were found on the 12 foods, the report said. Kale, collard and mustard greens contained the largest number of different pesticides — 103 types — followed by hot and bell peppers at 101.

Dirty Dozen 2023

2023 Dirty Dozen (most to least contaminated)

Strawberries

Spinach

Kale, collard and mustard greens

Peaches

Pears

Nectarines

Apples

Grapes

Bell and hot peppers

Cherries

Blueberries

Green beans

“Some of the USDA’s tests show traces of pesticides long since banned by the Environmental Protection Agency. Much stricter federal regulation and oversight of these chemicals is needed,” the report said.

“Pesticides are toxic by design,” said Jane Houlihan, former senior vice president of research for EWG. She was not involved in the report.

“They are intended to harm living organisms, and this inherent toxicity has implications for children’s health, including potential risk for hormone dysfunction, cancer, and harm to the developing brain and nervous system,” said Houlihan, who is now research director for Healthy Babies, Bright Futures, an organization dedicated to reducing babies’ exposures to neurotoxic chemicals.

There is good news, though. Concerned consumers can consider choosing conventionally grown vegetables and fruits from the EWG’s Clean 15, a list of crops that tested lowest in pesticides, the report said. Nearly 65% of the foods on the list had no detectable levels of pesticide.

2023 Clean 15

2023 Clean 15 (least to most contaminated)

Avocados

Sweet corn

Pineapple

Onions

Papaya

Frozen sweet peas

Asparagus

Honeydew melon

Kiwi

Cabbage

Mushrooms

Mangoes

Sweet potatoes

Watermelon

Carrots

Avocados topped 2023’s list of least contaminated produce again this year, followed by sweet corn in second place. Pineapple, onions and papaya, frozen sweet peas, asparagus, honeydew melon, kiwi, cabbage, mushrooms, mangoes, sweet potatoes, watermelon, and carrots made up the rest of the list.

Being exposed to a variety of foods without pesticides is especially important during pregnancy and throughout childhood, experts say. Developing children need the combined nutrients but are also harder hit by contaminants such as pesticides.

“Pesticide exposure during pregnancy may lead to an increased risk of birth defects, low birth weight, and fetal death,” the American Academy of Pediatrics noted. “Exposure in childhood has been linked to attention and learning problems, as well as cancer.”

The AAP suggests parents and caregivers consult the shopper’s guide if they are concerned about their child’s exposure to pesticides.

Houlihan, director of Healthy Babies, Bright Futures, agreed: “Every choice to reduce pesticides in the diet is a good choice for a child.”

Nearly 90% of blueberry and green bean samples had concerning findings, the report said.

In 2016, the last time green beans were inspected, samples contained 51 different pesticides, according to the report. The latest round of testing found 84 different pest killers, and 6% of samples tested positive for acephate, an insecticide banned from use in the vegetable in 2011 by the EPA.

“One sample of non-organic green beans had acephate at a level 500 times greater than the limit set by the EPA,” said Alexis Temkin, a senior toxicologist at the EWG with expertise in toxic chemicals and pesticides.

When last tested in 2014, blueberries contained over 50 different pesticides. Testing in 2020 and 2021 found 54 different pesticides — about the same amount. Two insecticides, phosmet and malathion, were found on nearly 10% of blueberry samples, though the levels decreased over the past decade.

Acephate, phosmet and malathion are organophosphates, which interfere with the normal function of the nervous system, according to the US Centers for Disease Control and Prevention.

A high dose of these chemicals can cause difficulty breathing, nausea, a lower heart rate, vomiting, weakness, paralysis and seizures, the CDC said. If exposed over an extended time to smaller amounts, people may “feel tired or weak, irritable, depressed, or forgetful.”

Why would levels of some pesticides be higher today than in the past?

“We do see drops in some pesticides since the early ’90s when the Food Quality Protection Act was put into place,” Temkin said. “But we’re also seeing increases of other pesticides that have been substituted in their place which may not be any safer. That’s why there’s a push towards overall reduction in pesticide use.”

Chris Novak, president and CEO of CropLife America, an industry association, told CNN the report “willfully misrepresented” the USDA data.

“Farmers use pesticides to control insects and fungal diseases that threaten the healthfulness and safety of fruits and vegetables,” Novak said via email. “Misinformation about pesticides and various growing methods breeds hesitancy and confusion, resulting in many consumers opting to skip fresh produce altogether.”

The Institute of Food Technologists, an industry association, told CNN that emphasis should be placed on meeting the legal limits of pesticides established by significant scientific consensus.

“We all agree that the best-case scenario of pesticide residues would be as close to zero as possible and there should be continued science-based efforts to further reduce residual pesticides,” said Bryan Hitchcock, IFT’s chief science and technology officer.

Many fruits and veggies with higher levels of pesticides are critical to a balanced diet, so don’t give them up, experts say. Instead, avoid most pesticides by choosing to eat organic versions of the most contaminated crops. While organic foods are not more nutritious, the majority have little to no pesticide residue, Temkin said.

“If a person switches to an organic diet, the levels of pesticides in their urine rapidly decrease,” Temkin told CNN. “We see it time and time again.”

If organic isn’t available or too pricey, “I would definitely recommend peeling and washing thoroughly with water,” Temkin said. “Steer away from detergents or other advertised items. Rinsing with water will reduce pesticide levels.”

Additional tips on washing produce, provided by the US Food and Drug Administration, include:

Handwashing with warm water and soap for 20 seconds before and after preparing fresh produce.
Rinsing produce before peeling, so dirt and bacteria aren’t transferred from the knife onto the fruit or vegetable.
Using a clean vegetable brush to scrub firm produce like apples and melons.
Drying the produce with a clean cloth or paper towel to further reduce bacteria that may be present.

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May 16, 2023

Don’t use sugar substitutes for weight loss, World Health Organization advises | CNN

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CNN
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Don’t use sugar substitutes if you are trying to lose weight, according to new guidance from the World Health Organization.

The global health body said a systematic review of the available evidence suggests the use of non-sugar sweeteners, or NSS, “does not confer any long-term benefit in reducing body fat in adults or children.”

“Replacing free sugars with non-sugar sweeteners does not help people control their weight long-term,” said Francesco Branca, director of WHO’s department of nutrition and food safety. “We did see a mild reduction of body weight in the short term, but it’s not going to be sustained.”

The guidance applies to all people except those with preexisting diabetes, Branca said. Why? Simply because none of the studies in the review included people with diabetes, and an assessment could not be made, he said.

The review also indicated that there might be “potential undesirable effects” from the long-term use of sugar substitutes such as a mildly increased risk of type 2 diabetes and cardiovascular diseases.

However, “this recommendation is not meant to comment on safety of consumption,” Branca said. “What this guideline says is that if we’re looking for reduction of obesity, weight control or risk of noncommunicable diseases, that is unfortunately something science been unable to demonstrate,” he said. “It’s not going to produce the positive health effects that some people might be looking for.”

Non-sugar sweeteners are widely used as an ingredient in prepackaged foods and beverages and are also sometimes added to food and drinks directly by consumers. WHO issued guidelines on sugar intake in 2015, recommending that adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake. Following that recommendation, interest in sugar alternatives intensified, the review said.

“This new guideline is based on a thorough assessment of the latest scientific literature, and it emphasises that the use of artificial sweeteners is not a good strategy for achieving weight loss by reducing dietary energy intake,” said nutrition researcher Ian Johnson, emeritus fellow at Quadram Institute Bioscience, formerly the Institute of Food Research, in Norwich, United Kingdom.

“However, this should not be interpreted as an indication that sugar intake has no relevance to weight-control,” Johnson said in a statement.

Instead, one should cut back on using sugar-sweetened drinks, and try to use “raw or lightly processed fruit as a source of sweetness,” Johnson added.

Dr. Keith Ayoob, scientific adviser for the Calorie Control Council, an international association representing the low-calorie food and beverage industry, told CNN via email the WHO’s “insistence on focusing only on prevention of unhealthy ‎weight gain and non-communicable diseases is at the very least, misguided.”

Robert Rankin, president of the Calorie Control Council, said “low- and no-calorie sweeteners are a critical tool that can help consumers manage body weight and reduce the risk of non-communicable diseases.”

The guidance is meant for government health organizations in countries who may wish to use the scientific analysis to implement policy changes for their citizens, Branca said.

“That will likely depend on the way that which sweeteners are consumed in a specific country,” he said. “For example, in a country where consumption patterns are high, those countries might decide to take action in a way or another.”

A total of 283 studies were included in the review. Both randomized controlled trials, considered the gold standard of research, and observational studies were included. Observational studies can only show an association, not direct cause and effect.

Results from randomized trials found the use of non-sugar sweeteners had a “low” impact on reducing body weight and calorie intake when compared with sugar, and no change in Intermediate markers of diabetes such as glucose and insulin, according to the report.

Observational studies also found a low impact on body weight and fat tissue, but no change in calorie intake. However, those studies found a low increase in risk for type 2 diabetes, high blood pressure, stroke, heart disease and death from heart disease, the report noted. A very low risk was also found for bladder cancer and an early death from any cause.

WHO said that the recommendation was “conditional” because the identified link between sweeteners and disease outcomes might be confounded by complicated patterns of sweetener use and the characteristics of the study participants.

In an emailed statement, the International Sweeteners Association, an industry assocation, said “it is a disservice to not recognise the public health benefits of low/no calorie sweeteners and is disappointed that the WHO’s conclusions are largely based on low certainty evidence from observational studies, which are at high risk of reverse causality.”

However, observational studies that follow people over time are important, Branca said. “To show that overweight people can reduce their body weight requires a long-term study. And we’re not seeing that impact from the research we have.”

The recommendation included low or no calorie synthetic sweeteners and natural extracts, which may or may not be chemically modified, such as acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives and monkfruit, the report said.

“Stevia and monkfruit are newer sweeteners so so there’s less published research in the scientific literature,” Branca said. “However they probably work in the body with a similar physiological mechanism as other sweeteners. We cannot say they are different from the others based on the data we have — they play the same role.”

Many people consider stevia products to be more “natural,” since they are derived from the stevia plant. Some natural and artificial sweeteners add bulking sugars to their products to cut their sweetness and add bulk to the product for baking.

A recent study by researchers at the US-based Cleveland Clinic found erythritol — used to add bulk or sweeten stevia, monkfruit and keto reduced-sugar products — was linked to blood clotting, stroke, heart attack and early death.

People with existing risk factors for heart disease, such as diabetes, were twice as likely to experience a heart attack or stroke if they had the highest levels of erythritol in their blood, the study found.

Just as many people have learned to eat and cook without salt, they can learn to reduce their dependence on free sugars and non-nutritive sweetners, Branca said.

“We need to target children in early life,” he said. “For example, why do parents typically use sweeteners as a reward for children and after almost every meal? We need to recommend to parents to avoid building that sweetness Interest in young children — that’s a very important action to take.”

Even if you are a true sugar “addict,” the good news is that you can tame your sweet tooth, registered dietitian Lisa Drayer said in an article for CNN. She provides the following steps:

Train your taste buds. If you gradually cut back on sugar — including artificial sweeteners — and include more protein and fiber-rich foods in your diet, that can help you crave less sugar, Drayer said.

“When we consume protein and fiber, it slows the rise in blood sugar if we consume it with a sugar-containing food. It can help satisfy us and help us reduce our sugar intake as well,” she said in a previous interview.

Choose no-sugar-added foods and avoid all sugar-sweetened drinks. For example, choose whole-grain cereal or Greek yogurt with no sweeteners. The sugar-sweetened drinks to take off your grocery list should include sodas, energy drinks, sports drinks and fruit punch. Choose water instead.

“If you like sweet carbonated beverages, add a splash of cranberry or orange juice to seltzer or try flavored seltzers. You can also flavor your own waters with fruit slices for natural sweetness or try herbal fruit teas,” Drayer said.

Drink coffee and tea with no or fewer sugars. Be careful at coffee shops, Drayer suggested. All those lattes and flavored coffees can have as much sugar as a can of soda, or more.

Enjoy fruit for dessert. Try cinnamon baked apples, berries or grilled peaches instead of cookies, cake, ice cream, pastries and other sweet treats, Drayer said.

Watch for stealth sugars. Added sugars are often present in foods that you might not think of as “sweet,” like sauces, breads, condiments and salad dressings, Drayer said.

“Pre-packaged sauces — like ketchup, BBQ sauce and tomato sauce — tend to be some of the biggest offenders of hidden added sugars in the diet,” Kristi King, senior pediatric dietitian at Texas Children’s Hospital and a national spokesperson for the Academy of Nutrition and Dietetics, told Drayer in a prior interview.

Check nutrition facts labels. All foods and beverages must list the amount and kind of sugar on the label.

Added sugars can go by other names such as “agave, brown sugar, corn sweetener, corn syrup, dextrose, evaporated cane juice, fructose, fruit juice concentrate, fruit nectar, glucose, high-fructose corn syrup, honey, invert sugar, lactose, malt syrup, maltose, molasses, maple syrups, raw sugar, sucrose, trehalose and turbinado sugar,” Drayer said.

The higher up these added sugars are on the ingredients list, the greater the amount of added sugar in the product, she said.

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May 8, 2023

Kids need to gain weight during adolescence. Here’s why | CNN

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Editor’s Note: Michelle Icard is the author of several books on raising adolescents, including “Fourteen Talks by Age Fourteen.”

CNN
—

I’ve worked with middle schoolers, their parents and their schools for 20 years to help kids navigate the always awkward, often painful, sometimes hilarious in hindsight, years of early adolescence.

Most of the social and development stretch marks we gain during adolescence fade to invisibility over time. We stop holding a grudge against the kid who teased us in class for tripping, or we forgive ourselves our bad haircuts, botched friendships and cringy attempts at popularity.

But one growing pain can be dangerously hard to recover from, and ironically, it’s the one that has most to do with our physical growth.

Children are supposed to keep growing in adolescence, and so a child’s changing body during that time should not be cause for concern. Yet it sends adults into a tailspin of fear around weight, health and self-esteem.

Kids have always worried about their changing bodies. With so many changes in such a short period of early puberty, they constantly evaluate themselves against each other to figure out if their body development is normal. “All these guys grew over the summer, but I’m still shorter than all the girls. Is something wrong with me?” “No one else needs a bra, but I do. Why am I so weird?”

But the worry has gotten worse over the past two decades. I’ve seen parents becoming increasingly worried about how their children’s bodies change during early puberty. When I give talks about parenting, I often hear adults express concern and fear about their children starting to gain “too much” weight during early adolescence.

Parents I work with worry that even kids who are physically active, engaged with others, bright and happy might need to lose weight because they are heavier than most of their peers.

Why are parents so focused on weight? In part, I think it’s because our national conversations about body image and disordered eating have reached a frenzy on the topic. Over the past year, two new angles have further complicated this matter for children.

Remember Jimmy Kimmel’s opening monologue at the Oscars making Ozempic and its weight-loss properties a household name? Whether it’s social media or the mainstream press, small bodies and weight loss are valued. It’s clear to young teens I know that celebrities have embraced a new way to shrink their bodies.

Constant messages about being thin and fit are in danger of overexposing kids to health and wellness ideals that are difficult to extract from actual health and wellness.

Compound this with the American Academy of Pediatrics recently changing its guidelines on treating overweight children, and many parents worry even more that saying or doing nothing about their child’s weight is harmful.

The opposite is true. Parents keep their children healthiest when they say nothing about their changing shape. Here’s why.

Other than the first year of life, we experience the most growth during adolescence. Between the ages of 13 and 18, most adolescents double their weight. Yet weight gain remains a sensitive, sometimes scary subject for parents who fear too much weight gain, too quickly.

It helps to understand what’s normal. On average, boys do most of their growing between 12 and 16. During those four years, they might grow an entire foot and gain as much as 50 to 60 pounds. Girls have their biggest growth spurt between 10 and 14. On average, they can gain 10 inches in height and 40 to 50 pounds during that time, according to growth charts from the US Centers for Disease Control and Prevention.

Boys do most of their growing between ages 12 and 16 on average. They may even grow an entire foot.

“It’s totally normal for kids to gain weight during puberty,” said Dr. Trish Hutchison, a board-certified pediatrician with 30 years of clinical experience and a spokesperson for the American Academy of Pediatrics, via email. “About 25 percent of growth in height occurs during this time so as youth grow taller, they’re also going to gain weight. Since the age of two or three, children grow an average of about two inches and gain about five pounds a year. But when puberty hits, that usually doubles.”

The American Academy of Pediatrics released a revised set of guidelines for pediatricians in January, which included recommendations of medications and surgery for some children who measure in the obese range.

In contrast, its 2016 guidelines talked about eating disorder prevention and “encouraged pediatricians and parents not to focus on dieting, not to focus on weight, but to focus on health-promoting behaviors,” said Elizabeth Davenport, a registered dietitian in Washington, DC.

“The new guidelines are making weight the focus of health,” she said. “And as we know there are many other measures of health.”

Davenport said she worries that kids could misunderstand their pediatricians’ discussions about weight, internalize incorrect information and turn to disordered eating.

“A kid could certainly interpret that message as not needing to eat as much or there’s something wrong with my body and that leads down a very dangerous path,” she said. “What someone could take away is ‘I need to be on a diet’ and what we know is that dieting increases the risk of developing an eating disorder.”

Many tweens have tried dieting, and many parents have put their kids on diets.

“Some current statistics show that 51% of 10-year-old girls have tried a diet and 37% of parents admit to having placed their child on a diet,” Hutchison said in an email, adding that dieting could be a concern with the new American Academy of Pediatrics guidelines.

“There is evidence that having conversations about obesity can facilitate effective treatment, but the family’s wishes should strongly direct when these conversations should occur,” Hutchison said. “The psychological impact may be more damaging than the physical health risks.”

It’s not that weight isn’t important. “For kids and teens, we need to know what their weight is,” Davenport said. “We are not, as dietitians, against kids being weighed because it is a measure to see how they’re growing. If there’s anything outstanding on an adolescent’s growth curve, that means we want to take a look at what’s going on. But we don’t need to discuss weight in front of them.”

In other words, weight is data. It may or may not indicate something needs addressing. The biggest concern, according to Davenport, is when a child isn’t gaining weight. That’s a red flag something unhealthy is going on.

“Obesity is no longer a disease caused by energy in/energy out,” Hutchison said. “It is much more complex and other factors like genetics, physiological, socioeconomic, and environmental contributors play a role.”

It’s important for parents and caregivers to know that “the presence of obesity or overweight is NOT an indication of poor parenting,” she said. “And it’s not the child or adolescent’s fault.”

It’s also key to note, Hutchison said, that the new American Academy of Pediatrics guidelines, which are only recommendations, are not for parents. They are part of a 100-page document that provides information to health care providers with clinical practice guidelines for the evaluation and treatment of children and adolescents who are overweight or obese. Medications and surgery are discussed in only four pages of the document.

Parents need to work on their own weight bias, but they also need to protect their children from providers who don’t know how to communicate with their patients about weight.

“Working in the field of eating disorder treatment for over 20 years, I sadly can’t tell you the number of clients who’ve come in and part of the trigger for their eating disorder was hearing from a medical provider that there was an issue or a concern of some sort with their weight,” Davenport said.

Hutchison said doctors and other health providers need to do better.

“We all have a lot of work to do when it comes to conversations about weight,” Hutchison said. “We need to approach each child with respect and without (judgment) because we don’t want kids to ever think there is something wrong with their body.”

The right approach, according to American Academy of Pediatrics training, is to ask parents questions that don’t use the word “weight.” One example Hutchison offered: “What concerns, if any, do you have about your child’s growth and health?”

Working sensitively, Hutchison said she feels doctors can have a positive impact on kids who need or want guidance toward health-promoting behaviors.

Kids can misunderstand doctors' discussions about their weight and internalize incorrect information.

Davenport and her business partner in Sunny Side Up Nutrition, with input from the Carolina Resource Center for Eating Disorders, have gotten more specific. They have created a resource called Navigating Pediatric Care to give parents steps they can take to ask health care providers to discuss weight only with them — not with children.

“Pediatricians are supposed to ask permission to be able to discuss weight in front of children,” Davenport said. “It’s a parent’s right to ask this and advocate for their child.”

Davenport advises parents to call ahead and schedule an appointment to discuss weight before bringing in a child for a visit. She also suggests calling or emailing ahead with your wishes, though she admits it may be less effective in a busy setting. She said to print out a small card to hand to the nurse and physician at the appointment. You can also say in front of the child, “We prefer not to discuss weight in front of my child.”

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April 29, 2023

Reset your body and mind with 10 ‘spring-cleaning’ tips | CNN

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Editor’s Note: Dana Santas, known as the “Mobility Maker,” is a certified strength and conditioning specialist and mind-body coach in professional sports, and is the author of “Practical Solutions for Back Pain Relief.”

CNN
—

With the weather warming up, you might feel inspired to clean out your closets, wash your windows and give your house a deep scrub and reorganization. Not only is a clean environment good for your physical health, but research has shown that the good feelings you get from having a clean, uncluttered home reduce stress levels and ward off depression.

Imagine how great you would feel if you took that same spring-cleaning approach to your body — your living, breathing home.

Of course, you should already be subscribing to annual checkups with your primary care physician and eye doctor, and you may even see your dentist biannually. But what about taking a closer look at how you fuel and move your body — and making healthy changes to clean up those areas?

As a mind-body coach in professional sports, I work with coaches, medical staff and expert consultants every year during baseball spring training to help players prepare their bodies for the season. In addition to conducting annual physicals, we do nutritional and movement assessments to create appropriate action plans.

You may not be a professional athlete, but your body is still the vehicle used to navigate your life, and the quality of its ability to move and how well you feel in it affects the overall quality of your life.

That’s why I enlisted the help of two nutrition and human movement experts to provide 10 “spring-cleaning” tips to avoid injury, move pain-free, reduce inflammation, maintain a healthy weight and generally feel better in your body.

Important note: It’s recommended to consult your doctor before starting any new exercise programs or dietary changes.

You might expect a cleanse to be tip No. 1, but think twice before you dive into one of the many popular advertised cleanses. A lot of them can “do more harm than good,” according to registered dietitian Angie Asche, owner of Eleat Sports Nutrition and author of “Fuel Your Body: How to Cook and Eat for Peak Performance.” Asche said cleanses can be dehydrating and contain herbal supplements with potentially negative side effects and contraindications with certain medications. What’s more, some of these regimens don’t deliver on their promise, according to the National Institutes of Health. “Most are missing key nutrients that are necessary for your body to naturally detoxify,” she explained.

Fiber, found in plant foods, is the key to safe and efficient cleansing, according to Asche. She advises eating five to nine fruits and vegetables daily for bowel regularity and weight management. “Not only do plant foods like nuts, seeds, legumes, whole grains, fruit and vegetables contain antioxidants,” Asche said, “but the more variety of plants we have in our diets, the better for the diversity of our gut biome.”

With your focus on eating more real, whole foods rich in fiber, Asche also recommends limiting ultraprocessed packaged foods such as cookies, candy, crackers, baked goods and fried foods. These foods are full of saturated fat, sodium, sugar and preservatives while being devoid of nutritional value.

How much water you drink affects all the functions of your body — including your mental performance; a body water loss of just 1% to 2% can impair cognitive function. To promote good health and weight management, Asche advises drinking at least half your body weight in ounces daily but said the amount can vary depending on a person’s activity level.

Asche said that most fluids, including tea, coffee and carbonated water, can count toward your water intake, but she points out that alcohol does not — and should be limited. “In large amounts, alcohol can overwhelm the gut, promoting intestinal inflammation and increasing harmful bacteria … (which) can lead to a wide range of health problems,” she said.

Screens that look at your ability to do functional movements, such as squatting and lunging, are a great way to proactively prevent injury, according to physical therapist Gray Cook, a cofounder of Functional Movement Systems.

“Signs of weakness, tightness and balance problems can be early indicators of arthritis and posture issues as well as increased injury risk for athletes and fall risk for the elderly,” Cook said.

You can get the assistance of a physical therapist or qualified trainer to perform a movement assessment, but a recent study showed that self-movement assessment (using an app codeveloped by Cook) is valid and reliable for identifying musculoskeletal risk factors.

Whether working with professional athletes or doing my own workouts, I ensure that I cover all primary functional movements in all planes of motion in every training session. Executing that kind of total-body workout sounds more complicated than it is. It’s simply about practicing and strengthening your ability to perform your body’s basic movement functions: squatting, hinging, pushing, pulling, rotating and stabilizing your core.

And, just like the multidirectional movement of everyday life, it helps to exercise in all three planes of motion: sagittal (forward/backward), frontal (side to side) and transverse (rotating). You can easily practice these movements with a body-weight workout or yoga flow.

It's important to practice and strengthen your ability to perform the body's basic movement functions.

The key to exercise’s effectiveness is consistency. With as little as 11 minutes of exercise per day, you can enjoy numerous health benefits — including increasing your life span. Walking outside is a great way to get in those 11 minutes daily, and because of the alternating and reciprocal nature of gait, it offers the opportunity to tune into your body and self-assess by noticing if there are any imbalances.

Breathing plays a vital role in how you think, feel and move. In addition to reducing your heart rate, blood pressure and stress response, learning how to breathe better will improve your diaphragm function and rib mobility, which can improve posture and reduce back pain. Practice taking breathing breaks a few minutes throughout your day.

Sleep is essential for overall health. Adults need at least seven hours of sleep nightly, according to the US Centers for Disease Control and Prevention. If you’re not getting that minimum amount of shut-eye, it’s time to clean up your sleep routine and start prioritizing rest.

Just like the physical and mental benefits of traditional spring-cleaning within your home, these 10 tips will refresh and revitalize your body and mind in noticeably positive ways.

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April 27, 2023

What’s the healthiest cheese? The best options, according to experts | CNN

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CNN
—

Cheese – what’s not to love? Its popularity is indisputable.

Americans consumed over 39 pounds of cheese per capita in 2021 alone, according to data from the US Department of Agriculture.

Whether eating cheese is healthy — that’s a little less clear.

High in protein, calcium, vitamins and essential amino acids, cheese is also a calorie-dense food, and can be high in fats and sodium.

“If you enjoy cheese and you like it, it could be a good source of protein. It could be a good source of calcium. You just want to eat it where you’re not overindulging too much, because it can quickly add up in terms of calories,” Lourdes Castro Mortillaro, a registered dietician and the director of the NYU Food Lab, told CNN.

The protein found in cheese is a good alternative to protein derived from flesh, because it is still of animal origin, and contains all the essential amino acids the body needs but can’t synthesize on its own, according to Castro Mortillaro.

This makes cheese a complete protein, she added.

However, as with all things nutrition, it’s the overall balance of what you eat day to day that should inform how much cheese you consume, Castro Mortillaro explained.

“You really have to see it in the context of, what else is going on in your life? And what else are you putting on your plate?” she said. “You don’t need that much to gain the positives from it.”

Which cheese is healthiest? The answer depends on your specific body and its nutritional needs, but here are some pointers from experts.

Both Castro Mortillaro and Emily Martorano, a registered dietitian with NYU Langone’s weight management program, agree on ricotta being a winner in the healthfulness department.

The name of the cheese translates to “cooked-again,” and Castro Mortillaro explained that authentic ricotta is produced by treating the whey that is leftover after milk (such as sheep’s milk) is coagulated to produce cheese (such as pecorino).

Ricotta has a high concentration of whey protein, which is easily absorbed by the body.

“Whey protein is one of the most absorbable forms of protein and it contains a very wide range of amino acids,” Martorano said. “So this is the best bet for someone who’s looking to build muscle, build strength while also losing fat and weight.”

Castro Mortillaro also pointed to ricotta’s potential sustainability benefits, as it puts to use the leftover byproducts of cheesemaking.

“That’s very Tuscan,” she added.

Castro Mortillaro believes harder cheeses such as Parmigiano, pecorino or gouda are also among the healthiest options, when consumed in moderation.

Because they contain less water and are more concentrated, “hard cheeses are going to be higher in calcium, and you’re probably going to be satiated with smaller amounts, so you tend to not to over-consume,” she said.

However, because they are more concentrated, harder cheeses also might have a higher sodium content than softer ones.

“If you’re hypertensive, or you really need to control your sodium intake, or maybe you have renal issues, then probably going for a softer cheese would be better,” Castro Mortillaro said.

If you’re watching your weight, protein is the name of the game. It keeps you full longer, and helps you build muscle.

Cheeses that are rich in protein and lower in fat are great options for folks looking to manage their weight, Martorano said.

A good way to determine which cheeses fall in this category is to consider a 1:10 ratio of protein to calories, according to Martorano.

“For every 100 calories, there should be at least 10 grams of protein – that will tell you if it’s a good source of protein and in turn a healthier cheese,” she explained.

Some cheeses that she recommended based on this are light Swiss cheese, light cheddar cheese and ricotta.

If possible, steer clear of the highly processed stuff, including cheese in a can, individually wrapped slices and those blocks that don’t even need to be refrigerated.

“Squeezable cheese, American cheese, even cream cheese, provide minimal protein for a much higher fat and sodium content,” Martorano said.

Some of the processed cheese varietals are not even technically classified as “cheeses” by the US Food and Drug Administration, but as “pasteurized process cheese foods” or “pasteurized process cheese products,” depending on the percentage of actual cheese they contain along with other ingredients.

“Fresh is always better,” according to Martorano.

Dietary trends come and go, and Castro Mortillaro remembers the “fat-free phase” in the 1990s and early 2000s.

“We had fat-free cheese and fat-free mayonnaise, and all this other kind of stuff, and it was just highly processed,” she said.

Castro Mortillaro thinks that unless your specific goal is to lose weight, full-fat cheese should have a place in your diet.

“It’s better to have a smaller amount of something that is just more wholesome, if you’re in that neutral category, and enjoy it,” she said.

Some cheeses can also be a good source of probiotics, according to Martorano, who pointed to feta, goat cheese and cheese made from raw or unpasteurized milk as great options.

The artisanal cheese varieties, however, can cost a pretty penny.

“Not everyone can afford to buy the most fancy cheese. When it comes to packaged cheeses, they’re all fine in moderation,” Martorano said.

It’s best to think of cheese as a flavoring agent rather than as a meal in itself, according to both Martorano and Castro Mortillaro.

“Instead of using cheese as the main source of nutrients, it really is a side,” Martorano told CNN.

“If we’re pairing that cheese with something else – a vegetable, a whole grain – that’s what’s going to make it more of a satisfying, filling meal,” she explained.

Ricotta for breakfast, paired with some oatmeal and fruit, could be a healthy start to the day, Martorano suggested.

An afternoon snack with Swiss cheese and vegetables, or a whole grain cracker, would also be a good idea, she said.

Ultimately, unless there are specific concerns you need to keep in mind, the healthiest cheese is your favorite one, enjoyed sparingly as the delicious occasional treat that it should be.

“At the end of the day, if there’s a cheese that someone likes and they want to have it in moderation, it’s better to have the one that you like. So always pick the one you enjoy the most,” Martorano said.

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March 27, 2023

Colorectal cancer is rising among younger adults and scientists are racing to uncover why | CNN

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CNN
—

Nikki Lawson received the shock of her life at age 35.

A couple of years ago, she noticed that her stomach often felt irritable, and she would get sudden urges to use the restroom, sometimes with blood in her stool. She even went to the hospital one day when her symptoms were severe, she said, and she was told it might be a stomach ulcer before being sent home.

“That was around the time when Chadwick Boseman, the actor, passed away. I remember watching him on the news and having the same symptoms,” Lawson said of the “Black Panther” star who died of colon cancer at age 43 in August 2020.

“But at that time, I was not thinking ‘this is something that I’m going through,’ ” she said.

Instead, Lawson thought changing her diet would help. She stopped eating certain red meats and ate more fruits and vegetables. She began losing a lot of weight, which she thought was the result of her new diet.

“But then I went for a physical,” Lawson said.

Her primary care physician recommended that she see a gastroenterologist immediately because she had low iron levels.

“When I went and I saw my gastro, she said, ‘I’m sorry, I have bad news. We see something. We sent it off to get testing. It looks like it is cancer.’ My whole world just kind of blanked out,” Lawson said. “I was 35, healthy, going about my day, raising my daughter, and to get a diagnosis like this, I was just so shocked.”

Lawson, who was diagnosed with stage III rectal cancer, is among a growing group of colon and rectal cancer patients in the United States who are diagnosed at a young age.

The share of colorectal cancer diagnoses among adults younger than 55 in the US has been rising since the 1990s, and no one knows why.

Researchers at Dana-Farber Cancer Institute are calling for more work to be done to understand, prevent and treat colorectal cancer at younger ages.

In a paper published last week in the journal Science, the researchers, Dr. Marios Giannakis and Dr. Kimmie Ng, outlined a way for scientists to accelerate their investigations into the puzzling rise of colorectal cancer among younger ages, calling for more specialized research centers to focus on younger patients with the disease and for diverse populations to be included in studies on early-onset colorectal cancer.

Their hope is that this work will help improve outcomes for young colorectal cancer patients like Lawson.

Among younger adults, ages 20 to 49, colorectal cancer is estimated to become the leading cause of cancer-related deaths in the United States by 2030.

Lawson, now 36 and living in Palm Bay, Florida, with her 5-year-old daughter, is in remission and cancer-free.

The former middle school teacher had several surgeries and received radiation therapy and chemotherapy to treat her cancer. She is now being monitored closely by her doctors.

For other young people with colorectal cancer, “my words of hope would be to just stay strong. Just find that courage within yourself to say, ‘You know what, I’m going to fight this.’ And I just looked within myself,” Lawson said.

“I also have a very supportive family system, so they were definitely there for me. But it was very emotional,” she said of her cancer treatments.

“I remember crying through chemotherapy sessions and the medicine making you so weak, and my daughter was 4, and having to be strong for her,” she said. “My advice to any young person: If you see symptoms or you see something’s not right and you’re losing a lot of weight and not really trying to, go to see a doctor.”

Signs and symptoms of colorectal cancer include changes in bowel habits, rectal bleeding or blood in the stool, cramping or abdominal pain, weakness and fatigue, and weight loss.

A report released this month by the American Cancer Society shows that the proportion of colorectal cancer cases among adults younger than 55 increased from 11% in 1995 to 20% in 2019. Yet the factors driving that rise remain a mystery.

There’s probably more than just one cause, said Lawson’s surgeon, Dr. Steven Lee-Kong, chief of colorectal surgery at Hackensack University Medical Center in New Jersey.

He has noticed an increase in colorectal cancer patients in their 40s and 30s within his own practice. His youngest patient was 21 when she was diagnosed with rectal cancer.

“There is a phenomenon of decreasing overall colorectal cancer rates in the population in general, we think because of the increase in screening for particularly for older adults,” Lee-Kong said. “But that doesn’t really account for the overall increase in the number of patients younger than, say, 50 and 45 that are developing cancer.”

Some of the factors known to raise anyone’s risk of colorectal cancer are having a family history of the disease, having a certain genetic mutation, drinking too much alcohol, smoking cigarettes or being obese.

“They were established as risk factors in older cohorts of patients, but they do seem to be also associated with early-onset disease, and those are things like excess body weight, lack of physical activity, high consumption of processed meat and red meat, very high alcohol consumption,” said Rebecca Siegel, a cancer epidemiologist and senior scientific director of surveillance research at the American Cancer Society, who was lead author of this month’s report.

“But the data don’t support these specific factors as solely driving the trend,” she said. “So if you have excess body weight, you are at a higher risk of colorectal cancer in your 40s than someone who is average weight. That is true. But the excess risk is pretty small. So again, that is probably not what’s driving this increase, and it’s another reason to think that there’s something else going on.”

Many people who are being diagnosed at a younger age were not obese, including some high-profile cases, such as Broadway actor Quentin Oliver Lee, who died last year at 34 after being diagnosed with stage IV colon cancer.

“Anecdotally, in conferences that I’ve attended, that is the word on the street: that most of these patients are very healthy. They’re not obese; they’re very active,” Siegel said, which adds to the mystery.

“We know that excess weight increases your risk, and we know that we’ve had a big increase in body weight in this country,” she said. “And that is contributing to more cancer for a lot of cancers and also for colorectal cancer. But does it explain this trend that we’re seeing, this steep increase? No, it doesn’t.”

Yet scientists remain divided when it comes to just how much of a role those known risk factors – especially obesity – play in the rise of colorectal cancer among adults younger than 55.

Even though the cause of the rise of colorectal cancer in younger adults is “still not very well understood,” Dr. Subhankar Chakraborty argues that dietary and lifestyle factors could be playing larger roles than some would think.

“We know that smoking, alcohol, lack of physical activity, being overweight or obese, increased consumption of red meat – so basically, dietary factors and environmental and lifestyle factors – are likely playing a big role,” said Chakraborty, a gastroenterologist with The Ohio State University Comprehensive Cancer Center.

“There are also some other factors, such as the growing incidence of inflammatory bowel disease, that may also be playing a role, and I think the biggest factors is most likely the diet, the lifestyle and the environmental factors,” he said.

It has been difficult to pinpoint causes of the rise of cases in younger ages because, if someone has a polyp in their colon for example, it can take 10 to 15 years to develop into cancer, he says.

“During that, all the way from a polyp to the cancer stage, the person is exposed to a variety of things in their life. And to really pinpoint what is going on, we would need to follow specific individuals over time to really understand their dietary patterns, medications and weight changes,” Chakraborty said. “So that makes it really hard, because of the time that cancer actually takes to develop.”

Some researchers have been investigating ways in which the rise in colorectal cancer among younger adults may be connected to increases in childhood obesity in the US.

“The rise in young-onset colorectal cancer correlates with a doubling of the prevalence of childhood obesity over the last 30 years, now affecting 20% of those under age 20,” Dr. William Karnes, a gastroenterologist and director of high-risk colorectal cancer services at the UCI Health Digestive Health Institute in California, said in an email.

“However, other factors may exist,” he said, adding that he has noticed “an increasing frequency of being shocked” by discoveries of colorectal cancer in his younger patients.

There could be correlations between obesity in younger adults, the foods they eat and the increase in colorectal cancers for the young adult population, said Dr. Shane Dormady, a medical oncologist from El Camino Health in California who treats colorectal cancer patients.

“I think younger people are on average consuming less healthy food – fast food, processed snacks, processed sugars – and I think that those foods also contain higher concentrations of carcinogens and mutagens, in addition to the fact that they are very fattening,” Dormady said.

“It’s well-publicized that child, adolescent, young adult obesity is rampant, if not epidemic, in our country,” he said. “And whenever a person is at an unhealthy weight, especially at a young age, which is when the cells are most susceptible to DNA damage, it really starts the ball rolling in the wrong direction.”

Yet at the Center for Young Onset Colorectal and Gastrointestinal Cancers at Memorial Sloan Kettering Cancer Center, researchers and physicians are not seeing a definite correlation between the rise in colorectal cancer among their younger adult patients and a rise in obesity, according to Dr. Robin Mendelsohn, gastroenterologist and co-director of the center, where scientists and doctors continue to work around the clock to solve this mystery.

“When we looked at our patients, the majority were more likely to be overweight and obese, but when we compare them to a national cohort without cancer, they’re actually less likely to be overweight and obese,” she said. “And anecdotally, a lot of the patients that we see are young and fit and don’t really fit the obesity profile.”

That leaves many oncologists scratching their heads.

Some scientists are also exploring whether genetic mutations that can raise someone’s risk for colorectal cancer have played a role in the rise of cases among younger adults – but the majority of these patients do not have them.

Karnes, of UCI Health, said “it is unlikely” that there has been an increase in the genetic mutations that raise the risk of colorectal cancer, “although, as expected, the percentage of colorectal cancers caused by such mutations, e.g., Lynch syndrome, is more common in people with young-onset colorectal cancer.”

Lynch syndrome is the most common cause of hereditary colorectal cancer, causing about 4,200 cases in the US per year. People with Lynch syndrome are more likely to get cancers at a younger age, before 50.

“In my practice and in the medical community, the oncologic community, I don’t think there’s any proof that genetic syndromes and gene mutations that patients are born with are becoming more frequent,” El Camino Health’s Dormady said. “I don’t think the inherent frequency of those mutations is going up.”

The tumors of younger colorectal cancer patients are very similar to those of older ones, said Mendelsohn at Memorial Sloan Kettering Cancer Center.

“So then, the question is, if they’re biologically the same, why are we seeing this increasingly in younger people?” she said. “About 20% may have a genetic mutation, so the majority of patients do not have a family history or genetic predisposition.”

Therefore, Mendelsohn added, “it’s likely some kind of exposure, whether it be diet, medication, changing microbiome,” that is driving the rise in colorectal cancers in younger adults.

That rise “has been something that’s been on our radar, and it has been increasing since the 1990s,” Mendelsohn said. “And even though it is increasing, the numbers are still small. So it’s still a small population.”

Dormady, at El Camino Health, said he now sees more colorectal cancer patients in their early to mid-50s than he did 20 years ago, and he wonders whether it might be a result of colorectal cancer screening being easier to access and better at detecting cancers.

“The first thing to consider is that some of our diagnostic modalities are becoming better,” he said, especially because there are now many at-home colorectal cancer testing kits. Also, in 2021, the US Preventive Services Task Force lowered the recommended age to start screening for colon and rectal cancers from 50 to 45.

“I think you have a subset of patients who are being screened earlier with colonoscopies; you have advancing technology where we can potentially detect tumor cell DNA in the stool sample, which is leading to earlier diagnosis. And sometimes that effect will skew statistics and make it look like the incidence is really on the rise, but deeper analysis shows you that part of that is due to earlier detection and more screening,” he said. “So that could be one facet of the equation.”

Overall, pinpointing what could be driving this surge in colorectal cancer diagnoses among younger ages will not only help scientists better understand cancer as a disease, it will help doctors develop personalized risk assessments for their younger patients, Ohio State University’s Chakraborty said.

“Because most of the people who go on to develop colorectal cancer really have no family history – no known family history of colon cancer – so they would really not be aware of their risk until they begin to develop symptoms,” he said.

“Having a personalized risk assessment tool that will take into account their lifestyle, their environmental factors, genetic factors – I think if we have that, then it would allow us hopefully, in the future, to provide some personalized recommendations on when a person should be screened for colorectal cancer and what should be the modality of screening based on their risk,” he said. “Younger adults tend to develop colon cancer mostly in the left side, whereas, as we get older, colon cancer tends to develop more on the right side. So there’s a little difference in how we could screen younger adults versus older adults.”

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March 18, 2023

Ozempic prescriptions can be easy to get online. Its popularity for weight loss is hurting those who need it most | CNN

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CNN
—

Telehealth and social media are playing a significant role in driving demand for Ozempic, a prescription drug that treats Type 2 diabetes, experts told CNN. The current drug shortage has limited access for patients with diabetes who rely on it to control their blood sugar.

Digital health companies make medications like Ozempic easier to get by providing prescriptions online. Many advertise quick and easy — sometimes same-day — access.

“Anecdotally, it’s almost easier to get medication [via digital health companies],” said Dr. Disha Narang, endocrinologist and director of obesity medicine at Northwestern Medicine, Lake Forest Hospital. “But not always the safest.” People who put in average weights on the online intake forms were still offered the antidiabetic drug, Narang told CNN.

In part because of Ozempic’s popularity, the prescription weight loss drug market has grown significantly, according to MarketData Enterprises, an independent market research and consulting firm. The market surpassed forecasters’ expectations for 2022 and is expected to become a nearly $2 billion industry in 2023.

WeightWatchers is also tapping into the telehealth prescription drug space. Last week, the company bought telehealth subscription service Sequence, which helps connect patients to doctors who can prescribe weight loss and diabetes drugs.

“At the start of 2022, these companies weren’t marketing this stuff,” Narang said, noting advertising around Ozempic took off in 2022. “I think we really need to start questioning our ethics around this.”

There are few across-the-board requirements when it comes to digital health companies’ intake processes, Dr. Bree Holtz, an associate professor at Michigan State University studying telemedicine, told CNN. Once a patient fills out the required forms online, information gets transferred to an in-state provider who can write the prescription. Some companies require that the patient hop on a video or phone call with the provider — others don’t require either.

“It’s a little scary that you can just wake up and get these appointments in — or these pharmaceuticals — and you’re not being cared for,” said Holtz.

Telehealth has been a game changer in providing access to health care, particularly during the pandemic. And especially for people living in places where high-quality primary care is not available, direct to consumer telehealth services can help fill a gap, said Dr. Laurie Buis, associate professor in the Department of Family Medicine at the University of Michigan, whose research focuses on digital health.

When patients begin to seek selective treatment from selective providers, however, Buis says it opens the door to problems like fragmented care or abuse. Telehealth providers may not have access to a patient’s full medical history and may be less able to provide holistic care that a primary care physician otherwise could.

“I have no doubt that some of these services are doing a good job,” said Buis. “There are also services that don’t take it quite as seriously. And that’s of concern.”

The US Food and Drug Administration first announced that Ozempic was in shortage last August. Supply will likely be strained through mid-March, according to the FDA drug shortages database.

Ozempic prescriptions in the US reached an all-time high in the last week of February, with over 373,000 prescriptions filled, according to a J.P. Morgan analysis of IQVIA data shared with CNN. That’s an increase of 111%, compared with the same week in 2022.

Of these, more than half were new prescriptions, according to a CNN review of J.P. Morgan’s analysis.

With many patients relying on Ozempic for diabetes treatment, providers like Narang are scrambling to figure out what alternatives to put their patients on.

“We’re getting messages daily about patients not being able to get their own medication,” Narang said. “It’s been tough for patients and providers alike.”

Ozempic currently holds more than 40% of the US market share of glucagon-like peptide 1 (GLP-1) agonists — a class of drugs that mimic an appetite-regulating hormone — according to analysis from J.P. Morgan. These drugs work by stimulating the release of insulin, which helps lower blood sugar. They also slow the passage of food through the gut.

Ozempic has grown quickly in popularity since it was first put on the market in 2018. The drug has safely and successfully been used to help diabetics improve blood sugar levels and put diabetes into remission, Narang told CNN. Ozempic is the most potent of all the GLP-1 medications, she said.

Behind the brand name Ozempic is the medication semaglutide. While Ozempic is used primarily to treat Type 2 diabetes, another drug by the name Wegovy — also semaglutide — is approved specifically for chronic weight management.

Although approved by the FDA in 2021, Wegovy was not readily available through most of last year, according to Narang, so people turned to Ozempic. According to the FDA drug shortages database, Wegovy was undersupplied starting at the end of last March but came back in stock earlier this year.

Social media buzz around the two drugs took off at the start of 2023. Celebrities shared their testimonies about how semaglutide helped them shed unwanted pounds. Elon Musk, for example, publicly credited Ozempic and Wegovy in part for his weight loss.

#Ozempic and #Wegovy have been “extremely popular” over the last few months on TikTok, according to company analytics.

The use of Ozempic and Wegovy for short-term weight loss has resulted in real consequences for patients who need the drugs most for diabetes treatment and chronic weight management, said Narang. For example, some insurance companies in the past have reportedly refused to cover Wegovy, one calling it a “vanity drug.”

Both drugs are intended for long-term use, not for short-term weight loss. Their appetite-regulating effects wear off quickly after you stop taking them.

“This is not meant to be a medication to take off your last five or 10 pounds to get ready for an event or something like that. It’s not for use of three or four weeks,” Narang said. “When we think about weight management, we’re thinking about the next 25 years of someone’s life.”

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March 5, 2023

Bempedoic acid improved heart health in patients who can’t tolerate statins, study finds | CNN

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CNN
—

Bempedoic acid may be an alternative for people who need to lower their cholesterol but can’t or won’t take statins, according to a large study published Saturday in the New England Journal of Medicine.

Statins are the most commonly prescribed cholesterol-lowering drugs that help lower what’s known as the “bad” cholesterol, or low-density lipoprotein (LDL) cholesterol in the blood; more than 90% of adults who take a cholesterol-lowering medicine use a statin, according to the US Centers for Disease Control and Prevention.

Statins are considered safe and effective, but there are millions of people who cannot or will not take them. For some people it causes intense muscle pain. Past research has shown anywhere between 7% and 29% of patients who need to lower cholesterol do not tolerate statins, according Dr. Steven Nissen, a cardiologist and researcher at the Cleveland Clinic and co-author of the new study.

“I see heart patients that come in with terrible histories, multiple myocardial infarction, sometimes bypass surgery, many stents and they say, ‘Doctor, I’ve tried multiple statins, but whenever I take a statin, my muscles hurt, or they’re weak. I can’t walk upstairs. I just can’t tolerate these drugs,’ ” Nissen said. “We do need alternatives for these patients.”

Doctors have a few options, including ezetimibe and a monoclonal antibody called a proprotein convertase subtilisin/kexin type 9, or PCSK9 inhibitors for short.

Bempedoic acid, sold under the name Nexletol, was designed specifically to treat statin-intolerant patients. The FDA approved it for this purpose in 2020, but the effects of the drug on heart health had not been fully assessed until this large trial. The new study was funded in part by Esperion Therapeutics, the maker of Nexletol.

For the study, which was presented Saturday at the American College of Cardiology’s Annual Scientific Session with the World Congress of Cardiology, Nissen and his colleagues enrolled 13,970 patients from 32 countries.

All of the patients were statin intolerant, typically due to musculoskeletal adverse effects. Patients had to sign an agreement that they couldn’t tolerate statins “even though I know they would reduce my risk of a heart attack or stroke or death,” and providers signed a similar statement.

The patients were then randomized into two groups. One was treated with bempedoic acid, the other was given a placebo, which does nothing. Researchers then followed up with those patients for up to nearly five years. The number of men and women in the trial were mostly evenly divided, and most participants, some 91%, were White, and 17% were Hispanic or Latino.

The drug works in a similar way that statins do, by drawing cholesterol out of a waxy substance called plaque that can build up in the walls of the arteries and interfere with the blood flow to the heart. If there is too much plaque buildup, it can lead to a heart attack or stroke.

But bempedoic acid is only activated in the liver, unlike a statin, so it is unlikely to cause muscle aches, Nissen said.

In the trial, investigators found that bempedoic acid was well-tolerated and the percent reduction in the “bad” cholesterol was greater with bempedoic acid than placebo by 21.7%.

The risk of cardiovascular events – including death, stroke, heart attack and coronary revascularization, a procedure or surgery to improve blood flow to the heart – was 13% lower with bempedoic acid than with placebo over a median of 3.4 years.

“The drug worked in primary and secondary prevention patients – that is, patients that had had event and patients who were very high risk for a first event. There were a lot of diabetics. These were very high risk people,” Nissen said. “So the drug met its expectations and probably did a lot better than a lot of people thought it would do.”

In the group that took bempedoic acid, there were a few more cases of gout and gallstones, compared with people who took a placebo.

“The number is small, and weighing that against a heart attack, I think most people would say, ‘OK I’d rather have a little gout attack,’ ” Nissen said.

Bempedoic acid had no observed effect on mortality, but that may be because the observation period was too short to tell if it had that kind of impact. Earlier trials on statins showed the same; it was only after there were multiple studies on statins that scientists were able to show an impact on mortality.

Dr. Howard Weintraub, a cardiologist at NYU Langone Health who did not work on this study, said that while he knows some people will not consider a medication successful unless it reduces mortality, he thinks that is short-sighted.

“I think there’s more to doing medicine then counting body bags,” Weintraub said.”Preventing things that can be life changing, crippling, and certainly change your quality of life forever going forward, and your cost of doing things going forward, I think is a good thing.”

He was pleased to see the results of this trial, especially since the people in this study are often what he called “forgotten individuals” – the millions who could benefit from lowering their cholesterol, but can’t take statins.

“It’s not like their LDL was 180 or 190 or 230, their LDL was 139. This is about average in our country,” Weintraub said. He said often doctors will just tell those patients to watch their diet, but he thinks this suggests they would benefit from medication.

“Both groups primary and secondary prevention got benefit, which I think is impressive with the modest amount of LDL reduction,” Weintraub said.

There are some limitations to this trial. It was narrowly focused on patients with a known statin intolerance. Nissen said the trial was not designed to determine whether bempedoic acid could be an alternative to statins.

“Statins are the gold standard. They are the cornerstone. The purpose of this study was not to replace statins, but to allow an alternative therapy for people who simply cannot take them,” Nissen said.

Bempedoic acid is a much more expensive drug than a statin. There are generic versions of statins and some cost only a few dollars. Bempedoic acid, on the other hand, has no generic alternative and a 30-day supply can cost more than $400, according to GoodRx.

“I think what insurance companies need to recognize that even though this drug is going to cost more than statins, having a heart attack or a stroke or needing a stent is expensive. A 23% reduction in (myocardial infarctions) is a considerable reduction,” Weintraub said.

In an editorial in the New England Journal of Medicine that accompanied the study, Dr. John H. Alexander, who works in the division of cardiology at Duke Clinical Research Institute, Duke Health, Durham said that doctors should take these results into consideration when treating patients with high cholesterol who can’t take statins.

“The benefits of bempedoic acid are now clearer, and it is now our responsibility to translate this information into better primary and secondary prevention for more at-risk patients, who will, as a result, benefit from fewer cardiovascular events,” Alexander wrote.

Dr. Manesh Patel, a cardiologist and volunteer with the American Heart Association who was not a part of the study, said that providers are already prescribing bempedoic acid for some patients, but with this new research, he thinks they will quickly be used with more statin-intolerant patients.

“We continue to see that if we can lower your LDL significantly, we improve people’s cardiovascular health. And so we need as many different arrows in our quiver to try to get that done,” Patel said.

Heart disease is the No. 1 killer for men and women in the world. One person dies every 34 seconds in the US from cardiovascular disease, according to the CDC. About 697,000 people in the US died from heart disease in 2020 alone – about the same number as the population of Oklahoma City.

“Given the number of people that are eligible for statins, which are tens of millions of patients already, the number of people who cannot tolerate statins is in the millions,” Nissen said. “This is a big public health problem and I think we’ve come up with something that directly addresses this.”

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March 3, 2023

How to stop dieting, according to people who have done it | CNN

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Editor’s Note: This is part of an ongoing series that takes a closer look at eating disorders, disordered eating and relationships with food and body image.

CNN
—

Ending cycles of dieting and learning to accept the body you are in sounds great, but it may feel a bit like a fairytale.

How can you control how you eat without counting calories? How should you stop planning for the day when you are thinner? How do you wake up one day without those shameful, mean thoughts knocking at the door to your brain?

It’s hard, said Bri Campos, a body image coach based in Paramus, New Jersey. The goal might not be fully celebrating your body or releasing yourself from all the negative thoughts about weight that comes from diet culture, she said. It could mean just making progress toward feeling less shame or self-criticism.

Diet culture is the widespread societal messages that small bodies are better, larger bodies are shameful and restricted eating is the key to an “acceptable” body. Ascribing to those messages is harmful to people of all body types, especially considering it can encourage eating disorders and make recovery therefrom even more difficult, according to the National Eating Disorder Association.

The promise of attaining (and retaining) the ideal body is hollow, as dropping weight drastically in a short period is likely to be followed by a person gaining it back again. Slow, sustained changes are often more successful, according to a 2017 study. And while some studies do recommend losing weight to reduce the risk of conditions such as heart disease and cancer, it’s also true that health is determined by many factors — shame doesn’t help.

There are ways to unlearn diet culture, Campos said. The process is different for each person, but it can help to find community with other people with similar goals, she added.

Here are several stories of people trying to reject diet culture and what they have found in their journeys along the way.

Shanea Pallone started to question her experience with diet culture after a doctor body-shamed her at an appointment. It’s been hard to be a patient in a medical system that has caused her great harm. “I am actively being harmed by providers who don’t see me as more than my weight on the scale,” Pallone said.

But Pallone, who lives in Houston, Texas, also works as a nurse; her job has required her to assess her patients’ weights, mark if they were considered obese on their medical charts and teach them the same dieting tactics she was trying to unlearn herself, she said.

Pallone recalled constantly asking herself, “How do I navigate my own care and giving good care and still work on unpacking some of the ways diet culture still sinks in?” Her answer included going back to research that showed that dieting wasn’t effective — and confirmed she could live healthfully and provide care without shame.

Learning about intuitive eating — an eating philosophy that relies on the body’s natural hunger and fullness cues — helped her in both her personal and professional journeys.

Changing her thinking doesn’t mean that intrusive thoughts about food and diet completely truly go away, but it has gotten easier to see them and try to quiet them, Pallone said. Now Pallone works to help her patients meet their health goals in a way that doesn’t keep them from the foods they love eating or make them feel like they’ve failed, she said.

But while she has been able to have some meaningful impacts on her patients, she had to accept she could not rescue everyone from diet culture.

“It is really hard to walk away from a woman in her 80s, who is moving toward hospice, who (is) like, ‘It’s really ok that I’m losing weight, I’ve always been a little chunky,’” Pallone said.

Amanda Mittman said the process of shedding diet culture is ongoing.

Amanda Mittman, a registered dietitian in Amherst, Massachusetts, began moving away from diet culture after her son was born. She couldn’t bring herself to return to a restrictive way of eating as a new mother, but still felt shame around the weight she hadn’t lost postpartum, she said.

“We’re all still swimming in the same toxic soup,” she said.

Mittman’s first step was to learn to identify diet culture around her, across entertainment media, in advertisements and even in conversations with friends and family, she said.

And once she saw it — like pulling the curtain back on the Wizard of Oz — she found she couldn’t go back to how she saw things before.

This didn’t mean she was ready to give up on dieting and completely accept her body. Diets had always offered her a magical solution: lose weight and you can have everything you’ve ever wanted. It was scary to give up on that dream — and to face the possibility that, in living differently, she might gain weight instead of losing it.

But as she found a community free of diet culture and moved her social media feeds to not value weight loss, Mittman said accepting the grief and mourning that comes with giving up on those goals became a big part of her process.

“I still have the thoughts of ‘wouldn’t it be great if I could lose weight?’” she said. But she reminds herself, “We have been down that road and that’s just not available to me anymore.”

The work to accept her body and love herself isn’t glamorous, she said. There’s “no cap and gowns, you don’t graduate — this is constant work,” Mittman said. “But it gets easier all the time.”

Sandra Thies' mirror was a big trigger and now is part of her healing.

After years on her college varsity rowing team and trying to shape her body to fit expectations, Sandra Thies found herself a little lost without a strict diet and exercise routine.

“The easy way out is to go on another diet, to buy into diet culture online, to restrict your eating,” Thies said. “It’s the easy way to feel that you have control.”

Much of that desire for control would come out around reflective surfaces, she said.

Whether it was the windows she walked by, mirrors in her work bathroom or even at home when she got out of the shower – all were places for Thies to poke and prod at her body, to see if she needed to work out or if she could give herself a little extra at dinner. And days wrestling with her reflection would lead to nights spent staring up at the ceiling, thinking about what she could do better the next day to get closer to her “ideal” body.

Thies, now an intuitive eating counselor in Kelowna, British Columbia, came across the concept in college and remembers thinking, “wouldn’t it be nice to be at peace with food and your body?” Four years later, she feels like she’s still learning how to move in a way that feels good, how to eat what her body needs and how to stand in front of her reflection without picking it apart.

But the mirror has actually become part of her solution, she said.

She has questions now written on her mirror at home: “What is the feeling? Where do you feel it in your body? How bad is it? Can we sit in this discomfort? What do you need in the moment?”

She now tries to take time to sit with those feelings. Sometimes, she can get through answering all the questions. But on the days she can’t, Thies said she gives herself permission to do what she can to keep her self-talk positive.

“I think about my body and food very frequently,” Thies said. “But the voice that I use has really changed. It leaves me feeling confident and empowered rather than broken down.”

Dani Bryant said she saw her own body in the women that came before her.

Dani Bryant thought her experiences with her body would threaten to her creative dreams, but instead they turned out to be an avenue to get there.

As a kid passionate about theater, Bryant heard similar messages from her directors, chorus teachers and costumers: You are so talented, but your body has to be smaller if you want to make it big.

She was only a 9-year-old when she first showed signs of disordered eating. By her sophomore year of college pursuing a career in theater, she had developed anorexia, Bryant said.

As part of Bryant’s recovery, she began writing and developed a theater company in Chicago centered around the experiences of body issues and disordered eating, Bryant said. There she found the support she felt was key to her developing relationship with her body.

“My healing is so much in sharing the lived experience, building community around it and that slow unlearning,” she said.

Bryant said finding a photo of her family coming to the US gave her better perspective on her own body.

One big moment in Bryant’s healing journey came when she went with her mother on a trip to Ellis Island in New York City, where they happened across a photograph of her family arriving in the United States generations ago.

In the photo, she saw her great grandmother, whose body was shaped just like her grandmother’s, her mother’s and her own, Bryant said.

There she realized her body was more than her choices or her dieting — it was the result of her family, genetics and her history.

She wished she could go back to the little girl she once was to show her that picture and ask her to stop fighting the “unwinnable war” for a smaller body she was never meant to have, she said.

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