Tag: weight loss diets

May 16, 2023

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

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CNN
— 

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 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 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 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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February 12, 2023

What’s the magic number of steps to keep weight off? Here’s what we know | CNN

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CNN
— 

Taking 8,600 steps a day will prevent weight gain in adults, while already overweight adults can halve their odds of becoming obese by adding an additional 2,400 steps — that’s 11,000 steps a day, according to an October 2022 study.

Studies show the average person gains between 1 and 2 pounds (0.5 to 1 kilograms) each year from young adulthood through middle age, slowly leading to an unhealthy weight and even obesity over time.

“People really can reduce their risk of obesity by walking more,” said study author Dr. Evan Brittain, associate professor in the division of cardiovascular medicine at Vanderbilt University Medical Center in Nashville.

The study also found key benefits for chronic diseases and conditions: “Diabetes, sleep apnea, hypertension, diabetes, depression, and GERD showed benefit with higher steps,” said Brittain via email.

“The relationship with hypertension and diabetes plateaued after about 8,000 to 9,000 steps but the others were linear, meaning higher steps continued to reduce risk,” he said. “I would say that the take home messages are that more steps are better.”

It’s yet another study illustrating the powerful impact that walking and other forms of exercise have on our health. In fact, if you get up and move for 21.43 minutes each day of the week, you cut your risk of dying from all causes by one-third, according to the US Centers for Disease Control and Prevention.

Current physical activity recommendations for adults are 150 minutes of moderate-intensity exercise, such as brisk walking, dancing, bicycling, doubles tennis and water aerobics, and two days of muscle-strengthening activity each week.

“Physical activity is just absolutely magnificent,” Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver, told CNN in an earlier interview.

“And when if you blend that with eating a more plant-based diet, de-stressing, sleeping enough and connecting with others — that’s your magic recipe,” Freeman said. “It’s the fountain of youth, if you will.”

Activity trackers allow researchers to get more accurate data that can be compared with health records.

The study analyzed an average of four years of activity and health data from more than 6,000 participants in the National Institutes of Health’s All of Us Research Program, dedicated to research on ways to develop individualized health care.

Participants in the study, published on October 10, 2022, in the journal Nature Medicine, wore activity trackers at least 10 hours a day and allowed researchers access to their electronic health records over multiple years.

“Our study had an average of 4 years of continuous activity monitoring. So, we were able to account for the totality of activity between when monitoring started and when a disease was diagnosed, which is a major advantage because we didn’t have to make assumptions about activity over time, unlike all prior studies,” Brittain said.

People in the study ranged in age from 41 to 67 and had body mass index levels from 24.3, which is considered in the healthy weight range, to 32.9, which is considered obese.

Researchers found that people who walked 4 miles a day — about 8,200 steps — were less likely to become obese or suffer from sleep apnea, acid reflux and major depressive disorder. Sleep apnea and acid reflux respond well to weight loss, which can reduce pressure on the throat and stomach, while exercise is a cornerstone treatment for depression.

The study also found that overweight participants (those with BMIs ranging from 25 to 29) cut their risk of becoming obese by half if they increased their steps to 11,000 steps a day. In fact, “this increase in step counts resulted in a 50% reduction in cumulative incidence of obesity at 5 years,” the study found.

Applying the data to a specific example, the authors said individuals with BMIs of 28 could lower their risk of obesity 64% by increasing steps from about 6,000 to 11,000 steps per day.

This research echoes results from a recent study in Spain in which researchers found health benefits rose with every step until about 10,000 steps, when the effects began to fade. Counting steps may be especially important for people who do unstructured, unplanned physical activity such as housework, gardening and walking dogs.

“Notably, we detected an association between incidental steps (steps taken to go about daily life) and a lower risk of both cancer and heart disease,” study coauthor Borja del Pozo Cruz told CNN in an earlier interview. Del Pozo Cruz is an adjunct associate professor at the University of Southern Denmark in Odense and senior researcher in health sciences for the University of Cadiz in Spain.

The same research team also published a similar study in September 2022 that found walking 10,000 steps a day lowered the risk for dementia by 50%; the risk decreased by 25% with as few as 3,800 steps a day.

However, if walking occurred at a brisk pace of 112 steps a minute for 30 minutes, it maximized risk reduction, leading to a 62% reduction in dementia risk. The 30 minutes of fast-paced walking didn’t have to occur all at once either — it could be spread out over the day.

Researchers found the association between peak 30-minute steps and risk reduction to be dependent on the disease studied: There was a 62% reduction for dementia, an 80% decline for cardiovascular disease and death, and about a 20% drop in risk for cancer.

The study also found an association between step intensity and health benefits as well, “although the relationships were less consistent than with step counts,” researchers said.

A major limitation of all studies using step trackers is that people who wear them tend to be more active and healthier than the norm, the researchers said. “Yet the fact that we were able to detect robust associations between steps and incident disease in this active sample suggests even stronger associations may exist in a more sedentary population,” they said.

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February 11, 2023

Restrict calories to live longer, study says, but critics say more proof is needed | CNN

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CNN
— 

People of normal weight may be able to extend their life span by restricting calories, according to a new study that attempted to measure the pace of aging in people asked to cut their calorie intake by 25% over two years.

“We’ve known for nearly 100 years that calorie restriction can extend healthy life span in a variety of laboratory animals,” said senior author Daniel Belsky, an associate professor of epidemiology at Columbia University Mailman School of Public Health.

“It does this by changing biology in ways consistent with a slowing of the process of aging, although the specific mechanisms of how this occurs are still under investigation,” said Belsky, who studies longevity. “We decided to drill down to the cellular level in people to see if the same is true.”

The study used what are commonly known as “biological clocks” to determine the pace of aging in its participants. Bioclocks are designed to measure how old people are biologically compared with their real ages chronologically.

“Our study found evidence that calorie restriction slowed the pace of aging in humans,” said colead author Calen Ryan, an associate research scientist at the Robert N. Butler Columbia Aging Center at Columbia.

“Our findings are important because they provide evidence from a randomized trial that slowing human aging may be possible,” Ryan said in a statement.

But longevity scientist Dr. Peter Attia dismissed the study results as “noise.”

“I just don’t see any evidence that any of the biologic clocks have meaning,” Attia, who was not involved in the study, said via email. He hosts “The Drive,” a podcast dedicated to explaining and applying longevity research to everyday life.

“The only validation that matters — which to my knowledge has not been done, but hopefully will be — is to see if ‘biologic age’ can predict future life better than chronological age,” he said.

Biological age predictors are controversial, said calorie restriction researcher Pankaj Kapahi, a professor at the Buck Institute for Research on Aging in Novato, California.

“At best, they’re telling you something about a very small aspect of aging,” said Kapahi, who was not involved in the study. “For example, grip strength is also a biological age predictor, how active you are is a predictor, and we all know people who fall apart physically but are cognitively all there, so you also need to test cognitive aging.

“Some researchers are trying to boil it down with bio-aging tests,” he added. “This is a much more complex problem, and I think it’s an overstatement to say the tests really predict biological age.”

Decades of research in animals have shown that calorie restriction produces health benefits, even slowing the pace of aging. Would the same be true in people?

A study in the 1950s asked people to reduce 50% of their calories, leading to malnutrition or a lack of key micronutrients in participants. Later research often focused on calorie reduction in people whose body mass index would be considered medically obese.

The first clinical trial of calorie restriction in people at normal weight (a BMI of about 20 to 25) started in 2007. It was called CALERIE, or the Comprehensive Assessment of Long-Term Effects of Reducing Intake of Energy.

Because of the malnutrition found in the earlier study that cut calories drastically, CALERIE asked 143 adults between the ages of 21 and 50 to cut 25% of the calories they typically ate for a two-year period. Another group of 75 people maintained their normal diets, serving as a control group.

During the trial, all manner of tests were done at six-month intervals to gather information on weight loss, change in resting metabolic rate, impact on cognitive function and markers of inflammation, cardiovascular health and insulin sensitivity.

The results of CALERIE, published in 2015, found that on average people in the restricted group were able to cut 14% of their calories, or about half of the 25% goal. However, that amount reduced their fat mass by about 10% and decreased their cardiometabolic risk factors with no adverse effects on quality of life, researchers said. There were also reductions in tumor necrosis factor alpha, a protein that promotes insulin resistance and obesity-induced type 2 diabetes.

A number of other studies have used blood samples and other data collected on the CALERIE participants to explore other ways modest calorie restriction might benefit the body. For example, Yale University researchers found restricting calories increased the health of the thymus, an organ that produces immune system T cells — one of the body’s key warriors against invaders.

The new study, published Thursday in the journal Nature Aging, culled DNA sequences from white blood cells taken at 12-month intervals from participants in CALERIE. Belsky’s team then analyzed methylation marks — signs of epigenetic changes — on the DNA, looking for symptoms of aging.

Epigenes are proteins and chemicals that sit like freckles on each gene, waiting to tell the gene “what to do, where to do it, and when to do it,” according to the National Human Genome Research Institute.

“Increasingly, changes to our cells’ epigenomes, the systems that control which genes in the genome are turned on and off, are being recognized as drivers of the aging process,” said anti-aging expert David Sinclair, a professor of genetics in the Blavatnik Institute at Harvard Medical School and codirector of the Paul F. Glenn Center for Biology of Aging Research.

“Clocks that measure these changes are proving to be indicators of future health and what interventions might slow and even reverse the aging process,” said Sinclair, who was not involved in the study.

In the new study, researchers used two epigenetic clocks — PhenoAge and GrimAge — and a new tool Belsky recently invented in conjunction with Duke University. This third bioclock, called DunedinPACE, attempts to determine the pace of aging from a single blood test, Belsky said.

The PhenoAge and GrimAge bioclocks showed no signs of reduced aging in the blood samples of participants in CALERIE, said Belsky, who is also a scientist with Columbia’s Robert N. Butler Aging Center.

However, DunedinPACE, the clock created by Belsky’s and Duke’s teams, did find a 2% to 3% reduction in the pace of aging, “which in other studies translates to a 10-15 percent reduction in mortality risk, an effect similar to a smoking cessation intervention,” according to a statement from Columbia.

Critics of the study, however, were not impressed. The performance of the DunedinPACE test was “mediocre at best,” Attia said, finding only a weak association with biological aging.

The fact that the two other bioclocks found no anti-aging benefits was no surprise, said the Buck Institute’s Kapahi: “These biological age predictors don’t agree with each other and don’t necessarily agree with other biological measures.

“It’s going to confuse the public, and unfortunately people are buying these tests when there’s very little useful information that comes out of them.”

While it’s true epigenetic biomarkers are not yet ready to be used in clinical trials, “many different studies in many different datasets and populations have shown these algorithms are predictive of differences between people in who gets sick and who lives or dies,” Belsky countered.

“This is not a game over moment. It’s more like game on,” Belsky said. “What we have now is a proof of concept — a methylation biomarker that shows faster aging in people we know to be at higher risk for disease, disability and death, and slower aging in people who we know to be at lower risk.”

Putting aside the debate over how slower aging is measured, there is a role for caloric restriction in extending life, especially in “overnourished” individuals, Attia said.

“I don’t want a reader to think this intervention (calorie restriction) is of no value, only that (the study) does not ‘prove’ a reduction in the pace of aging,” he said in an email.

Time-restricted eating and dietary restriction of certain foods are two additional ways to curb “overnutrition,” which Attia believes is the biggest driver of insulin resistance, type 2 diabetes and other chronic diseases.

“I am not aware of any evidence that one ‘strategy’ or method is superior. The best one is the one that works for a person, but calorie restriction certainly works for some, and therefore is clearly beneficial,” Attia said. “All of these interventions will lead to a longer and better life, but these aging clocks tell us less than zero about that process.”

There are many other ways to curb aging as well, Kapahi said.

“We’re trying to learn more about aging and we are, but calorie restriction is just one intervention,” he said. “You likely need to do that in combination with exercise, with good sleep, with a positive attitude and good mental health. All these things combined will likely play a much bigger role in slowing aging.”

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January 30, 2023

Weight loss surgery extends lives, study finds | CNN

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CNN
— 

Weight loss surgery reduces the risk of premature death, especially from such obesity-related conditions as cancer, diabetes and heart disease, according to a new 40-year study of nearly 22,000 people who had bariatric surgery in Utah.

Compared with those of similar weight, people who underwent one of four types of weight loss surgery were 16% less likely to die from any cause, the study found. The drop in deaths from diseases triggered by obesity, such as heart disease, cancer and diabetes, was even more dramatic.

“Deaths from cardiovascular disease decreased by 29%, while deaths from various cancers decreased by 43%, which is pretty impressive,” said lead author Ted Adams, an adjunct associate professor in nutrition and integrative physiology at the University of Utah’s School of Medicine.

“There was also a huge percentage drop — a 72% decline — in deaths related to diabetes in people who had surgery compared to those who did not,” he said. One significant downside: The study also found younger people who had the surgery were at higher risk for suicide.

The study, published Wednesday in the journal Obesity, reinforces similar findings from earlier research, including a 10-year study in Sweden that found significant reductions in premature deaths, said Dr. Eduardo Grunvald, a professor of medicine and medical director of the weight management program at the University of California San Diego Health.

The Swedish study also found a significant number of people were in remission from diabetes at both two years and 10 years after surgery.

“This new research from Utah is more evidence that people who undergo these procedures have positive, beneficial long-term outcomes,” said Grunvald, who coauthored the American Gastroenterological Association’s new guidelines on obesity treatment.

The association strongly recommends patients with obesity use recently approved weight loss medications or surgery paired with lifestyle changes.

“And the key for patients is to know that changing your diet becomes more natural, more easy to do after you have bariatric surgery or take the new weight loss medications,” said Grunvald, who was not involved in the Utah study.

“While we don’t yet fully understand why, these interventions actually change the chemistry in your brain, making it much easier to change your diet afterwards.”

Despite the benefits though, only 2% of patients who are eligible for bariatric surgery ever get it, often due to the stigma about obesity, said Dr. Caroline Apovian, a professor of medicine at Harvard Medical School and codirector of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston. Apovian was the lead author for the Endocrine Society’s clinical practice guidelines for the pharmacological management of obesity.

Insurance carriers typically cover the cost of surgery for people over 18 with a body mass index of 40 or higher, or a BMI of 35 if the patient also has a related condition such as diabetes or high blood pressure, she said.

“I see patients with a BMI of 50, and invariably I will say, ‘You’re a candidate for everything — medication, diet, exercise and surgery.’ And many tell me, ‘Don’t talk to me about surgery. I don’t want it.’ They don’t want a surgical solution to what society has told them is a failure of willpower,” she said.

“We don’t torture people who have heart disease: ‘Oh, it’s because you ate all that fast food.’ We don’t torture people with diabetes: ‘Oh, it’s because you ate all that cake.’ We tell them they have a disease, and we treat it. Obesity is a disease, too, yet we torture people with obesity by telling them it’s their fault.”

Most of the people who choose bariatric surgery — around 80% — are women, Adams said. One of the strengths of the new study, he said, was the inclusion of men who had undergone the procedure.

“For all-causes of death, the mortality was reduced by 14% for females and by 21% for males,” Adams said. In addition, deaths from related causes, such as heart attack, cancer and diabetes, was 24% lower for females and 22% lower for males who underwent surgery compared with those who did not, he said.

Four types of surgery performed between 1982 and 2018 were examined in the study: gastric bypass, gastric banding, gastric sleeve and duodenal switch.

Gastric bypass, developed in the late 1960s, creates a small pouch near the top of the stomach. A part of the small intestine is brought up and attached to that point, bypassing most of the stomach and the duodenum, the first part of the small intestine.

In gastric banding, an elastic band that can be tightened or loosened is placed around the top portion of the stomach, thus restricting the volume of food entering the stomach cavity. Because gastric banding is not as successful in creating long-term weight loss, the procedure “is not as popular today,” Adams said.

“The gastric sleeve is a procedure where essentially about two-thirds of the stomach is removed laparoscopically,” he said. “It takes less time to perform, and food still passes through the much-smaller stomach. It’s become a very popular option.”

The duodenal switch is typically reserved for patients who have a high BMI, Adams added. It’s a complicated procedure that combines a sleeve gastrectomy with an intestinal bypass, and is effective for type 2 diabetes, according to the Cleveland Clinic.

One alarming finding of the new study was a 2.4% increase in deaths by suicide, primarily among people who had bariatric surgery between the ages of 18 and 34.

“That’s because they are told that life is going to be great after surgery or medication,” said Joann Hendelman, clinical director of the National Alliance for Eating Disorders, a nonprofit advocacy group.

“All you have to do is lose weight, and people are going to want to hang out with you, people will want to be your friend, and your anxiety and depression are going to be gone,” she said. “But that’s not reality.”

In addition, there are postoperative risks and side effects associated with bariatric surgery, such as nausea, vomiting, alcoholism, a potential failure to lose weight or even weight gain, said Susan Vibbert, an advocate at Project HEAL, which provides help for people struggling with eating disorders.

“How are we defining health in these scenarios? And is there another intervention — a weight neutral intervention?” Vibbert asked.

Past research has also shown an association between suicide risk and bariatric surgery, Grunvald said, but studies on the topic are not always able to determine a patient’s mental history.

“Did the person opt for surgery because they had some unrealistic expectations or underlying psychological disorders that were not resolved after the surgery? Or is this a direct effect somehow of bariatric surgery? We can’t answer that for sure,” he said.

Intensive presurgery counseling is typically required for all who undergo the procedure, but it may not be enough, Apovian said. She lost her first bariatric surgery patient to suicide.

“She was older, in her 40s. She had surgery and lost 150 pounds. And then she put herself in front of a bus and died because she had underlying bipolar disorder she had been self-medicating with food,” Apovian said. “We as a society use a lot of food to hide trauma. What we need in this country is more psychological counseling for everybody, not just for people who undergo bariatric surgery.”

Managing weight is a unique process for each person, a mixture of genetics, culture, environment, social stigma and personal health, experts say. There is no one solution for all.

“First, we as a society must consider obesity as a disease, as a biological problem, not as a moral failing,” Grunvald said. “That’s my first piece of advice.

“And if you believe your life is going to benefit from treatment, then consider evidence-based treatment, which studies show are surgery or medications, if you haven’t been able to successfully do it with lifestyle changes alone.”

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