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Tag: obesity

  • Weight-Loss Devices to the Extreme | NutritionFacts.org

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    Let’s discuss the safety and efficacy of various weight-loss methods, ranging from Botox and corsets to siphons and tapeworms.

    A moderately obese person doing moderately intense physical activity, like biking or brisk walking, would burn off approximately 350 calories an hour, but most drinks, snacks, and other processed junk are consumed at a rate of about 70 calories (293 kJ) per minute. Therefore, it only takes five minutes to wipe out a whole hour of exercise.

    Enter the AspireAssist siphon assembly.

    It’s a percutaneous gastrostomy device, meaning surgeons cut a hole in a person’s stomach and tunnel a fistula out through the abdominal wall. So, after each meal, the person can attach a suction gadget to the hole and directly drain out their stomach contents, as you can see below and at 0:47 in my video Extreme Weight-Loss Devices.

    This means you could gorge on donuts, spew them out through the hole in your stomach, then gorge on more donuts. Have your cake, and eat it, too…and two, three, and four times!

    It seems to be the quintessential American invention, straight from the land that brought us Jell-O salads, spray cheese, and deep-fried Snickers bars. Patients do lose weight, perhaps in part because the fistula may interfere with the relaxation of the stomach wall during a meal. The process also requires drinking lots of water and thoroughly chewing food, both of which may help with weight loss by increasing hydration and slowing the eating rate. Patients also started making healthier choices to avoid the unpleasant sight of gastric aspirate from unhealthy foods. (The tubing is clear, and, evidently, fried foods look particularly gross as they are pumped out.)

    All patients need to take supplemental potassium, since it’s sucked out in stomach juices. Otherwise, they risk becoming potassium-deficient (a common complication in bulimia), but most side effects are just minor wound complications. Serious adverse effects, like abdominal abscesses, are rare. The big selling point is that the siphon device doesn’t change the gastrointestinal tract’s anatomy. That seems like a low bar, but in today’s Wild West world of weight-loss procedures, you can’t take anything for granted. Take the duodenal-jejunal bypass liner, for example.

    Gastric bypass surgery works in part by cutting out a portion of the small intestine so it’s no longer in the flow of food, thereby helping to prevent the absorption of calories. Instead of major surgery, how about just dropping down a couple of feet of plastic tubing to line the intestinal walls? The problem with the EndoBarrier is that it has to be anchored in the digestive tract. This is accomplished with 10 barbed hooks that cause lacerations, accounting for the majority of the 891 adverse effects reported in 1,056 patients—nearly 9 out of 10 people. Severe penetrating trauma, resulting in esophageal perforation or liver abscesses, is rarer (occurring in only about 1 in 27 patients).

    Concern has been raised about the “palatability” of the AspireAssist stomach pump, but the most cringeworthy endoscopic procedure I discovered in my research was intestinal “resurfacing.” Why cover the inside of your intestines with plastic to prevent absorption when you can just “thermally ablate the superficial duodenal mucosa”? In other words, have your intestinal lining burned off—or rather, “resurfaced.”

    Surgeons have tried injecting Botox into the stomach walls of obese individuals, hoping it would partially paralyze their gastric muscles, slow stomach emptying, make people feel fuller longer, and lose weight. It didn’t work.

    Researchers in Sweden tried randomizing people to wear corsets for 12 to 16 hours a day, seven days a week, for nine months. And it didn’t work. The study participants just didn’t wear the corsets—they were “perceived as uncomfortable.” Duh.

    “Sanitized tapeworms” have evidently been widely advertised as a weight-loss remedy since back in the early 1900s. The fact that living tapeworms have been discovered during bariatric surgery operations suggests that infesting yourself with parasites may not be particularly effective either.

    Speaking of disgusting strategies, how about disgust itself? A study entitled “Harnessing the Power of Disgust: A Randomized Trial to Reduce High-Calorie Food Appeal Through Implicit Priming” tried using subliminal messages to ruin people’s appetite. Just before showing images of healthy foods, researchers briefly flashed happy images—such as a group of kittens—for 20 milliseconds. That’s too quick to consciously register, but the hope was to plant a positive imprint on the brain. Before showing images of high-calorie foods like ice cream, they flashed negative scenes, like a cockroach on a pizza slice, vomit in a dirty bathroom, and a burn wound. Apparently, it worked! Subjects subsequently reported a reduced desire to eat high-calorie foods, though this wasn’t tested directly. The researchers concluded that subliminal revulsion might be “a successful tactic to combat the onslaught of food cues that promote unhealthy eating….”

    The rest of the world looks on, bemused by American machinations, penning commentaries like “Don’t Let Them Eat Cake! A View from Across the Pond.” A paper in the journal Obesity Surgery entitled “What Are the Yanks Doing?” reviewed “The U.S. Experience with Implantable Gastric Stimulation,” inserting electrodes into the muscular layer of the stomach wall. When that didn’t work, colon electrical stimulation was tried.

    Even more shocking were studies like “Repetitive electric brain stimulation reduces food intake in humans.” Though placing deep-brain electrodes is considered a complication-prone operation, scientists have long pondered whether “placing an electrode somewhere in the brain could make people eat less.” Holes were drilled through the skulls of five obese individuals, and wires were pushed into their brains for “electrostimulatory exploration.” Once the researchers poked around and found spots where they were able to elicit convincing hunger responses, they sent in enough juice to fry out electro-coagulatory lesions. It seemed to work in cats and monkeys, but the researchers found that burning holes in people’s brains did not result in weight loss in obese humans. Thankfully, as I explained in my book How Not to Diet, healthy, sustainable weight loss isn’t brain surgery.

    Doctor’s Note

    Check out Is Gastric Balloon Surgery Safe and Effective for Weight Loss?.

    What about drugs? See Are Weight Loss Pills Safe? and Are Weight Loss Pills Effective?.

    So, what’s the best way to lose weight? I wrote a whole book about it! How Not to Diet is focused exclusively on sustainable weight loss. Borrow it from your local library or pick up a copy from your favorite bookseller. (All proceeds from my books are donated to charity.) To whet your appetite, take a peek: Trailer for How Not to Diet: Dr. Greger’s Guide to Weight Loss.

    For more on this topic, check out related posts below.

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    Michael Greger M.D. FACLM

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  • From Gastric Balloons to Fake Knee Surgeries: When the Fix Is an Illusion | NutritionFacts.org

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    Sham surgery trials have shown that some of our most popular surgeries are themselves shams.

    Intragastric balloons “arrived with much fanfare in the 1980s,” since they could be implanted into the stomach and inflated with air or water to fill much of the space. Unfortunately, surgical devices are often brought to the market before there is adequate evidence of effectiveness and safety, and the balloons were no exception.

    The “gastric bubble” had its bubble burst when a study at the Mayo Clinic found that 8 out of 10 balloons “spontaneously deflated,” which is potentially dangerous because they could pass into the intestines and cause an obstruction, as you can see below and at 0:40 in my video Is Gastric Balloon Surgery Safe and Effective for Weight Loss?.

    Before balloons deflated, however, they apparently caused gastric erosions in half the patients, damaging their stomach lining. The kicker is that, in terms of inducing weight loss, they didn’t even work when compared to diet and other behavior modification strategies. Eventually, intragastric balloons were pulled from the market. But now, balloons are back.

    After a 33-year hiatus, the U.S. Food and Drug Administration started approving a new slew of intragastric balloons in 2015, which immediately resulted in the placement of more than 5,000 devices. By then, the Sunshine Act had passed. It forced drug companies and the surgical and medical device industry to disclose any payments made to physicians, shining a disinfecting light on industry enticements. By now, most people know about the overly cozy financial relationships doctors can have with Big Pharma, but fewer may realize that surgeons can also get payments from the companies for the devices they use. The 100 top physician recipients of industry payments received an unbelievable $12 million from device companies in a single year. Yet outrageously, when they published papers, only a minority disclosed the blatant conflict of interest.

    The benefit of balloons over most types of bariatric surgery is that they’re reversible, but that doesn’t mean they’re benign. The FDA has released a series of advisories about the risks, which include death. But how could someone suffer a stomach perforation with a smooth, rounded object? By that smooth, rounded object causing the patient to vomit so much that they rupture their stomach and die. Nausea and vomiting are unsurprisingly “very common side effects,” affecting the majority of those who have balloons placed inside of them. Persistent vomiting likely also explains cases of life-threatening nutrient deficiencies after balloon implantation.

    Some complications, such as bowel obstruction, are due to the balloons deflating, but others, oddly enough, are due to the balloons suddenly overinflating, causing pain, vomiting, and abdominal distention, as you can see below and at 2:45 in my video.

    This issue was first noticed in breast implants, as documented in reports such as “The Phenomenon of the Spontaneously Autoinflating Breast Implant.” Out of nowhere, the implants can just start growing, increasing breast volume by an average of more than 50%. “It remains an underreported and poorly understood phenomenon,” one review noted. (Interestingly, breast implants were actually used as some of the first failed experimental intragastric balloons.)

    As with any medical decision, though, it’s all about risks versus benefits. Industry-funded trials display “notable weight loss,” but it’s hard to tease out the effect of the balloon on its own from the accompanying “supervised diet and lifestyle changes” prescribed in the studies. In drug trials, you can randomize study participants to sugar pills, but how do you eliminate the placebo effect of undergoing a procedure? Perform sham surgery.

    In 2002, a courageous study was published in The New England Journal of Medicine. The most common orthopedic surgery—arthroscopic surgery of the knee—was put to the test. Billions of dollars are spent on sticking scopes into knee joints and cutting away damaged tissue in osteoarthritis and knee injuries, but does that actually work? People suffering from knee pain were randomized to get the actual surgery versus a sham surgery, in which surgeons sliced into people’s knees and pretended to perform the procedure—even splashing saline—without actually treating the joint.

    The trial caused an uproar. How could anyone randomize people to get cut open for fake surgery? Professional medical associations questioned the ethics of the surgeons as well as “the sanity” of the patients who agreed to be part of the trial. Guess what happened? The surgical patients got better, but so did the placebo patients, as you can see below and at 4:42 in my video.

    The surgeries had no actual effect. Currently, rotator cuff shoulder surgery is facing the same crisis of confidence.

    When intragastric balloons were put to the test, sham-controlled trials showed that both older and newer devices sometimes fail to offer any weight-loss benefit. Even when they do work, the weight loss may be temporary because balloons are only allowed to stay in for six months (at which point the deflation risk gets too great). Why can’t you keep putting new ones in? That’s been tried; it failed to improve long-term weight outcomes. A sham-controlled trial showed that any effects of the balloon on appetite and satiety may vanish with time, perhaps as your body gets used to the new normal.

    What sham surgery trials have shown us is that some of our most popular surgeries are themselves shams. Doctors like to pride themselves on being men and women of science. For example, we rightly rail against the anti-vaccination movement. Many of us in medicine have been troubled by the political trend in which people “choose their own facts.” But when I read that some of these still-popular surgeries are not only useless but may actually make matters worse (for example, increasing the risk of progression to a total knee replacement), I can’t help but think we are hardly immune to our own versions of fake news and alternative facts.

    Doctor’s Note

    Next in this two-part series is Extreme Weight-Loss Devices.

    For more on bariatric surgery, check out related posts below.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Borrow it from your local library or pick up a copy from your favorite bookseller. (All proceeds from my books are donated to charity.)

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    Michael Greger M.D. FACLM

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  • Could Your Pills and Food Be Causing a Leaky Gut? | NutritionFacts.org

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    Common drugs, foods, and beverages can disrupt the integrity of our intestinal barrier, causing a leaky gut.

    Intestinal permeability, the leakiness of our gut, may be a new target for both disease prevention and therapy. With all its tiny folds, our intestinal barrier covers a surface of more than 4,000 square feet—that’s bigger than a tennis court—and requires about 40% of our body’s total energy expenditure to maintain.

    There is growing evidence implicating “the disruption of intestinal barrier integrity” in the development of a number of conditions, including celiac disease and inflammatory bowel disease. Researchers measured intestinal permeability using blue food coloring. It remained in the gut of healthy participants but was detected in the blood of extremely sick patients with sepsis with a damaged gut barrier. You don’t have to end up in the ICU to develop a leaky gut, though. Simply taking some aspirin or ibuprofen can do the trick.

    Indeed, taking two regular aspirin (325 mg tablets) or two extra-strength aspirin (500 mg tablets) just once can increase the leakiness of our gut. These results suggest that even healthy people should be cautious when using aspirin, as it may cause gastrointestinal barrier dysfunction.

    What about buffered aspirin, an aspirin-antacid combination which theoretically “buffers” gastrointestinal irritation? It apparently doesn’t make any difference: Regular aspirin and Bufferin both produced multiple erosions in the inner lining of the stomach and intestine. Researchers put a scope down people’s throats and saw extensive erosions and redness inside 90% of those who took aspirin or Bufferin at their recommended doses. How many hours does it take for the damage to occur? None. It can happen within just five minutes. Acetaminophen, sold as Tylenol in the United States, may not lead to gastrointestinal damage and could be a better choice, unless you have problems with your liver. And rather than making things better, vitamin C supplements appeared to make the aspirin-induced increase in gut leakiness even worse.

    Interestingly, this may be why NSAID drugs like aspirin, ibuprofen, and naproxen “are involved in up to 25% of food-induced anaphylaxis.” In other words, they are associated with over 10-fold higher odds of life-threatening food allergy attacks, presumably because these drugs increase the leakiness of the intestinal barrier, causing tiny food particles to slip into the bloodstream. But can exercise increase risk, too?

    Strenuous exercise—for instance, an hour at 70% maximum capacity—may divert so much blood to the muscles and away from our internal organs that it may cause transient injury to our intestines, causing mild gut leakiness. But this can be aggravated if athletes take ibuprofen or any other NSAID drugs, which is unfortunately all too common.

    Alcohol can also be a risk factor for food allergy attacks for the same reason—increasing gut leakiness. But cut out the alcohol, and our gut might heal up.

    What other dietary components can make a difference? Elevated consumption of saturated fat, which is found in meat, dairy, and junk food, can cause the growth of bad bacteria that make the rotten-egg gas hydrogen sulfide, which can degrade the protective mucus layer. You can see the process below and at 3:21 in my video Avoid These Foods to Prevent a Leaky Gut.

    It is said to be clear that high-fat diets in general have a negative impact on intestinal health by “disrupting the intestinal barrier system through a variety of mechanisms,” but most of the vast array of studies that cited the negative effects were done on lab animals or in a petri dish. Are people affected the same way? You don’t know for sure until you put it to the test.

    Rates of obesity and other cardiometabolic disorders have increased rapidly alongside a transition from traditional lower-fat diets to higher-fat diets. We know a disturbance in our good gut flora has been shown to be associated with a high risk of many of these same diseases, and studies using rodents suggest that a high-fat diet “unbalances” the microbiome while impairing the gut barrier, resulting in disease. To connect all the dots, though, we need a human interventional trial—and we got one: a six-month randomized controlled-feeding trial on the effects of dietary fat on gut microbiota. It found that, indeed, higher fat consumption was associated with unfavorable changes in the gut microbiome and proinflammatory factors in the blood. Note that this wasn’t even primarily saturated fat, such as from meat and dairy. The researchers just replaced refined carbohydrates with refined fats—swapping out white rice and wheat flour for soybean oil. These findings suggest that countries westernizing their diets should advise against increasing dietary fat intake, while countries that have already adopted such diets should consider cutting down.

    Doctor’s Note

    For more on leaky gut, check out The Leaky Gut Theory of Why Animal Products Cause Inflammation and How to Heal a Leaky Gut with Diet.

    I also talked about gut leakiness in my SIBO video: Friday Favorites: Tests, Fiber, and Low FODMAP for Small Intestinal Bacterial Overgrowth (SIBO).

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    Michael Greger M.D. FACLM

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  • Keeping Better Score of Your Diet | NutritionFacts.org

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    How can you get a perfect diet score?

    How do you rate the quality of people’s diets? Well, “what could be more nutrient-dense than a vegetarian diet?” Indeed, if you compare the quality of vegetarian diets with non-vegetarian diets, the more plant-based diets do tend to win out, and the higher diet quality in vegetarian diets may help explain greater improvements in health outcomes. However, vegetarians appear to have a higher intake of refined grains, eating more foods like white rice and white bread that have been stripped of much of their nutrition. So, just because you’re eating a vegetarian diet doesn’t mean you’re necessarily eating as healthfully as possible.

    Those familiar with the science know the primary health importance of eating whole plant foods. So, how about a scoring system that simply adds up how many cups of fruits, vegetables, whole grains, beans, chickpeas, split peas, and lentils, and how many ounces of nuts and seeds per 1,000 calories (with or without counting white potatoes)? Looking only at the total intake of whole plant foods doesn’t mean you aren’t also stuffing donuts into your mouth. So, you could imagine proportional intake measures, based on calories or weight, to determine the proportion of your diet that’s whole plant foods. In that case, you’d get docked points if you eat things like animal-derived foods—meat, dairy, or eggs—or added sugars and fats.

    My favorite proportional intake measure is McCarty’s “phytochemical index,” which I’ve profiled previously. I love it because of its sheer simplicity, “defined as the percent of dietary calories derived from foods rich in phytochemicals.” It assigns a score from 0 to 100, based on the percentage of your calories that are derived from foods rich in phytochemicals, which are biologically active substances naturally found in plants that may be contributing to many of the health benefits obtained from eating whole plant foods. “Monitoring phytochemical intake in the clinical setting could have great utility” in helping people optimize their diet for optimal health and disease prevention. However, quantifying phytochemicals in foods or tissue samples is impractical, laborious, and expensive. But this concept of a phytochemical index score could be a simple alternative method to monitor phytochemical intake.

    Theoretically, a whole food, plant-based or vegan diet that excluded refined grains, white potatoes, hard liquors, added oils, and added sugars could achieve a perfect score of 100. Lamentably, most Americans’ diets today might be lucky to score just 20. What’s going on? In 1998, our shopping baskets were filled with about 20% whole plant foods; more recently, that has actually shrunk, as you can see below and at 2:49 in my video Plant-Based Eating Score Put to the Test.

    Wouldn’t it be interesting if researchers used this phytochemical index to try to correlate it with health outcomes? That’s exactly what they did. We know that studies have demonstrated that vegetarian diets have a protective association with weight and body mass index. For instance, a meta-analysis of five dozen studies has shown that vegetarians had significantly lower weight and BMI compared with non-vegetarians. And even more studies show that high intakes of fruits, vegetables, whole grains, and legumes may be protective regardless of meat consumption. So, researchers wanted to use an index that gave points for whole plant foods. They used the phytochemical index and, as you may recall from an earlier video, tracked people’s weight over a few years, using a scale of 0 to 100 to simply reflect what percentage of a person’s diet is whole plant foods. And even though the healthiest-eating tier only averaged a score of about 40, which meant the bulk of their diet was still made up of processed foods and animal products, just making whole plant foods a substantial portion of the diet may help prevent weight gain and decrease body fat. So, it’s not all or nothing. Any steps we can take to increase our whole plant food intake may be beneficial.

    Many more studies have since been performed, with most pointing in the same direction for a variety of health outcomes—indicating, for instance, higher healthy plant intake is associated with about a third of the odds of abdominal obesity and significantly lower odds of high triglycerides. So, the index may be “a useful dietary target for weight loss,” where there is less focus on calorie intake and more on increasing consumption of these high-nutrient, lower-calorie foods over time. Other studies also suggest the same is true for childhood obesity.

    Even at the same weight, with the same amount of belly fat, those eating plant-based diets tend to have higher insulin sensitivity, meaning the insulin they make works better in their body, perhaps thanks to the compounds in plants that alleviate inflammation and quench free radicals. Indeed, the odds of hyperinsulinemia—an indicator of insulin resistance—were progressively lower with greater plant consumption. No wonder researchers found 91% lower odds of prediabetes for people getting more than half their calories from healthy plant foods.

    They also found significantly lower odds of metabolic syndrome and high blood pressure. There were only about half the odds of being diagnosed with hypertension over a three-year period among those eating more healthy plants. Even mental health may be impacted—about 80% less depression, 2/3 less anxiety, and 70% less psychological distress, as you can see below and at 5:15 in my video.

    Is there a link between the dietary phytochemical index and benign breast diseases, such as fibrocystic diseases, fatty necrosis, ductal ectasia, and all sorts of benign tumors? Yes—70% lower odds were observed in those with the highest scores. But what about breast cancer? A higher intake of healthy plant foods was indeed associated with a lower risk of breast cancer, even after controlling for a long list of other factors. And not just by a little bit. Eating twice the proportion of plants compared to the standard American diet was linked to more than 90% lower odds of breast cancer.

    Doctor’s Note

    You can learn more about the phytochemical index in Calculate Your Healthy Eating Score.

    If you’re worried about protein, check out Flashback Friday: Do Vegetarians Get Enough Protein?

    It doesn’t have to be all or nothing, though. Do Flexitarians Live Longer?

    For more on plant-based junk, check out Friday Favorites: Is Vegan Food Always Healthy?.

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    Michael Greger M.D. FACLM

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  • Trump signs bill allowing whole milk to return to school lunches

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    Whole milk is heading back to school cafeterias across the country after President Trump signed a bill Wednesday overturning Obama-era limits on higher-fat milk options. 

    Nondairy drinks such as fortified soy milk may also be on the menu in the coming months following the adoption of the Whole Milk for Healthy Kids Act, which cleared Congress in the fall.

    The action allows schools participating in the National School Lunch Program to serve whole and 2% fat milk, along with the skim and low-fat products required since 2012.

    “Whether you’re a Democrat or a Republican, whole milk is a great thing,” Mr. Trump said at a White House signing ceremony that featured lawmakers, dairy farmers and their children.

    The law also permits schools to serve nondairy milk that meets the nutritional standards of milk and requires schools to offer a nondairy milk alternative if kids provide a note from their parents, not just from doctors, saying they have a dietary restriction.

    President Trump touches a container of milk as he speaks in the Oval Office of the White House, Wednesday, Jan. 14, 2026, in Washington.

    Alex Brandon / AP


    The signing comes days after the release of the 2025-2030 Dietary Guidelines for Americans, which emphasize consumption of full-fat dairy products as part of a healthy diet. Previous editions advised that consumers older than 2 should consume low-fat or fat-free dairy.

    Earlier this week, the Agriculture Department sent a social media post showing Mr. Trump with a glass of milk and a “milk mustache” that declared: “Drink Whole Milk.”

    The change could take effect as soon as this fall, though school nutrition and dairy industry officials said it may take longer for some schools to gauge demand for full-fat dairy and adjust supply chains.

    “The long wait is over! Whole milk is coming back to schools! This law is a win for our children, parents, and school nutrition leaders, giving schools the flexibility to offer the flavored and unflavored milk options, across all healthy fat levels, that meet students’ needs and preferences,” said Michael Dykes, president and CEO of the International Dairy Foods Association.

    Long sought by the dairy industry, the return of whole and 2% milk to school meals reverses provisions of the Healthy Hunger-Free Kids Act championed by former first lady Michelle Obama. Enacted more than a dozen years ago, the law aimed to slow obesity and boost health by cutting kids’ consumption of saturated fat and calories in higher-fat milk.

    Nutrition experts, lawmakers and the dairy industry have argued whole milk is a delicious, nutritious food that has been unfairly vilified, and that some studies suggest kids who drink it are less likely to develop obesity than those who drink lower-fat options. Critics have also said many children don’t like the taste of lower-fat milk and don’t drink it, leading to missed nutrition and food waste.

    The new rules will change meals served to about 30 million students enrolled in the National School Lunch Program.

    Health Secretary Robert F. Kennedy Jr. described the new law as “a long-overdue correction to school nutrition policy.” Agriculture Secretary Brooke Rollins said it fixed Michelle Obama’s “short-sighted campaign to ditch whole milk.”

    Schools will be required to provide students with a range of fluid milk options, which can now include flavored and unflavored organic or conventional whole milk, 2%, 1% and lactose-free milk, as well as non-dairy options that meet nutrition standards.

    The new dietary guidelines call for “full-fat dairy with no added sugars,” which would preclude chocolate- and strawberry-flavored milks allowed under a recent update of school meal standards. Agriculture officials will have to translate that recommendation into specific requirements for schools to eliminate flavored milks.

    The new law exempts milk fat from being considered as part of federal requirements that average saturated fats make up less than 10% of calories in school meals.

    One top nutrition expert, Dr. Dariush Mozaffarian of Tufts University, has said there is “no meaningful benefit” in choosing low-fat over high-fat dairy. Saturated fatty acids in dairy have a different composition than other fat, such as beef fat, plus different beneficial compounds that could offset theoretical harms, he added.

    “Saturated fat in dairy has not been linked to any adverse health outcomes,” Mozaffarian said in an interview.

    Research has shown that changes in the federal nutrition program after the Obama-era law was enacted slowed the rise in obesity among U.S. kids, including teenagers. 

    But some nutrition experts point to newer research that suggests kids who drink whole milk could be less likely to be overweight or to develop obesity than children who drink lower-fat milk. One 2020 review of 28 studies suggests that the risk was 40% less for kids who drank whole milk, although the authors noted they couldn’t say whether milk consumption was the reason.

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  • The Hidden Costs of Bariatric Surgery | NutritionFacts.org

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    Weight regain after bariatric surgery can have devastating psychological effects.

    How Sustainable Is the Weight Loss After Bariatric Surgery? I explore that issue in my video of the same name. Most gastric bypass patients end up regaining some of the fat they lose by the third year after surgery, but after seven years, 75% of patients followed at 10 U.S. hospitals maintained at least a 20% weight loss.

    The typical trajectory for someone who starts out obese at 285 pounds, for example, would be to drop to an overweight 178 pounds two years after bariatric surgery, but then regain weight up to an obese 207 pounds. This has been chalked up to “grazing” behavior, where compulsive eaters may shift from bingeing (which becomes more difficult post-surgery) to eating smaller amounts constantly throughout the day. In a group of women followed for eight years after gastric bypass surgery, about half continued to describe episodes of disordered eating. As one pediatric obesity specialist described, “I have seen many patients who put chocolate bars into a blender with some cream, just to pass technically installed obstacles [e.g., a gastric band].”

    Bariatric surgery advertising is filled with “happily-ever-after” fairytale narratives of cherry-picked outcomes offering, as one ad analysis put it, “the full Cinderella-romance happy ending.” This may contribute to the finding that patients often overestimate the amount of weight they’ll lose with the procedure and underestimate the difficulty of the recovery process. Surgery forces profound changes in eating habits, requiring slow, small bites that have been thoroughly chewed. Your stomach goes from the volume of two softballs down to the size of half a tennis ball in stomach stapling and half a ping-pong ball in the case of gastric bypass or banding.

    As you can imagine, “weight regain after bariatric surgery can have a devastating effect psychologically as patients feel that they have failed their last option”—their last resort. This may explain why bariatric surgery patients face a high risk of depression. They also have an increased risk of suicide.

    Severe obesity alone may increase the risk of suicidal depression, but even at the same weight, those going through surgery appear to be at a higher risk. At the same BMI (body mass index), age, and gender, bariatric surgery patients have nearly four times the odds of self-harm or attempted suicide compared with those who did not undergo the procedure. Most convincingly, so-called “mirror-image analysis” comparing patients’ pre- and post-surgery events showed the odds of serious self-harm increased after surgery.

    About 1 in 50 bariatric surgery patients end up killing themselves or being hospitalized for self-harm or attempted suicide. And this only includes confirmed suicides, excluding masked attempts such as overdoses classified as having “undetermined intention.” Bariatric surgery patients may also have an elevated risk of accidental death, though some of this could be due to changes in alcohol metabolism. When individuals who have had a gastric bypass were given two shots of vodka, their blood alcohol level surpassed the legal driving limit within minutes due to their altered anatomy. It’s unclear whether this plays a role in the 25% increase in prevalence of alcohol problems noted during the second postoperative year.

    Even those who successfully lose their excess weight and keep it off appear to have a hard time coping. Ten years out, though physical health-related quality of life may improve, general mental health can significantly deteriorate compared to pre-surgical levels, even among those who lost the most weight. Ironically, there’s a common notion that bariatric surgery is for “cheaters” who take the easy way out by choosing the “low-effort” method of weight loss.

    Shedding the weight may not shed the stigma of prior obesity. Studies suggest that “in the eyes of others, knowing that an individual was at one time fat will lead him/her to always be treated like a fat person.” And there can be a strong anti-surgery bias on top of that—those who chose the scalpel to lose weight over diet or exercise were rated more negatively (for example, being considered less physically attractive). One can imagine how remaining a target of prejudice even after joining the “in-group” could potentially undercut psychological well-being.

    There can also be unexpected physical consequences of massive weight loss, like large hanging flaps of excess skin. Beyond being heavy and uncomfortable and interfering with movement, the skin flaps can result in itching, irritation, dermatitis, and skin infections. Getting a panniculectomy (removing the abdominal “apron” of hanging skin) can be expensive, and its complication rate can exceed 50%, with dehiscence (rupturing of the surgical wound) one of the most common complications.

    “Even if surgery proves sustainably effective,” wrote the founding director of Yale University’s Prevention Research Center, “the need to rely on the rearrangement of natural gastrointestinal anatomy as an alternative to better use of feet and forks [exercise and diet] seems a societal travesty.”

    In the Middle Ages, starving peasants dreamed of gastronomic utopias where food just rained down from the sky. The English called it the Kingdom of Cockaigne. Little could medieval fabulists predict that many of their descendants would not only take permanent residence there but also cut out parts of their stomachs and intestines to combat the abundance. Critics have pointed out the irony of surgically altering healthy organs to make them dysfunctional—malabsorptive—on purpose, especially when it comes to operating on children. Bariatric surgery for kids and teens has become widespread and is being performed on children as young as five years old. Surgeons defend the practice by arguing that growing up fat can leave “‘emotional scars’ and lifelong social retardation.”

    Promoters of preventive medicine may argue that bariatric surgery is the proverbial “ambulance at the bottom of the cliff.” In response, proponents of pediatric bariatric surgery have written: “It is often pointed out that we should focus on prevention. Of course, I agree. However, if someone is drowning, I don’t tell them, ‘You should learn how to swim’; no, I rescue them.”

    A strong case can be made that the benefits of bariatric surgery far outweigh the risks if the alternative is remaining morbidly obese, which is estimated to shave up to a dozen or more years off one’s life. Although there haven’t been any data from randomized trials yet to back it up, compared to non-operated obese individuals, those getting bariatric surgery would be expected to live significantly longer on average. No wonder surgeons have consistently framed the elective surgery as a life-or-death necessity. This is a false dichotomy, though. The benefits only outweigh the risks if there are no other alternatives. Might there be a way to lose weight healthfully without resorting to the operating table? That’s what my book How Not to Diet is all about.

    Doctor’s Note

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your library or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

    This is the final segment in a four-part series on bariatric surgery, which includes:

    This blog contains information regarding suicide. If you or anyone you know is exhibiting suicide warning signs, please get help. Go to https://988lifeline.org for more information.

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    Michael Greger M.D. FACLM

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  • Is Surgery Necessary to Reverse Diabetes? | NutritionFacts.org

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    Losing weight without rearranging your gastrointestinal anatomy carries advantages beyond just the lack of surgical risk.

    The surgical community objects to the characterization of bariatric surgery as internal jaw wiring and cutting into healthy organs just to discipline people’s behavior. They’ve even renamed it “metabolic surgery,” suggesting the anatomical rearrangements cause changes in digestive hormones that offer unique physiological benefits. As evidence, they point to the remarkable remission rates for type 2 diabetes.

    After bariatric surgery, about 50% of obese people with diabetes and 75% of “super-obese” diabetics go into remission, meaning they have normal blood sugar levels on a regular diet without any diabetes medication. The normalization of blood sugar can happen within days after the surgery. And 15 years after the surgery, 30% remained free from their diabetes, compared to a 7% remission rate in a nonsurgical control group. Are we sure it was the surgery, though?

    One of the most challenging parts of bariatric surgery is lifting the liver. Since obese individuals tend to have such large, fatty livers, there is a risk of liver injury and bleeding. An enlarged liver is one of the most common reasons a less invasive laparoscopic surgery can turn into a fully invasive open surgery, leaving the patient with a large belly scar, along with an increased risk of wound infections, complications, and recovery time. But lose even just 5% of your body weight, and your fatty liver may shrink by 10%. That’s why those awaiting bariatric surgery are put on a diet. After surgery, patients are typically placed on an extremely low-calorie liquid diet for weeks. Could their improvement in blood sugar levels just be from the caloric restriction, rather than some sort of surgical metabolic magic? Researchers decided to put it to the test.

    At a bariatric surgery clinic at the University of Texas, patients with type 2 diabetes scheduled for a gastric bypass volunteered to stay in the hospital for 10 days to follow the same extremely low-calorie diet—less than 500 calories a day—that they would be placed on before and after surgery, but without undergoing the procedure itself. After a few months, once they had regained the weight, the same patients then had the actual surgery and repeated their diet, matched day to day. This allowed researchers to compare the effects of caloric restriction with and without the surgical procedure—the same patients, the same diet, just with or without the surgery. If there were some sort of metabolic benefit to the anatomical rearrangement, the patients would have done better after the surgery, but, in some ways, they actually did worse.

    The caloric restriction alone resulted in similar improvements in blood sugar levels, pancreatic function, and insulin sensitivity, but several measures of diabetic control improved significantly more without the surgery. The surgery seemed to put them at a metabolic disadvantage.

    Caloric restriction works by first mobilizing fat out of the liver. Type 2 diabetes is thought to be caused by fat building up in the liver and spilling over into the pancreas. Everyone may have a “personal fat threshold” for the safe storage of excess fat. When that limit is exceeded, fat gets deposited in the liver, where it can cause insulin resistance. The liver may then offload some of the fat (in the form of a fat transport molecule called VLDL), which can then accumulate in the pancreas and kill off the cells that produce insulin. By the time diabetes is diagnosed, half of our insulin-producing cells may have been destroyed, as seen below and at 3:36 in my video Bariatric Surgery vs. Diet to Reverse Diabetes. Put people on a low-calorie diet, though, and this entire process can be reversed.

    A large enough calorie deficit can cause a profound drop in liver fat sufficient to resurrect liver insulin sensitivity within seven days. Keep it up, and the calorie deficit can decrease liver fat enough to help normalize pancreatic fat levels and function within just eight weeks. Once you drop below your personal fat threshold, you should then be able to resume normal caloric intake and still keep your diabetes at bay, as seen below and at 4:05 in my video. 

    The bottom line: Type 2 diabetes is reversible with weight loss, if you catch it early enough.

    Lose more than 30 pounds (13.6 kilograms), and nearly 90% of those who have had type 2 diabetes for less than four years can achieve non-diabetic blood sugar levels (suggesting diabetes remission), whereas it may only be reversible in 50% of those who’ve lived with the disease for eight or more years. That’s by losing weight with diet alone, though. For people with diabetes, losing more than twice as much weight with bariatric surgery, diabetes remission may only be around 75% of those who’ve had the disease for up to six years and only about 40% for those who’ve had diabetes longer, as seen below and at 4:41 in my video.

    Losing weight without surgery may offer other benefits as well. Individuals with diabetes who lose weight with diet alone can significantly improve markers of systemic inflammation, such as tumor necrosis factor, whereas levels significantly worsened when about the same amount of weight was lost from a gastric bypass.

    What about diabetic complications? One reason to avoid diabetes is to avoid its associated conditions, like blindness or kidney failure requiring dialysis. Reversing diabetes with bariatric surgery can improve kidney function, but, surprisingly, it may not prevent the occurrence or progression of diabetic vision loss—perhaps because bariatric surgery affects quantity but not necessarily quality when it comes to diet. This reminds me of a famous study published in The New England Journal of Medicine that randomized thousands of people with diabetes to an intensive lifestyle program focused on weight loss. Ten years in, the study was stopped prematurely because the participants weren’t living any longer or having any fewer heart attacks. This may be because they remained on the same heart-clogging diet but just in smaller portions.

    Doctor’s Note

    This is the third blog in a four-part series on bariatric surgery. If you missed the first two, check out The Mortality Rate of Bariatric Weight-Loss Surgery and The Complications of Bariatric Weight-Loss Surgery.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local library, or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

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    Michael Greger M.D. FACLM

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  • Wegovy is now available as a pill. Here’s what you need to know

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    (CNN) — Americans seeking to lose weight now have a new option – taking Wegovy as a daily pill, rather than a weekly injection.

    Patients with a prescription could obtain the starter 1.5 mg dose of the tablet as of Monday, with the higher doses becoming available by the end of the week, according to manufacturer Novo Nordisk.

    Being able to address obesity with a GLP-1 pill is a significant advance in weight management. Eli Lilly is expected to receive US Food and Drug Administration approval for its oral medication, which is called orforglipron until it receives a brand name, by summer.

    But the arrival of an oral option has also sparked a multitude of questions. Here’s what we know:

    Where can I get the Wegovy pill?

    The tablet form of Wegovy can be found at pharmacies, including CVS and Costco, certain telehealth providers, such as Ro and LifeMD and Weight Watchers, NovoCare Pharmacy, GoodRx and other locations.

    Will it be hard to find?

    While overwhelming demand led to initial shortages of the GLP-1 injections, Novo Nordisk said it is confident that it can meet the demand for the Wegovy tablet.

    The Danish drug maker noted that it has invested in its manufacturing capabilities for several years. The Wegovy pill is produced entirely in its North Carolina facilities.

    How much will the pill cost?

    The 1.5 mg starter dose of the pill costs $149 a month for patients who pay cash, as part of a recent deal Novo Nordisk made with the Trump administration. The 4 mg dose costs the same amount until April 15, after which the price will increase to $199.

    However, the 9 mg and 25 mg doses cost $299 a month.

    That compares to a $349 monthly price tag for the injectable version for self-pay consumers, though new patients can receive two months of the lowest two doses for $199 each until March.

    Patients whose insurance plans cover the drug for obesity could pay as little as $25 a month for the pill or injection under a savings program offered by Novo Nordisk.

    How is the pill different from the injection?

    The pill uses the same active ingredient, semaglutide, as the injection. They’re approved by the US Food and Drug Administration for the same groups of people: those with obesity, typically defined as having a body mass index of 30 or higher, and those with overweight, or a BMI of 27 or more along with a weight-related health issue such as high blood pressure.

    The main difference between the two is how you take them – as a daily pill versus a weekly shot. The pill also must be taken on an empty stomach, with a small amount of water and no other food, drink or medicines for at least 30 minutes.

    The medicine won’t be effective if patients don’t wait 30 minutes to give the tablet time to absorb, according to Novo Nordisk.

    How much weight could I lose?

    The Wegovy tablet and injection resulted in similar weight loss in clinical trials.

    The pill showed average weight loss of 14% over 64 weeks, compared with 2% for a placebo. The injection showed weight loss of 15% in its key trial, versus 2% for placebo.

    Eli Lilly’s orforglipron showed 11% weight loss over 72 weeks on its highest dose, compared with 2% for the placebo group. Zepbound, Eli Lilly’s injectable weight loss drug, showed weight loss of 21% on its highest dose, compared with 3% for those on a placebo.

    What are the side effects of the Wegovy pill?

    Like all medicines in the class known as GLP-1s, the Wegovy pill is also associated with side effects such as nausea, vomiting, constipation and diarrhea. The pill and injection had similar tolerability in clinical trials.

    Should I consider switching from the injection to the pill?

    That depends on your specific circumstances, doctors say. If you’re someone who’d prefer a daily pill to a weekly shot, and can deal with delaying food, drink and other medications for 30 minutes after taking the Wegovy pill, it might be the right choice. Others may prefer the simplicity of a weekly injection, if they don’t mind needles.

    Dr. Jorge Moreno, an obesity specialist with Yale Medicine, said a switch to the pill may be a consideration for people who’ve experienced more tolerability issues with the injections.

    “If patients have not tolerated the injection or are having a tough time going up on the dose, they may opt to switch to the Wegovy pill,” Moreno told CNN.

    Dr. Judith Korner, an endocrinologist and director of the Metabolic and Weight Control Center at Columbia University Vagelos College of Physicians and Surgeons, pointed out that the weekly injections might be “a bit longer-lasting,” and so any uncomfortable side effects patients experience “may last longer than if you take a pill” as well, where “if you really don’t like the way you feel you don’t take it the next day.”

    If you miss a dose of the pill, that dose should be skipped, and the next dose should be taken the following day.

    Both doctors emphasized that cost also plays a large role in decision-making.

    “Insurance coverage is still hard to predict at this point,” Moreno said. “I am hopeful with lower costs for the Wegovy pill, more insurances will opt to cover it.”

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    Tami Luhby, Meg Tirrell and CNN

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  • Aiming for a healthier year? A doctor shares the 5 science-backed habits that matter most

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    (CNN) — Was that you I spotted at that New Year’s Day group class at my local YMCA? If not, don’t worry. It’s not too late. The start of a new year is a natural time to think about health and make resolutions for science-backed habits that make a difference over months and years.

    Rather than extreme diets or complicated regimens, decades of research point to a handful of simple behaviors that are consistently tied to better long-term health.

    To start the year right, I wanted you to know the most important things you can focus on this year to improve your current physical and mental well-being and have it pay off for decades to come. And yes, I know how hard it can be to realistically follow through when motivation is low or life gets busy.

    I asked CNN wellness expert Dr. Leana Wen to break down five practical, evidence-based actions that can make a real difference in 2026 and beyond. Wen is an emergency physician and adjunct associate professor at George Washington University. She previously served as Baltimore’s health commissioner.

    CNN: For your first tip, you said to prioritize regular exercise. Why does exercise matter so much for health?

    Dr. Leana Wen: Regular physical activity is one of the most powerful tools we have for preventing chronic disease and improving quality of life. It benefits virtually every organ system in the body. Even short bouts of moderate exercise, such as brisk walking, can lower blood pressure, improve cholesterol levels, boost mood and strengthen the heart.

    For adults, the US Centers for Disease Control and Prevention recommend at least 150 minutes of moderate-intensity activity per week plus muscle-strengthening activities on two or more days. Even if you can’t hit those recommendations, some activity is better than none. If you do not currently exercise, start with a 5- or 10-minute brisk walk once a day; if you already walk regularly, try adding a few extra minutes at a time and increasing your pace.

    CNN: Your second tip is to get checkups at least annually. Why is that so important?

    Wen: Periodic checkups with a clinician are essential because many high-risk conditions develop silently. Hypertension, or high blood pressure, and type 2 diabetes, for example, often have no obvious symptoms until they have already caused significant damage to the heart, kidneys and blood vessels. Detecting and treating these conditions early dramatically lowers the risk of heart attack, stroke, kidney disease and other serious complications.

    A checkup gives you a chance to assess risk factors like cholesterol, glucose levels, body mass index and lifestyle habits. You also can establish monitoring or treatment plans with your provider before problems become severe. Timely treatment through lifestyle changes, medication or both can slow or even reverse disease progression.

    These visits also pose an important opportunity to review vaccinations. Recommendations and public messaging from federal health agencies may change, but your clinician can help you understand which vaccines are appropriate for you based on your age, health conditions and personal risk. Staying up to date on routine vaccines — such as flu, Covid-19 and others recommended for your situation — remains one of the most effective ways to prevent serious illness and protect both individual and community health.

    CNN: Your third tip is to get adequate sleep. Why does sleep matter as much as diet or exercise?

    Wen: Sleep is not optional; it’s a biological necessity that affects nearly every aspect of health we care about. Without adequate sleep, your body has trouble repairing tissues, regulating hormones and managing energy balance.

    Research suggests that chronic insufficient sleep is linked to greater risk of obesity, type 2 diabetes, cardiovascular disease and mood disorders. One reason may involve hormonal regulation: Sleep deprivation increases hunger hormones and decreases satiety hormones, which can promote overeating, especially of high-calorie foods.

    Sleep also affects immune function and cognitive performance, so consistent rest helps us to better respond to stress and supports memory, attention and emotional regulation. Most adults benefit from seven to nine hours of sleep per night, and prioritizing regular sleep schedules can improve quality over time.

    CNN: Your fourth tip centers on diet quality, in particular cutting out ultraprocessed foods. Why is working toward a healthier diet so important, and what steps can people take to improve nutrition?

    Wen: What you eat influences your health in important ways. Ultraprocessed foods have become a dominant part of the American diet, accounting for more than half of total calories in many age groups. These foods, which include sugary drinks, packaged snacks, fast food, ready meals and sweetened cereals, are generally high in added sugars, unhealthy fats and sodium, and low in fiber, vitamins and minerals.

    High consumption of ultraprocessed foods is linked to obesity, type 2 diabetes, cardiovascular disease, and even depression and mental health conditions. Replacing ultraprocessed items with whole or minimally processed foods (vegetables, fruits, whole grains, lean proteins, legumes and nuts) supports both physical and mental health and helps stabilize energy, blood sugar and appetite.

    CNN: Your fifth tip may surprise some people: Consider social connection a core part of staying healthy.

    Wen: Human beings are social creatures, and our relationships have direct implications for our health. Strong social connections with family, friends, colleagues and community groups are associated with lower rates of anxiety and depression, better immune function, and reduced risk of chronic diseases such as hypertension and diabetes. Conversely, social isolation and loneliness have been linked to increased risk of cardiovascular disease, cognitive decline and early mortality.

    Social connection motivates healthier behaviors and provides emotional support during stress, and it encourages engagement in physical activity and other positive habits. Simple acts, such as going for walks with friends, regular catch-up phone calls, shared meals or other group activities, are good for short-term mental health. These interactions also represent a long-term investment in your mental and physical health.

    CNN: What advice do you have for people trying to follow these five tips in real life?

    Wen: The most important thing is to concentrate on consistency. These habits do not need to be done perfectly to have an impact. Small, repeated actions add up. For instance, walking most days is far better than exercising hard once a month. Going to regular checkups is crucial, rather than waiting until something feels wrong. Improving sleep by even 30 to 60 minutes a night can make a meaningful difference.

    It also helps to remember that these five areas are deeply connected. Getting enough sleep makes it easier to exercise and eat well. Regular physical activity improves sleep quality and mood. Social connection supports motivation and resilience, making it more likely that people stick with healthy routines. So instead of treating these as separate goals, think of them as reinforcing one another.

    Finally, give yourself permission to start where you are. Health is not built in January alone, and it is not derailed by a bad week or a missed goal. The aim is consistent progress. Choosing habits that feel realistic and sustainable, and returning to them when life gets busy, is what makes these five tips work over the long run.

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    Katia Hetter and CNN

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  • Body Condition, Weight Management, and Healthy Dog Diets | Animal Wellness Magazine

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    Learn how to score your dog’s body condition and discover healthy dog diets that can make weight management a breeze!                          

    Keeping your dog at a healthy weight is one of the most important things you can do to ensure a long, active, and happy life. Excess weight and obesity can cause joint problems, heart and respiratory issues, diabetes, reduced immunity, decreased energy and quality of life, and a shorter lifespan. Fortunately, it’s easy to manage your dog’s weight. Today, learn about body condition to help you keep an eye on things and get some great pointers about healthy dog diets that are tasty and nutritious.

    Body Condition Scores Can Help You Track Your Dog’s Weight

    A body condition score is a numerical assessment of your dog indicating whether they’re underweight, at a healthy weight, or overweight. It’s a simple way to assess and track weight because you don’t need any special tools. Rather, you can score your dog based on how they look and feel. The scale goes from 1 to 9, with the numbers meaning:

    • 1-2: Too thin
    • 3: Thin
    • 4-5: Ideal
    • 6-7: Overweight
    • 8-9: Obese

    How to Assess Your Dog’s Body Condition

    One: Stand Above and Look Down at Your Dog

    • Underweight: You can see rib and hip bones prominently, there’s little to no fat, and there’s muscle loss.
    • Ideal: You can see their body narrow at the waist.
    • Overweight: You can’t see the ribs and waist because of excess fat.

    Two: Examine Your Dog from the Side

    • Underweight: The stomach tucks up sharply from the ribs toward the hind legs, and the ribs are prominent.
    • Ideal: The stomach tucks up from the ribs toward the hind legs, but you can’t see the bones of the ribs prominently.
    • Overweight: The stomach is flat or sagging.

    Three: Feel Their Ribs, Spine, and Hips

    • Underweight: You can feel the ribs, spine, and hip bones because there’s little to no fat covering them.
    • Ideal: You can feel a thin layer of fat covering the ribs, spine, and hip bones.
    • Overweight: You can’t feel the ribs, spine, and hip bones because of a thick layer of fat.

    Healthy Dog Diets from NutriSource Simplify Weight Management

    Feeding the right diet is one of the most important things you can do to keep your dog at a healthy weight. Choice recipes from NutriSource are packed with everything your pup needs to thrive. The wet and dry recipes feature animal protein as the first ingredient and have L-carnitine, taurine, omega-3 fatty acids, and omega-6 fatty acids to support the heart, skin & coat, and cells. The recipes start with high-quality ingredients and include Bioplex trace minerals to improve nutrient absorption. Designed for efficient nutrition, Choice recipes enable you to feed less while still keeping your dog satisfied and healthy, making weight management easier than ever!

    Learn more about healthy dog diets and Choice recipes from NutriSource!

    Post Views: 17


    Animal Wellness is North America’s top natural health and lifestyle magazine for dogs and cats, with a readership of over one million every year. AW features articles by some of the most renowned experts in the pet industry, with topics ranging from diet and health related issues, to articles on training, fitness and emotional well being.

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  • Bariatric Surgery: Risks in the OR and Beyond | NutritionFacts.org

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    The extent of risk from bariatric weight-loss surgery may depend on the skill of the surgeon.

    After sleeve gastrectomy and Roux-en-Y gastric bypass, the third most common bariatric procedure is a revision to fix a previous bariatric procedure, as you can see below and at 0:16 in my video The Complications of Bariatric Weight-Loss Surgery.

    Up to 25% of bariatric patients have to go back into the operating room for problems caused by their first bariatric surgery. Reoperations are even riskier, with up to 10 times the mortality rate, and there is “no guarantee of success.” Complications include leaks, fistulas, ulcers, strictures, erosions, obstructions, and severe acid reflux.

    The extent of risk may depend on the skill of the surgeon. In a study published in The New England Journal of Medicine, bariatric surgeons voluntarily submitted videos of themselves performing surgery to a panel of their peers for evaluation. Technical proficiency varied widely and was related to the rates of complications, hospital readmissions, reoperations, and death. Patients operated on by less competent surgeons suffered nearly three times the complications and five times the rate of death.

    “As with musicians or athletes, some surgeons may simply be more talented than others”—but practice may help make them perfect. Gastric bypass is such a complicated procedure that the learning curve may require 500 cases for a surgeon to master the procedure. Risk for complications appears to plateau after about 500 cases, with the lowest risk found among surgeons who had performed more than 600 bypasses. The odds of not making it out alive may be double under the knife of those who had performed less than 75 compared to more than 450, as seen below and at 1:47 in my video.

    So, if you do choose to undergo the operation, I’d recommend asking your surgeon how many procedures they’ve done, as well as choosing an accredited bariatric “Center of Excellence,” where surgical mortality appears to be two to three times lower than non-accredited institutions.

    It’s not always the surgeon’s fault, though. In a report entitled “The Dangers of Broccoli,” a surgeon described a case in which a woman went to an all-you-can-eat buffet three months after a gastric bypass operation. She chose really healthy foods—good for her!—but evidently forgot to chew. Her staples ruptured, and she ended up in the emergency room, then the operating room. They opened her up and found “full chunks of broccoli, whole lima beans, and other green leafy vegetables” inside her abdominal cavity. A cautionary tale to be sure, but perhaps one that’s less about chewing food better after surgery than about chewing better foods before surgery—to keep all your internal organs intact in the first place.

    Even if the surgical procedure goes perfectly, lifelong nutritional replacement and monitoring are required to avoid vitamin and mineral deficits. We’re talking about more than anemia, osteoporosis, or hair loss. Such deficits can cause full-blown cases of life-threatening deficiencies, such as beriberi, pellagra, kwashiorkor, and nerve damage that can manifest as vision loss years or even decades after surgery in the case of copper deficiency. Tragically, in reported cases of severe deficiency of a B vitamin called thiamine, nearly one in three patients progressed to permanent brain damage before the condition was caught.

    The malabsorption of nutrients is intentional for procedures like gastric bypass. By cutting out segments of the intestines, you can successfully impair the absorption of calories—at the expense of impairing the absorption of necessary nutrition. Even people who just undergo restrictive procedures like stomach stapling can be at risk for life-threatening nutrient deficiencies because of persistent vomiting. Vomiting is reported by up to 60% of patients after bariatric surgery due to “inappropriate eating behaviors.” (In other words, trying to eat normally.) The vomiting helps with weight loss, similar to the way a drug for alcoholics called Antabuse can be used to make them so violently ill after a drink that they eventually learn their lesson.

    “Dumping syndrome” can work the same way. A large percentage of gastric bypass patients can suffer from abdominal pain, diarrhea, nausea, bloating, fatigue, or palpitations after eating calorie-rich foods, as they bypass your stomach and dump straight into your intestines. As surgeons describe it, this is a feature, not a bug: “Dumping syndrome is an expected and desired part of the behavior modification caused by gastric bypass surgery; it can deter patients from consuming energy-dense food.

    Doctor’s Note

    This is the second in a four-part series on bariatric surgery. If you missed the first one, see The Mortality Rate of Bariatric Weight-Loss Surgery.

    Up next: Bariatric Surgery vs. Diet to Reverse Diabetes and How Sustainable Is the Weight Loss After Bariatric Surgery?.

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local library, or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

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    Michael Greger M.D. FACLM

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  • Bariatric Weight-Loss Surgery and Mortality | NutritionFacts.org

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    Today, death rates after weight-loss surgery are considered to be “very low,” occurring in perhaps 1 in 300 to 1 in 500 patients on average.

    The treatment of obesity has long been stained by the snake-oil swindling of profiteers, hustlers, and quacks. Even the modern field of bariatric medicine (derived from the Greek word baros, meaning “weight”) is pervaded by an “insidious image of sleaze.” Beguiled by advertising for fairy tale magic bullets of rapid, effortless weight loss, people blame themselves for failing to manifest the miracle or imagine themselves metabolically broken. On the other end of the spectrum are overly pessimistic practitioners of the opinion that “people who are fat are born fat, and nothing much can be done about it.” The truth lies somewhere in between.

    The difficulty of curing obesity has been compared to learning a foreign language. It’s an achievement virtually anyone can attain with a sufficient investment of energies, “but it always takes a considerable amount of time and trouble.” And, of those who do stick with it, most will regain much of the weight lost. To me, this speaks to the difficulty, rather than the futility. It may take smokers an average of 30 attempts to finally kick the habit. Like quitting smoking, curing obesity is just something that has to be done. As the chair of the Association for the Study of Obesity put it, it doesn’t take “will power” to do essential tasks like getting up at night to feed a baby; it’s just something that has to be done.

    Our collective response doesn’t seem to match the rhetoric or reality. If obesity is such a “national crisis” reaching alarming proportions, dubbed by the post-9/11 Surgeon General as “every bit as devastating as terrorism,” why has our reaction been so tepid? For example, governments meekly suggest the food industry take “voluntary initiatives to restrict the marketing of less healthy food options to children….” Have we just given up and ceded control?

    Our timid response to the obesity epidemic is encapsulated by a national initiative promulgated by a Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council: the “small-changes approach.” Since “small changes are more feasible to achieve,” suggestions include “using mustard instead of mayonnaise” and “eating 1 rather than 2 doughnuts in the morning.” Seems a bit like bringing a butter knife to a gunfight. Proponents of the small-changes approach lament that, unlike other addictions—for example, alcohol, cocaine, gambling, or tobacco—we can’t counsel our obese patients to give up the addictive element completely, as “[n]o one can give up eating.” But just because we have to breathe, doesn’t mean it has to be through the end of a cigarette. And just because we have to eat doesn’t mean we have to eat junk.

    What about bringing a scalpel to the gunfight instead? The use of bariatric surgery has exploded from about 40,000 procedures noted in the first international survey in 1998 to hundreds of thousands performed now every year in the United States alone. The first technique that was developed, the intestinal bypass, involved carving out about 19 feet of intestines. More than 30,000 intestinal bypass operations were performed before we recognized “catastrophic” and “disastrous outcomes” resulted from these procedures. This included protein deficiency-induced liver disease, “which often progressed to liver failure and death.” This inauspicious start is remembered as “one of the dark blots in the history of surgery,” as I discuss in my video The Mortality Rate of Bariatric Weight-Loss Surgery.

    Today, death rates after bariatric surgery are considered “very low,” occurring on average in perhaps 1 in 300 to impacting 1 in 500 patients. The most common procedure is stomach stapling, also known as sleeve gastrectomy, in which most of the stomach is permanently removed. Only a narrow tube of the stomach is left so as to restrict how much food people can eat at any one time. It’s ironic that many patients choose bariatric surgery convinced that, “for them, ‘diets do not work,’” when, in reality, that’s all the surgery may be—an enforced diet. Bariatric surgery can be thought of as a form of internal jaw wiring.

    Gastric bypass, known as Roux-en-Y gastric bypass, is the second most common bariatric surgery. It combines restriction—stapling the stomach into a pouch smaller than a golf ball—with malabsorption by rearranging one’s anatomy to bypass the first part of the small intestine. It appears to be more effective than just cutting out most of the stomach, resulting in a loss of about 63% of excess weight compared to 53% with a gastric sleeve. But gastric bypass carries a greater risk of serious complications. Many are surprised to learn that new “surgical procedures…do not require premarket testing and approval by the Food and Drug Administration (FDA)” and are largely exempt from rigorous regulatory scrutiny.

    Doctor’s Note

    I didn’t know there wasn’t some kind of approval process for new surgical procedures!

    This is the first video in a four-part series on bariatric surgery. Coming up are:

    My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local public library or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

     

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    Michael Greger M.D. FACLM

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  • 4 Healthy Cat Diet Tips to Prevent Obesity | Animal Wellness Magazine

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    These four key healthy cat diet tips will help you understand how to use food to keep your feline friend lean and full of energy!

    Obesity is a common health issue in cats. In fact, it’s estimated that over 60% of cats are overweight or obese. Luckily, it’s easy to prevent, and there are plenty of reasons you should take steps to do so. Excess weight can shorten their lifespan, reduce their quality of life, and cause health conditions like diabetes, joint problems, and heart and liver disease. Regular play and exercise are essential components for a healthy lifestyle, but the real key to preventing obesity in cats lies in their food bowl. Here are four healthy cat diet tips that will help you keep your kitty lean, happy, and healthy!

    1. Practice Portion Control

    Overfeeding is one of the biggest contributors to cat obesity. The easiest way to combat it is by feeding your cat twice daily instead of allowing them to free feed, which can easily lead to constant snacking, overeating, and weight gain. And be sure to measure the proper amount of food for your cat based on the feeding guidelines provided by your vet or the food manufacturer.

    2. Adjust Calories Based on Life Stage and Activity Level

    Cats have different caloric needs depending on their age and how active they are. Kittens need more calories and nutrients to support growth, while adults and seniors typically require fewer calories. Spayed or neutered cats also have slower metabolisms and may gain weight more easily. Similarly, indoor cats who aren’t as active as outdoor cats may need a weight-maintenance formula. Regular checkups with your veterinarian will help you stay on track with a healthy cat diet.

    3. Prioritize Nutrient-Rich Cat Foods

    While it is important to pay attention to the number of calories your cat consumes, it’s just as important to make sure they’re getting the right nutrients. Cats are obligate carnivores, and they thrive on meat-rich diets. Look for foods with real animal protein as the first ingredient, minimal carbohydrates, and no artificial additives. High-quality foods ensure your cat gets the vitamins, minerals, and nutrients they need while also helping them feel satisfied with smaller portions.

    4. Keep Treats and Human Food to a Minimum

    Treats are okay, as long as they’re just that—treats. They shouldn’t make up more than 10% of your cat’s daily calories. And that includes human food. Even though some human foods are safe for cats (like lean meats, salmon, tuna, and even some vegetables), you must be careful not to overfeed. When you do feed treats, prioritize nutrient-dense ones. Here are some things to look for:

    • Single- or minimal-ingredient treats
    • Meat as the first ingredient
    • No added salt or sugar
    • Real-food ingredients

    A Healthy Cat Diet Starts with NutriSource Recipes!

    NutriSource has been nourishing cats for over 60 years with nutrient-dense foods, prioritizing high-quality ingredients and meat-rich recipes that supply cats with the calories and nutrients they need to maintain energy and a healthy body condition. They have a variety of options for cats of all ages in their NutriSource, Element, and PureVita lines, including grain-inclusive options, grain-free recipes, and weight management formulations, all of which feature animal protein as the first ingredient.

    Visit NutriSource to learn more and find the purrfect healthy cat diet for your feline friend!

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    Animal Wellness is North America’s top natural health and lifestyle magazine for dogs and cats, with a readership of over one million every year. AW features articles by some of the most renowned experts in the pet industry, with topics ranging from diet and health related issues, to articles on training, fitness and emotional well being.

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    Animal Wellness

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  • Plant-Based Hospital Menus | NutritionFacts.org

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    The American Medical Association passed a resolution encouraging hospitals to offer healthy plant-based food options.

    “Globally, 11 million deaths annually are attributable to dietary factors, placing poor diet ahead of any other risk factor for death in the world.” Given that diet is our leading killer, you’d think that nutrition education would be emphasized during medical school and training, but there is a deficiency. A systematic review found that, “despite the centrality of nutrition to a healthy lifestyle, graduating medical students are not supported through their education to provide high-quality, effective nutrition care to patients…”

    It could start in undergrad. What’s more important? Learning about humanity’s leading killer or organic chemistry?

    In medical school, students may average only 19 hours of nutrition out of thousands of hours of instruction, and they aren’t even being taught what’s most useful. How many cases of scurvy and beriberi, diseases of dietary deficiency, will they encounter in clinical practice? In contrast, how many of their future patients will be suffering from dietary excesses—obesity, diabetes, hypertension, and heart disease? Those are probably a little more common than scurvy or beriberi. “Nevertheless, fully 95% of cardiologists [surveyed] believe that their role includes personally providing patients with at least basic nutrition information,” yet not even one in ten feels they have an “expert” grasp on the subject.

    If you look at the clinical guidelines for what we should do for our patients with regard to our number one killer, atherosclerotic cardiovascular disease, all treatment begins with a healthy lifestyle, as shown below and at 1:50 in my video Hospitals with 100-Percent Plant-Based Menus.

    “Yet, how can clinicians put these guidelines into practice without adequate training in nutrition?”

    Less than half of medical schools report teaching any nutrition in clinical practice. In fact, they may be effectively teaching anti-nutrition, as “students typically begin medical school with a greater appreciation for the role of nutrition in health than when they leave.” Below and at 2:36 in my video is a figure entitled “Percentage of Medical Students Indicating that Nutrition is Important to Their Careers.” Upon entry to different medical schools, about three-quarters on average felt that nutrition is important to their careers. Smart bunch. Then, after two years of instruction, they were asked the same question, and the numbers plummeted. In fact, at most schools, it fell to 0%. Instead of being educated, they got de-educated. They had the notion that nutrition is important washed right out of their brains. “Thus, preclinical teaching”— the first two years of medical school—“engenders a loss of a sense of the relevance of the applied discipline of nutrition.”

    Following medical school, during residency, nutrition education is “minimal or, more typically, absent.” “Major updates” were released in 2018 for residency and fellowship training requirements, and there were zero requirements for nutrition. “So you could have an internal medicine graduate who comes out of a terrific program and has learned nothing—literally nothing—about nutrition.”

    “Why is diet not routinely addressed in both medical education and practice already, and what should be done about that?” One of the “reasons for the medical silence in nutrition” is that, “sadly…nutrition takes a back seat…because there are few financial incentives to support it.” What can we do about that? The Food Law and Policy Clinic at Harvard Law School identified a dozen different policy levers at all stages of medical education and the kinds of policy recommendations there could be for the decision-makers, as you can see here and at 3:48 in my video.

    For instance, the government could require doctors working for Veterans Affairs (VA) to get at least some courses in nutrition, or we could put questions about nutrition on the board exams so schools would be pressured to teach it. As we are now, even patients who have just had a heart attack aren’t changing their diet. Doctors may not be telling them to do so, and hospitals may be actively undermining their future with the food they serve.

    The good news is that the American Medical Association (AMA) has passed a resolution encouraging hospitals to offer healthy food options. What a concept! “Our AMA hereby calls on [U.S.] Health Care Facilities to improve the health of patients, staff, and visitors by: (a) providing a variety of healthy food, including plant-based meals, and meals that are low in saturated and trans fat, sodium, and added sugars; (b) eliminating processed meats from menus; and (c) providing and promoting healthy beverages.” Nice!

    “Similarly, in 2018, the State of California mandated the availability of plant-based meals for hospital patients,” and there are hospitals in Gainesville (FL), the Bronx, Manhattan, Denver, and Tampa (FL) that “all provide 100% plant-based meals to their patients on a separate menu and provide educational materials to inpatients to improve education on the role of diet, especially plant-based diets, in chronic illness.”

    Let’s check out some of their menu offerings: How about some lentil Bolognese? Or a cauliflower scramble with baked hash browns for breakfast, mushroom ragu for lunch, and, for supper, white bean stew, salad, and fruit for dessert. (This is the first time a hospital menu has ever made me hungry!)

    The key to these transformations was “having a physician advocate and increasing education of staff and patients on the benefits of eating more plant-based foods.” A single clinician can spark change in a whole system, because science is on their side. “Doctors have a unique position in society” to influence policy at all levels; it’s about time we used it.

    For more on the ingrained ignorance of basic clinical nutrition in medicine, see the related posts below.

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    Michael Greger M.D. FACLM

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  • Why Employers Still Cover GLP-1 Drugs as Prices Skyrocket

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    Among the workplace benefits employees say they appreciate most are flexible work arrangements, paid time off, 401(k) retirement accounts, career development programs, and of course company health insurance plans. But now, many businesses are scaling back or ending an increasingly popular benefit within their wider healthcare coverage – paying for workers’ use of glucagon-like peptide-1 (GLP-1) medication for weight loss.

    Initially developed to treat diabetes by regulating blood sugar levels, GLP-1 medication has become increasingly popular for losing weight. Recent surveys found that 60 percent of people taking Ozempic, Wegovy, Mounjaro, Saxenda, and other versions of the drug did so primarily for weight loss. But that surging demand has led pharmaceutical manufactures to repeatedly hike their prices for GPL-1s, which has spiked the costs of employer coverage of the drugs. As a result, many businesses are now having to rethink the terms of including those medications in their plans, or remove them entirely.

    Most businesses had already had to adjust to the average 6 percent rise in their employee health insurance premiums this year, with many facing double-digit rises in 2026. At the same time, a recent joint study by nonprofits Peterson Center on Healthcare and KFF determined employee use of GLP-1s has been far higher than anyone had anticipated — mostly due to the drug’s growing use for weight loss. Those factors are adding to the financial pinch for employer health plans and forcing them to respond.

    According to the Peterson-KFF survey, 19 percent of all employers with 200 employees or more cover GLP-1 use for losing weight in their health plans. But that rises to 30 percent among companies with 1,000-5,000 workers, and 43 percent for even bigger firms. Those latter figures represent a roughly 28 increase in coverage of the drug compared to 2024.

    Not surprisingly, nearly a quarter of all employers said staff use GLP-1 drugs for weight loss was higher than they expected, with that number rising to nearly 60 percent at larger businesses. That led nearly a third of respondents to report those medications had “significantly impacted their prescription drug spending,” rising to 66 percent at companies with 5,000 workers or more.

    “Before we knew it, we spent half a million dollars and were projected to go up to $1.2 million the following year,” a benefits manager with a retailing company said in anonymous comments to the Peterson-KFF survey about GLP-1 costs.

    Many employers are responding to both rising premiums and higher medication costs by passing on some of the increases to employees, and inching up co-pays workers have to finance. But that probably won’t be enough to offset the surging costs of GLP-1s. As a result, most companies are revising the way their plans cover the medication.

    Many businesses are limiting GLP-1 exclusively for diabetes treatment — with some requiring company health officials to approve that use beforehand. But because taking the medication has become so popular for weight loss, other employers don’t feel they can cut employees off from it.

    On the one hand, by covering the drug under company health plans, some employers have found GLP-1s have become a de facto benefit capable of attracting new recruits, while also helping to retain existing workers. Meantime, a lot of businesses have calculated that as expensive as the medication is, its effectiveness in helping weight loss has led to reduced costs related to employee cardiovascular diseases and other conditions attributed to obesity.

    Still, employers facing rising prices of the drug are having to stem its spreading use. In some cases, companies have decided to continue covering GLP-1s for weight loss, but only by employees above new body mass index (BMI) thresholds. Others additional measures include creating lifestyle and nutrition programs to make sure workers using the medication stay slimmer once they stop taking the medication.

    “(W)e put in the requirement that you have type 2 diabetes for certain GLP-1s, and then we put in a BMI of 35 or higher for the weight loss GLP-1s,” a HR official with a manufacturing company said in survey comments, noting some employees had been “grandfathered in” for continued use while others will need to qualify for it in the future. “We are trying to decide how to manage this crazy cost of the GLP-1s.”

    What’s behind that determination to keep covering GLP-1s?

    It comes partly from employers’ desire to safeguard employees’ health while sparing them much of the costs of doing that. At the same time, a lot of managers already recognize GLP-1 medications are likely to become ever bigger factors in healthcare coverage. That’s growing increasingly likely with the number of diseases the drug has been shown to improve continuing to multiply over time.

    As a result, even health insurance companies providing employee health coverage to business owners have warned that GLP-1 isn’t going away any time soon — whether the drugs are used for treating diabetes, losing weight, or addressing other conditions.

    “Our insurance provider, Cigna told us that within the next nine to 12 months, there’s really not going to be a choice,” said a health manager with a manufacturing company in the survey comments. “(A)ll insurance companies are probably going to be covering GLP-1s for weight loss.” 

    And as a result, many employers are resolving themselves to do likewise — though they’re starting so set some limits.

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    Bruce Crumley

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  • Ozempic’s Latest Weight Loss Competition Is Like Nothing We’ve Seen Before

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    The race to develop the next generation of weight loss drugs has taken an interesting new turn. In recent research, Eli Lilly’s experimental treatment eloralintide helped people lose a substantial amount of weight—without needing to use the same approach as existing popular medications like Ozempic.

    Earlier this month in The Lancet, Eli Lilly researchers and others published the latest phase II trial results of eloralintide. Over a 48-week span, people taking eloralintide lost up to 20% of their baseline body weight, well above the average weight loss experienced by those on placebo. Eloralintide’s early success so far is all the more notable because it isn’t a GLP-1 drug.

    A different mechanism

    Eloralintide mimics the hormone amylin. Our pancreas naturally releases amylin alongside insulin into the bloodstream in response to eating food. Once released, amylin helps tell our body that it’s full, tamps down our appetite, and slows the passage of food through our digestive system.

    The most effective weight loss drugs today, such as semaglutide (the active ingredient in Ozempic and Wegovy), are long-acting mimics of the hormone GLP-1. Like GLP-1, amylin plays a part in regulating our hunger and blood sugar control. The two hormones even share some overlap in how they affect the body to carry out these functions. But they also have some key distinctions, and that’s made amylin a promising new target for obesity treatment.

    There is an existing amylin-based drug, pramlintide, which was first approved two decades ago as a treatment for diabetes. But it’s the newest amylin analogues in development, like eloralintide, that have really excited scientists. These experimental drugs are designed to last much longer in the body than natural amylin, ideally boosting the hormone’s effects to help people lose weight and control their blood sugar. Much like semaglutide, eloralintide is intended to be taken once a week via subcutaneous injection.

    Early promise

    Eli Lilly’s phase II trial involved 263 participants without type 2 diabetes who had obesity (a body mass index over 30) or who were overweight (a BMI over 27) with weight-related health conditions. They were randomly assigned to either receive a placebo or varying doses of eloralintide. Some were given the same dosage of the drug throughout the study, while others were given gradually escalating dosages.

    People on eloralintide, no matter the dosing strategy, saw greater improvements in weight loss over 48 weeks on average compared to the placebo group, the study showed. People taking the highest weekly dose, nine milligrams, saw the best results, an average 20% weight loss during the study, as did people who steadily increased their dose from six to nine milligrams.

    It also appeared to be safe and generally well-tolerated. The adverse events typically associated with the drug were gastrointestinal, similar to the known side effects of GLP-1 therapy. The most common adverse event was nausea, with about a third of people on the highest dose reporting the symptom.

    “Eloralintide produced clinically meaningful, dose-dependent reductions in bodyweight over 48 weeks and was generally well tolerated, supporting eloralintide’s potential use for obesity treatment,” the study researchers wrote.

    What does this mean for the future of weight loss?

    GLP-1s have greatly changed the field of obesity medicine in recent years. And though these drugs aren’t risk-free and can be highly expensive, they’ve already started to turn back the clock on obesity. For the first time in years, America’s obesity rate has noticeably declined as the use of these drugs has steadily climbed.

    There are now plenty of obesity drugs in development, many of which are iterations of GLP-1. Other drugs are combining GLP-1 with other hunger-related hormones, including amylin. Eloralintide’s results are especially tantalizing, though, since the drug is only relying on amylin. That’s important because it may mean that eloralintide can eventually become an appealing alternative for people who haven’t responded to GLP-1 therapy.

    It’s far too early to be sure, especially without a study directly comparing these medications in a trial. But it’s worth noting that semaglutide only helped people lose about 15% of their body weight on average in clinical trials. Eli Lilly’s existing obesity drug tirzepatide, which pairs GLP-1 and the hormone GIP, has shown weight loss rates hovering around 20%.

    These early findings will have to be verified by data from larger trials, of course. But if this research continues to show promise, eloralintide could open up a whole new area of obesity treatment.

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    Ed Cara

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  • Trump is ramping up a new effort to convince a skeptical public he can fix affordability worries

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    WASHINGTON (AP) — President Donald Trump is adjusting his messaging strategy to win over voters who are worried about the cost of living with plans to emphasize new tax breaks and show progress on fighting inflation.

    The messaging is centered around affordability, and the push comes after inflation emerged as a major vulnerability for Trump and Republicans in Tuesday’s elections, in which voters overwhelmingly said the economy was their biggest concern.

    Democrats took advantage of concerns about affordability to run up huge margins in the New Jersey and Virginia governor races, flipping what had been a strength for Trump in the 2024 presidential election into a vulnerability going into next year’s midterm elections.

    White House officials and others familiar with their thinking requested anonymity to speak for this article in order to not get ahead of the president’s actions. They stressed that affordability has always been a priority for Trump, but the president plans to talk about it more, as he did Thursday when he announced that Eli Lilly and Novo Nordisk would reduce the price of their anti-obesity drugs.

    “We are the ones that have done a great job on affordability, not the Democrats,” Trump said at an event in the Oval Office to announce the deal. “We just lost an election, they said, based on affordability. It’s a con job by the Democrats.”

    The White House is keeping up a steady drumbeat of posts on social media about prices and deals for Thanksgiving dinner staples at retailers such as Walmart, Lidl, Aldi and Target.

    “I don’t want to hear about the affordability, because right now, we’re much less,” Trump told reporters Thursday, arguing that things are much better for Americans with his party in charge.

    “The only problem is the Republicans don’t talk about it,” he said.

    The outlook for inflation is unclear

    As of now, the inflation outlook has worsened under Trump. Consumer prices in September increased at an annual rate of 3%, up from 2.3% in April, when the president first began to roll out substantial tariff hikes that suddenly burdened the economy with uncertainty. The AP Voter Poll showed the economy was the leading issue in Tuesday’s elections in New Jersey, Virginia, New York City and California.

    Grocery prices continue to climb, and recently, electricity bills have emerged as a new worry. At the same time, the pace of job gains has slowed, plunging 23% from the pace a year ago.

    The White House maintains a list of talking points about the economy, noting that the stock market has hit record highs multiple times and that the president is attracting foreign investment. Trump has emphasized that gasoline prices are coming down, and maintained that gasoline is averaging $2 a gallon, but AAA reported Thursday that the national average was $3.08, about two cents lower than a year ago.

    “Americans are paying less for essentials like gas and eggs, and today the Administration inked yet another drug pricing deal to deliver unprecedented health care savings for everyday Americans,” said White House spokesman Kush Desai.

    Trump gets briefed about the economy by Treasury Secretary Scott Bessent and other officials at least once a week and there are often daily discussions on tariffs, a senior White House official said, noting Trump is expected to do more domestic travel next year to make his case that he’s fixing affordability.

    But critics say it will be hard for Trump to turn around public perceptions on affordability.

    “He’s in real trouble and I think it’s bigger than just cost of living,” said Lindsay Owens, executive director of Groundwork Collaborative, a liberal economic advocacy group.

    Owens noted that Trump has “lost his strength” as voters are increasingly doubtful about Trump’s economic leadership compared to Democrats, adding that the president doesn’t have the time to turn around public perceptions of him as he continues to pursue broad tariffs.

    New hype about income tax cuts ahead of April

    There will be new policies rolled out on affordability, a person familiar with the White House thinking said, declining to comment on what those would be. Trump on Thursday indicated there will be more deals coming on drug prices. Two other White House officials said messaging would change — but not policy.

    A big part of the administration’s response on affordability will be educating people ahead of tax season about the role of Trump’s income tax cuts in any refunds they receive in April, the person familiar with planning said. Those cuts were part of the sprawling bill Republicans muscled through Congress in July.

    This individual stressed that the key challenge is bringing prices down while simultaneously having wages increase, so that people can feel and see any progress.

    There’s also a bet that the economy will be in a healthier place in six months. With Federal Reserve Chair Jerome Powell’s term ending in May, the White House anticipates the start of consistent cuts to the Fed’s benchmark interest rate. They expect inflation rates to cool and declines in the federal budget deficit to boost sentiment in the financial markets.

    But the U.S. economy seldom cooperates with a president’s intentions, a lesson learned most recently by Trump’s predecessor, Democrat Joe Biden, who saw his popularity slump after inflation spiked to a four-decade high in June 2022.

    The Trump administration maintains it’s simply working through an inflation challenge inherited from Biden, but new economic research indicates Trump has created his own inflation challenge through tariffs.

    Since April, Harvard University economist Alberto Cavallo and his colleagues, Northwestern University’s Paola Llamas and Universidad de San Andres’ Franco Vazquez, have been tracking the impact of the import taxes on consumer prices.

    In an October paper, the economists found that the inflation rate would have been drastically lower at 2.2%, had it not been for Trump’s tariffs.

    The administration maintains that tariffs have not contributed to inflation. They plan to make the case that the import taxes are helping the economy and dismiss criticisms of the import taxes as contributing to inflation as Democratic talking points.

    The fate of Trump’s country-by-country tariffs is currently being decided by the Supreme Court, where justices at a Wednesday hearing seemed dubious over the administration’s claims that tariffs were essentially regulations and could be levied by a president without congressional approval. Trump has maintained at times that foreign countries pay the tariffs and not U.S. citizens, a claim he backed away from slightly Thursday.

    “They might be paying something,” he said. “But when you take the overall impact, the Americans are gaining tremendously.”

    _____

    Associated Press writers Will Weissert and Michelle L. Price contributed to this report.

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  • Rates of high blood pressure in children have nearly doubled in 20 years

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    (CNN) — Global rates of hypertension, or high blood pressure, in childhood and adolescence have nearly doubled since 2000, putting more kids at risk for poor health later in life.

    “In 2000, about 3.4% of boys and 3% of girls had hypertension. By 2020, those numbers had risen to 6.5% and 5.8% respectively,” said Dr. Peige Song, a researcher from the School of Public Health at Zhejiang University School of Medicine in China. Song is one of the authors of a study describing the findings that published Wednesday in the journal The Lancet Child and Adolescent Health.

    Children who have hypertension could be at greater risk later on of developing heart disease –– the No. 1 cause of death in the United States, said Dr. Mingyu Zhang, assistant professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. He was not involved in the research.

    “The good news is that this is a modifiable risk,” Song said in an email. “With better screening, earlier detection, and a stronger focus on prevention, especially around healthy weight and nutrition, we can intervene before complications arise.”

    High blood pressure in kids can be addressed

    The rise in hypertension in children is likely due to many factors.

    Childhood obesity is a significant risk factor, because it is associated with factors like insulin resistance, inflammation and vascular function, Song said.

    Dietary factors such as consuming high levels of sodium and ultraprocessed food can also contribute to hypertension risk, as well as poor sleep quality, stress and genetic predisposition, she said.

    Many children also get less movement than past generations and spend more time on sedentary activities, like screen use, which may be affecting risk, she said.

    “We are also starting to know that other factors, including environmental pollutants, can contribute,” Zhang added.

    Zhang served as senior author on a previous study that showed a connection between prebirth exposure to chemicals called PFAS — a class of about 15,000 human-made compounds linked to cancers, endocrine-related conditions and developmental issues in children — and childhood hypertension. Short for perfluoroalkyl and polyfluoroalkyl substances, PFAS are sometimes called “forever chemicals” because they don’t fully break down in the environment.

    The biggest takeaway of this research for families is not to assume high blood pressure is only a problem for adults, Song said.

    If you are worried about your child’s risk for obesity or hypertension, pressure, shame and restriction are not the best approaches.

    Instead, focus on increasing healthy behaviors in a happy way, said Jill Castle, a pediatric dietitian in Massachusetts, in a previous CNN article.

    “The goal of the food pillar is really to embrace flexibility with food and to emphasize foods that are highly nutritious and … to allow foods also that might be minimally nutritious within the diet in ways that can be fully enjoyed and flexible,” Castle said.

    Try to prioritize sitting down as a family for meals and avoid labeling foods as “good” or “bad,” said Castle, author of “Kids Thrive at Every Size.”

    “The clean plate club or rewarding with sweets — they might work in the moment, but they don’t do a good job of establishing the self-trust and an intuitive, good relationship with food as kids grow up,” Castle said.

    Masked hypertension in children

    The study didn’t just track rates in the United States. Instead, researchers analyzed data from 96 studies across 21 countries.

    Another important consideration the study team made is how blood pressure differs in and outside the doctor’s office. Some children might have normal blood pressure at home, but a higher reading in the office, while others might have a lower blood pressure in the office than they normally would.

    By including data from both office visits and at-home blood pressure readings, the researchers were able to include hypertension rates that are “masked,” or wouldn’t be caught in a doctor’s visit, Zhang said. Masked hypertension was found to be the most common kind, according to the data.

    “This is important because it means that many children with true hypertension could go undetected if we rely only on office blood pressure readings,” he said.

    The result show that one reading may not be enough, and there may be a need for more scalable solutions for better monitoring and care of hypertension around the world, Song added.

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    Madeline Holcombe and CNN

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  • Pfizer clinches deal for obesity drug developer Metsea after a bidding war with Novo Nordisk

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    Pfizer has signed a deal to purchase Metsera Inc., an obesity drugmaker in the development stage, after winning a bidding war against Novo Nordisk

    NEW YORK — U.S. pharmaceutical giant Pfizer signed a deal to purchase development-stage obesity drugmaker Metsera Inc., winning a bidding war against Novo Nordisk, the Danish drugmaker behind weight-loss treatments Ozempic and Wegovy.

    Metsera, based in New York, has no products on the market, but it is developing oral and injectable treatments. That includes some potential treatments that could target lucrative fields for obesity and diabetes.

    The deal comes as Pfizer is attempting to develop its own stake in that market, several months after ending development of a potential pill treatment for obesity.

    In a statement issued Friday, Metsera said Pfizer will acquire the company for up to $86.25 per share, consisting of $65.60 per share in cash and a contingent value right entitling holders to additional payments of up to $20.65 per share in cash.

    Metsera cited U.S. antitrust risks in Novo’s bid, saying in its statement that the board has determined Pfizer’s revised terms represent “the best transaction for shareholders, both from the perspective of value and certainty of closing.”

    The deal comes three days after Novo Nordisk raised the stakes in its push to outbid Pfizer, saying Tuesday it would offer to pay as much as $10 billion for Metsera. That was higher than its previous bid of up to $9 billion which sparked a lawsuit from Pfizer.

    Pfizer had also altered the offer it made in September of nearly $4.9 billion to provide more cash up front, Metsera had said.

    New York-based Pfizer said in an email that it was happy with the terms of the deal, and expects to close the transaction shortly following the Metsera shareholder meeting on Nov. 13.

    Novo Nordisk said Saturday it would not increase its offer and would leave the race to acquire Metsera.

    Novo’s proposed deal had involved paying $62.20 in cash for each Metsera share, up from its previous bid of $56.50. The Danish drugmaker planned to tack on a contingent value right payment of $24, another improvement from its previous bid, if certain development and regulatory milestones were met.

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  • Pfizer Clinches Deal for Obesity Drug Developer Metsea After a Bidding War With Novo Nordisk

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    NEW YORK (AP) — U.S. pharmaceutical giant Pfizer signed a deal to purchase development-stage obesity drugmaker Metsera Inc., winning a bidding war against Novo Nordisk, the Danish drugmaker behind weight-loss treatments Ozempic and Wegovy.

    Metsera, based in New York, has no products on the market, but it is developing oral and injectable treatments. That includes some potential treatments that could target lucrative fields for obesity and diabetes.

    The deal comes as Phizer is attempting to develop its own stake in that market, several months after ending development of a potential pill treatment for obesity.

    In a statement issued Friday, Metsera said Pfizer will acquire the company for up to $86.25 per share, consisting of $65.60 per share in cash and a contingent value right entitling holders to additional payments of up to $20.65 per share in cash.

    Metsera cited U.S. antitrust risks in Novo’s bid, saying in its statement that the board has determined Pfizer’s revised terms represent “the best transaction for shareholders, both from the perspective of value and certainty of closing.”

    Pfizer had also altered the offer it made in September of nearly $4.9 billion to provide more cash up front, Metsera had said.

    New York-based Pfizer said in an email that it was happy with the terms of the deal, and expects to close the transaction shortly following the Metsera shareholder meeting on Nov. 13.

    Novo’s proposed deal had involved paying $62.20 in cash for each Metsera share, up from its previous bid of $56.50. The Danish drugmaker planned to tack on a contingent value right payment of $24, another improvement from its previous bid, if certain development and regulatory milestones were met.

    Copyright 2025 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

    Photos You Should See – Oct. 2025

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    Associated Press

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