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Tag: obesity

  • Trump unveils deal to expand coverage and lower costs on obesity drugs

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    WASHINGTON (AP) — President Donald Trump unveiled a deal Thursday with drugmakers Eli Lilly and Novo Nordisk to expand coverage and reduce prices for the popular obesity treatments Zepbound and Wegovy.

    Known as GLP-1 receptor agonists, the drugs have soared in popularity in recent years, but patient access has been a consistent problem because of their cost — around $500 a month for higher doses — and insurance coverage has been spotty. More than 100 million American adults are obese, according to federal estimates.

    Coverage of the drugs for obesity will expand to Medicare patients starting next year, according to the administration, which said some lower prices also will be phased in for patients without coverage. Starting doses of new, pill versions of the treatments also will cost $149 a month if they are approved.

    “(It) will save lives, improve the health of millions and millions of Americans,” said Trump, in an Oval Office announcement in which he referred to GLP-1s as a “fat drug.”

    Thursday’s announcement is the latest attempt by the Trump administration to rein in soaring drug prices in its efforts to address cost-of-living concerns among voters. Pfizer and AstraZeneca recently agreed to lower the cost of prescription drugs for Medicaid after an executive order in May set a deadline for drugmakers to electively lower prices or face new limits on what the government will pay.

    As with the other deals, it’s not clear how much the price drop will be felt by consumers. Drug prices can vary based on the competition for treatments and insurance coverage.

    Obesity drugs are popular, but costly

    The obesity drugs work by targeting hormones in the gut and brain that affect appetite and feelings of fullness. In clinical trials, they helped people shed 15% to 22% of their body weight — up to 50 pounds or more in many cases.

    Patients usually start on smaller doses and then work up to larger amounts, depending on their needs. They need to stay on the the treatments indefinitely or risk regaining weight, experts say.

    The medications have proven especially lucrative for Lilly and Novo. Lilly said recently that sales of Zepbound have tripled so far this year to more than $9 billion.

    But for many Americans, their cost has made them out of reach.

    Medicare, the federally funded coverage program mainly for people ages 65 and over, now covers the cost of the drugs for conditions such as type 2 diabetes and cardiovascular disease, but not for weight loss alone. Trump’s predecessor, Joe Biden, proposed a rule last November that would have changed that, but the Trump administration nixed it.

    Few state and federally funded Medicaid programs, for people with low incomes, offer coverage. And employers and insurers that provide commercial coverage are wary of paying for these drugs in part because so many people might use them.

    The $500 monthly price for higher doses of the treatments also makes them unaffordable for those without insurance, doctors say.

    Trump tries to show he is in touch with cost-of-living concerns

    Thursday’s announcement comes as the White House is looking to demonstrate that Trump is in touch with Americans’ frustrations with rising costs for food, housing, health care and other necessities.

    “Trump is the friend of the forgotten American,” said Health and Human Services Secretary Robert F. Kennedy, Jr. at Thursday’s announcement. “Obesity is a disease of poverty. And overwhelmingly, these drugs have only been available for people who have wealth.”

    (Obesity rates actually are slightly higher for middle-income Americans than they are for those with the lowest and highest incomes, according to 2017-2020 data collected by the U.S. Centers for Disease Control and Prevention.)

    Kennedy had previously expressed skepticism about GLP-1s, but he was full of praise for Trump for pushing to help a broader segment of Americans have access to the drug.

    Trump, who has a history of commenting on people’s appearance, asked the officials who joined him in the Oval Office whether they had used the weight-loss medications.

    “Do you take any of this stuff, Howard?” Trump asked Commerce Secretary Howard Lutnick. “Not yet,” Lutnick replied. “He’s taking it,” the president said of Steven Cheung, who is the White House director of communications.

    The drug-pricing announcement came days after Democrats swept elections in races across the country. Economic worries were the dominant concern for those casting their ballots, according to findings from the AP voter poll.

    Plan calls for phased-in price reductions

    The White House sought to diminish price-reduction efforts by the previous Democratic administration as a gift to the pharmaceutical industry.

    Trump, instead, consummated a deal that ensures Americans aren’t unfairly financing the pharmaceutical industry’s innovation, claimed a senior administration official, who briefed reporters ahead of Thursday’s Oval Office announcement.

    Another senior administration official said coverage of the drugs will expand to Medicare patients starting next year. The program will start covering the treatments for people who have severe obesity and others who are overweight or obese and have serious health problems, the official said. Those who qualify will pay $50 copays for the medicine.

    Lower prices also will be phased in for people without coverage through the administration’s TrumpRx program, which will allow people to buy drugs directly from manufacturers, starting in January.

    Administration officials said the average price of the drugs sold on TrumpRx will start at around $350 and then drop to $245 over the next two years.

    A Novo Nordisk spokesperson declined to provide details on their pricing changes.

    Lilly said it will sell a starter dose of Zepbound for $299 a month and additional doses at up to $449. Both represent $50 reductions from current prices for doses it sells directly to patients.

    Administration officials said lower prices also will be provided for state and federally funded Medicaid programs. And starting doses of new, pill versions of the obesity treatments will cost $149 a month if they are approved.

    U.S. health regulators on Thursday separately agreed to dramatically expedite review of Lilly’s obesity pill, orforglipron. An FDA decision on Novo Nordisk’s Wegovy pill is expected later this year.

    Doctors who treat patients for obesity say help is needed to improve access. Dr. Leslie Golden says she has roughly 600 patients taking one of these treatments, and at least 75% struggle to afford them. Even with coverage, some face $150 copayments for refills.

    “Every visit it’s, ‘How long can we continue to do this? What’s the plan if I can’t continue?’” said Golden, an obesity medicine specialist in Watertown, Wisconsin. “Some of them are working additional jobs or delaying retirement so they can continue to pay for it.”

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    AP Health Writer Matthew Perrone contributed to this report.

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    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

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  • Pfizer sues to stop rival bid for drugmaker Metsera by Denmark’s Novo Nordisk

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    Pfizer is suing over some unsolicited competition in its nearly $5 billion bid to buy the drugmaker Metsera.

    New York-based Pfizer said Friday after markets closed that it was suing Metsera and a third drugmaker, Denmark’s Novo Nordisk, over a bid for Metsera that Novo announced Thursday.

    Novo said it planned to buy Metsera in a deal that could be worth up to $9 billion, and Metsera said the offer appeared to be superior to Pfizer’s bid, which was announced in September.

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

    Novo already has the treatments Wegovy and Ozempic on the market in those respective categories.

    Pfizer said the offer from Novo cannot be considered superior to its bid because it carries significant regulatory risk that makes it unlikely to be completed.

    Pfizer, which ended development of a potential pill to treat obesity this spring, also said Novo’s offer represents “an illegal attempt by a company with a dominant market position to suppress competition.”

    Representatives of both Novo and Metsera did not immediately respond to requests for comment from The Associated Press.

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  • Obesity, Diabetes Treatments Fuel Eli Lilly Growth and Spark Bidding War

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    The market for obesity and diabetes treatments remains scorching hot, funneling billions in sales to Eli Lilly and fueling a bidding war over another drugmaker.

    Lilly said Thursday that its top-selling drugs, Mounjaro and Zepbound, brought in more than $10 billion combined during the recently completed third quarter. That made up over half of the drugmaker’s $17.6 billion in total sales.

    Separately, Danish drugmaker Novo Nordisk announced plans to buy Metsera Inc. in a deal that could be worth up to $9 billion.

    Popular treatments labeled GLP-1 receptor agonists are fueling the soaring sales and deal interest. They work by mimicking hormones in the gut and the brain to regulate appetite and feelings of fullness. But they don’t work for everyone and can produce side effects that include nausea and stomach pain.

    Supplies of the drugs have improved this year, and some insurance coverage is growing. That helps improve access to drugs that can cost around $500 a month without coverage. That can put them out of reach for many patients.

    U.S. sales of Lilly’s weight-loss treatment Zepbound nearly tripled to $3.57 billion in the third quarter. Meanwhile, revenue from the diabetes drug Mounjaro, which has been on the market longer, doubled to $6.52 billion thanks to growth outside the U.S.

    Combined, the drugs have brought in nearly $25 billion in sales so far this year for Indianapolis-based Lilly. That surpasses the entire company’s revenue total from 2020.

    The drugs helped Eli Lilly and Co. record a $5.58 billion profit in the third quarter and deliver a better performance than Wall Street expected.

    Novo Nordisk said it will pay $56.50 in cash for each Metsera share and could pay an extra $21.25 if the company meets some drug development milestones. The drugmaker already has the obesity and diabetes treatments Wegovy and Ozempic on the market.

    That combined total of $77.75 more than doubles the closing price of Metsera shares on Sept. 19, the last trading day before Pfizer made its offer.

    Pfizer Inc. is known for the COVID-19 vaccine Comirnaty and the treatment Paxlovid, among other drugs. But the New York drugmaker decided to take another stab at obesity treatments months after ending development of its own drug.

    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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  • Poll: Americans Getting Skinnier, Weight Loss Drug Use Expands – KXL

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    FILE – This file photo shows a closeup of a beam scale in New York, April 3, 2018. (AP Photo/Patrick Sison, File)

    WASHINGTON, DC – America is reportedly getting skinnier and weight loss drugs may be a contributing factor. According to a self-reported Gallup poll, for the first time in more than 15 years, obesity rates in the U.S. have fallen from almost 40-percent in 2022 to 37-percent today. That’s an estimated seven-point-six million fewer obese adults.

    According to a self-reported Gallup poll, for the first time in more than 15 years, obesity rates in the U.S. have fallen from almost 40-percent in 2022 to 37-percent today. Acquired Through MGN Online

    The same poll reports 15-percent of women and just under 10-percent of men are on GLP-1 drugs like Ozempic, more than double the number who said they used them last year.

    More about:

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    Tim Lantz

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  • Obesity rate is declining as more Americans use weight loss drugs, survey finds

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    As more Americans turn to weight loss drugs, the U.S. adult obesity rate is declining, according to new survey data from Gallup.

    The data published Tuesday showed the obesity rate among participants has gradually declined to 37% in 2025 after previously hitting a record high of 39.9% in 2022. Results were based on data from three nationally representative surveys of 16,946 U.S. adults interviewed by web in the first three quarters of 2025.

    “This is a statistically meaningful decrease representing an estimated 7.6 million fewer obese adults compared with three years ago,” the report noted.

    In the report, obesity was defined using the federal standard of having a BMI of 30 or higher.

    The report also explored the simultaneous increase in GLP-1 drug usage for weight loss, including semaglutides like Ozempic and Wegovy. These drugs are also used to treat type 2 diabetes, which the report noted was still at an all-time high, with 13.8% of Gallup’s Well-Being Index participants saying they’ve been diagnosed with the chronic disease.

    When Gallup first measured GLP-1 usage in February 2024, 5.8% of adults reported taking this type of medicine for weight loss. Now, the percentage has increased to 12.4%, the report said.

    “Amid increased use of GLP-1 injectables for weight loss, obesity rates have been coming down for most age groups since 2022,” the report added.

    The report found the biggest reduction in obesity was among those aged 40 to 49 and those aged 50 to 64. These are the same age groups with the highest rates of GLP-1 injectables for weight loss, the report said.

    The report does have some limitations, however, including potential bias in how respondents present themselves.

    “However, because Gallup’s method of collecting self-reported weight and height has been consistent, the trend still provides valuable information regarding changes over time,” the report said.

    Gallup also did not measure GLP-1 usage for weight loss in 2022 or 2023, but said available data via its Well-Being Index are “consistent with reports of steadily increasing use since the initial FDA approval in 2021.”

    Despite the reported decline in obesity rates, the U.S. continues to exceed many Western countries in weight, the report pointed out — but expanding access to weight loss treatments may be a factor in the obesity decline becoming a lasting trend, the authors note.

    Around 40% of adults in the U.S. are obese, data from the Centers for Disease Control and Prevention suggested in September 2024 — marking the first time in over a decade that the nation’s obesity rate has not inched up, results from the federal government’s national health survey showed. 

    Edited by

    Kiki Intarasuwan

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  • Skinny Is the New Fat: Plenty of People Have ‘Normal’ BMI but Hidden Obesity, Study Finds

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    Your number on the bathroom scale could be misleading. New research finds that a substantial portion of people with “normal” weight still have obesity—and the higher risk of other health problems that goes along with it.

    A large, international team of scientists examined survey data from the World Health Organization. They found that roughly one in five people worldwide with a healthy body mass index (BMI) show clear signs of abdominal obesity, or excess body fat. These skinny-fat individuals were also more likely to have conditions like high blood pressure. Doctors could be missing important health issues if they only focus on their patients’ BMI, the researchers say.

    “Relying solely on BMI may be insufficient to identify these high-risk individuals and provide timely interventions,” they wrote in their paper, published this month in JAMA Network Open.

    “Normal” but obese

    BMI is calculated using a person’s weight and height, with obesity traditionally defined as having a BMI of 30 and over. In recent years, however, some doctors and patients have pushed for an expansion of what should be considered obese.

    In January, a large group of obesity experts, backed by organizations like the American Heart Association, released alternative criteria for diagnosing obesity. This criterion asks doctors to either use BMI alongside one other measurement of excess body fat or to rely on these other measurements entirely. One such measurement is waist circumference.

    In this new study, the researchers analyzed data from the WHO STEPS survey, a long-running project monitored by the WHO that allows countries to keep track of their residents’ risk factors for noncommunicable diseases, particularly those related to their lifestyle. In total, they looked at nearly a half million participants across 91 countries between 2000 and 2020.

    All in all, 21% of respondents met the threshold for “normal-weight abdominal obesity,” meaning they had a healthy BMI but a large enough waistline to be categorized as obese. Compared to people with a normal BMI and healthy waistline, this group also had a higher prevalence of hypertension, high cholesterol, and diabetes, the researchers found.

    Not just BMI

    Other recent research has highlighted the importance of moving past BMI alone.

    A study earlier this month, for instance, found that nearly 70% of Americans today meet the newer definition of obesity; this included 25% of Americans who had a normal BMI but other measures of excess body fat, such as waist circumference. This study also found that people with skinny obesity had a higher overall risk of health problems than nonobese people. That said, the authors of the latest study say theirs is the first to examine how common this form of hidden obesity is across the globe.

    Rather than wholly abandon BMI altogether, the study researchers argue that doctors should use it in combination with these other measurements to truly get a better sense of their patients’ overall cardiovascular and metabolic health.

    “Our findings suggest the need to use both BMI and waist circumference together, rather than in isolation, to provide a more complete and accurate assessment of cardiometabolic risk across diverse populations,” they wrote.

    These results should also motivate the average person to get a thorough checkup at their next physical, one that doesn’t just stop at BMI.

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    Ed Cara

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  • Study Promoting Apple Cider Vinegar for Weight Loss Was Complete Bunk

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    Anyone who’s tried to lose weight knows there’s no shortage of products or fad foods out there that will supposedly speed up your slimming. One such advertised food, apple cider vinegar, will have less credibility behind it now, as a clinical trial claiming to show its weight loss success has just been yanked by the publisher.

    BMJ Group announced the retraction of the study this afternoon. Originally published last year, the small trial purportedly showed that people who drank apple cider vinegar daily lost more weight than controls over a three-month period. The publisher cited several factors, including implausible data, as reasons to yank the study.

    “Tempting though it is to alert readers to an ostensibly simple and apparently helpful weight loss aid, at present the results of the study are unreliable, and journalists and others should no longer reference or use the results of this study in any future reporting,” said Helen Macdonald, Publication Ethics and Content Integrity Editor at BMJ Group, in a statement from BMJ.

    Too good to be true

    Researchers in Lebanon conducted the study, first published in March 2024 in the journal BMJ Nutrition, Prevention & Health. The trial reportedly involved 120 teens and young adults who were overweight and obese. The volunteers were randomly assigned to one of four groups: three groups were asked to drink different doses of apple cider vinegar (diluted in water) once a day in the morning, while the fourth was asked to drink a placebo liquid.

    The trial reportedly ran for 12 weeks, and by the study’s end, the researchers claimed that people drinking apple cider vinegar lost significantly more weight than those on the placebo. On average, people taking apple cider vinegar were said to have lost between 13 and 17 pounds, and those who drank the most apple cider vinegar also tended to lose more weight than the other groups—a potential sign that the ingredient was truly improving people’s odds of weight loss (in medicine, this is called a dose-response effect). People on the apple cider vinegar diet were also said to have improved their levels of blood glucose, triglycerides, and cholesterol as well.

    It wasn’t long before outside scientists began to raise red flags about the statistical analysis underpinning the study’s findings, however. The BMJ Group initially saw fit to publish some of these critiques alongside the study itself, a common practice in science. But after further review, they determined that this wasn’t a mere disagreement about some figures here and there, but something more concerning. They enlisted statisticians to examine the raw data and to try replicating the study results from said data.

    Ultimately, the outside experts were not able to replicate the authors’ analyses; what’s more, they identified other sketchy stuff. They determined that the data contained “implausible values” and found potential evidence that participants were not truly randomized into their group as claimed. The authors also failed to proactively register their trial prior to performing it—a common precaution against later data tweaking that’s required by the BMJ Group—and didn’t explain their methods thoroughly enough, the publisher determined.

    The study authors, according to the BMJ, maintain that the statistical oddities were only honest mistakes in how they presented, exported, or calculated the data. But they’ve nonetheless agreed with the publisher’s decision to retract the work.

    Gizmodo reached out to the study authors for comment but did not receive a response by the time of publication.

    The weight loss takeaway

    Even before this retraction, though, there really wasn’t much evidence to suggest that apple cider vinegar—or any single food, for that matter—can supercharge your weight loss attempt.

    Yes, people can certainly lose weight, even lots of it, through healthy changes in their diet and lifestyle. The much harder part is maintaining this weight loss for a sustained period of time, which is why many, if not most, people eventually regain the weight back. Newer options like GLP-1 therapies have made it easier to treat obesity, though these too aren’t miracles with no drawbacks.

    Unfortunately, long-term successful weight loss still remains a challenge, and no amount of apple cider vinegar will change that reality.

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    Ed Cara

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  • Coloradans can get updated COVID vaccines, but insurance might not cover the shots

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    Anyone 6 months and older who wants a COVID-19 shot in Colorado can now get one, but the vaccine will only be free for those with the right insurance — at least for now.

    Initially, pharmacies couldn’t administer the updated shots in Colorado unless a patient had a prescription. The state allows pharmacists to administer vaccines recommended by the Centers for Disease Control and Prevention’s advisory committee, but not other shots.

    Dr. Ned Calonge, chief medical officer for the state health department, responded by issuing a standing order — essentially, a prescription for every resident – allowing them to get vaccinated at retail pharmacies.

    But that order doesn’t guarantee insurance will cover the shots or that pharmacies will choose to stock them. Last year, fewer than half of people over 65 nationwide received an updated COVID-19 shot, with uptake dropping further in younger age groups, raising questions about whether health care providers will believe demand is high enough to justify buying the vaccine.

    “The standing order provides accessibility. It doesn’t necessarily provide availability,” Calonge said Tuesday.

    The Colorado Division of Insurance issued a draft rule last week that would require state-regulated plans to cover COVID-19 vaccines without out-of-pocket costs for people of any age, assuming the division passes it as written. Insurance cards from state-regulated plans typically have CO-DOI printed in the lower left corner.

    The state’s rule doesn’t apply to federally regulated plans, which account for about 30% of employer-sponsored insurance plans in Colorado, Calonge said. Typically, however, those plans try to offer competitive benefits, since they mostly serve large employers, he said.

    “My hope would be they would want to keep up with other insurers,” he said.

    This isn’t the first time that people on state-regulated plans have had benefits not guaranteed for people with federally regulated insurance.

    Colorado capped the cost of insulin and epinephrine shots to treat severe allergic reactions in state plans, but couldn’t require the same for plans the state doesn’t oversee. In those cases, it offered an “affordability program” requiring manufacturers to supply the medication at a lower cost for people who aren’t covered by the state caps, Medicare or Medicaid.

    At least two Colorado insurers surveyed by The Denver Post said all of their plans will cover COVID-19 vaccines, while others hedged.

    Select Health, which sells Medicare and individual marketplace plans in Colorado, said its plans currently cover COVID-19 vaccines without out-of-pocket costs for everyone. Kaiser Permanente Colorado said in a message to members that it will pay for the shot for anyone 6 months or older.

    Donna Lynne, CEO of Denver Health, said the health system’s insurance arm is waiting on clarification about when it should cover the vaccines. Denver Health Medical Plan offers multiple plan types, some state-regulated and some under federal rules, she said.

    “It’s less of a decision on our part than understanding what the health department and the insurance department are saying,” she said. “You can’t have one insurance company saying they are doing it and one saying they aren’t doing it.”

    Anthem said it considers immunizations “medically necessary” if the American Academy of Pediatrics, American Academy of Family Physicians or the CDC’s vaccine advisory committee has recommended them, but didn’t specify whether it would charge out-of-pocket costs for medically necessary vaccines.

    If those bodies stated that certain people could get a particular vaccine — but not that they should — Anthem would decide about coverage “on an individual basis,” its website said. The other groups have recommended the shots for people over 18 or under 2, with the option for healthy children in between to get a booster if their parents wish.

    The state’s Medicaid program is still waiting for guidance from federal authorities about whose vaccines it can cover, according to the Colorado Department of Health Care Policy and Financing, and Medicare isn’t yet paying for the shots.

    For most of the COVID-19 vaccines’ relatively brief existence, they were free and recommended for everyone 6 months and older. In 2024, the federal government stopped paying for them, which meant uninsured people no longer could be sure they could get the shot without paying.

    Almost all insurance plans still were required to pay for the shots, though, because the CDC’s Advisory Committee on Immunization Practices recommended them.

    In previous years, the committee recommended updated shots within days of the U.S. Food and Drug Administration approving them. In late August, the FDA approved the updated vaccines for people over 65 and those with one of about 30 conditions increasing their risk of severe disease, including asthma, obesity and diabetes.

    Doctors still could prescribe the vaccine “off-label” to healthy people, in the same way that they prescribe adult medications for children when an alternative specifically approved for kids isn’t available.

    This year, however, the committee won’t meet until Thursday, and may not recommend the shots when it does. Secretary of Health and Human Services Robert F. Kennedy Jr. dismissed all of the committee’s members earlier this year and replaced them with new appointees, most of whom oppose COVID-19 vaccines.

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    Meg Wingerter

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  • Taking Advantage of Sensory-Specific Satiety  | NutritionFacts.org

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    How can we use sensory-specific satiety to our advantage?

    When we eat the same foods over and over, we become habituated to them and end up liking them less. That’s why the “10th bite of chocolate, for example, is desired less than the first bite.” We have a built-in biological drive to keep changing up our foods so we’ll be more likely to hit all our nutritional requirements. The drive is so powerful that even “imagined consumption reduces actual consumption.” When study participants imagined again and again that they were eating cheese and were then given actual cheese, they ate less of it than those who repeatedly imagined eating that food fewer times, imagined eating a different food (such as candy), or did not imagine eating the food at all.

    Ironically, habituation may be one of the reasons fad “mono diets,” like the cabbage soup diet, the oatmeal diet, or meal replacement shakes, can actually result in better adherence and lower hunger ratings compared to less restrictive diets.

    In the landmark study “A Satiety Index of Common Foods,” in which dozens of foods were put to the test, boiled potatoes were found to be the most satiating food. Two hundred and forty calories of boiled potatoes were found to be more satisfying in terms of quelling hunger than the same number of calories of any other food tested. In fact, no other food even came close, as you can see below and at 1:14 in my video Exploiting Sensory-Specific Satiety for Weight Loss.

    No doubt the low calorie density of potatoes plays a role. In order to consume 240 calories, nearly one pound of potatoes must be eaten, compared to just a few cookies, and even more apples, grapes, and oranges must be consumed. Each fruit was about 40 percent less satiating than potatoes, though, as shown here and at 1:45 in my video. So, an all-potato diet would probably take the gold—the Yukon gold—for the most bland, monotonous, and satiating diet.

    A mono diet, where only one food is eaten, is the poster child for unsustainability—and thank goodness for that. Over time, they can lead to serious nutrient deficiencies, such as blindness from vitamin A deficiency in the case of white potatoes.

    The satiating power of potatoes can still be brought to bear, though. Boiled potatoes beat out rice and pasta in terms of a satiating side dish, cutting as many as about 200 calories of intake off a meal. Compared to boiled and mashed potatoes, fried french fries or even baked fries do not appear to have the same satiating impact.

    To exploit habituation for weight loss while maintaining nutrient abundance, we could limit the variety of unhealthy foods we eat while expanding the variety of healthy foods. In that way, we can simultaneously take advantage of the appetite-suppressing effects of monotony while diversifying our fruit and vegetable portfolio. Studies have shown that a greater variety of calorie-dense foods, like sweets and snacks, is associated with excess body fat, but a greater variety of vegetables appears protective. When presented with a greater variety of fruit, offered a greater variety of vegetables, or given a greater variety of vegetable seasonings, people may consume a greater quantity, crowding out less healthy options.

    The first 20 years of the official Dietary Guidelines for Americans recommended generally eating “a variety of foods.” In the new millennium, they started getting more precise, specifying a diversity of healthier foods, as seen below and at 3:30 in my video. 

    A pair of Harvard and New York University dietitians concluded in their paper “Dietary Variety: An Overlooked Strategy for Obesity and Chronic Disease Control”: “Choose and prepare a greater variety of plant-based foods,” recognizing that a greater variety of less healthy options could be counterproductive.

    So, how can we respond to industry attempts to lure us into temptation by turning our natural biological drives against us? Should we never eat really delicious food? No, but it may help to recognize the effects hyperpalatable foods can have on hijacking our appetites and undermining our body’s better judgment. We can also use some of those same primitive impulses to our advantage by minimizing our choices of the bad and diversifying our choices of the good. In How Not to Diet, I call this “Meatball Monotony and Veggie Variety.” Try picking out a new fruit or vegetable every time you shop.

    In my own family’s home, we always have a wide array of healthy snacks on hand to entice the finickiest of tastes. The contrasting collage of colors and shapes in fruit baskets and vegetable platters beat out boring bowls of a single fruit because they make you want to mix it up and try a little of each. And with different healthy dipping sauces, the possibilities are endless.

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    Michael Greger M.D. FACLM

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  • CVS, Walgreens now require prescriptions for COVID vaccines in Colorado

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    People who want to get an updated COVID-19 vaccine at CVS or Walgreens pharmacies in Colorado this fall will need to present a prescription.

    State law allows pharmacists to administer vaccines recommended by the Advisory Committee on Immunization Practices, a group that counsels the director of the Centers for Disease Control and Prevention about who will benefit from which shots.

    In previous years, the committee recommended updated COVID-19 vaccines within days of the U.S. Food and Drug Administration approving them. This year, the committee doesn’t have any meetings scheduled until late September, and may not recommend the shot when it does meet, since Secretary of Health and Human Services Robert F. Kennedy Jr. appointed multiple members with anti-vaccine views after removing all prior appointees in June.

    The lack of a recommendation also means that insurance companies aren’t legally required to pay for the COVID-19 vaccine without out-of-pocket costs. Most private insurers will cover the updated shots this year, though that could change in 2026, according to Reuters.

    Initially, CVS said it couldn’t give the COVID-19 vaccine to anyone in Colorado or 15 other states, because of their ACIP-approval requirement. As of Friday morning, its pharmacies can offer the shots to eligible people who have a prescription, spokeswoman Amy Thibault said.

    As of about 10 a.m. Friday, CVS’s website wouldn’t allow visitors to schedule COVID-19 shots in Colorado.

    Walgreens didn’t respond to questions about its COVID-19 vaccine policy, but its website said patients need a prescription in Colorado. A New York Times reporter found the same in 15 other states.

    The FDA this week recommended the updated shots only for people who are over 65 or have a health condition that puts them at risk for severe disease.

    The listed conditions include:

    • Asthma and other lung diseases
    • Cancer
    • History of stroke or disease in the brain’s blood vessels
    • Chronic kidney disease
    • Liver disease
    • Cystic fibrosis
    • Diabetes (all types)
    • Developmental disabilities, such as Down syndrome
    • Heart problems
    • Mental health conditions, including depression and schizophrenia
    • Dementia
    • Parkinson’s disease
    • Obesity
    • Physical inactivity
    • Current or recent pregnancy
    • Diseases or medications that impair the immune system
    • Smoking

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    Meg Wingerter

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  • Dietary Diversity and Overeating  | NutritionFacts.org

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    Big Food uses our hard-wired drive for dietary diversity against us.

    How did we evolve to solve the daunting task of selecting a diet that supplies all the essential nutrients? Dietary diversity. By eating a variety of foods, we increase our chances of hitting all the bases. If we only ate for pleasure, we might just stick with our favorite food to the exclusion of all others, but we have an innate tendency to switch things up.

    Researchers found that study participants ended up eating more calories when provided with three different yogurt flavors than just one, even if that one is the chosen favorite. So, variation can trump sensation. They don’t call it the spice of life for nothing.

    It appears to be something we’re born with. Studies on newly weaned infants dating back nearly a century show that babies naturally choose a variety of foods even over their preferred food. This tendency seems to be driven by a phenomenon known as sensory-specific satiety.

    Researchers found that, “within 2 minutes after eating the test meal, the pleasantness of the taste, smell, texture, and appearance of the eaten food decreased significantly more than for the uneaten foods.” Think about how the first bite of chocolate tastes better than the last bite. Our body tires of the same sensations and seeks out novelty by rekindling our appetite every time we’re presented with new foods. This helps explain the “dessert effect,” where we can be stuffed to the gills but gain a second wind when dessert arrives. What was adaptive for our ancient ancestors to maintain nutritional adequacy may be maladaptive in the age of obesity.

    When study participants ate a “varied four-course meal,” they consumed 60 percent more calories than those given the same food for each course. It’s not only that we get bored; our body has a different physiological reaction.

    As you can see below and at 2:13 in my video How Variation Can Trump Sensation and Lead to Overeating, researchers gave people a squirt of lemon juice, and their salivary glands responded with a squirt of saliva. But when they were given lemon juice ten times in a row, they salivated less and less each time. When they got the same amount of lime juice, though, their salivation jumped right back up. We’re hard-wired to respond differently to new foods. 
    Whether foods are on the same plate, are at the same meal, or are even eaten on subsequent days, the greater the variety, the more we tend to eat. When kids had the same mac and cheese dinner five days in a row, they ended up eating hundreds fewer calories by the fifth day, compared to kids who got a variety of different meals, as you can see below and at 2:35 in my video.

    Even just switching the shape of food can lead to overeating. When kids had a second bowl of mac and cheese, they ate significantly more when the noodles were changed from elbow macaroni to spirals. People allegedly eat up to 77 percent more M&Ms if they’re presented with ten different colors instead of seven, even though all the colors taste the same. “Thus, it is clear that the greater the differences between foods, the greater the enhancement of intake,” the greater the effect. Alternating between sweet and savory foods can have a particularly appetite-stimulating effect. Do you see how, in this way, adding a diet soda, for instance, to a fast-food meal can lead to overconsumption?

    The staggering array of modern food choices may be one of the factors conspiring to undermine our appetite control. There are now tens of thousands of different foods being sold.

    The so-called supermarket diet is one of the most successful ways to make rats fat. Researchers tried high-calorie food pellets, but the rats just ate less to compensate. So, they “therefore used a more extreme diet…[and] fed rats an assortment of palatable foods purchased at a nearby supermarket,” including such fare as cookies, candy, bacon, and cheese, and the animals ballooned. The human equivalent to maximize experimental weight gain has been dubbed the cafeteria diet.

    It’s kind of the opposite of the original food dispensing device I’ve talked about before. Instead of all-you-can-eat bland liquid, researchers offered free all-you-can-eat access to elaborate vending machines stocked with 40 trays with a dizzying array of foods, like pastries and French fries. Participants found it impossible to maintain energy balance, consistently consuming more than 120 percent of their calorie requirements.

    Our understanding of sensory-specific satiety can be used to help people gain weight, but how can we use it to our advantage? For example, would limiting the variety of unhealthy snacks help people lose weight? Two randomized controlled trials made the attempt and failed to show significantly more weight loss in the reduced variety diet, but they also failed to get people to make much of a dent in their diets. Just cutting down on one or two snack types seems insufficient to make much of a difference, as seen below and at 4:44 in my video. A more drastic change may be needed, which we’ll cover next.

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    Michael Greger M.D. FACLM

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  • Hijacking Our Appetites  | NutritionFacts.org

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    I debunk the myth of protein as the most satiating macronutrient.

    The importance of satiety is underscored by a rare genetic condition known as Prader-Willi syndrome. Children with the disorder are born with impaired signaling between their digestive system and their brain, so they don’t know when they’re full. “Because no sensation of satiety tells them to stop eating or alerts their body to throw up, they can accidentally consume enough in a single binge to fatally rupture their stomach.” Without satiety, food can be “a death sentence.”

    Protein is often described as the most satiating macronutrient. People tend to report feeling fuller after eating a protein-rich meal, compared to a carbohydrate- or fat-rich one. The question is: Does that feeling of fullness last? From a weight-loss standpoint, satiety ratings only matter if they end up cutting down on subsequent calorie intake, and even a review funded by the meat, dairy, and egg industries acknowledges that this does not seem to be the case for protein. Hours later, protein consumed earlier doesn’t tend to end up cutting calories later on.

    Fiber-rich foods, on the other hand, can suppress appetite and reduce subsequent meal intake more than ten hours after consumption—even the next day—because their site of action is 20 feet down in the lower intestine. Remember the ileal brake from my Evidence-Based Weight Loss lecture? When researchers secretly infused nutrients into the end of the small intestine, study participants spontaneously ate as many as hundreds fewer calories at a meal. Our brain gets the signal that we are full, from head to tail.

    We were built for gluttony. “It is a wonderful instinct, developed over millions of years, for times of scarcity.” Stumbling across a rare bounty, those who could fill themselves the most to build up the greatest reserves would be more likely to pass along their genes. So, we are hard-wired not just to eat until our stomach is full, but until our entire digestive tract is occupied. Only when our brain senses food all the way down at the end does our appetite fully dial down.

    Fiber-depleted foods get rapidly absorbed early on, though, so much of it never makes it down to the lower gut. As such, if our diet is low in fiber, no wonder we’re constantly hungry and overeating; our brain keeps waiting for the food that never arrives. That’s why people who even undergo stomach-stapling surgeries that leave them with a tiny two-tablespoon-sized stomach pouch can still eat enough to regain most of the weight they initially lost. Without sufficient fiber, transporting nutrients down our digestive tract, we may never be fully satiated. But, as I described in my last video, one of the most successful experimental weight-loss interventions ever reported in the medical literature involved no fiber at all, as you can see here and at 2:47 in my video Foods Designed to Hijack Our Appetites.

    At first glance, it might seem obvious that removing the pleasurable aspects of eating would cause people to eat less, but remember, that’s not what happened. The lean participants continued to eat the same amount, taking in thousands of calories a day of the bland goop. Only those who were obese went from eating thousands of calories a day down to hundreds, as shown below and at 3:22 in my video. And, again, this happened inadvertently without them apparently even feeling a difference. Only after eating was disconnected from the reward was the body able to start rapidly reining in the weight.

    We appear to have two separate appetite control systems: “the homeostatic and hedonic pathways.” The homeostatic pathway maintains our calorie balance by making us hungry when energy reserves are low and abolishes our appetite when energy reserves are high. “In contrast, hedonic or reward-based regulation can override the homeostatic pathway” in the face of highly palatable foods. This makes total sense from an evolutionary standpoint. In the rare situations in our ancestral history when we’d stumble across some calorie-dense food, like a cache of unguarded honey, it would make sense for our hedonic drive to jump into the driver’s seat to consume the scarce commodity. Even if we didn’t need the extra calories at the time, our body wouldn’t want us to pass up that rare opportunity. Such opportunities aren’t so rare anymore, though. With sugary, fatty foods around every corner, our hedonic drive may end up in perpetual control, overwhelming the intuitive wisdom of our bodies.

    So, what’s the answer? Never eat really tasty food? No, but it may help to recognize the effects hyperpalatable foods can have on hijacking our appetites and undermining our body’s better judgment.

    Ironically, some researchers have suggested a counterbalancing evolutionary strategy for combating the lure of artificially concentrated calories. Just as pleasure can overrule our appetite regulation, so can pain. “Conditioned food aversions” are when we avoid foods that made us sick in the past. That may just seem like common sense, but it is actually a deep-seated evolutionary drive that can defy rationality. Even if we know for a fact a particular food was not the cause of an episode of nausea and vomiting, our body can inextricably tie the two together. This happens, for example, with cancer patients undergoing chemotherapy. Consoling themselves with a favorite treat before treatment can lead to an aversion to their favorite food if their body tries to connect the dots. That’s why oncologists may advise the “scapegoat strategy” of only eating foods before treatment that you are okay with, never wanting to eat again.

    Researchers have experimented with inducing food aversions by having people taste something before spinning them in a rotating chair to cause motion sickness. Eureka! A group of psychologists suggested: “A possible strategy for encouraging people to eat less unhealthy food is to make them sick of the food, by making them sick from the food.” What about using disgust to promote eating more healthfully? Children as young as two-and-a-half years old will throw out a piece of previously preferred candy scooped out of the bottom of a clean toilet.

    Thankfully, there’s a way to exploit our instinctual drives without resorting to revulsion, aversion, or bland food, which we’ll explore next.

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    Michael Greger M.D. FACLM

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  • Lose 200 Lbs Without Feeling Hungry  | NutritionFacts.org

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    I dive into one of the most fascinating series of studies I’ve ever come across.

    Anyone can lose weight by eating less food. Anyone can be starved thin. Starvation diets are rarely sustainable, though, since hunger pangs drive us to eat. We feel unsatisfied and unsatiated on low-calorie diets. We do have some level of voluntary control, of course, but our deep-seated instinctual drives may win out in the end.

    For example, we can consciously hold our breath. Try it right now. How long can you go before your body’s self-preservation mechanisms take over and overwhelm your deliberate intent not to breathe? Our body has our best interests at heart and is too smart to allow us to suffocate ourselves—or starve ourselves, for that matter. If our body were really that smart, though, how could it let us become obese? Why doesn’t our body realize when we’re too heavy and allow us the leeway to slim down? Maybe our body is very aware and actively trying to help, but we’re somehow undermining those efforts. How could we test this theory to see if that’s true?

    So many variables go into choosing what we eat and how much. “The eating process involves an intricate mixture of physiologic, psychologic, cultural, and esthetic considerations.” To strip all that away and stick just to the physiologic variable, Columbia University researchers designed a series of famous experiments using a “food dispensing device.” The term “food” is used very loosely here. As you can see at 2:02 in my video 200-Pound Weight Loss Without Hunger, the researchers’ feeding machine was a tube hooked up to a pump that delivered a mouthful of bland liquid formula every time a button was pushed. Research participants were instructed to eat as much or as little as they wanted at any time. In this way, eating was reduced to just the rudimentary hunger drive. Without the usual trappings of “sociability,” meal ceremony, and the pleasures of the palate, how much would people be driven to eat? 
    Put a normal-weight person in this scenario, and something remarkable happens. Day after day, week after week, with nothing more than their hunger to guide them, they eat exactly as much as they need, perfectly maintaining their weight, as shown below and at 2:36 in my video.

    They needed about 3,000 calories a day, and that’s just how much they unknowingly gave themselves. Their body just intuitively seemed to know how many times to press that button, as seen here and at 2:48 in my video.

    Put a person with obesity in that same scenario, and something even more remarkable happens. Driven by hunger alone, with the enjoyment of eating stripped away, they wildly undershoot, giving themselves a mere 275 calories a day, total. They could eat as much as they wanted, but they just weren’t hungry. It’s as if their body knew how massively overweight they were, so it dialed down their natural hunger drive to almost nothing. One participant started the study at 400 pounds and steadily lost weight. After 252 days of sipping the bland liquid, he lost 200 pounds, as you can see here and at 3:35 in my video.

    This groundbreaking discovery was initially interpreted to mean that obesity is not caused by some sort of metabolic disturbance that drives people to overeat. In fact, the study suggested quite the opposite. Instead, overeating appeared to be a function of the meaning people attached to food, “aside from its use as fuel,” whether as a source of pleasure or perhaps as relief from boredom or stress. In this way, obesity seemed more psychological than physical. Subsequent experiments with the feeding machine, though, flipped such conceptions on their head once again.

    When researchers covertly doubled the calorie concentration of the formula given to lean study participants, they unconsciously cut their consumption in half to continue to perfectly maintain their weight, as seen here and at 4:24 in my video. Their body somehow detected the change in calorie load and sent signals to the brain to press the button half as often to compensate. Amazing!

    When the same was done with people with obesity, though, nothing changed. They continued to drastically undereat just as much as before. Their body seems incapable of detecting or reacting to the change in calorie load, suggesting a physiological inability to regulate intake, as shown below and at 4:40 in my video. 
    Might the brains of persons with obesity somehow be insensitive to internal satiety signals? We don’t know if it’s cause or effect. Maybe that’s why they’re obese in the first place, or maybe the body knows how obese it is and shuts down its hunger drive regardless of the calorie concentration. Indeed, the participants with obesity continued to steadily lose weight eating out of the machine, regardless of the calorie concentration and the food being dispensed, as you can see here and at 5:19 in my video. 
    It would be interesting to see if they regained the ability to respond to changing calorie intake once they reached their ideal weight. Regardless, what can we apply from these remarkable studies to facilitate weight loss out in the real world? We’ll explore just that question next.

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    Michael Greger M.D. FACLM

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  • Boosting Your Metabolism Safely  | NutritionFacts.org

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    If you drink two cups of water, the adrenal hormone noradrenaline can surge in your bloodstream, similar to the response of smoking a few cigarettes or having a few cups of coffee.

    Given the 60 percent surge in noradrenaline within minutes of drinking just two cups of water, as shown in the graph below and at 0:13 in my video What Is the Safest Metabolism Booster?, might one be able to get the weight-loss benefits of noradrenaline-releasing drugs like ephedra—without the risks? You don’t know until you put it to the test. Published in the Journal of the Endocrine Society, the results were described as “uniquely spectacular.” Researchers found that drinking two cups of water increased the metabolic rate of men and women by 30 percent. The increase started within ten minutes and reached a maximum within an hour. In the 90 minutes after drinking one tall glass of water, the study participants burned about an extra 25 calories (100 kJ). Do that four times throughout the day, and you could eliminate 100 additional calories (400 kJ). That’s more than if you had taken ephedra! You’d trim off more calories drinking water than taking weight-loss doses of the banned substance ephedrine (the active component of ephedra) three times a day. And we’re just talking about plain, cheap, safe, and legal tap water.

    Using the Ten-Calorie Rule I’ve explained previously, drinking that much water could make us lose ten pounds over time unless we somehow compensated by eating more or moving less. Concluded one research team, “In essence, water drinking provides negative calories.

    A similar effect was found in overweight and obese children. Drinking about two cups of water led to a 25 percent increase in metabolic rate within 24 minutes, and it lasted at least 66 minutes, until the experiment ended. So, just getting the recommended daily “adequate intake” of water—about 7 cups (1.7 L) a day for children aged 4 through 8, and for ages 9 through 13, 8 cups (2.1 L) for girls and 10 cups (2.4 L) for boys, as shown below and at 1:45 in my video—may offer more than just hydration benefits. 

    Not all research teams were able to replicate these findings, though. For example, one found an increase of only about 10 to 20 percent, while another found only a 5 percent increase, and yet another team found effectively none at all. What we care about, though, is weight loss. The proof is in the pudding. Let’s test the waters, shall we?

    Some researchers suggest that the “increase in metabolic rate with water drinking could be systematically applied in the prevention of weight gain….” Talk about a safe, simple, side-effect-free solution. It’s free in every sense. Drug companies may spend billions of dollars getting a new drug to market. Surely a little could be spared to test something that, at the very least, couldn’t hurt. That’s the problem, though. Drinking water is a “cost-free intervention.”

    There are observational studies suggesting that those who drink four or more cups (1 L) of water a day, for example, appear to lose more weight, independent of confounding factors, such as drinking less soda or exercising more. What happens when you put it to the test?

    In 2013, “Effect of ‘Water Induced Thermogenesis’ on Body Weight, Body Mass Index and Body Composition of Overweight Subjects” was published. Fifty “overweight girls”—who were actually women, aged 18 to 23—“were instructed to drink 500 ml [2 cups] of water, three times a day, half an hour before breakfast, lunch, and dinner, which was over and above their daily water intake” and without otherwise changing their diets or physical activity. The result? They lost an average of three pounds (1.4 kg) in eight weeks. What happened to those in the control group? There was no control group, a fatal flaw for any weight-loss study due to the “Hawthorne effect,” where just knowing you’re being watched and weighed may subtly affect your behavior. Of course, we’re just talking about drinking water. With no downsides, why not give it a try? I’d feel more confident if there were some randomized, controlled trials to really put it to the test. Thankfully, there are!

    I hate it when the title ruins the suspense. “Water Consumption Increases Weight Loss During a Hypocaloric Diet Intervention in Middle-Aged and Older Adults.” Overweight and obese men and women randomized to two cups of water before each meal lost nearly five pounds more body fat in 12 weeks than those in the control group, as shown below and at 4:08 in my video. Both groups were put on the same calorie-restricted diet, but the one with the added water lost weight 44 percent faster.

    A similar randomized controlled trial found that about 1 in 4 in the water group lost more than 5 percent of their body weight compared to only 1 in 20 in the control group. The average weight-loss difference was only about three pounds (1.3 kg), but those who claimed to have actually complied with the three-times-a-day instructions lost about eight more pounds (4.3 kg) compared to those who only drank the extra water once a day or less. This is comparable to commercial weight-loss programs, like Weight Watchers, and all the participants did was drink some extra water. 

    The video I mentioned is The New Calories per Pound of Weight Loss Rule.

    If you missed my previous video, see The Effect of Drinking Water on Adrenal Hormones.

    For all the specifics, check out Optimizing Water Intake to Lose Weight, coming up next. 

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    Michael Greger M.D. FACLM

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  • Tackling Common Canine Diseases for a Longer, Healthier Life | Animal Wellness Magazine

    Tackling Common Canine Diseases for a Longer, Healthier Life | Animal Wellness Magazine

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    Every dog parent dreams of seeing their furry friend thrive for years to come. However, common canine diseases can significantly impact a dog’s quality of life and longevity. Understanding these health challenges is the first step toward prevention and effective management. From heartworm to obesity, being informed can save a life. Here are some common diseases to avoid in dogs. 

    Heartworm Disease

    Heartworm disease is often overlooked but poses a serious threat to dogs. Transmitted by mosquitoes, this disease can lead to severe heart and lung damage. With early detection and proper treatment, an affected dog can be cured, which tells us regular veterinary check-ups are crucial. Preventive medications are available, making it easier for dog parents to shield their companions from this silent killer.

    Obesity

    Obesity is a common issue among dogs, leading to numerous health complications like diabetes and joint problems. Dogs can become lethargic and lose their playful spirit due to excess weight. Their transformation can begin with a balanced diet and regular exercise. This shows that small changes, like incorporating playtime or long walks, can dramatically improve health. Remember, a healthy dog is a happy dog!

    The Importance of Core Vaccines 

    Core vaccines are a fundamental tool in combating infectious diseases. Diseases like parvovirus, distemper, and rabies can be fatal but are preventable through timely vaccinations. Staying updated on vaccinations or disease-related titers not only protects individual dogs but also helps control outbreaks in the community. The important thing is to avoid over-vaccination. To do that, you can have your vet check your dog’s titer values, which let you know whether or not you need to re-vaccinate. 

    Nutritional Deficiency

    A nutritious diet is vital for preventing disease and promoting longevity. Choosing high quality dog food with appropriate ingredients can make a big difference. Dogs can thrive on a diet rich in proteins and Omega fatty acids, which improve coat condition and energy levels. Engaging with a veterinarian about the best dietary choices can help tailor nutrition to suit your dog’s specific needs and lifestyles.

    Regular Veterinary Visits

    Routine veterinary visits are essential for maintaining a dog’s health. These check-ups can catch potential issues early, such as dental disease or skin allergies, which may otherwise go unnoticed. For example, you may have a Beagle who seems perfectly fine until a routine visit reveals severe dental problems. After treatment, her energy returns, showcasing the importance of proactive healthcare. Regular visits ensure dogs stay on track for a long, healthy life.

    Conclusion

    The journey to ensuring a long, healthy life for your dog is filled with education, proactive measures, and love. By having the knowledge about common diseases to avoid in dogs , dog parents can foster an environment where their furry friends flourish. 


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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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  • Epigenetics and Obesity  | NutritionFacts.org

    Epigenetics and Obesity  | NutritionFacts.org

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    Identical twins don’t just share DNA; they also share a uterus. Might that help account for some of their metabolic similarities? “Fetal overnutrition, evidenced by large infant birth weight for gestational age, is a strong predictor of obesity in childhood and later life.” Could it be that you are what your mom ate?

    A dramatic illustration from the animal world is the crossbreeding of Shetland ponies with massive draft horses. Either way, the offspring are half pony/half horse, but when carried in the pony uterus, they come out much smaller, as you can see below and at 0:47 in my video The Role of Epigenetics in the Obesity Epidemic. (Thank heavens for the pony mother!) This is presumably the same reason why the mule (horse mom and donkey dad) is larger than the hinny (donkey mom and horse dad). The way you test this in people is to study the size of babies from surrogates after in vitro fertilization. 

    Who do you think most determines the birth weight of a test-tube baby? Is it the donor mom who provided all the DNA or the surrogate who provided the intrauterine environment? When it was put to the test, the womb won. Incredibly, a baby who had a thin biological mother but was born to a surrogate with obesity may harbor a greater risk of becoming obese than a baby with a heavier biological mother but born to a slim surrogate. The researchers “concluded that the environment provided by the human mother is more important than her genetic contribution to birth weight.”

    The most compelling data come from comparing obesity rates in siblings born to the same mother, before and after her bariatric surgery. Compared to their brothers and sisters born before the surgery, those born when mom weighed about 100 pounds less had lower rates of inflammation, metabolic derangements, and, most critically, three times less risk of developing severe obesity—35 percent of those born before the weight loss were affected, compared to 11 percent born after. The researchers concluded that “these data emphasize how critical it is to prevent obesity and treat it effectively to prevent further transmission to future generations.”

    Hold on. Mom had the same DNA before and after surgery. She passed down the same genes. How could her weight during pregnancy affect the weight destiny of her children any differently? Darwin himself admitted, “In my opinion, the greatest error which I have committed, has been not allowing sufficient weight to the direct action of the environment, i.e. food…independently of natural selection.” We finally figured out the mechanism by which this can happen—epigenetics.

    Epigenetics, which means “above genetics,” layers an extra level of information on top of the DNA sequence that can be affected by our surroundings, as well as potentially passed on to our children. This is thought to explain the “developmental programming” that can occur in the womb, depending on the weight of the mother—or even the grandmother. Since all the eggs in your infant daughter’s ovaries are already preformed before birth, a mother’s weight status during pregnancy could potentially affect the obesity risk of her grandchildren, too. Either way, you can imagine how this could result in an intergenerational vicious cycle where obesity begets obesity.

    Is there anything we can do about it? Well, breastfed infants may be at lower risk for later obesity, though the benefits may be confined to those who are exclusively breastfed, as the effect may be due to growth factors triggered by exposure to the excess protein in baby formula, as you can see below and at 3:51 in my video. The breastfeeding data are controversial, though, with charges leveled of a “white hat bias.” That’s the concern that public health researchers might disproportionally shelve research results that don’t fit some goal for the greater good. (In this case, preferably publishing breastfeeding studies showing more positive results.) But, of course, that criticism came from someone who works for an infant formula company. Breast is best, regardless. However, its role in the childhood obesity epidemic remains arguably uncertain.

    Prevention may be the key. Given the epigenetic influence of maternal weight during pregnancy, a symposium of experts on pediatric nutrition concluded that “planning of pregnancy, including prior optimization of maternal weight and metabolic condition, offers a safe means to initiate the prevention rather than treatment of pediatric obesity.” Easier said than done, but overweight moms-to-be may take comfort in the fact that after the weight loss in the surgery study, even the moms who gave birth to kids with three times lower risk were still, on average, obese themselves, suggesting weight loss before pregnancy is not an all-or-nothing proposition.

    What triggered the whole obesity epidemic to begin with? There are a multitude of factors, and I covered many of them in my 11-video series on the epidemic in the related posts below.

    We are what our moms ate in other ways, too. Check out: 

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    Michael Greger M.D. FACLM

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  • The Largest Study on Fasting in the World  | NutritionFacts.org

    The Largest Study on Fasting in the World  | NutritionFacts.org

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    The Buchinger-modified fasting program is put to the test.

    A century ago, fasting—“starvation, as a therapeutic measure”—was described as “the ideal measure for the human hog…” (Fat shaming is not a new invention in the medical literature.) I’ve covered fasting for weight loss extensively in a nine-video series, but what about all the other purported benefits? I also have a video series on fasting for hypertension, but what about psoriasis, eczema, type 2 diabetes, lupus, metabolic disorder, rheumatoid arthritis, other autoimmune disorders, depression, and anxiety? Why hasn’t it been tested more?

    One difficulty with fasting research is: What do you mean by fasting? When I think of fasting, I think of water-only fasting, but, in Europe, they tend to practice “modified therapeutic fasting,” also known as Buchinger fasting, which is more like a very low-calorie juice fasting with some vegetable broth. Some forms of fasting may not even cut calories at all. As you can see below and at 1:09 in my video The World’s Largest Fasting Study, Ramadan fasting, for example, is when devout Muslims abstain from food and drink from sunrise to sunset, yet, interestingly, they end up eating the same amount—or even more food—overall.

    The largest study on fasting to date was published in 2019. More than a thousand individuals were put through a modified fast, cutting daily intake down to about ten cups of water, a cup of fruit juice, and a cup of vegetable soup. They reported very few side effects. In contrast, the latest water-only fasting data from a study that involved half as many people reported nearly 6,000 adverse effects. Now, the modified fasting study did seem to try to undercount adverse effects by only counting reported symptoms if they were repeated three times. However, adverse effects like nausea, feeling faint, upset stomach, vomiting, or palpitations were “observed only in single cases,” whereas the water-only fasting study reported about 100 to 200 of each, as you can see below and at 2:05 in my video. What about the benefits though?

    In the modified fasting study, participants self-reported improvements in physical and emotional well-being, along with a surprising lack of hunger. What’s more, the vast majority of those who came in with a pre-existing health complaint reported feeling better, with less than 10 percent stating that their condition worsened, as you can see in the graph below and at 2:24 in my video. 

    However, the study participants didn’t just fast; they also engaged in a lifestyle program, which included being on a plant-based diet before and after the modified fast. If only the researchers had had some study participants follow the healthier, plant-based diet without the fast to tease out fasting’s effects. Oh, but they did! About a thousand individuals fasted for a week on the same juice and vegetable soup regimen and others followed a normocaloric (normal calorie) vegetarian diet.

    As you can see below and at 2:54 in my video, both groups experienced significant increases in both physical and mental quality of life, and, interestingly, there was no significant difference between the groups.

    In terms of their major health complaints—including rheumatoid arthritis; chronic pain syndromes, like osteoarthritis, fibromyalgia, and back pain; inflammatory and irritable bowel disease; chronic pulmonary diseases; and migraine and chronic tension-type headaches—the fasting group appeared to have an edge, but both groups did well, with about 80 percent reporting improvements in their condition and only about 4 percent reporting feeling worse, as you can see below and at 3:25 in my video. 

    Now, this was not a randomized study; people chose which treatment they wanted to follow. So, maybe, for example, those choosing fasting were sicker or something. Also, the improvements in quality of life and disease status were all subjective self-reporting, which is ripe for placebo effects. There was no do-nothing control group, and the response rates to the follow-up quality of life surveys were only about 60 to 70 percent, which also could have biased the results. But extended benefits are certainly possible, given they all tended to improve their diets, as you can see below and at 4:00 in my video.

    They ate more fruits and vegetables, and less meats and sweets, and therein may lie the secret. “Principally, the experience of fasting may support motivation for lifestyle change. Most fasters experience clarity of mind and feel a ‘letting go’ of past actions and experiences and thus may develop a more positive attitude toward the future.”

    As a consensus panel of fasting experts concluded, “Nutritional therapy (theory and practice) is a vital and integral component of fasting. After the fasting therapy and refeeding period, nutrition should follow the recommendations/concepts of a…plant-based whole-food diet…”

    If you missed the previous video, check out The Benefits of Fasting for Healing.

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    Michael Greger M.D. FACLM

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  • Can Fasting Be Healing?  | NutritionFacts.org

    Can Fasting Be Healing?  | NutritionFacts.org

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    Where did the idea of therapeutic fasting come from?

    The story of life on Earth is a story of starvation. Ash from massive volcanoes and asteroids blocked out the sun, which killed the plants, which then killed almost everything else. As Darwin pointed out: “Thus, from the war of nature, from famine and death, the most exalted object which we are capable of conceiving” arose—namely, us.

    “Among apes, humans are particularly well adapted to prolonged fasting.” Evolving in a context of scarcity is believed to have shaped “our exceptional ability to store large amounts of energy [calories] when food is available.” Of course, nowadays, our ability to easily pack on pounds is leading to modern diseases, like obesity and type 2 diabetes. But, without the ability to store so much body fat, we may not have made it to tell the tale.

    Scarcity wasn’t just caused by the asteroids millions of years ago. “All of Upper Egypt was dying of hunger,” reads an inscription on an Egyptian tomb from about 4,000 years ago, “to such a degree that everyone had come to eating his children…” Just hundreds of years ago, “[p]arents killed their children and children killed parents” and ate them, and “the bodies of executed criminals were eagerly snatched from the gallows.” Hunger wiped out as many as two-thirds of the population of Italy and one-third of the population of Paris. So, we don’t have to go back to ancient history. “Even the most secure and affluent populations of today need only trace their history back a short distance to find evidence of famines that would have impinged on their forebears.” For example, there have been nearly 200 famines in Britain over the last 2,000 years.

    Now, we tend to be suffering from too much food, which carries its problems, but “what about the consequences of not ever starving?” This was a question raised nearly 60 years ago. If our physiology is so well-tuned to periodic starvation, by eliminating that, might we be harming our overall well-being? We just didn’t know.

    The lack of research in the area of starvation was attributed to the “difficulty of securing willing human subjects.” So, what little we had may have come from unwilling subjects. Physicians within the Warsaw Ghetto made detailed accounts before they succumbed, and Irish Republican Army prisoners in Northern Ireland starved themselves to death after hunger striking up to 73 days. However, starvation isn’t necessarily the same as fasting, an issue raised in medical journals more than a century ago. “Starvation is normally a forced, mentally stressful, and chronic condition, whereas [therapeutic] fasting is voluntary, limited in duration, and usually practiced by people in adequate nutritional state”—that is, individuals who start with adequate nutrition.

    Therapeutic fasting? Where did we get this idea of fasting therapy? “Fasting for medical purpose”? As I discuss in my video The Benefits of Fasting for Healing, it may have originally arisen out of the observation that when people get acutely ill, they tend to lose their appetite, so maybe there’s something in the wisdom of our body to stop eating. That’s presumably where the whole “starve a fever” folklore came from.

    There was a sense that “fasting affords physiologic rest” for the body—not just for the digestive tract, but throughout—allowing the body to concentrate on healing. It was evidently “an open secret” that veterinarians used to hospitalize dogs with “various dyspeptic and metabolic ailments” only to fast them back to health. So, the theory went, maybe it might work for people, too.

    Beyond just freeing up all the resources that would normally be used for nutrient digestion and storage, there’s a concept that, during fasting, our cells switch over to some sort of protection mode. Why would fasting reduce free radical “oxidative damage and inflammation, optimize energy metabolism, and bolster cellular protection”? It’s the “that which doesn’t kill us makes us stronger” concept known as hormesis. That’s kind of the opposite of the “let the body rest” theory. It’s more like “let the body stress.” The stress of fasting may steel the body against other stresses coming our way. This was demonstrated perhaps most starkly in a set of cringe-worthy experiments in which mice were blasted with Hiroshima-level gamma radiation sufficient to kill 50 percent within two weeks, but of the mice who had first been intermittently fasted for six weeks before, not a single one died, as you can see in the graph below and at 4:33 in my video.

    It’s these kinds of dramatic data that led to extraordinary claims like therapeutic fasting could drive half of all doctors out of business. You don’t know until you put it to the test, and we’ll explore that next.

    There’s been an explosion in research interest in fasting over the last few years. Stay tuned for The World’s Largest Fasting Study.

    Due to my work on How Not to Diet, I have discussed several studies in videos that are already available to you on fasting and weight loss. Check out the related posts below.

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    Michael Greger M.D. FACLM

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  • What’s the Best Weight-Loss and Disease-Prevention Diet?  | NutritionFacts.org

    What’s the Best Weight-Loss and Disease-Prevention Diet?  | NutritionFacts.org

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    The most effective diet for weight loss may also be the most healthful.

    Why are vegetarian diets so effective in preventing and treating diabetes? Maybe it is because of the weight loss. As I discuss in my video The Best Diet for Weight Loss and Disease Prevention, those eating more plant-based tend to be significantly slimmer. That isn’t based on looking at a cross-section of the population either. You can perform an interventional trial and put it to the test in a randomized, controlled community-based trial of a whole food, plant-based diet.

    “The key difference between this trial [of plant-based nutrition] and other approaches to weight loss was that participants were informed to eat the WFPB [whole food, plant-based] diet ad libitum and to focus efforts on diet, rather than increasing exercise.” Ad libitum means they could eat as much as they want; there was no calorie counting or portion control. They just ate. It was about improving the quality of the food rather than restricting the quantity of food. In the study, the researchers had participants focus just on a diet rather than exercising more exercise because they wanted to isolate the effects of eating more healthfully.

    So, what happened? At the start of the study, the participants were, on average, obese at nearly 210 pounds (95 kg) with an average height of about 5’5” (165 cm). Three months into the trial, they were down about 18 pounds (8 kg)—without portion restrictions and eating all the healthy foods they wanted. At six months in, they were closer to 26 pounds (12 kg) lighter. You know how these weight-loss trials usually go, though. However, this wasn’t an institutional study where the participants were locked up and fed. In this trial, no meals were provided. The researchers just informed them about the benefits of plant-based eating and encouraged them to eat that way on their own, with their own families, and in their own homes, in their own communities. What you typically see in these “free-living” studies is weight loss at six months, with the weight creeping back or even getting worse by the end of a year. But, in this study, the participants were able to maintain that weight loss all year, as you can see below and at 1:57 in my video.

    What’s more, their cholesterol got better, too, but the claim to fame is that they “achieved greater weight loss at 6 and 12 months than any other trial that does not limit energy [caloric] intake or mandate regular exercise.” That’s worth repeating. A whole food, plant-based diet achieved the greatest weight loss ever recorded at 6 and 12 months compared to any other such intervention published in the medical literature. Now, obviously, with very low-calorie starvation diets, you can drop down to any weight. “However, medically supervised liquid ‘meal replacements’ are not intended for ongoing use”—obviously, they’re just short-term fixes—“and are associated with ‘high costs, high attrition rates, and a high probability of regaining 50% or more of lost weight in 1 to 2 years.’” In contrast, the whole point of whole food, plant-based nutrition is to maximize long-term health and longevity.

    What about low-carb diets? “Studies on the effects of low-carbohydrate diets have shown higher rates of all-cause mortality”—meaning a shorter lifespan—“decreased peripheral flow-mediated dilation [artery function], worsening of coronary artery disease, and increased rates of constipation, headache, halitosis [bad breath], muscle cramps, general weakness, and rash.”

    The point of weight loss is not to fit into a smaller casket. A whole food, plant-based diet is more effective than low-carb diets for weight loss and has the bonus of having all good side effects, such as decreasing the risk of diabetes beyond just weight loss.

    “The lower risk of type 2 diabetes among vegetarians may be explained in part by improved weight status (i.e., lower BMI). However, the lower risk also may be explained by higher amounts of ingested dietary fiber and plant protein, the absence of meat- and egg-derived protein and heme iron, and a lower intake of saturated fat. Most studies report the lowest risk of type 2 diabetes among individuals who adhere to vegan diets. This may be explained by the fact that vegans, in contrast to ovo- and lacto-ovo-vegetarians, do not ingest eggs. Two separate meta-analyses linked egg consumption with a higher risk of type 2 diabetes.”

    Maybe it’s eating lower on the food chain, thereby avoiding the highest levels of persistent organic pollutants, like dioxins, PCBs, and DDT in animal products. Those have been implicated as a diabetes risk factor. Or maybe it has to do with the gut microbiome. With all that fiber in a plant-based diet, it’s no surprise there would be fewer disease-causing bugs and more protective gut flora, which can lead to less inflammation throughout the body that “may be the key feature linking the vegan gut microbiota with protective health effects”—including the metabolic dysfunction you can see in type 2 diabetes.

    The multiplicity of benefits from eating plant-based can help with compliance and family buy-in. “Whereas a household that includes people who do not have diabetes may be unlikely to enthusiastically follow a ‘diabetic diet,’ a low-fat plant-based approach is not disease-specific and has been shown to improve other chronic conditions. While the patient [with diabetes] will likely see improvement in A1C [blood sugar control], a spouse suffering from constipation or high blood pressure may also see improvements, as may children with weight issues,” if you make healthy eating a family affair.

    This is just a taste of my New York Times best-selling book, How Not to Diet. (As with all of my books, all proceeds I received went to charity.) Watch the book trailer. You may also be interested in its companion, The How Not to Diet Cookbook.

    Check out my hour-long Evidence-Based Weight Loss lecture for more. 

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    Michael Greger M.D. FACLM

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  • Testing for Vitamin B12 Deficiency  | NutritionFacts.org

    Testing for Vitamin B12 Deficiency  | NutritionFacts.org

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    Many doctors mistakenly rely on serum B12 levels in the blood to test for vitamin B12 deficiency.

    There were two cases of young, strictly vegetarian individuals with no known vascular risk factors. One suffered a stroke, and the other had multiple strokes. Why? Most probably because they weren’t taking vitamin B12 supplements, which leads to high homocysteine levels, which can attack our arteries.

    So, those eating plant-based who fail to supplement with B12 may increase their risk of both heart disease and stroke. However, as you can see in the graph below and at 0:47 in my video How to Test for Functional Vitamin B12 Deficiency, vegetarians have so many heart disease risk factor benefits that they are still at lower risk overall, but this may help explain why vegetarians were found to have more stroke. This disparity would presumably disappear with adequate B12 supplementation, and the benefit of lower heart disease risk would grow even larger.

    Compared with non-vegetarians, vegetarians enjoy myriad other advantages, such as better cholesterol, blood pressure, blood sugars, and obesity rates. But, what about that stroke study? Even among studies that have shown benefits, “the effect was not as pronounced as expected, which may be a result of poor vitamin B12 status due to a vegetarian diet. Vitamin B12 deficiency may negate the cardiovascular disease prevention benefits of vegetarian diets. To further reduce the risk of cardiovascular disease, vegetarians should be advised to use vitamin B12 supplements.” 

    How can you determine your B12 status? By the time you’re symptomatic with B12 deficiency, it’s too late. And, initially, the symptoms can be so subtle that you might even miss them. What’s more, you develop metabolic vitamin B12 deficiency well before you develop a clinical deficiency, so there’s “a missed opportunity to prevent dementia and stroke” when you have enough B12 to avoid deficiency symptoms, but not enough to keep your homocysteine in check. “Underdiagnosis of this condition results largely from a failure to understand that a normal serum [blood level] B12 may not reflect an adequate functional B12 status.” The levels of B12 in our blood do not always represent the levels of B12 in our cells. We can have severe functional deficiency of B12 even though our blood levels are normal or even high.

    “Most physicians tend to assume that if the serum B12 is ‘normal,’ there is no problem,” but, within the lower range of normal, 30 percent of patients could have metabolic B12 deficiency, with high homocysteine levels. 

    Directly measuring levels of methylmalonic acid (MMA) or homocysteine is a “more accurate reflection of vitamin B12 functional statuses.” Methylmalonic acid can be checked with a simple urine test; you’re looking for less than a value of 4 micrograms per milligram of creatinine. “Elevated MMA is a specific marker of vitamin B12 deficiency while Hcy [homocysteine] rises in both vitamin B12 and folate deficiencies.” So, “metabolic B12 deficiency is strictly defined by elevation of MMA levels or by elevation of Hcy in folate-replete individuals,” that is, in those getting enough folate. Even without eating beans and greens, which are packed with folate, folic acid is added to the flour supply by law, so, these days, high homocysteine levels may be mostly a B12 problem. Ideally, you’re looking for a homocysteine level in your blood down in the single digits.

    Measured this way, “the prevalence of subclinical functional vitamin B12 deficiency is dramatically higher than previously assumed…” We’re talking about 10 to 40 percent of the general population, more than 40 percent of vegetarians, and the majority of vegans who aren’t scrupulous about getting their B12. Some suggest that those on plant-based diets should check their vitamin B12 status every year, but you shouldn’t need to if you’re adequately supplementing. 

    There are rare cases of vitamin B12 deficiency that can’t be picked up on any test, so it’s better to just make sure you’re getting enough.

    If you do get your homocysteine tested and it’s still too high, up in the double digits despite B12 supplementation and eating beans and greens, I have a suggestion for you in the final videos of this series, which we’ll turn to next with: Should Vegetarians Take Creatine to Normalize Homocysteine? and The Efficacy and Safety of Creatine for High Homocysteine.

    How did we end up here? To watch the full series if you haven’t yet, check the related posts below. 

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    Michael Greger M.D. FACLM

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