Bryant Stamford| Special to the Courier Journal

There is no delicate way to put it. Americans are fat and getting fatter every year.

Currently, 38% of men and 41% of women are obese, numbers that have doubled over the past three decades, and worse, the number of fat children and teens has tripled. But, why are we so fat?

The simple explanation is that we eat more calories than we burn each day, leading to an excess of calories in the body that are converted to fat and stored.

An argument can be made that this is not entirely our fault as we have fallen victim to lifestyle trends that sneaked up on us, and this is especially true for our children. For example, consider the role of our school systems. Kids expend fewer calories each day because of a reduction in physical education classes and recess, and less participation in organized sports. In addition, to boost revenue, many school systems have contracts with soft drink and fast-food companies, encouraging unhealthy and fat-promoting eating practices at school.

Add to all this the fact that at home, kids are playing video games or engaging in social media, instead of going outside to play. And, of course, adults move less as well, with space-age appliances, multiple car families, and too much TV, plus working more to pay for the high cost of living.

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Other behind-the-scenes trends have been operating as well, including high fructose corn syrup resulting in more calorically dense soft drinks, snacks and convenience foods. The fast-food industry also was hard at work contributing to American fatness. First was the introduction of "value meals," which combined sugary soft drinks with high-fat French fries and burgers. Soft drinks cause a big insulin response while fries and burgers provide lots of dietary fat calories. Insulin not only regulates blood sugar, but it also promotes the conversion of excess calories into body fat.

Another problem with fast food was the introduction of "supersizing" as the portion of French fries was greatly increased, tripling the number of calories per serving.

At the same time, busy Americans had less time to cook wholesome meals at home, and the frequency of eating out doubled in recent years. Eating out typically results in eating more than you do at home. Not only is volume increased, but restaurants need to appeal to our taste buds to draw us in, which means more emphasis on fat and sugar.

So, what can we do about it?

The American lifestyle combined with our genetic inheritance is the perfect storm when it comes to promoting body fatness. Genetically, we are programmed to survive, and in order to survive, we must have an ongoing supply of energy. No problem, right?

Certainly not in today's society with a fast-food restaurant on every corner. Unfortunately, our genes don't take into account our current ready availability of food. On the contrary, we evolved from early man when eating was unpredictable, and that fact combined with our drive to survive has shaped our behavior in a number of ways, starting with hunger, our strongest drive.

If we are denied food for a prolonged period, the hunger drive is so strong we will do almost anything to assuage it. For example, early man had to be driven hard by hunger every day to put forth the extreme effort required to procure food to feed a family. Now, fast forward to today and imagine being hungry and walking into a fast-food restaurant. Compared to early man, there's no effort involved in getting food, plus there are no limits. As a result, we regularly overeat far more than the body needs.

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Worse, it feels natural, and it is.

When our ancestors selected foods to eat, their choices were limited. If they ate meat, it was wild game, lean and tough and low in fat and calories. The things they could gather or grow, nuts, roots, fruits and vegetables, also were very low in calories. That means they had to eat a lot in order to take in enough energy to survive. This combined with the strong hunger drive and the unreliability of food, caused them to eat as much as possible any time they had the chance.

Fast forward to today, and it's no wonder we find ourselves eating large portions and seeking out all-you-can-eat restaurants. In fact, lack of portion control is a huge factor in obesity, especially with high-calorie foods. Sound familiar?

Sure, because it feels natural, and it is.

When we consume too many calories, our bodies are programmed to take the excess energy and store it in the form of body fat. This, too, makes sense to the body, because carrying around a bunch of extra stored energy in the form of fat takes some of the pressure off needing to consistently find and consume calories in order to survive. If you can't eat for a while, a common occurrence for our ancestors, you can simply tap into the energy you have stored as fat.

This is why your body loves every ounce of fat you have on you, and it always wants more, because more fat means more energy and more energy boosts the odds of survival or, at least it did way back then. Today all this excess fat is killing us, and the fact that our body loves fat helps explains why it is so reluctant to shed fat and keep it off.

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The bottom line is the deck is stacked against us when it comes to weight management. Our lifestyle combined with our genetic programming conspire to make us fat. Ironically, it all feels quite natural, and it is. This doesnt mean its impossible to buck the odds. Not at all. But it takes considerable dedication and effort, plus you cannot let your guard down.

Let me add that the worst mistake you can make is to allow yourself to gain body fat with the thought that you will take it off later. Its much easier to prevent gaining fat than it is to lose it.

Reach Bryant Stamford, a professor of kinesiology and integrative physiology at Hanover College, at stamford@hanover.edu.

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America, you're fat. Here are 3 reasons why and what can we do to lose weight - Courier Journal

Jaimy Lee

A decades-old law is keeping older adults in the U.S. from trying new weight-management therapies like Wegovy -- and drug companies are paying millions of dollars to try to get it changed.

A pair of new drugs offer something many Americans desperately want: a way to lose weight.

In clinical trials, Novo Nordisk's Wegovy helped adults lose about 15% of their body weight. The drug, which received approval from the U.S. Food and Drug Administration last year, had such a successful launch that it's now in short supply. Eli Lilly's (LLY) tirzepatide, meanwhile, is still in clinical trials, but data from a Phase 3 trial showed that people taking the drug lost up to 22% of their body weight.

For the roughly 42% of Americans who are obese, these results are nothing short of a miracle.

Wall Street is thrilled, predicting a global market for the drugs as big as $54 billion by 2030. And physicians feel they finally have a new treatment option for their patients. "I was prescribing Wegovy almost as fast as I could," said Elizabeth Fryoux, a physician who practices obesity medicine at the University of Mississippi Medical Center.

And there is more research coming: Lilly and Novo are also running studies to figure out if the same drugs can reduce the risk of death or improve outcomes for conditions like high blood pressure and stroke that often go hand in hand with obesity.

But there are roadblocks to getting these therapies to patients who need them. Late last year, Wegovy ran into supply issues brought on by a combination of high demand and production issues involving the syringes used in the pens that inject the medication. The issues are expected to resolve sometime beforethe end of the year. The stigma surrounding obesity, meanwhile, may be discouraging insurers and policymakers from covering these drugs.

The drugs developed by Novo and Lilly to treat obesity have both been approved, in different formulations, to treat Type 2 diabetes. Those therapies -- Novo's Ozempic and Lilly's Mounjaro, which got FDA approval in May -- are covered by Medicare, the federal health-insurance program for older adults and people with disabilities. Medicare doesn't cover Wegovy or other FDA-approved weight-management therapies, including Vivus' Qsymia.

"If we have a drug that is Wegovy that is for weight loss, and it's not covered, but we have a drug that is Ozempic, and it's for diabetes, the exact same drug is covered," said Holly Lofton, a physician who works in obesity medicine at NYU Langone Health in New York City. "There's not a drug issue. There's a 'we don't want to treat this patient' issue. That comes from stigma or discrimination or lack of knowledge about obesity as a condition."

A decades-old law prohibits Medicare from covering prescription drugs to treat weight gain or weight loss. That means the roughly 49 million people in the U.S. who get their prescription drug coverage from Medicare would have to spend more than $1,300 a month for a Wegovy prescription, putting access far out of reach for many. Even for people with private health insurance, these drugs may not be covered. Less than 10% of people have commercial health insurance that covers weight-management therapies like Wegovy.

But an aggressive lobbying push in Washington and quiet support in different parts of the Biden administration indicate that the longstanding rule is being reconsidered. The House Appropriations Committee in June described Medicare coverage for obesity drugs as a "matter of health equity." The Office of Personnel Management, the federal government's human resources department, this year reiterated that obesity drugs can't be excluded from insurance plans for federal workers. "The bottom line is that we follow the science and, in this instance, the science is telling us that we should recommend uptake of anti-obesity drugs more strongly than we did previously," an OPM spokesperson told MarketWatch.

This line of thinking suggests that "additional federal coverage may not be far behind," said UBS analyst Colin Bristow.

Ted Kyle runs ConscienHealth, an obesity advocacy organization. "That momentum comes from people having a better understanding of what we're dealing with," he said. "Ten years ago, policymakers would come out and say, 'Fat people need to eat less and move more.'"

A vanity drug or an outdated policy?

Until recently, the medical community often blamed obesity on a lack of willpower or a mismatch between calories consumed and calories burned. The American Medical Association now considers obesity a disease, and doctors describe patients as having overweight or obesity, not as being overweight and obese, and refer to weight management, not weight loss.

But that shift in thinking is still relatively new -- the American Board of Obesity Medicine, which certifies physicians who work in this field, was set up in 2011 -- and challenges remain. A story published last spring in The New York Times reported that a health insurer had declined to cover Wegovy for a patient on the grounds that it's a "vanity drug."

"That feels so stigmatizing," said Diana Thiara, medical director of the University of California San Francisco's weight management program.

The Medicare ban on covering weight-loss drugs, which was part of the implementation of the Medicare Part D program in 2003, likely results from that same stigma. It also followed the fenfluramine phentermine ("fen-phen") crisis of the late 1990s, in which the stimulants fenfluramine and dexfenfluramine, prescribed for short-term use for weight loss, were pulled from the market when it was discovered they could cause heart-valve damage that in some cases resulted in death.

The newest class of weight-management drugs -- as well as therapies like Qsymia and Currax Pharmaceuticals' Contrave, which were approved about a decade ago -- are not stimulants. Wegovy, which is the first new weight-management drug to have been approved since 2014, is a glucagon-like peptide-1 (GLP-1) agonist, while tirzepatide is a GIP (glucose-dependent insulinotropic polypeptide) and GLP-1 receptor agonist. When paired with physical activity and calorie reduction, they help slow digestion and increase the release of insulin so that patients end up feeling full faster and for longer.

"These actually are now very physiologic," Lofton said. "Most of them [are] hormones that we're giving people to adjust their gut and brain pathways to send different messages about hunger and fullness and desire to eat."

Medicare does pay for bariatric surgery and behavioral weight-loss therapy. Over the years, legislative fixes to the medication ban have been proposed, including the Treat and Reduce Obesity Act, which has been introduced several times over the past decade, most recently in March of 2021. Lilly and Novo are both lobbying to change the Medicare language, and physicians, including NYU's Lofton, have also been calling on lawmakers to do so.

So far, those efforts have not been successful.

"Medicare is behind the times, and it's hampered by its own outdated policies," said Dorothea Vafiadis, director of the National Council on Aging's Center for Healthy Aging. "If you look at the CMS stated commitment, they are designed to close gaps in healthcare access, quality, and outcomes for underserved populations. And this really kind of flies in the face of that commitment."

The National Council on Aging, along with obesity advocacy organizations such as the Obesity Action Coalition, receive funding from the drug companies that market or are developing weight-management therapies. So do Kyle and Lofton, among other physicians and advocates. These financial relationships, though common in U.S. medicine and public policy, also underscore the billions of dollars in sales that may be at stake for Lilly and Novo.

A $54 billion market

Companies are racing not only to develop the most effective weight-management drug but to market the one that can best improve outcomes for obese patients beyond losing weight.

Novo expects to have the first batch of data from its Phase 3 clinical trial -- which will show whether Wegovy can reduce the risk of heart disease and stroke -- by mid-2023, according to a spokesperson. (The company also makes Saxenda, an older weight-management drug that's been shown to reduce body weight by about 5%.) Lilly, which is expected to soon file for FDA approval of tirzepatide as a weight-management therapy, also plans to launch a Phase 3 trial later this year to evaluate whether its drug can reduce morbidity and mortality.

If either study shows positive results, it could change the conversation with insurers and employers, because the value of an individual patient taking one of these medications will then be twofold. Not only will patients lose weight, but their comorbidities may improve, possibly averting costly medical care down the line.

Morgan Stanley predicts an obesity-drug market as large as $54 billion by 2030. UBS predicts $25 billion in peak sales for tirzepatide, which would make it "one of the bestselling drugs in history," according to the bank's analysts. SVB Securities puts peak sales expectations for tirzepatide, taking into account its potential use for both diabetes and obesity, a little lower, at roughly $21 billion. For context, Humira, AbbVie's rheumatoid-arthritis drug, is the world's top-selling drug, generating $20.7 billion in annual sales in 2021.

"Historically, [insurance] payers viewed obesity drugs like they did Botox for wrinkles. They viewed it as something that was a cosmetic drug that should not be covered by insurance," said David Risinger, an SVB analyst. "There needs to be a rethinking of coverage when there are drugs that offer transformational health benefits for a disease, even if it's common."

If that's the case, think of these drugs less like Botox and more like a new knee.

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'There's no way that patients are going to be able to afford that.' Why aren't new drugs that can help you lose weight more widely used? - Morningstar

According to the CDC, 94 million Americans are living with high cholesterol. "There are ways to manage high cholesterol, and the wonderful news is that heart disease is 90% preventable," says preventative cardiologist Leslie Cho, MD. "Even if you have a significant family history of high cholesterol, you can prevent heart disease." Here are five ways to reverse bad cholesterol, fast. Read onand to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

Avoiding saturated and trans fats can help lower cholesterol. "You can lower your cholesterol by limiting the type of foods you eat," says Dr. Cho. "This means becoming a food label reader. There should be no more than 2 grams of fat per serving, and it should account for less than 7% of your daily calorie intake. Trans fats have a very negative impact on the body. Not only do they worsen your cholesterol, but they also increase your markers of inflammation." This can lead to inflamed blood vessels, a risk factor for heart attacks."

Belly fat is strongly linked to high cholesterol. "Importantly, central obesity is a marker for increased inflammation within the body, which can result in cholesterol buildup in your blood vessels," says Joshua Septimus, MD, associate professor of clinical medicine and medical director of Houston Methodist Primary Care Group Same Day Clinics. "It's also a marker for unstable plaque. Remember, once plaque becomes unstable, the risk of stroke and heart attack increase."

Losing weight can have a significant impact on cholesterol levels, doctors say. "If you lose even a small amount of weight, your HDL will go up and your LDL will come down," says Dr. Cho. "Losing five to 10 pounds can lower your total cholesterol by 5% to 10%."

Not smoking can positively impact cholesterol levels, doctors say. "Smoking causes inflammation and damage to your blood vessels, leading to unstable cholesterol plaque and, ultimately, increases your risk of plaque rupture," says Dr. Septimus.

Regular exercise is key to lowering cholesterol and keeping it down. "Exercise is a great place to start if you're trying to lower bad cholesterol," says Dr. Cho. "But it doesn't stop there. Combining exercise with healthier diet and lifestyle choices makes the most impact. Always check with your doctor before starting an exercise program, especially if your high cholesterol is putting you at more immediate risk for heart disease or stroke,"6254a4d1642c605c54bf1cab17d50f1e

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You Can Reverse High Cholesterol "Fast" and Here's How Eat This Not That - Eat This, Not That

Garth Brooks is feeling like his younger self! The country music superstar recently wrapped up a 5-night performance in Ireland, and when talking to the press before the event, the 60-year-old revealed that he's back to the weight he was at age 35.

Garth was accompanied by his wife Trisha Yearwood for the concerts in Dublin's Croke Park. The concerts were a reunion of sorts: It marked Garth's return to the venue after performing there in 1997. Garth was inspired to get in shape after revisiting the concert hall from 25 years ago. According to the Irish Mirror, he said, "What happened was, weirdly, at the 25th anniversary of Croke Park and Central Park, and I was sitting there looking at it thinking everyone looks the same"

For Garth, the transformation wasn't about appearances but about performing. He explained that fitness became a priority after being a "soccer dad" to his three daughters for 16 years. He said, "You want to try to be as fit as you can. Because my job is to get to everyone in that stadium. And we have two and a half hours to get it done. So we will be moving a lot. And physically I wanted to not have that as an obstacle.

Garth Brooks, Croke Park

Terry Wyatt//Getty Images

Judging by photos from the event, it looks like his mission was accomplished! Garth confirmed, "Im the same weight I was when we played here in 97, thats what I want."

Garth's fans took notice of his new fit physique. Garth and Trisha posted a recent Instagram video, and fans commented on the transformation.

The couple of 16 years treated the trip to Ireland as a second honeymoon. Garth told the Irish Mirror, "Weve spent every anniversary weve ever had with our girls, so this is going to be like our honeymoon, and were just going to go for 2 weeks and just go around and be a couple and I cant imagine a better place to do it than the land of love, this is going to be good."

The Croke Park shows wrapped up Garth's record-breaking stadium tour. We're looking forward to whatever's next for the star.

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Garth Brooks Opens Up About His Weight Loss Journey in New Interview - Country Living

Weight loss is much more beneficial for people with excess weight compared to individuals who are already lean, according to new research.

The study, which published in PLOS Medicine Tuesday, evaluated weight loss strategies and their health effects in nearly 200,000 people and found that people with obesity who lost weight had a significantly lower risk of type 2 diabetes, however, when lean people attempted to lose weight, their risk of type 2 diabetes increased.

Bariatric physicians were surprised to learn that weight loss strategies had such opposite health effects on people depending on their body mass index (BMI) at baseline.

They suspect that underlying biological differences impact how and why peoples bodies respond differently to weight loss efforts.

The main takeaway is that weight loss is beneficial for those who are overweight; lean individuals did not experience the same or more benefit, Dr. Mir Ali, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, told Healthline.

Ali was not involved in the study.

The researchers studied the health data of nearly 200,000 people from three prospective cohort studies conducted between 1988 and 2017.

People were deemed lean if they had a BMI under 25. If it was 25 to 30 they were deemed as having overweight and if it was above 30 they were deemed as having obesity.

The team evaluated various weight-loss strategies including a low-calorie diet, exercise, low-calorie diet and exercise, fasting, a commercial weight loss program (CWLP), and diet pills in people who lost at least 4.5 kilograms, or about 10 pounds.

They also looked at people who did not lose weight.

Of the people who lost at least 4.5 kilograms team found that all of the weight-loss strategies were associated with less weight gain and a lower risk of diabetes among people who have obesity at baseline, however, exercise was the most effective strategy.

The primary determinant for success in obtaining and sustaining weight loss is exercise capacity. This study and many others support this fact once again, says Dr. David Prologo, a board-certified obesity medicine physician, who was not involved with the study.

Over the course of 24 years, people with obesity who exercised had a 21% lower risk of diabetes and those who took diet pills had a 13% lower risk. People, who have overweight and who exercised, had a 9% lower risk of Type 2 diabetes and those who took diet pills had a 42% higher risk of diabetes.

If you are overweight or obese, even moderate weight loss up to 4.5% showed pretty significant gains in overall health and reduction in disease risk, says Dr. Dana Ellis Hunnes, a senior clinical dietitian at UCLA medical center, assistant professor at UCLA Fielding school of public health, and author of Recipe for Survival.

The health effects were opposite among lean people, and according to the study, lean people who intentionally lost weight tended to gain back more weight and have a higher risk of diabetes.

Lean people who exercised in order to lose weight had a 9% greater risk of diabetes and lean individuals who took diet pills or followed a commercial weight loss program to lose weight had a 54% increased risk of diabetes.

These findings are surprising because it would seem that weight loss would be beneficial for everyone; based on this study, lean individuals seem to have a different biological makeup, Ali said.

Obesity causes hormonal and metabolic complications that can contribute to a range of health problems, including type 2 diabetes, insulin resistance, hypertension and heart disease.

Hunnes said the risk of diabetes and other health issues can increase depending on a persons weight.

When people, who have obesity, lose weight they eliminate some of the fatty tissue that produces inflammation, disrupts hormonal production, and contributes to insulin resistance.

Decreasing the volume of that tissue directly results in improved health, says Prologo.

Lean individuals, on the other hand, have a different hormonal and metabolic makeup, which likely causes them to respond different to weight loss.

When you are leantrying to lose weight can actually have negative effects on your overall metabolism, mental health, and possibly even overall health as you increase the likelihood youre going to be hungry and eat more and possibly gain weight, says Hunnes.

People who are already lean should engage in maintenance activities, says Prologo. This could include activities such as exercise and eating nutrient-dense whole foods while eliminating or reducing the consumption of ultra-processed foods.

Ali says he often sees people try weight-loss strategies that arent sustainable most diets will work for a time, he says, but the weight comes right back when the diet ends.

The key is making dietary and exercise changes that can be maintained long term, Ali said.

Weight loss is much more beneficial for people with excess weight compared to individuals who are already lean, according to new research. While the mechanisms are unclear, health experts suspect that underlying biological differences impact how peoples bodies respond to weight loss efforts. While even moderate weight loss can lead to significant health gains in people with obesity and overweight, lean people should focus on weight maintenance activities rather than weight loss strategies.

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Not Everyone Gets Healthier When they Lose Weight - Healthline

Almost four in five (78%) Americans say it is possible to love your body and still want to lose weight.

Thats according to a new survey of 2,000 Americans who are looking to lose weight, where about half (51%) also reported having felt or experienced body shame due to their weight.

Most commonly, that shame came from a friend (51%), partner or spouse (46%), family member (45%) or doctor (40%).

After experiencing body shame, respondents shared feeling like they have no willpower (60%), like its their fault (55%) and that theyre lazy (52%).

Thus, its not surprising that the majority (65%) are willing to try anything to lose weight, no matter how restrictive or unreasonable the approach might sound.

Conducted by OnePoll on behalf ofWeightWatchers (WW), the survey explored Americans mindsets when looking to lose weight, including how culture, society and ones environment might impact their frame of mind.

While 77% of respondents said that having a community of like-minded people is important to them, along with accountability (73%), some also reported being hesitant to share their weight loss journey with others.

In fact, more than half (56%) said their journey is a personal experience they want to keep private, and 45% avoid sharing so as not to be shamed for wanting to lose weight.

Weight-based stigma is pervasive and pernicious in our society. This stigmatization and shaming is cruel and harmful. It leads people to engage in unhealthy behaviors and has lasting effects on how people view themselves neither of which are helpful for a successful weight loss journey, said Gary Foster, PhD, author of The Shift: 7 Powerful Mindset Changes for Lasting Weight Loss and Chief Scientific Officer at WeightWatchers. Its crucial to view the journey as something youre doing for yourself and not against yourself.

For the majority of respondents (69%), minimizing the risk of other health issues associated with weight gain was their top motivator for losing weight.

This was followed by improving self-esteem and confidence (65%) as well as looking and feeling their best (62%).

The survey also took a larger look at how Americans think about themselves and their weight loss journey.

While exercise and diet topped the list as two essential factors, 85% agreed that your mindset is important when looking to lose weight.

When it comes to peoples mindset, almost two-thirds (63%) believe theyre more likely to focus on whats not going well than what is.

Even so, when facing a setback on a weight loss journey, 75% are more likely to speak negatively to themselves than they would to a friend.

And while almost two-thirds (65%) expect setbacks to happen on a regular basis, 76% agreed that once they hit an obstacle or setback, they feel discouraged and feel like giving up.

This may be because respondents have faced barriers, such as losing focus because of too much happening in their lives (55%), a regimen being too restrictive (53%) or not having a community or support system (41%).

While eating and activity are important for weight loss, your mindset is what matters most and drives long-term success, added Dr. Foster. Treating yourself with kindness, particularly when navigating setbacks, is critical to making the weight loss journey positive, not punitive. Self-compassion beats self-criticism every single time.

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Is it possible to love your body and still want to lose weight? - New York Post

Ever since her rise to fame in 2007, Khlo Kardashian has battled with her body image after being constantly compared to her sisters. In 2015, the star recalled being made to feel like the fat sister by the media, and opened up about the devastating impact that it had on the way that she viewed herself. I didnt really realize that I was the fat sister, if you will, until I went on TV and the media started saying that about me, she told People magazine at the time. I almost let that take ownership of me. [But really] I wasn't fat. I wasn't obese. But I would let society make me believe that I was." Khlo went on to admit that shed never felt negatively about her body until she found fame, and growing up, she felt beautiful despite looking different from Kim and Kourtney Kardashian. "I knew I didn't look like my sisters and I didn't have those shapes, but I didn't think that was wrong," she explained. "I had parents who were incredibly loving and nurturing and always made me feel beautiful so I never really questioned that." But as her star power grew, Khlo began to transform her body and before long weight loss had become an established part of her brand whether it be through her 2017 reality series, Revenge Body, or her book, Strong Looks Better Naked. Despite her image overhaul throughout the years, her ongoing, deep-rooted insecurities were highlighted in April 2021, when an unedited bikini picture went viral after it was accidentally posted online. Khlo looked sensational in the unauthorized photo, but she was reported to have been embarrassed and freaked out by it, and social media accounts that reposted the image were threatened with legal action in her bid to scrub it from the internet. The star addressed the leak on Instagram a few days later, where she admitted to struggling with body image her whole life. Khlo went on to add: In truth, the pressure, constant ridicule and judgment my entire life to be perfect and meet [others'] standards of how I should look has been too much to bear. Its almost unbearable trying to live up to the impossible standards that the public have all set for me, she continued, before declaring: My body, my image and how I choose to look and what I want to share is my choice. It's not for anyone to decide or judge what is acceptable or not anymore." And when Khlo was left heartbroken by her then-partner Tristan Thompsons paternity scandal eight months later, she appeared to lose even more weight. On Thursday, a source told BuzzFeed News that Tristan and Khlo were secretly engaged when it was revealed via leaked court documents that he was expecting a baby with personal trainer Maralee Nichols. Tristan had attempted to keep the scandal from Khlo and appeared to have no intention of telling her that he had a baby on the way with another woman. It has since been revealed that Tristan was also encouraging Khlo to go forward with their surrogacy plans for their second baby, and the embryo was transferred to the surrogate just days before news of Maralees pregnancy broke online and Khlo found out with the rest of the world. Khlo opened up about the devastating impact that Tristans betrayal had on her in last weeks premiere episode of The Kardashians Season 2, where she also discussed her surrogacy journey and sons birth in July for the first time. And in this weeks episode, which was filmed earlier in the year, Kim revealed that their younger sisters, Kendall and Kylie Jenner, had expressed concern for Khlos extreme weight loss amid all of the drama. Looking at her sister as they lounged on a bed together, Kim said: You look very skinny. I will say that Kendall and Kylie not that Im trying to out them but they did text me and say that they were a little concerned for you because youre really skinny. I said, 'I think she's a bit stressed.'" As the camera cut to Khlo, she appeared to be elated by the comment as a huge smile crept across her face and she held a hand to her chest in disbelief. And Kendall said it? she grinned as she asked Kim. The model?! Kendall said it, Kim confirmed. I said, 'no, guys, shes fine,' and I said, 'you absolutely have every right to be concerned, but Im telling you shes fine.' Ignoring the concern from which these comments were made, Khlo let out an excited gasp and playfully posed with her leg in the air while smiling to herself. Later in the episode, Khlo visited Kendall at her home and as they hugged and said hello, Kendall exclaimed, Youre so skinny! to which Khlo replied, Oh my gosh, youre so skinny! Kendall then repeated, Youre so skinny! And both scenes left viewers at home feeling a little uncomfortable, with many expressing their sadness at Khlos gleeful reaction to being told that people are concerned about her due to her weight loss. So sad to see Khlo look delighted when Kim tells her shes skinny and theyre all worried about her, one person wrote on a Reddit thread. Someone replied: And then her and Kendall hugging and celebrating being skinny wtf. Yeah. I was kinda done with that. Sisters apparently expressing concern about her health & she celebrates? another user wrote. The sentiment was echoed in a second Reddit thread, where a user commented: So fucking sad to watch Khloe react with pure elation as Kim told her the siblings expressed concern over her dramatic weight loss Its almost as if the only thing her self worth is tied to now is her BMI Why was Khloe literally excited that Kendall thought she was getting too skinny ?! another asked. One person replied: Shes been told for so long that shes overweight by her family and media that it can be validating to hear the opposite, especially when people think youre skinny enough that they get concerned. Its sad though. Others werent impressed with the way that the show presented the concern, with a fan writing: Then they just glossed over it? Completely erasing the severity and complexity of her new weight loss they couldve turned the moment into a meaningful conversation and also maybe added a trigger warning. This isn't the first time that the Kardashians have been called out for glorifying weight loss. In 2018 Kim was forced to apologize after her sisters shared a series of videos where they praised her for being "skinny," and she joyfully responded to being called "anorexic." And earlier this year Kim was also criticized by a registered dietician for setting a "terrible example" and "perpetuating eating disorders" by boasting about losing a significant amount of weight to fit into her Met Gala dress. Elsewhere in Thursday's episode of The Kardashians, Khlo did go on to admit that she was struggling, explaining: Its a lot, but I just like to isolate and deal with things on my own and everyone has problems so why would I bring it, youve just got to deal with that. What I do know is that all of it sucks and its humiliating, its hurtful, I just dont have anything else to give, she added. Khlo and Tristan have had an on-and-off relationship since 2016, which has been dogged with infidelity. Just days before Khlo gave birth to their first child daughter True in 2018, it was revealed that Tristan had been cheating on her throughout her pregnancy. The following year, he was caught kissing Kylies thenbest friend Jordyn Woods at a party, and it has now been revealed that Tristan proposed to Khlo that December, even though they werent officially back together at the time. Khlo turned him down, but a source told BuzzFeed News that they revisited the subject of an engagement in February 2021 and she accepted, but they did not publicly announce the news. One month after their engagement, Tristan left the 30th birthday party that Khlo had thrown for him to have sex with Maralee who hed been seeing sporadically for sex for months prior. Maralee got pregnant and ended up filing legal documents against Tristan for child support and pregnancy-related expenses. In the paperwork, she claimed that Tristan had offered her $75,000 to get an abortion and warned her that hed play no role in their childs life. Khlo was unaware of Maralee, her pregnancy, and Tristans lawsuit until it was reported in the press in December 2021, shortly before Maralee gave birth to her son, Theo. Khlos second child with Tristan, a baby boy, was already on the way at this point, but Khlo ended their engagement and is now said to only speak to Tristan about parenting-related matters. incoming

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Kendall And Kylie Jenner Expressed Their Concern Over Khlo Kardashians Extreme Weight Loss And Her Reaction Was Heartbreaking - BuzzFeed News

Whether you call Boston home sweet home or consider yourself a passionate foodie (or both!), you may know of Michael Scelfo. This proud father and Boston-based chef owns internationally acclaimed restaurants, including Waypoint, The Longfellow Bar, and Alden & Harlow. Scelfo has also been featured in Food & Wine's "Best New Restaurants," Cond Nast Traveler's "Best Restaurants in the World," and Bon Apptit's "America's Best New Restaurants." Recently, Scelfo has taken his family, friends, and fans through an inspirational journey, documenting his just-under 100-pound weight loss transformation on Instagram.

If you're trying to lose a substantial amount of weight, but feel like nothing's doing the trick, or you need a solid dose of motivation to get back on track at the gym, we're here to share this chef's moving story with you. Keep reading to learn more about his just-under 100-pound weight loss.

Four weeks ago, Scelfo posted side-by-side shirtless photos of himself on Instagram, writing, "85 pounds, 306 days ago. focus, determination, willpower, perspective, healing." Most recently, on September 21, the chef posted another comparison before and after he dropped almost 100 pounds, captioning his post, "A little mid week motivation for us, just over a year ago, and almost 100 pounds heavier. I've started adding some daily physical routine to the diet (walking, planks, etc), nothing too crazy, but it's adding another dimension and another layer for me to latch on to. Doing what works for me, in the hopes you'll do the same. Gonna hit you with some healthy turkey stuffed peppers on the reel soon too. Keep at it! LFG."

We had the opportunity to speak with Scelfo, and he shares exactly what his routine consisted of to lose almost 100 pounds.

Related: This Man's 30-Pound Weight Loss Has Him Feeling Younger Than 50

With a history of heart issues within his family, Scelfo was motivated to begin his weight loss journey. "My blood pressure was becoming a problem, and emotionally, I was at the bottom and really needed a life change," he shares.

How did Scelfo accomplish his just-under 100-pound weight loss? His exercise consisted mostly of walking, saying, "I really wanted to make changes that felt comfortable and sustainable to who I am. As time has gone on, and I've been motivated by results, I've added more physicality to the routine because I want to add levels now."

Related: The #1 Machine Workout To Shrink Belly Fat and Slow Aging

As far as nutrition is concerned, Scelfo followed a "very regimented diet." Now that he's lost a substantial amount of weight, he occasionally indulges "modestly" on weekends. On an everyday basis, he maintains a strict diet, keeping his calories to about 1,500. That number is reevaluated consistently based on his doctor's feedback. Scelfo tells us, "It's very protein-forward, tons of veggies, and a bit of certain fruits. Generally, it's no sugar, carbs, oils, and fats and very minimal dairy."

This chef's goal was to drop 50 pounds within six months, then hit 190 on the scale, which he accomplished four months after. Now, Scelfo is focusing on tightening things up and developing his muscles. He weighed 279 pounds when he first started his weight loss journey and is currently 189 pounds.

Scelfo reveals the journey has been life-changing in many ways. His motivation and positivity have increased dramatically, and he's able to breathe so much better.6254a4d1642c605c54bf1cab17d50f1e

He shares advice for others who hope to lose a significant amount of weight or simply kickstart their fitness journey, "I would just say, at the risk of being cliche, that you just really have to commit and believe in yourself. You really have to find the bottom in a lot of ways before you can truly make a change. At least for me that's what happened. And that's different for everyone. The thing I tell people the most is that 'it feels good to feel good,' and that's about so much more than weight."

Alexa Mellardo

Read more:
This Chef's Just-under 100-Pound Weight Loss Journey Is So Inspiring Eat This Not That - Eat This, Not That

More than 70% of adults in the US are overweight or considered obese. Its important not to advise a patient to simply eat less and exercise more, said presenter Irene W. Bean, DNP, APRN, PMHNP, PNAP, FAANP, FAAN, executive director and founder of the Tennessee Nurse Practitioner Association.

Obesity is a chronic disease and global health issue, Bean said, and clinicians know that, if left untreated, obesity can lead to insulin resistance, hypertension, and dyslipidemia, and cause further complications, such as type 2 diabetes, cardiovascular disease, nonalcoholic fatty liver disease, and in some cases, death.1

It is important to know what your options are as a provider and understand which methods of treatment might be the best fit for your patients. It is important to familiarize yourself with the proper dosages of obesity and weight loss drugs, according to Bean. Some providers may be unfamiliar with prescribing, she said, and begin at too high of a dose or raise the dosage too quickly, which can cause indigestion, nausea, and vomiting.

Bean began her presentation highlighting the mechanisms of glucagon-like peptide-1 (GLP-1) receptor agonists, which she explained are preferred to amphetamine-based therapieslike phenterminewhich can worsen blood pressure, heart rate, anxiety, and insomnia.

There are several options for obesity and weight loss treatment, including oral medications, but Bean directed her presentation toward GLP-1 receptor agonist injectables.

First approved on June 4, 2021 by the US Food and Drug Administration (FDA), the once-weekly semaglutide injection 2.4 mg (Wegovy) became the first and only prescription weight loss medication with a once-weekly dosage. The approval was based on results from the Semaglutide Treatment Effect in People with Obesity (STEP) clinical trial program, which progressed through 4 phase 3a trials and involved approximately 4500 participants. In the STEP 1 trial, Bean pointed out, the 83.5% of patients achieved a loss of 5% or more body weight reduction compared to placebo (3.1%). Patients also saw an average body weight reduction of 15.6% at 68 weeks, according to study results.

The once-weekly semaglutide injection had previously been approved for treatment of type 2 diabetes under the brand name Ozempic. When used with diet and exercise, it improves glycemic control in adults with Type 2 diabetes, Bean said. It has been proven to reduce the risk of major adverse cardiovascular events, such as death, nonfatal myocardial infarction, or nonfatal stroke in adults with Type 2 diabetes and established cardiovascular disease.

Next is tirzepatide (Mounjaro), a once-weekly glucose-dependent insulinotropic polypeptide (GIP) and GLP-1 receptor agonist. The first and only FDA-approved dual-action GIP and GLP-1 receptor agonist for diabetes, tirzepatide is also being studied as potential treatment for non-alcohol steatohepatitis.

A 3mg injection of liraglutide (Saxenda) is another option, Bean pointed out. This GLP-1 receptor agonist influences certain brain receptors that control appetite, and cause feelings of fullness and reduced hunger, which may result in reduced calorie consumption. It is the first and only GLP-1 receptor for weight management in adolescents (ages 12 to 17), meant to be combined with exercise and a low-calorie diet. Weight loss with liraglutide can start within 2 weeks and continues for 9 months to a year, Bean said.

This dosage of liraglutide showed significant results for lowering BMI-for-age during the clinical stages, Bean said, citing a study that followed adolescents ages 12 to 17 years with obesity. Those receiving liraglutide for 1 year reduced their BMI-for-age by 0.23%, whereas the BMI-for-age in adolescents not treated with liraglutide did not change at all.

While weight loss results can be achieved with GLP-1 agonist receptors, it is important for clinicians to know potential side effects, especially when counseling patients. These include nausea, vomiting, stomach pain, headache, dizziness, fatigue, constipation or diarrhea, heartburn or gastroesophageal reflux disease, low blood sugar in people with type 2 diabetes, mood changes, and drug interactions. Less common side effects include allergic reaction, acute pancreatitis, acute cholelithiasis, suicidal thoughts or behavior, and risk of thyroid C-cell tumors.

It is important for providers to assess patients for contraindications including heart disease, sleep apnea, hypertension, hyperlipidemia, nonalcoholic fatty liver disease, nonalcohol steatohepatitis, cholelithiasis, and cancer.

Reference

Continue reading here:
A glimpse into GLP-1 receptor agonists: what to know about the market of obesity and weight loss drugs - Contemporary Obgyn

High adherence to the palaeolithic diet helps reduce sleep apnoea in menopausal women who are overweight, with the benefit linked to weight loss, according to a secondary analysis of a trial comparing a 2-year intervention of a palaeolithic diet with a low-fat control diet according to the Nordic Nutritional Recommendations.

The analysis included 70 healthy, nonsmoking women (mean age 60 years, mean body mass index [BMI] 33 kg/m2). Two years of palaeolithic diet intervention led to greater weight loss compared with the control diet (mean, 7.2 kg, 95 percent confidence interval [CI], 5.39.2 vs 3.9 kg, 95 percent CI, 1.95.9; p<0.021). [Int J Obesity 2022;46:1833-1839]

Weight loss translated to a reduction in the apnoea-hypopnoea index (AHI) in the palaeolithic diet group (p=0.034) but not in the control group (p=0.69). BMI changes also showed a significant correlation with AHI changes in the palaeolithic diet group only (p=0.03 and p=0.70).

After 2 years, AHI improved in women who lost weight by >8 kg, regardless of the diet group. About 40 percent of women in the palaeolithic diet group and 20 percent in the control group had lost >8 kg at follow-up.

The present data support the finding that the more weight that is lost, the greater the reduction in the AHI found in previous trials, according to the investigators. [BMJ 2009;339:b4609;Am J Respir Crit Care Med 2009;179:320-327; Arch Intern Med 2009;169:1619-1626;JAMA 2012;308:1142-1149]

Caveman diet

Palaeolithic diet typically includes meat, fish, eggs, fruits and vegetables, seeds, and nuts, along with healthy fats and oils. It is the modern interpretation of the diet that humans ate during the Palaeolithic or "Old Stone Age" era and centres on the idea that eating like them can promote good health. [Eur J Endocrinol2019;180:417-427;Adv Nutr2019;10:634-646; Obes Rev2019;20:1132-1147]

How palaeolithic diet can help with weight loss and sleep apnoea may be related to the previously reported improvements in components of the metabolic syndrome, notably waist circumference and triglyceride levels, that the diet induces, with close relationships having been established between the metabolic syndrome and the AHI. [Am J Clin Nutr 2015;102:922-932;Sleep Med 2011;12:329-334]

A palaeolithic diet can therefore be recommended to women who are overweight after menopause, with the understanding that it will only affect the severity of sleep apnoea if weight is reduced by more than 8 kg, the investigators said.

However, they stressed that the diet had no effect on excessive daytime sleepiness, which is suggested as the most important symptom of sleep apnoea.

It is possible that daytime sleepiness in women with overweight after menopause is primarily due to factors other than sleep apnoea. This may explain why no effect was found between weight reduction and daytime sleepiness in the present trial, the investigators explained.

Further studies with large sample sizes are needed before a palaeolithic diet can be recommended to people with obstructive sleep apnoea, they added.

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Palaeolithic diet-induced weight loss extends benefits to sleep apnoea in women | Latest news for Doctors, Nurses and Pharmacists | Respirology - MIMS