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What it's like to play the baddest opera villain in the world

<p>As we mark the 100th anniversary of Giacomo Puccini’s passing, Opera Australia is pulling out all the stops to celebrate the legendary Italian composer with two of his most celebrated works at the iconic Sydney Opera House this winter. Kicking off the season is Edward Dick’s five-star production of <em>Tosca</em>, which had its opening night on June 25.</p> <p>This electrifying new take on Puccini’s action-packed thriller is captivating audiences with its compelling narrative and intense emotional depth. <em>Tosca</em> unfolds over a swift 24-hour period, weaving a tale of passion and power, jealousy and betrayal, love and tragedy. It's a perfect introduction to opera for newcomers and a beloved classic for seasoned fans, promising an edge-of-your-seat experience.</p> <p>Renowned for his ability to breathe fresh life into classic works, Director Edward Dick has assembled an award-winning creative team to deliver a visually stunning production. Tom Scutt's set design brilliantly juxtaposes Renaissance grandeur with contemporary elegance, featuring a suspended gilded dome revealing a breathtaking Renaissance fresco. BAFTA-winning costume designer Fotini Dimou dresses the performers in chic, modern attire, while Lee Curran's stadium-style lighting adds a dramatic flair.</p> <p>The cast is equally stellar. Making her Opera Australia debut, Northern Irish soprano Giselle Allen has taken on the titular role of Tosca, sharing the stage with OA favourite Karah Son, who received critical acclaim for her performance in Melbourne.</p> <p>Joining them is Korean tenor Young Woo Kim, debuting at the Sydney Opera House as the love-struck painter Cavaradossi. The role of the villainous Scarpia will be portrayed for the first half of the show's run by Armenian dramatic baritone Gevorg Hakobyan, also making his OA debut, until award-winning local baritone Warwick Fyfe takes over the role for the second half of the run, beginning on July 31 until the run's conclusion on August 16.</p> <p>Over60 was thrilled to be given the chance to interview Fyfe in the lead-up to his Sydney performance. </p> <p><em><strong>O60: Firstly, by way of an introduction to Warwick Fyfe the Australian Helden bass baritone – can you summarise your career?</strong></em></p> <p><strong>Fyfe: </strong>“In <em>Yes, Minister</em>, Sir Humphrey once – referring to Bernard – used the expression “a low flyer supported by occasional gusts of hot air”. I suppose I’m a bit like that. But I have a single major achievement, to wit: I’m still here! Over several decades I’ve seen hot shots come and go and change careers but I’m still earning a living at singing. Moreover, I think I might at last be getting the hang of it.” </p> <p><strong><em>O60: What is your history with this opera Tosca by Puccini?</em></strong></p> <p><strong>Fyfe: </strong>“I sang the Sacristan in the 1995 Victoria State Opera production. That was the start. The director John Copley was very supportive and taught me a lot. Also, I got to know the great John Wegner, having previously only seen him from the auditorium. He was a great influence even though he and I were very different. I’d watch him every night from the wings during Act 2. Then years later, having done countless Sacristans, I did a Scarpia of my own, taking over from John at the tail end of a season. Then in 2022 I was to sing Scarpia for West Australian Opera. Alas, the season was severely damaged when I caught Covid. I only did the first and last shows and not very well. This current production allows me at last to put my stamp on the role and do it properly. It went well in the Melbourne run.” </p> <p><em><strong>O60: How do you approach learning the role of Scarpia and connecting with a villainous character?</strong></em></p> <p><strong>Fyfe: </strong>“Tosca is very standard repertoire and additionally I was the Sacristan early in my career so that I had an osmotically acquired sense of the thing from early on. Also, the donkey work of learning and memorising the notes and words is a task of only moderate proportions with this role. So one just sits down at the piano and starts hacking away at it. </p> <p>“The other two bits of the equation (which can’t actually be separated) are the singing of the role and the inhabiting of the character. Vocally, it requires that I be at peak form. I can sing it much better than when I was young but it requires much more conscious effort to sustain it. My teacher Christina Henson Hayes has helped me enormously on that front. </p> <p>“Dramatically, it’s almost always possible to find in some dark recess of oneself something which is reflected in the character. Having found this way in, one can push it and stretch it and eventually pop out like a newborn into the new fictional world where that person lives. But equally important, especially for the in-the-round, creaturely and not at all stylised characters of verismo, one needs to have lived and absorbed that which is around one. Read good books, watch great actors – not in an ad hoc sense but generally. Be a cultural sponge. Make reading good books and watching great actors as constant and inevitable a part of life as eating. Read everything, listen to everything, observe everything. If the singer has no cultural hinterland, it is to be hoped that the director is a magician!” </p> <p><em><strong>O6O: You recently performed in this production in Melbourne’s Margaret Court Arena – the first opera to be staged on the tennis court. How did you find that experience and will anything about your performance be different for the Sydney season?</strong></em></p> <p>“Well, it was lovely because all my colleagues were lovely. As well as all my Opera Australia chums, there were people new to me such as Nadine Benjamin and Young Woo Kim – people so warm and friendly, not to mention talented, that one feels almost abashed and instinctively tries in response to be the best colleague one knows how to be. </p> <p>“Nevertheless, I’m a traditionalist who believes that opera will always be better for all concerned in a conventional, properly appointed theatre. Opera singers do not like being miked. For me, however good the technicians, the sense of one’s sound being only partially in one’s own control is uncomfortable. On the other hand, feeling one’s voice commanding a huge space as if one were a Rabelaisian giant is quite thrilling and of course it opens up possibilities for the company commercially.” </p> <p><em><strong>O60: Opera Australia is presenting several Puccini works this year in celebration of the legendary composer as 2024 marks the 100th anniversary of Puccini’s death, so let’s chat about Puccini’s contribution to the world of opera. He was a champion of verismo; can you explain what that means? What should audiences expect from the performance?</strong></em></p> <p>“Verismo is simply realism. Characters presented in the round rather than as two-dimensional types or figures of heightened allegory. In place of a stylised, artificial or high-flown approach, the composers wished to present real people in plausible dramatic settings. Of course this presents an apparent contradiction because in real life we don’t sing at each other. However, in practice you can have your cake and eat it because the genius of Puccini, from a starting point of a verisimilitudinous situation and story, can take it to another plane of intensity and power. But the roots in reality are unbroken. That reality is in the DNA of every cell of the artwork which rises majestically from those roots. Hence the opera feels real despite the built-in artificiality of the art form. By contrast, a composer of another era and school might take his subject away from reality to a more rarefied place. Audiences should expect an intense, purely human drama.” </p> <p><em><strong>O60: Puccini is known for his innovative use of the orchestra and an expansive use of instruments; what should audiences be listening for when they come to Tosca?</strong></em></p> <p>“Different composers have their preferred palettes. This also varies on national as well as individual lines. As Puccini is the supreme figure in verismo, he IS the archetype so that I can answer the question in a circular way by saying that it will sound very Italian, very verismo. Lush, yes, but a Puccinian version thereof rather than a Straussian one. </p> <p>“There are also exquisite touches, sort of musical special effects used judiciously and sparingly enough so as not to seem gimmicky. For example, the bells and spoken Latin of the Te Deum or the distanced effect of the oratorio in Act 2. The arias are of course high points but much of the interest lies in the meat connecting those moments.” </p> <p><em><strong>O60: Which of Puccini’s works is your preferred or do you find one most revolutionary?</strong></em></p> <p>“For brutal intensity, <em>Tosca</em> represents the high-water mark, especially Act 2. I love the kaleidoscopic richness of <em>Turandot</em>. The story is horrible but this is not a negative if one accepts it as a fable which has different rules from those applying to a pungently realistic tale. Also, <em>Turandot</em> is structurally flawed because he didn’t finish it. It is, however, musically astonishingly good. If you said I had to see a Puccini opera tonight but I could choose which one, I’d definitely choose <em>La Fanciulla del West</em>. Not only is it a masterpiece, it doesn’t get done nearly enough.”</p> <p>---</p> <p>Don't miss this extraordinary celebration of Puccini's legacy. Whether you're an opera aficionado or a first-time attendee, this production of <em>Tosca</em> is set to be an unforgettable highlight of the cultural calendar. Get ready to be swept off your feet by the sheer drama, passion, and beauty of Puccini’s masterpiece. Visit <a href="https://opera.org.au/" target="_blank" rel="noopener">https://opera.org.au/</a> for more info.</p> <p><em>Images: Opera Australia</em></p>

Music

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"Felt like a criminal": Mother and disabled son "kicked out" of Pink concert

<p>A distraught mother has taken to social media to recall the moment her and her seven-year-old son, who has Down syndrome, were asked to leave a concert venue. </p> <p>Vanessa Vasey, 48, spent over $1,000 to take her son Jesse to see Pink in London during her UK stadium tour, but when the pair arrived at the venue, things took a turn. </p> <p>Jesse struggled to stay still in his seat and was soon surrounded by "six security guards" who ordered the disabled boy to sit down, otherwise they would have to leave.</p> <p>She said she tried to explain her son’s condition to the guards but they ended up being “escorted from the premises” just as Pink took to the stage.</p> <p>On Facebook, Vasey wrote in detail about what happened, saying her son had been “robbed” of a special experience.</p> <p>“Music is his life and Pink is one of his absolute favourites,” she wrote.</p> <p>“We successfully saw her perform at BST Hyde Park last year and were thrilled to learn of her return again this year.”</p> <p>Vasey said she purchased more expensive “hospitality tickets” allowing people to move between bars and food outlets during the night “so that Jesse wouldn’t be pressured into remaining in one seat all night, as he gets overwhelmed in busy environments and finds it hard to sit still.”</p> <p>“We spent some time in the bar leading up to the main act, and Jesse was having a wonderful time, until about 45 minutes before Pink was due to come on, they suddenly shut all the blinds, obstructing us from seeing anything,” she wrote.</p> <p>“I tried to consult with the hospitality managers over this, and explained Jesse’s needs, but they wouldn’t budge on it. So not wanting Jesse to stare at a blind all night, we attempted to go into the seating zone."</p> <p>“We couldn’t get him to sit in his seat, but he was happy dancing and singing at the front railings, and even interacting with some of the other guests."</p> <p>“Doing no harm to anyone, or obstructing anyone’s view. This seemed OK for about half an hour or so. Then ... just as Pink dropped from the sky in her opening number, we had six security guards come into the zone and ask us to leave or sit in our seats.”</p> <p>Vasey said the security guards were “abrupt, intimidating and unpleasant”, as they "tried to force us to take Jesse to a sensory room which was soundproof, and watch Pink on a screen.” </p> <div> </div> <p>“Something we could do at home, robbing us of the whole experience, as if my son was some sort of inconvenience, and better off shut in a room out of sight.”</p> <p>When Vasey complained to venue staff, she claims that more security guards appeared and they had no choice but to leave. </p> <p>“We were escorted out of the building like criminals and saw no more of the Pink show. Jesse was utterly devastated, and they showed absolutely zero care or understanding."</p> <p>“Shame on you Tottenham Stadium,” she concluded. “My poor boy deserved so much better than this!”</p> <p>After UK media picked up Vasey's story, Tottenham Stadium released a statement explaining their actions. </p> <p>“Following further investigation, we can confirm that Ms Vasey was offered assistance by our Safeguarding and Welfare teams throughout the night to provide Jesse with a comfortable viewing experience, including access to our dedicated Sensory Room,” the statement read.</p> <p>“The offers of assistance were declined by Ms Vasey and the party chose to leave the event.”</p> <p>Vasey was soon set upon by online trolls who condemned her choice to take Jesse to the concert in the first place, to which she issues a lengthy statement about inclusivity and not singling people out for their disabilities. </p> <p>“Why do we take them [to events]? Because, as parents, we have the same dreams and aspirations for our children as any other parent,” she wrote.</p> <p>“We have the same desires to see our children’s faces light up, as any other parent would. Our children are exposed to the same world as other children, and they enjoy the same things."</p> <p>“They have the same likes and desires. The only thing that’s different is their needs, their abilities and their way of accessing their dreams."</p> <p>“Why should these things deny them of fulfilling these dreams and passions? This is meant to be a world of inclusion. So let’s start including!"</p> <p>“That means adapting, understanding, supporting and most importantly; changing the way we deliver these privileges so that they are privileges for all of us, and not just some of us.”</p> <p><em>Image credits: Facebook/Richard Isaac/Shutterstock Editorial </em></p> <div class="hide-print ad-no-notice css-qyun7f-StyledAdUnitWrapper ezkyf1c0" style="box-sizing: border-box; caret-color: #292a33; color: #292a33; font-family: HeyWow, Montserrat, 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 15px;"> </div>

Caring

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How to buy a home: 7 tips for negotiating like a pro

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/park-thaichon-175182">Park Thaichon</a>, <a href="https://theconversation.com/institutions/university-of-southern-queensland-1069">University of Southern Queensland</a></em></p> <p>The main purpose of negotiation is to find a mutually acceptable solution for buyers and sellers. Good negotiations greatly improve relationships between buyers, sellers and agents. They also help avoid future problems and conflicts.</p> <p>Negotiating skills become even more important for home buyers in a “seller’s market”, where demand from buyers exceeds supply from sellers. That’s <a href="https://propertyupdate.com.au/australian-property-market-predictions/">currently the case</a> in all Australian capital cities and major regional cities such as Gold Coast, Sunshine Coast and others.</p> <p>Many home buyers mistakenly believe negotiation only occurs during the signing of the sale contract. However, it involves distinct stages: <em>pre-negotiation</em> and <em>during negotiation</em>.</p> <p>So how can people maximise their chances of successfully negotiating a purchase in a seller’s market? I offer the following tips.</p> <h2>Be someone the seller’s agent wants to do business with</h2> <p>Buyers often communicate solely with the seller’s agent, rather than directly with the seller. It’s crucial to ensure the agent views the buyer positively. Ultimately, it’s the agent who presents offers to the seller for their decision.</p> <p>It’s important, then, to understand what might motivate the seller’s agent to choose your offer. The key performance indicator for the agent often revolves around closing a property sale at a reasonable price within a certain time.</p> <p>This means price is a crucial factor. However, other factors can influence the seller’s agent and seller.</p> <p>For example, having pre-approved finance can increase the agent’s confidence in the buyer. If the buyer appears serious, can make quick decisions and makes a good impression, the agent may be more motivated to push for them, even if their offer is slightly lower than others without pre-approved finance.</p> <h2>Be a big fish (for the seller’s agent)</h2> <p>The next strategy is to give the seller’s agent extra incentive to favour you and your offer. <a href="https://www.emerald.com/insight/content/doi/10.1108/MIP-09-2019-0489/full/html">Our research</a> in customer behaviour suggests businesses value customers who make frequent purchases or engage them for long-term services.</p> <p>For example, the agent would be pleased to learn that the buyer might be interested in buying another property in the near future or in using their rental service for the new property. You have an advantage if you can position yourself as someone who could provide them with extra business.</p> <h2>Point to competing options</h2> <p>In a positive manner, let the seller’s agent know you are considering two or three properties, and this specific property is among those you are inclined to make an offer on.</p> <p>In certain situations, it may stimulate competitive pricing when multiple properties of similar quality are available in the same area. Make it clear to the agent you will choose the property that offers you the best overall value.</p> <p>While this strategy might not necessarily lower the price in a seller’s market, it can prompt the agent to have a fuller discussion with you.</p> <h2>Think beyond price</h2> <p>The next set of tips focuses on the <em>during negotiation</em> stages. It can be challenging for buyers to negotiate a lower price in a market with low supply and high demand. You might have to “think outside the price box”.</p> <p>Buyers often have a specific price range or fixed budget in mind when they start discussions with a seller. However, other factors besides price can influence a property’s overall value.</p> <p>So if a seller won’t adjust the price, consider negotiating for other concessions that could reduce your expenses.</p> <p>These may include:</p> <p><strong>Settlement period</strong></p> <p>Consider the expenses associated with the settlement period. A shorter settlement period could enable buyers to move into the property sooner and save on rent. For example, if a buyer is paying $600 per week in rent, an early settlement could save them around $2,400 per month.</p> <p><strong>Insurance costs after contract signing</strong></p> <p>In many states, buyers’ <a href="https://www.finder.com.au/home-insurance/home-insurance-cost">home insurance cover</a> is required to begin from the date of contract signing. It’s reasonable for buyers to include a special condition requesting the seller to bear the insurance costs until settlement. On average, home insurance may amount to about $140 per month.</p> <p><strong>Cleaning expenses</strong></p> <p>Consider negotiating a condition stipulating that the seller must ensure the property is professionally cleaned by settlement. Failure to do so could result in a $500 adjustment in the buyer’s favour at settlement.</p> <p>In some states, like Queensland, sellers are not obligated to deliver a clean property. Based on typical end-of-lease cleaning charges, internal cleaning of a four-bedroom property could cost <a href="https://firstcallhomeservices.com.au/service-menu/bond-exit-end-lease-cleaning/">$455 to $590</a>.</p> <p><strong>Building and pest inspection costs</strong></p> <p>Buyers should always include a 14-day pre-purchase inspection clause for <a href="https://www.topdogpestcontrol.com.au/building-pest-inspections-gold-coast/">building and pest inspections</a> in their offer. Although they may cost $300 to $600, these inspections provide a clear report that could lead to negotiations after contract signing if they find any issues with the property.</p> <h2>Be careful with your first offer</h2> <p>Don’t present the first offer in writing. It can be challenging to negotiate down the price once it has been written in an offer document.</p> <p>Instead, the buyer should begin by testing the expected price of the property. As well as obtaining property reports from multiple banks, the buyer could talk with the seller’s agent in person about a price range that would be agreeable to the seller.</p> <p>You could include phrases like “a price that will make the seller happy” or “a price that will make the seller accept the offer”. While the agent might not provide a specific price, this talk can provide a guideline for the buyer. All properties up for auction or private sale should have an expected price set, which may or may not be discussed with potential buyers.</p> <p>It’s also advisable to consult a solicitor before submitting an offer or signing a contract. They can offer valuable suggestions to smooth the purchase process and identify any issues.</p> <h2>Use the power of 900</h2> <p>Buyers often submit offers with round numbers, such as $700,000 or $750,000. In a competitive seller’s market, aim to submit an offer with a number that stands out from the rest, yet remains within your budget.</p> <p>An example of such a number is $900. For instance, comparing $700,000 to $700,900, the extra $900 makes the offer feel closer to $710,000.</p> <h2>Write a personalised letter</h2> <p>It’s true the most important point of selling a house for many sellers is price. But they are human and have emotions. Finishing a purchasing offer with a personal letter to the seller can make a difference.</p> <p>Often that $3,000 to $20,000 could be a lot of money for a buyer, but it may not be as much for someone selling a house for $700,000 or $1,000,000. Write the letter to express your feelings about the property in a way that makes it clear you will care for it. Most people selling their home would prefer to have someone look after it well.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226237/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/park-thaichon-175182">Park Thaichon</a>, Associate Professor of Marketing, <a href="https://theconversation.com/institutions/university-of-southern-queensland-1069">University of Southern Queensland</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-to-buy-a-home-7-tips-for-negotiating-like-a-pro-226237">original article</a>.</em></p> </div>

Money & Banking

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4 things you’re likely doing that are damaging your hearing

<p>Your hearing is a precious gift, so it’s important to take good care of your ears. We’ve got some advice on the things to avoid, and what you can do to protect your hearing.</p> <p><strong>Using cotton tips</strong></p> <p>Though they’re commonly used for the job, cotton tips should never be used to clean out your ears. In fact, no solid object should be put inside your ears. Cotton tips account for around four per cent of all ruptured eardrums.</p> <p>These innocuous-looking objects can also cause bleeding, scratch your ear canal, or trigger an infection. So put them down and step away. Instead, use a commercial ear cleaner, or even just a few drops of mineral oil, baby oil, or glycerine to soften the earwax.</p> <p><strong>Don’t wait and see</strong></p> <p>If your hearing in one or both ears suddenly disappears without cause, you need to go and see your doctor as soon as you can. It could be inflammation, infection, or a decrease in blood supply to the area.</p> <p>If you need treatment, you’ll likely need it immediately to have any hope of restoring your hearing.</p> <p><strong>Using eardrops without advice</strong></p> <p>There are many over-the-counter eardrops available to help with things like swimmer’s ear. But in extreme cases, these products can cause deafness. Before you use anything, including a home remedy, get your doctor to check that you don’t have a ruptured eardrum.</p> <p>Some people may be born that way, or have had surgery as a child, or suffered an injury. If the ingredients in these drops make their way inside your eardrum, it can cause a lot of pain, and permanent deafness.</p> <p><strong>Always protect your ears</strong></p> <p>It’s incredibly important to protect your ears from permanent damage. Tiny hairs inside your ears act as hearing receptors, and these can be broken by extremely loud noises. Once they’re gone, they don’t come back.</p> <p>So things like loud music, fireworks, machinery, and artillery are all risky to be around. The best thing you can do is cover up with earmuffs whenever you’re around these things – especially if it’s on a regular basis. For extra safety, use earplugs as well.</p> <p><em>Image credits: Shutterstock </em></p>

Body

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Drinking lots of water may seem like a healthy habit – here’s when and why it can prove toxic

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a></em></p> <p>In late 2023, actor <a href="https://www.glamour.com/story/brooke-shields-recently-experienced-a-full-blown-seizure-and-bradley-cooper-came-running?utm_source=instagram&amp;utm_medium=social&amp;utm_content=instagram-bio-link&amp;client_service_id=31196&amp;client_service_name=glamour&amp;service_user_id=1.78e+16&amp;supported_service_name=instagram_publishing&amp;utm_brand=glm&amp;utm_social_type=owned">Brooke Shields</a> suffered a seizure after “flooding” her body with water. Shields became dangerously low on sodium while preparing for her show by drinking loads of water. “I flooded my system and I drowned myself,” she would later explain. “And if you don’t have enough sodium in your blood or urine or your body, you can have a seizure.”</p> <p>Shields said she found herself walking around outside for “no reason at all”, wondering: “Why am I out here?”</p> <blockquote> <p>Then I walk into the restaurant and go to the sommelier who had just taken an hour to watch my run through. That’s when everything went black. Then my hands drop to my side and I go headfirst into the wall.</p> </blockquote> <p>Shields added that she was “frothing at the mouth, totally blue, trying to swallow my tongue”.</p> <p>Like Shields, many people may be unaware of the dangers of drinking excessive amounts of water – especially because hydration is so often associated with health benefits. Models and celebrities <a href="https://www.teenvogue.com/story/drinking-water-flawless-skin#:%7E:text=If%20you're%20reading%20a,long%20hours%20at%20a%20time.">often advocate</a> drinking lots of water to help maintain clear, smooth skin. Some <a href="https://www.independent.co.uk/life-style/75-hard-challenge-before-and-after-tiktok-b2382706.html">social media influencers</a> have promoted drinking a gallon of water daily for weight loss.</p> <p>But excessive water consumption can cause <a href="https://patient.info/treatment-medication/hyponatraemia-leaflet">hyponatraemia</a> – a potentially fatal condition of low sodium in the blood.</p> <h2>Worried about hydration levels? Check your urine</h2> <p>The body strictly regulates its water content to maintain the optimum level of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2323003/">total body water</a> and “osmolality” – the concentration of dissolved particles in your blood. Osmolality increases when you are dehydrated and decreases when you have too much fluid in your blood.</p> <p>Osmolality is monitored by <a href="https://pubmed.ncbi.nlm.nih.gov/9074779/">osmoreceptors</a> that regulate sodium and water balance in the hypothalamus – the part of the brain that controls numerous hormones. These osmoreceptors signal the release of antidiuretic hormone (ADH), which acts on blood vessels and the kidneys to control the amount of water and salt in the body.</p> <figure><iframe src="https://www.youtube.com/embed/Qghf7Y9ILAs?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>In healthy people, the body releases ADH when osmolality becomes high. ADH tells the kidneys to reabsorb water, which makes urine more concentrated. The reabsorbed water dilutes the blood, bringing osmolality back to normal levels.</p> <p>Low blood osmolality suppresses the release of ADH, reducing how much water the kidneys reabsorb. This dilutes your urine, which the body then passes to rid itself of the excess water.</p> <p>Healthy urine should be clear and odourless. Darker, yellower urine with a noticeable odour can indicate dehydration – although medications and certain foods, including <a href="https://pubmed.ncbi.nlm.nih.gov/3433805/">asparagus</a>, can affect urine colour and odour, too.</p> <h2>How much is too much?</h2> <p>Adults should consume <a href="https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/water-drinks-nutrition/">two-to-three litres per day</a>, of which around 20% comes from food. However, we can lose <a href="https://www.ncbi.nlm.nih.gov/books/NBK236237/">up to ten litres</a> of water through perspiration – so sweating during exercise or in hot weather increases the amount of water we need to replace through drinking.</p> <p>Some medical conditions can cause overhydration. Approximately <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616165/">one in five</a> schizophrenia patients drink water compulsively, a dangerous condition known as <a href="https://www.theguardian.com/uk-news/2024/apr/15/woman-died-mental-hospital-excessive-water-drinking-inquest#:%7E:text=Woman%20died%20at%20mental%20hospital%20after%20excessive%20water%20drinking%2C%20inquest%20told,-Parents%20of%20Lillian&amp;text=A%20woman%20collapsed%20and%20died,water%2C%20an%20inquest%20has%20heard.">psychogenic polydipsia</a>. One long-term study found that patients with psychogenic polydipsia have a <a href="https://pubmed.ncbi.nlm.nih.gov/18984069/">“74% greater chance</a> of dying before a non-polydipsic patient”.</p> <p>In <a href="https://pubmed.ncbi.nlm.nih.gov/22306188/">some cases</a>, people with <a href="https://psychiatry-psychopharmacology.com/en/childhood-and-adolescence-disorders-psychogenic-polydipsia-in-an-adolescent-with-eating-disorder-a-case-report-132438">anorexia nervosa</a> can also suffer from compulsive water drinking.</p> <figure><iframe src="https://www.youtube.com/embed/ReQew2zcN7c?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>For those suffering from polydipsia, treatment is focused on medication to reduce the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10675986/">urge to drink</a>, as well as <a href="https://www.uptodate.com/contents/overview-of-the-treatment-of-hyponatremia-in-adults/print">increasing sodium levels</a>. This should be done gradually to avoid causing <a href="https://www.ncbi.nlm.nih.gov/books/NBK562251/">myelinolysis</a> – <a href="https://www.ncbi.nlm.nih.gov/books/NBK551697/">neurological damage</a> caused by rapid changes in sodium levels in nerve cells.</p> <p>In rare but often highly publicised cases such as that of <a href="http://news.bbc.co.uk/onthisday/hi/dates/stories/november/13/newsid_2516000/2516593.stm">Leah Betts</a> in 1995, some users of the illegal drug MDMA (also known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119400/">ecstasy)</a> have <a href="https://pubmed.ncbi.nlm.nih.gov/11265566/">died</a> after drinking copious amounts of water to rehydrate after dancing and sweating.</p> <p>The drug <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008716/">increases body temperature</a>, so users drink water to avoid overheating. Unfortunately, MDMA also triggers the <a href="https://pubmed.ncbi.nlm.nih.gov/12105115/">unnecessary release of ADH</a>, causing water retention. The body becomes unable to rid itself of excess water, which affects its electrolyte levels – causing cells to swell with water.</p> <p>Symptoms of water intoxication start with nausea, vomiting, blurred vision and dizziness. As the condition progresses, sufferers can often display symptoms of <a href="https://www.nhs.uk/mental-health/conditions/psychosis/symptoms/">psychosis</a>, such as inappropriate behaviour, confusion, delusions, disorientation and hallucinations.</p> <p>These symptoms are caused by <a href="https://www.ncbi.nlm.nih.gov/books/NBK470386/">hyponatraemia</a>, where sodium levels are diluted or depleted in blood and the subsequent imbalance of electrolytes affects the nervous system. Water begins to move into the brain causing <a href="https://www.sciencedirect.com/science/article/pii/S1572349604000149">a cerebral oedema</a> – brain swelling because of excessive fluid buildup, which is usually fatal if not treated.</p> <p>A healthy body will tell you when it needs water. If you’re thirsty and your urine is dark with a noticeable odour, then you need to drink more. If you aren’t thirsty and your urine is clear or the colour of light straw, then you’re already doing a good job of hydrating yourself.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/228715/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/adam-taylor-283950"><em>Adam Taylor</em></a><em>, Professor and Director of the Clinical Anatomy Learning Centre, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drinking-lots-of-water-may-seem-like-a-healthy-habit-heres-when-and-why-it-can-prove-toxic-228715">original article</a>.</em></p> </div>

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"Looks nothing like her": Kate Middleton portrait ridiculed

<p>A painted portrait of Kate Middleton has gone viral for all the wrong reasons, after royal fans everywhere claimed the artwork "looks nothing like" the Princess of Wales. </p> <p>The image, created by artist Hannah Uzor, appeared on the front cover of UK magazine <em>Tatler</em>, as the artist recreated Middleton's appearance at a banquet held in South Africa in 2022. </p> <p>The Princess wore a white beaded Jenny Packham gown, and also donned her famous tiara, the Lover’s Knot, which was previously worn by Princess Diana.</p> <p>Uzor explained that in creating the artwork, she was inspired by the composure and bravery demonstrated by the royal mum-of-three in her emotional cancer diagnosis video in March.</p> <p>“A moment of dealing with something difficult, speaking from the heart, having the courage to tackle it head-on,” she explained in awe.</p> <p>However, many royal fans slated the artist on social media, simply asking, “are you kidding me?”.</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/p/C7Qy93EtBeT/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/C7Qy93EtBeT/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Tatler (@tatlermagazine)</a></p> </div> </blockquote> <p>“This is just plain weird, looks nothing like her,” one person commented.</p> <p>“What have they done to her face,” asked another.</p> <p>A third agreed: “Doesn’t look like Catherine at all. If she wasn’t wearing that dress I’d have no clue as to who it’s meant to be.”</p> <p>“Are you kidding me? … You must be joking,” scorned someone else.</p> <p>Others slated the artwork by saying they believed it looked “like it was created by a child”.</p> <p>“It’s absolutely dreadful and should never have seen the light of day, let alone appear on the cover,” agreed another.</p> <p>Hannah Uzor defended her artwork, saying she had to draw on other sources as she was not able to meet the Princess directly to create her portrait. </p> <p>She said, “When you can’t meet the sitter in person, you have to look at everything you can find and piece together the subtle human moments revealed in different photographs: do they have a particular way of standing or holding their head or hands? Do they have a recurrent gesture?"</p> <p>“[Kate] has really risen up to her role – she was born for this. She carries herself with such dignity, elegance and grace."</p> <p><em>Image credits: Tatler Magazine / Chris Jackson/WPA Pool/Shutterstock Editorial </em></p>

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If I’m diagnosed with one cancer, am I likely to get another?

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/sarah-diepstraten-1495268">Sarah Diepstraten</a>, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> and <a href="https://theconversation.com/profiles/terry-boyle-1521638">Terry Boyle</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p>Receiving a cancer diagnosis is life-changing and can cause a range of concerns about ongoing health.</p> <p>Fear of cancer returning is one of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9321869/">top health concerns</a>. And <a href="https://www.cancercouncil.com.au/cancer-information/living-well/after-cancer-treatment/fear-of-the-cancer-returning/managing-fear-of-recurrence/">managing this fear</a> is an important part of cancer treatment.</p> <p>But how likely is it to get cancer for a second time?</p> <h2>Why can cancer return?</h2> <p>While initial cancer treatment may seem successful, sometimes a few cancer cells remain dormant. Over time, these cancer cells can grow again and may start to cause symptoms.</p> <p>This is known as cancer recurrence: when a cancer returns after a period of remission. This period could be days, months or even years. The new cancer is the same type as the original cancer, but can sometimes grow in a new location through a process called <a href="https://theconversation.com/how-does-cancer-spread-to-other-parts-of-the-body-219616">metastasis</a>.</p> <p>Actor Hugh Jackman has gone public about his <a href="https://www.skincancer.org/blog/is-basal-cell-carcinoma-serious/">multiple diagnoses</a> of basal cell carcinoma (a type of skin cancer) over the <a href="https://www.bbc.com/news/world-australia-65158945">past decade</a>.</p> <p>The exact reason why cancer returns differs depending on the cancer type and the treatment received. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486871/">Research</a> is <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.3408">ongoing</a> to identify genes associated with cancers returning. This may eventually allow doctors to tailor treatments for high-risk people.</p> <h2>What are the chances of cancer returning?</h2> <p>The risk of cancer returning differs between cancers, and between <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8019423/">sub-types</a> of the same cancer.</p> <p>New screening and treatment options have seen reductions in recurrence rates for many types of cancer. For example, between 2004 and 2019, the risk of colon cancer recurring dropped by <a href="https://jamanetwork.com/journals/jamaoncology/fullarticle/2812113">31-68%</a>. It is important to remember that only someone’s treatment team can assess an individual’s personal risk of cancer returning.</p> <p>For most types of cancer, the highest risk of cancer returning is within the <a href="https://pubmed.ncbi.nlm.nih.gov/31231898/">first three years</a> after entering remission. This is because any leftover cancer cells not killed by treatment are likely to start growing again sooner rather than later. Three years after entering remission, recurrence rates for most cancers decrease, meaning that every day that passes lowers the risk of the cancer returning.</p> <p>Every day that passes also increases the numbers of new discoveries, and cancer drugs being developed.</p> <h2>What about second, unrelated cancers?</h2> <p>Earlier this year, we learned Sarah Ferguson, Duchess of York, had been diagnosed with malignant melanoma (a type of skin cancer) <a href="https://www.bbc.com/news/uk-68047608">shortly after</a> being treated for breast cancer.</p> <p>Although details have not been confirmed, this is likely a new cancer that isn’t a recurrence or metastasis of the first one.</p> <p>Australian research from <a href="https://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-11-83">Queensland</a> and <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.31247">Tasmania</a> shows adults who have had cancer have around a 6-36% higher risk of developing a second primary cancer compared to the risk of cancer in the general population.</p> <h2>Who’s at risk of another, unrelated cancer?</h2> <p>With improvements in cancer diagnosis and treatment, people diagnosed with cancer are living longer than ever. This means they need to consider their long-term health, including their risk of developing another unrelated cancer.</p> <p>Reasons for such cancers <a href="https://www.cancer.net/survivorship/what-second-cancer">include</a> different types of cancers sharing the same kind of lifestyle, environmental and genetic risk factors.</p> <p>The increased risk is also likely partly due to the effects that some cancer treatments and imaging procedures have on the body. However, this increased risk is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6435077/">relatively small</a> when compared with the (sometimes lifesaving) benefits of these treatment and procedures.</p> <p>While a 6-36% greater chance of getting a second, unrelated cancer may seem large, only around 10-12% of participants developed a second cancer in the Australian studies we mentioned. Both had a median follow-up time of around five years.</p> <p>Similarly, in a <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.30164">large US study</a> only about one in 12 adult cancer patients developed a second type of cancer in the follow-up period (an average of seven years).</p> <p>The kind of first cancer you had also affects your risk of a second, unrelated cancer, as well as the type of second cancer you are at risk of. For example, in the two Australian studies we mentioned, the risk of a second cancer was greater for people with an initial diagnosis of head and neck cancer, or a haematological (blood) cancer.</p> <p>People diagnosed with cancer as a <a href="https://www.mja.com.au/journal/2020/212/3/second-primary-cancers-people-who-had-cancer-children-australian-childhood">child</a>, <a href="https://www.liebertpub.com/doi/10.1089/jayao.2022.0074">adolescent or young adult</a> also have a greater risk of a second, unrelated cancer.</p> <h2>What can I do to lower my risk?</h2> <p>Regular follow-up examinations can give peace of mind, and ensure any subsequent cancer is caught early, when there’s the best chance of successful treatment.</p> <p><a href="https://www.lymphoma.org.au/lymphoma/treatments/maintenance-therapy/">Maintenance therapy</a> may be used to reduce the risk of some types of cancer returning. However, despite ongoing <a href="https://febs.onlinelibrary.wiley.com/doi/10.1111/febs.15626">research</a>, there are no <em>specific</em> treatments against cancer recurrence or developing a second, unrelated cancer.</p> <p>But there are things you can do to help lower your general risk of cancer – not smoking, being physically active, eating well, maintaining a healthy body weight, limiting alcohol intake and being sun safe. These all reduce the chance of <a href="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21719">cancer returning</a> and <a href="https://www.cancer.net/survivorship/what-second-cancer">getting a second cancer</a>.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226386/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/sarah-diepstraten-1495268">Sarah Diepstraten</a>, Senior Research Officer, Blood Cells and Blood Cancer Division, <a href="https://theconversation.com/institutions/walter-and-eliza-hall-institute-822">Walter and Eliza Hall Institute</a> and <a href="https://theconversation.com/profiles/terry-boyle-1521638">Terry Boyle</a>, Senior Lecturer in Cancer Epidemiology, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/if-im-diagnosed-with-one-cancer-am-i-likely-to-get-another-226386">original article</a>.</em></p> </div>

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What happens when I stop taking a drug like Ozempic or Mounjaro?

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p>Drugs like Ozempic are very <a href="https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.12932">effective</a> at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger.</p> <p>But does weight come back when you stop using it?</p> <p>The short answer is yes. Stopping <a href="https://jamanetwork.com/journals/jama/fullarticle/2812936">tirzepatide</a> and <a href="https://doi.org/10.1111/dom.14725">semaglutide</a> will result in weight regain in most people.</p> <p>So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far.</p> <h2>It’s a long-term treatment, not a short course</h2> <p>If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone.</p> <p>For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns.</p> <p>Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.)</p> <p>Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less.</p> <h2>Why do people stop?</h2> <p>Research trials show anywhere from <a href="https://asean-endocrinejournal.org/index.php/JAFES/article/view/1771">6%</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/35015037/">13.5%</a> of participants stop taking these drugs, primarily because of <a href="https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more">side effects</a>.</p> <p>But these studies don’t account for those forced to stop because of cost or <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">widespread supply issues</a>. We don’t know how many people have needed to stop this medication over the past few years for these reasons.</p> <p>Understanding what stopping does to the body is therefore important.</p> <h2>So what happens when you stop?</h2> <p>When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to <a href="https://pubmed.ncbi.nlm.nih.gov/30565096/">move out of your system</a>. As it does, a number of things happen:</p> <ul> <li>you start feeling hungry again, because both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119845/">your brain and your gut</a> no longer have the medication working to make you feel full</li> </ul> <ul> <li> <p>blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/carbohydrates-and-the-glycaemic-index">low glycemic index</a> to stabilise your blood sugars</p> </li> <li> <p>over the longer term, most people experience a return to their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092593/">previous blood pressure and cholesterol levels</a>, as the weight comes back</p> </li> <li> <p>weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle.</p> </li> </ul> <p>While you were on the medication, you will have lost <a href="https://academic.oup.com/jes/article/5/Supplement_1/A16/6240360">proportionally less skeletal muscle than fat</a>, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat.</p> <h2>Is stopping and starting the medications a problem?</h2> <p>People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of <a href="https://pubmed.ncbi.nlm.nih.gov/21829159/">yo-yo dieting</a>.</p> <p>When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to <a href="https://www.jomes.org/journal/view.html?doi=10.7570/jomes.2017.26.4.237">deal with</a> spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can <a href="https://cardiab.biomedcentral.com/articles/10.1186/s12933-022-01735-x">stress</a> your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual.</p> <p>Interestingly, the risk to the body from weight fluctuations is greater for people who are <a href="https://jech.bmj.com/content/74/8/662">not obese</a>. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight.</p> <h2>How can you avoid gaining weight when you stop?</h2> <p>Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include:</p> <ul> <li> <p>getting quality <a href="https://www.hindawi.com/journals/ije/2010/270832/">sleep</a></p> </li> <li> <p>exercising in a way that builds and maintains muscle. While on the medication, you will <a href="https://pubmed.ncbi.nlm.nih.gov/32628589/">likely have lost muscle</a> as well as fat, although this is not inevitable, especially if you <a href="https://www.europeanreview.org/article/34169">exercise regularly</a> while taking it</p> </li> </ul> <ul> <li> <p>addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.159491">fat-phobic and discriminates</a> against people in larger bodies</p> </li> <li> <p>eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes.</p> </li> </ul> <p>Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important.</p> <hr /> <p><em>Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224972/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></em></p> <p><em><a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-when-i-stop-taking-a-drug-like-ozempic-or-mounjaro-224972">original article</a>.</em></p> </div>

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Eye infections might seem like a minor complaint – but in some cases they can cause blindness and even death

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a></em></p> <p>When you think of eye infections, what comes to mind? Puffy, swollen bruised feeling eyelids that get glued together with gunk overnight? That feeling of having grit in your eye that can’t be cleaned away? Eye infections may seem like a relatively minor – if unsightly and inconvenient – complaint, but they can also be far more serious.</p> <p>Take the deadly outbreak of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5022785/">antibiotic resistant</a> bacteria <a href="https://www.cff.org/managing-cf/burkholderia-cepacia-complex-b-cepacia"><em>Burkholderia cepacia</em></a> in 2023-24, for example.</p> <p>Between January 2023 and February 2024, contaminated brands of lubricating eye gel were linked to the infection of at least 52 patients. <a href="https://www.independent.co.uk/news/health/contaminated-eye-gel-outbreak-death-b2523446.html">One person died</a> and at least 25 others suffered serious infections.</p> <p>The outbreak has now subsided and products are <a href="https://www.gov.uk/drug-device-alerts/specific-brands-of-carbomer-eye-gel-recall-of-aacarb-eye-gel-aacomer-eye-gel-and-puroptics-eye-gel-potential-risk-of-infection-dsi-slash-2023-slash-11#update-2-april-2024">back on the shelves</a> but it isn’t the first time that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8335909/">medicinal products</a> have led to outbreaks of <em>B cepacia</em>.</p> <p>The bacterium is an opportunistic pathogen known to pose a significant risk to people with cystic fibrosis, chronic lung conditions and weakened immune systems. The infection likely progresses from the mucous membranes of the eyelids to the lungs where it leads to pneumonia and septicaemia causing <a href="https://erj.ersjournals.com/content/17/2/295">death in days</a>.</p> <p>But it’s not just <em>B cepacia</em> that can threaten our health. Something as simple as rubbing our eyes can introduce pathogens leading to infection, blindness and, in the worst case, death.</p> <p>Bacteria account for up to <a href="https://pubmed.ncbi.nlm.nih.gov/16148850/">70% of eye infections</a> and globally <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9032492/">over 6 million people</a> have blindness or moderate visual impairment from ocular infection. Contact lens wearers are at <a href="https://www.aao.org/eye-health/diseases/contact-lens-related-eye-infections">increased risk</a>.</p> <figure><iframe src="https://www.youtube.com/embed/pWsx8i1kaxs?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>The eye is a unique structure. It converts light energy to chemical and then electrical energy, which is transmitted to the brain and converted to a picture. The eye uses about <a href="https://www.ncbi.nlm.nih.gov/books/NBK11556/">6 million cones and 120 million rods</a> which detect colour and light.</p> <p>Eye cells have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8775779/">no ability to regenerate</a> so, once damaged or injured, cannot be repaired or replaced. The body tries its best to preserve the eyes by encasing them in a <a href="https://www.ncbi.nlm.nih.gov/books/NBK531490/">bony protective frame</a> and <a href="https://www.ncbi.nlm.nih.gov/books/NBK482428/">limiting exposure</a> having eyelids to defend against the environmental damage and ensure the eyes are kept lubricated.</p> <p>Despite our bodies’ best efforts to shield the eyes from harm, there are a number of common eye infections that can result from introducing potential pathogens into the eyes.</p> <h2>Conjunctivitis</h2> <p>The outer-most layer of the eye, the sclera, bears the brunt of exposure and to help protect it, it is lined by a thin moist membrane called the <a href="https://my.clevelandclinic.org/health/body/24329-conjunctiva">conjunctiva</a>.</p> <figure><iframe src="https://www.youtube.com/embed/RZ4danuJwd0?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>The conjunctiva is <a href="https://innovations.bmj.com/content/9/4/253">highly vascularised</a>, which means it has lots of blood vessels. When microbes enter the eye, it is this layer that mounts an immune response causing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328962/">blood vessels to dilate</a> in the conjunctiva. This results in <a href="https://www.cdc.gov/conjunctivitis/about/symptoms.html">“pink eye”</a>, a common form of conjunctivitis. Conjunctivitis can be caused by bacteria, allergens or viruses and typically heals by itself.</p> <h2>Blepharitis</h2> <p>Blepharitis is an inflammation of the eyelid and usually affects both sides. It can cause itchy eyes and dandruff-like flakes. It’s most commonly caused by <a href="https://www.tandfonline.com/doi/pdf/10.3109/09273948.2013.870214"><em>Staphylococcus</em> bacteria</a>, or the <a href="https://cks.nice.org.uk/topics/blepharitis/background-information/causes/">dysfunction of the glands</a> of the eyelids. It can be treated by <a href="https://www.nhs.uk/conditions/blepharitis/">cleaning the eyes</a> regularly.</p> <h2>Stye</h2> <p>A stye (also called <a href="https://www.college-optometrists.org/clinical-guidance/clinical-management-guidelines/hordeolum">hordeolum</a>) is a painful infection of the upper or lower eyelid. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370090/">Internal styes</a> are caused by infection of an oil-producing gland inside the eyelid, whereas <a href="https://pubmed.ncbi.nlm.nih.gov/28723014/">external styes</a> develop at the base of the eyelash because of an infection of the hair follicle. Both are caused by bacteria, typically <a href="https://jamanetwork.com/journals/jamaophthalmology/fullarticle/1874715">the <em>S aureus</em> form of the <em>Staphylococcus</em> species</a>.</p> <figure><iframe src="https://www.youtube.com/embed/INKrGOdy824?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>Styes can be treated by holding a clean flannel soaked in warm water against the affected eye for five to ten minutes, three or four times a day. Do not try to burst styes – this could spread the infection.</p> <h2>Keratitis</h2> <p>Keratitis is the inflammation of the cornea, the transparent part of the eye that light passes through. The cornea is part of the eye’s main barrier against dirt, germs, and disease. Severe keratitis can cause ulcers, damage to the eye and even blindness.</p> <p>The most common type is bacterial keratitis; however, it can also be caused by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998329/">amoeba</a>, which can migrate to other parts of the body – including the brain – and cause infection and <a href="https://theconversation.com/nasal-rinsing-why-flushing-the-nasal-passages-with-tap-water-to-tackle-hay-fever-could-be-fatal-225811">even death</a>.</p> <p>Noninfectious keratitis is most commonly caused by wearing contact lenses for too long, especially while sleeping. This can cause scratches, dryness and soreness of the cornea, which leads to inflammation.</p> <h2>Uveitis</h2> <p><a href="https://www.nhs.uk/conditions/uveitis/">Uveitis</a> is inflammation of the middle layer of the eye. Although relatively rare, it is a serious condition and usually results from viral infections such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8501150/">herpes simplex</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/29023181/">herpes zoster</a> or <a href="https://link.springer.com/chapter/10.1007/978-3-319-09126-6_40">trauma</a>. Depending on where the inflammation is in the eye, the symptoms can be anything from redness, pain and floaters to blurred vision and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1772296/">partial blindness</a>.</p> <h2>Exogenous endophthalmitis</h2> <p>This is a rare but serious infection caused by eye surgery complications, penetrating ocular trauma (being stabbed in the eye with a sharp object) or foreign bodies in the eye. Foreign bodies can be anything from dirt and dust to small projectiles such as shards of metal from drilling, explosives or soil from farm machinery and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286045/">many other sources</a>.</p> <h2>Dacryocystitis</h2> <p>Dacryocystitis is the inflammation of the nasolacrimal sac, which drains tears away from the eye into the nose. This condition can be <a href="https://pubmed.ncbi.nlm.nih.gov/8443113/">acute</a>, <a href="https://www.nature.com/articles/6700662">chronic</a> or <a href="https://www.jebmh.com/articles/a-study-of-congenital-dacryocystitis.pdf.pdf">acquired at birth</a>. Most cases are caused by <a href="https://bmcophthalmol.biomedcentral.com/articles/10.1186/s12886-020-01792-4"><em>Streptococcus pneumoniae</em> and <em>Staphylococcus aureus</em></a> bacteria.</p> <p>The condition mainly affects newborns and those over 40. Seventy-five per cent of cases are women and it’s most commonly found in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039673/">white adults</a>. It can lead to the stagnation of tears, creating a breeding ground for microbes.</p> <h2>Careful with contacts</h2> <p>Proper eye hygiene reduces the risk of all these conditions – and this is even more important for contact lens wearers.</p> <figure><iframe src="https://www.youtube.com/embed/uENHAntJOIA?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <p>Appropriate hygienic cleaning of lenses is paramount. <a href="https://pubmed.ncbi.nlm.nih.gov/30789440/">Non-sterile water</a>, <a href="https://www.aao.org/eye-health/glasses-contacts/contact-lens-care">spit</a> and other fluids can transfer <a href="https://www.science.org/content/article/bacteria-living-your-contact-lens-solution">potentially dangerous</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482476/">microbes</a> into the eye – a warm, moist environment that makes an ideal breeding ground for bacteria – leading to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542356/">localised infection</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972779/">blindness</a> or progress to a more serious <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9835757/">systemic infection or death</a>.</p> <p>Any persistent and painful redness or swelling of eyes should be checked by a registered health professional.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/227252/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/adam-taylor-283950">Adam Taylor</a>, Professor and Director of the Clinical Anatomy Learning Centre, <a href="https://theconversation.com/institutions/lancaster-university-1176">Lancaster University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/eye-infections-might-seem-like-a-minor-complaint-but-in-some-cases-they-can-cause-blindness-and-even-death-227252">original article</a>.</em></p> </div>

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No, taking drugs like Ozempic isn’t ‘cheating’ at weight loss or the ‘easy way out’

<p><em><a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a></em></p> <p>Obesity medication that is effective has been a long time coming. Enter semaglutide (sold as Ozempic and Wegovy), which is helping people improve weight-related health, including <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">lowering the risk</a> of a having a heart attack or stroke, while also silencing “<a href="https://theconversation.com/some-ozempic-users-say-it-silences-food-noise-but-there-are-drug-free-ways-to-stop-thinking-about-food-so-much-208467">food noise</a>”.</p> <p>As demand for semaglutide increases, so are <a href="https://www.smh.com.au/lifestyle/health-and-wellness/in-a-fat-phobic-world-ozempic-is-hardly-the-easy-way-out-20240401-p5fgjd.html">claims</a> that taking it is “cheating” at weight loss or the “easy way out”.</p> <p>We don’t tell people who need statin medication to treat high cholesterol or drugs to manage high blood pressure they’re cheating or taking the easy way out.</p> <p>Nor should we shame people taking semaglutide. It’s a drug used to treat diabetes and obesity which needs to be taken long term and comes with risks and side effects, as well as benefits. When prescribed for obesity, it’s given alongside advice about diet and exercise.</p> <h2>How does it work?</h2> <p>Semaglutide is a <a href="https://en.wikipedia.org/wiki/GLP-1_receptor_agonist">glucagon-like peptide-1</a> receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called <a href="https://en.wikipedia.org/wiki/Glucagon-like_peptide-1">GLP-1</a> for short, work better.</p> <p>GLP-1 gets secreted by cells in your gut when it <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">detects increased nutrient levels</a> after eating. This stimulates insulin production, which lowers blood sugars.</p> <p>GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating.</p> <p><iframe id="tc-infographic-1031" class="tc-infographic" style="border: none;" src="https://cdn.theconversation.com/infographics/1031/c11b606581d4bc58a71f066492d7f740b52c04e1/site/index.html" width="100%" height="400px" frameborder="0"></iframe></p> <p>GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action.</p> <p>Some studies have found less GLP-1 gets released after meals in <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">adults with obesity or type 2 diabetes mellitus</a> compared to adults with normal glucose tolerance. So having less GLP-1 circulating in your blood means you don’t feel as full after eating and get hungry again sooner compared to people who produce more.</p> <p>GLP-1 has a very short half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/28443255/">two minutes</a>. So GLP-1RA medications were designed to have a very long half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">seven days</a>. That’s why semaglutide is given as a weekly injection.</p> <h2>What can users expect? What does the research say?</h2> <p>Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly).</p> <p>A large group of <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">randomised controlled trials</a>, called STEP trials, all tested weekly 2.4mg semaglutide injections versus different interventions or placebo drugs.</p> <p>Trials lasting 1.3–2 years consistently found weekly 2.4 mg semaglutide injections <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">led to 6–12% greater weight loss</a> compared to placebo or alternative interventions. The average weight change depended on how long medication treatment lasted and length of follow-up.</p> <p>Weight reduction due to semaglutide also leads to a <a href="https://pubmed.ncbi.nlm.nih.gov/36769420/">reduction in systolic and diastolic blood pressure</a> of about 4.8 mmHg and 2.5 mmHg respectively, a reduction in <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/triglycerides">triglyceride levels</a> (a type of blood fat) and <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">improved physical function</a>.</p> <p>Another recent trial in adults with pre-existing heart disease and obesity, but without type 2 diabetes, found adults receiving weekly 2.4mg semaglutide injections had a <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">20% lower risk</a> of specific cardiovascular events, including having a non-fatal heart attack, a stroke or dying from cardiovascular disease, after three years follow-up.</p> <h2>Who is eligible for semaglutide?</h2> <p>Australia’s regulator, the Therapeutic Goods Administration (TGA), has <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">approved</a> semaglutide, sold as Ozempic, for treating type 2 diabetes.</p> <p>However, due to shortages, the TGA had advised doctors not to start new Ozempic prescriptions for “off-label use” such as obesity treatment and the Pharmaceutical Benefits Scheme doesn’t currently subsidise off-label use.</p> <p>The TGA has <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy to treat obesity</a> but it’s not currently available in Australia.</p> <p>When it’s available, doctors will be able to prescribe <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">semaglutide to treat obesity</a> in conjunction with lifestyle interventions (including diet, physical activity and psychological support) in adults with obesity (a BMI of 30 or above) or those with a BMI of 27 or above who also have weight-related medical complications.</p> <h2>What else do you need to do during Ozempic treatment?</h2> <p>Checking details of the <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">STEP trial intervention components</a>, it’s clear participants invested a lot of time and effort. In addition to taking medication, people had brief lifestyle counselling sessions with dietitians or other health professionals every four weeks as a minimum in most trials.</p> <p>Support sessions were designed to help people stick with consuming 2,000 kilojoules (500 calories) less daily compared to their energy needs, and performing 150 minutes of <a href="https://www.healthdirect.gov.au/tips-for-getting-active">moderate-to-vigorous physical activity</a>, like brisk walking, dancing and gardening each week.</p> <p>STEP trials varied in other components, with follow-up time periods varying from 68 to 104 weeks. The aim of these trials was to show the effect of adding the medication on top of other lifestyle counselling.</p> <p>A <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">review of obesity medication trials</a> found people reported they needed less <a href="https://pubmed.ncbi.nlm.nih.gov/28652832/">cognitive behaviour training</a> to help them stick with the reduced energy intake. This is one aspect where drug treatment may make adherence a little easier. Not feeling as hungry and having environmental food cues “switched off” may mean less support is required for goal-setting, self-monitoring food intake and <a href="https://theconversation.com/9-ways-wont-power-is-better-than-willpower-for-resisting-temptation-and-helping-you-eat-better-71267">avoiding things that trigger eating</a>.</p> <h2>But what are the side effects?</h2> <p>Semaglutide’s side-effects <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">include</a> nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain.</p> <p>In one study these <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">led to</a> discontinuation of medication in 6% of people, but interestingly also in 3% of people taking placebos.</p> <p>More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions.</p> <p>To reduce risk or severity of side-effects, <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">medication doses are increased very slowly</a> over months. Once the full dose and response are achieved, research indicates you need to take it long term.</p> <p>Given this long-term commitment, and associated <a href="https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/out-of-pocket-costs#:%7E:text=An%20out%20of%20pocket%20cost,called%20gap%20or%20patient%20payments">high out-of-pocket cost of medication</a>, when it comes to taking semaglutide to treat obesity, there is no way it can be considered “cheating”.</p> <hr /> <p><em>Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219116/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/clare-collins-7316"><em>Clare Collins</em></a><em>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a></em></p> <p><em>Image credits: </em><em>Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/no-taking-drugs-like-ozempic-isnt-cheating-at-weight-loss-or-the-easy-way-out-219116">original article</a>.</em></p>

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Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

<p><em><a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p>Many have <a href="https://www.economist.com/leaders/2023/03/02/new-drugs-could-spell-an-end-to-the-worlds-obesity-epidemic">declared</a> drugs like Ozempic could “end obesity” by reducing the appetite and waistlines of millions of people around the world.</p> <p>When we look past the hype, this isn’t just untrue – it can also be harmful. The focus on weight, as opposed to health, is a feature of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277539521001217">diet culture</a>. This frames the pursuit of thinness as more important than other aspects of physical and cultural wellbeing.</p> <p>The Ozempic buzz isn’t just rooted in health and medicine but plays into ideas of <a href="https://butterfly.org.au/weight-bias-fatphobia-diet-culture/#:%7E:text=Weight%20bias%2C%20sometimes%20also%20called,or%20being%20around%20fat%20people.">fat stigma and fat phobia</a>. This can perpetuate fears of fatness and fat people, and the behaviours that <a href="https://link.springer.com/article/10.1186/S12916-018-1116-5">harm people who live in larger bodies</a>.</p> <h2>Not the first ‘miracle’ weight-loss drug</h2> <p>This isn’t the first time we have heard that weight-loss drugs will change the world. Ozempic and <a href="https://www.ncbi.nlm.nih.gov/books/NBK551568/">its family</a> of GLP-1-mimicking drugs are the <a href="https://theconversation.com/ozempic-is-in-the-spotlight-but-its-just-the-latest-in-a-long-and-strange-history-of-weight-loss-drugs-209324">latest in a long line of weight loss drugs</a>. Each looked promising at the time. But none have lived up to the hype in the long term. Some have even been withdrawn from sale due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126837/">severe side effects</a>.</p> <p>Science does improve <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30028-8/fulltext">incrementally</a>, but diet culture also keeps us on a cycle of hope for the next <a href="https://sahrc.org/2022/04/diet-culture-a-brief-history/">miracle cure</a>. So drugs like Ozempic might not deliver the results individuals expect, continuing the cycle of hope and shame.</p> <h2>Ozempic doesn’t work the same for everyone</h2> <p>When we talk about the results of studies using Ozempic, we often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719041/">focus on the average</a> (also known as the mean) results or the maximum (or peak) results. So, studies might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">show</a> those using the drug lost an average of 10.9% of their body weight, but some lost more than 20% and others less than 5%</p> <p>What we don’t talk about as much is that responses are variable. Some people are “<a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769">non-responders</a>”. This means not everyone loses as much weight as the average, and some don’t lose weight at all. For some people, the side-effects will outweigh the benefits.</p> <p>When people are on drugs like Ozempic, their blood sugar is better controlled by enhancing the release of insulin and reducing the levels of another hormone called glucagon.</p> <p>But there is greater variability in the amount of <a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769#bib88">weight lost</a> than the variability in blood sugar control. It isn’t clear why, but is likely due to differences in genetics and lifestyles, and weight being more complex to regulate.</p> <h2>Treatment needs to be ongoing. What will this mean?</h2> <p>When weight-loss drugs do work, they are only effective while they’re being taken. This means that to keep the weight off people need to keep taking them long term. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542252/">One study found</a> an average weight loss of more than 17% after a year on Ozempic became an average net weight loss of 5.6% more than two years after stopping treatment.</p> <p>Short-term side effects of drugs like Ozempic include dizziness, nausea, vomiting and other gastrointestinal upsets. But because these are new drugs, we simply don’t have data to tell us if side effects will increase as people take them for longer periods.</p> <p>Nor do we know if <a href="https://www.medicalnewstoday.com/articles/why-weight-loss-drugs-stop-working-how-to-break-past-ozempic-plateau#:%7E:text=A%20lifetime%20commitment%20to%20Ozempic&amp;text=By%20these%20standards%2C%20such%20drugs,long%2Dterm%20risk%20is%20unknown.">effectiveness will be reduced</a> in the long term. This is called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/drug-tolerance#:%7E:text=A%20condition%20that%20occurs%20when,or%20different%20medicine%20is%20needed.">drug tolerance</a> and is documented for other long-term treatments such as antidepressants and chemotherapies.</p> <h2>Biology is only part of the story</h2> <p>For some people, using GLP-1-mimicking drugs like Ozempic will be validating and empowering. They will feel like their biology has been “normalised” in the same way that blood pressure or cholesterol medication can return people to the “normal” range of measures.</p> <p>But biologically, obesity <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202176/#:%7E:text=Obesity%20behaves%20as%20complex%20polygenic,about%2080%25%20(3).">isn’t solely about GLP-1 activity</a> with <a href="https://www.worldobesity.org/what-we-do/our-policy-priorities/the-roots-of-obesity">many other</a> hormones, physical activity, and even our gut microbes involved.</p> <p>Overall, <a href="https://www.ncbi.nlm.nih.gov/books/NBK278977/">obesity is complex and multifaceted</a>. Obesity isn’t just driven by personal biology and choice; it has social, cultural, political, environmental and economic determinants.</p> <h2>A weight-centred approach misses the rest of the story</h2> <p>The weight-centred approach <a href="https://butterfly.org.au/body-image/health-not-weight/#:%7E:text=Health%20and%20wellbeing%20are%20multi,on%20their%20size%20or%20appearance.">suggests that leading with thinness means health will follow</a>. But changing appetite is only part of the story when it comes to health.</p> <p>Obesity often <a href="https://www.sciencedirect.com/science/article/pii/S2667368123000335#:%7E:text=Obesity%20related%20malnutrition%20can%20also,%5D%2C%20%5B7%5D%5D.">co-exists with malnutrition</a>. We try to separate the effects in research using statistics, but focusing on the benefits of weight-loss drugs without addressing the underlying malnutrition means we aren’t likely to see the <a href="https://www.wsj.com/articles/ozempic-diet-exercise-healthy-43eee86c">improved health outcomes in everyone who loses weight</a>.</p> <h2>Obesity isn’t an issue detached from people</h2> <p>Even when it is well-intentioned, the rhetoric around the joy of “ending the obesity epidemic” can <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">harm people</a>. Obesity doesn’t occur in isolation. It is people who are obese. And the celebration and hype of these weight-loss drugs can reinforce harmful fat stigma.</p> <p>The framing of these drugs as a “cure” exacerbates the binary view of thin versus fat, and healthy versus unhealthy. These are not binary outcomes that are good or bad. Weight and health exist on a spectrum.</p> <p>Ironically, while fat people are told they need to lose weight for their health, they are also <a href="https://www.dailytelegraph.com.au/news/nsw/ozempic-shame-why-users-are-embarrassed-to-admit-using-weight-loss-wonder-drug/news-story/ee52a819c69459afe6576d25988f9bd6">shamed for “cheating” or taking shortcuts</a> by using medication.</p> <h2>Drugs are tools, not silver bullets</h2> <p>The creation of these drugs is a start, but they remain expensive, and the hype has been followed by <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#:%7E:text=Consumer%20Medicine%20Information%20.-,Why%20the%20Ozempic%20shortage%20happened,label%20prescribing%20for%20weight%20loss.">shortages</a>. Ultimately, complex challenges aren’t addressed with simple solutions. This is particularly true when people are involved, and even more so when there isn’t even an agreement on what the challenge is.</p> <p>Many organisations and individuals see obesity is a disease and believe this framing helps people to seek treatment.</p> <p>Others think it’s unnecessary to attach medical labels to body types and <a href="https://www.forbes.com/sites/geoffreykabat/2013/07/09/why-labeling-obesity-as-a-disease-is-a-big-mistake/?sh=5ca95cc2103b">argue</a> it confuses risk factors (things that are linked to increased risk of illness) with illness itself.</p> <p>Regardless, two things will always remain true. Drugs can only ever be tools, and those tools need to be applied in a context. To use these tools ethically, we need to remain mindful of who this application harms along the way.</p> <hr /> <p><em>Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219309/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></em></p> <p><em><a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, Adjunct Senior Lecturer, Nutrition, Dietetics &amp; Food Innovation - School of Health Sciences, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/drugs-like-ozempic-wont-cure-obesity-but-they-might-make-us-more-fat-phobic-219309">original article</a>.</em></p>

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"Finally felt like the right time": John Farnham's huge announcement

<p>John Farnham has announced his triumphant return one year on from his cancer surgery, sharing the news of a highly anticipated project. </p> <p>The 74-year-old Aussie music icon is set to tell his story in his own words with the release of his own candid memoir titled <em>The Voice Inside</em>. </p> <p>The autobiography, which will be released on October 30th, is co-written by Poppy Stockwell, who is the award-winning writer and director of the critically acclaimed biopic Finding the Voice.</p> <p>The book documents Farnham's early life and stardom growing up in Melbourne in the 1960s, to his comeback 1986 album <em>Whispering Jack</em>.</p> <p>It will recall the highs and lows of fame, including when his stellar career stalled, record companies turned their backs and he faced financial ruin.</p> <p><em>The Voice Inside</em> will also detail his shocking diagnosis of mouth cancer in 2022 which turned his life upside down. </p> <p>The book was announced on Farnham's Facebook page, with a statement sharing how he felt it was "the right time" to tell his story. </p> <p><iframe style="border: none; overflow: hidden;" src="https://www.facebook.com/plugins/post.php?href=https%3A%2F%2Fwww.facebook.com%2Fjohnfarnham%2Fposts%2Fpfbid02tZwog7QbEW6AxDUxNMp3Kn5msAghjd9yUQe56optBdyX8ZL1DQFm4qvpUYsSjo2Rl&show_text=true&width=500" width="500" height="728" frameborder="0" scrolling="no" allowfullscreen="allowfullscreen"></iframe></p> <p>"Having been asked many times, it finally felt like the right time to sit down and tell my story," he said.</p> <p>"It is a very strange feeling looking back on my life, on the good and the bad, and now that I have started, it is all rushing back. I hope the book engages and entertains, because that’s what so much of my life has been about."</p> <p>The book will "chart John Farnham’s very personal and public journey, told in his own words and with his inimitable humour, insight, and humility."</p> <p>The post was quickly flooded with comments from fans eager to get their hands on the memoir, while many shared their well wishes as he continues his lengthy recovery from cancer. </p> <p><em>Image credits: Getty Images </em></p>

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Considering taking a weight-loss drug like Ozempic? Here are some potential risks and benefits

<p><a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <em><a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <em><a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a></em></p> <p>After weight-loss drugs like Ozempic exploded onto the market, celebrities and social media influencers were quick to spruik their benefits, leading to their rapid rise in use. In the last three months of 2022, clinicians in the United States alone wrote <a href="https://www.washingtonpost.com/business/2023/09/27/ozempic-prescriptions-data-analysis/">more than nine million prescriptions</a> for these drugs.</p> <p>As they’ve grown in popularity, we’ve also heard more about the potential side effects – from common gastrointestinal discomforts, to more serious mental health concerns.</p> <p>But what does the science say about how well Ozempic and Wegovy (which are both brand names of the drug semaglutide) work for weight loss? And what are the potential side effects? Here’s what to consider if you or a loved one are thinking of taking the drug.</p> <h2>Potential benefits</h2> <p><strong>1) It’s likely to help you lose weight</strong></p> <p>The largest, well-conducted <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">research study</a> of semaglutide was from United Kingdom in 2021. Some 1,961 people who were classified as “overweight” or “obese” were randomly assigned to have either semaglutide or a placebo and followed for 68 weeks (about 1.3 years). All participants also had free access to advice about healthy eating and physical activity.</p> <p>The study found those taking semaglutide lost weight – significantly more than people who had the placebo (-14.9% of their body weight compared with -2.4% of body weight).</p> <p>In another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">study</a> in the United States, one health-care clinic gave 408 people weekly injections of semaglutide. Over the first three months, those included in the final analysis (175 people) lost an average of 6.7kg. Over the first six months, they lost an average of 12.3kg.</p> <p>Large weight losses have been found in a more <a href="https://www.nature.com/articles/s41591-022-02026-4">recent trial</a> of semaglutide, suggesting weight loss is a very likely outcome of ongoing use of the medication.</p> <p><strong>2) It may reduce your chronic disease risk factors</strong></p> <p>When people in the overweight or obese weight categories lose <a href="https://www.sciencedirect.com/science/article/pii/S1550413116300535">at least 5%</a> of their body weight, physiological changes often occur beyond a change in weight or shape. This <a href="https://www.nih.gov/news-events/nih-research-matters/research-context-obesity-metabolic-health">might include</a> lowered cholesterol levels, lowered blood pressure and lowered blood glucose levels, which all reduce the risk of chronic diseases.</p> <p>In one of the semaglutide <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">trials</a>, most people (87.3%) lost at least 5% of their body weight. Although most of the large studies of semaglutide excluded people with metabolic health conditions such as type 2 diabetes, metabolic health gains were <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">observed</a>, including lowered blood pressure, blood glucose levels and fasting blood lipid (fat) levels.</p> <p>In the UK <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">study</a> from 2021, people taking semaglutide had greater improvements in physical capabilities and risk factors for heart disease and diabetes, including reductions in waist circumference, markers of inflammation, blood pressure and blood glucose levels.</p> <p><strong>3) It might improve your quality of life, emotional wellbeing or sense of achievement</strong></p> <p>The original trial of semaglutide did not focus on this bundle of benefits, but further follow-ups show additional benefits associated with the medication. Compared to the placebo, people taking semaglutide saw significant <a href="https://www.tandfonline.com/doi/full/10.1080/00325481.2022.2150006">improvements</a> in their physical functioning and perceptions of their general health, social functioning and mental health.</p> <p>Anecdotally (not based on scientific research), people using semaglutide, such as <a href="https://people.com/oprah-winfrey-reveals-weight-loss-medication-exclusive-8414552">Oprah Winfrey</a>, report a reclaiming or turning point of their life, social situation and body image.</p> <h2>What about the risks?</h2> <p><strong>1) You may experience gastrointestinal symptoms</strong></p> <p>In the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">US clinical trial</a>, nearly half (48.6%) of people taking semaglutide reported experiencing adverse effects. Nausea and vomiting were the most frequently experienced (36.6%) followed by diarrhea (8.6%), fatigue (6.3%) and constipation (5.7%).</p> <p>In the UK study, nausea and diarrhoea were also commonly reported.</p> <p>In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">another trial</a>, many participants (74.2%) using semaglutide reported gastrointestinal symptoms. However, nearly half (47.9%) using the placebo also reported gastrointestinal symptoms, indicating that symptoms may be similar to those experienced during normal daily living.</p> <p>Most gastrointestinal symptoms were mild to moderate in severity, and resolved for most people without the need to stop participating in the study.</p> <p><strong>2) You might feel fatigued</strong></p> <p>Fatigue was the second most common side effect for participants in the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, affecting 6.3% of participants.</p> <p><strong>3) You might be among the minority who don’t tolerate the drug</strong></p> <p>Australia’s Therapeutic Goods Administration (TGA) has <a href="https://www.tga.gov.au/news/safety-alerts/compounding-safety-information-semaglutide-products">approved</a> Ozempic as safe to use, for the treatment of type 2 diabetes but it has not yet been approved for weight loss. The TGA has also <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy</a> (a higher dose of semagtlutide) for weight loss, however it’s not yet available in Australia.</p> <p>In the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, no unexpected safety issues were reported. However, five patients (2.9%) had to stop taking the medication because they could not tolerate the adverse effects. Fifteen (8.6%) had to either reduce the dose or remain on the same dose to avoid the adverse effects.</p> <p>In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">other studies</a>, some patients stopped the trial due to gastrointestinal symptoms being so severe they could not tolerate continuing.</p> <p>More severe safety concerns reported in <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">studies</a> include gallbladder-related disorders (mostly cholelithiasis, also known as gallstones) in 34 patients (2.6%) and mild acute pancreatitis in three patients (0.2%). All people recovered during the trial period.</p> <p>A 2024 European <a href="https://link.springer.com/article/10.1007/s11096-023-01694-7">study</a> analysed psychiatric adverse events associated with semaglutide, liraglutide and tirzepatide (which work in a similar way to semaglutide). Between January 2021 and May 2023, the drug database recorded 481 psychiatric events (about 1.2% of the total reported) associated with these drugs. About half of these events were reported as depression, followed by anxiety (39%) and suicidal ideation (19.6%). Nine deaths and 11 life-threatening outcomes were reported during the study period.</p> <p>Due to the severity and fatal outcomes of some of these reports, <a href="https://www.fda.gov/drugs/drug-safety-and-availability/update-fdas-ongoing-evaluation-reports-suicidal-thoughts-or-actions-patients-taking-certain-type">the US Food and Drug Administration</a> investigated further but did not find evidence that use of these medicines caused suicidal thoughts or actions.</p> <p><strong>4) It might be difficult to access</strong></p> <p>Despite being considered safe, the TGA has <a href="https://www.tga.gov.au/safety/shortages/medicine-shortage-alerts/update-prescribers-advised-not-start-new-patients-ozempic#:%7E:text=Ozempic%27s%20TGA%2Dapproved%20indication%20is,consult%20the%20appropriate%20prescribing%20guidelines.">warned</a> significant Ozempic access barriers are likely to continue throughout 2024.</p> <p>To manage the shortage, pharmacists are instructed to give preference to people with type 2 diabetes who are seeking the medication.</p> <p><strong>5) You might not always get clear information from vested interests</strong></p> <p>Given the popularity of Ozempic and Wegovy, health organisations such as the World Obesity Federation have expressed <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">concern</a> about the medication’s marketing, PR and strong <a href="https://www.theguardian.com/australia-news/2023/jan/06/tga-investigates-influencers-after-diabetes-drug-ozempic-promoted-as-weight-loss-treatment">social media presence</a>.</p> <p>Some journalists have <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">raised conflict of interest concerns</a> about the relationship between some obesity researchers and Novo Nordrisk, Ozempic and Wegovy’s manufacturer. The worry is that researchers might be influenced by their relationship with Novo Nordrisk to produce study results that are more favourable to the medications.</p> <h2>Bottom line</h2> <p>Ozempic is a medication that should be used in conjunction with your health care provider. But remember, weight is only one aspect of your health and wellbeing. It’s important to take a holistic view of your health and prioritise eating well, moving more and getting enough sleep.</p> <hr /> <p><em>Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-132745">Ozempic series</a> here.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219312/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Lecturer, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">original article</a>.</em></p>

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"There's no place like home": Marcia Hines and her amazing cat share sweet message

<p>Australian music icon and <em>Australian Idol</em> judge Marcia Hines recently took to social media to express her heartfelt gratitude to those who supported her during a <a href="https://www.oversixty.com.au/health/caring/marcia-hines-rushed-to-hospital" target="_blank" rel="noopener">recent medical incident</a>. The beloved singer and performer shared a touching message on Instagram, reflecting on the challenges she faced and the overwhelming support she received from healthcare professionals, family, friends and fans – but mostly from her amazing-looking cat, Sistah!</p> <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/p/C5AeYisL9Pu/?utm_source=ig_embed&amp;utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/C5AeYisL9Pu/?utm_source=ig_embed&amp;utm_campaign=loading" target="_blank" rel="noopener">A post shared by Marcia Hines (@themarciahines)</a></p> </div> </blockquote> <p>The incident unfolded backstage at Sydney’s Coliseum Theatre just before last Sunday night’s <em>Australian Idol</em> finale. Hines, known for her vibrant presence and insightful critiques on the talent show, collapsed, prompting concerns among the show's crew and audience. As a result, she had to miss the episode, with fellow musician Guy Sebastian stepping in as a guest judge.</p> <p>Following her collapse, Hines was swiftly taken to the hospital, where she received treatment for head injuries, including stitches. Despite the setback, she was able to make a remarkable recovery <a href="https://www.oversixty.com.au/entertainment/tv/marcia-hines-returns-as-australian-idol-fans-cry-foul-over-upset-win" target="_blank" rel="noopener">in time to return</a> for the Grand Finale show on Monday night.</p> <p>In her Instagram post, Hines expressed profound gratitude for the exceptional care she received during her hospital stay, particularly praising Brad Ceely and the entire team at Blacktown Hospital.</p> <p>"There’s no place like home….." Hines wrote. "Especially when Sistah is here to greet me 🐾 What an action-packed week ❤️ I’ve experienced so much care and love, and none moreso than the exceptional treatment that Brad Ceely and his entire team at Blacktown Hospital gave me during my stay with them.</p> <p>"We are so fortunate to live in a country with such incredible healthcare, and the amazing facilities we have in our Western Sydney suburbs - wow! I’m so grateful to all of the hospital staff - from the tireless nurses to the wonderful administration staff. A special thanks to all of the staff at Mount Druitt Emergency Department, all of the Ambulance teams who got me safely to-and-from hospitals this weekend, and of course Dr Kit Rowe for stitching me up so nicely after my fall. Ouch lol 🤕Thank you for being you and keeping us all safe 🫶🏾</p> <p>"Thank you also to Kyle, Amy and all the team at @australianidol for your love, and also to my @greaseoztour family who I’ll be seeing soon. Thank you also to my family and friends - you’re always there when I need you most 💝"</p> <p>The response to Hines' message was overwhelmingly positive, with fans and well-wishers flooding the comments section with messages of support, encouragement and excitement for her upcoming projects. Many expressed relief at her recovery and eagerly anticipated her return to the stage, particularly in her role in <em>Grease the Musical</em>. </p> <p><em>Images: Instagram</em></p>

Caring

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What will aged care look like for the next generation?

<p><a href="https://theconversation.com/profiles/hal-swerissen-9722">Hal Swerissen</a>, <em><a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a></em></p> <p>Aged care financing is a vexed problem for the Australian government. It is already underfunded for the quality the community expects, and costs will increase dramatically. There are also significant concerns about the complexity of the system.</p> <p>In 2021–22 the federal government spent <a href="https://www.health.gov.au/resources/publications/final-report-of-the-aged-care-taskforce?language=en">A$25 billion</a> on aged services for around 1.2 million people aged 65 and over. Around 60% went to residential care (<a href="https://www.gen-agedcaredata.gov.au/topics/people-using-aged-care#:%7E:text=On%2030%20June%202022%2C%20approximately,and%203%2C500%20using%20transition%20care.">190,000 people</a>) and one-third to home care (<a href="https://www.gen-agedcaredata.gov.au/topics/people-using-aged-care#:%7E:text=On%2030%20June%202022%2C%20approximately,and%203%2C500%20using%20transition%20care.">one million people</a>).</p> <p>The <a href="https://www.health.gov.au/resources/publications/final-report-of-the-aged-care-taskforce?language=en">final report from the government’s Aged Care Taskforce</a>, which has been reviewing funding options, estimates the number of people who will need services is likely to grow to more than two million over the next 20 years. Costs are therefore likely to more than double.</p> <p>The taskforce has considered what aged care services are reasonable and necessary and made recommendations to the government about how they can be paid for. This includes getting aged care users to pay for more of their care.</p> <p>But rather than recommending an alternative financing arrangement that will safeguard Australians’ aged care services into the future, the taskforce largely recommends tidying up existing arrangements and keeping the status quo.</p> <h2>No Medicare-style levy</h2> <p>The taskforce <a href="https://www.health.gov.au/resources/publications/final-report-of-the-aged-care-taskforce?language=en">rejected</a> the aged care royal commission’s recommendation to introduce a levy to meet aged care cost increases. A 1% levy, similar to the Medicare levy, could have raised around <a href="https://www.thenewdaily.com.au/finance/finance-news/2021/03/03/cost-of-aged-care-levy#:%7E:text=Overall%2C%20a%201%20per%20cent%20levy%20would%20raise,necessary%20to%20provide%20decent%20aged%20care%20for%20all.">$8 billion a year</a>.</p> <p>The taskforce failed to consider the mix of taxation, personal contributions and social insurance which are commonly used to fund aged care systems internationally. The <a href="https://www.oecd.org/els/health-systems/Japan-OECD-EC-Good-Time-in-Old-Age.pdf">Japanese system</a>, for example, is financed by long-term insurance paid by those aged 40 and over, plus general taxation and a small copayment.</p> <p>Instead, the taskforce puts forward a simple, pragmatic argument that older people are becoming wealthier through superannuation, there is a cost of living crisis for younger people and therefore older people should be required to pay more of their aged care costs.</p> <h2>Separating care from other services</h2> <p>In deciding what older people should pay more for, the taskforce divided services into care, everyday living and accommodation.</p> <p>The taskforce thought the most important services were clinical services (including nursing and allied health) and these should be the main responsibility of government funding. Personal care, including showering and dressing were seen as a middle tier that is likely to attract some co-payment, despite these services often being necessary to maintain independence.</p> <p>The task force recommended the costs for everyday living (such as food and utilities) and accommodation expenses (such as rent) should increasingly be a personal responsibility.</p> <h2>Making the system fairer</h2> <p>The taskforce thought it was unfair people in residential care were making substantial contributions for their everyday living expenses (about 25%) and those receiving home care weren’t (about 5%). This is, in part, because home care has always had a muddled set of rules about user co-payments.</p> <p>But the taskforce provided no analysis of accommodation costs (such as utilities and maintenance) people meet at home compared with residential care.</p> <p>To address the inefficiencies of upfront daily fees for packages, the taskforce recommends means testing co-payments for home care packages and basing them on the actual level of service users receive for everyday support (for food, cleaning, and so on) and to a lesser extent for support to maintain independence.</p> <p>It is unclear whether clinical and personal care costs and user contributions will be treated the same for residential and home care.</p> <h2>Making residential aged care sustainable</h2> <p>The taskforce was <a href="https://www.health.gov.au/resources/publications/final-report-of-the-aged-care-taskforce?language=en">concerned</a> residential care operators were losing $4 per resident day on “hotel” (accommodation services) and everyday living costs.</p> <p>The taskforce recommends means tested user contributions for room services and everyday living costs be increased.</p> <p>It also recommends that wealthier older people be given more choice by allowing them to pay more (per resident day) for better amenities. This would allow providers to fully meet the cost of these services.</p> <p>Effectively, this means daily living charges for residents are too low and inflexible and that fees would go up, although the taskforce was clear that low-income residents should be protected.</p> <h2>Moving from buying to renting rooms</h2> <p>Currently older people who need residential care have a choice of making a refundable up-front payment for their room or to pay rent to offset the loans providers take out to build facilities. Providers raise capital to build aged care facilities through equity or loan financing.</p> <p>However, the taskforce did not consider the overall efficiency of the private capital market for financing aged care or alternative solutions.</p> <p>Instead, it recommended capital contributions be streamlined and simplified by phasing out up-front payments and focusing on rental contributions. This echoes the royal commission, which found rent to be a more efficient and less risky method of financing capital for aged care in private capital markets.</p> <p>It’s likely that in a decade or so, once the new home care arrangements are in place, there will be proportionally fewer older people in residential aged care. Those who do go are likely to be more disabled and have greater care needs. And those with more money will pay more for their accommodation and everyday living arrangements. But they may have more choice too.</p> <p>Although the federal government has <a href="https://www.abc.net.au/news/2024-03-11/aged-care-task-force-hands-down-recommendations/103573554">ruled out an aged care levy</a> and <a href="https://www.abc.net.au/news/2024-02-15/no-plan-to-touch-aged-care-asset-test/103470442">changes to assets test on the family home</a>, it has yet to respond to the majority of the recommendations. But given the aged care minister chaired the taskforce, it’s likely to provide a good indication of current thinking.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225551/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/hal-swerissen-9722">Hal Swerissen</a>, Emeritus Professor, <em><a href="https://theconversation.com/institutions/la-trobe-university-842">La Trobe University</a></em></p> <p><em>Image: Getty</em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-will-aged-care-look-like-for-the-next-generation-more-of-the-same-but-higher-out-of-pocket-costs-225551">original article</a>.</em></p>

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Running or yoga can help beat depression, research shows – even if exercise is the last thing you feel like

<p><em><a href="https://theconversation.com/profiles/michael-noetel-147460">Michael Noetel</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p>At least <a href="https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.665019/full">one in ten people</a> have depression at some point in their lives, with some estimates <a href="https://www.sciencedirect.com/science/article/pii/S0749379720301793">closer to one in four</a>. It’s one of the worst things for someone’s wellbeing – worse than <a href="https://www.happinessresearchinstitute.com/_files/ugd/928487_4a99b6e23f014f85b38495b7ab1ac24b.pdf">debt, divorce or diabetes</a>.</p> <p><a href="https://theconversation.com/why-are-so-many-australians-taking-antidepressants-221857">One in seven</a> Australians take antidepressants. Psychologists are in <a href="https://theconversation.com/we-cant-solve-australias-mental-health-emergency-if-we-dont-train-enough-psychologists-here-are-5-fixes-190135">high demand</a>. Still, only <a href="http://dx.doi.org/10.1371/journal.pmed.1003901">half</a> of people with depression in high-income countries get treatment.</p> <p>Our <a href="https://www.bmj.com/content/384/bmj-2023-075847">new research</a> shows that exercise should be considered alongside therapy and antidepressants. It can be just as impactful in treating depression as therapy, but it matters what type of exercise you do and how you do it.</p> <h2>Walk, run, lift, or dance away depression</h2> <p>We found 218 randomised trials on exercise for depression, with 14,170 participants. We analysed them using a method called a network meta-analysis. This allowed us to see how different types of exercise compared, instead of lumping all types together.</p> <p>We found walking, running, strength training, yoga and mixed aerobic exercise were about as effective as <a href="https://theconversation.com/explainer-what-is-cognitive-behaviour-therapy-37351">cognitive behaviour therapy</a> – one of the <a href="https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2018.00004/full">gold-standard treatments</a> for depression. The effects of dancing were also powerful. However, this came from analysing just five studies, mostly involving young women. Other exercise types had more evidence to back them.</p> <p>Walking, running, strength training, yoga and mixed aerobic exercise seemed more effective than antidepressant medication alone, and were about as effective as exercise alongside antidepressants.</p> <p>But of these exercises, people were most likely to stick with strength training and yoga.</p> <p><iframe id="cZaWb" class="tc-infographic-datawrapper" style="border: none;" src="https://datawrapper.dwcdn.net/cZaWb/2/" width="100%" height="400px" frameborder="0"></iframe></p> <p>Antidepressants certainly help <a href="https://www.thelancet.com/article/S0140-6736(17)32802-7/fulltext">some people</a>. And of course, anyone getting treatment for depression should talk to their doctor <a href="https://australia.cochrane.org/news/new-cochrane-review-explores-latest-evidence-approaches-stopping-long-term-antidepressants">before changing</a> what they are doing.</p> <p>Still, our evidence shows that if you have depression, you should get a psychologist <em>and</em> an exercise plan, whether or not you’re taking antidepressants.</p> <h2>Join a program and go hard (with support)</h2> <p>Before we analysed the data, we thought people with depression might need to “ease into it” with generic advice, <a href="https://www.who.int/initiatives/behealthy/physical-activity">such as</a> “some physical activity is better than doing none.”</p> <p>But we found it was far better to have a clear program that aimed to push you, at least a little. Programs with clear structure worked better, compared with those that gave people lots of freedom. Exercising by yourself might also make it hard to set the bar at the right level, given low self-esteem is a symptom of depression.</p> <p>We also found it didn’t matter how much people exercised, in terms of sessions or minutes a week. It also didn’t really matter how long the exercise program lasted. What mattered was the intensity of the exercise: the higher the intensity, the better the results.</p> <h2>Yes, it’s hard to keep motivated</h2> <p>We should exercise caution in interpreting the findings. Unlike drug trials, participants in exercise trials know which “treatment” they’ve been randomised to receive, so this may skew the results.</p> <p>Many people with depression have physical, psychological or social barriers to participating in formal exercise programs. And getting support to exercise isn’t free.</p> <p>We also still don’t know the best way to stay motivated to exercise, which can be even harder if you have depression.</p> <p>Our study tried to find out whether things like setting exercise goals helped, but we couldn’t get a clear result.</p> <p>Other reviews found it’s important to have a <a href="https://pubmed.ncbi.nlm.nih.gov/31923898/">clear action plan</a> (for example, putting exercise in your calendar) and to <a href="https://pubmed.ncbi.nlm.nih.gov/19916637/">track your progress</a> (for example, using an app or smartwatch). But predicting which of these interventions work is notoriously difficult.</p> <p>A <a href="https://www.nature.com/articles/s41586-021-04128-4">2021 mega-study</a> of more than 60,000 gym-goers <a href="https://www.nature.com/articles/s41586-021-04128-4/figures/1">found</a> experts struggled to predict which strategies might get people into the gym more often. Even making workouts fun didn’t seem to motivate people. However, listening to audiobooks while exercising helped a lot, which no experts predicted.</p> <p>Still, we can be confident that people benefit from personalised support and accountability. The support helps overcome the hurdles they’re sure to hit. The accountability keeps people going even when their brains are telling them to avoid it.</p> <p>So, when starting out, it seems wise to avoid going it alone. Instead:</p> <ul> <li> <p>join a fitness group or yoga studio</p> </li> <li> <p>get a trainer or an exercise physiologist</p> </li> <li> <p>ask a friend or family member to go for a walk with you.</p> </li> </ul> <p>Taking a few steps towards getting that support makes it more likely you’ll keep exercising.</p> <h2>Let’s make this official</h2> <p>Some countries see exercise as a backup plan for treating depression. For example, the American Psychological Association only <a href="https://www.apa.org/depression-guideline/">conditionally recommends</a> exercise as a “complementary and alternative treatment” when “psychotherapy or pharmacotherapy is either ineffective or unacceptable”.</p> <p>Based on our research, this recommendation is withholding a potent treatment from many people who need it.</p> <p>In contrast, The Royal Australian and New Zealand College of Psychiatrists <a href="https://www.ranzcp.org/getmedia/a4678cf4-91f5-4746-99d4-03dc7379ae51/mood-disorders-clinical-practice-guideline-2020.pdf">recommends</a> vigorous aerobic activity at least two to three times a week for all people with depression.</p> <p>Given how common depression is, and the number failing to receive care, other countries should follow suit and recommend exercise alongside front-line treatments for depression.</p> <p><em>I would like to acknowledge my colleagues Taren Sanders, Chris Lonsdale and the rest of the coauthors of the paper on which this article is based.</em></p> <p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223441/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><a href="https://theconversation.com/profiles/michael-noetel-147460">Michael Noetel</a>, Senior Lecturer in Psychology, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/running-or-yoga-can-help-beat-depression-research-shows-even-if-exercise-is-the-last-thing-you-feel-like-223441">original article</a>.</em></p>

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How to navigate a parent’s cancer diagnosis – like Princes William and Harry will now have to do

<p><em><a href="https://theconversation.com/profiles/lydia-harkin-1510450">Lydia Harkin</a>, <a href="https://theconversation.com/institutions/nottingham-trent-university-1338">Nottingham Trent University</a></em></p> <p>King Charles’ <a href="https://www.bbc.co.uk/news/uk-68209998">cancer diagnosis</a> means the royal family has joined the approximately 3 million families in the UK affected by the disease. His family has already gathered around in support. William, Prince of Wales, has taken over some public duties for his father. And younger son Harry, who lives in California, flew to the UK to visit after the diagnosis was announced.</p> <p>If you, like William and Harry, are navigating a parent’s diagnosis, you are not alone. Around 400,000 people are <a href="https://www.macmillan.org.uk/about-us/what-we-do/research/cancer-statistics-fact-sheet">diagnosed</a> each year. This can be a <a href="https://doi.org/10.1002/pon.4287">frightening</a> and difficult time for families, and can change family dynamics.</p> <p>Adult children may find themselves offering emotional and practical support for a parent in a way that has not been required before, through managing medications and symptoms, travel to medical appointments, help with meal preparation and financial support.</p> <p>It can be rewarding to support a loved one and an important way to actively work together, but it can also be stressful. <a href="https://doi.org/10.1002/pon.4056">Studies have found</a> that family caregivers are generally more anxious and more likely to hide their emotional distress when compared with their family member with cancer.</p> <h2>Being a supportive family, even in conflict</h2> <p>Family support can act as a <a href="https://doi.org/10.1002/ejsp.2333">“social cure”</a> against the stress of a life-changing illness. The social cure theory proposes that being a part of a social group (or multiple groups) has benefits for our health and wellbeing. Social groups, particularly those with whom we strongly identify, like families, provide support and help us to combat times of stress.</p> <p>The key psychological component here is that people feel they belong to and identify with their groups. While undergoing cancer treatment, someone may not be able to participate in their usual social groups – through work or hobbies – as much as they used to. These groups may then become incompatible with a person’s new identity as a cancer survivor.</p> <p>Of course, not all families work together harmoniously, and may be in conflict through divorce, separation or estrangement. Social psychologists have <a href="https://doi.org/10.1111/bjso.12155">found that</a> “incompatible” social groups can lead to poorer mental health.</p> <p>Separated families can still come together and be a helpful social group, but they must offer the kind of support that their loved one needs. To figure this out, it is important to think about the person’s <a href="https://doi.org/10.1002/ejsp.2333">identity</a> within the family.</p> <p>For example, a father may view his identity as an advisor, but a cancer diagnosis requires him to be cared for and to seek advice. He may feel a sense of loss for his typical family role, a loss of meaning and of control.</p> <p>However, if his family communicates openly about the difficulties they are all facing, the father may be able to continue to advise his family, in addition to receiving their advice. This can help to maintain his sense of identity as an advisor within his family, while navigating a new status as a cancer survivor.</p> <h2>Communication and support networks</h2> <p>Cancer throws patients and their loved ones into a complex health system, often for the first time, where medical decisions and terminology become important every day. Understanding <a href="https://doi.org/10.1016/j.ejon.2014.03.012">the “language of cancer”</a> can help families feel more in control after a diagnosis.</p> <p>Equally important is communication within a family. Talking about the cancer, rather than treating it as a taboo topic, can improve <a href="https://doi.org/10.1016/j.ejon.2020.101841">mental health for both patients and their families</a>. It may also be an opportunity to empower patients and their loved ones to seek outside support, such as counselling.</p> <p>Families spread across geographical distances (like the royal family) can offer emotional support through regular phone calls or online tools. During the pandemic, <a href="https://doi.org/10.2196/42172">I developed</a> and trialled an app to help older adults combat loneliness. The app allowed them to see a digital map of their social groups, including family members.</p> <p>Your family member with cancer may feel like a burden. This is a common fear in older adulthood generally. But reminding them of how many people are in their lives – and how many people they support – can combat this feeling.</p> <p>Social media is one way to get more involved in these reciprocal support networks. In my work, families affected by cancer have reported using online communities to <a href="https://doi.org/10.1007/s11764-017-0616-1">better understand what their family is going through</a>. Private social media groups <a href="https://doi.org/10.1177/2055207619898993">dedicated to illness</a> can be helpful spaces to meet other patients and families, share experiences and normalise cancer.</p> <p>Cancer communities exist on <a href="https://doi.org/10.4103%2Fijpvm.IJPVM_36_19">Instagram</a>, on <a href="https://doi.org/10.1007/s00345-018-2254-2">YouTube and X/Twitter</a> and through registered cancer charities like <a href="https://www.macmillan.org.uk/">Macmillan Cancer Support</a>. These online resources all provide a way to build a network following a cancer diagnosis.</p> <p>Just as group identification is important within families, having more groups to connect to can act as a buffer during stressful times and help you all cope with your new reality.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223214/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/lydia-harkin-1510450"><em>Lydia Harkin</em></a><em>, Principal Lecturer in Psychology, <a href="https://theconversation.com/institutions/nottingham-trent-university-1338">Nottingham Trent University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-to-navigate-a-parents-cancer-diagnosis-like-princes-william-and-harry-will-now-have-to-do-223214">original article</a>.</em></p>

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How dieting, weight suppression and even misuse of drugs like Ozempic can contribute to eating disorders

<p><em><a href="https://theconversation.com/profiles/samantha-withnell-1504436">Samantha Withnell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a></em></p> <p>Up to 72 per cent of women and 61 per cent of men are dissatisfied with their weight or <a href="https://doi.org/10.1016/j.eatbeh.2014.04.010">body image</a>, according to a U.S. study. Globally, millions of people <a href="https://doi.org/10.1111%2Fobr.12466">attempt to lose weight</a> every year with the hope that weight loss will have positive effects on their body image, health and quality of life.</p> <p>However, these motivated individuals often struggle to maintain new diets or exercise regimens. The rise of medications such as semaglutides, like <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101298">Ozempic</a> or <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101765">Wegovy</a>, <a href="https://www.cbc.ca/news/health/ozempic-weight-loss-1.6772021">might be viewed as an appealing “quick fix”</a> alternative to meet weight loss goals.</p> <p>Research led by our team and others suggests that such attempts to lose weight often do more harm than good, and even increase the risk of <a href="https://osf.io/9stq2">developing an eating disorder</a>.</p> <h2>Weight loss and eating disorders</h2> <p>Eating disorders are <a href="https://doi.org/10.1002/eat.20589">serious mental health conditions</a> primarily characterized by extreme patterns of under- or over-eating, concerns about one’s shape or body weight or other behaviours intended to influence body shape or weight such as exercising excessively or self-inducing vomiting.</p> <p>Although once thought to only affect young, white adolescent girls, eating disorders do not discriminate; eating disorders can develop in people of <a href="https://doi.org/10.1002/erv.2553">any age, sex, gender or racial/ethnic background</a>, with an estimated <a href="https://nedic.ca/general-information/">one million Canadians</a> suffering from an eating disorder at any given time. Feb. 1 to 7 is <a href="https://nedic.ca/edaw/">National Eating Disorders Awareness Week</a>.</p> <p>As a clinical psychologist and clinical psychology graduate student, our research has focused on how eating disorders develop and what keeps them going. Pertinent to society’s focus on weight-related goals, our research has examined associations between weight loss and eating disorder symptoms.</p> <h2>Eating disorders and ‘weight suppression’</h2> <p>In eating disorders research, the state of maintaining weight loss is referred to as “weight suppression.” Weight suppression is typically defined as the difference between a person’s current weight and their highest lifetime weight (excluding pregnancy).</p> <p>Despite the belief that weight loss will improve body satisfaction, we found that in a sample of over 600 men and women, weight loss had no impact on women’s negative body image and was associated with increased body dissatisfaction in <a href="https://doi.org/10.1016/j.bodyim.2023.01.011">men</a>. Importantly, being more weight suppressed has been associated with the <a href="https://doi.org/10.1093/ajcn/nqaa146">onset of eating disorders</a>, including anorexia nervosa and bulimia nervosa.</p> <p><a href="https://doi.org/10.1007/s11920-018-0955-2">One proposed explanation</a> for the relationship between weight suppression and eating disorders is that maintaining weight loss becomes increasingly difficult as body systems that <a href="https://doi.org/10.3945/ajcn.110.010025">reduce metabolic rate and energy expenditure, and increase appetite</a>, are activated to promote weight gain.</p> <p>There is growing awareness that <a href="https://doi.org/10.1136/bmj.g2646">weight regain is highly likely following conventional diet programs</a>. This might lead people to engage in more and more extreme behaviours to control their weight, or they might shift between extreme restriction of food intake and episodes of overeating or binge eating, the characteristic symptoms of bulimia nervosa.</p> <h2>Ozempic and other semaglutide drugs</h2> <p>Semaglutide drugs like Ozempic and Wegovy are part of a class of drug called <a href="https://pdf.hres.ca/dpd_pm/00067924.PDF">glucagon-like peptide-1 agonists (GLP-1As)</a>. These drugs work by mimicking the hormone GLP-1 to interact with neural pathways that signal satiety (fullness) and slow stomach emptying, leading to reduced food intake.</p> <p>Although GLP-1As are indicated to treat Type 2 diabetes, <a href="https://www.cbc.ca/news/canada/london/ozempic-off-label-1.6884141">they are increasingly prescribed off-label</a> or being <a href="https://www.bbc.com/news/health-67414203">illegally purchased</a> without a prescription because of their observed effectiveness at inducing weight loss. Although medications like Ozempic do often lead to weight loss, the rate of weight loss may <a href="https://doi.org/10.1001/jama.2021.3224">slow down or stop over time</a>.</p> <p>Research by Lindsay Bodell, one of the authors of this story, and her colleagues on weight suppression may help explain why effects of semaglutides diminish over time, as <a href="https://doi.org/10.1016/j.physbeh.2019.112565">weight suppression is associated with reduced GLP-1 response</a>. This means those suppressing their weight could become less responsive to the satiety signals activated by GLP-1As.</p> <p>Additionally, weight loss effects are only seen for as long as the medication is taken, meaning those who take these drugs to achieve some weight loss goal are <a href="https://doi.org/10.1111/dom.14725">likely to regain most, if not all, weight lost</a> when they stop taking the medication.</p> <h2>Risks of dieting and weight-loss drugs</h2> <p>The growing market for off-label weight loss drugs is concerning, because of the exacerbation of <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">weight stigma</a> and the serious <a href="https://doi.org/10.1016/j.jand.2022.01.004">health risks</a> associated with unsupervised weight loss, including developing eating disorders.</p> <p>Researchers and health professionals are already raising the alarm about the use of GLP-1As in children and adolescents, due to concerns about their possible <a href="https://doi.org/10.1017/cts.2023.612">impact on growth and development</a>.</p> <p>Moreover, popular weight-loss methods, whether they involve pills or “crash diets,” often mimic symptoms of eating disorders. For example, intermittent fasting diets that involve long periods of fasting followed by short periods of food consumption may mimic and <a href="https://doi.org/10.1016/j.eatbeh.2022.101681">increase the risk of developing binge eating problems</a>.</p> <p>The use of diet pills or laxatives to lose weight has been found to increase the risk of <a href="https://doi.org/10.2105/AJPH.2019.305390">being diagnosed with an eating disorder in the next one to three years</a>. Drugs like Ozempic may also be <a href="https://doi.org/10.1002/eat.24109">misused by individuals already struggling with an eating disorder</a> to suppress their appetite, compensate for binge eating episodes or manage fear of weight gain.</p> <p>Individuals who are already showing signs of an eating disorder, such as limiting their food intake and intense concerns about their weight, may be most at risk of spiralling from a weight loss diet or medication into an eating disorder, <a href="https://doi.org/10.1002/eat.24116">even if they only lose a moderate amount of weight</a>.</p> <p>People who are dissatisfied with their weight or have made multiple attempts to lose weight often feel pressured to try increasingly drastic methods. However, any diet, exercise program or weight-loss medication promising a quick fix for weight loss should be treated with extreme caution. At best, you may gain the weight back; at worst, you put yourself at risk for much more serious eating disorders and other health problems.<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221514/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/samantha-withnell-1504436"><em>Samantha Withnell</em></a><em>, PhD Candidate, Clinical Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, Assistant Professor of Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-dieting-weight-suppression-and-even-misuse-of-drugs-like-ozempic-can-contribute-to-eating-disorders-221514">original article</a>.</em></p>

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I have COVID. How likely am I to get long COVID?

<p><em><a href="https://theconversation.com/profiles/andrew-baillie-646956">Andrew Baillie</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/amelia-gulliver-17440">Amelia Gulliver</a>, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a>; <a href="https://theconversation.com/profiles/lena-sanci-523666">Lena Sanci</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/lucette-cysique-1495512">Lucette Cysique</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/philip-britton-1127089">Philip Britton</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>EG.5 or the Eris COVID variant is dominant in parts of <a href="https://www.health.nsw.gov.au/Infectious/covid-19/Documents/respiratory-surveillance-20231202.pdf">Australia</a>. Eris, along with other circulating strains, are descendants of Omicron.</p> <p>While these strains appear less severe than the original Alpha and Delta variants, the risk of long COVID remains.</p> <p>So what does the latest data say about the chance of long COVID? What symptoms should you look out for? And what can be done to support people with long COVID?</p> <h2>When COVID becomes ‘long COVID’</h2> <p>For most people, long COVID means not getting better after a COVID infection.</p> <p>The World Health Organization <a href="https://www.who.int/publications-detail-redirect/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1">defines long COVID</a> as continuing or new symptoms at least three months from the start of a COVID infection that last at least two months and cannot be explained by an alternative diagnosis.</p> <p>The most <a href="https://link.springer.com/article/10.1007/s10654-022-00962-6">common symptoms</a> include fatigue, brain fog, breathlessness, headaches and abdominal pain. But people with long COVID can experience <a href="https://www.sciencedirect.com/science/article/pii/S1684118222001864?via%3Dihub">a wide range</a> of problems including cardiovascular issues, mental health problems such as depression and anxiety, insomnia, muscle and joint pain, and gastrointestinal problems.</p> <h2>How common is long COVID?</h2> <p>Australian data on long COVID <a href="https://www.mja.com.au/journal/2023/218/10/long-covid-australia-achieving-equitable-access-supportive-health-care">remains limited</a> compared to <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2023001/article/00015-eng.htm">international data</a>, and estimates of its prevalence have varied. A report from Australia’s parliamentary inquiry into long COVID, <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportrep/RB000006/toc_pdf/SickandtiredCastingalongshadow.pdf">published in April</a>, suggested 2%-20% of people may develop long COVID following an infection.</p> <p>A recent Australian study conducted when vaccines were widely available indicates earlier Omicron variants <a href="https://doi.org/10.3390/ijerph20186756">saw 10% of people</a> who caught COVID develop long COVID.</p> <p>Another recent study, yet to be peer-reviewed, found <a href="https://www.medrxiv.org/content/10.1101/2023.08.06.23293706v1">18.2%</a> of those infected went on to have long COVID. The wide-ranging estimates are likely to be because of different COVID variants, differences in vaccination, and different long COVID definitions and assessment methods.</p> <p>The risk is lower in children. One Australian study indicated persistent symptoms in <a href="https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00124-3/fulltext">8% of children</a> who had COVID in 2020, while <a href="https://www.medrxiv.org/content/10.1101/2023.03.14.23287239v1">preliminary research</a> points to a slightly lower risk among children infected in 2021.</p> <p>But more research is needed, especially as the virus continues to evolve. This can be complicated because typical long COVID symptoms are common to many other health problems. As in other countries, more research is now underway <a href="https://www.apprise.org.au/broad-research-area/insights-into-long-covid/">in Australia</a> to determine the accurate prevalence of the condition using a definition and methods that carefully exclude other causes.</p> <p>Although research on long COVID risk factors with new variants is ongoing, we expect being female, having more severe initial disease and having other health conditions will <a href="https://doi.org/10.1001/jamainternmed.2023.0750">increase a person’s chance</a> of getting long COVID.</p> <h2>What’s different this time?</h2> <p>Research shows COVID vaccines offer <a href="https://www.mdpi.com/1660-4601/19/19/12422">protection</a> against long COVID. As well as vaccinations, immunity from previous COVID infections and antiviral treatments are contributing to less severe COVID and potentially <a href="https://theconversation.com/could-antivirals-reduce-your-risk-of-long-covid-where-the-research-is-up-to-on-prevention-and-treatment-216529">less long COVID</a> than we saw earlier in the pandemic.</p> <p>But while the Omicron waves may lead to <a href="https://www.smh.com.au/national/newer-virus-strains-less-likely-to-cause-long-covid-20231123-p5emag.html">fewer cases of long COVID</a> than the earlier Alpha and Delta variants, because so many Australians are contracting COVID, this will still result in a large number of people with long COVID. And each <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2023001/article/00015-eng.htm">repeat infection</a> presents a new risk of prolonged symptoms.</p> <h2>Long COVID can affect all aspects of life</h2> <p>Long COVID can <a href="https://doi.org/10.1093/ije/dyad033">impact</a> a person’s life in many ways. Fatigue following exertion, brain fog and other symptoms can reduce capacity to perform tasks such as concentrating at a computer, manual labour, and even normal household tasks.</p> <p>Many people with long COVID submitted evidence to the recent <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/House/Health_Aged_Care_and_Sport/LongandrepeatedCOVID/Report/Chapter_4_-_Lived_experiences_of_long_COVID">parliamentary inquiry</a> that they were unsupported, stigmatised, isolated, and not taken seriously by health professionals.</p> <p>Evidence suggests many symptoms <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-77622200250-2/fulltext">will improve</a> in most people over <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00138-4/fulltext">12 to 18 months</a>, although recovery time can differ between symptoms. Some, including gastrointestinal and respiratory symptoms, tend to <a href="https://www.nature.com/articles/s41579-022-00846-2">resolve sooner than others</a>, such as cognitive symptoms.</p> <h2>I think I have long COVID, what can I expect from my doctor?</h2> <p>Long COVID is the kind of challenge Australia’s <a href="https://dx.doi.org/10.5694/mja2.51950">health system finds most difficult</a>. GPs are stretched and the small number of specialist <a href="https://www.abc.net.au/news/2023-12-12/long-covid-clinics-are-closing-as-us-clinic-expands/103186272">long COVID clinics</a> are struggling to maintain funding.</p> <p>Australia has trailed behind the US, the UK and Europe in rolling out care for long COVID, and in collecting data on the condition.</p> <p>As a result, support for long COVID in Australia is <a href="https://doi.org/10.3389/phrs.2023.1606084">hard to access</a>, expensive and patchy.</p> <p>However, there is consensus on what constitutes good care. Clinicians seeing patients with possible long COVID should:</p> <ul> <li> <p>validate the person’s experience of symptoms and the impact their symptoms are having on their functioning, particularly when the cause is not clear</p> </li> <li> <p>diagnose and treat any other health conditions that are part of the picture</p> </li> <li> <p>support people to minimise the impairment their symptoms cause by pacing of physical and cognitive activities. Importantly, this doesn’t involve pushing through fatigue.</p> </li> </ul> <p>These steps are not a cure but they may improve a person’s ability to function in their day-to-day life, at work and to fulfil their caring responsibilities.</p> <h2>We still need to focus on reducing COVID transmission</h2> <p>The best way to prevent long COVID is to avoid contracting – and spreading – COVID. This means:</p> <ul> <li> <p>getting vaccinated or boosted, if you’re eligible</p> </li> <li> <p>staying home if you feel unwell</p> </li> <li> <p>wearing a mask to protect yourself and vulnerable community members</p> </li> <li> <p>testing for COVID if you have symptoms and if you test positive, taking antivirals (if eligible) and isolating until your symptoms resolve.</p> </li> </ul> <p>Long COVID is not going away, but we all have a role to play in preventing and responding to it.</p> <p><em>Ruby Biezen from the APPRISE Network and the University of Melbourne and Andrew Lloyd from the Kirby Institute at UNSW contributed to this article.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/218808/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/andrew-baillie-646956"><em>Andrew Baillie</em></a><em>, Professor of Allied Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/amelia-gulliver-17440">Amelia Gulliver</a>, Senior Research Fellow, ANU College of Health and Medicine, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a>; <a href="https://theconversation.com/profiles/lena-sanci-523666">Lena Sanci</a>, Professor, Department of General Practice and Primary Care, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a>; <a href="https://theconversation.com/profiles/lucette-cysique-1495512">Lucette Cysique</a>, Senior Research Fellow, Viral Immunology Systems Program, The Kirby Institute, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a>, and <a href="https://theconversation.com/profiles/philip-britton-1127089">Philip Britton</a>, Associate Professor, Child and Adolescent Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-have-covid-how-likely-am-i-to-get-long-covid-218808">original article</a>.</em></p>

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