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Woman baffled by mother-in-law’s insane ask over baby name

A woman has gone head-to-head with her mother-in-law over the name she has chosen for her unborn child. The pregnant woman took to Reddit to share her unusual predicament, explaining how her mother-in-law has demanded she change the name of her baby. The soon-to-be mum shared how she recently had dinner with her husband’s family, where she decided to reveal the baby’s gender and name. She had been keeping the information secret, but with only a few weeks of her pregnancy left, she decided to share the happy news that she was having a baby boy and had chosen the name Shawn for her son. But not everyone shared her happiness over the moniker, as her mother-in-law went pale with shock and demanded she choose a new name. “My in-laws got quiet for a moment before asking if there were other options we'd considered. Apparently, Shawn is the name of my 17-year-old sister-in-law Ashley's former bully who tormented her [for years],” the pregnant woman explained on Reddit. While she empathised with her in-laws, she didn’t want to change the name as it was the only one her and her husband agreed on for their son. She also explained that she hadn’t known about the family connection when they picked the name, and hadn’t picked it out of any malicious intent. “We took forever to pick a name,” she said. “Shawn is the only one we could agree on.” The dinner party soon ended after the argument began, but the mother-in-law didn’t back down, sending the expecting mum demanding messages. “She texted me and my husband again to ask us to find a new name for Ashley's sake.” “Would I be the a**hole for not wanting to change it? We were only able to agree on it a few weeks ago.” Commenters were torn over the subject, with many rushing to the pregnant woman’s defence, saying she can pick whatever name she wants for her son. “My spouse and sibling have the same name. Somehow, you just compartmentalise it,” one shared. “I feel like if a new baby in my family shared a name with my bully I'd just adapt,” another wrote. “After all, Shawn is a VERY common name, so I can't freak out every time I hear it and survive in this world.” However, a select few sided with the mother-in-law, sharing how stunned they were that the couple couldn't find enough compassion to pick another name. One person said, “I understand the difficulty of finding a name that feels right, but for me, after learning this, Shawn would quickly become another name that didn't work. It's only been decided on it for a few weeks so I'd just go back to the drawing board.” Image credits: Shutterstock

Family & Pets

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

<a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> 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. But does weight come back when you stop using it? 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. So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far. <h2>It’s a long-term treatment, not a short course</h2> 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. 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. 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.) 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. <h2>Why do people stop?</h2> 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>. 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. Understanding what stopping does to the body is therefore important. <h2>So what happens when you stop?</h2> 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: <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> 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 </li> <li> 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 </li> <li> weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle. </li> </ul> 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. <h2>Is stopping and starting the medications a problem?</h2> 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>. 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. 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. <h2>How can you avoid gaining weight when you stop?</h2> 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: <ul> <li> getting quality <a href="https://www.hindawi.com/journals/ije/2010/270832/">sleep</a> </li> <li> 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 </li> </ul> <ul> <li> 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 </li> <li> 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. </li> </ul> 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. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<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" /> <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> Image credits: Getty Images 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>.

Body

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

<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> 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>”. 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”. 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. 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. <h2>How does it work?</h2> 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. 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. GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating. <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> GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action. 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. 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. <h2>What can users expect? What does the research say?</h2> Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly). 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. 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. 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>. 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. <h2>Who is eligible for semaglutide?</h2> 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. 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. 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. 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. <h2>What else do you need to do during Ozempic treatment?</h2> 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. 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. 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. 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>. <h2>But what are the side effects?</h2> Semaglutide’s side-effects <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">include</a> nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain. 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. More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions. 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. 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”. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<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" /> <a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Getty Images 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>.

Body

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

<a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> 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. 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. 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>. <h2>Not the first ‘miracle’ weight-loss drug</h2> 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>. 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. <h2>Ozempic doesn’t work the same for everyone</h2> 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% 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. 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. 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. <h2>Treatment needs to be ongoing. What will this mean?</h2> 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. 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. 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&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. <h2>Biology is only part of the story</h2> 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. 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. 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. <h2>A weight-centred approach misses the rest of the story</h2> 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. 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>. <h2>Obesity isn’t an issue detached from people</h2> 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. 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. 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. <h2>Drugs are tools, not silver bullets</h2> 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. Many organisations and individuals see obesity is a disease and believe this framing helps people to seek treatment. 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. 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. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<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" /> <a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, Adjunct Senior Lecturer, Nutrition, Dietetics & Food Innovation - School of Health Sciences, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Getty Images 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>.

Body

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

<a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <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>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> 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. 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. 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. <h2>Potential benefits</h2> 1) It’s likely to help you lose weight 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. 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). 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. 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. 2) It may reduce your chronic disease risk factors 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. 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. 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. 3) It might improve your quality of life, emotional wellbeing or sense of achievement 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. 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. <h2>What about the risks?</h2> 1) You may experience gastrointestinal symptoms 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%). In the UK study, nausea and diarrhoea were also commonly reported. In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&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. Most gastrointestinal symptoms were mild to moderate in severity, and resolved for most people without the need to stop participating in the study. 2) You might feel fatigued 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. 3) You might be among the minority who don’t tolerate the drug 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. 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. In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&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. More severe safety concerns reported in <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&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. 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. 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. 4) It might be difficult to access 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. To manage the shortage, pharmacists are instructed to give preference to people with type 2 diabetes who are seeking the medication. 5) You might not always get clear information from vested interests 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>. 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. <h2>Bottom line</h2> 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. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-132745">Ozempic series</a> here.<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" /> <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> Image credits: Getty Images 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>.

Body

Does the royal family have a right to privacy? What the law says

<a href="https://theconversation.com/profiles/gemma-horton-1515949">Gemma Horton</a>, <a href="https://theconversation.com/institutions/university-of-sheffield-1147">University of Sheffield</a> From court cases to conspiracy theories, the royal family’s right to privacy is, somewhat ironically, nearly always in the spotlight. The latest focus is Kate Middleton, Princess of Wales, whose whereabouts have been the subject of <a href="https://www.townandcountrymag.com/society/tradition/a60008117/kate-middleton-health-speculation-conspiracy-theories-online/">online speculation</a> after it was announced she was undergoing abdominal surgery and would be away from public duties until after Easter. This comes just weeks after King Charles <a href="https://www.bbc.co.uk/news/uk-68208157">revealed that he is undergoing treatment for cancer</a>, and a legal settlement between Prince Harry and Mirror Group Newspapers over <a href="https://www.bbc.co.uk/news/uk-68249009">illegal phone hacking</a>. Interest in the personal lives of the royals and other celebrities <a href="https://www.tandfonline.com/doi/full/10.1080/1461670X.2016.1150193">is a constant</a>, driving newspaper sales and online clicks for decades. You only needs to consider the media frenzy that followed Princess Diana to <a href="https://www.tandfonline.com/doi/full/10.1080/17512786.2013.833678">see this</a>, and its potentially devastating consequences. From a legal perspective, the British courts have ruled that everyone – the royal family included – is entitled to a right to privacy. The Human Rights Act incorporates into British law the rights set out by the European Convention on Human Rights. This includes article 8, which focuses on the right to privacy. In the years after the Human Rights Act came into force, courts ruled on a string of cases from celebrities claiming that the press invaded their privacy. Courts had to balance article 8 of the convention against article 10, the right to freedom of expression. Rulings repeatedly stated that, despite being in and sometimes seeking the limelight, celebrities should still be afforded a right to privacy. Some disagree with this position, such as prominent journalist <a href="https://www.independent.co.uk/news/uk/home-news/prince-harry-hacking-piers-morgan-b2336442.html">Piers Morgan, who has criticised</a> the Duke and Duchess of Sussex asking for privacy when they have also released a Netflix documentary, a broadcast interview with Oprah Winfrey and published a memoir. But the courts have made the position clear, as in the case concerning Catherine Zeta-Jones and Michael Douglas after Hello! Magazine published unauthorised photographs from their wedding. The <a href="https://eprints.whiterose.ac.uk/190559/3/Final%20Edited%20Version%20-%20Celebrity%20Privacy%20and%20Celebrity%20Journalism-%20Has%20anything%20changed%20since%20the%20Leveson%20Inquiry_.pdf">court stated</a> that: “To hold that those who have sought any publicity lose all protection would be to repeal article 8’s application to very many of those who are likely to need it.” There is no universal definition of privacy, but scholars have identified key concepts encompassing what privacy can entail. In my own research, I have argued that the <a href="https://eprints.whiterose.ac.uk/190559/3/Final%20Edited%20Version%20-%20Celebrity%20Privacy%20and%20Celebrity%20Journalism-%20Has%20anything%20changed%20since%20the%20Leveson%20Inquiry_.pdf">notion of choice</a> is one of these. Privacy allows us to control the spread of information about ourselves and disclose information to whom we want. <h2>Privacy and the public interest</h2> There are exceptions to these protections if the person involved had no reasonable expectation of privacy, or if it was in the public interest for this information to be revealed. There is no solid, legal definition of the “public interest”, so this is decided on a case-by-case basis. <a href="https://www.tandfonline.com/doi/full/10.1080/17577632.2021.1889866">In the past</a>, the public interest defence has been applied because a public figure or official has acted hypocritically and the courts have stated there is a right for a publisher to set the record straight. When it comes to medical records and information concerning health, case law and journalistic <a href="https://www.ipso.co.uk/editors-code-of-practice/">editorial codes of conduct</a> are clear that this information is afforded the utmost protection. Model Naomi Campbell was pictured leaving a Narcotics Anonymous meeting and these images were published by the Daily Mirror. The court found that there had been a public interest in revealing the fact she was attending these meetings, as she had previously denied substance abuse. The House of Lords accepted that there was a public interest in the press “setting the record straight”. Nonetheless, the publication of additional, confidential details, and the photographs of her leaving the meeting were a <a href="https://www.theguardian.com/media/2004/may/06/mirror.pressandpublishing1">step too far</a>. The House of Lords highlighted the importance of being able to keep medical records and information private. <h2>Royal health</h2> When it comes to the royals, the history of <a href="https://www.townandcountrymag.com/society/tradition/a23798094/lindo-wing-st-marys-hospital-facts-photos/">publicity</a> around royal births, often posing with the newborn royal baby outside of the hospital, has set a precedent for what the public can expect about the royals’ medical information. When they choose to go against this tradition, it can frustrate both royal-watchers and publishers. King Charles made the choice to openly speak about his enlarged prostate to “assist public understanding”. And, as Prostate Cancer UK noted, this has worked – they noted a <a href="https://www.independent.co.uk/news/uk/home-news/king-charles-cancer-statement-treatment-b2494190.html">500% increase in people visiting their website</a>. However, he has chosen to not to divulge information about his cancer diagnosis beyond the fact that he is receiving treatment. This is his right. While revealing further information might stop speculation and rumours about his health, it is not the king’s duty to divulge private, medical information. However, if his health begins to impact his ability to act as monarch, the situation could change. It might be that the press finds more information about his health without his knowledge, but unless they have a genuine public interest in publishing this information, privacy should prevail. You would no doubt want your private medical information kept secret, not shared around your workplace and speculated on unless it was absolutely necessary. It is thanks to these laws and court precedent that you don’t have to worry about this. The royal family, regardless of their position, should expect the same standard. <a href="https://theconversation.com/profiles/gemma-horton-1515949">Gemma Horton</a>, Impact Fellow for Centre for Freedom of the Media, <a href="https://theconversation.com/institutions/university-of-sheffield-1147">University of Sheffield</a> Image credits: Getty Images 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/does-the-royal-family-have-a-right-to-privacy-what-the-law-says-224881">original article</a>.

Legal

“My sister-in-law announced she was pregnant at my child’s funeral”

A woman has asked for advice on how to navigate her relationship with her sister-in-law, after the woman overheard an inappropriate conversation at her child’s funeral. The grieving mother, a 28-year-old named Melissa, took to Reddit to share the heartbreaking story of how her toddler passed away after a battle with cancer. Melissa described the time as the “hardest in my life”, explaining how she felt she lost “a part of herself” after the funeral. While Melissa expected her toddlers’ memorial service to be difficult, she never predicted a family member would make it even harder. The mother said that when she heard her sister-in-law telling people about her pregnancy, she thought the move was just cruel. “She didn't make a big announcement but more than ten people at the service 'heard' and it's what everyone was talking about. To understate it, I was livid,” Melissa wrote on Reddit. Melissa’s post then asked social media users for advice, as she was unsure how much of a relationship she wanted to have with her sister-in-law after the stunt. The 28-year-old shared that she had fallen pregnant herself, and was facing pressure to have a party in celebration, but she didn’t want her whole family in attendance. “I've been working on who I want to invite, and I really don't want my SIL there,” she said. “Besides what she did, she's a vindictive and mean person and I cannot stand her.” “I mentioned it to my husband and he says he couldn't care less whether she's there or not. But for the sake of saving face, I want opinions before I do this.” She asked the online forum if she would be “an a**hole” for not inviting her, addin that she would still be inviting her husband's other sister and husband's brother's wife. “The original SIL will be the only one not invited,” she clarified. The post was flooded with comments as many backed up Melissa, slamming the sister-in-law for her selfish behaviour. “I wouldn't want someone like that around me. Announcing a pregnancy at a child's funeral is insane,” one said. “Cut her off and ignore everyone close to her. You are right to have nothing to do with her. She's totally classless.” However, others encouraged her to have an adult conversation with her sister-in-law in an attempt to mend their relationship. “Please let it go,” one person began. “This happened on a terrible day during a bad time for you. It's possible that could be clouding how you're looking at this, she may not have been malicious at all.” Image credits: Shutterstock

Family & Pets

Mother bans in-laws from seeing her baby after they go against her wishes

A woman has banned her in-laws from seeing her newborn daughter after they “betrayed her trust” and directly went against her wishes. The new mum shared the story to Reddit, as she explained why she was cutting contact with her husband’s parents after they pierced her child’s ears without their knowledge or consent. “My husband is from a culture where it's not uncommon to pierce baby girls' ears and his mother started pestering me about getting my daughter's ears pierced a few days after she was born,” the 32-year-old mum began. “I made it clear that I would not be doing that, and that I'd be waiting until she's old enough to ask for it herself. We live in my country where piercing a baby's ears isn't common at all.” The new mum's world soon came crashing down after the baby spent a weekend with her grandparents, before she went back to her parents red in the face and screaming. “My mother-in-law was looking after her over the weekend and decided to pierce her ears without my knowledge or consent.” “When I saw this I threw a fit. My baby was crying in pain, and I actually took her to the doctor to get their advice on whether or not to take them out.” The doctor advised the parent to take the earrings out as they were irritating the baby, but the issue didn’t end there. “I decided at that moment that my mother-in-law and everyone else on that side of the family (except for my sister-in-law, who's on my side about this) is going to have no alone contact with my daughter ever again - or at least until she's a teenager.” “My worry is that she'll do the same thing again, and to be frank, she's lost my trust entirely. I told her that if she had a problem with that, I'd report what she did to the police.” The husband of the baby girl reluctantly sided with his wife over the issue, despite saying it wasn’t a big deal and suggesting everyone move on from the incident. The story prompted a mixed response online, with some people saying the woman was overreacting and should work towards rebuilding trust with her in-laws. Others, however, had the opposite opinion, with one person saying, “Forget rebuilding trust, I'd be having them charged with assault.” Another person said, “They mutilated a child and they knew it was against the parents wishes. These people have serious problems. Not that I'd press charges, but getting holes poked in someone else's kid is a huge thing.” Image credits: Getty Images

Family & Pets

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

<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> 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. 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. 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>. <h2>Weight loss and eating disorders</h2> 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. 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>. 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. <h2>Eating disorders and ‘weight suppression’</h2> 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). 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. <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. 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. <h2>Ozempic and other semaglutide drugs</h2> 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. 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>. 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. 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. <h2>Risks of dieting and weight-loss drugs</h2> 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. 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>. 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>. 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. 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>. 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.<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" /> <a href="https://theconversation.com/profiles/samantha-withnell-1504436">Samantha Withnell</a>, 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> Image credits: Getty Images 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>.

Body

"I was terrified": Law & Order star reveals traumatic past

Warning: This story contains graphic content. Mariska Hargitay, who plays Olivia Benson, a character that investigate rapists on Law & Order: Special Victims Unit, has revealed that she too is a victim of sexual assault. The actress opened up about her traumatic past in a powerful essay written for <a href="https://people.com/mariska-hargitay-experience-rape-renewal-reckoning-8424247" target="_blank" rel="noopener">People Magazine</a>, where she revealed that she was raped by “a friend" when she was in her thirties. "A man raped me in my thirties," she bravely revealed in the essay. "It wasn’t sexual at all. It was dominance and control. Overpowering control." The actress revealed that he was a friend who "made a unilateral decision" and recalled the fear she felt when the incident occurred. "He grabbed me by the arms and held me down. I was terrified," she said. "I didn’t want it to escalate to violence. I now know it was already sexual violence, but I was afraid he would become physically violent. "I went into freeze mode, a common trauma response when there is no option to escape. I checked out of my body," she recalled. Hargitay, who is the daughter of the late actress Jane Mansfield, said that she never thought of herself as a "survivor", and often "minimised" what happened to her when she talked about it with others. "My husband Peter remembers me saying, “I mean, it wasn’t rape," she wrote. "Then things started shifting in me, and I began talking about it more in earnest with those closest to me. They were the first ones to call it what it was." The actress said that she wants other survivors to feel "no shame" about sexual assault and wants "this violence to end." She added that justice "may look different for each survivor," but for her she wants "an acknowledgment and an apology" after what happened. "This is a painful part of my story. The experience was horrible. But it doesn’t come close to defining me, in the same way that no other single part of my story defines me," she concluded, adding that she feels for all sexual violence survivors. "I’m turning 60, and I’m so deeply grateful for where I am. I’m renewed and I’m flooded with compassion for all of us who have suffered. And I’m still proudly in process." Hargitay started her own foundation, the Joyful Heart Foundation, in 2004 to help survivors of sexual assault. Image: Getty

Caring

Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria

<a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Antibiotic resistance occurs when a microorganism changes and no longer responds to an antibiotic that was previously effective. It’s <a href="https://thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00502-2/fulltext">associated with</a> poorer outcomes, a greater chance of death and higher health-care costs. In Australia, antibiotic resistance means some patients are admitted to hospital because oral antibiotics are <a href="https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance">no longer effective</a> and they need to receive intravenous therapy via a drip. Antibiotic resistance is rising to high levels in certain parts of the world. Some hospitals <a href="https://www.reactgroup.org/news-and-views/news-and-opinions/year-2022/the-impact-of-antibiotic-resistance-on-cancer-treatment-especially-in-low-and-middle-income-countries-and-the-way-forward/">have to consider</a> whether it’s even viable to treat cancers or perform surgery due to the risk of antibiotic-resistant infections. Australia is <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-aura/aura-2023-fifth-australian-report-antimicrobial-use-and-resistance-human-health">one of the highest users</a> of antibiotics in the developed world. We need to use this precious resource wisely, or we risk a future where a simple infection could kill you because there isn’t an effective antibiotic. <h2>When should antibiotics not be used?</h2> Antibiotics only work for some infections. They work against bacteria but <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/do-i-really-need-antibiotics">don’t treat</a> infections caused by viruses. Most community acquired infections, even those caused by bacteria, are likely to get better without antibiotics. Taking an antibiotic when you don’t need it won’t make you feel better or recover sooner. But it can increase your chance of side effects like nausea and diarrhoea. Some people think green mucus (or snot) is a sign of bacterial infection, requiring antibiotics. But it’s actually <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-11/aura_2023_do_i_really_need_antibiotics.pdf">a sign</a> your immune system is working to fight your infection. <h2>If you wait, you’ll often get better</h2> <a href="https://www.tg.org.au/">Clinical practice guidelines</a> for antibiotic use aim to ensure patients receive antibiotics when appropriate. Yet 40% of GPs say they prescribe antibiotics <a href="https://doi.org/10.1071/HI13019">to meet patient expectations</a>. And <a href="https://pubmed.ncbi.nlm.nih.gov/35973750/">one in five</a> patients expect antibiotics for respiratory infections. It can be difficult for doctors to decide if a patient has a viral respiratory infection or are at an early stage of serious bacterial infection, particularly in children. One option is to “watch and wait” and ask patients to return if there is clinical deterioration. An alternative is to prescribe an antibiotic but advise the patient to not have it dispensed unless specific symptoms occur. This can <a href="https://doi.org/10.1002/14651858.CD004417.pub5">reduce antibiotic use by 50%</a> with no decrease in patient satisfaction, and no increase in complication rates. <h2>Sometimes antibiotics are life-savers</h2> For some people – particularly those with a weakened immune system – a simple infection can become more serious. Patients with life-threatening suspected infections should receive an appropriate antibiotic <a href="https://www.safetyandquality.gov.au/our-work/clinical-care-standards/antimicrobial-stewardship-clinical-care-standard">immediately</a>. This includes serious infections such as <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/bacterial-meningitis#:%7E:text=What%20is%20bacterial%20meningitis%3F,can%20cause%20life%2Dthreatening%20problems.">bacterial meningitis</a> (infection of the membranes surrounding the brain) and <a href="https://clinicalexcellence.qld.gov.au/priority-areas/safety-and-quality/sepsis/adult-sepsis#:%7E:text=Adult%20patients%20with%20sepsis%20also,adult%20emergency%20department%20sepsis%20pathway.">sepsis</a> (which can lead to organ failure and even death). <h2>When else might antibiotics be used?</h2> Antibiotics are sometimes used to prevent infections in patients who are undergoing surgery and are at significant risk of infection, such as those undergoing bowel resection. These patients will <a href="https://www.tg.org.au">generally receive</a> a single dose before the procedure. Antibiotics may also <a href="https://www.tg.org.au">be given</a> to patients undergoing chemotherapy for solid organ cancers (of the breast or prostate, for example), if they are at high risk of infection. While most sore throats are caused by a virus and usually resolve on their own, some high risk patients with a bacterial strep A infection which can cause “scarlet fever” are given antibiotics to prevent a more serious infection like <a href="https://www.rhdaustralia.org.au/">acute rheumatic fever</a>. <h2>How long is a course of antibiotics?</h2> The recommended duration of a course of antibiotics depends on the type of infection, the likely cause, where it is in your body and how effective the antibiotics are at killing the bacteria. In the past, courses were largely arbitrary and based on assumptions that antibiotics should be taken for long enough to eliminate the infecting bacteria. More recent research does not support this and shorter courses are <a href="https://www.acpjournals.org/doi/full/10.7326/M19-1509">nearly always as effective as longer ones</a>, particularly for community acquired respiratory infections. For <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736742/">community acquired pneumonia</a>, for example, research shows a three- to five-day course of antibiotics is at least as effective as a seven- to 14-day course. The “take until all finished” approach is no longer recommended, as the longer the antibiotic exposure, the greater the chance the bacteria will develop resistance. However, for infections where it is more difficult to eradicate the bacteria, such as tuberculosis and bone infections, a combination of antibiotics for many months is usually required. <h2>What if your infection is drug-resistant?</h2> You may have an antibiotic-resistant infection if you don’t get better after treatment with standard antibiotics. Your clinician will collect samples for lab testing if they suspect you have antibiotic-resistant infection, based on your travel history (especially if you’ve been hospitalised in a country with high rates of antibiotic resistance) and if you’ve had a recent course of antibiotics that hasn’t cleared your infection. Antibiotic-resistant infections are managed by prescribing broad-spectrum antibiotics. These are like a sledgehammer, wiping out many different species of bacteria. (Narrow-spectrum antibiotics conversely can be thought of as a scalpel, more targeted and only affecting one or two kinds of bacteria.) Broad-spectrum antibiotics are usually more expensive and come with more severe side effects. <h2>What can patients do?</h2> Decisions about antibiotic prescriptions should be made using <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-specific-conditions">shared decision aids</a>, where patients and prescribers discuss the risks and benefits of antibiotics for conditions like a sore throat, middle ear infection or acute bronchitis. Consider asking your doctor questions such as: <ul> <li>do we need to test the cause of my infection?</li> <li>how long should my recovery take?</li> <li>what are the risks and benefits of me taking antibiotics?</li> <li>will the antibiotic affect my regular medicines?</li> <li>how should I take the antibiotic (how often, for how long)?</li> </ul> Other ways to fight antibiotic resistance include: <ul> <li>returning leftover antibiotics to a pharmacy for safe disposal</li> <li>never consuming leftover antibiotics or giving them to anyone else</li> <li>not keeping prescription repeats for antibiotics “in case” you become sick again</li> <li>asking your doctor or pharmacist what you can do to feel better and ease your symptoms rather than asking for antibiotics.</li> </ul> <a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, Antimicrobial Stewardship Pharmacist, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, PhD candidate, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, Research Assistant, College of Health, Medicine and Wellbeing, School of Biomedical Science and Pharmacy, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Shutterstock 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/do-you-really-need-antibiotics-curbing-our-use-helps-fight-drug-resistant-bacteria-217920">original article</a>.

Body

Drug resistance may make common infections like thrush untreatable

<a href="https://theconversation.com/profiles/christine-carson-109004">Christine Carson</a>, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a> We’ve all heard about antibiotic resistance. This happens when bacteria develop strategies to avoid being destroyed by an antibiotic. The consequences of antibiotic resistance mean an antibiotic previously used to cure bacterial infections no longer works effectively because the bacteria have become resistant to the drug. This means it’s getting harder to cure the infections some bacteria cause. But unfortunately, it’s only one part of the problem. The same phenomenon is also happening with other causes of infections in humans: fungi, viruses and parasites. “Antimicrobial resistance” means the drugs used to treat diseases caused by microbes (bugs that cause infection) no longer work. This occurs with antibacterial agents used against bacteria, antifungal agents used against fungi, anti-parasitic agents used against parasites and antiviral agents used against viruses. This means a wide range of previously controllable infections are becoming difficult to treat – and may become untreatable. <h2>Fighting fungi</h2> Fungi are responsible for a range of infections in humans. Tinea, ringworm and vulvovaginal candidiasis (thrush) are some of the more familiar and common superficial fungal infections. There are also life-threatening fungal infections such as aspergillosis, cryptococcosis and invasive fungal bloodstream infections including those caused by Candida albicans and Candida auris. Fungal resistance to antifungal agents is a problem for several reasons. First, the range of antifungal agents available to treat fungal infections is limited, especially compared to the range of antibiotics available to treat bacterial infections. There are only four broad families of antifungal agents, with a small number of drugs in each category. Antifungal resistance further restricts already limited options. Life-threatening fungal infections happen less frequently than life-threatening bacterial infections. But they’re rising in frequency, especially among people whose immune systems are compromised, including by <a href="https://7news.com.au/news/qld/first-heart-transplant-patient-to-die-from-fungal-infection-at-brisbanes-prince-charles-hospital-identified-as-mango-hill-gp-muhammad-hussain-c-12551559">organ transplants</a> and chemotherapy or immunotherapy for cancer. The threat of getting a drug-resistant fungal infection makes all of these health interventions riskier. The greatest <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2017.00735/full">burden of serious fungal disease</a> occurs in places with limited health-care resources available for diagnosing and treating the infections. Even if infections are diagnosed and antifungal treatment is available, antifungal resistance reduces the treatment options that will work. But even in Australia, common fungal infections are impacted by resistance to antifungal agents. Vulvovaginal candidiasis, known as thrush and caused by Candida species and some closely related fungi, is usually reliably treated by a topical antifungal cream, sometimes supplemented with an oral tablet. However, instances of <a href="https://www.theage.com.au/national/victoria/they-can-t-sit-properly-doctors-treat-growing-number-of-women-with-chronic-thrush-20230913-p5e499.html">drug-resistant thrush</a> are increasing, and new treatments are needed. <h2>Targeting viruses</h2> Even <a href="https://theconversation.com/why-are-there-so-many-drugs-to-kill-bacteria-but-so-few-to-tackle-viruses-137480">fewer antivirals</a> are available than antibacterial and antifungal agents. Most antimicrobial treatments work by exploiting differences between the microbe causing the infection and the host (us) experiencing the infection. Since viruses use our cells to replicate and cause their infection, it’s difficult to find antiviral treatments that selectively target the virus without damaging us. With so few antiviral drugs available, any resistance that develops to one of them significantly reduces the treatment options available. Take COVID, for example. Two antiviral medicines are in widespread use to treat this viral infection: Paxlovid (containing nirmatrelvir and ritonavir) and Lagevrio (molnupiravir). So far, SARS-CoV-2, the virus that causes COVID, has not developed significant resistance to either of these <a href="https://www.cidrap.umn.edu/covid-19/low-levels-resistance-paxlovid-seen-sars-cov-2-isolates">treatments</a>. But if SARS-CoV-2 develops resistance to either one of them, it halves the treatment options. Subsequently relying on one would likely lead to its increased use, which may heighten the risk that resistance to the second agent will develop, leaving us with no antiviral agents to treat COVID. The threat of antimicrobial resistance makes our ability to treat serious COVID infections rather precarious. <h2>Stopping parasites</h2> Another group of microbes that cause infections in humans are single-celled microbes such as Plasmodium, Giardia, Leishmania, and Trypanosoma. These microbes are sometimes referred to as parasites, and they are becoming increasingly resistant to the very limited range of anti-parasitic agents used to treat the infections they cause. Several Plasmodium species cause malaria and anti-parasitic drugs have been the cornerstone of malaria treatment for decades. But their usefulness has been significantly reduced by the <a href="https://www.mmv.org/our-work/mmvs-pipeline-antimalarial-drugs/antimalarial-drug-resistance">development of resistance</a>. Giardia parasites cause an infection called giardiasis. This can resolve on its own, but it can also cause severe gastrointestinal symptoms such as diarrhea, nausea, and bloating. These microbes have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207226/">developed resistance</a> to the main treatments and patients infected with drug-resistant parasites can have protracted, unpleasant infections. <h2>Resistance is a natural consequence</h2> Treating infections influences microbes’ evolutionary processes. Exposure to drugs that stop or kill them pushes microbes to either evolve or die. The exposure to antimicrobial agents provokes the evolutionary process, selecting for microbes that are resistant and can survive the exposure. The pressure to evolve, provoked by the antimicrobial treatment, is called “selection pressure”. While most microbes will die, a few will evolve in time to overcome the antimicrobial drugs used against them. The evolutionary process that leads to the emergence of resistance is inevitable. But some things can be done to minimise this and the problems it brings. Limiting the use of antimicrobial agents is one approach. This means reserving antimicrobial agents for when their use is known to be necessary, rather than using them “just in case”. Antimicrobial agents are precious resources, holding at bay many infectious diseases that would otherwise sicken and kill millions. It is imperative we do all we can to preserve the effectiveness of those that remain, and give ourselves more options by working to discover and develop new ones.<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/213460/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/christine-carson-109004">Christine Carson</a>, Senior Research Fellow, School of Medicine, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a> Image credits: Getty Images 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/drug-resistance-may-make-common-infections-like-thrush-untreatable-213460">original article</a>.

Body

5 reasons why climate change may see more of us turn to alcohol and other drugs

<a href="https://theconversation.com/profiles/helen-louise-berry-8608">Helen Louise Berry</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/francis-vergunst-230743">Francis Vergunst</a>, <a href="https://theconversation.com/institutions/university-of-oslo-934">University of Oslo</a> Climate change will affect every aspect of our <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01859-7/fulltext">health and wellbeing</a>. But its potential harms go beyond the body’s ability to handle extreme heat, important as this is. Extreme weather events, such as floods, droughts, storms and wildfires, are becoming more frequent and severe. These affect our <a href="https://pubmed.ncbi.nlm.nih.gov/36165756/">mental health</a> in a multitude of <a href="https://www.nature.com/articles/s41558-018-0102-4">ways</a>. Coping with climate change can be overwhelming. Sometimes, the best someone can do is to seek refuge in alcohol, tobacco, over-the-counter and prescription drugs, or other psychoactive substances. This is understandable, but dangerous, and can have serious consequences. We outline <a href="https://journals.sagepub.com/doi/full/10.1177/17456916221132739">five ways</a> climate change could increase the risk of harmful substance use. <h2>1. Mental health is harmed</h2> Perhaps the most obvious way climate change can be linked to harmful substance use is by damaging mental health. This <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.12448">increases the risk</a> of new or worsened substance use. People with a mental disorder are <a href="https://www.hindawi.com/journals/psychiatry/2018/5697103/">at high risk</a> of also having a <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-11-25#:%7E:text=Prevalence%20of%20comorbidity%20in%20epidemiological%20studies&text=Among%20subjects%20with%20an%20alcohol,a%20comorbid%20SUD%20%5B39%5D.">substance-use disorder</a>. This often precedes their mental health problems. Climate change-related increases in the number and nature of extreme events, in turn, are escalating risks to mental health. For example, extreme heat is linked to increased <a href="https://pubmed.ncbi.nlm.nih.gov/27727320/">distress</a> across the whole population. In extreme heat, more people go to the <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2789481">emergency department</a> for psychiatric problems, including for <a href="https://www.sciencedirect.com/science/article/abs/pii/S0048969720338249">alcohol</a> and <a href="https://www.nature.com/articles/s43856-023-00346-1">substance use</a> generally. This is even true for <a href="https://www.sciencedirect.com/science/article/pii/S0048969720325572">a single very hot day</a>. Post-traumatic stress disorder, depression, anxiety and <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja13.10307">other mental health</a> problems are <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2019.00367/full">common</a> at the time of extreme weather events and can persist for months, even years afterwards, especially if people are exposed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9116266/">multiple events</a>. This can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101235/">increase</a> the likelihood of using substances as a way to cope. <h2>2. Worry increases</h2> With <a href="https://climatecommunication.yale.edu/publications/climate-change-in-the-american-mind-beliefs-attitudes-december-2022/">increasing public awareness</a> of how climate change is endangering wellbeing, people are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/worriesaboutclimatechangegreatbritain/septembertooctober2022#:%7E:text=The%20level%20of%20worry%20about,lives%20right%20now%20(29%25).">increasingly worried</a> about what will happen if it remains unchecked. Worrying isn’t the same as meeting the criteria for a mental disorder. But <a href="https://www.undp.org/publications/peoples-climate-vote">surveys</a> show climate change generates complex emotional responses, <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00278-3/fulltext">especially in children</a>. As well as feelings of worry, there is anxiety, fear, guilt, anger, grief and helplessness. Some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904966/">emotional states</a>, such as <a href="https://www.pnas.org/doi/full/10.1073/pnas.1909888116">sadness</a>, are linked with long-term tobacco use and also make substance use <a href="https://pubmed.ncbi.nlm.nih.gov/16011392/">relapse</a> more likely. <h2>3. Physical injuries hurt us in many ways</h2> Physical injuries caused by extreme weather events – such as smoke inhalation, burns and flood-related cuts and infections – increase the risk of harmful substance use. That’s partly because they <a href="https://pubmed.ncbi.nlm.nih.gov/20033251/">increase</a> the risk of psychological distress. If injuries cause long-term illness or disability, consequent feelings of hopelessness and depression can dispose some people to self-medicate with alcohol or other drugs. Substance use itself can also generate long-term physiological harm, disabilities or other chronic health problems. These are <a href="https://www.tandfonline.com/doi/abs/10.3109/00952999609001655">linked with</a> higher rates of harmful substance use. <h2>4. Our day-to-day lives change</h2> A single catastrophic event, such as a storm or flood, can devastate lives overnight and change the way we live. So, too, can the more subtle changes in climate and day-to-day weather. Both can disrupt behaviour and routines in ways that risk new or worsened substance use, for example, using stimulants to cope with fatigue. Take, for example, hotter temperatures, which disrupt <a href="https://www.cell.com/one-earth/fulltext/S2590-3322(22)00209-3?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2590332222002093%3Fshowall%3Dtrue">sleep</a>, undermine <a href="https://jhr.uwpress.org/content/57/2/400">academic performance</a>, <a href="https://www.nature.com/articles/s41562-017-0097">reduce physical activity</a>, and promote <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00173-5/fulltext">hostile language</a> and <a href="https://www.cambridge.org/core/elements/abs/climate-change-and-human-behavior/F64471FA47B8A6F5524E7DDDDE571D57">violent behaviour</a>. <h2>5. It destabilises communities</h2> Finally, climate change is destabilising the socioeconomic, natural, built and geopolitical <a href="https://www.nature.com/articles/s41558-018-0102-4">systems</a> on which human wellbeing – <a href="https://theconversation.com/climate-change-and-health-ipcc-reports-emerging-risks-emerging-consensus-24213">indeed survival</a> – depends. Damaged infrastructure, agricultural losses, school closures, homelessness and displacement are significant <a href="https://www.nature.com/articles/s41558-018-0102-4">sources of psychosocial distress</a> that prompt acute (short-term) and chronic (long-term) stress responses. <a href="https://doi.org/10.1196/annals.1441.030">Stress</a>, in turn, can <a href="https://doi.org/10.1007/s002130100917">increase</a> the risk of <a href="https://link.springer.com/article/10.1007/s002130100917">harmful substance use</a> and make people more likely to relapse. <h2>Why are we so concerned?</h2> Substance-use disorders are economically and socially <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30337-7/fulltext">very costly</a>. Risky substance use that doesn’t meet the criteria for a formal diagnosis <a href="https://digitalcommons.fiu.edu/srhreports/health/health/32/">can also harm</a>. Aside from its direct physical harm, harmful substance use disrupts <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843305/">education</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234116/">employment</a>. It increases the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676144/">accidents</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/09595230600944479">crime</a>, and it undermines social relationships, intimate <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795906/#:%7E:text=Results%20indicated%20that%20alcohol%20use,drinkers%20with%20low%20relationship%20satisfaction.">partnerships</a> and <a href="https://www.cambridge.org/core/journals/development-and-psychopathology/article/abs/longitudinal-relations-between-parental-drinking-problems-family-functioning-and-child-adjustment/CE508589A9E799FD6DC9E23DF364FB8F">family functioning</a>. <h2>Politicians take note</h2> As we head towards the <a href="https://www.cop28.com">COP28 global climate talks</a> in Dubai, climate change is set to hit the headlines once more. Politicians know climate change is undermining human health and wellbeing. It’s well past time to insist they act. As we have seen for populations as a whole, there are multiple possible ways for climate change to cause a rise in harmful substance use. This means multidimensional <a href="https://www.nature.com/articles/s41558-018-0102-4">prevention strategies</a> are needed. As well as addressing climate change more broadly, we need strategies including: <ul> <li> supporting vulnerable individuals, especially <a href="https://journals.sagepub.com/doi/full/10.1177/21677026211040787">young people</a>, and marginalised commmunities, who are <a href="https://www.nature.com/articles/s41558-018-0102-4">hit hardest</a> by extreme weather-related events </li> <li> focusing health-related policies more on broadscale health promotion, for example, healthier eating, active transport and community-led mental health support </li> <li> investing in climate-resilient infrastructure, such as heat-proofing buildings and greening cities, to prevent more of the destabilising effects and stress we know contributes to mental health problems and harmful substance use. </li> </ul> There is now <a href="https://news.un.org/en/story/2022/10/1129912">no credible pathway</a> to avoiding dangerous climate change. However, if <a href="https://carnegieendowment.org/2023/01/12/climate-protests-tracking-growing-unrest-pub-88778#:%7E:text=These%20are%20just%20a%20few,even%20more%20numerous%20and%20influential.">increasing rates</a> of climate protests are anything to go by, the world may finally be ready for radical change – and perhaps for reduced harmful substance use.<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/217894/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/helen-louise-berry-8608">Helen Louise Berry</a>, Honorary Professor, Centre for Health Systems and Safety Research, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/francis-vergunst-230743">Francis Vergunst</a>, Associate Professor, Psychosocial Difficulties, <a href="https://theconversation.com/institutions/university-of-oslo-934">University of Oslo</a> Image credits: Getty Images 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/5-reasons-why-climate-change-may-see-more-of-us-turn-to-alcohol-and-other-drugs-217894">original article</a>.

Mind

No gavels, no hearsay and lots of drinking: a law expert ranks legal dramas by their accuracy

<a href="https://theconversation.com/profiles/dale-mitchell-1468293">Dale Mitchell</a>, <a href="https://theconversation.com/institutions/university-of-the-sunshine-coast-1068">University of the Sunshine Coast</a> From Elle Woods in Legally Blonde to <a href="https://www.tandfonline.com/doi/abs/10.1080/10383441.2015.1087367">Jennifer Walters in She-Hulk</a>, Atticus Finch in To Kill a Mockingbird to Denny Crane in Boston Legal, our popular culture is often where we first see and witness legal practice. Sometimes this comes via the silver screen, other times television. But it would be wrong to think that all we see on legal television shows is accurate – even when it claims to capture reality. Most legal dramas are terrible at capturing the realities of law. <h2>Not accurate: Law(less) and (dis)Order</h2> Law and Order (1990-) innovated television drama by showcasing both the investigation of a crime by police, and then its prosecution in court. With its multiple spin-offs, including Law and Order: Special Victims Unit (1999-) and the shortlived Law and Order: Trial by Jury (2005-2006) (which had the <a href="https://www.youtube.com/watch?v=aolG65V1Dx8">best theme song of all the series</a>), the Law and Order franchise is a televisual legal juggernaut. <figure><iframe src="https://www.youtube.com/embed/aolG65V1Dx8?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> As with most serials, Law and Order presents the criminal justice system as moving quicker than you can say dun dun. This couldn’t be further from the truth. The mean duration of criminal law matters in Australian higher courts was <a href="https://www.abs.gov.au/statistics/people/crime-and-justice/criminal-courts-australia/latest-release">almost one year</a> (50 weeks) across 2021-22. While <a href="http://classic.austlii.edu.au/au/legis/qld/consol_reg/ucpr1999305/s5.html">procedural rules in civil matters</a> require courts to facilitate the “just and efficient resolution of disputes at minimum expense”, in criminal law, speed and efficiency must not be prioritised over accuracy: a person’s liberty is at stake. Most criminal matters do not proceed to a full trial as an accused will often plead guilty to the charges. As a result, the matter proceeds to sentencing without prosecutors needing to prove the offence. The rates of this occurring are quite alarming. <a href="https://www.abs.gov.au/statistics/people/crime-and-justice/criminal-courts-australia/latest-release">Data across 2021-22</a> reveals over 75% of defendants in Australian courts entered a guilty plea, and almost four in five criminal convictions (79%) resulted from a guilty plea. <a href="https://law.unimelb.edu.au/__data/assets/pdf_file/0009/1705761/32_1_8.pdf">Research suggests</a> defendants plead guilty for a variety of reasons, including to avoid the cost of a trial and to receive a lesser sentence. <a href="https://theconversation.com/pandemic-pushed-defendants-to-plead-guilty-more-often-including-innocent-people-pleading-to-crimes-they-didnt-commit-165056">Data from the United States</a> suggests the pressures of the pandemic led to innocent people pleading guilty to crimes they didn’t commit. If Law and Order was a more accurate reflection of criminal law, matters would proceed immediately to sentencing due to guilty pleas. And should an accused be found guilty, a chunk of their sentence would be reduced by time served awaiting trial. <figure><iframe src="https://www.youtube.com/embed/60GV5lv8h3o?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>Not accurate: Suits</h2> Suits (2011-19) centres around law firm partner Harvey Specter (Gabriel Macht) and his mentorship of Mike Ross (Patrick Adams) – the “lawyer” who never graduated law school and provides legal advice thanks to his photographic memory. This is, obviously, a brutal ethical breach for all involved, and clearly fraud. In Australia, law students who present themselves to be lawyers are <a href="https://www.abc.net.au/news/2016-09-07/law-graduate-jacob-reichman-fined-posing-solicitor-gold-coast/7824324">subject to sanctions</a> by the Legal Services Commission. They can <a href="https://www.lawyersweekly.com.au/biglaw/35821-fake-lawyer-cops-suspended-jail-sentence">cause harm to clients</a> who have hired their services. And the Legal Admissions Board may <a href="https://www.qlsproctor.com.au/2020/11/chief-justice-wants-answers-before-considering-lawyer-impersonators-bid-to-become-legal-practitioner/">deny their entry</a> into the profession. (Spoilers) Ross is eventually sentenced to two years in prison for this fraud, a similar sentence to <a href="https://www.law.com/thelegalintelligencer/almID/1202786675709/">a recent case in the United States</a>, but he only serves three months before solving a crime and earning early release. More unrealistic than this early release is that Ross does fairly quickly thereafter gain admission to the profession, which seems unlikely to occur so soon after such an act of fraud. While Suits has left its mark(le) on the popular imagination of law, it fails to address one of the primary duties of civil litigation: the duty of disclosure. The MacGuffin-ing of law is common in TV serials. It’s the “smoking gun” found on the day of the trial, or for the lawyers in Suits, the random document which shows up during the trial to turn the case - dramatically presented by our protagonists as they flail into court armed with this data sans ethics. This is not quite accurate. In adversarial legal systems like Australia, New Zealand, the UK and the US, civil litigation rules <a href="http://classic.austlii.edu.au/au/legis/qld/consol_reg/ucpr1999305/s211.html">require parties</a> to disclose to one another all documents in their possession or control which are directly relevant to a matter in dispute. This is a continuing duty, so if you discover such a document at any time during the case, it must be disclosed. While <a href="http://classic.austlii.edu.au/au/legis/qld/consol_reg/ucpr1999305/s212.html">exceptions</a> based on various privileges may apply, this essentially means civil litigation must be run in an “all cards on the table” manner. Randomly producing undisclosed material at trial requires the leave of the court and may result in orders of contempt and <a href="http://classic.austlii.edu.au/au/legis/qld/consol_reg/ucpr1999305/s225.html">cost penalties</a>. It’s not like the lawyers of Suits have ever really been concerned about ethics, though. <figure><iframe src="https://www.youtube.com/embed/wUh9jomHZp4?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>Not accurate: How to Get Away with Murder(ing rules of evidence)</h2> While most lawyers would support making it a criminal offence to critique Viola Davis, How to Get Away with Murder (2014-20) presents one of the most common offences within legal dramas: the haphazard approach to rules of evidence. Annalise Keating (Davis) and her ragtag team of morally illiterate law students (although I never see them studying?!?!) manipulate people to obtain evidence and then dramatically prompt witnesses on the stand to read this information into the record, or otherwise “sneak” it into the trial. This is not accurate. And it ignores the basic reality that so much of legal practice is about not just obtaining evidence, but ensuring that evidence is admissible in court. One of the most important rules of evidence deals with <a href="http://classic.austlii.edu.au/au/legis/cth/consol_act/ea199580/s59.html">hearsay evidence</a>. A court cannot allow evidence to be considered if its reliability is unable to be interrogated. Witnesses can only present evidence that they saw, heard or perceived themselves. Unless an exception to the hearsay rule applies, such evidence would be inadmissible. Like in Suits, these approaches to presenting evidence may have serious implications. This poor trial management results in <a href="https://www.aic.gov.au/sites/default/files/2020-05/rpp074.pdf">delays to criminal trials.</a>. <figure><iframe src="https://www.youtube.com/embed/rMB_Gw5-T-I?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>Accurate: Fisk</h2> Fisk (2021-) follows Helen Tudor-Fisk (Kitty Flanagan), an established contract lawyer whose personal dramas lead her to move to the boutique Melbourne probate law firm of Gruber and Gruber (played by Marty Sheargold and Julia Zamero). Fisk excels in showing the importance of lawyer-client relations and the word-of-mouth that sustains much of small legal practice. It’s the anti-Suits, and Fisk is more powerful for it. The discussions of wills and estates and most basic legal principles in Fisk are mostly sound – and the show doesn’t need to get into “legalese” as matters are resolved out-of-court. This is a distinct reality of law: litigation is a last resort. Forms of <a href="https://www.qls.com.au/Practising-law-in-Qld/ADR/Alternative-Dispute-Resolution/Types-of-Alternative-Dispute-Resolution-(ADR)">alternative dispute resolution</a>, including mediation, negotiation and conciliation, have become the primary way of resolving legal disputes. Fuelled by <a href="https://www.ag.gov.au/legal-system/alternative-dispute-resolution/civil-dispute-resolution-act-2011">legislative changes</a> which require the exhaustion of alternative dispute resolution measures before proceeding to litigation, and a pursuit of reduced costs, the drama of trial is not something anyone should yearn for. <figure><iframe src="https://www.youtube.com/embed/N1Qt0Wo1gGo?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> <h2>Accurate: Rake</h2> Cleaver Greene, a character said to be loosely based on the career of a Sydney barrister, shows us the absolute madness of work as a “<a href="https://nswbar.asn.au/the-bar-association/senior-counsel#:%7E:text=Senior%20counsel%20are%20barristers%20who,a%20QC%20or%20queen's%20counsel.">silk</a>”. Rake excels at showing the reality of law. The show raises interesting and accurate questions of law (yes, it is true there is no <a href="https://opus.lib.uts.edu.au/bitstream/10453/18992/1/2011006119.pdf">explicit offence</a> of cannibalism in New South Wales) and presents Australian court process accurately. Thankfully, there’s not a gavel in sight. <a href="https://www.survivelaw.com/post/941-working-hardly-random-facts-about-the-gavel">Australian courts do not use gavels</a>, and their presence in legal dramas in Australian and UK courts shows a lack of attention to detail. The presence of the gavel as a symbol of justice is <a href="http://www5.austlii.edu.au/au/journals/NSWBarAssocNews/1994/17.pdf">an entirely American invention</a>. <figure><iframe src="https://www.youtube.com/embed/qWWI2EdOssk?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe></figure> Rake is accurate, in part, because the site of drama is rarely the courtroom, but rather Greene’s personal life. The accuracy of that element for law I will leave up to the jury. But with a <a href="https://www.tandfonline.com/doi/abs/10.1080/13218719.2013.822783">2014 study</a> finding 35% of lawyers engaged in hazardous or harmful drinking and another showing <a href="https://www.abc.net.au/news/2019-08-15/study-finds-high-rates-anxiety-depression-in-legal-profession/11412832">high rates of anxiety and depression</a> in the legal profession, the evidence is compelling.<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/212880/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/dale-mitchell-1468293">Dale Mitchell</a>, Lecturer in Law, <a href="https://theconversation.com/institutions/university-of-the-sunshine-coast-1068">University of the Sunshine Coast</a> Image credits: Getty Images 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-gavels-no-hearsay-and-lots-of-drinking-a-law-expert-ranks-legal-dramas-by-their-accuracy-212880">original article</a>.

Legal

Ozempic is in the spotlight but it’s just the latest in a long and strange history of weight-loss drugs

<a href="https://theconversation.com/profiles/laura-dawes-1445353">Laura Dawes</a>, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> Losing weight conveniently, cheaply, safely. That’s been the holy grail of weight-loss ever since 19th century English undertaker and weight-loss celebrity William Banting’s 1863 <a href="https://www.gutenberg.org/files/57545/57545-h/57545-h.htm">Letter on Corpulence</a> spruiked his “miraculous” method of slimming down. Since then, humans have tried many things – diet, exercise, psychotherapy, surgery – to lose weight. But time and again we return to the promise of a weight-loss drug, whether it’s a pill, injection, or tonic. A “diet drug”. The <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674281448#:%7E:text=Childhood%2520Obesity%2520in%2520America%2520traces,problem%2520facing%2520American%2520children%2520today.">history of diet drugs</a> is not a glowing one, however. There have been so many popular drug treatments for excess weight over the years. All, however, have eventually lost their shine and some have even been banned. <h2>Ozempic is a recent arrival</h2> <a href="https://www.novonordisk.com/our-products/our-medicines.html">Ozempic and its sister drug Wegovy</a>, both manufactured by Novo Nordisk, are the latest offerings in a long history of drug treatments for people who are overweight. They contain the same active ingredient – semaglutide, which mimics a hormone, <a href="https://www.sciencedirect.com/science/article/abs/pii/S1544319118303273">GLP-1</a> (glucagon-like peptide-1) that acts on the hypothalamus (the brain’s “hunger centre”) to regulate appetite. As an obesity treatment, semaglutide appears to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573908/">work</a> in part by reducing appetite. These are injections. And there can be <a href="https://www.novonordisk.com.au/content/dam/nncorp/au/en/pdfs/Ozempic-1mg-cmi-v3.0.pdf%22%22">side effects</a>, most commonly nausea and diarrhoea. Although marketed as treatments for chronic obesity and diabetes, they have <a href="https://www.forbes.com/health/body/ozempic-for-weight-loss/#footnote_1">exploded in popularity</a> as diet drugs, largely thanks to social media. This has helped drive a <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#:%7E:text=Why%2520the%2520Ozempic%2520shortage%2520happened,label%2520prescribing%2520for%2520weight%2520loss.">shortage of Ozempic</a> for diabetes treatment. <h2>From ‘gland treatment’ to amphetamines</h2> But Ozempic is not the first weight-loss drug. For example, organotherapy (gland treatment) was <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674281448#:%7E:text=Childhood%20Obesity%20in%20America%20traces,problem%20facing%20American%20children%20today.">hugely popular</a> in the 1920s to 1940s. It rode on a wave of enthusiasm for endocrinology and specifically the discovery that “ductless glands” – such as the thyroid, pituitary and renal glands – secreted chemical messengers (or “hormones”, as they came to be known). These hormones coordinate the activities and growth of different parts of the body. Doctors prescribed overweight people extracts of animal glands – either eaten raw or dried in pill form or injected – to treat their <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674281448#:%7E:text=Childhood%20Obesity%20in%20America%20traces,problem%20facing%20American%20children%20today.">supposedly “sluggish glands”</a>. For slaughterhouse companies, this was a lucrative new market for offal. But organotherapy soon fell from favour. There was no evidence excess weight was usually caused by underperforming glands or that gland extracts (thyroid in particular) were doing anything other than <a href="https://my.clevelandclinic.org/health/diseases/21741-thyrotoxicosis">poisoning you</a>. <a href="https://nyupress.org/9780814776391/on-speed/">Amphetamines</a> were first used as a nasal decongestant in the 1930s, but quickly found a market for weight-loss. Why they worked was complex. The drug operated on the hypothalamus but also had an effect on mental state. Amphetamine is, of course, an “upper”. The theory was it helped people feel up to dieting and gave pleasure not found on a plate. Amphetamines too, <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2007.110593">fell from treatment use</a> in the 1970s with Nixon’s “war on drugs” and recognition they were addictive. <h2>Another decade, another drug</h2> Each decade seems to produce its own briefly popular weight-loss drug. For example, the popular <a href="https://www.nytimes.com/1997/09/23/science/how-fen-phen-a-diet-miracle-rose-and-fell.html">diet drug</a> of the 1980s and 90s was fen-phen, which contained appetite suppressants fenfluramine and phentermine. During the height of its craze, vast numbers of users testified to dramatic weight loss. But after users experienced heart valve and lung disease, fen-phen was <a href="https://pubmed.ncbi.nlm.nih.gov/9688104/">withdrawn</a> from the market in 1997. Its producer allocated a <a href="https://www.bloomberg.com/news/articles/2012-08-23/pfizer-asks-end-to-fen-phen-suits-linked-to-lung-ailment">reported US$21 billion</a> to settle the associated lawsuits. The hormone <a href="https://www.webmd.com/obesity/features/the-facts-on-leptin-faq">leptin</a> aroused excitement in the mid-1990s. Leptin seemed, for a brief moment, to hold the key to how the hypothalamus regulated fat storage. Pharmaceutical company Amgen <a href="https://www.science.org/doi/10.1126/science.7732366">wagered millions</a> buying the <a href="https://pubmed.ncbi.nlm.nih.gov/30532682/">rights</a> to the research in the hope this discovery could be turned into a treatment, only to discover it didn’t translate from mice into people. Far from not having enough leptin, people with obesity tend to be <a href="https://www.healthline.com/nutrition/leptin-101">leptin-resistant</a>. So taking more leptin doesn’t help with weight-loss. Amgen <a href="https://news.harvard.edu/gazette/story/2009/01/obesity-reviving-the-promise-of-leptin/">sold</a> the rights it had paid so much for. <a href="https://www.healthline.com/nutrition/ephedra-sinica">Ephedra</a> was popular as a weight-loss treatment and as a stimulant in the 1990s and 2000s, finding buyers among athletes, body builders and in the military. But the US Food and Drug Administration <a href="https://ods.od.nih.gov/HealthInformation/Ephedra.aspx">banned</a> the sale of dietary supplements containing ephedra in 2004 after it was linked to <a href="https://www.nejm.org/doi/full/10.1056/nejmc1502505">health problems</a> ranging from heart attacks and seizures to strokes and even death, and in Australia ephedra is <a href="https://www.legislation.gov.au/Details/F2023L00864">prescription-only</a>. Now we have Ozempic. Just because the history of diet drugs has <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362858/">been so dire</a>, we shouldn’t jump to conclusions about new ones – Ozempic is not a drug of the 1920s or 1960s or 1990s. And as <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674281448#:%7E:text=Childhood%2520Obesity%2520in%2520America%2520traces,problem%2520facing%2520American%2520children%2520today.">history recognises</a>, multiple complexities can combine to push a drug into popularity or damn it to history’s rubbish bin. These include patients’, physicians’ and industry interests; social attitudes about drug treatment; evidence about safety and efficacy; beliefs and knowledge about the cause of excess weight. One noticeable contrast with past diet drug experiences is that now, many people are <a href="https://www.nytimes.com/2022/11/22/well/ozempic-diabetes-weight-loss.html">happy to talk</a> about using Ozempic. It seems to be increasingly socially acceptable to use a drug to achieve weight-loss for primarily aesthetic reasons. (Due to Ozempic shortages in Australia, though, doctors have been <a href="https://www.tga.gov.au/safety/shortages/medicine-shortage-alerts/ozempic-semaglutide-supply-update">asked</a> to direct current supplies to people with type 2 diabetes who satisfy certain criteria. In other words, it’s not really meant to be used just to treat obesity). <h2>Our enduring search for weight-loss drugs</h2> Ozempic is predicted to earn Novo Nordisk <a href="https://www.pharmaceutical-technology.com/comment/novo-nordisk-ozempic/">US$12.5 billion this year alone</a>, but it’s not just industry interests stoking this enduring desire for weight-loss drugs. Patients on an endless cycle of dieting and exercise want something more convenient, with a more certain outcome. And doctors, too, want to offer patients effective treatment, and a drug prescription is a workable option given the constraints of appointment times. The body positivity movement has not yet ousted anti-fat bias or stigma. And despite <a href="https://www.who.int/teams/health-promotion/enhanced-wellbeing/first-global-conference">decades of recognition</a> of the major role our physical and social environment plays in human health, there’s little political, public or industry appetite for change. Individuals are left to personally defend against an obesogenic environment, where economic, cultural, social, health and urban design policies can conspire to make it easy to gain weight but hard to lose it. It is no wonder demand for weight-loss drugs continues to soar.<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/209324/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/laura-dawes-1445353">Laura Dawes</a>, Research Fellow in Medico-Legal History, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> Image credits: Shutterstock 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/ozempic-is-in-the-spotlight-but-its-just-the-latest-in-a-long-and-strange-history-of-weight-loss-drugs-209324">original article</a>.

Body

Promising Alzheimer’s drug offers hope for a bright future in treatment

A remarkable and significant breakthrough in the fight against Alzheimer’s disease is ushering in a new era of hope and possibilities for patients grappling with early onset dementia. Scientists and researchers are celebrating this groundbreaking development, viewing it as a tremendous opportunity to transform the landscape of Alzheimer's treatment. The drug in question, donanemab, developed by Eli Lilly, has shown remarkable success in clinical trials and is anticipated to receive approval from the Food and Drug Administration later this year, according to a report in the <a href="https://nypost.com/2023/07/17/alzheimers-drug-donanemab-lowers-risk-of-dementia/" target="_blank" rel="noopener">New York Post</a>. Individuals who participated in the donanemab trials experienced a remarkable 40% reduction in the risk of transitioning from mild cognitive impairment to mild or moderate dementia. This is an extraordinary advancement that brings renewed optimism to those affected by this devastating condition. Donanemab would be the third Alzheimer’s drug to emerge in recent months, following the introduction of Leqembi and Aduhelm. This is just the beginning of an exciting new chapter in the realm of molecular therapies for Alzheimer's, as expressed by Dr. Gil Rabinovici, director of the University of California San Francisco’s Memory and Ageing Centre, in an editorial for JAMA. Dr. Daniel Skovronsky, the chief scientific and medical officer at Lilly, has emphasised the significance of this breakthrough. He states, "This will be a very important and meaningful drug," as quoted in Fierce Biotech. Skovronsky further adds, "[T]here’s a huge opportunity here for patients." Such resolute optimism is inspiring, reflecting the tremendous potential this drug holds for transforming lives. Similar to Leqembi and Aduhelm, donanemab is a monoclonal antibody designed to target plaque in the brain, specifically the amyloid protein. These amyloid plaques are responsible for the propagation of another protein called tau, which contributes to the development of Alzheimer's disease. Notably, the donanemab trial also revealed that the drug slowed cognitive decline by an impressive 35% compared to a placebo in individuals with low to intermediate levels of tau protein in the brain. In fact, donanemab demonstrated superior efficacy in clearing amyloid plaques when compared to Aduhelm and Leqembi. Moreover, unlike Leqembi, which necessitates long-term usage, patients taking donanemab may follow a fixed-duration dosing schedule, potentially allowing some individuals to discontinue the treatment after a certain period. "I expect that many patients will be able to stop dosing even as soon as 12 months," Skovronsky affirmed. This stands as a significant departure from being prescribed a lifelong medication, providing an exciting and meaningful prospect for patients. While it is important to note that these new Alzheimer’s drugs do carry limitations and risks, medical experts remain cautiously optimistic. Donanemab, along with the other emerging drugs, has been associated with brain swelling and bleeding. Tragically, three individuals in the donanemab clinical trial lost their lives due to these side effects. The risk of brain swelling and bleeding is heightened among those carrying the APOE4 gene, which is associated with an increased susceptibility to Alzheimer’s. Furthermore, individuals with more advanced stages of the disease showed minimal to no benefit compared to those who received a placebo. As a result, it is possible that donanemab will be recommended primarily for individuals with low to intermediate levels of tau proteins, indicating milder forms of the disease. Nevertheless, Skovronsky and other medical experts maintain their optimism regarding the FDA's approval, expressing the urgent need for it to come to fruition. Skovronsky highlights, "Every day that goes by, there are some patients who pass through this early stage of Alzheimer’s disease and become more advanced, and they won’t benefit from treatment. That’s a very pressing sense of urgency." While challenges and risks remain, the emergence of donanemab and its potential approval by the FDA represents a beacon of hope for the millions of individuals and families affected by Alzheimer's disease. It symbolises the start of a new chapter in the fight against this debilitating condition, offering renewed prospects for a brighter future filled with effective treatments and improved quality of life. Image: Shutterstock

Mind

Why can’t I use my phone or take photos on the airport tarmac? Is it against the law?

<a href="https://theconversation.com/profiles/doug-drury-1277871">Doug Drury</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Mobile phones are not allowed to be used while on a plane because they can interfere with the aeroplane’s navigation instruments and <a href="https://theconversation.com/heres-the-real-reason-to-turn-on-aeroplane-mode-when-you-fly-188585">cause various safety and social issues</a>. As soon as the plane lands, we’re permitted to turn off flight mode, but at some airports we can’t get much of a signal. That’s because airports are known as mobile signal “<a href="https://thepointsguy.com/news/slow-connection-airport-tarmacs/">dead zones</a>” due to a lack of mobile towers – they can’t be placed at the airport itself due to height restrictions. Any nearby mobile towers would be located away from the airport’s runway systems to avoid interfering with the aeroplane’s flight path, especially take-off and landing direction. Most airports put up indoor repeater antennas within the airport terminal; these help increase the mobile signal strength coming from the nearest mobile tower somewhere near the airport. But you won’t be allowed to make calls while walking away from the plane, anyway. <h2>Why can’t I use my phone on the tarmac?</h2> As we are taxiing in, the <a href="https://www.qantas.com/au/en/qantas-experience/onboard/communication.html">cabin crew</a> remind us not to smoke outside of designated areas at the terminal and not to use our mobile phones until we are inside the terminal building. If you exit the plane down the rear stairs, why aren’t you allowed to use your phone once away from the aeroplane, if you can get a signal? Surely it won’t affect navigation. The answer is manifold, and regulations aren’t the same across the world. In Australia, a <a href="https://www.casa.gov.au/operations-safety-and-travel/travel-and-passengers/onboard-safety-and-behaviour/using-your-electronic-devices-flights">government regulation</a> prohibits the use of mobile phones on the tarmac – the aeroplane movement and parking area of the airport. You won’t be fined if you whip your phone out while walking to the terminal, but the airline may admonish you for not following the rules. However, if you decide to (<a href="https://www.smh.com.au/national/victoria/woman-arrested-after-running-onto-tarmac-at-melbourne-airport-20151125-gl7bkq.html">run around on the tarmac</a>, you could get arrested by federal police. The airport tarmac is very busy not just with aircraft, but also baggage carts, catering trucks, aeroplane waste removal trucks, and fuel trucks. Getting passengers off the tarmac and into the terminal building quickly and safely is a priority for the staff. If you are distracted while walking to the terminal building because you’re talking on your phone, it can be <a href="https://www.theguardian.com/us-news/2023/jan/25/alabama-airport-worker-killed-jet-engine-safety-warnings">highly dangerous and even deadly</a> if you end up too close to an operating plane. An operating jet engine is extremely hot and has a strong exhaust. Additionally, the front of the engine has a low-pressure area called an <a href="https://www.ukfrs.com/guidance/search/aircraft-systems-and-construction">ingestion zone</a> that can suck in a person. Ground staff are trained to stay at least ten metres away from this area. However, this information is not shared with the passengers. <h2>A myth about fuel</h2> You may have heard that mobile phones are a fire hazard near fuel, and aeroplanes are, of course, refuelled on the tarmac. However, the chances of fuel catching fire during this process are extremely low, because the refuelling truck is <a href="https://safetyfirst.airbus.com/safe-aircraft-refuelling/">bonded and “grounded” to the plane</a>: the operator attaches a wire to the aircraft to move built-up static electricity to the ground to prevent any chance of a spark. <figure class="align-right zoomable"><figcaption></figcaption></figure> There have been stories in the press about mobile phones sparking <a href="https://www.verizon.com/about/news/vzw/2014/12/fact-or-fiction-using-a-cell-phone-at-the-gas-station-can-cause-a-fire">fires at petrol stations in Indonesia and Australia</a>, but these turned out to be inaccurate. There is <a href="https://www.nfpa.org/assets/files/AboutTheCodes/30A/FI%20-%20NFPA%2030A-2015%20Para%208.3.1%20-%20Attachments%2014-19.2017-04-04.pdf">no evidence a phone can spark a fire at a fuel pump</a>, despite the warning labels you might see. Either way, the chances of a mobile phone causing this on the tarmac with a refuelling truck that is grounded to the aeroplane are extremely low, not least because the passenger permitted areas and refuelling areas are completely separated. <h2>Why are we told not to take photos on the tarmac?</h2> This rule varies from airport to airport depending on their <a href="https://www.tsa.gov/travel/frequently-asked-questions/can-i-film-and-take-photos-security-checkpoint">security processes</a>. Such restrictions are carryovers from the changes to airport security following the <a href="https://heinonline.org/HOL/P?h=hein.journals/jlecono50&i=739">September 11 2001 terrorist attacks</a>. The now federalised security teams, TSA (Transportation Security Administration) in the United States and the Department of Home Affairs in Australia, change their processes frequently to prevent having any identifiable patterns that could be used to create a security breach. The increased security measures also mean new technologies were introduced; airport security sections do not want photos taken of how they operate. The airport security process is a major choke point in the flow of passenger movement due to the screening process. If a passenger is perceived to be slowing the process down by taking photos or talking on their phone, they will be reminded to turn off their device and/or stop taking photos of security personnel and equipment. If you refuse to follow the rules of the screening process, you will be <a href="https://www.homeaffairs.gov.au/about-us/what-we-do/travelsecure/passenger-screening">denied entry</a> into the airport terminal gate area and miss your flight. Can you also get arrested for using your phone? Depends on the airport and country. I, for one, do not want to find out.<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/207926/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/doug-drury-1277871">Doug Drury</a>, Professor/Head of Aviation, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Image credits: Getty Images 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/why-cant-i-use-my-phone-or-take-photos-on-the-airport-tarmac-is-it-against-the-law-207926">original article</a>.

Travel Tips

Wacky pet laws that will make you laugh

There are laws to protect people from harm, animals from cruelty and to keep the animal-human relationship harmonious. But then there are those wacky laws that will make you scratch your head and wonder how they became laws in the first place. 1. In some areas of Oklahoma dogs must have a permit signed by the mayor in order to congregate in groups of three or more on private property. 2. In Chicago, you cannot bring your French poodle to the opera. 3. In Berea, Ohio, any pet that goes out after dark must wear a tail light. 4. In Creskill, New York, all outside cats must wear three bells to warn birds of their approach. 5. In Madison, Wisconsin dogs are forbidden from harassing squirrels in the public park next to the capital. 6. In Denver Colorado an animal control officer must notify dogs of any impending impounds three days before it’s due to happen. They do this by posting notices on trees in the public parks and along the road running next to the park. 7. In Memphis, Tennessee, if a frog's croaking keeps you awake at night, you can have that frog arrested. 8. In Turin, Italy owners can be fined up to $650 for not walking their dog at least three times a day. 9. In Reed City, Michigan, you cannot own a pet cat and bird simultaneously. 10. In French Lick Springs, Indiana, all black cats must wear bells on Friday the 13th. 11. In certain areas of Oklahoma it is against the law to make “ugly” or “mean” faces at a dog. 12. In Honolulu, Hawaii, it’s unlawful to annoy birds at any public park. Image credit: Shutterstock

Legal

Advice on dealing with tricky in-laws

From heated discussions to awkward family dinners, your relationship with your in-laws can have a big impact on family time. Here’s how to navigate this sometimes tricky dynamic. There’s nothing worse than heading to a family engagement when you have a son-in-law (or your daughter’s parents-in-law) that you just don’t get along with. Whether there's been a fight that you haven’t been able to move on from, or you simply don’t get along, if you find your in-laws draining or annoying, you may need to change the boundaries. Do you know the old saying, “good fences make good neighbours”? Think of your in-laws like your neighbours – there needs to be really good fences (aka boundaries) in place for the relationship to run smoothly. The best way to go about this is in such a way that you don’t make anyone feel as though you're closing them out, but rather comes off that you are simply focussing on yourself and things you have going on. Once you’ve set boundaries, don’t be afraid to talk to your family and in-laws about them, they’re not as fragile as you think. But do choose your words carefully and keep the focus on you and what your needs are, rather than making any judgements or comments about them or their behaviour. Still not sure how to deal with your son, daughter, sister or brother in-law? Here are some top tips for setting boundaries and dealing with awkward situations: <ol> <li>The person with the primary relationship (for example your daughter, not your son-in-law) should be the one to step in and help fix a problem if it arises. You should never be the messenger or go straight to an in-law. Gently raise the issue or concern with your immediate family member. </li> <li>Decide with your partner, or in your own time if you are single or widowed, what type of role you want your in-law/s to play in your life. If you don’t get along and spending time with them just seems to cause issues, then you might want to limit catch-ups to birthdays and big events. This is ok. Just be gentle if asked to explain. And keep your explanation brief and about you. Something along the lines of, my schedule is quite busy at the moment or I don’t feel up to going out too much, but I am looking forward to the next family get together. </li> <li>Never criticise your family for their relationship with his or her spouse/your in-laws, nor comment on your in-law to your immediate family member – for example don’t criticise your son-in-law to your daughter/his wife. This tends to only lead to complications and awkwardness. And remember, you only know what your daughter tells you and if they come to you everytime they’re upset or angry with their partner or their partner’s extended family, you’re only hearing the problems when your daughter is frustrated and upset. You might not hear all the good things and about when they make up. Don’t take these things on board and stay out of it by reserving any judgement or comments. </li> <li>Don’t get involved. Easier said than done, right? You have to trust that you have brought your children up right and they are responsible enough to navigate their own relationships, treat others respectfully and can stand up for themselves if need be. As such, you should not get involved in their issues, arguments and general day-to-day dealings with their other relationships. Stay on the peripheral, be there for some light guidance if need be, but ultimately you should just help them come to their own opinions, decisions and judgements on things rather than sharing your ones with them. </li> <li>Don’t get pulled into arguments by your child and in-law. You can be supportive and still let the couple handle their own problems. Take a step back and trust that you have raised an adult who has the vision and the courage to resolve the problems that concern his/her own family. Couples need to set boundaries for their own relationships and this can, as I am sure you know, take some time to find the right ones. </li> <li>Think of yourself as a guest. When spending time with family in big groups, and especially when you’re at someone else’s home, it is best to think of yourself as a guest and act accordingly. For example you may not like the way you son’s wife is doing things in her home (child rearing, cooking, cleaning etc), but unfortunately it is not really any of your business. This is between your son and his wife. A good checkpoint is to ask yourself if you have a sense of entitlement and expectancy that is inappropriate. If there are issues that you just can’t stand but can’t let go, then you may need to consider not visiting them.</li> </ol> Image credits: Getty Images

Family & Pets

"Makes me vomit": Richard Dreyfuss slams new Hollywood diversity laws

Richard Dreyfuss has taken a stand against new diversity laws that will come into affect at next year's Oscars, saying the new rules make him "vomit". The legendary actor condemned the change to the standards, claiming the laws are trying to legislate people's feelings. Appearing on PBS show Firing Line with Margaret Hoover, a fired-up Dreyfuss said, “This is an art form. It’s also a form of commerce, and it makes money. But it’s an art.” “And no one should be telling me as an artist that I have to give in to the latest, most current idea of what morality is.” Mr Dreyfuss, who famously played Matt Hooper in the 1975 horror film Jaws, went on to say that minorities should not be "catered to" in the arts, but rather awards given based on merit. “What are we risking? Are we really risking hurting people’s feelings? You can’t legislate that. And– you have to let life be life. And I’m sorry, I don’t think that there is a minority or a majority in the country that has to be catered to like that,” he said. With the rules set to come into effect in 2024, a film will have to meet certain diversity and inclusion standards in four different categories set out by the Academy of Motion Picture Arts and Sciences to be considered for “Best Picture” at the Oscars. The categories, each pertaining to different aspects of a movie’s production, would require new diversity measures to be met through “On-screen Representation,” “Creative Leadership and Project Team,” “Industry Access and Opportunities,” and “Audience Advancement.” “On-screen Representation” is classified as at least one lead character from an under-represented racial or ethnic group, which the Academy defines as women, people of colour, people who identify as LGBTQ+ or people with disabilities, with the new standards meant to encourage diversity on and off the screen. Dreyfuss continued his rant about the new standards, saying the rules will limit what roles actors are able to take, and simply described outdated racist ideals as forms of "art". “Am I being told that I will never have a chance to play a black man? Is someone else being told that if they’re not Jewish, they shouldn’t play the Merchant of Venice? Are we crazy? Do we not know that art is art? This is so patronising. It’s so thoughtless, and treating people like children.” Image credits: Getty Images

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Woman baffled by mother-in-law’s insane ask over baby name

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

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

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

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

Does the royal family have a right to privacy? What the law says

“My sister-in-law announced she was pregnant at my child’s funeral”

Mother bans in-laws from seeing her baby after they go against her wishes

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

"I was terrified": Law & Order star reveals traumatic past

Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria

Drug resistance may make common infections like thrush untreatable

5 reasons why climate change may see more of us turn to alcohol and other drugs

No gavels, no hearsay and lots of drinking: a law expert ranks legal dramas by their accuracy

Ozempic is in the spotlight but it’s just the latest in a long and strange history of weight-loss drugs

Promising Alzheimer’s drug offers hope for a bright future in treatment

Why can’t I use my phone or take photos on the airport tarmac? Is it against the law?

Wacky pet laws that will make you laugh

Advice on dealing with tricky in-laws

"Makes me vomit": Richard Dreyfuss slams new Hollywood diversity laws

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Travel

Health

Lifestyle

Finance

Entertainment

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Woman baffled by mother-in-law’s insane ask over baby name

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

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

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

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

Does the royal family have a right to privacy? What the law says

“My sister-in-law announced she was pregnant at my child’s funeral”

Mother bans in-laws from seeing her baby after they go against her wishes

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

"I was terrified": Law & Order star reveals traumatic past

Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria

Drug resistance may make common infections like thrush untreatable

5 reasons why climate change may see more of us turn to alcohol and other drugs

No gavels, no hearsay and lots of drinking: a law expert ranks legal dramas by their accuracy

Ozempic is in the spotlight but it’s just the latest in a long and strange history of weight-loss drugs

Promising Alzheimer’s drug offers hope for a bright future in treatment

Why can’t I use my phone or take photos on the airport tarmac? Is it against the law?

Wacky pet laws that will make you laugh

Advice on dealing with tricky in-laws

"Makes me vomit": Richard Dreyfuss slams new Hollywood diversity laws

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