Refeeding Syndrome — Cure Worse Than Condition

The commonality amongst all kinds of starvation, whether unavoidably imposed or intentional, is that a person cannot simply start eating normally again. This is due to the condition called refeeding syndrome, which is characterized, if the word can even be used for such a general purpose, by “a wide range of symptoms and a lack of clear diagnostic criteria.”

Consequently, although various recommendations have been made for the management of refeeding syndrome, they “remain controversial due to a lack of objective data and quantification standards.”

Who gets refeeding syndrome? Anyone who receives increased nutrition after a prolonged experience of starvation, and this includes a lot of people because there are plenty of “populations at high risk for malnutrition.” Whatever the cause of their malnutrition, they can’t just start randomly and heedlessly eating again. Immediately following World War II, this problem was dramatically apparent among certain populations…

[…] when individuals living during the famine unexpectedly became ill following nutritional reconstitution. In 1951, Schnitker et al reported that one-fifth of Japanese prisoners starved in prison camps died suddenly after nutritional and vitamin replenishment.

The lack of food in a concentration camp or POW camp is not the only possible cause of malnutrition. Even in peacetime, ordinary citizens may be in this kind of trouble for a number of reasons. In some cases, they may experience malnutrition because of inflammatory bowel disease and other conditions that impede the absorption of nutrients.

Poorly controlled diabetes is another possible cause, as well as cancer-related conditions; inadequate post-operative recovery; undergoing dialysis because of renal failure; chronic alcoholism; extreme weight loss from a starting point of morbid obesity; or suffering from an eating disorder.

Kids with problems

That last cause is where the topic intersects with childhood obesity, because teenagers trying to be thin can kill themselves by developing refeeding syndrome with its consequent “electrolyte and metabolic disturbances that manifest in cardiopulmonary, hematologic, and neurological dysfunction.” This is just a rough outline of what can happen when nutrition is replenished carelessly: Glucose levels, rise, followed by insulin levels…

[…] which then drive phosphorus and potassium intracellularly, causing a decrease in the amount of available extracellular potassium or hypokalemia… This increase in insulin and the effects on electrolyte migration (intracellular vs. extracellular) are compounded by nutritional electrolyte deficiencies.

The many and varied effects on the body of being fed after starvation include potentially fatal conditions with exotic names like torsades de pointes and Wernicke-Korsakoff encephalopathy. Because there is so much going on, treatment requires not just a doctor or a hospital bed, but an entire interprofessional team.

A WebMD article by multiple authors also asserts that “malnutrition has serious health consequences” and provides a list of ten of them, including paralysis and cardiac arrest, and also affirms that the cure for it, “refeeding syndrome is a life-threatening complication… without swift treatment, refeeding syndrome can result in death.” According to the article,

You will need to be admitted to the hospital, and doctors will prescribe a special formula of artificial nutrients to replenish your body. This process is called refeeding. You’ll get the artificial nutrients by mouth or through a tube.‌..

During refeeding, your metabolism can start to overproduce insulin, which triggers your body to synthesize protein and produce fat. The process can monopolize the electrolytes in your body. You don’t get sufficient electrolytes to your organs and this results in organ system problems.

A Cleveland Clinic website goes into more detail, naming phosphate deficiency (hypophosphatemia) which can manifest in a number of harmful ways. Or the person might experience a magnesium deficiency, which brings its own list of problems. Or a shortage of potassium or thiamine, adding such possibilities as delirium and amnesia.

Then, there are dehydration and blood sugar maladjustments. Ominously, one risk factor that could lead to refeeding syndrome is “recent loss of more than 10% of your body weight.” This fact might need special attention in light of the recent popularity of miracle weight-loss drugs.

The Cleveland Clinic notes,

Refeeding syndrome is a complication of treatment for malnourishment. This is already a stressful condition for your body to endure. It may seem counterintuitive, but too much cure too quickly can be harmful. Refeeding is a delicate and complex process. Ideally, it should be medically supervised. During medical refeeding, your healthcare team will monitor you closely. They’ll work to prevent refeeding syndrome and will be prepared to manage it if needed.

In other words, with refeeding syndrome, the cure can literally be worse than the condition. It can be so bad that medical personnel would much prefer to avoid and prevent it, and not have to reach the point of needing to treat it.

Your responses and feedback are welcome!

Source: “Refeeding Syndrome,” NIH.gov, 11/07/22
Source: “Refeeding Syndrome,” WebMD.com, 07/19/23
Source: “Refeeding Syndrome,” ClevelandClinic.org, undated
Image by Emilio Labrador/Attribution 2.0 Generic

Almost Half a Ton, Continued

Katie Peterson realized she needed help, but was trapped in the old catch-22 known as needing help too much. She had to lose 200 pounds before any medical institution would even consider her case; and was turned away by several facilities, which did not even want to make an appointment to talk it over until those 200 pounds were gone.

The general guidelines to qualify for bariatric surgery would frustrate a saint. As journalist Kati Blocker explained in a meticulously detailed piece for UCHealth.org,

You must have a BMI of 40 or more; or a BMI of 35 or more, plus a serious obesity-related health problem, such as type 2 diabetes, high blood pressure, or sleep apnea.

But at the same time, with all that going on, the patient must be deemed healthy enough to undergo surgery. Also, the doctors require the patient not to be a smoker — which Peterson was. The hopeful patient must have tried other weight-loss methods, like diet and exercise. There is a mandatory psychological exam.

Blocker writes,

Most importantly, you have to be committed to the long-term process of weight loss. By following the post-surgery recommendations, you give yourself the best possible chance to begin successfully.

In 2016, the family encountered both interpersonal and financial difficulties. Katie’s son got in some trouble serious enough to be arrested for. At this point, her lifelong habit of stress eating extended to consuming a bottle of pills all at once. She was hospitalized until a judge had pretty much no choice other than to let her go home, because no mental health facility would take her. She was still too big. Despite periodic talks with a therapist, she reverted to type:

I again stress ate. I was eating this whole time. From when I woke up to when I went to bed, I was eating something.

Although outside pressures eased a bit, Katie was up to 700 pounds and facing even more determined rejection from medical institutions. The math was simple. No 200-pound loss equals no surgery. Her depression did not lift, and the non-stop stress eating continued. But when her son graduated from high school, she felt inspired to look for help again and found an intriguing article online. After filling out a form, she was invited to meet with Dr. Robert Quaid of UCHealth.

The three-hour trip to Colorado involved being loaded into a minivan by half a dozen firefighters, and at Poudre Valley Hospital she weighed in at 890 pounds. This was the occasion of the quotation borrowed for our title:

I was flabbergasted. I couldn’t believe I’d let my life go that far where I was almost half a ton.

Dr. Quaid, the bariatric surgeon, made a treatment plan that would include attempted removal of the lap band, then a sleeve gastrectomy, to be followed around 18 months later by a single anastomosis duodenal switch, and then at some future point the removal of around 100 pounds of “excess tissue and skin.”

To help her attain mental and physical readiness, Peterson was paired up with nurse navigator Michelle Carpenter for ten months of preparatory life changes. In May of 2022, it finally happened. After the very complicated first surgery, she spend five days in the hospital before returning to Wyoming where therapy continued, along with virtual support group attendance and communication with Carpenter. The three-month follow-up visit was good, and by the six-month check-up Peterson had lost 242 pounds since surgery. She was down to 648.

Almost exactly one year ago, journalist Kati Blocker published another follow-up story about Katie Peterson, who had already lost 330 pounds at that point, a considerable improvement from her days of weighing “almost half a ton.” In the meantime, she had been cheered by messages from many strangers who reached out to encourage her and also to express how much she had encouraged them. These include a young man (almost 700 pounds) about whom Kati Blocker also wrote a very recent article.

Your responses and feedback are welcome!

Source: “900 pounds and hopeless:” Katie’s weight-loss story, UCHealth.org, 01/17/23
Source: “From 900 pounds to independence,” UCHealth.org, 11/07/23
Source: “Once nearly 700 pounds, this young man is on the road to better health,” UCHealth.org, 09/19/24
Image by Ian Britton/Attribution-NonCommercial 2.0 Generic

Halloween Tips and Tricks to Minimize the Candy

With Halloween only one day away, let’s take a quick look at the advice pediatric obesity experts are giving to minimize — or at least control — the deluge of candy. Between the parties and trick-or-treating it’s very possible for parents and guardians to lose track of how much candy and processed, unhealthy food the kids are eating.

However, with these tips, parents streamline the fun without having kids overindulge. Yes, much of this advice is obvious — and it’s easier said than to follow — but it’s worth revisiting. In an interview with Fox News Digital, Dr. Dyan Hes, medical director at Concorde Pediatrics of Northwell Health in New York City, along with a few other experts, shared these tips.

Don’t banish all candy, set limits

Dr. Hes rightly pointed out that families that are overly strict about candy consumption can lead to kids sneaking “forbidden food.” Instead, set the limit on how many pieces of candy your child or children can have on Halloween night and any satellite events and parties.

The Fox News Digital article author, Lifestyle Reporter Angelica Stabile writes:

The American Heart Association recommends that kids don’t consume more than 25 grams of added sugar per day.

That’s the equivalent of about four to five mini Milky Ways, three fun-size Snickers or three bags of M&Ms, according to registered dietitian nutritionist Ilana Muhlstein.

“Knowing there’s a clear and fair allotment ahead of time will minimize any friction later on,” the Los Angeles-based expert told Fox News Digital.

“It will also encourage them to prioritize their favorite candies, eat them more slowly and savor them more mindfully,” she went on.

“It’s a great opportunity to demonstrate moderation and balance.”

Dr. Hes also suggests storing leftover candy out of sight after Halloween and give out only two treats max per day (the fewer the better). Even better, donate the candy.

Serve balanced meals

Before trick-or-treating, serve your kids healthy, nutritious food with plenty of veggies, protein, and fiber. You can have fun with it, too, by keeping the Halloween theme throughout. Muhlstein told Stabile:

This will help the kids feel full, balance their blood sugar levels, improve their energy and reduce the likelihood of overindulging in candy later on.

“Treats” don’t have to be just candy

Treats don’t equal only candy. Think about getting or giving out trinkets, stickers, temporary tattoos, toys, and other items.

Muhlstein said:

It’s a great way to help your kids foster a healthy relationship with the holidays, so they see that there are more ways to treat yourself and celebrate, beyond food.

Consider non-candy activities

Whether you are hosting or attending a party, instead of filling up on candy, think about activities that involve movement, like a dance party, a costume fashion show or a contest, or a scavenger hunt. Not into that? Suggest a DIY art project (the internet is full of themed suggestions, with printable instructions and handy materials).

To quote Muhlstein again:

Alternative celebrations like these also help prevent the risks of overindulging in sweets, including upset stomachs, hyperactivity and cavities.

Think about gut health

In his article for The Conversation, gastroenterologist and gut microbiome researcher at the University of Washington School of Medicine Christopher Damman also warns to stay away — or at least limit — sugar-laden treats, choosing more microbiome-friendly offerings:

Not all Halloween treats are created equal, especially when it comes to their nutritional value and effects on gut health. Sugar-coated nuts and fruit such as honey-roasted almonds and candy apples rank among the top, offering whole food benefits just beneath the sugary coating. Packed with fiber and polyphenols, they help support gut health and healthy metabolism.

On the opposite end of the spectrum are chewy treats such as candy corn, Skittles, Starbursts and Twizzlers. These sugar-laden confections are mostly made of high fructose corn syrup, saturated fat and additives. They can increase the unsavory bacterial species in your gut and lead to inflammation, making them one of the least healthy Halloween choices.

Pure chocolate candy, especially dark chocolate, are a better option than candy that contains only a small amount of chocolate (we’re looking at you, Twix, Three Musketeers and Milky Way).

Well, there you have it. Hopefully, armed with this expert advice, you’ll have a fun, safe Halloween! We’ve been discussing and doling out Halloween-related advice on this blog for years, so if you’re interested, just type “Halloween” on our homepage in the search box, and a treasure trove of posts dating years back is all yours!

Your responses and feedback are welcome!

Source: “Halloween candy overload: 5 ways to keep kids from overindulging,” Fox News Digital, 10/28/24
Source: “Halloween candy binges can overload your gut microbiome – a gut doctor explains how to minimize spooking your helpful bacteria,” The Conversation, 10/23/24
Image by Mary Jane Duford on Unsplash

Almost Half a Ton

Is it exploitative to pass along the story of an extremely obese person? How could it be, if the subject voluntarily signs a contract and is appropriately compensated? On the other hand, there have been some TV programs, for instance, that did not really need to be made; some shows centering on obesity which the world could have happily gotten along without.

Before even thinking about spreading some types of news, this is what publishers, editors, and journalists would do well to pause and consider: Does the public really need to be told this story, and if so, why? Are we just going for cheap sensationalism here, or what?

In many cases, however, the motive is obviously sincere. For instance, not long ago journalist Kati Blocker wrote for UCHealth.org a very comprehensive biographical piece about one Katie Peterson, who at age 44 weighed nearly 900 pounds. Raised in a tiny midwestern town, Katie felt chronically stressed by negative emotions caused by traumatic life events. Despite having been adopted as a baby, she was aware of at least some of her genetic medical history, including proneness to obesity and heart disease.

Katie was a chubby baby and a heavy child. She was raised to believe that “it was something you were doing wrong. Obesity was your fault. It wasn’t hereditary. You ate too much.” She told Blocker,

I’ll be the first to say I have a food addiction. But at (a young) age, you don’t want to hear that. I started at age 12 seeing a therapist, my parents telling me there must be some tragic thing that happened for me to eat the way I ate.

In 2001, Katie married her first husband and gave birth to a son. She kept on gaining weight and was up to 646 pounds when she became pregnant again. For that high-risk delivery, she traveled to a neighboring state. A few years later, she traveled to yet another state for lap band surgery. She was able to lose 250 pounds in a year, but still could never get below 400.

Still, she felt pretty good, relative to how things had been. But life happened. There was a divorce, an attempt at college that failed, and another marriage. She met her biological father and began to build a relationship, but he died soon after. Other life reversals and family disasters followed, some of which caused her to feel guilt.

Following the classic tropes of eating the feelings or stuffing them deep inside, her consumption only increased. She says,

I dove into food like it wouldn’t be there anymore. I kept eating large amounts of things. It was horrible.

Blocker described Katie’s very circumscribed life, moving “with help from her then fiancé and her 17-year-old daughter” from the bed to the living room sofa, then back to bed at night. She wrote of her subject,

Like many people with a food addiction, eating made Peterson forget about life, so she’d have half of a pizza rather than a few slices. Chips and dip, cookies, candy — she didn’t care what it was.

Is it universally accepted that an addict just doesn’t care? Is it an immutable truism that a hooked person will ingest or inject anything, led on by even the faintest hope that it will put their head where they want it to be? Just throw any old substance in there, and hope for the best? Is this why so many die from fentanyl?

At any rate, the agony of existence was not purely mental. Carrying around all those pounds caused Peterson constant pain in the back, hips, and legs.

(To be continued…)

Your responses and feedback are welcome!

Source: “900 pounds and hopeless: Katie’s weight-loss story,” UCHealth.org, 01/17/23
Image by Pete Markham/Attribution-ShareAlike 2.0 Generic

A Very Unusual Case

Ed Cara of Gizmodo.com recently reported on a medical situation in Ecuador involving a 24-year-old woman who sought help because of severe stomach pain along with frequent vomiting. Barely able to eat or drink, she had lost a considerable amount of weight.

Upon examination of her midsection, a hard mass could be felt from the outside. During a 45-minute procedure, surgeons removed from the patient’s stomach a compacted two-pound lump of hair whose 16-inch length included an incursion into the small intestine. (Yes, there is a photo). Her doctors estimated that the accumulated hair had been eaten over a period of at least two years.

Hair-pulling disorder, or trichotillomania, is classified as a body-focused repetitive behavior (a topic which Dr. Pretlow has addressed) and also as a mental health condition. Although the head is most often involved, a sufferer might pluck hair from any part of the body. There may be a ritualistic element, like choosing a certain hair that feels just right. Victims describe the urge to pluck hairs as irresistible, and they are often impelled to bite, chew, or even swallow the extirpated hair.

Hair-pulling may relieve negative feelings or even generate positive ones. An internal conflict or other psychological, or emotional issue is always presumed to be involved. The habit usually shows up between the ages of nine and 13, and some people coexist with it throughout their lives. It is unlikely to just go away, and an ignored, untreated hairball that causes intestinal blockage can be fatal.

The childhood obesity connection

Trichotillomania is often classified as a co-occurring disorder, which means that it typically develops along with another illness; chiefly anorexia, bulimia, or binge eating. Consequently, the two disorders must both be treated at the same time:

[O]ptions for treating both of these conditions include psychosocial methods, such as the use of cognitive-behavioral methods, as well as the utilization of medications. Ideally, all implemented strategies for addressing these issues should be under the guidance of a comprehensive treatment team of eating disorder specialists.

Along with psychological and behavioral therapy, SSRI drugs may help, though no specific drug to knock out trichotillomania has been discovered or developed. This condition has been seen often enough that the compacted mass of hair removed from the Ecuadorian woman and similar patients has a name: It is a bezoar.

The term, referring to any indigestible mass found in an animal’s gastrointestinal system, has ancient connotations. Historically, a bezoar was valued for its alleged curative power, for instance as an antidote to the poison that an enemy had dropped into one’s goblet. A bezoar could typically be worth several times its weight in gold, and might be embellished with precious metals and jewels. But a person unable to afford their own could rent an unadorned bezoar (or a fake one, made of polished stone) from the local alchemist.

Your responses and feedback are welcome!

Source: “Doctors Pulled a 2-Pound Hairball From a Woman’s Stomach,” Gizmodo.com, /07/19/24
Source: “Trichotillomania (hair-pulling disorder),” MayoClinic.org, undated
Source: “Trichotillomania and Eating Disorders,” EatingDisorderHope.com, 06/12/12
Images by Dr. Alexey Yakovlev and Gee Hair/Attribution-ShareAlike 2.0 Generic

How Thinking on Obesity Has Shifted Over Time

Over the years, the way society thinks about obesity has undergone a profound transformation. What was once viewed as a simple issue of personal responsibility has now evolved into a more nuanced understanding of a complex, chronic condition influenced by various factors beyond individual control. This shift in thinking has far-reaching implications for public health, healthcare, and the well-being of individuals living with obesity.

From personal failure to a complex condition

For much of recent history, obesity was seen as the result of poor lifestyle choices — too much food and too little exercise. It was commonly viewed as a moral or personal failing, with public health campaigns often focusing on slogans like the “war on obesity” or the “obesity epidemic.”

These messages reinforced harmful stereotypes of larger-bodied people as lazy or lacking self-control. As a result, many people with obesity experience stigma, discrimination, and shame, not only from society but also within the healthcare system. (We’ve written plenty about fat shaming alone over the years.)

This narrow view of obesity failed to consider the broader range of factors that contribute to weight gain. In recent years, research has increasingly shown that obesity is influenced by a variety of complex factors, including genetics, socioeconomic status, psychological well-being, medications, and the environment. While diet and physical activity remain important, they are only part of the puzzle.

Is the word “obesity” offensive?

A recent article for The Conversation, “How we think about ‘obesity’ and body weight is changing. Here’s why,” Executive Editor Stephen Khan used the word “obesity” with an asterisk (“ob*sity”) throughout his article, explaining,

Historical reflections on the word “obesity” reveal its offensive origins, with advocates suggesting the term ob*sity should be used with an asterisk to acknowledge this. To show our respect, we will adopt this language here.

He also noted that in 2014, the American Medical Association classified obesity as a chronic disease, sparking debate about whether this label pathologizes natural body changes and fuels discrimination.

Why we should fight stigma

A lengthy article by the American Psychological Association by Zara Abrams cites plenty of research to back up the notion that stigma can lead to serious consequences in the person’s physical and mental well-being, quoting a few experts, including Sarah Novak, Ph.D., an associate professor of psychology at Hofstra University in Hempstead, New York, who says,

There’s a perception that weight stigma might feel bad but [that] it’s tough love and it’s going to motivate people… But research shows that this isn’t true.

Citing this and this research on the subject, Abrams writes,

Like other forms of bias and discrimination, weight stigma, also called sizeism, leads to suffering and psychological distress. Sizeism increases a person’s risk for mental health problems such as substance use and suicidality.

Perception of sizeism has been difficult to change

Sizeism is one of the most deeply entrenched stigmas in today’s society, partly because of “sociocultural ideals tying thinness to core American values such as hard work and individualism.” Abrams also notes that “weight-based bullying is more common than bullying based on race, sexual orientation, or disability status” among children, according to some research results published in the Journal of Adolescence. Sadly, family members are “high on the list of perpetrators.”

Psychologists have tested various interventions to reduce sizeism, including empathy-building and education about body weight. However, these approaches have had little effect on anti-fat biases. Unlike racism and sexism, weight discrimination remains legal in most places, with only a few states and cities banning it. This lack of legal protection allows weight-based discrimination in hiring, promotions, and wages to persist. Though public support exists for stronger protections, policy changes have been slow.

Shifting public health approaches

As our understanding of obesity has grown, so too has the way public health professionals approach the issue. The previous weight-centric model — where weight loss was the primary health goal — has come under scrutiny. Many experts now believe that focusing solely on weight loss can lead to negative outcomes, including weight cycling (repeatedly losing and regaining weight), increased stigma, and negative mental and physical health effects.

In response, a new weight-inclusive approach to health has gained momentum. This perspective promotes healthy behaviors — such as balanced eating, regular physical activity, and mental well-being — regardless of whether they lead to weight loss. This approach aims to reduce the harm caused by weight stigma and support people in improving their overall health, rather than fixating on a number on the scale.

The role of healthcare providers

Healthcare providers play a critical role in how obesity is addressed in medical settings. Historically, larger-bodied patients often experienced weight bias, even from their doctors. This stigma can lead to worse health outcomes, as patients may avoid seeking care or feel blamed for their condition rather than supported.

Today, there is a growing recognition of the need for more compassionate and inclusive care. Health professionals are encouraged to use person-first language (e.g., “person living with obesity”) to avoid reducing individuals to their weight. Additionally, clinicians are urged to shift their focus from weight to health behaviors, helping patients set goals around physical activity, nutrition, and mental well-being without making weight loss the central objective.

Your responses and feedback are welcome!

Source: “How we think about ‘obesity’ and body weight is changing. Here’s why,” The Conversation, 9/18/24
Source: “The burden of weight stigma,” American Psychological Association, 3/1/22
Image by RDNE Stock project

Teal-o-Ween Catches On

It appears that pumpkin aficionados will be spotting more teal pumpkins this year. The color does not simply mean “no candy,” although that concept in itself is quite valid — but there is a lot more to it.

A few years back, in a relatively quiet American state, a revolutionary movement began with the Food Allergy Community of East Tennessee (in particular, Becky Basalone.) The Teal Pumpkin Project has spread because this broad issue touches children in every state. In the USA alone, around six million children (roughly one out of 13) suffer from food allergies, and nearly half of those affected have experienced at least one serious allergic reaction.

Commercially available candy, and this goes double for the specialized Halloween variety, is very likely to include in its recipe one or more common allergens. These include milk, eggs, wheat, soy, peanuts, tree nuts, and sesame. Also, as has been widely publicized over the past few years, any type of candy is likely to contain unhealthful amounts of sweeteners with serious downsides.

A worldwide sensation

FARE, the organization concerned with Food Allergy Research and Education, says that…

Kids with food allergy are not the only ones who benefit from non-food treats. Many other medical conditions make candy off-limits, such as food intolerances, eosinophilic esophagitis (EoE), celiac disease, food protein-induced enterocolitis syndrome (FPIES), diabetes, and having a feeding tube.

Now in its 10th year, the Teal Pumpkin Project has been catching on in other countries, too. Even more significant, its core principle has encompassed other groups, such as kids with autism spectrum disorder, who encounter their own set of difficulties. This area is a bit controversial, however.

While allergic children can collect treats in any receptacle of their choosing, autistic children are encouraged to carry a blue hollow plastic pumpkin or some other blue container, as a signal that they may be unable to make the traditional “Trick or Treat!” request. The notion is problematic from the start, because in the minds of many observers, teal is blue, and vice-versa. And this goes double after dark.

On the psychological level, this self-labeling can easily be interpreted as different from the other kind, and among children, adults, neighbors, and medical professionals, the response to the concept is mixed. Other controversies exist too, of course, and some grouches enjoy telling the parents of differently abled children that “Your kid’s problem is your problem. Not mine.”

FARE’s website is a place to download signs to print out at home or at school or wherever, that part does not matter as long as people are inspired to use them. “Non-food treats available here” is a friendly, neighborly, inclusive message. As for what those treats might be, this page offers a very comprehensive list, compiled by Maria Chamberlain, of possible alternatives to sweets. (A few more suitable items not included on that list are key rings, mini notebooks, mini puzzles, and fidget toys.) The page also offers the official posters available for download and print.

To be a good Teal host…

— Please register ahead of time with the Teal Pumpkin Project Map, if your community offers this amenity. If it does not, find out how to promote the movement locally. In the Age of Social Media, there is very little we can escape knowing about, so jumping on board with this trend should be easy.

— Parents can also pass out flyers at school events, well ahead of time, to alert others to the possibilities. Workplaces can educate their employees about the idea, and you know that retail stores will jump right on it and promote it if they sell anything relevant, from teal paint to little non-food prizes.

— For everyone’s convenience, have the non-food treats in a separate container from the food treats, this just goes without saying.

— Display a Teal Pumpkin Project sign from a window, porch step, or in some other visible area.

— A person doesn’t even need to have a house from which to operate, but, depending on the environment, can get together with one or two like-minded adults, set up a “Trunk-or-Treat” car, and distribute treats from any available space. If the weather or the neighborhood’s ambiance is likely to be too harsh, get together with other parents and responsible adults to plan an indoor event.

— Have big fun.

Your responses and feedback are welcome!


Source: “Bring Magic to Halloween With the Teal Pumpkin Project,” FoodAllergy.org, 10/15/24
Source: “Here’s what the Teal Pumpkin Project is and why it matters,” NBCNewYork.com, 10/18/24
Image by Jen Reeves/Attribution 2.0 Generic

How to Survive Halloween

Some very ambitious activists envision the possibility of a society-wide adjustment in the theory and practice of Halloween. It is almost as if adding on pounds has become the national sport, and they are determined to resist this trend. In recent years, to the point where politics often become involved, the holiday has increasingly attracted the notice of people who would like to see (and help) the entire landscape improve.

Former First Lady Michelle Obama poured a lot of energy into trying to end childhood obesity, or at least to make a dent in it. But what happened in Washington? “White House M&Ms” were the presidential treat, inviting snide comments from some members of the press. Today, one shudders to imagine the photo-worthy costumes that might hit the streets, which celebrating the holiday so close to Election Day will no doubt inspire.

Why the concern? As the first of a series of occasions where food is the signifier of love, togetherness, hospitality, generosity, and, in too many cases, regret, Halloween kicks off the eating season. As first in line, this quaint holiday can be a horror for an overweight kid. It’s all about doing the exact thing she or he is not supposed to do — acquire and consume a bunch of sweets.

Here’s a thought: Let’s figure out how to reduce the amount of junk the kids collect, how much they hold onto, and how much of it they ultimately consume. The goal is to minimize the acquisition, retention, and consumption of candy. Mainly, the first. The method is to offer, and even create, alternatives that are more desirable.

So much angst

Critics say those industrial-size packages of candy appear on supermarket shelves earlier every year. (Maybe. Is Easter too early?) Worse yet, some wary folks suspect that most of it is left over from last year. Can you tell the difference between a fresh bag of candy corn and a superannuated one?

Even people who don’t want to abolish the holiday altogether would like to radically change its nature. Plenty of parents are nervous about the whole trick-or-treat concept. All year, kids are told “Never take candy from a stranger” and suddenly, the rule is ignored. Every autumn, rumors circulate about shady neighbors who are said to tuck razor blades or various substances into the treats they distribute.

As the wisecrack goes, “That’s crazy. Nobody gives away perfectly good drugs.” Above that is a layer of cosmic humor. The candy, stuffed with not only sugar but high fructose corn syrup, food dyes, and all sorts of additives, is capable of doing more damage than some drugs. Childhood obesity, as many news items remind us, is growing by leaps and bounds.

Look to the future

Why? Because it might make a big difference in the outcome — that outcome being your child’s or children’s health for the rest of their lives. Okay, so maybe you missed the boat this time. Maybe you already bought the jumbo bags of sweet treats, weeks ago on the way home from a day at the outdoor swimming pool, on the theory that the price would rise as Halloween approached. Maybe some hungry family member has already depleted the stock. It might be a good idea to check, as there is still time to get more.

None of this needs to happen

Look to the future, parents, but first think back to previous Halloweens, especially last year. Did you make any notes to yourself about doing things differently? Maybe it is not too late. And there is always next year.

Meanwhile, set aside some time in the months that lead to Halloween 2025, to have a look at a little story of how things could be. For further inspiration, check out one or several previous Childhood Obesity News posts on the subject.

Things don’t have to stay the way they are! The future is ours to create.

Your responses and feedback are welcome!

Image by Da Puglet/Attribution-ShareAlike 2.0 Generic

How Are Weight Loss Medications Covered Globally?

We’ve been following the developments in the realm of GLP-1 agonists for a while now, including their potential to treat various conditions, risks, and availability. Let’s take a quick look at the recent headlines.

France is the latest European nation to decide against covering weight loss medications through its national insurance program. While the anti-obesity drug Wegovy is now available in the country, the French government is not offering enthusiastic support for it.

Novo Nordisk, the Danish pharmaceutical company that also manufactures the popular diabetes drug Ozempic, announced that Wegovy is now on sale in France for individuals struggling with obesity. According to a company representative, 10,000 people in France have already accessed the drug through an early access program.

Wegovy is expected to cost patients between €270 and €330 per month, but France’s national health insurance won’t cover the cost, meaning users will need to pay out-of-pocket. The drug is recommended only as a secondary option for those whose weight loss efforts through diet and exercise have failed.

Additionally, France’s drug safety agency mandates that initial prescriptions for Wegovy must come from an obesity specialist to prevent misuse, such as by individuals without weight-related health problems who may seek it for cosmetic purposes.

Elsewhere in Europe

Despite the widespread popularity of these anti-obesity drugs, which are predicted to generate global sales of $131 billion (€117.4 billion) by 2028, there have been shortages in the European Union since 2022. However, some experts, such as Dr. Jens-Christian Holm from Denmark’s University of Copenhagen, remain skeptical.

Dr. Holm said that the medications are “not the Holy Grail,” adding:

There are problems there. They cost a lot of money. There are side effects, and they are not working when you stop using them.

France is not alone in its cautious stance. For example, Germany’s national health system is prohibited by a 1980s law from covering drugs aimed at “lifestyle” conditions like obesity, smoking cessation, or hair loss. Therefore, while Wegovy has been available in Germany since 2023, only privately insured patients or those who pay out-of-pocket can access it, with the highest dose costing €302 per month.

In Denmark, where Novo Nordisk is based, the drug is also not typically covered. The Danish health authority has estimated that it would cost around 6 million Danish kroner (€805,000) to prevent a single cardiovascular event, a major factor in its decision not to cover the medication.

Meanwhile, in the United Kingdom, the health service recommends that Wegovy be used for a maximum of two years, refusing to fund longer-term use due to concerns about its cost-effectiveness. Given that many patients regain weight after stopping the medication, there is an ongoing debate among researchers, policymakers, and pharmaceutical companies about extending this usage period.

Wegovy is also available in other countries such as Norway, Spain, Switzerland, Italy, Iceland (where usage “increased by more than twenty-fold in five years,”) Australia, Brazil, Canada, Japan, the U.S., and the UAE, with further international launches planned.

Some nations are waiting to observe the effects of the drug before introducing it. For instance, while Wegovy is not yet available in the Netherlands, Dutch officials are already wary of the potential financial strain. Last year, Novo Nordisk requested that Wegovy be included in the Netherlands’ basic health insurance program. However, a government advisory panel expressed concerns in July about the drug’s long-term effects and the potential €1.3 billion annual cost, deeming it “socially irresponsible.”

These financial concerns might shift in the future, as Novo Nordisk has indicated that it could offer flexible pricing to encourage broader adoption of the drug. Additionally, new medications entering the market in the coming years could help reduce prices.

A Novo Nordisk spokesperson told Euronews Health that the company is continuously exploring ways to collaborate with healthcare systems to make its products more accessible, particularly for patients with significant unmet needs.

The U.S.: cost vs. benefits

Also in recent news, according to the U.S. Congressional Budget Office (CBO), the cost of paying for obesity drugs would be greater than the economic benefits. The CBO estimates that Medicare would spend $35 billion more on obesity drugs from 2026 to 2034, but the savings from improved health would be small.

Here are some details from the CBO’s analysis:

  • The CBO estimates that the federal government would pay an average of $5,600 per user in 2026, and $4,300 per user by 2034.
  • The CBO estimates that the savings from improved health would be less than $50 million in 2026, and increase to $1 billion in 2034.
  • The CBO projects that expanded use of obesity drugs would improve beneficiaries’ health, mainly by reducing the incidence of obesity-related chronic diseases.
  • The CBO continues to monitor trends in the use of obesity drugs, including their prices, effects on health, and coverage by insurance plans.

Your responses and feedback are welcome!

Source: “France won’t pay for weight loss drug Wegovy. What about other European countries?,” EuroNews Health, 11/10/24
Source: “Iceland Sees Sharp Rise in Use of Weight-Management Medications,” Iceland Review, 10/9/24
Source: “How Would Authorizing Medicare to Cover Anti-Obesity Medications Affect the Federal Budget?,” CBO.gov, October 2024
Image by Jakub Żerdzicki on Unsplash

A Halloween Retrospective

The trick-or-treat ritual boils down to three elements: First, prepare a costume in which to collect candy. Next, collect candy. Finally, decide what to do with the candy. Send it to our troops overseas? Donate it to dentists who offer something useful or philanthropic in return? Take it downtown and give it to the first person whose worldly goods are in a shopping cart?

Most likely, kids are going to opt for eating all of it. Otherwise, why did they go to the trouble? Often, the only choice parents have — if any — is to decree that their offspring should ration the goodies over a period of days. Good luck with that, by the way.

Through the years, Childhood Obesity News had offered numerous suggestions to help bring some sanity into the proceedings. “The Most Fun with the Least Sugar” is our motto, or would have been if we had thought of it sooner.

But seriously, this blog has touched upon many topics with the potential to bring on more smiles while minimizing the tummy aches, not to mention the calories. The holiday is a danger zone for kids who are in good shape. For those who are conscious of being overweight or obese, or at risk, it can be an ordeal.

Something else to focus on

Not surprisingly, a lot of anti-Halloween sentiment centers around the health aspect. The whole point and purpose of these suggestions for fun is to turn the spotlight away from the sugar treats and shift the emphasis to creativity and participation. Figuring this out could be an opportunity for family togetherness so memorable that even sweets are forgotten. At least temporarily.

For instance, if you plan to distribute trick-or-treat goodies from the front porch, there are very good reasons to switch over to non-food items. Of course, your kids will be expert consultants on this decision. Go out and get some exercise walking around in a store, or shop online for inexpensive but desirable objects to distribute. Pencils with miniature jack-o-lanterns on top, or even some non-Halloween-related gadgets that can be bought in bulk.

Parents, this is a secret worth remembering. What your kids really want is your attention, and generally the younger they are, the more true this is. Entertaining activities can go a long way toward persuading little ones to do what you want, which is to forget about candy for a while. Make up a game that could become a treasured tradition. Incidentally, check out this little tale depicting what could so easily become a normal way of doing things.

Is there an infant in the house?

An ever-popular Halloween sub-category is costumes for babies. A very young minor child is granted no say in the matter, and might turn up disguised as a taco, a banana, a chili pepper, a hamburger, a slice of pizza, a lobster, a hot dog, a roast turkey, a packet of ketchup, a candy bar, or a gingerbread man. (That last choice is economical, as it can be recycled for Christmas.)

In a dystopian vision, it is possible that some far-sighted disreputable second cousin might smell future profit and encourage the silliest costumes and snap plenty of photos, with an eye toward growing a nice passive income stream by blackmailing those former babies when they reach an embarrassment-prone age.

Just kidding. But seriously, this might be the year to adopt a new paradigm. Take a look at one or all of the previous posts on this topic. Try substituting attention for treats, and encourage activity rather than consumption. If the results are not what you hoped for, we have the whole year to construct and refine a plan for next year. Refuse to accept discouragement, and remember, because individuals and families vary greatly, nothing works for everybody. It is equally certain that nothing works if we don’t try it.

Your responses and feedback are welcome!

Image by Theo Crazzolara/Attribution 2.0 Generic

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources