Coronavirus Chronicles — COVID-19 and Kids, Yes, It Happens 

Girl wearing mask

Hot off the presses: The New York State Department of Health (NYSDOH) sent out an announcement to every official, functionary, bureaucrat, clinician, and news outlet in the state. There was recently a sharp upward trend in COVID-related pediatric hospitalizations. In other words, kids get it worse now than ever. The focus is December 5, 2021, through December 19, the week when the number of New York City children hospitalized by the virus multiplied by four. It gets worse:

  • Approximately half of the admissions are less than five years of age and thus vaccine ineligible.
  • For the most recent week… none of the 5-11-year-old patients was fully vaccinated (compared to 16.1% overall in that age group).

Here is what NYSDOH wants authority figures to do:

​Counsel parents that although COVID-19 is usually mild in children, there are risks of serious illness and sequelae for children, and if not isolated they can contribute to community transmission.

Unbelievably, despite the ever-mounting evidence, there are still people who will declare that children don’t catch it, or don’t develop serious cases. But they do, and they also get long-haul COVID and/or the mysteriously similar multi-system inflammatory syndrome, or MIS-C.​

An update on MIS-C

Meanwhile, discussion of MIS-C continues. Is it or is it not the same as “long COVID” in pediatric format? In 2020 Dr. Bo Stapler wrote, “MIS-C is thought to be an abnormal immune response to the novel coronavirus that often occurs after the acute infection has passed.” To some minds, it might as well be considered just a different phase of COVID. A MIS-C diagnosis…

[…] broadly includes fever, a positive test for SARS-CoV-2 or a clear exposure, elevated markers of inflammation, and evidence that multiple organ systems are affected (for example, two or more of the following symptoms: rash, swelling of the hands or feet, red eyes, blood clots, swollen lymph nodes, abdominal pain, diarrhea, seizure, or stroke).

It is taking a while for word to circulate that children can get sick and stay sick. The numbers are low enough for skeptical adults to treat the matter cavalierly, but the numbers are likely to grow. Natasha Hinde recounted the experiences of several children and their families for HuffPo:

An informal survey of parents in the group found children affected were most commonly experiencing fatigue, sore throat, gastrointestinal issues, headaches, muscle pain, and weakness months after first becoming sick…​

Young Thomas, for instance, when interviewed, had suffered for a year, with constantly swollen glands, mysterious high fevers, and pain everywhere. The writer called him “a 6-year-old in a 90-year-old’s body” and he holds the unenviable honor of being the first child diagnosed with long COVID by the Royal Manchester Children’s Hospital. ​

Your responses and feedback are welcome!

Source: “The Latest on the Mysterious Inflammatory Syndrome in Children,” Elemental.com
Source: ‘”‘A 6-Year-Old In A 90-Year-Old’s Body’ – The Children Devastated By Long Covid,” HuffPost
Source: “HEALTH ADVISORY: Increase in COVID-19 Pediatric Hospitalizations,” Health.NY.gov
Images by Nik Anderson/CC BY-ND 2.0

Coronavirus Chronicles — Obesity, Long COVID, and a Mystery

So, we have just been going on and on about the collusion between COVID and obesity, and honestly, it never ends. There really needs to be more awareness about the fact that children can and do get “long-haul COVID” (aka post-acute sequelae SARS-CoV-2 infection, or PASC), a condition ideally suited to set them up for lifelong battles against weight.

Additionally, there is an extensive amount of discussion about whether PASC is basically the same as MIS-C, or multisystem inflammatory syndrome. The whole thing is a mess. Let’s back up to about a year ago, and follow along with some selected news stories.

Last November, Ashley Zlatopolsky published “Children Are Covid-19 Long-Haulers, Too.” She wrote,

According to the Mayo Clinic, in children with MIS-C, organs and tissues such as the heart, lungs, digestive system, and brain can become severely inflamed. [M]any questions remain unanswered, including whether the cause is in fact MIS-C or if they’re in the same mysterious boat as adult Covid “long-haulers.”

Are two different things involved really, or are they just different names for the same problem? Either way, when a child experiences these symptoms for months on end, obesity is in the cards, because being that sick inevitably means dietary laxity and a serious absence of healthy exercise.

It is possible that some are rendered more vulnerable by “ongoing low-level inflammation or autoimmune conditions,” but others with no such problems seem to go ahead and get long-haul COVID anyway, maybe because of an unsuitably exaggerated immune response. At any rate, several weeks after the child has apparently recovered from the virus, the unanticipated trouble begins.

Dr. Nick Hysmith, of Le Bonheur Children’s Hospital in Memphis, has named conditions from prolonged fever to heart dysfunction, that can lead to a stay in the ICU.

Other possible symptoms reported elsewhere include but are not limited to headache, joint pain, muscle pain and weakness, fatigue, off-kilter reflexes, blurred vision, conjunctivitis, strange tastes in the mouth, intractable nausea, stomach pain, vomiting, diarrhea, skin rashes, hypotension, palpitations, mucocutaneous lesions, insomnia, altered mental status; and other respiratory, cardiovascular, renal, and neurologic problems.

Word from overseas

At the end of 2020, news came out about a German study that examined 100 adults who had ostensibly recovered from COVID. About one-fifth of them emerged from the acute stage with cardiac problems, including scarring of the heart itself. Patients reported feeling empty, scooped out, unable to function or to perceive any light at the end of the tunnel. Conversely, a subgroup who had not been vaccinated before suffering from the virus were vaccinated afterward, and experienced some relief from long-haul symptoms.

In March, a multi-author study published in Nature Medicine spoke of “increasing reports of persistent and prolonged effects after acute COVID-19, including sequelae or aftereffects in the pulmonary, hematologic, cardiovascular, and neuropsychiatric realms.”

(To be continued…)

Your responses and feedback are welcome!

Source: “Children Are Covid-19 Long-Haulers, Too,” Medium.com, 11/11/20
Source: “The Plague Year,” NewYorker.com, 12/28/20
Source: “Post-acute COVID-19 syndrome,” Nature.com, 03/22/21
Image by quapan/CC BY 2.0

Coronavirus Chronicles — Fat Cells and Long COVID

The revelation that COVID hides in fat cells, provoking the release of inflammatory cytokines and other kinds of trouble, is causing a bit of a stir. Well-known journalist Glenn Greenwald was chastised as being irresponsible for tweeting the news, although he did mention that the study was not yet peer-reviewed. The important thing is,

What’s new from this new study is obesity’s role in long COVID due to storage in fat cells.

He is talking about a multi-author study, with most of them being from Stanford University School of Medicine. Many additional experts are acknowledged for their assistance in such areas as logistic support, data analysis, immunological assays, and other very niche fields.

A sinister association

Multisystem Inflammatory Syndrome (which affects children) is a lot like “long COVID,” or post-acute sequelae SARS-CoV-2 infection (PASC) as it is now officially known. Childhood Obesity News has mentioned before a theory associated with both — namely, that the virus can lurk undetected in body cells so it seems to be gone, but it’s not.

Now, back to the new paper under discussion which says,

[I]f adipose cells constitute a reservoir for viral infection, obesity may contribute not only to severe acute disease, but also to long-COVID syndrome.

One of our posts said,

Unfortunately, obesity appears to guarantee a pretty much perpetual state of inflammation. Adipose tissue, aka fat, causes low-grade inflammation that is a constant background in the bodies of obese people.

This is of course the exact kind of environment the virus likes to move in and take advantage of, and capitalize on.

Back to the current, 18-author paper:

In this report, we demonstrate that human adipose tissue from multiple depots is permissive to SARS-CoV-2 infection and that infection elicits an inflammatory response, including the secretion of known inflammatory mediators of severe COVID-19.

Adipose tissue, or fat, has different kinds of cells. Here are some important words:

Importantly, we demonstrated infection and inflammation in adipose tissue adjacent to critical organs such as the heart and intestine, thus pointing to the potential for adipose tissue potentiation of organ damage in severe COVID-19. Collectively, our data implies that infection in adipose tissue may partially explain the link between obesity and severe COVID-19.

It is beginning to look as if both obesity and the virus will continue to be inescapable aspects of life. Neither one of them will go away unless the other does too. It is almost like the current dilemma is payback for the decades of refusal to face up to the public health crisis of obesity and take it seriously.

Your responses and feedback are welcome!

Source: Glenn Greenwald on Twitter
Source: “SARS-CoV-2 infects human adipose tissue and elicits an inflammatory response consistent with severe COVID-19,'” BioRxiv.org, 10/25/21
Images by Photography Montreal/Public Domain and g4ll4is/CC BY-ND 2.0

Coronavirus Chronicles — More About Bariatric Surgery and COVID-19

A few weeks ago, correspondent Lindsay Peyton wrote for the Houston Chronicle that bariatric surgeries have increased during the pandemic because people understand the link between obesity and COVID-19, and believe that acting promptly in proceeding toward surgery will help them avoid the virus. Heather Sarten, who is director of bariatric navigation at HCA Gulf Coast Division, explains that most of the massive amount of work involved in preparing for this type of surgery can be done remotely. Consequently, she said, “As soon as we opened up and were able to do surgery again, we were jam packed.”

It has been known for some time that patients who are overweight or obese are more likely to develop severe COVID-19, and more likely to die as a result. Suspicions ultimately came closer to certainty: the virus can directly infect fat cells. In fact, it loves to go after “certain immune cells within body fat.” Then, it causes an immune response that makes everything worse. Journalist Roni Caryn Rabin clarifies,

Body fat used to be thought of as inert, a form of storage. But scientists now know that the tissue is biologically active, producing hormones and immune-system proteins that act on other cells, promoting a state of nagging low-grade inflammation even when there is no infection.

Dr. Catherine Blish said, “We’re seeing the same inflammatory cytokines that I see in the blood of the really sick patients being produced in response to infection of those tissues.” Dr. David Kass of Johns Hopkins notes that, as the inflammatory response picks up momentum, cytokines cause additional inflammation, which in turn calls for the release of more cytokines. In trying to defend itself, the body sabotages its own integrity. (The good news is, this discovery could lead to treatments that specialize in penetrating fat.)

In league with others

SARS-CoV-2 is not the first villain to hide in fat. Dr. Vishwa Deep Dixit, who teaches comparative medicine and immunology at Yale, notes that flu and HIV are both prone to conceal themselves there. Somehow, the virus seems to understand that the immune system is at a disadvantage when dealing with what, for a truly obese person, is effectively their largest bodily organ — the mass of fat.

The senior study authors, Dr. Blish and Dr. Tracey McLaughlin, point out the societal implications:

Most American adults are overweight, and 42 percent have obesity. Black, Hispanic, Native American and Alaska Native people in the U.S. have higher obesity rates than white adults and Asian Americans; they have also been disproportionately affected by the pandemic, with death rates roughly double those of white Americans.

Although this particular study had not yet been peer-reviewed, its publication struck a chord with many other researchers. An academic unrelated to the study, Dr. Philipp Scherer, paraphrased a popular Las Vegas advertising slogan — “Whatever happens in fat doesn’t stay in fat.”

At the same time, and although the pandemic has caused an increase in demand for obesity treatment in the United Arab Emirates, a childhood obesity clinic in Abu Dhabi has been telling parents that surgery is not necessarily the quick fix they envision it as. These doctors want parents to take more responsibility, and stop feeding their kids — because if they can’t handle that change of lifestyle today, they will not be successful in losing weight despite surgical intervention.

Your responses and feedback are welcome!

Source: “Here’s why bariatric surgeries have increased during the pandemic,” HoustonChronicle.com, 11/28/21
Source: “The Coronavirus Attacks Fat Tissue, Scientists Fin,” NYTimes.com, 12/14/21
Source: “UAE child obesity clinic tells parents that diet not surgery is the answer,” TheNationalNews.com, 12/18/21″
Image by Damian Zech/CC BY 2.0

Coronavirus Chronicles — Bariatric Surgery and COVID-19, Continued

Although this could change, since the beginning obesity has been the biggest predictor of COVID-19 fatality. For this and other reasons, bariatric surgery has been making it through the pandemic quite satisfactorily.

Dr. Matthew Hutter of Harvard Medical School is well aware of the close entanglement between COVID-19 and obesity, and is able to articulate how the medical profession has coped with the challenge. Since a large part of bariatric surgery is preparation and another large part is maintenance, this type of intervention is very amenable to the telehealth format. Even the pre-surgical sitdowns with the anesthesiologist and the pre-admission testing can be conducted remotely. The stay is short — “When patients come to the hospital, they are tested within 72 hours before surgery to ensure they are COVID-19 free […] and they go home the next day after surgery.”

The ability to follow patients remotely is priceless. In a way that is atypical of most disease processes, fending off obesity is a long-term proposition. With a “completely virtual option,” as long as both sides fulfill their obligations, it seems to work. Dr. Hutter speaks of the advantages of being “almost 100% telehealth”:

We have more focused discussions, and we’re able to have more frequent meetings as people don’t have to worry about things like daycare, parking or driving into Boston.

Of course, anything can be argued, but this sounds like a collection of best practices. If there must be such a thing as bariatric surgery, this is very likely how it should be done.

A paper published by a government website in February outlined why obesity worsens the virus. The weakened lungs labor extra hard just to push the excess weight around while inhaling and exhaling. Also, obesity often travels in company with type 2 diabetes, hypertension, cardiovascular disease, atherosclerosis, and even cancer. Then, there are the hypercoagulopathy and hyperinflammation often associated with obesity. COVID also promotes blood clotting, and having two different conditions that both do so is not recommended.

This work also pointed out that, on top of the usual difficulties in adhering to the program, pandemic anxiety contributes to “increased emotional distress and difficulty adhering to healthy lifestyle changes post-surgery.” In conclusion:

This study showed that the COVID-19 pandemic has impacted patients’ ability to self-manage obesity and their mental health in a variety of ways. These findings suggest that patients may experience unique psychological distress and challenges requiring personalized care strategies to improve obesity self-care and overall well-being.

Another angle is presented by Sage Publishing, which said in April of this year,

The global COVID-19 pandemic has resulted in the widespread suspension of bariatric surgical programs.

While the writer acknowledges that cutting back was initially necessary, caution has to be weighed against “the implications of delaying the most effective treatment for weight loss in a population at risk from this crisis.” In other words, do the benefits outweigh the risks?

The conclusion is,

From the patient’s perspective, postponing surgery has been deleterious and efforts to safely reintroduce bariatric programs should be promoted.

Your responses and feedback are welcome!

Source: “Bariatric Surgery in the Time of COVID-19,” MassGeneral.org 01/08/21
Source: “The impact of COVID-19 pandemic on bariatric patients’ self-management post-surgery,” NIH.gov, 02/19/21
Source: “Serious Impacts of Postponing Bariatric Surgery as a Result of the COVID-19 Pandemic: The Patient Perspective,” SagePub.com. 04/07/21
Image by Daniel Lobo/Public Domain

Coronavirus Chronicles — Bariatric Surgery and COVID-19

We know that, for the past couple of years, a hospital has been a particularly dangerous place to be. We know that the influx of coronavirus patients has caused a shortage of beds and a paucity of staff, and many patients who needed immediate intervention have been shunted aside for the sake of those affected with COVID who require the whole complicated and expensive life-support system.

We know that elective surgery has been discouraged, with people being advised to wait until this is all over. Mainly, there has been disagreement over whether bariatric surgery is an urgent procedure or whether, like a facelift, it can be put off until an optimal time. And yet surprisingly, in some locales anyway, bariatric surgery is thriving.

Six of one, half a dozen of the other

Let’s turn back to September of 2020, when a government website explained the pros and cons:

There is a risk of infection transmission […] and the signs and symptoms of the disease make it difficult for patients to be followed up after surgery… [S]ome pulmonologists and bariatric surgeons believe that BS is an elective operation and it is better to postpone surgery.

Others believe that obesity is one of the risk factors for admission to the ICU and COVID-19 severity and mortality, so it is not an elective surgery and postponing metabolic surgery due to the complications of morbid obesity, comorbidities such as diabetes, the role of obesity, and these comorbidities on COVID-19 may increase risk of death and complications.

That piece concluded by noting that different scientific societies held different opinions, and by pleading insufficient data, which gave both physicians and patients an opportunity to exercise informed choice.

During the same month, Advisory.com published a piece titled “Bariatric surgery is booming,” citing information from a Cleveland Clinic study, which discovered that “patients with obesity who’ve had bariatric surgery were 25% less likely to require hospitalization after contracting Covid-19 when compared with obese patients who have not had the surgery.” Also, of the hospitalized patients in the study who had previously had bariatric surgery, none were sick enough to be in the ICU, and none died.

Inarguable demand

Concurrently, The Wall Street Journal reported that the demand for bariatric surgery, including gastric bypasses, laparoscopic bands, and gastric sleeves, rebounded much more quickly than other types of elective procedures. Journalist Robbie Whelan quoted Dr. John Morton of Yale Medical Center as saying, “The only two surgeries that have been Covid-proof have been cancer and bariatric,” he said.

In January of 2021, Harvard Medical School’s Dr. Matthew Hutter explained how obesity and the coronavirus are in league with each other, and how bariatric surgery can prevent COVID-19 fatalities because…

Some data and articles indicate that individuals with obesity are more than 46% more likely to be COVID-19 positive. Their risk of ICU admission is increased almost twofold. They face a 50% higher risk for death.

He emphasized the slim possibility of anything going wrong, saying that “all treatments are just as safe during the pandemic as they were before.”

(To be continued…)

Your responses and feedback are welcome!

Source: “Bariatric Surgery During the COVID-19 Pandemic—the Perspective of Physicians and Patients,” NIH.gov, 09/22/20
Source: “Bariatric surgery is booming, as obese patients worry about their Covid-19 risks,” Advisory.com, 09/30/20
Source: “Patients Seek Surgery to Combat Major Covid-19 Risk Factor: Obesity,” WSJ.com, 09/28/20
Source: “Bariatric Surgery in the Time of COVID-19,” MassGeneral.org 01/08/21
Images by Mike Licht and FolsomNatural/CC BY 2.0

Two More Brands of Seasonal Distress

Regardless of how many people want to pretend otherwise, the COVID-19 pandemic is not over. It’s not the once-pandemic or the former pandemic. It walks among us, sometimes disguised as our nearest and dearest. Which is why, for Woman’s Day, Alesandra Dubin quoted Dr. Caroline Leaf on preparing a family safety plan for the holidays:

It’s best to take as many precautions as possible when planning family and friend gatherings this holiday season. As different people face different risks and have different risk tolerances, I would recommend discussing your holiday plans with your loved ones as soon as possible to avoid extra tension…

Regarding social events, people would do well to think about adequate ventilation and air filtration. Is there a porch or patio or backyard where fresh air circulates freely? A host might want to lay in a supply of masks, plain or holiday-themed, and will surely provide hand sanitizer and plenty of paper towels. A guest might consider bringing along a few extra masks to share.

Grief

What segue could be smoother than the transition between COVID and grief? An awful lot of living people have lost relatives and friends. The tendency to overeat in the hope of achieving comfort is so common that the German language invented a word for it, Frustfressen, or frustration eating. There is also a word for the pounds acquired — Kummerspeck, or grief bacon. As we have seen, obese people are more susceptible to the virus and more difficult to treat. The virus not only kills people, it sets up a chain reaction designed to provide itself with more ripe victims.

Over the past months, the world has learned that children can catch COVID, as can healthy adults with no underlying conditions. Children have been orphaned and left with nobody really paying attention to what or how much they eat. The often-quoted Jessica Maharaj addressed the issue of grief over the holidays:

The anticipation of sadness may be stressful, but the holidays provide an opportunity for healing.

It is healthy to acknowledge your feelings and work through them, rather than suppressing them.

Don’t search for solace in unhealthy foods or alcohol.

Keep in mind that the loved ones you lost would want you to remember them fondly, to enjoy the holiday season, and to find comfort in having the family come together.

Some families routinely view old videos or even older photo albums, replete with reminders of relatives and friends who have passed away. Even without specific visual reminders, people tend to think back on the gatherings of former years, and feel the absence of the missing. When any type of mental illness is present in a family or friend group, coping can be even more difficult for everybody.

Maharaj urges us to accept our feelings, resist pressure to partake in traditions that bring pain, and look for and appreciate the good moments. Above all, as a solid base for everything else, we need to practice responsible self-care. Especially, we must be careful not to use the holidays as an excuse to break from helpful routines like taking supplements or doing a daily run. Needless to say, any measures recommended to people with particularly challenging situations can also be very helpful to those of us with just “routine” holiday stress.

Your responses and feedback are welcome!

Source: “40 Easy Tips for a Stress-Free Christmas,” WomansDay.com, 09/20/21
Source: “Avoiding Holiday Stressors,” NAMI.org, 12/03/18
Image by Ron Frazier/CC BY 2.0

Seasonal Stress in Two Flavors

The last few posts have been about seasonal stress, whose most obvious and apparent symptom is often overconsumption. The yearly profits of large corporations depend on inducing people to overeat and overdrink during the winter holidays. On the home front, the familial reputations of nephews and cousins depend on how convincingly they can assure older relatives that they really, truly do love fruitcake.

Adults who are nervous wrecks tend to abandon all sense of discretion about their food intake and to lose track of how much the children under their care are consuming. What the heck, it’s the tail end of a generally unsatisfactory year, and any joy that can be derived from chowing down on chocolate-covered cherries is well-deserved. That is what we tell ourselves, anyway, or some version of it. Ordinary self-deception does a lot of damage, and so does a painful condition that, fortunately, can be successfully treated, even by such remote means as telepsychiatry.

An old name and a new one

SAD, short for Seasonal Affective Disorder, was the old name. The new specific term is Major Depressive Disorder with a Seasonal Pattern. The changing of the season triggers chemical reactions in the brain and body, and the outcome is depression. Elizabeth Scott, Ph.D., wrote,

It’s a subtle but very real condition that can cast a pall over the whole season and be a source of stress and unhappiness during a time that people expect to feel just the opposite.

Jessica Maharaj has gathered several self-help options for the National Alliance on Mental Illness website. The point here is, anything that would alleviate such a serious condition could probably help just about anybody who gets slammed by the more widespread emotional storm engendered by the winter holidays. Here are the facts:

Hydration nourishes the brain and its physical effects can improve your overall mood.

[A]ny form of exercise will release endorphins, which can lessen the symptoms of depression.

[S]ocial interaction […] can help lessen the feelings of loneliness that may come around this time of year.

Taking a bath, having a warm drink or getting a massage can create a sense of calm and happiness.

[O]ver-indulging in unhealthy food around the holidays can negatively impact symptoms.

So, drink lots of water, and moisturize your skin, too. Do something pleasantly physical. Socialize with people whose presence improves your quality of life, and avoid the other kind. In the realm of calorie consumption, don’t trade short-term satisfaction for long-term regret. Move around, outdoors if possible, and take appropriate precautions against the coronavirus pandemic.

Your responses and feedback are welcome!

Source: “Managing the Seemingly Inevitable Holiday Season Stress,” VeryWellMind.com,01/15/21
Source: “Avoiding Holiday Stressors,” NAMI.org, 12/03/18
Image by Paul VanDerWerf/CC BY 2.0

Wide-Ranging Stress Defenses

There is general advice, and then there is specialized advice. For instance, the website MSFocus.org offers holiday season tips that are particularly helpful to people who suffer from multiple sclerosis, a potentially disabling and (so far) incurable autoimmune disease of the central nervous system. The wide variety of symptoms can ebb and flow for no discernible reason, and stress can certainly have a worsening effect. Any warning that can improve matters for people with such a serious and unpredictable illness will certainly help those with a relatively less severe stress reaction, like overeating. What kind of advice is given to MS patients?

An extreme degree of foresight is certainly helpful, especially when it comes to travel arrangements. Long trips and long waiting periods between stages of travel can be annoying to a healthy person. They can be excruciating for anyone who has trouble with such functions as balance, coordination, medication side effects, impaired vision, and general uncertainty about how seriously one’s symptoms might flare up within the next hours or days. Writer Matt Cavallo gives this advice:

If something isn’t on your list and you don’t think you can make it, just say no.

If something is outside your budget even though you think it would be a perfect gift, just say no.

If traveling for a holiday obligation leads to unwanted stress, just say no.

The extra piece of pie? Just say no.

These are precautions that work for everyone! So, in fact, does the advice collected by counselor Jessica Maharaj, tailored for people served by the National Alliance on Mental Illness. Make a budget, she suggests, and don’t forget to figure in shipping costs if you do your own gift-wrapping and packaging. Even if you are flying to visit someone, try not to carry gifts, but send them ahead of time or better yet, have the merchant send them.

Sew that pocket shut

Many therapists agree on the importance of curbing the impulse to overspend. You don’t want to be paying off Christmas bills until next December. Set a realistic budget ahead of time and adhere to it. Try giving something personal like a hand-painted greeting card, a poem, or a cute video greeting. Consider giving an experience instead of a thing. Tickets to something would be nice, in a normal year, anyway. The recipient could go to the event with you or with another person.

Designate a certain sum for spontaneous discretionary purchases, because “the holidays tend to bring out the generosity in us.” So, allow for that extra bit of giving spirit, and then stick to the number you allotted for it. And budget the personal appearance time, too. This year, saying no to massive hospitality is easier than ever, because a lot of people have learned to use software that does not require showing up in person.

The temptation to overcommit is huge but it can be resisted. When filling in the calendar, remember that your plans could be disrupted by surprise visitors, phone calls, emergency grocery runs, or foul weather. There are no guarantees.

Hit up the post-holiday sales for deals on cards, gift-wrap paper, ribbon, and any other accouterments you know you can use next year. This is a great opportunity to stock up on cut-rate candy canes, which last forever. Maharaj writes,

The reality is that potential hazards exist at every turn during the holidays. These situations can trigger heightened difficulties for people suffering from depression, anxiety, PTSD and other mental illnesses. The holidays can also introduce additional stressors such as complicated relationship dynamics at family gatherings, grief over losing a loved one or simply trying to live up to the unattainable expectations of the “perfect holiday.”

Next time, we will discuss in more detail the particular challenges faced by people who are also dealing with grief, Seasonal Affective Disorder, or fear of COVID-19.

Your responses and feedback are welcome!

Source: “5 Tips for Managing Holiday Stress with MS,” MSFocus.org, undated
Source: “Avoiding Holiday Stressors,” NAMI.org, 12/03/18
Image by Liz West/CC BY 2.0

Be the Change You Want to See

In a family or a friend group, the older humans influence the ones who haven’t been around for quite as long. That is simply how things are. The youngsters learn from us every minute of every day — how to solve problems, how to handle conflict, how to offer and ask for help, how to deal with frustration… how to navigate through stressful holidays without doubling our weight and ruining our health.

As we have seen, list-making and delegation are powerful tools. Their combined strength can be shown by creating an efficient roster of tasks and details to be offloaded into someone else’s responsibility basket. A lot of us feel like we have to compulsively clutch the reins at all times. Dr. Jennifer Barton has plenty to say about the wisdom of releasing our grip:

Many people will need to let go of the “if I want something done right, I have to do it myself” mentality or “I don’t want to bother anybody else.” You need to take a deep breath and just let go. Realize that when you delegate something, it’s now out of your hands — and that can be a good thing. As hard as it may seem, wait until the final product before judging how the delegation is going.

Excellent results might come from letting others demonstrate how competent and responsible they can be. Another choice that can be made about a task is: Delegate it to nobody. Toss is onto the pile of things you have decided will no longer be allowed to ruffle your majestic serenity.

How to catch a clue

Do you send out Christmas cards? Great. Must you make time to go to the post office for special Christmas stamps? No, that is not required. You can use any stamp of the correct denomination. Don’t worry, the world at large will not find out about your lapse. People may display your greeting card, but it is doubtful that they will hang up the envelope too.

If you just can’t get comfortable with omitting the seasonal postage stamps, make a deal with yourself: Skip it this year, and print it in capital letters at the top of next year’s list. In 2022, buying Christmas-themed stamps in a timely manner will be your first priority. What the heck, go ahead and promise the same for every succeeding year, too. Then relax and forget about it for 10 months, okay?

Here, from Jessica Maharaj, is a gem of a shopping tip that is valid all year round:

[T]ry to go during the day and park farther away from the stores. Your time in the sunlight walking to or from your car can boost your serotonin levels.

This habit will also, of course, help a lot if you happen to be trying for the recommended 10,000 steps per day.

Miscellaneous coping strategies

Nutrition counselors have handy suggestions like, during holiday time, keep sweets and alcohol out of your own home, because you know you will encounter plenty of them elsewhere. And make sure to get enough fiber, Vitamin C, and Vitamin B; for digestion, the immune system, and stress response, respectively.

Next: If you can possibly afford to, spare yourself the ordeal of putting together a thing. G. Gaynor McTigue, author of Why Make Yourself Crazy?, says if the assembly is required, deputize an experienced assembler, even if there is a fee. They can do it fast, they can do it correctly, they can do it in their sleep, and you can’t.

Your responses and feedback are welcome!

Source: “10 Tips to De-stress During the Holidays,” JacksonHealth.org, undated
Source: “Avoiding Holiday Stressors,” NAMI.org, 12/03/18
Source: “40 Easy Tips for a Stress-Free Christmas,” WomansDay.com, 09/20/21
Image by artistmac/CC BY-SA 2.0

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Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

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