Shedding Some Obesity Myths
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Let’s shed some obesity myths!
There are a lot of myths and misconceptions surrounding obesity… And then there are also reactive opposite myths and misconceptions, which can sometimes be just as harmful!
To tackle them all would take a book, but in classic 10almonds style, we’re going to put a spotlight on some of the ones that might make the biggest difference:
True or False: Obesity is genetically pre-determined
False… With caveats.
Some interesting results have been found from twin studies and adoption studies, showing that genes definitely play some role, but lifestyle is—for most people—the biggest factor:
- The body-mass index of twins who have been reared apart
- An adoption study of human obesity
- Using a sibling-adoption design to parse genetic and environmental influences on children’s body mass index
In short: genes predispose; they don’t predetermine. But that predisposition alone can make quite a big difference, if it in turn leads to different lifestyle factors.
But upon seeing those papers centering BMI, let’s consider…
True or False: BMI is a good, accurate measure of health in the context of bodyweight
False… Unless you’re a very large group of thin white men of moderate height, which was the demographic the system was built around.
Bonus information: it was never intended to be used to measure the weight-related health of any individual (not even an individual thin white man of moderate height), but rather, as a tool to look at large-scale demographic trends.
Basically, as a system, it’s being used in a way it was never made for, and the results of that misappropriation of an epidemiological tool for individual health are predictably unhelpful.
To do a deep-dive into all the flaws of the BMI system, which are many, we’d need to devote a whole main feature just to that.
Update: we have now done so!
Here it is: When BMI Doesn’t Measure Up
True or False: Obesity does not meaningfully impact more general health
False… In more ways than one (but there are caveats)
Obesity is highly correlated with increased risk of all-cause mortality, and weight loss, correspondingly, correlates with a reduced risk. See for example:
So what are the caveats?
Let’s put it this way: owning a horse is highly correlated with increased healthy longevity. And while owning a horse may come with some exercise and relaxation (both of which are good for the health), it’s probably mostly not the horse itself that conveys the health benefits… it’s that someone who has the resources to look after a horse, probably has the resources to look after their own health too.
So sometimes there can be a reason for a correlation (it’s not a coincidence!) but the causative factor is partially (or in some cases, entirely) something else.
So how could this play out with obesity?
There’s a lot of discrimination in healthcare settings, unfortunately! In this case, it often happens that a thin person goes in with a medical problem and gets treated for that, while a fat person can go in with the same medical problem and be told “you should try losing some weight”.
Top tip if this happens to you… Ask: “what would you advise/prescribe to a thin person with my same symptoms?”
Other things may be more systemic, for example:
When a thin person goes to get their blood pressure taken, and that goes smoothly, while a fat person goes to get their blood pressure taken, and there’s not a blood pressure cuff to fit them, is the problem the size of the person or the size of the cuff? It all depends on perspective, in a world built around thin people.
That’s a trivial-seeming example, but the same principle has far-reaching (and harmful) implications in healthcare in general, e.g:
- Surgeons being untrained (and/or unwilling) to operate on fat people
- Getting a one-size-fits-all dose that was calculated using average weight, and now doesn’t work
- MRI machines are famously claustrophobia-inducing for thin people; now try not fitting in it in the first place
…and so forth. So oftentimes, obesity will be correlated with a poor healthcare outcome, where the problem is not actually the obesity itself, but rather the system having been set up with thin people in mind.
It would be like saying “Having O- blood type results in higher risks when receiving blood transfusions”, while omitting to add “…because we didn’t stock O- blood”.
True or False: to reduce obesity, just eat less and move more!
False… Mostly.
Moving more is almost always good for most people. When it comes to diet, quality is much more important than quantity. But these factors alone are only part of the picture!
But beyond diet and exercise, there are many other implicated factors in weight gain, weight maintenance, and weight loss, including but not limited to:
- Disrupted sleep
- Chronic stress
- Chronic pain
- Hormonal imbalances
- Physical disabilities that preclude a lot of exercise
- Mental health issues that add (and compound) extra levels of challenge
- Medications that throw all kinds of spanners into the works with their side effects
…and even just those first two things, diet and exercise, are not always so correlated to weight as one might think—studies have found that the difference for exercise especially is often marginal:
Read: Widespread misconceptions about obesity ← academic article in the Journal of the College of Family Physicians of Canada
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When Age Is A Flexible Number
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Aging, Counterclockwise!
In the late 1970s, Dr. Ellen Langer hypothesized that physical markers of aging could be affected by psychosomatic means.
Note: psychosomatic does not mean “it’s all in your head”.
Psychosomatic means “your body does what your brain tells it to do, for better or for worse”
She set about testing that, in what has been referred to since as…
The Counterclockwise Study
A small (n=16) sample of men in their late 70s and early 80s were recruited in what they were told was a study about reminiscing.
Back in the 1970s, it was still standard practice in the field of psychology to outright lie to participants (who in those days were called “subjects”), so this slight obfuscation was a much smaller ethical aberration than in some famous studies of the same era and earlier (cough cough Zimbardo cough Milgram cough).
Anyway, the participants were treated to a week in a 1950s-themed retreat, specifically 1959, a date twenty years prior to the experiment’s date in 1979. The environment was decorated and furnished authentically to the date, down to the food and the available magazines and TV/radio shows; period-typical clothing was also provided, and so forth.
- The control group were told to spend the time reminiscing about 1959
- The experimental group were told to pretend (and maintain the pretense, for the duration) that it really was 1959
The results? On many measures of aging, the experimental group participants became quantifiably younger:
❝The experimental group showed greater improvement in joint flexibility, finger length (their arthritis diminished and they were able to straighten their fingers more), and manual dexterity.
On intelligence tests, 63 percent of the experimental group improved their scores, compared with only 44 percent of the control group. There were also improvements in height, weight, gait, and posture.
Finally, we asked people unaware of the study’s purpose to compare photos taken of the participants at the end of the week with those submitted at the beginning of the study. These objective observers judged that all of the experimental participants looked noticeably younger at the end of the study.❞
Remember, this was after one week.
Her famous study was completed in 1979, and/but not published until eleven years later in 1990, with the innocuous title:
Higher stages of human development: Perspectives on adult growth
You can read about it much more accessibly, and in much more detail, in her book:
Counterclockwise: A Proven Way to Think Yourself Younger and Healthier – by Dr. Ellen Langer
We haven’t reviewed that particular book yet, so here’s Linda Graham’s review, that noted:
❝Langer cites other research that has made similar findings.
In one study, for instance, 650 people were surveyed about their attitudes on aging. Twenty years later, those with a positive attitude with regard to aging had lived seven years longer on average than those with a negative attitude to aging.
(By comparison, researchers estimate that we extend our lives by four years if we lower our blood pressure and reduce our cholesterol.)
In another study, participants read a list of negative words about aging; within 15 minutes, they were walking more slowly than they had before.❞
Read the review in full:
Aging in Reverse: A Review of Counterclockwise
The Counterclockwise study has been repeated since, and/but we are still waiting for the latest (exciting, much larger sample, 90 participants this time) study to be published. The research proposal describes the method in great detail, and you can read that with one click over on PubMed:
It was approved, and has now been completed (as of 2020), but the results have not been published yet; you can see the timeline of how that’s progressing over on ClinicalTrials.gov:
Clinical Trials | Ageing as a Mindset: A Counterclockwise Experiment to Rejuvenate Older Adults
Hopefully it’ll take less time than the eleven years it took for the original study, but in the meantime, there seems to be nothing to lose in doing a little “Citizen Science” for ourselves.
Maybe a week in a 20 years-ago themed resort (writer’s note: wow, that would only be 2004; that doesn’t feel right; it should surely be at least the 90s!) isn’t a viable option for you, but we’re willing to bet it’s possible to “microdose” on this method. Given that the original study lasted only a week, even just a themed date-night on a regular recurring basis seems like a great option to explore (if you’re not partnered then well, indulge yourself how best you see fit, in accord with the same premise; a date-night can be with yourself too!).
Just remember the most important take-away though:
Don’t accidentally put yourself in your own control group!
In other words, it’s critically important that for the duration of the exercise, you act and even think as though it is the appropriate date.
If you instead spend your time thinking “wow, I miss the [decade that does it for you]”, you will dodge the benefits, and potentially even make yourself feel (and thus, potentially, if the inverse hypothesis holds true, become) older.
This latter is not just our hypothesis by the way, there is an established potential for nocebo effect.
For example, the following study looked at how instructions given in clinical tests can be worded in a way that make people feel differently about their age, and impact the results of the mental and/or physical tests then administered:
❝Our results seem to suggest how manipulations by instructions appeared to be more largely used and capable of producing more clear performance variations on cognitive, memory, and physical tasks.
Age-related stereotypes showed potentially stronger effects when they are negative, implicit, and temporally closer to the test of performance. ❞
(and yes, that’s the same Dr. Francesco Pagnini whose name you saw atop the other study we cited above, with the 90 participants recreating the Counterclockwise study)
Want to know more about [the hard science of] psychosomatic health?
Check out Dr. Langer’s other book, which we reviewed recently:
The Mindful Body: Thinking Our Way to Chronic Health – by Dr. Ellen Langer
Enjoy!
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Self-Compassion In A Relationship (Positives & Pitfalls)
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Practise Self-Compassion In Your Relationship (But Watch Out!)
Let’s make clear up-front: this is not about “…but not too much”.
With that in mind…
Now let’s set the scene: you, a happily-partnered person, have inadvertently erred and upset your partner. They may or may not have already forgiven you, but you are still angry at yourself.
Likely next steps include all or any of:
- continuing to apologise and try to explain
- self-deprecatory diatribes
- self-flagellation, probably not literally but in the sense of “I don’t deserve…” and acting on that feeling
- self-removal, because you don’t want to further inflict your bad self on your partner
As you might guess, these are quite varied in their degree of healthiness:
- apologising is good, as even is explaining, but once it’s done, it’s done; let it go
- self-deprecation is pretty much never useful, let alone healthy
- self-flagellation likewise; it is not only inherently self-destructive, but will likely create an additional problem for your partner too
- self-removal can be good or bad depending on the manner of that removal: there’s a difference between just going cold and distant on your partner, and saying “I’m sorry; this is my fault not yours, I don’t want to take it out on you, so please give me half an hour by myself to regain my composure, and I will come back with love then if that’s ok with you”
About that last: mentioning the specific timeframe e.g. “half an hour” is critical, by the way—don’t leave your partner hanging! And then do also follow through on that; come back with love after the half-hour elapses. We suggest mindfulness meditation in the interim (here’s our guide to how), if you’re not sure what to do to get you there.
To Err Is Human; To Forgive, Healthy (Here’s How To Do It) ← this goes for when the forgiveness in question is for yourself, too—and we do write about that there (and how)!
This is important, by the way; not forgiving yourself can cause more serious issues down the line:
If, by the way, you’re hand-wringing over “but was my apology good enough really, or should I…” then here is how to do it. Basically, do this, and then draw a line under it and consider it done:
The Apology Checklist ← you’ll want to keep a copy of this, perhaps in the notes app on your phone, or a screenshot if you prefer
(the checklist is at the bottom of that page)
The catch
It’s you, you’re the catch 👈👈😎
Ok, that being said, there is actually a catch in the less cheery sense of the word, and it is:
“It is important to be compassionate about one’s occasional failings in a relationship” does not mean “It is healthy to be neglectful of one’s partner’s emotional needs; that’s self-care, looking after #1; let them take care of themself too”
…because that’s simply not being a couple at all.
Think about it this way: the famous airline advice,
“Put on your own oxygen mask before helping others with theirs”
…does not mean “Put on your own oxygen mask and then watch those kids suffocate; it’s everyone for themself”
So, the same goes in relationships too. And, as ever, we have science for this. There was a recent (2024) study, involving hundreds of heterosexual couples aged 18–73, which looked at two things, each measured with a scaled questionnaire:
- Subjective levels of self-compassion
- Subjective levels of relationship satisfaction
For example, questions included asking participants to rate, from 1–5 depending on how much they felt the statements described them, e.g:
In my relationship with my partner, I:
- treat myself kindly when I experience sorrow and suffering.
- accept my faults and weaknesses.
- try to see my mistakes as part of human nature.
- see difficulties as part of every relationship that everyone goes through once.
- try to get a balanced view of the situation when something unpleasant happens.
- try to keep my feelings in balance when something upsets me.
Note: that’s not multiple choice! It’s asking participants to rate each response as applicable or not to them, on a scale of 1–5.
And…
❝Women’s self-compassion was also positively linked with men’s total relationship satisfaction. Thus, men seem to experience overall satisfaction with the relationship when their female partner is self-kind and self-caring in difficult situations.
Unexpectedly, however, we found that men’s relationship-specific self-compassion was negatively associated with women’s fulfillment.
Baker and McNulty (2011) reported that, only for men, a Self-Compassion x Conscientiousness interaction explained whether the positive effects of self-compassion on the relationship emerged, but such an interaction was not found for women.
Highly self-compassionate men who were low in conscientiousness were less motivated than others to remedy interpersonal mistakes in their romantic relationships, and this tendency was in turn related to lower relationship satisfaction❞
~ Dr. Astrid Schütz et al. (2024)
And if you’d like to read the cited older paper from 2011, here it is:
Read in full: Self-compassion and relationship maintenance: the moderating roles of conscientiousness and gender
The take-away here is not: “men should not practice self-compassion”
(rather, they absolutely should)
The take-away is: we must each take responsibility for managing our own mood as best we are able; practice self-forgiveness where applicable and forgive our partner where applicable (and communicate that!)…. And then go consciously back to the mutual care on which the relationship is hopefully founded.
Which doesn’t just mean love-bombing, by the way, it also means listening:
The Problem With Active Listening (And How To Do Better)
To close… We say this often, but we mean it every time: take care!
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28-Day FAST Start Day-by-Day – by Gin Stephens
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We have previously reviewed Gin Stephens’ other book, “Fast. Feast. Repeat.”, so what’s so special about this one that it deserves reviewing too?
This one is all about troubleshooting the pitfalls that many people find when taking up intermittent fasting.
To be clear: the goal here is not a “28 days and yay you did it, put that behind you now”, but rather “28 days and you are now intermittently fasting easily each day and can keep it up without difficulty”. As for the difficulties that may arise early in the 28 days…
Not just issues of willpower, but also the accidental breaks. For example, some artificial sweeteners, while zero-calorie, trigger an insulin response, which breaks the fast on the metabolic level (avoiding that is the whole point of IF). Lots of little tips like that peppered through the book help the reader to stop accidentally self-sabotaging their progress.
The author does talk about psychological issues too, and also how it will feel different at first while the liver is adapting, than later when it has already depleted its glycogen reserves and the body must burn body fat instead. Information like that makes it easier to understand that some initial problems (hunger, getting “hangry”, feeling twitchy, or feeling light-headed) will last only a few weeks and then disappear.
So, understanding things like that makes a big difference too.
The style of the book is simple and clear pop-science, with lots of charts and bullet points and callout-boxes and the like; it makes for very easy reading, and very quick learning of all the salient points, of which there are many.
Bottom line: if you’ve tried intermittent fasting but struggled to make it stick, this book can help you get to where you want to be.
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Feta Cheese vs Mozzarella – Which is Healthier?
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Our Verdict
When comparing feta to mozzarella, we picked the mozzarella.
Why?
There are possible arguments for both, but there are a couple of factors that we think tip the balance.
In terms of macronutrients, feta has more fat, of which, more saturated fat, and more cholesterol. Meanwhile, mozzarella has about twice the protein, which is substantial for a cheese. So this section’s a fair win for mozzarella.
In the category of vitamins, however, feta wins with more of vitamins B1, B2, B3, B6, B9, B12, D, & E. In contrast, mozzarella boasts only a little more vitamin A and choline. An easy win for feta in this section.
When it comes to minerals, the matter is decided, we say. Mozzarella has more calcium, magnesium, phosphorus, and potassium, while feta has more copper, iron, and (which counts against it) sodium. A win for mozzarella.
About that sodium… A cup of mozzarella contains about 3% of the RDA of sodium, while a cup of feta contains about 120% of the RDA of sodium. You see the problem? So, while mozzarella was already winning based on adding up the previous categories, the sodium content alone is a reason to choose mozzarella for your salad rather than feta.
That settles it, but just before we close, we’ll mention that they do both have great gut-healthy properties, containing healthy probiotics.
In short: if it weren’t for the difference in sodium content, this would be a narrow win for mozzarella. As it is, however, it’s a clear win.
Want to learn more?
You might like to read:
- Making Friends With Your Gut (You Can Thank Us Later)
- Is Dairy Scary? ← the answer is “it can be, but it depends on the product, and some are healthy; the key is in knowing which”
- How Too Much Salt May Lead To Organ Failure
Take care!
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The 3 Phases Of Fat Loss (& How To Do It Right!)
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Cori Lefkowith, of “Redefining Strength” and “Strength At Any Age” fame, has advice:
As easy as 1, 2, 3?
Any kind of fat loss plan will not work unless it takes into account that the body can and will adapt to a caloric deficit, meaning that constantly running a deficit will only ever yield short term results, followed by regaining weight (and feeling hungry the whole time). So, instead, if fat loss is your goal, you might want to consider doing it in these stages:
1. Lifestyle adjustments (main phase)
Focus on sustainable, gradual improvements in diet and workouts.
- Key strategies:
- Start with small, manageable changes, for example focusing on making your protein intake around 30–35% of your total calories.
- Track your current habits to identify realistic adjustments.
- Balance strength training and cardio, as maintaining your muscle is (and will remain) important.
- Signs of Progress:
- Slow changes in the numbers on the scale (up to 1 lb/week).
- Inches being lost (but probably not many), improved energy levels, and stable performance in workouts.
Caution: avoid feelings of extreme hunger or restriction. This is not supposed to be arduous.
2. Mini cut (short-term intensive)
Used for quick fat loss or breaking plateaus; lasts 7–14 days.
- Key strategies:
- Larger calorie deficit (e.g: 500 calories).
- High protein intake (40–50% of your total calories).
- Focus on strength training and reduce cardio, to avoid muscle loss.
- Signs of Progress:
- Rapid scale changes (up to 5 lbs/week).
- Reduced bloating, potential energy dips, and cravings.
- Temporary performance stagnation in workouts. Don’t worry about this; it’s expected and fine.
Caution: do not exceed 21 days, to avoid the metabolic adaptation that we talked about.
3. Diet break (rest & reset)
A maintenance period to recharge mentally and physically, typically lasting 7–21 days.
- Key strategies:
- Gradually increase calories (200–500) to maintenance level.
- Focus on performance goals and reintroducing foods you enjoy.
- Combine strength training with steady-state cardio.
- Signs of Progress:
- Increased energy, improved workout performance, and feeling fuller.
- Scale may fluctuate initially but stabilize or decrease by the end.
- Inches will be lost as muscle is built and fat is burned.
The purpose of this third stage is to prevent metabolic adaptation, regain motivation, and (importantly!) test maintenance.
For more on these and how best to implement them, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Take care!
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- Key strategies:
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Oral retinoids can harm unborn babies. But many women taking them for acne may not be using contraception
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Oral retinoids are a type of medicine used to treat severe acne. They’re sold under the brand name Roaccutane, among others.
While oral retinoids are very effective, they can have harmful effects if taken during pregnancy. These medicines can cause miscarriages and major congenital abnormalities (harm to unborn babies) including in the brain, heart and face. At least 30% of children exposed to oral retinoids in pregnancy have severe congenital abnormalities.
Neurodevelopmental problems (in learning, reading, social skills, memory and attention) are also common.
Because of these risks, the Australasian College of Dermatologists advises oral retinoids should not be prescribed a month before or during pregnancy under any circumstances. Dermatologists are instructed to make sure a woman isn’t pregnant before starting this treatment, and discuss the risks with women of childbearing age.
But despite this, and warnings on the medicines’ packaging, pregnancies exposed to oral retinoids continue to be reported in Australia and around the world.
In a study published this month, we wanted to find out what proportion of Australian women of reproductive age were taking oral retinoids, and how many of these women were using contraception.
Our results suggest a high proportion of women are not using effective contraception while on these drugs, indicating Australia needs a strategy to reduce the risk oral retinoids pose to unborn babies.
Contraception options
Using birth control to avoid pregnancy during oral retinoid treatment is essential for women who are sexually active. Some contraception methods, however, are more reliable than others.
Long-acting-reversible contraceptives include intrauterine devices (IUDs) inserted into the womb (such as Mirena, Kyleena, or copper devices) and implants under the skin (such as Implanon). These “set and forget” methods are more than 99% effective.
The effectiveness of oral contraceptive pills among “perfect” users (following the directions, with no missed or late pills) is similarly more than 99%. But in typical users, this can fall as low as 91%.
Condoms, when used as the sole method of contraception, have higher failure rates. Their effectiveness can be as low as 82% in typical users.
Oral retinoid use over time
For our study, we analysed medicine dispensing data among women aged 15–44 from Australia’s Pharmaceutical Benefit Scheme (PBS) between 2013 and 2021.
We found the dispensing rate for oral retinoids doubled from one in every 71 women in 2013, to one in every 36 in 2021. The increase occurred across all ages but was most notable in young women.
Most women were not dispensed contraception at the same time they were using the oral retinoids. To be sure we weren’t missing any contraception that was supplied before the oral retinoids, we looked back in the data. For example, for an IUD that lasts five years, we looked back five years before the oral retinoid prescription.
Our analysis showed only one in four women provided oral retinoids were dispensed contraception simultaneously. This was even lower for 15- to 19-year-olds, where only about one in eight women who filled a prescription for oral retinoids were dispensed contraception.
A recent study found 43% of Australian year 10 and 69% of year 12 students are sexually active, so we can’t assume this younger age group largely had no need for contraception.
One limitation of our study is that it may underestimate contraception coverage, because not all contraceptive options are listed on the PBS. Those options not listed include male and female sterilisation, contraceptive rings, condoms, copper IUDs, and certain oral contraceptive pills.
But even if we presume some of the women in our study were using forms of contraception not listed on the PBS, we’re still left with a significant portion without evidence of contraception.
What are the solutions?
Other countries such as the United States and countries in Europe have pregnancy prevention programs for women taking oral retinoids. These programs include contraception requirements, risk acknowledgement forms and regular pregnancy tests. Despite these programs, unintended pregnancies among women using oral retinoids still occur in these countries.
But Australia has no official strategy for preventing pregnancies exposed to oral retinoids. Currently oral retinoids are prescribed by dermatologists, and most contraception is prescribed by GPs. Women therefore need to see two different doctors, which adds costs and burden.
Rather than a single fix, there are likely to be multiple solutions to this problem. Some dermatologists may not feel confident discussing sex or contraception with patients, so educating dermatologists about contraception is important. Education for women is equally important.
A clinical pathway is needed for reproductive-aged women to obtain both oral retinoids and effective contraception. Options may include GPs prescribing both medications, or dermatologists only prescribing oral retinoids when there’s a contraception plan already in place.
Some women may initially not be sexually active, but change their sexual behaviour while taking oral retinoids, so constant reminders and education are likely to be required.
Further, contraception access needs to be improved in Australia. Teenagers and young women in particular face barriers to accessing contraception, including costs, stigma and lack of knowledge.
Many doctors and women are doing the right thing. But every woman should have an effective contraception plan in place well before starting oral retinoids. Only if this happens can we reduce unintended pregnancies among women taking these medicines, and thereby reduce the risk of harm to unborn babies.
Dr Laura Gerhardy from NSW Health contributed to this article.
Antonia Shand, Research Fellow, Obstetrician, University of Sydney and Natasha Nassar, Professor of Paediatric and Perinatal Epidemiology and Chair in Translational Childhood Medicine, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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