How weight bias in health care can harm patients with obesity: Research
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Patients who weigh more than what medical authorities generally consider healthy often avoid seeing doctors for fear of being judged, insulted or misdiagnosed, decades of research find. Meanwhile, academic studies consistently show many health care professionals discriminate against heavier patients and that weight bias can drive people with obesity to gain weight.
Weight bias refers to negative attitudes, stereotypes and discrimination aimed at individuals with excess body fat. When scholars reviewed 41 studies about weight bias in health care, published from 1989 to 2021, they found it comes in many forms: contemptuous language, inappropriate gestures, expressing a preference for thinner patients, avoiding physical touch and eye contact, and attributing all of a person’s health issues to their weight.
“Weight bias has been reported in physicians, nurses, dietitians, physiotherapists, and psychologists, as well as nutritionists and exercise professionals, and it is as pervasive among medical professionals as it is within the general population,” write the authors of the research review, published in 2021 in the journal Obesity.
That’s a problem considering an estimated 4 out of 10 U.S. adults aged 20 years and older have obesity, a complex and often misunderstood illness that the American Medical Association voted in 2013 to recognize as a disease. By 2030, half of U.S. adults will have obesity, researchers project in a 2020 paper in the International Journal of Epidemiology.
Worldwide, the obesity rate among adults aged 18 and older was 13% in 2016, according to the World Health Organization. If current trends continue, the World Obesity Federation projects that, by 2035, 51% of the global population will be living with overweight or obesity.
The harms of weight bias
Weight stigma — the societal devaluation of people perceived to be carrying excess weight — drives weight bias. It’s so physically and emotionally damaging that a panel of 36 international experts issued a consensus statement in 2020 to raise awareness about and condemn it. Dozens of medical and academic organizations, including 15 scholarly journals, endorsed the document, published in Nature Medicine.
The release of a consensus statement is a significant event in research, considering it represents the collective position that experts in a particular field have taken on an issue, based on an analysis of all the available evidence.
Research to date indicates heavier individuals who experience weight bias and stigma often:
- Avoid doctors and other health care professionals, skipping routine screenings as well as needed treatments.
- Change doctors frequently.
- Are at a higher risk for depression, anxiety, mood disorders and other mental health problems.
- Avoid or put off exercise.
- Consume more food and calories.
- Gain weight.
- Have disrupted sleep.
The consensus statement notes that educating health care providers, journalists, policymakers and others about obesity is key to changing the narrative around the disease.
“Weight stigma is reinforced by misconceived ideas about body-weight regulation and lack of awareness of current scientific evidence,” write the experts, led by Francesco Rubino, the chair of metabolic and bariatric surgery at Kings College London.
“Despite scientific evidence to the contrary, the prevailing view in society is that obesity is a choice that can be reversed by voluntary decisions to eat less and exercise more. These assumptions mislead public health policies, confuse messages in popular media, undermine access to evidence-based treatments, and compromise advances in research.”
Weight bias and stigma appear to stimulate the secretion of the stress hormone cortisol and promote weight gain, researchers write in a 2016 paper published in Obesity.
A. Janet Tomiyama, a psychology professor at UCLA who directs the university’s Dieting, Stress, and Health research lab, describes weight stigma as “a ‘vicious cycle’ — a positive feedback loop wherein weight stigma begets weight gain.”
“This happens through increased eating behavior and increased cortisol secretion governed by behavioral, emotional, and physiological mechanisms, which are theorized to ultimately result in weight gain and difficulty of weight loss,” Tomiyama writes in her 2014 paper, “Weight Stigma is Stressful. A Review of Evidence for the Cyclic Obesity/Weight-Based Stigma Model.”
The consensus statement spotlights 13 recommendations for eliminating weight bias and stigma, some of which are specifically aimed at health care providers, the media, researchers or policymakers. One of the recommendations for the health care community: “[Health care providers] specialized in treating obesity should provide evidence of stigma-free practice skills. Professional bodies should encourage, facilitate, and develop methods to certify knowledge of stigma and its effects, along with stigma-free skills and practices.”
The one recommendation for the media: “We call on the media to produce fair, accurate, and non-stigmatizing portrayals of obesity. A commitment from the media is needed to shift the narrative around obesity.”
Why obesity is a complicated disease
It’s important to point out that having excess body fat does not, by itself, mean an individual is unhealthy, researchers explain in a 2017 article in The Conversation, which publishes research-based news articles and essays. But it is a major risk factor for cardiovascular disease, including stroke, as well as diabetes, some types of cancer, and musculoskeletal disorders such as osteoarthritis.
Doctors often look at patients’ body mass index — a number that represents their weight in relation to their height — to gauge the amount of fat on their bodies. A BMI of 18.5 to 24.9 is ideal, according to the U.S. Centers for Disease Control and Prevention. A BMI of 25.0 to 29.9, indicates excess body fat, or “overweight,” while a BMI of 30 and above indicates obesity.
In June, the American Medical Association announced a new policy clarifying how BMI can be used to diagnose obesity. Because it’s an imperfect measure for body fat, the organization suggests BMI be used in conjunction with other measures such as a patient’s waist circumference and skin fold thickness.
Two specialists who have been working for years to dispel myths and misconceptions about obesity are Fatima Cody Stanford, an obesity physician and associate professor at Harvard Medical School, and Rebecca Puhl, the deputy director of the Rudd Center for Food Policy and Obesity at the University of Connecticut.
Cody Stanford has called obesity “a brain disease” because the brain tells the body how much to eat and what to do with the food consumed. One pathway in the brain directs the body to eat less and store less fat, she explains in a February 2023 podcast produced by the American Medical Association.
“For people that signal really great down this pathway, they tend to be very lean, not struggle with their weight in the same way that people that have excess weight do,” she says during the podcast, adding that people with obesity receive signals from an alternate pathway that “tells us to eat more and store more.”
Academic studies demonstrate that a wide variety of factors can affect weight regulation, including sleep quality and duration, gut health, genetics, medication, access to healthy foods and even early life experiences.
For example, a 2020 paper in the journal JAMA Network Open suggests female infants born by cesarean delivery have a higher risk of obesity during adulthood than female infants born by vaginal delivery. The study of 33,226 U.S. women born between 1946 and 1964 found that a cesarean delivery is associated with an 11% higher risk of developing obesity and a 46% higher risk of developing type 2 diabetes.
Scholars have also found that traumatic childhood experiences such as abuse and neglect are linked to adult obesity, according to a research review published in 2020.
Income inequality seems to play a role as well. When researchers from the Johns Hopkins Bloomberg School of Public Health studied the link between income inequality and obesity for a sample of 36,665 U.S. adults, they discovered women with lower incomes are more likely to have obesity than women with higher incomes.
Their analysis indicates the opposite is true for men, whose odds of obesity rise with their income, the researchers write in a 2021 paper in the International Journal of Environmental Research and Public Health.
Weight bias among doctor trainees
While scholars have learned a lot about obesity and weight bias in recent decades, the information might not be reaching people training to become doctors. A study published in October finds that some resident physicians believe obesity to be the result of poor choices and weak willpower.
Researchers asked 3,267 resident physicians who graduated from a total of 49 U.S. medical schools a series of questions to gauge their knowledge of obesity and attitudes toward heavier patients. What they learned: Nearly 40% of resident physicians agreed with the statement, “Fat people tend to be fat pretty much through their own fault.” Almost half agreed with the statement, “Some people are fat because they have no willpower.”
The study also reveals that about one-third of participants said they “feel more irritated when treating an obese patient than a non-obese patient.”
“Notably, more than a quarter of residents expressed slight-to-strong agreement with the item ‘I dislike treating obese patients,’” the researchers write.
Another takeaway from the paper: Resident physicians specializing in orthopedic surgery, anesthesiology and urology expressed the highest levels of dislike of heavier patients. Of the 16 medical specialties represented, residents in family medicine, psychiatry and pediatrics reported the lowest levels of dislike.
Kimberly Gudzune, medical director of the American Board of Obesity Medicine, asserts that doctors and medical students need to be educated about obesity. The topic “is grossly neglected” in medical schools and medical training programs worldwide, research has found.
Many physicians don’t understand obesity, Gudzune explains in a July 2023 interview on the internal medicine podcast “The Curbsiders.”
“I think back to when I was a medical student, when I was a resident, I really didn’t learn much about obesity and how to treat it, yet it’s a problem that affects the majority of our patients,” she tells podcast listeners. “I think there’s a lot of evidence out there showing that primary care physicians don’t really know where to start.”
In 2011, the American Board of Obesity Medicine established a program through which doctors could become certified in obesity medicine. Since then, a total of 6,729 U.S. doctors have earned certification, the vast majority of whom specialize in family and internal medicine.
What health care providers think
The experts who created the consensus statement on weight bias and stigma noted health care providers’ shortcomings in the document. They write that the common themes they discovered in the research include “contemptuous, patronizing, and disrespectful treatment” of patients, a lack of training, poor communication and assumptions about weight gain.
Puhl, the deputy director of the Rudd Center at the University of Connecticut, is a pioneer in weight bias research and one of the experts who wrote the consensus statement. During an episode of “The Leading Voices in Food,” a podcast created by Duke University’s World Food Policy Center, she shares details about what she has learned over the years.
“[Health care providers’] views that patients with obesity are lazy or lacking control, are to blame for their weight or noncompliant with treatment,” she says during the interview. “We know, for example, that some physicians spend less time in their appointments with patients [who] have a larger body size. They give them less education about health. They’re more reluctant to perform certain screenings. They talk about treating patients with obesity as being a greater waste of their time than providing care to thinner patients. And we know that patients seem to be aware of these biases from providers and that can really contribute to patients avoiding health care because they just don’t want to repeat those negative experiences of bias.”
To set the record straight, the experts who wrote the the consensus statement listed the following five common assumptions as being “at odds with a definitive body of biological and clinical evidence.”
1. Body weight = calories in – calories out.
This equation oversimplifies the relationship between body weight and energy consumed and used, the experts write. “Both variables of the equation depend on factors additional to just eating and exercising. For instance, energy intake depends on the amount of food consumed, but also on the amount of food-derived energy absorbed through the gastrointestinal tract, which in turn is influenced by multiple factors, such as digestive enzymes, bile acids, microbiota, gut hormones, and neural signals, none of which are under voluntary control.”
2. Obesity is primarily caused by voluntary overeating and a sedentary lifestyle.
According to the experts, overeating and forgoing exercise might be symptoms of obesity rather than the root causes. There are many possible causes and contributors “including geneticand epigenetic factors, foodborne factors, sleep deprivation and circadian dysrhythmia, psychological stress, endocrine disruptors, medications, and intrauterine and intergenerational effects. These factors do not require overeating or physical inactivity to explain excess weight.” they write.
3. Obesity is a lifestyle choice.
“People with obesity typically recognize obesity as a serious health problem, rather than a conscious choice,” the experts write. “Given the negative effects of obesity on quality of life, the well-known risks of serious complications and reduced life expectancy associated with it, it is a misconception to define obesity as a choice.”
4. Obesity is a condition, not a disease.
The criteria generally used to determine disease status “are clearly fulfilled in many individuals with obesity as commonly defined, albeit not all,” the experts explain. “These criteria include specific signs or symptoms (such as increased adiposity), reduced quality of life, and/or increased risk of further illness, complications, and deviation from normal physiology — or well-characterized pathophysiology (for example, inflammation, insulin resistance, and alterations of hormonal signals regulating satiety and appetite).”
5. Severe obesity is usually reversible by voluntarily eating less and exercising more.
“A large body of clinical evidence has shown that voluntary attempts to eat less and exercise more render only modest effects on body weight in most individuals with severe obesity,” the experts write. “When fat mass decreases, the body responds with reduced resting energy expenditure and changes in signals that increase hunger and reduce satiety (for example, leptin, ghrelin). These compensatory metabolic and biologic adaptations promote weight regain and persist for as long as persons are in the reduced-energy state, even if they gain some weight back.”
Health care facility improvements
The expert panel also determined that many health care facilities aren’t equipped to treat people with obesity. Examination gowns, blood pressure cuffs, chairs and examination tables often are too small, patients have reported.
When researchers from the University of Minnesota, Minneapolis Veterans Affairs Medical Center and Mayo Clinic studied the quality of care that patients with obesity receive, they learned that a clinic’s physical environment can have a big effect on a patient’s experience.
They write in a 2015 study published in Obesity Reviews: “Waiting room chairs with armrests can be uncomfortable or too small. Equipment such as scales, blood pressure cuffs, examination gowns and pelvic examination instruments are often designed for use with smaller patients. When larger alternatives are not available, or are stored in a place that suggests infrequent use, it can signal to patients that their size is unusual and that they do not belong. These experiences, which are not delivered with malicious intent, can be humiliating.”
When medical equipment is the wrong size, it may not work correctly. For instance, chances are high that a blood pressure reading will be inaccurate if a health care professional uses a blood pressure cuff that’s too small on a patient with obesity, a 2022 paper finds.
To create a comfortable environment for patients with high body weights, the Rudd Center for Food Policy and Obesity recommends that health care facilities provide, among other things, extra-large exam gowns, chairs that can support more than 300 pounds and do not have arms, and wide exam tables that are bolted to the floor so they don’t move.
The consensus statement also recommends improvements to health care facilities.
“Given the prevalence of obesity and obesity-related diseases,” the 36 international experts write, “appropriate infrastructure for the care and management of people with obesity, including severe obesity, must be standard requirement for accreditation of medical facilities and hospitals.”
Source list:
Weight Bias Among Health Care Professionals: A Systematic Review and Meta-Analysis
Blake J. Lawrence; et al. Obesity, November 2021.
Joint International Consensus Statement for Ending Stigma of Obesity
Francesco Rubino, et al. Nature Medicine, March 2020.
Perceived Weight Discrimination and Chronic Biochemical Stress: A Population-Based Study Using Cortisol in Scalp Hair
Sarah E. Jackson, Clemens Kirschbaum and Andrew Steptoe. Obesity, December 2016.
Weight Stigma is Stressful. A Review of Evidence for the Cyclic Obesity/Weight-Based Stigma Model
A. Janet Tomiyama. Appetite, November 2014.
Association of Birth by Cesarean Delivery with Obesity and Type 2 Diabetes Among Adult Women
Jorge E. Chavarro. JAMA Network Open, April 2020.
Adverse Childhood Experiences and Adult Obesity: A Systematic Review of Plausible Mechanisms and Meta-Analysis of Cross-Sectional Studies
David A. Wiss and Timothy D. Brewerton. Physiology & Behavior, September 2020.
Income Inequality and Obesity among U.S. Adults 1999–2016: Does Sex Matter?
Hossein Zare, Danielle D. Gaskin and Roland J. Thorpe Jr. International Journal of Environmental Research and Public Health, July 2021.
Comparisons of Explicit Weight Bias Across Common Clinical Specialties of U.S. Resident Physicians
Samantha R. Philip, Sherecce A. Fields, Michelle Van Ryn and Sean M. Phelan. Journal of General Internal Medicine, October 2023.
Impact of Weight Bias and Stigma on Quality of Care and Outcomes for Patients with Obesity
S.M. Phelan; et al. Obesity Reviews, April 2015.
One Size Does Not Fit All: Impact of Using A Regular Cuff For All Blood Pressure Measurements
Tammy. M. Brady; et al. Circulation, April 2022.
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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If you’re worried about inflammation, stop stressing about seed oils and focus on the basics
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You’ve probably seen recent claims online seed oils are “toxic” and cause inflammation, cancer, diabetes and heart disease. But what does the research say?
Overall, if you’re worried about inflammation, cancer, diabetes and heart disease there are probably more important things to worry about than seed oils.
They may or may not play a role in inflammation (the research picture is mixed). What we do know, however, is that a high-quality diet rich in unprocessed whole foods (fruits, vegetables, nuts, seeds, grains and lean meats) is the number one thing you can to do reduce inflammation and your risk of developing diseases.
Rather than focusing on seed oils specifically, reduce your intake of processed foods more broadly and focus on eating fresh foods. So don’t stress out too much about using a bit of seed oils in your cooking if you are generally focused on all the right things.
What are seed oils?
Seed oils are made from whole seeds, such as sunflower seeds, flax seeds, chia seeds and sesame seeds. These seeds are processed to extract oil.
The most common seed oils found at grocery stores include sesame oil, canola oil, sunflower oil, flaxseed oil, corn oil, grapeseed oil and soybean oil.
Seed oils are generally affordable, easy to find and suitable for many dishes and cuisines as they often have a high smoke point.
However, most people consume seed oils in larger amounts through processed foods such as biscuits, cakes, chips, muesli bars, muffins, dipping sauces, deep-fried foods, salad dressings and margarines.
These processed foods are “discretionary”, meaning they’re OK to have occasionally. But they are not considered necessary for a healthy diet, nor recommended in our national dietary guidelines, the Australian Guide for Healthy Eating.
Seed oils often have a high smoke point.
Gleb Usovich/ShutterstockI’ve heard people say seed oils ‘promote inflammation’. Is that true?
There are two essential types of omega fatty acids: omega-3 and omega-6. These are crucial for bodily functions, and we must get them through our diet since our bodies cannot produce them.
While all oils contain varying levels of fatty acids, some argue an excessive intake of a specific omega-6 fatty acid in seed oils called “linoleic acid” may contribute to inflammation in the body.
There is some evidence linoleic acid can be converted to arachidonic acid in the body and this may play a role in inflammation. However, other research doesn’t support the idea reducing dietary linoleic acid affects the amount of arachidonic acid in your body. The research picture is not clear cut.
But if you’re keen to reduce inflammation, the best thing you can do is aim for a healthy diet that is:
- high in antioxidants (found in fruits and vegetables)
- high in “healthy”, unsaturated fatty acids (found in fatty fish, some nuts and olive oil, for example)
high in fibre (found in carrots, cauliflower, broccoli and leafy greens) and prebiotics (found in onions, leeks, asparagus, garlic and legumes)
low in processed foods.
If reducing inflammation is your goal, it’s probably more meaningful to focus on these basics than on occasional use of seed oils.
Choose foods high in fibre (like many vegetables) and prebiotics (like legumes).
Kiian Oksana/ShutterstockWhat about seed oils and heart disease, cancer or diabetes risk?
Some popular arguments against seed oils come from data from single studies on this topic. Often these are observational studies where researchers do not make changes to people’s diet or lifestyle.
To get a clearer picture, we should look at meta-analyses, where scientists combine all the data available on a topic. This helps us get a better overall view of what’s going on.
A 2022 meta-analysis of randomised controlled trials investigated the relationship between supplementation with omega-6 fatty acid (often found in seed oils) and cardiovascular disease risk (meaning disease relating to the heart and blood vessels).
The researchers found omega-6 intake did not affect the risk for cardiovascular disease or death but that further research is needed for firm conclusions. Similar findings were observed in a 2019 review on this topic.
The World Health Organization published a review and meta-analysis in 2022 of observational studies (considered lower quality evidence compared to randomised controlled trials) on this topic.
They looked at omega-6 intake and risk of death, cardiovascular disease, breast cancer, mental health conditions and type 2 diabetes. The findings show both advantages and disadvantages of consuming omega-6.
The findings reported that, overall, higher intakes of omega-6 were associated with a 9% reduced risk of dying (data from nine studies) but a 31% increased risk of postmenopausal breast cancer (data from six studies).
One of the key findings from this review was about the ratio of omega-3 fatty acids to omega-6 fatty acids. A higher omega 6:3 ratio was associated with a greater risk of cognitive decline and ulcerative colitis (an inflammatory bowel condition).
A higher omega 3:6 ratio was linked to a 26% reduced risk of depression. These mixed outcomes may be a cause of confusion among health-conscious consumers about the health impact of seed oils.
Overall, the evidence suggests that a high intake of omega-6 fatty acids from seed oils is unlikely to increase your risk of death and disease.
However, more high-quality intervention research is needed.
The importance of increasing your omega-3 fatty acids
On top of the mixed outcomes, there is clear evidence increasing the intake of omega-3 fatty acids (often found in foods such as fatty fish and walnuts) is beneficial for health.
While some seed oils contain small amounts of omega-3s, they are not typically considered rich sources.
Flaxseed oil is an exception and is one of the few seed oils that is notably high in alpha-linolenic acid (sometimes shortened to ALA), an omega-3 fatty acid.
If you are looking to increase your omega-3 intake, it’s better to focus on other sources such as fatty fish (salmon, mackerel, sardines), chia seeds, hemp seeds, walnuts, and algae-based supplements. These foods are known for their higher omega-3 content compared to seed oils.
The bottom line
At the end of the day, it’s probably OK to include small quantities of seed oils in your diet, as long as you are mostly focused on eating fresh, unprocessed foods.
The best way to reduce your risk of inflammation, heart disease, cancer or diabetes is not to focus so much on seed oils but rather on doing your best to follow the Australian Guide for Healthy Eating.
Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Lecturer, Southern Cross University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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12 Foods That Fight Depression & Anxiety
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Food impacts mental health, and while it won’t magically cure mental illness, dietary changes can do a lot to improve mood. Here’s how:
Nutraceuticals
We’ll not keep the 12 nutraceutical foods a mystery; here’s what they are and a few words on how they work (in many cases, we could write whole articles about them; in some cases, we already have! You can find many of them by using the search function in the top-right of each page).
- Walnuts are rich in omega-3s for brain health; arguably the best nut for depression relief.
- Fermented foods because probiotics in foods like yogurt and sauerkraut support the gut-brain connection as well as serotonin production there, enhancing mood.
- Cherry tomatoes are rich in lycopene, which helps combat both depression and mood swings.
- Leafy greens reduce brain inflammation linked to depression.
- Apples and other fruit are high in fiber and antioxidants that stabilize blood sugar and mood, reducing brain inflammation.
- Beans are high in B vitamins, crucial for neurotransmitter production and mood regulation (without also being high in brain-harmful things, as red meat is).
- Berries are super-high antioxidants and cortisol-lowering anthocyanidins, promoting calmness and reducing stress.
- Oats contain the healthiest kind of fiber, β-glucan, and additionally help stabilize blood sugar and mood; they’re also rich in selenium, which boosts mood.
- Mushrooms help regulate blood sugar and act as prebiotics, supporting serotonin production in the gut.
- Avocados are famously rich in healthy fats, including omega-3s and oleic acid, which support brain health and combat depression.
- Dark chocolate contains antioxidants, magnesium, and gut-healthy prebiotics that indirectly reduce mental stress and improve brain function. Also a famous comfort food for many, of course, and that factor’s not to be overlooked either.
- Pumpkin seeds are rich in tryptophan, which boosts serotonin production. As a bonus, they also help some kinds of antidepressant to work better—check with your doctor or pharmacist to be sure in your case, though.
For more on all of these, enjoy:
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Want to learn more?
You might also like to read:
The 6 Pillars Of Nutritional Psychiatry
Take care!
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What is Ryeqo, the recently approved medicine for endometriosis?
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For women diagnosed with endometriosis it is often a long sentence of chronic pain and cramping that impacts their daily life. It is a condition that is both difficult to diagnose and treat, with many women needing either surgery or regular medication.
A medicine called Ryeqo has just been approved for marketing specifically for endometriosis, although it was already available in Australia to treat a different condition.
Women who want the drug will need to consult their local doctor and, as it is not yet on the Pharmaceutical Benefits Scheme, they will need to pay the full cost of the script.
What does Ryeqo do?
Endometriosis affects 14% of women of reproductive age. While we don’t have a full understanding of the cause, the evidence suggests it’s due to body tissue that is similar to the lining of the uterus (called the endometrium) growing outside the uterus. This causes pain and inflammation, which reduces quality of life and can also affect fertility.
Ryeqo is a tablet containing three different active ingredients: relugolix, estradiol and norethisterone.
Relugolix is a drug that blocks a particular peptide from releasing other hormones. It is also used in the treatment of prostate cancer. Estradiol is a naturally occurring oestrogen hormone in women that helps regulate the menstrual cycle and is used in menopausal hormone therapy. Norethisterone is a synthetic hormone commonly used in birth control medications and to delay menstruation and help with heavy menstrual bleeding.
All three components work together to regulate the levels of oestrogen and progesterone in the body that contribute to endometriosis, alleviating its symptoms.
Relugolix reduces the overall levels of oestrogen and progesterone in the body. The estradiol compensates for the loss of oestrogen because low oestrogen levels can cause hot flushes (also called hot flashes) and bone density loss. And norethisterone blocks the effects of estradiol on the uterus (where too much tissue growth is unwanted).
Is it really new?
The maker of Ryeqo claims it is the first new drug for endometriosis in Australia in 13 years.
But individually, all three active ingredients in Ryeqo have been in use since 2019 or earlier.
Ryeqo has been available in Australia since 2022, but until now was not specifically indicated for endometriosis. It was originally approved for the treatment of uterine fibroids, which share some common symptoms with endometriosis and have related causes.
In addition to Ryeqo, current medical guidance lists other drugs that are suitable for endometriosis and some reformulations of these have also only been recently approved.
The oral medicine Dienogest was approved in 2021, and there have been a number of injectable drugs for endometriosis recently approved, such as Sayana Press which was approved in a smaller dose form for self-injection in 2023.
You can’t take the contraceptive pill with Ryeqo but the endometriosis drug could replace it.
ShutterstockHow to take it and what not to do
Ryeqo is a once-a-day tablet. You can take it with, or without food, but it should be taken about the same time each day.
It is recommended you start taking Ryeqo within the first five days after the start of your next period. If you start at another time during your period, you may experience initial irregular or heavier bleeding.
Because it contains both synthetic and natural hormones, you can’t use the contraceptive pill and Ryeqo together. However, because Ryeqo does contain norethisterone it can be used as your contraception, although it will take at least one month of use to be effective. So, if you are on Ryeqo, you should use a non-hormonal contraceptive – such as condoms – for a month when starting the medicine.
Ryeqo may be incompatible with other medicines. It might not be suitable for you if you take medicines for epilepsy, HIV and AIDS, hepatitis C, fungal or bacterial infections, high blood pressure, irregular heartbeat, angina (chest pain), or organ rejection. You should also not take Ryeqo if you have a liver tumour or liver disease.
The possible side effects of Ryeqo are similar to those of oral contraceptives. Blood clots are a risk with any medicine that contains an oestrogen or a progestogen, which Ryeqo does. Other potential side effects include bone loss, a reduction in menstrual blood loss or loss of your period.
It’s costly for now
Ryeqo can now be prescribed in Australia, so you should discuss whether Ryeqo is right for you with the doctor you usually consult for your endometriosis.
While the maker has made a submission to the Pharmaceutical Benefits Advisory Committee, it is not yet subsidised by the Australian government. This means that rather than paying the normal PBS price of up to A$31.60, it has been reported it may cost as much as $135 for a one-month supply. The committee will make a decision on whether to subsidise Ryeqo at its meeting next month.
Correction: this article has been updated to clarify the recent approval of specific formulations of drugs for endometriosis.
Nial Wheate, Associate Professor of the School of Pharmacy, University of Sydney and Jasmine Lee, Pharmacist and PhD Candidate, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Thai-Style Kale Chips
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…that are actually crispy, tasty, and packed with nutrients! Lots of magnesium and calcium, and array of health-giving spices too.
You will need
- 7 oz raw curly kale, stalks removed
- extra virgin olive oil, for drizzling
- 3 cloves garlic, crushed
- 2 tsp red chili flakes (or crushed dried red chilis)
- 2 tsp light soy sauce
- 2 tsp water
- 1 tbsp crunchy peanut butter (pick one with no added sugar, salt, etc)
- 1 tsp honey
- 1 tsp Thai seven-spice powder
- 1 tsp black pepper
- 1 tsp MSG or 1 tsp low-sodium salt
Method
(we suggest you read everything at least once before doing anything)
1) Pre-heat the oven to 180℃ / 350℉ / Gas mark 4.
2) Put the kale in a bowl and drizzle a little olive oil over it. Work the oil in gently with your fingertips so that the kale is coated; the leaves will also soften while you do this; that’s expected, so don’t worry.
3) Mix the rest of the ingredients to make a sauce; coat the kale leaves with the sauce.
4) Place on a baking tray, as spread-out as there’s room for, and bake on a middle shelf for 15–20 minutes. If your oven has a fierce heat source at the top, it can be good to place an empty baking tray on a shelf above the kale chips, to baffle the heat and prevent them from cooking unevenly—especially if it’s not a fan oven.
5) Remove and let cool, and then serve! They can also be stored in an airtight container if desired.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Brain Food? The Eyes Have It!
- Our Top 5 Spices: How Much Is Enough For Benefits?
- What’s The Truth About MSG?
Take care!
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The Well Plated Cookbook – by Erin Clarke
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Clarke’s focus here is on what she calls “stealthy healthy”, with the idea of dishes that feel indulgent while being great for the health.
The recipes, of which there are well over 100, are indeed delicious and easy to make without being oversimplified, and since she encourages the use of in-season ingredients, many recipes come with a “market swaps” substitution guide, to make each recipe seasonal.
The book is largely not vegetarian, let alone vegan, but the required substitutions will be second-nature to any seasoned vegetarian or vegan. Indeed, “skip the meat sometimes” is one of the advices she offers near the beginning of the book, in the category of tips to make things even healthier.
Bottom line: if you want to add dishes to your repertoire that are great for entertaining and still super-healthy, this book will be a fine addition to your collection.
Click here to check out The Well Plated Cookbook, and get cooking!
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Glucomannan For Weight Loss, Gut Health, & More
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Glucomannan is a water-soluble dietary fiber found in the root of the konjac plant.
If you’ve had konjac noodles, also called shirataki, that’s what those are mostly made of, and it’s why they have next-to-no calories.
You may be wondering: if it’s water-soluble, how do the noodles not dissolve in water? And the answer is that the noodle-making process involves making a gel out of the fiber and water, which is then extruded into noodle shapes. In this gelatinous form, they’re fairly stable (it’s one of the most viscous dietary fibers), but yes, if you were to boil them for a long time, they would indeed turn the entire liquid contents of the saucepan into gel.
How it works for weight loss
Because of its viscosity, adding even a small amount of powdered* glucomannan to a glass of water will turn the whole thing into gel in seconds. This means that if you take glucomannan capsules with a glass of water, then so far as your stomach is concerned, you just ate a cup of gel, and the water is now processed as food, staying longer in the stomach than it otherwise would, and promoting feelings of fullness.
*i.e. dry powder, not in a gelatinous form like the noodles
As for its efficacy in weight loss, see for example:
❝Glucomannan was well-tolerated and resulted in significant weight loss in overweight and obese individuals❞
Read more: Glucomannan and obesity: a critical review
So, that covers the basic requirements, but may be wondering: does it have other benefits? And the answer is yes, it does:
❝Glucomannan appears to beneficially affect total cholesterol, LDL cholesterol, triglycerides, body weight, and fasting blood glucose❞
To further corroborate that and comment on safety…
❝Results showed a significant mean weight loss using glucomannan over an eight-week period. Serum cholesterol and low-density lipoprotein cholesterol were significantly reduced in the glucomannan treated group. No adverse reactions to glucomannan were reported.❞
Read more: Effect of glucomannan on obese patients: a clinical study
As to whether other gel-making agents work the same way, the answer is no, they don’t seem to:
❝Glucomannan induced body weight reduction in healthy overweight subjects, whereas the addition of guar gum and alginate did not seem to cause additional loss of weight❞
Read more: Experiences with three different fiber supplements in weight reduction
How it works for gut health
In the words of Dr. Yu Li et al.,
❝Konjaku flour can achieve positive effects on treating obesity, which manifest on reducing BMI, fat mass, blood glucose, and blood lipid, improving hepatic function, and also regulating intestinal microfloral structure.
Therefore, changes in gut microbiota may explain in part the effects of konjaku flour.❞
Read in full: Effects of Konjaku Flour on the Gut Microbiota of Obese Patients
This has extra positive knock-on effects too:
Want to try some?
We don’t sell it, but here for your convenience are example products on Amazon:
Konjac noodles | Glucomannan capsules
Enjoy!
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