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Pay-by-weight airfares are an ethical minefield. We asked travellers what they actually think

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/denis-tolkach-11345">Denis Tolkach</a>, <a href="https://theconversation.com/institutions/james-cook-university-1167">James Cook University</a> and <a href="https://theconversation.com/profiles/stephen-pratt-335188">Stephen Pratt</a>, <a href="https://theconversation.com/institutions/university-of-central-florida-1925">University of Central Florida</a> Imagine checking in for a flight with your two teenage children. At the counter, you are told that your youngest teenager’s suitcase is two kilograms over the limit. You get slapped with a $75 penalty for their excess luggage. This penalty feels arbitrary and unfair. The youngest weighs about 45 kg, and their luggage weighs 25 kg, making their total payload on the flight 70 kg. Their older sibling, on the other hand, weighs 65 kg, and has brought 23 kg of luggage to check in. Their total weight is higher – 88 kg – yet they receive no penalty. Obviously, things aren’t that simple. Charging passengers based on their weight is highly controversial for many reasons. But that hasn’t stopped some airlines <a href="https://theweek.com/articles/466035/should-airlines-charge-passengers-by-weight">experimenting</a> with such policies. Imagine checking in for your flight only to have the staff tell you to <a href="https://edition.cnn.com/travel/article/plus-size-travelers-slam-airline-seat-policies/index.html">purchase an extra seat</a> as you are a plus-size passenger. You feel discriminated against because you are using the same service as other passengers and your weight is beyond your control. But despite the lived experience of many and hot debate in the media, there has not been a formal study into what passengers themselves think about this matter. Our recently published <a href="https://doi.org/10.1002/jtr.2691">research</a> examined air passengers’ views on alternative airfare policies to understand whether the public finds them acceptable and what ethical considerations determine their views. Though we found a range of ethical contradictions, most travellers were guided by self-interest. <h2>A controversial but important topic</h2> The issue of whether airlines should weigh passengers is an ethical minefield with no easy answers. Despite its sensitivity, the aviation industry can’t ignore passenger weight. Airlines intermittently undertake <a href="https://www.forbes.com/sites/marisagarcia/2024/02/11/despite-backlash-heres-why-airlines-need-to-weigh-passengers/?sh=5f07623e1bfa">passenger weight surveys</a> as they need to accurately calculate payload to ensure flight safety and estimate fuel consumption. The evidence shows passengers are <a href="https://www.forbes.com/sites/marisagarcia/2024/02/11/despite-backlash-heres-why-airlines-need-to-weigh-passengers/?sh=5f07623e1bfa">getting heavier</a>. Airlines including the now-defunct <a href="https://theweek.com/articles/466035/should-airlines-charge-passengers-by-weight">Samoa Air</a> and <a href="https://www.theguardian.com/us-news/2016/oct/23/hawaiian-airlines-american-samoa-weight-passengers">Hawaiian Airlines</a> have taken things one step further and experimented with weighing passengers regularly. Samoa Air, for example, became the first airline to introduce a “pay-as-you-weigh” policy, where the cost of your ticket was directly proportional to the combined weight of you and your luggage. In contrast, Canada has now long had a “<a href="https://otc-cta.gc.ca/eng/publication/additional-seating-and-one-person-one-fare-requirement-domestic-travel-a-guide">one person, one fare</a>” policy. It is prohibited and deemed discriminatory to force passengers living with a disability to purchase a second seat for themselves if they require one, including those with functional disability due to obesity. To complicate matters further, the issue of passenger and luggage weight is not only ethical and financial, but also environmental. More weight on an aircraft leads to more jet fuel being burned and more carbon emissions. About <a href="https://www.nature.com/articles/s41467-021-24091-y">5%</a> of human-driven climate change can be attributed to aviation, and the industry faces enormous pressure to reduce fuel consumption while it waits for low carbon substitutes to become available. <h2>What do passengers actually think?</h2> To get a better sense of how the public actually feels about this issue, we surveyed 1,012 US travellers of different weights, presenting them with three alternatives: <ul> <li>standard policy – currently the most widely used policy with passengers paying a standard price, irrespective of their weight</li> <li>threshold policy – passengers are penalised if they are over a threshold weight</li> <li>unit of body weight policy – passengers pay a personalised price based on their own body weight, per each pound.</li> </ul> The standard policy was the most acceptable for participants of differing weight, although the heavier the passenger, the more they preferred the standard policy. This can be partially explained by status quo bias. Generally, people are likely to choose a familiar answer. The threshold policy was the least acceptable. This policy was seen to violate established social norms and be generally less fair. The unit of body weight policy was preferred to the threshold policy, although participants raised concerns about whether it would be accepted by society. Perhaps unsurprisingly, we found that self-interest played a clear role in determining whether respondents considered a policy acceptable. Younger, male, financially well-off travellers with lower personal weight generally found the alternative policies more acceptable. <h2>An ethical conflict</h2> Alternative airfare policies that are based on passenger weight bring environmental and ethical concerns into conflict. Obviously, the effect isn’t from any one traveller, in particular, but averages over the entire industry. Interestingly, respondents that were more concerned about the environment – “ecocentric” – preferred air fare policies that would reduce the carbon emissions. This made them more open to the controversial alternatives. While the threshold policy was clearly rejected by many respondents as discriminatory, environmental concern played a role in the level of acceptance of the unit of body weight policy. It’s important to apply a critical lens here. These ecocentric travellers were also generally younger and had lower personal weights, so many would benefit from the alternative policies financially. For policymakers overall, our study suggests when it comes to controversial ticketing policies, the public is more likely to be swayed by self-interest than anything else.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/237856/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/denis-tolkach-11345">Denis Tolkach</a>, Senior Lecturer, <a href="https://theconversation.com/institutions/james-cook-university-1167">James Cook University</a> and <a href="https://theconversation.com/profiles/stephen-pratt-335188">Stephen Pratt</a>, Professor, <a href="https://theconversation.com/institutions/university-of-central-florida-1925">University of Central Florida</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/pay-by-weight-airfares-are-an-ethical-minefield-we-asked-travellers-what-they-actually-think-237856">original article</a>. </div>

Travel Trouble

Aussies top global list for biggest gambling losses

A new report has revealed that Australians are the biggest gambling losers in the world, with the average Australian adult gambling away $1635 per year according to the Grattan Institute think tank. That is more than most households pay for power and exceeds the average spend in similar countries like the US and New Zealand. Collectively, Australians lost $24 billion to gambling in 2020-21, with half of that amount lost through poker machines. The rest was lost on sports or race betting, in casinos, and on lotteries and Keno. The report also claims that there are more pokies than post boxes and public toilets across Australia, bringing light to the "lax approach" that has let the industry "run wild". "Gambling products are designed to be addictive, and the consequences can be catastrophic: job loss, bankruptcy, relationship breakdown, family violence, even suicide," the report's authors wrote. People in the Northern Territory and NSW lost the most amount of money, with the two states having the highest concentration of polies in their jurisdiction. The report recommended the federal government ban all gambling advertisements and urged them to cut the number of pokies in each state over time. They also suggested a mandatory pre-commitment system for online gambling and pokies, which would put a limit on daily losses. There are many different ways to get help and information about gambling. Call the National Gambling Helpline on 1800 858 858; use <a href="https://www.gamblinghelponline.org.au/tools-resources/chat-counselling" target="_blank" rel="noopener">online counselling</a>. Images: SNEHIT PHOTO / Shutterstock.com

Money & Banking

Considering taking Wegovy to lose weight? Here are the risks and benefits – and how it differs from Ozempic

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> The weight-loss drug <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2022-PI-01930-1&d=20240731172310101&d=20240827172310101">Wegovy</a> is now <a href="https://www.tga.gov.au/safety/shortages/medicine-shortage-alerts/new-semaglutide-product-becomes-available">available</a> in Australia. Wegovy is administered as a once-weekly injection and is approved specifically for weight management. It’s intended to be used <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2022-PI-01930-1&d=20240731172310101">in combination</a> with a reduced-energy diet and increased physical activity. So how does Wegovy work and how much weight can you expect to lose while taking it? And what are the potential risks – and costs – for those who use it? Let’s look at what the science says. <h2>What is Wegovy?</h2> Wegovy is a brand name for the medication semaglutide. Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called GLP-1 for short, work better. Normally when you eat, the body releases the GLP-1 hormone which helps signal to your brain that you are full. Semaglutides enhance this effect, leading to a feeling of fullness, even when you haven’t eaten. Another role of GLP-1 is to stimulate the body to produce more insulin, a hormone which helps lower the level of glucose (sugar) in the blood. That’s why semaglutides have been used for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6231279/">several years</a> to treat type 2 diabetes. <h2>How does Wegovy differ from Ozempic?</h2> Like Wegovy, Ozempic is a semaglutide. The way Wegovy and Ozempic work in the body are essentially the same. They’re made by the same pharmaceutical company, Novo Nordisk. But there are two differences: 1) They are approved for two different (but related) reasons. In Australia (and the United States), Ozempic is <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/ozempic-novo-nordisk-pharmaceuticals-pty-ltd">approved for use</a> to improve blood glucose levels in adults with type 2 diabetes. By managing blood glucose levels effectively, the medication aims to reduce the risk of major complications, such as heart disease. Wegovy is <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2022-PI-01930-1&d=20240731172310101">approved for use</a> alongside diet and exercise for people with a body mass index (BMI) of 30 or greater, or 27 or greater but with other conditions such as high blood pressure. Wegovy can also be used in people aged 12 years and older. Like Ozempic, Wegovy aims to reduce the risk of future health complications, including heart disease. 2) They are both injected but come in different strengths. Ozempic is available in pre-loaded single-dose pens with varying dosages of 0.25 mg, 0.5 mg, 1 mg, or 2 mg per injection. The dose can be slowly increased, up to a maximum of 2 mg per week, if needed. Wegovy is available in prefilled single-dose pens with doses of 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, or 2.4 mg. The treatment starts with a dose of 0.25 mg once weekly for four weeks, after which the dose is gradually increased until reaching a maintenance dose of 2.4 mg weekly. While it’s unknown what the impact of Wegovy’s introduction will be on Ozempic’s availability, Ozempic is still <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-2024">anticipated to be in low supply</a> for the remainder of 2024. <h2>Is Wegovy effective for weight loss?</h2> Given Wegovy is a semaglutide, there is <a href="https://www.cochranelibrary.com/central/doi/10.1002/central/CN-02495006/full">very strong evidence</a> it can help people lose weight and maintain this weight loss. A recent <a href="https://www.nature.com/articles/s41591-024-02996-7">study</a> found that over four years, participants taking Wevovy as indicated experienced an average weight loss of 10.2% body weight and a reduction in waist circumference of 7.7cm. For those who stop taking the medication, analyses have shown that about two-thirds of weight lost is <a href="https://pubmed.ncbi.nlm.nih.gov/35441470/">regained</a>. <h2>What are the side effects of Wegovy?</h2> The most common <a href="https://www.wegovy.com/dashboard/my-library/week-02-tips-for-managing-common-side-effects.html">side effects</a> are nausea and vomiting. However, other serious side effects are also possible because of the whole-of-body impact of the medication. Thyroid tumours and cancer have been detected as a risk in animal studies, yet are rarely seen in human <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11050669/">scientific literature</a>. In the four-year Wegovy <a href="https://www.nejm.org/doi/10.1056/NEJMoa2307563">trial</a>, 16.6% of participants who received Wegovy (1,461 people) experienced an adverse event that led to them permanently discontinuing their use of the medication. This was higher than the 8.2% of participants (718 people) who received the placebo (with no active ingredient). Side effects included gastrointestinal disorders (including nausea and vomiting), which affected 10% of people who used Wegovy compared to 2% of people who used the placebo. Gallbladder-related disorders occurred in 2.8% of people who used Wegovy, and 2.3% of people who received the placebo. Recently, concerns about suicidal thoughts and behaviours have been raised, after a <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2822453">global analysis</a> reviewed more than 36 million reports of adverse events from semaglutide (Ozempic or Wegovy) since 2000. There were 107 reports of suicidal thoughts and self-harm among people taking semaglutide, sadly including six actual deaths. When people stopped the medication, 62.5% found the thoughts went away. What we don’t know is whether dose, weight loss, or previous mental health status or use of antidepressants had a role to play. Finally, concerns are growing about the negative effect of semaglutides on our social and emotional connection with food. <a href="https://www.theguardian.com/food/2022/nov/09/i-miss-eating-weight-loss-drug-ozempic-food-repulsive">Anecdotal</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839771/">scientific</a> evidence suggests people who use semaglutides significantly reduce their daily dietary intake (as anticipated) by skipping meals and avoiding social occasions – not very enjoyable for people and their loved ones. <h2>How can people access Wegovy?</h2> Wegovy is available for purchase at pharmacists with a prescription from a doctor. But there is a hefty price tag. Wegovy is <a href="https://www.diabetesaustralia.com.au/news/wegovy-to-be-available-in-australia/">not currently subsidised</a> through the Pharmaceutical Benefits Scheme, leaving patients to cover the cost. The current cost is <a href="https://www1.racgp.org.au/newsgp/clinical/wegovy-launches-in-australia#:%7E:text=Novo%20Nordisk%20told%20newsGP%20the,each%20dose%20lasting%20one%20month.">estimated at around A$460</a> per month dose. If you’re considering Wegovy, <a href="https://www1.racgp.org.au/newsgp/clinical/wegovy-launches-in-australia#:%7E:text=The%20manufacturer%20assured%20GPs%20supply,cost%20to%20customers%20than%20Ozempic.">make an appointment</a> with your doctor for individual advice.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/237308/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, Professor of Community Health and Wellbeing, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, Accredited Practising Dietitian and Lecturer, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/considering-taking-wegovy-to-lose-weight-here-are-the-risks-and-benefits-and-how-it-differs-from-ozempic-237308">original article</a>. </div>

Body

Jelena Dokic's candid admission on weight loss

Jelena Dokic has opened up on her 20kg weight loss and her previous struggles with depression and an eating disorder. The former tennis player took to Instagram on Sunday to share before and after shots from her weight loss, taken seven years apart, and her past battles with self-worth. She explained to her followers that her current weight loss was a result of her prioritising her mental health. "This is not about body size but feeling that I am not worthy enough to even live!!! On the left 7 years ago," she said. "Even though I have a bit less weight now on the right, this is not about weight. Because even if I was half the size on the left, I would still feel the same. And how is that? Not worthy enough to even live!!" She explained that in the first photo she was afraid to leave the house and was "broken" from her battle with depression and PTSD. "My face, body language and even clothing on the left says it all. This is how low my self worth was. I was afraid to get out of the house," she shared. "I was not able to look people in the eye, I just wanted to wear black or dark grey and cover myself up. I even remember wishing to somehow fully cover my face and head and could I possibly not even need to go out of the house for the rest of my life." "This was anxiety, depression, debilitating effect of trauma that made me feel I was worthless and not even worthy of living. "This was the result of being put down my whole life especially by people close to me." "The person on the left was broken, shattered, battling anxiety, depression, PTSD, BPD and an eating disorder. At times I hoped I wouldn't wake up so that I don't have to feel like this anymore," she continued. She then explained that she wasn't asking for pity as she didn't want to victimise herself. "I wanted to survive and thrive and I got there." She then shared a few motivating words on courage and resilience, saying: "Fight hard. Every single day, don't give up and no matter how scary it is get outside of your comfort zone. It will get easier and more comfortable to do so." "Keep going after it even when it's scary. Be brave and never give up. The way to start feeling good in your own skin and life is to be who you really are and embrace and love yourself." "Don't be afraid of mistakes and failures, they make you learn and as long as you get back up, that's all that matters." "Don't you ever give up on yourself and your goals. Don't ever be defined by someone else's judgement and comments." She encouraged her followers to stay true to themselves and remember their self-worth. "Be yourself. Being authentic, real and vulnerable is the way to being happy and thriving. You are worthy and never allow anyone to tell you otherwise." Images: Instagram

Body

New study links Ozempic and Wegovy to suicidal thoughts

A new study has found a link between weight reduction drugs and reports of suicidal thoughts. Semaglutide, the drug sold under the brand names Ozempic and Wegovy, has been widely used for weight loss despite only being approved for the treatment of diabetes. An analysis of data on the adverse drug reactions database of the World Health Organisation found a disproportionate number of people reporting suicidal thoughts while using semaglutide. The research published in JAMA Network also found that the effect was "significant" compared to other diabetes medication, and that people with anxiety and depression were more likely to report suicidal thoughts when taking the drug. The researches have called for "urgent clarification" and larger studies around how semaglutide medications impact the brain. "The study raises key questions about whether additional precautions are needed when prescribing semaglutide," Trevor Steward, a neurobiology researcher from the University of Melbourne said. However, there are a few limitations with the study as there were a lack of information about the dosages, and did not adjust for things like alcohol and substance misuse and off-label use. While the study did not find a direct cause between suicidal thoughts and the use of semaglutide, it is important to raise concerns, especially for those who may want to use these drugs based on information they found on social media, and therefore do not fully understand the risks. The use of semaglutide for weight loss in Australia is considered 'off label', meaning that it has been prescribed for purposes outside of its approved use. The Therapeutic Goods Administration (TGA) believes that these prescriptions have been driving shortages, which they are trying to address and believe will last until 2025. Images: Shutterstock

Caring

Strength training has a range of benefits for women. Here are 4 ways to get into weights

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/erin-kelly-1497598">Erin Kelly</a>, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Picture a gym ten years ago: the weights room was largely a male-dominated space, with women mostly doing cardio exercise. Fast-forward to today and you’re likely to see women of all ages and backgrounds confidently navigating weights equipment. This is more than just anecdotal. According to data from the <a href="https://app.powerbi.com/view?r=eyJrIjoiZGU1YWFhZDgtMmRhZi00YTgyLThhMzItYjc2ODk5NTg0MTg1IiwidCI6IjhkMmUwZjRjLTU1ZjItNGNiMS04ZWU3LWRhNWRkM2ZmMzYwMCJ9">Australian Sports Commission</a>, the number of women <a href="https://www.clearinghouseforsport.gov.au/research/ausplay/results#portal">participating in weightlifting</a> (either competitively or not) grew nearly five-fold between 2016 and 2022. Women are discovering what research has long shown: strength training offers benefits beyond sculpted muscles. <h2>Health benefits</h2> <a href="https://www.womenshealth.gov/a-z-topics/osteoporosis">Osteoporosis</a>, a disease in which the bones become weak and brittle, affects more women than men. Strength training increases <a href="https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/strength-training/art-20046670">bone density</a>, a crucial factor for <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-8-47">preventing osteoporosis</a>, especially for women negotiating menopause. Strength training also improves <a href="http://link.springer.com/10.1007/s40279-015-0379-7">insulin sensitivity</a>, which means your body gets better at using insulin to manage blood sugar levels, reducing the risk of type 2 diabetes. Regular strength training contributes to better <a href="https://doi.org/10.1139/apnm-2020-0245">heart health</a> too. There’s a mental health boost as well. Strength training has been linked to reduced symptoms of <a href="https://doi.org/10.1001/jamapsychiatry.2018.0572">depression</a> and <a href="http://link.springer.com/10.1007/s40279-017-0769-0">anxiety</a>. <h2>Improved confidence and body image</h2> Unlike some forms of exercise where progress can feel elusive, strength training offers clear and tangible measures of success. Each time you add more weight to a bar, you are reminded of your ability to meet your goals and <a href="https://www.tandfonline.com/doi/full/10.1080/2159676X.2019.1634127">conquer challenges</a>. This sense of achievement doesn’t just stay in the gym – it can change how women see themselves. A <a href="https://linkinghub.elsevier.com/retrieve/pii/S1755296623000194">recent study</a> found women who regularly lift weights often feel more empowered to make positive changes in their lives and feel ready to face life’s challenges outside the gym. Strength training also has the potential to positively impact <a href="https://journals.lww.com/nsca-jscr/abstract/2002/11000/Relations_of_Strength_Training_to_Body_Image_Among.25.aspx">body image</a>. In a world where women are often judged on appearance, lifting weights can shift the focus <a href="http://journals.sagepub.com/doi/10.1177/0193732502238256">to function</a>. Instead of worrying about the number on the scale or fitting into a certain dress size, women often come to appreciate their bodies for what they can do. “Am I lifting more than I could last month?” and “can I carry all my groceries in a single trip?” may become new measures of physical success. Lifting weights can also be about challenging outdated ideas of how women “should” be. Qualitative <a href="https://journals.humankinetics.com/view/journals/wspaj/aop/article-10.1123-wspaj.2022-0088/article-10.1123-wspaj.2022-0088.xml">research</a> I conducted with colleagues found that, for many women, strength training becomes a powerful form of rebellion against unrealistic beauty standards. As one participant told us: <blockquote> I wanted something that would allow me to train that just didn’t have anything to do with how I looked. </blockquote> Society has long told women to be small, quiet and not take up space. But when a woman steps up to a barbell, she’s pushing back against these outdated rules. One woman in our study said: <blockquote> We don’t have to […] look a certain way, or […] be scared that we can lift heavier weights than some men. Why should we? </blockquote> This shift in mindset helps women see themselves differently. Instead of worrying about being objects for others to look at, they begin to see their bodies as capable and strong. Another participant explained: <blockquote> Powerlifting changed my life. It made me see myself, or my body. My body wasn’t my value, it was the vehicle that I was in to execute whatever it was that I was executing in life. </blockquote> This newfound confidence often spills over into other areas of life. As one woman said: <blockquote> I love being a strong woman. It’s like going against the grain, and it empowers me. When I’m physically strong, everything in the world seems lighter. </blockquote> <h2>Feeling inspired? Here’s how to get started</h2> 1. Take things slow Begin with bodyweight exercises like squats, lunges and push-ups to build a foundation of strength. Once you’re comfortable, add external weights, but keep them light at first. Focus on mastering <a href="https://theconversation.com/what-are-compound-exercises-and-why-are-they-good-for-you-228385">compound movements</a>, such as deadlifts, squats and overhead presses. These exercises engage multiple joints and muscle groups simultaneously, making your workouts more efficient. 2. Prioritise proper form Always prioritise proper form over lifting heavier weights. Poor technique can lead to injuries, so learning the correct way to perform each exercise is crucial. To help with this, consider working with an exercise professional who can provide personalised guidance and ensure you’re performing exercises correctly, at least initially. 3. Consistency is key Like any fitness regimen, consistency is key. Two to three sessions a week are plenty for most women to see benefits. And don’t be afraid to occupy space in the weights room – remember you belong there just as much as anyone else. 4. Find a community Finally, join a community. There’s nothing like being surrounded by a group of strong women to inspire and motivate you. Engaging with a supportive community can make your strength-training journey more enjoyable and rewarding, whether it’s an in-person class or an online forum. <h2>Are there any downsides?</h2> Gym memberships can be expensive, especially for specialist weightlifting gyms. Home equipment is an option, but quality barbells and weightlifting equipment can come with a hefty price tag. Also, for women juggling work and family responsibilities, finding time to get to the gym two to three times per week can be challenging. If you’re concerned about getting too “bulky”, it’s very difficult for <a href="https://journals.sagepub.com/doi/epub/10.1177/0031512520967610">women</a> to bulk up like male bodybuilders without pharmaceutical assistance. The main risks come from poor technique or trying to lift too much too soon – issues that can be easily avoided with some guidance.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221307/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/erin-kelly-1497598">Erin Kelly</a>, Lecturer and PhD Candidate, Discipline of Sport and Exercise Science, <a href="https://theconversation.com/institutions/university-of-canberra-865">University of Canberra</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/strength-training-has-a-range-of-benefits-for-women-here-are-4-ways-to-get-into-weights-221307">original article</a>. </div>

Body

3 signs your diet is causing too much muscle loss – and what to do about it

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/nick-fuller-219993">Nick Fuller</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> When trying to lose weight, it’s natural to want to see quick results. So when the number on the scales drops rapidly, it seems like we’re on the right track. But as with many things related to weight loss, there’s a flip side: rapid weight loss can result in a significant loss of muscle mass, as well as fat. So how you can tell if you’re losing too much muscle and what can you do to prevent it? <h2>Why does muscle mass matter?</h2> Muscle is an important factor in determining our metabolic rate: how much energy we burn at rest. This is determined by how much muscle and fat we have. Muscle is more metabolically active than fat, meaning it burns more calories. When we diet to lose weight, we create a calorie deficit, where our bodies don’t get enough energy from the food we eat to meet our energy needs. Our bodies start breaking down our fat and muscle tissue for fuel. A decrease in calorie-burning muscle mass slows our metabolism. This quickly slows the rate at which we lose weight and impacts our ability to maintain our weight long term. <h2>How to tell you’re losing too much muscle</h2> Unfortunately, measuring changes in muscle mass is not easy. The most accurate tool is an enhanced form of X-ray called a dual-energy X-ray absorptiometry (DXA) scan. The scan is primarily used in medicine and research to capture data on weight, body fat, muscle mass and bone density. But while DEXA is becoming more readily available at weight-loss clinics and gyms, it’s not cheap. There are also many “smart” scales available for at home use that promise to provide an accurate reading of muscle mass percentage. However, the accuracy of these scales is questionable. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122302/">Researchers found</a> the scales tested massively over- or under-estimated fat and muscle mass. Fortunately, there are three free but scientifically backed signs you may be losing too much muscle mass when you’re dieting. <h2>1. You’re losing much more weight than expected each week</h2> Losing a lot of weight rapidly is one of the early signs that your diet is too extreme and you’re losing too much muscle. Rapid weight loss (of more than 1 kilogram per week) results in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702468/">greater muscle mass loss</a> than slow weight loss. Slow weight loss better preserves muscle mass and often has the added benefit of <a href="https://www.sciencedirect.com/science/article/pii/S0195666312000153">greater fat mass loss</a>. One study compared people in the obese weight category who followed either a very low-calorie diet (500 calories per day) for five weeks or a low-calorie diet (1,250 calories per day) for 12 weeks. While both groups lost similar amounts of weight, participants following the very low-calorie diet (500 calories per day) for five weeks lost <a href="https://pubmed.ncbi.nlm.nih.gov/26813524/">significantly more muscle mass</a>. <h2>2. You’re feeling tired and things feel more difficult</h2> It sounds obvious, but feeling tired, sluggish and finding it hard to complete physical activities, such as working out or doing jobs around the house, is another strong signal you’re losing muscle. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648712/">Research</a> shows a decrease in muscle mass may negatively impact your body’s physical performance. <h2>3. You’re feeling moody</h2> Mood swings and feeling anxious, stressed or depressed may also be signs you’re losing muscle mass. <a href="https://pubmed.ncbi.nlm.nih.gov/26228522/">Research</a> on muscle loss due to ageing suggests low levels of muscle mass can negatively impact mental health and mood. This seems to stem from the relationship between low muscle mass and proteins called neurotrophins, which help regulate mood and feelings of wellbeing. <h2>So how you can do to maintain muscle during weight loss?</h2> Fortunately, there are also three actions you can take to maintain muscle mass when you’re following a calorie-restricted diet to lose weight. <h2>1. Incorporate strength training into your exercise plan</h2> While a broad exercise program is important to support overall weight loss, strength-building exercises are a surefire way to help prevent the loss of muscle mass. A <a href="https://pubmed.ncbi.nlm.nih.gov/29596307/">meta-analysis of studies</a> of older people with obesity found resistance training was able to prevent almost 100% of muscle loss from calorie restriction. Relying on diet alone to lose weight will reduce muscle along with body fat, slowing your metabolism. So it’s essential to make sure you’ve incorporated sufficient and appropriate exercise into your weight-loss plan to hold onto your muscle mass stores. But you don’t need to hit the gym. Exercises using body weight – such as push-ups, pull-ups, planks and air squats – are just as effective as lifting weights and using strength-building equipment. Encouragingly, moderate-volume resistance training (three sets of ten repetitions for eight exercises) <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/sms.14237">can be as effective</a> as high-volume training (five sets of ten repetitions for eight exercises) for maintaining muscle when you’re following a calorie-restricted diet. <h2>2. Eat more protein</h2> Foods high in protein play an essential role in building and maintaining muscle mass, but <a href="https://europepmc.org/article/MED/19927027">research</a> also shows these foods help prevent muscle loss when you’re following a calorie-restricted diet. But this doesn’t mean just eating foods with protein. Meals need to be balanced and include a source of protein, wholegrain carb and healthy fat to meet our dietary needs. For example, eggs on wholegrain toast with avocado. <h2>3. Slow your weight loss plan down</h2> When we change our diet to lose weight, we take our body out of its comfort zone and trigger its survival response. It then counteracts weight loss, triggering <a href="https://pubmed.ncbi.nlm.nih.gov/25896063/">several physiological responses</a> to defend our body weight and “survive” starvation. Our body’s survival mechanisms want us to regain lost weight to ensure we survive the next period of famine (dieting). <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/">Research</a> shows that more than half of the weight lost by participants is regained within two years, and more than 80% of lost weight is regained within five years. However, a slow and steady, stepped approach to weight loss, prevents our bodies <a href="https://pubmed.ncbi.nlm.nih.gov/38193357/">from activating defence mechanisms</a> to defend our weight when we try to lose weight. Ultimately, losing weight long-term comes down to making gradual changes to your lifestyle to ensure you form habits that last a lifetime. <hr /> At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223865/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nick-fuller-219993">Nick Fuller</a>, Charles Perkins Centre Research Program Leader, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/3-signs-your-diet-is-causing-too-much-muscle-loss-and-what-to-do-about-it-223865">original article</a>. </div>

Body

‘I keep away from people’ – combined vision and hearing loss is isolating more and more older Australians

<a href="https://theconversation.com/profiles/moira-dunsmore-295190">Moira Dunsmore</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/annmaree-watharow-1540942">Annmaree Watharow</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/emily-kecman-429210">Emily Kecman</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Our <a href="https://www.who.int/news-room/fact-sheets/detail/ageing-and-health">ageing population</a> brings a growing crisis: people over 65 are at greater risk of dual sensory impairment (also known as “deafblindness” or combined vision and hearing loss). Some 66% of people over 60 have hearing loss and 33% of older Australians have low vision. Estimates suggest more than a quarter of Australians over 80 are <a href="https://www.senseswa.com.au/wp-content/uploads/2016/01/a-clear-view---senses-australia.pdf">living with dual sensory impairment</a>. Combined vision and hearing loss <a href="https://doi.org/10.1177/0264619613490519">describes</a> any degree of sight and hearing loss, so neither sense can compensate for the other. Dual sensory impairment can occur at any point in life but is <a href="https://doi.org/10.1016/j.annepidem.2012.02.004">increasingly common</a> as people get older. The experience can make older people feel isolated and unable to participate in important conversations, including about their health. <h2>Causes and conditions</h2> Conditions related to hearing and vision impairment often <a href="https://theconversation.com/why-we-lose-our-hearing-and-vision-as-we-age-67930">increase as we age</a> – but many of these changes are subtle. Hearing loss can start <a href="https://www.who.int/teams/noncommunicable-diseases/sensory-functions-disability-and-rehabilitation/highlighting-priorities-for-ear-and-hearing-care">as early as our 50s</a> and often accompany other age-related visual changes, such as <a href="https://www.mdfoundation.com.au/">age-related macular degeneration</a>. Other age-related conditions are frequently prioritised by patients, doctors or carers, such as <a href="https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-disease/overview">diabetes or heart disease</a>. Vision and hearing changes can be easy to overlook or accept as a normal aspect of ageing. As an older person we interviewed for our <a href="https://hdl.handle.net/2123/29262">research</a> told us <blockquote> I don’t see too good or hear too well. It’s just part of old age. </blockquote> <h2>An invisible disability</h2> Dual sensory impairment has a significant and negative impact in all aspects of a person’s life. It reduces access to information, mobility and orientation, impacts <a href="https://doi.org/10.1080/09638280210129162">social activities and communication</a>, making it difficult for older adults to manage. It is underdiagnosed, underrecognised and sometimes misattributed (for example, to <a href="https://doi.org/10.1093/geronb/gbz043">cognitive impairment or decline</a>). However, there is also growing evidence of links between <a href="https://doi.org/10.1002/dad2.12054">dementia and dual sensory loss</a>. If left untreated or without appropriate support, dual sensory impairment diminishes the capacity of older people to live independently, <a href="https://doi.org/10.1002/dad2.12054">feel happy and be safe</a>. A dearth of specific resources to educate and support older Australians with their dual sensory impairment means when older people do raise the issue, their GP or health professional may not understand its significance or where to refer them. One older person told us: <blockquote> There’s another thing too about the GP, the sort of mentality ‘well what do you expect? You’re 95.’ Hearing and vision loss in old age is not seen as a disability, it’s seen as something else. </blockquote> <h2>Isolated yet more dependent on others</h2> Global trends show a worrying conundrum. Older people with dual sensory impairment become <a href="https://doi.org/10.1002/dad2.12054">more socially isolated</a>, which impacts their mental health and wellbeing. At the same time they can become increasingly dependent on other people to help them navigate and manage day-to-day activities with limited sight and hearing. One aspect of this is how effectively they can <a href="https://doi.org/10.1001/jamanetworkopen.2020.25522">comprehend and communicate in a health-care setting</a>. Recent research shows <a href="http://dx.doi.org/10.3390/healthcare12080852">doctors and nurses in hospitals</a> aren’t making themselves understood to most of their patients with dual sensory impairment. Good communication in the health context is about more than just “knowing what is going on”, <a href="https://www.mdpi.com/2227-9032/12/8/852">researchers note</a>. It facilitates: <ul> <li>shorter hospital stays</li> <li>fewer re-admissions</li> <li>reduced emergency room visits</li> <li>better treatment adherence and medical follow up</li> <li>less unnecessary diagnostic testing</li> <li>improved health-care outcomes.</li> </ul> <h2>‘Too hard’</h2> Globally, there is a better understanding of how important it is to <a href="https://www.who.int/publications/i/item/9789240030749">maintain active social lives</a> as people age. But this is difficult for older adults with dual sensory loss. One person told us <blockquote> I don’t particularly want to mix with people. Too hard, because they can’t understand. I can no longer now walk into that room, see nothing, find my seat and not recognise [or hear] people. </blockquote> Again, these experiences increase reliance on family. But caring in this context is tough and largely <a href="https://doi.org/10.3389/feduc.2020.572201">hidden</a>. Family members describe being the “eyes and ears” for their loved one. It’s a 24/7 role which can bring <a href="https://doi.org/10.1159/000507856">frustration, social isolation and depression</a> for carers too. One spouse told us: <blockquote> He doesn’t talk anymore much, because he doesn’t know whether [people are] talking to him, unless they use his name, he’s unaware they’re speaking to him, so he might ignore people and so on. And in the end, I noticed people weren’t even bothering him to talk, so now I refuse to go. Because I don’t think it’s fair. </blockquote> So, what can we do? Dual sensory impairment is a growing problem with potentially devastating impacts. It should be considered a unique and distinct disability in all relevant protections and policies. This includes the right to dedicated diagnosis and support, accessibility provisions and specialised skill development for health and social professionals and carers. We need to develop resources to help people with dual sensory impairment and their families and carers understand the condition, what it means and how everyone can be supported. This could include communication adaptation, such as social haptics (communicating using touch) and specialised support for older adults to <a href="https://www.tandfonline.com/doi/full/10.1080/09649069.2019.1627088">navigate health care</a>. Increasing awareness and understanding of dual sensory impairment will also help those impacted with everyday engagement with the world around them – rather than the isolation many feel now.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/232142/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/moira-dunsmore-295190">Moira Dunsmore</a>, Senior Lecturer, Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/annmaree-watharow-1540942">Annmaree Watharow</a>, Lived Experience Research Fellow, Centre for Disability Research and Policy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/emily-kecman-429210">Emily Kecman</a>, Postdoctoral research fellow, Department of Linguistics, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/i-keep-away-from-people-combined-vision-and-hearing-loss-is-isolating-more-and-more-older-australians-232142">original article</a>.

Body

How often should you really weigh yourself?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/nick-fuller-219993">Nick Fuller</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Few topics are more debated in health than the value of the humble bathroom scale. Some experts advocate daily self-weigh-ins to promote accountability for weight management, particularly when we’re following a diet and exercise program to lose weight. Others suggest ditching self-weigh-ins altogether, arguing they can trigger negative <a href="https://link.springer.com/article/10.1007/s13679-015-0142-2">psychological responses and unhealthy behaviours</a> when we don’t like, or understand, the number we see on the scale. Many, like me, recommend using scales to weigh yourself weekly, even when we’re not trying to lose weight. Here’s why. <h2>1. Weighing weekly helps you manage your weight</h2> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588640/?tool=pmcentrez&report=abstract">Research</a> confirms regular self-weighing is an effective weight loss and management strategy, primarily because it helps increase awareness of our current weight and any changes. A <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588640/?tool=pmcentrez&report=abstract">systematic review of 12 studies</a> found participants who weighed themselves weekly or daily over several months lost 1–3 BMI (body mass index) units more and regained less weight than participants who didn’t weight themselves frequently. The weight-loss benefit was evident with weekly weighing; there was no added benefit with daily weighing. Self-weigh-ins are an essential tool for weight management as we age. Adults <a href="https://pubmed.ncbi.nlm.nih.gov/23638485/">tend to gain weight</a> progressively <a href="https://pubmed.ncbi.nlm.nih.gov/8363190/">through middle age</a>. While the average weight gain is typically between <a href="https://www.sciencedirect.com/science/article/abs/pii/S0031938414001528">0.5–1kg per year</a>, this modest accumulation of weight can lead to obesity over time. Weekly weighing and keeping track of the results helps avoid unnecessary weight gain. Tracking our weight can also help identify medical issues early. Dramatic changes in weight can be an early sign of some conditions, including problems with our thyroid, digestion and diabetes. <h2>2. Weekly weighing accounts for normal fluctuations</h2> Our body weight can fluctuate within a single day and across the days of the week. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7192384/">Studies</a> show body weight fluctuates by 0.35% within the week and it’s typically higher after the weekend. Daily and day-to-day body weight fluctuations have several causes, many linked to our body’s water content. The more common causes include: The type of food we’ve consumed When we’ve eaten a dinner higher in carbohydrates, we’ll weigh more the next day. This change is a result of our bodies temporarily carrying more water. We <a href="https://pubmed.ncbi.nlm.nih.gov/25911631/">retain 3–4 grams of water</a> per gram of carbohydrate consumed to store the energy we take from carbs. Our water content also increases when we consume <a href="https://www.ncbi.nlm.nih.gov/books/NBK50952/">foods higher in salt</a>. Our bodies try to maintain a balance of sodium and water. When the concentration of salt in our bloodstream increases, a mechanism is triggered to restore balance by retaining water to dilute the excess salt. Our food intake Whether it’s 30 grams of nuts or 65 grams of lean meat, everything we eat and drink has weight, which increases our body weight temporarily while we digest and metabolise what we’ve consumed. Our weight also tends to be lower first thing in the morning after our food intake has been restricted overnight and higher in the evening after our daily intake of food and drinks. Exercise If we weigh ourselves at the gym after a workout, there’s a good chance we’ll weigh less due to sweat-induced fluid loss. The amount of water lost varies depending on things like our workout intensity and duration, the temperature and humidity, along with our sweat rate and hydration level. On average, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4993146/">we lose 1 litre of sweat</a> during an hour of <a href="https://link.springer.com/article/10.1007/BF00421168">moderate-intensity exercise</a>. Hormonal changes <a href="https://theconversation.com/from-energy-levels-to-metabolism-understanding-your-menstrual-cycle-can-be-key-to-achieving-exercise-goals-131561">Fluctuations in hormones</a> within your menstrual cycle can also affect fluid balance. Women may experience <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154522/">fluid retention</a> and temporarily gain 0.5–2kg of weight at this time. Specifically, the luteal phase, which represents the second half of a woman’s cycle, results in a shift of fluid from your blood plasma to your cells, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154522/">bloating</a>. Bowel movements Going to the bathroom can lead to small but immediate weight loss as waste is eliminated from the body. While the amount lost will vary, we generally eliminate <a href="https://pubmed.ncbi.nlm.nih.gov/1333426/">around 100 grams of weight</a> through our daily bowel movements. All of these fluctuations are normal, and they’re not indicative of significant changes in our body fat or muscle mass. However, seeing these fluctuations can lead to unnecessary stress and a fixation with our weight. <h2>3. Weekly weighing avoids scale obsession and weight-loss sabotage</h2> Weighing too frequently can create an obsession with the number on the scales and do more harm than good. Often, our reaction when we see this number not moving in the direction we want or expect is to further restrict our food intake or embark on fad dieting. Along with not being enjoyable or sustainable, fad diets also ultimately increase our weight gain rather than reversing it. This was confirmed in a <a href="https://pubmed.ncbi.nlm.nih.gov/21829159/">long-term study</a> comparing intentional weight loss among more than 4,000 twins. The researchers found the likelihood of becoming overweight by the age of 25 was significantly greater for a twin who dieted to lose 5kg or more. This suggests frequent dieting makes us more susceptible to weight gain and prone to future weight gain. <h2>So what should you do?</h2> Weighing ourselves weekly gives a more accurate measure of our weight trends over time. Aim to weigh yourself on the same day, at the same time and in the same environment each week – for example, first thing every Friday morning when you’re getting ready to take a shower, after you’ve gone to the bathroom, but before you’ve drunk or eaten anything. Use the best quality scales you can afford. Change the batteries regularly and check their accuracy by using a “known” weight – for example, a 10kg weight plate. Place the “known” weight on the scale and check the measurement aligns with the “known” weight. Remember, the number on the scale is just one part of health and weight management. Focusing solely on it can overshadow other indicators, such as <a href="https://theconversation.com/can-you-be-overweight-and-healthy-182219">how your clothes fit</a>. It’s also essential to pay equal attention to how we’re feeling, physically and emotionally. Stop weighing yourself – at any time interval – if it’s triggering anxiety or stress, and get in touch with a health-care professional to discuss this. <hr /> At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/223864/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nick-fuller-219993">Nick Fuller</a>, Charles Perkins Centre Research Program Leader, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-often-should-you-really-weigh-yourself-223864">original article</a>. </div>

Body

"A true fighter": Tragic loss to Australian media

Trailblazing journalist and editor Judith Whelan has passed away at the age of 63. The ABC confirmed Whelan's death, saying she died on Wednesday after a long battle with cancer. ABC managing director David Anderson was among the first to pay tribute to the “loved and respected” Whelan, confirming her death. “We have lost a great friend and journalism has lost a true fighter,” <a href="https://www.abc.net.au/about/media-centre/statements-and-responses/judith-whelan-announcement/104027286?utm_content=link&utm_medium=content_shared" target="_blank" rel="noopener">he said in a statement</a> released by the public broadcaster. “Judith always had the instincts that made her such a formidable journalist. She carried with her a commitment to truth and accountability and instilled these values in those who worked with her." “A valued mentor to younger journalists, Judith nurtured while leading by example. Judith was tough but caring and wanted those around her to succeed. Young reporters knew Judith would champion their work if the story needed to be told.” Sydney Morning Herald editor Bevan Shields said Whelan will always remain a beloved part of their team. “Judith was a wonderful editor, colleague and friend. She was at the Herald for more than three decades and remains part of our DNA. We are heartbroken by her death,” he told the Herald. “She had a finely tuned news radar but also revelled in journalism that could entertain and inform readers. She was a natural leader and a beautiful person. Our thoughts are with Chris, Sophia and Patrick.” Whelan first joined the ABC in 2016, where she was first appointed Director of Regional and Local News before taking the role of ABC editorial director in 2022. Prior to her work at the public broadcaster, Whelan worked for several other publications, including Sydney Morning Herald, where she also served as news director and editor of its weekend edition. The talented media executive was one of just three female editors in the SMH’s history. Well respected in her field, Whelan’s career also saw her stationed in both the Pacific and Europe as a foreign correspondent, and she was also nominated for a Walkley Award for her news and feature writing. Image credits: ABC

Caring

Jelena Dokic hits back at body shaming trolls

Jelena Dokic has hit back at body shaming trolls after revealing her dramatic weight loss. The former tennis player revealed that she has lost 20kgs after becoming concerned about her family's health history, and she had a message for online bullies. “It’s not good if you gain weight and it’s not good if you lose weight. It’s not good if you are a size zero, 10 or 18 it seems,” she wrote in the raw Instagram post on Monday. “So you all know I am very open and honest. “Whether I gain weight, lose weight, depressed, feel great, go through the good or the bad, I am always honest about both sides. “So I thought I would just quickly address my recent weight loss because a few people have written to me and also commented. “So, I have lost 20 kilos from my heaviest weight last year. “I had some health issues but also I just wanted to get healthier and fitter and when I turned 40 last year, I really started to think about my family history of diabetes, high blood pressure and heart problems. “Also, my work has increased dramatically and I needed to be fitter both physically and mentally and have more energy. “I didn’t have enough energy especially mentally to keep up. I needed to eat healthier to achieve that. “So, I didn’t focus on weight so much but just making better choices to feel my best. “With that the weight started coming off.” While she has previously faced people bullying her over her weight gain, she revealed that she's also been copping flak for losing weight, with some shaming her saying that: "I have succumbed to the ‘diet culture’ and don’t represent the plus size people anymore." "Please don’t even go there,” she said. She added that she will always stand up for people no matter their size, especially women. “It was always about not judging, shaming and bullying people no matter what their weight and size is and instead highlighting that kindness is what matters, not our size. “So, while I have lost 20 kilos it changes nothing. “I still want people to value me and others based on whether we are kind and good people. “I will always be proud of myself and not hide or be embarrassed no matter what size I am. And I will always be against body shaming and against valuing people based on their size and weight no matter if I gain or lose some kilos and dress sizes. “Always against body shaming no matter what.” Her post has already received over 45,000 likes and 3,000 comments, with many praising her for speaking up. “Keep well Jelena, don’t listen to the noise, you will never please everyone. Just keep doing the amazing work you do, love your commentary,” wrote one follower. Images: Instagram

Body

Weight loss: drinking a gallon of water a day probably won’t help you lose weight

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/duane-mellor-136502">Duane Mellor</a>, <a href="https://theconversation.com/institutions/aston-university-1107">Aston University</a> It’s often claimed that if you’re trying to lose weight, one of the things you should do each day is drink plenty of water – with some internet advice even suggesting this should be as much as a gallon (about 4.5 litres). The claim is that water helps burn calories and reduce appetite, which in turn leads to weight loss. But while we all might wish it was this easy to lose weight, unfortunately there’s little evidence to back up these claims. <h2>Myth 1: water helps burn calories</h2> One <a href="https://pubmed.ncbi.nlm.nih.gov/14671205/">small study</a>, of 14 young adults, found drinking 500ml of water increased resting energy expenditure (the amount of calories our body burns before exercise) by about 24%. While this may sound great, this effect only lasted an hour. And this wouldn’t translate to a big difference at all. For an average 70kg adult, they would only use an additional 20 calories – a quarter of a biscuit – for every 500ml of water they drank. <a href="https://pubmed.ncbi.nlm.nih.gov/16822824/">Another study</a> of eight young adults only saw an increase in energy expenditure when the water was fridge cold – reporting a very modest 4% increase in calories burned. This may be because the body needs to use more energy in order to bring the water up to body temperature, or because it requires more energy for the body to filter the increased volume of fluid through the kidneys. And again, this effect was only seen for about an hour. So although scientifically it might be possible, the actual net increase in calories burned is tiny. For example, even if you drank an extra 1.5l of water per day, it would save fewer calories than you’d get in a slice of bread. It’s also worth noting that all this research was in young healthy adults. More research is needed to see whether this effect is also seen in other groups (such as middle-aged and older adults). <h2>Myth 2: water with meals reduces appetite</h2> This claim again seems sensible, in that if your stomach is at least partly full of water there’s less room for food – so you end up eating less. A number of studies actually support this, particularly those conducted in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859815/#:%7E:text=Thus%2C%20when%20combined%20with%20a,meal%20EI%20following%20water%20ingestion.">middle-aged and older adults</a>. It’s also a reason people who are unwell or have a poor appetite are advised <a href="https://www.ageuk.org.uk/bp-assets/globalassets/salford/forms/improve-your-food-and-drink-intake.pdf">not to drink before eating</a> as it may lead to under-eating. But for people looking to lose weight, the science is a little less straightforward. <a href="https://pubmed.ncbi.nlm.nih.gov/17228036/">One study</a> showed middle-aged and older adults lost 2kg over a 12-week period when they drank water before meals compared with people who didn’t drink any water with their meal. Younger participants (aged 21-35) on the other hand did not lose any weight, regardless of whether they drank water before their meal or not. But since the study didn’t use blinding (where information which may influence participants is withheld until after the experiment is finished), it means that participants may have become aware of why they were drinking water before their meal. This may have led some participants to purposefully change how much they ate in the hopes it might increase their changes of losing weight. However, this doesn’t explain why the effect wasn’t seen in young adults, so it will be important for future studies to investigate why this is. The other challenge with a lot of this kind of research is that it only focuses on whether participants eat less during just one of their day’s meals after drinking water. Although this might suggest the potential to lose weight, there’s <a href="https://pubmed.ncbi.nlm.nih.gov/20736036/">very little good-quality evidence</a> showing that reducing appetite in general leads to weight loss over time. Perhaps this is due to our body’s biological drive to <a href="https://pubmed.ncbi.nlm.nih.gov/28193517/">maintain its size</a>. It’s for this reason that no claims can be legally made in Europe about foods which help make you <a href="https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/satietyenhancing-products-for-appetite-control-science-and-regulation-of-functional-foods-for-weight-management/E4CCAE4C90A220994FD29C27FAE7F666">feel fuller for longer</a> with <a href="https://www.gov.uk/government/publications/nutrition-and-health-claims-guidance-to-compliance-with-regulation-ec-1924-2006-on-nutrition-and-health-claims-made-on-foods/nutrition-and-health-claims-guidance-to-compliance-with-regulation-ec-19242006#section-6">reference to weight loss</a>. So, although there might be some appetite-dulling effects of water, it seems that it might not result in long-term weight change – and may possibly be due to making conscious changes to your diet. <h2>Just water isn’t enough</h2> There’s a pretty good reason why water on its own is not terribly effective at <a href="https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/eating-habits-and-appetite-control-a-psychobiological-perspective/0D0605739F5150D1A7C49420D75F3CDF">regulating appetite</a>. If it did, prehistoric humans might have starved. But while appetite and satiation – feeling full and not wanting to eat again – aren’t perfectly aligned with being able to <a href="https://pubmed.ncbi.nlm.nih.gov/20736036/">lose weight</a>, it might be a helpful starting point. Part of what helps us to feel full is our stomach. When food enters the stomach, it triggers stretch receptors that in turn lead to the release of hormones which tell us we’re full. But since water is a liquid, it’s rapidly emptied from our stomach – meaning it doesn’t actually fill us up. Even more interestingly, due to the <a href="https://pubmed.ncbi.nlm.nih.gov/16934271/">stomach’s shape</a>, fluids can bypass any semi-solid food content that’s being digested in the lower part of the stomach. This means that water can still be quickly emptied from the stomach. So even if it’s consumed at the end of a meal it might not necessarily extend your feelings of fullness. If you’re trying to eat less and lose weight, drinking excessive amounts of water may not be a great solution. But there is evidence showing when water is mixed with other substances (such as <a href="https://pubmed.ncbi.nlm.nih.gov/30166637/">fibre</a>, <a href="https://www.sciencedirect.com/science/article/pii/0031938494903034">soups</a> or vegetable sauces) this can delay how fast the stomach empties its contents – meaning you feel fuller longer. But while water may not help you lose weight directly, it may still aid in weight loss given it’s the healthiest drink we can choose. Swapping high-calorie drinks such as soda and alcohol for water may be an easy way of reducing the calories you consume daily, which may help with weight loss.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/211311/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/duane-mellor-136502">Duane Mellor</a>, Lead for Evidence-Based Medicine and Nutrition, Aston Medical School, <a href="https://theconversation.com/institutions/aston-university-1107">Aston University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/weight-loss-drinking-a-gallon-of-water-a-day-probably-wont-help-you-lose-weight-211311">original article</a>. </div>

Body

Telstra announces thousands of job losses

Telstra is set to axe 2,800 jobs, or 9 percent of their total workforce, by the end of 2024 in a bid to save a whopping $350 million. The telco giant announced that the job cuts would "begin immediately" as a result of the impending business "reset" strategy. Chief executive officer Vicki Brady announced the cuts on Tuesday, and said the job cuts were "difficult" but "necessary" as parts of Telstra were not performing to the required levels. <div> <div>"We need to be a more efficient and sustainable business to ensure we can keep investing at the levels required to meet the ever-increasing demand for our connectivity and services for our customers right across the country," she said.</div> </div> Ms Brady also assured Telstra customers that the job losses would not affect customer service teams. “We have invested significantly in our customer service over recent years. That includes on-shoring our call centres for consumer and small business customers, it includes buying back our stores to deliver consistently good experience,” she said. “None of these changes impact those commitments." “As we work through the further changes still to come that I expect to be able to share with our employees in mid-July, customer service and experience will continue to be a key priority in that.” Despite Ms Brady's claims, Communication Workers Union (CWU) National Assistant Secretary, James Perkins, who represents Telstra workers said there was no way the substantial job cuts would not affect services. “While the detail of where exactly these jobs are being cut from is still unclear, one thing is certain – it will have a devastating impact on services,” Mr Perkins said. “You can’t slash thousands of jobs without seriously impacting the delivery of services across the country. Telstra has to answer to this.” The job cuts come as Telstra continues to scale up AI adoption, after the company announced in February it was expanding two in-house developed generative AI solutions following “promising pilots with frontline team members, enabling faster and more successful interactions with customers”. Image credits: Shutterstock

Money & Banking

"Forever grateful": Jana Pittman's heartbreaking loss

Former Olympian Jana Pittman is in mourning after the sudden death of her long-time coach and friend Jackie Byrnes. Pittman paid tribute to Byrnes on Instagram after her death on Thursday, following a long battle with an illness. Byrnes had previously spoken about her ongoing journey with various skin cancers and melanomas in late 2021, saying it was “amazing” that she had survived to that point. The legendary sporting coach led both Pittman and Melinda Gainsford-Taylor, who also became a world champion, to the elite level while having a major impact on athletics for decades. Athletes both described Byrnes as a second mum in emotional tribute posts after Athletics Australia broke the news of her passing. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/p/C7EbnHuPFlF/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/p/C7EbnHuPFlF/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Jana Pittman (@janapittmanofficial)</a> </div> </blockquote> “It is with great sadness to share that one of my coaches Jackie Byrnes passed away last night,” Pittman wrote. “She coached me to my first Olympic Games and three world youth/junior gold medals... but it was more than her amazing athletic skills." “It was Jackie’s ability to embrace my quirks, emotions, chaos and passion. She set the framework for all my future success." “For dozens of athletes she was a coach, mother, mentor and friend, including the incredible Melinda!! I still vividly remember the day Jackie asked me to join them and train with Mel!" “Many times since I have wondered what could have been if I had stayed longer under her stewardship!" “All that had the privilege of being guided by her will agree she had a unique gift of leaving everyone she met better than before, and for that, we are forever grateful." “Her legacy of kindness, resilience, and inspiration will always be remembered. Thank you Jackie for the gift you gave us all.. genuine care and love! Rest in peace, Jackie.” Image credits: Instagram

Family & Pets

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

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Drugs like Ozempic are very <a href="https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.12932">effective</a> at helping most people who take them lose weight. Semaglutide (sold as Wegovy and Ozempic) and tirzepatide (sold as Zepbound and Mounjaro) are the most well known in the class of drugs that mimic hormones to reduce feelings of hunger. But does weight come back when you stop using it? The short answer is yes. Stopping <a href="https://jamanetwork.com/journals/jama/fullarticle/2812936">tirzepatide</a> and <a href="https://doi.org/10.1111/dom.14725">semaglutide</a> will result in weight regain in most people. So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far. <h2>It’s a long-term treatment, not a short course</h2> If you have a bacterial infection, antibiotics will help your body fight off the germs causing your illness. You take the full course of medication, and the infection is gone. For obesity, taking tirzepatide or semaglutide can help your body get rid of fat. However it doesn’t fix the reasons you gained weight in the first place because obesity is a chronic, complex condition. When you stop the medications, the weight returns. Perhaps a more useful comparison is with high blood pressure, also known as hypertension. Treatment for hypertension is lifelong. It’s the same with obesity. Medications work, but only while you are taking them. (Though obesity is more complicated than hypertension, as many different factors both cause and perpetuate it.) Therefore, several concurrent approaches are needed; taking medication can be an important part of effective management but on its own, it’s often insufficient. And in an unwanted knock-on effect, stopping medication can undermine other strategies to lose weight, like eating less. <h2>Why do people stop?</h2> Research trials show anywhere from <a href="https://asean-endocrinejournal.org/index.php/JAFES/article/view/1771">6%</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/35015037/">13.5%</a> of participants stop taking these drugs, primarily because of <a href="https://www.health.harvard.edu/staying-healthy/glp-1-diabetes-and-weight-loss-drug-side-effects-ozempic-face-and-more">side effects</a>. But these studies don’t account for those forced to stop because of cost or <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">widespread supply issues</a>. We don’t know how many people have needed to stop this medication over the past few years for these reasons. Understanding what stopping does to the body is therefore important. <h2>So what happens when you stop?</h2> When you stop using tirzepatide or semaglutide, it takes several days (or even a couple of weeks) to <a href="https://pubmed.ncbi.nlm.nih.gov/30565096/">move out of your system</a>. As it does, a number of things happen: <ul> <li>you start feeling hungry again, because both <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119845/">your brain and your gut</a> no longer have the medication working to make you feel full</li> </ul> <ul> <li> blood sugars increase, because the medication is no longer acting on the pancreas to help control this. If you have diabetes as well as obesity you may need to take other medications to keep these in an acceptable range. Whether you have diabetes or not, you may need to eat foods with a <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/carbohydrates-and-the-glycaemic-index">low glycemic index</a> to stabilise your blood sugars </li> <li> over the longer term, most people experience a return to their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10092593/">previous blood pressure and cholesterol levels</a>, as the weight comes back </li> <li> weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle. </li> </ul> While you were on the medication, you will have lost <a href="https://academic.oup.com/jes/article/5/Supplement_1/A16/6240360">proportionally less skeletal muscle than fat</a>, muscle loss is inevitable when you lose weight, no matter whether you use medications or not. The problem is, when you stop the medication, your body preferentially puts on fat. <h2>Is stopping and starting the medications a problem?</h2> People whose weight fluctuates with tirzepatide or semaglutide may experience some of the downsides of <a href="https://pubmed.ncbi.nlm.nih.gov/21829159/">yo-yo dieting</a>. When you keep going on and off diets, it’s like a rollercoaster ride for your body. Each time you regain weight, your body has to <a href="https://www.jomes.org/journal/view.html?doi=10.7570/jomes.2017.26.4.237">deal with</a> spikes in blood pressure, heart rate, and how your body handles sugars and fats. This can <a href="https://cardiab.biomedcentral.com/articles/10.1186/s12933-022-01735-x">stress</a> your heart and overall cardiovascular system, as it has to respond to greater fluctuations than usual. Interestingly, the risk to the body from weight fluctuations is greater for people who are <a href="https://jech.bmj.com/content/74/8/662">not obese</a>. This should be a caution to those who are not obese but still using tirzepatide or semaglutide to try to lose unwanted weight. <h2>How can you avoid gaining weight when you stop?</h2> Fear of regaining weight when stopping these medications is valid, and needs to be addressed directly. As obesity has many causes and perpetuating factors, many evidence-based approaches are needed to reduce weight regain. This might include: <ul> <li> getting quality <a href="https://www.hindawi.com/journals/ije/2010/270832/">sleep</a> </li> <li> exercising in a way that builds and maintains muscle. While on the medication, you will <a href="https://pubmed.ncbi.nlm.nih.gov/32628589/">likely have lost muscle</a> as well as fat, although this is not inevitable, especially if you <a href="https://www.europeanreview.org/article/34169">exercise regularly</a> while taking it </li> </ul> <ul> <li> addressing emotional and cultural aspects of life that contribute to over-eating and/or eating unhealthy foods, and how you view your body. Stigma and shame around body shape and size is not cured by taking this medication. Even if you have a healthy relationship with food, we live in a culture that is <a href="https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.159491">fat-phobic and discriminates</a> against people in larger bodies </li> <li> eating in a healthy way, hopefully continuing with habits that were formed while on the medication. Eating meals that have high nutrition and fibre, for example, and lower overall portion sizes. </li> </ul> Many people will stop taking tirzepatide or semaglutide at some point, given it is expensive and in short supply. When you do, it is important to understand what will happen and what you can do to help avoid the consequences. Regular reviews with your GP are also important. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224972/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, General Practitioner, PhD Candidate, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-when-i-stop-taking-a-drug-like-ozempic-or-mounjaro-224972">original article</a>. </div>

Body

"I miss her hugs": British acting legend shares heartbreaking loss

Actor Warwick Davis has shared the heartbreaking news of his wife's death. The actor, known for his roles in Harry Potter and Star Wars, took to social media to share the news of his wife Samantha's death, who passed away at the age of 53. “Her passing has left a huge hole in our lives as a family. I miss her hugs”, Warwick, 54, said. He added, “She was a unique character, always seeing the sunny side of life she had a wicked sense of humour and always laughed at my bad jokes. “Without Sammy, there would have been no Tenable quiz show, no Willow series. No Idiot Abroad Series 3.” Warwick said Samantha was his “most trusted confidant and an ardent supporter of everything I did in my career”. The couple’s children, Harrison and Annabelle, added, “Mum is our best friend and we’re honoured to have received a love like hers “Her love and happiness carried us through our whole lives”. Warwick and Samantha met on the set of the movie Willow in 1988 and got married three years later. Samantha had achondroplasia, a bone growth disorder that causes disproportionate dwarfism. Warwick has previously opened up about his wife’s health after she was rushed to hospital with sepsis in 2018, and had to undergo several different surgeries to stabilise her condition. Warwick, co-founder of charity Little People UK, has often spoken out about the health battles related to his condition, as well his wife’s. He was born with Spondyloepiphyseal dysplasia congenita (SED), an extremely rare genetic form of dwarfism, which has been inherited by both their daughter Annabelle and son Harrison. Image credits: Getty Images

Caring

Foreign Minister Penny Wong’s heartbreaking loss

Penny Wong has shared the devastating news of her mother's passing. The Australian Foreign Minister took to Instagram to pay tribute to her mother, Jane Chapman, who passed away on Sunday. "Yesterday my beloved mother, Jane Chapman, left us peacefully," she began her post. "Mum was a woman of exceptional intellect and penetrating insight, of mischievous wit and endless curiosity. “Most of all she was a woman of deep compassion and principle,” Wong said. “She gave expression to her compassion through her courage and determination for justice, qualities that have steeled me through all my life’s challenges. “Through her work, her choices, her courage and her deeds, she inspired and empowered me and so many others. "Mum loved me completely. And she loved her granddaughters Alexandra and Hannah beyond measure," she continued. "We will miss her terribly." She then thanked Tony Michele and the staff at Mary Potter Hospice for taking care of her mum and for their kindness. Parliamentary colleagues and the public shared their condolences in the comments. "My heart goes out to you. Nothing can prepare us for the loss of a parent. Jane was an incredible woman. Sending love to you and the family," Prime Minister Anthony Albanese wrote. "Sorry for your loss Penny. Losing your mum is so incredibly hard," added TV personality and former Gogglebox star Yvie Jones. "Your mum was great. Staunch, fierce, funny. I and aĺl her yoga class friends will miss her," one person wrote. "Words are completely inadequate at a time like this. I am so very sorry for your loss Penny. I hope the love and support of friends and family can offer you some comfort," added another. Chapman married Chinese-Malay architect Francis Wong while he was studying in Adelaide on a scholarship and shared two children together Penny and Toby. When they divorced, Chapman moved back to South Australia with her children. In 2001, 10 days after his 30th birthday and on the same day Wong was elected to the senate, Toby took his own life. Francis Wong passed away in May 2023. Image: Instagram

Family & Pets

Judge finds Bruce Lehrmann raped Brittany Higgins and dismisses Network 10 defamation case. How did it play out?

<a href="https://theconversation.com/profiles/brendan-clift-715691">Brendan Clift</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Bruce Lehrmann has lost his defamation suit against Channel Ten and journalist Lisa Wilkinson after the media defendants proved, on the balance of probabilities, that Lehrmann raped his colleague Brittany Higgins in Parliament House in 2019. After a trial lasting around a month, Federal Court Justice Michael Lee – an experienced defamation judge – concluded that both Lehrmann and Higgins had credibility issues, but ultimately <a href="https://www.judgments.fedcourt.gov.au/judgments/Judgments/fca/single/2024/2024fca0369">he was persuaded</a> that Lehrmann raped Higgins, as she’d alleged and he’d denied. <h2>Criminal trials by proxy</h2> Ordinarily, charges like rape would be resolved through the criminal courts, but Lehrmann’s criminal trial was <a href="https://www.abc.net.au/news/2022-10-27/jury-discharged-in-trial-of-bruce-lehrmann-brittany-higgins/101583486">aborted</a> in October 2022 after juror misconduct. The charges against him were soon <a href="https://www.news.com.au/national/nsw-act/courts-law/bruce-lehrmann-sexual-assault-charge-dropped-dpp-confirms/news-story/3f82dd388d2cfa38680f7d4f4ceb1c5e">dropped</a>, nominally over concerns for Higgins’ mental health. Higgins, however, foresaw civil proceedings and <a href="https://www.theguardian.com/australia-news/2023/dec/05/brittany-higgins-volunteered-to-be-defamation-trial-witness-as-she-would-not-let-rapist-become-a-millionaire-ntwnfb">offered to testify</a> should they arise. That they did, as Lehrmann, free from the burden of any proven crime, sued several media outlets for defamation over their reporting into the allegations (<a href="https://www.fedcourt.gov.au/services/access-to-files-and-transcripts/online-files/lehrmann">the ABC</a> and <a href="https://www.theguardian.com/australia-news/2023/dec/06/abc-agrees-to-pay-bruce-lehrmann-150000-to-settle-defamation-claim-court-documents-reveal">News Corp</a> both settled out of court). <iframe class="flourish-embed-iframe" style="width: 100%; height: 550px;" title="Interactive or visual content" src="https://flo.uri.sh/visualisation/17195035/embed" width="100%" height="400" frameborder="0" scrolling="no" sandbox="allow-same-origin allow-forms allow-scripts allow-downloads allow-popups allow-popups-to-escape-sandbox allow-top-navigation-by-user-activation"></iframe> <div style="width: 100%!; margin-top: 4px!important; text-align: right!important;"><a class="flourish-credit" href="https://public.flourish.studio/visualisation/17195035/?utm_source=embed&utm_campaign=visualisation/17195035" target="_top"><img src="https://public.flourish.studio/resources/made_with_flourish.svg" alt="Made with Flourish" /></a></div> Like Ben Roberts-Smith’s <a href="https://theconversation.com/dismissed-legal-experts-explain-the-judgment-in-the-ben-roberts-smith-defamation-case-191503">recent defamation suit</a> against the former Fairfax papers, this became another case of civil proceedings testing grave allegations in the absence of a criminal law outcome. The form of proceedings made for some key differences with the aborted criminal trial. In criminal cases, prosecutors are ethically bound to act with moderation in pursuing a conviction, which requires proof beyond a reasonable doubt, while defendants have the right to silence. By contrast, this trial featured detailed accounts from both sides as each sought to convince, in essence, that their contentions were likely to be correct. Also like the Roberts-Smith case, live streaming of the trial generated very high levels of public engagement. Today’s stream reached audiences of more than 45,000 people. It gave us the chance to assess who and what we believe, and to scrutinise the parties’ claims and the media’s reporting. The Federal Court doesn’t have juries, but we, the public, acted as a de facto panel of peers. We saw accusations and denials, revealing <a href="https://www.abc.net.au/news/2023-12-23/bruce-lehrmann-defamation-trial-network-ten-lisa-wilkinson-ends/103260752">cross-examination</a> of the protagonists, witness testimony from colleagues, CCTV footage from nightclubs to Parliament House complete with lip-reading, expert testimony on alcohol consumption and consent, and lawyers constructing timelines which supported or poked holes in competing versions of events. The complexity of high-stakes legal proceedings was on display, with Justice Lee issuing many interim decisions on questions of procedure and evidence. Whenever transparency was at stake, it won. The preference for full disclosure led to the <a href="https://www.theguardian.com/law/2024/apr/02/bruce-lehrmann-defamation-trial-network-10-fresh-evidence-bid-lisa-wilkinson-brittany-higgins-delay-ntwnfb">case being re-opened</a> at the eleventh hour to call former Channel 7 producer Taylor Auerbach as a witness, providing a denouement that the judge called “sordid”, but which had little relevance to the final result. <h2>An argument over the truth</h2> Lehrmann had the burden of proving that the defendants published matter harmful to his reputation. That matter was Wilkinson’s interview with Higgins on Channel Ten’s The Project in which the allegations were made. A statement is only defamatory if it’s untrue, but in Australian law, the publisher bears the burden of proving truth, should they opt for that defence. And more serious allegations usually require more compelling proof, as the law views them as inherently more unlikely. This can be onerous for a defamation defendant, but it also involves risk for the plaintiff, should the defendant embark on an odyssey of truth-telling yet more damaging to the plaintiff’s image. That happened to <a href="https://www.bbc.com/news/world-australia-65717684">Ben Roberts-Smith</a> and it happened to Lehrmann here. On the other hand, if the media hasn’t done their homework, as in <a href="https://www.judgments.fedcourt.gov.au/judgments/Judgments/fca/single/2023/2023fca1223">Heston Russell’s case</a> against the ABC (also presided over by Justice Lee), the complainant can be vindicated. This case was a manifestation of Lehrmann’s professed desire to “<a href="https://www.theguardian.com/australia-news/2023/oct/26/how-bruce-lehrmanns-media-interviews-cost-him-his-anonymity-in-toowoomba-case">light some fires</a>”. Few players in this extended saga have emerged without scars, and here he burned his own fingers, badly. As Justice Lee put it, Lehrmann, “having escaped the lion’s den [of criminal prosecution], made the mistake of coming back to get his hat”. <h2>How was the case decided?</h2> Lehrmann denied having sex with Higgins, whereas Higgins alleged there had been non-consensual sex. The defamatory nature of the publication centred on the claim of rape, so that was what the media defendants sought to prove. This left open the curious possibility that consensual sex might have taken place: if so, Lehrmann would have brought his case on a false premise (there had been no sex), but the media would have failed to defend it (by not proving a lack of consent), resulting in a Lehrmann win. That awkward scenario did not arise. The court found sex did in fact take place, Higgins in her heavily-inebriated and barely-conscious state did not give consent, and Lehrmann was so intent on his gratification that he ignored the requirement of consent. Justice Lee found Lehrmann to be a persistent, self-interested liar, whereas Higgin’s credibility issues were of lesser degree, some symptomatic of a person piecing together a part-remembered trauma. The judge drew strongly on the evidence of certain neutral parties who could testify to incidents or words spoken in close proximity to the events. <h2>Defamation laws favour the aggrieved</h2> Australian defamation law has historically favoured plaintiffs and, despite recent <a href="https://www.ruleoflaw.org.au/civil/defamation/2021-law-reform/">rebalancing attempts</a>, it remains a favoured legal weapon for those with the resources to use it. This includes our political class, who sue their critics for defamation with unhealthy frequency for a democracy. In the United States, public figures don’t have it so easy: to win they must prove their critics were lying. In Australia, the media sometimes succeeds in proving truth, but contesting defamation proceedings comes at great financial cost and takes an emotional toll on the journalists involved. Nor can a true claim always be proven to a court’s satisfaction, given the rules of evidence and the fact that sources may be reluctant to testify or protected by a reporter’s guarantee of confidentiality. But this case demonstrates that publishers with an appetite for the legal fight can come out on top.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225891/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/brendan-clift-715691">Brendan Clift</a>, Lecturer of law, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/judge-finds-bruce-lehrmann-raped-brittany-higgins-and-dismisses-network-10-defamation-case-how-did-it-play-out-225891">original article</a>.

Legal

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

<a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Obesity medication that is effective has been a long time coming. Enter semaglutide (sold as Ozempic and Wegovy), which is helping people improve weight-related health, including <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">lowering the risk</a> of a having a heart attack or stroke, while also silencing “<a href="https://theconversation.com/some-ozempic-users-say-it-silences-food-noise-but-there-are-drug-free-ways-to-stop-thinking-about-food-so-much-208467">food noise</a>”. As demand for semaglutide increases, so are <a href="https://www.smh.com.au/lifestyle/health-and-wellness/in-a-fat-phobic-world-ozempic-is-hardly-the-easy-way-out-20240401-p5fgjd.html">claims</a> that taking it is “cheating” at weight loss or the “easy way out”. We don’t tell people who need statin medication to treat high cholesterol or drugs to manage high blood pressure they’re cheating or taking the easy way out. Nor should we shame people taking semaglutide. It’s a drug used to treat diabetes and obesity which needs to be taken long term and comes with risks and side effects, as well as benefits. When prescribed for obesity, it’s given alongside advice about diet and exercise. <h2>How does it work?</h2> Semaglutide is a <a href="https://en.wikipedia.org/wiki/GLP-1_receptor_agonist">glucagon-like peptide-1</a> receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called <a href="https://en.wikipedia.org/wiki/Glucagon-like_peptide-1">GLP-1</a> for short, work better. GLP-1 gets secreted by cells in your gut when it <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">detects increased nutrient levels</a> after eating. This stimulates insulin production, which lowers blood sugars. GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating. <iframe id="tc-infographic-1031" class="tc-infographic" style="border: none;" src="https://cdn.theconversation.com/infographics/1031/c11b606581d4bc58a71f066492d7f740b52c04e1/site/index.html" width="100%" height="400px" frameborder="0"></iframe> GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action. Some studies have found less GLP-1 gets released after meals in <a href="https://pubmed.ncbi.nlm.nih.gov/38218319/">adults with obesity or type 2 diabetes mellitus</a> compared to adults with normal glucose tolerance. So having less GLP-1 circulating in your blood means you don’t feel as full after eating and get hungry again sooner compared to people who produce more. GLP-1 has a very short half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/28443255/">two minutes</a>. So GLP-1RA medications were designed to have a very long half-life of about <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">seven days</a>. That’s why semaglutide is given as a weekly injection. <h2>What can users expect? What does the research say?</h2> Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly). A large group of <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">randomised controlled trials</a>, called STEP trials, all tested weekly 2.4mg semaglutide injections versus different interventions or placebo drugs. Trials lasting 1.3–2 years consistently found weekly 2.4 mg semaglutide injections <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">led to 6–12% greater weight loss</a> compared to placebo or alternative interventions. The average weight change depended on how long medication treatment lasted and length of follow-up. Weight reduction due to semaglutide also leads to a <a href="https://pubmed.ncbi.nlm.nih.gov/36769420/">reduction in systolic and diastolic blood pressure</a> of about 4.8 mmHg and 2.5 mmHg respectively, a reduction in <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/triglycerides">triglyceride levels</a> (a type of blood fat) and <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">improved physical function</a>. Another recent trial in adults with pre-existing heart disease and obesity, but without type 2 diabetes, found adults receiving weekly 2.4mg semaglutide injections had a <a href="https://pubmed.ncbi.nlm.nih.gov/37952131/">20% lower risk</a> of specific cardiovascular events, including having a non-fatal heart attack, a stroke or dying from cardiovascular disease, after three years follow-up. <h2>Who is eligible for semaglutide?</h2> Australia’s regulator, the Therapeutic Goods Administration (TGA), has <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023">approved</a> semaglutide, sold as Ozempic, for treating type 2 diabetes. However, due to shortages, the TGA had advised doctors not to start new Ozempic prescriptions for “off-label use” such as obesity treatment and the Pharmaceutical Benefits Scheme doesn’t currently subsidise off-label use. The TGA has <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy to treat obesity</a> but it’s not currently available in Australia. When it’s available, doctors will be able to prescribe <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">semaglutide to treat obesity</a> in conjunction with lifestyle interventions (including diet, physical activity and psychological support) in adults with obesity (a BMI of 30 or above) or those with a BMI of 27 or above who also have weight-related medical complications. <h2>What else do you need to do during Ozempic treatment?</h2> Checking details of the <a href="https://pubmed.ncbi.nlm.nih.gov/36691309/">STEP trial intervention components</a>, it’s clear participants invested a lot of time and effort. In addition to taking medication, people had brief lifestyle counselling sessions with dietitians or other health professionals every four weeks as a minimum in most trials. Support sessions were designed to help people stick with consuming 2,000 kilojoules (500 calories) less daily compared to their energy needs, and performing 150 minutes of <a href="https://www.healthdirect.gov.au/tips-for-getting-active">moderate-to-vigorous physical activity</a>, like brisk walking, dancing and gardening each week. STEP trials varied in other components, with follow-up time periods varying from 68 to 104 weeks. The aim of these trials was to show the effect of adding the medication on top of other lifestyle counselling. A <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">review of obesity medication trials</a> found people reported they needed less <a href="https://pubmed.ncbi.nlm.nih.gov/28652832/">cognitive behaviour training</a> to help them stick with the reduced energy intake. This is one aspect where drug treatment may make adherence a little easier. Not feeling as hungry and having environmental food cues “switched off” may mean less support is required for goal-setting, self-monitoring food intake and <a href="https://theconversation.com/9-ways-wont-power-is-better-than-willpower-for-resisting-temptation-and-helping-you-eat-better-71267">avoiding things that trigger eating</a>. <h2>But what are the side effects?</h2> Semaglutide’s side-effects <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">include</a> nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain. In one study these <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">led to</a> discontinuation of medication in 6% of people, but interestingly also in 3% of people taking placebos. More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions. To reduce risk or severity of side-effects, <a href="https://pubmed.ncbi.nlm.nih.gov/36934408/">medication doses are increased very slowly</a> over months. Once the full dose and response are achieved, research indicates you need to take it long term. Given this long-term commitment, and associated <a href="https://www.health.gov.au/topics/private-health-insurance/what-private-health-insurance-covers/out-of-pocket-costs#:%7E:text=An%20out%20of%20pocket%20cost,called%20gap%20or%20patient%20payments">high out-of-pocket cost of medication</a>, when it comes to taking semaglutide to treat obesity, there is no way it can be considered “cheating”. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/219116/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/clare-collins-7316">Clare Collins</a>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/no-taking-drugs-like-ozempic-isnt-cheating-at-weight-loss-or-the-easy-way-out-219116">original article</a>.

Body

Ozempic isn’t approved for weight loss in Australia. So how are people accessing it?

<a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/andrew-bartlett-849104">Andrew Bartlett</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> To say that Ozempic is a <a href="https://www.theguardian.com/business/2024/jan/31/obesity-drug-ozempic-novo-nordisk-record-wegovy">blockbuster drug</a> is an understatement. Manufacturer Novo Nordisk is scrambling to expand production sites to keep up with global demand. While Ozempic is only approved for the treatment of diabetes in Australia, it is also marketed overseas for weight loss under the brand name Wegovy. Social media is full of posts and endorsements by celebrities who are using it for weight loss. Faced with limited access in Australia, some people who need the medication for diabetes can’t access it. Others are turning to the internet to source it from compounding pharmacies – a practice Australia’s regulator, the Therapeutic Goods Administration (TGA), plans to clamp down on. <h2>How doctors are prescribing Ozempic</h2> Use of Ozempic for weight loss in Australia is considered “<a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#why-the-tga-cant-stop-offlabel-prescribing">off label</a>”. This is when a doctor prescribes a medicine for a purpose outside of what is approved. Ozempic is only approved to be used for the treatment of diabetes in Australia, but its off-label prescribing for weight loss is driving <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#when-will-the-ozempic-shortage-end">shortages</a> which the TGA thinks will last until 2025. To manage these shortages, Australian doctors and pharmacies are being asked <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#information-for-prescribers">not to start new patients</a> on Ozempic and to prioritise it for patients with type 2 diabetes who are already stabilised on this medicine. However, the TGA <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#why-the-tga-cant-stop-offlabel-prescribing">says</a> it: "does not have the power to regulate the clinical decisions of health professionals and is unable to prevent doctors from using their clinical judgement to prescribe Ozempic for other health conditions." <h2>Why can’t we just make more?</h2> The active ingredient in Ozempic, semaglutide, is a delicate <a href="https://www.britannica.com/story/what-is-the-difference-between-a-peptide-and-a-protein">peptide</a> molecule made up of two small chains of amino acids. It’s just one in a family of drugs that are classified as GLP-1 inhibitors. Because it’s a peptide, its manufacture is complex and requires specialised facilities beyond those used to make normal chemical-based drugs. It is also delivered via an injection, meaning that it has to be manufactured under strict conditions to ensure it is both sterile and temperature controlled. This means increasing production is not as simple as just deciding to manufacture more. Its manufacturer <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#why-the-tga-cant-stop-offlabel-prescribing">needs time</a> to build new facilities to increase production. <h2>Compounding pharmacies are making their own</h2> <a href="https://www.fda.gov/drugs/guidance-compliance-regulatory-information/human-drug-compounding#:%7E:text=Compounding%20is%20generally%20a%20practice,needs%20of%20an%20individual%20patient">Compounding</a> is the practice of combining, mixing, or altering ingredients of a drug to create a formulation tailored to the needs of an individual patient. Australian law allows <a href="https://www.pharmacyboard.gov.au/codes-guidelines.aspx">pharmacists to compound</a> only when it is for the treatment of a particular patient to meet their individual clinical need and there is no suitable commercially manufactured product available. An example is making a liquid form of a drug from a tablet for people unable to swallow. Compounded products are not held to the same safety, quality and efficacy standards required for mass produced medicines. This recognises the one-off nature of such compounded medicines and the professional training of the pharmacists who prepare them. Recently, pharmacies have been relying on these compounding rules to produce their own Ozempic-like products at scale and ship them to consumers around Australia. However, there are risks when using these products. The US Food and Drug Administration (FDA) has recently <a href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/medications-containing-semaglutide-marketed-type-2-diabetes-or-weight-loss#:%7E:text=Are%20there%20concerns%20with%20compounded,available%20to%20treat%20a%20patient.">warned consumers</a> of the dangers of using compounded formulations that contain particular salt formulations of semaglutide. It has received more reports of side effects in patients using these products. <h2>How the regulator plans to tighten the loophole</h2> The TGA is taking a number of steps to tighten the compounding loophole and there are ongoing investigations in this area. In December 2023, the agency issued a <a href="https://www.tga.gov.au/news/safety-alerts/compounding-safety-information-semaglutide-products">public safety warning</a> on the dangers of these compounded medicines. More recently, it has proposed <a href="https://www.abc.net.au/news/2024-02-29/compounding-pharmacies-mounjaro-ozempic/103283926">removing GLP-1 drugs</a>, which includes Ozempic, from Australia’s compounding exemptions. This would effectively ban pharmacies from making off-brand Ozempic. This proposal is <a href="https://www.tga.gov.au/news/media-releases/consultation-remove-glucagon-peptide-1-glp-1-receptor-agonist-analogues-pharmacist-extemporaneous-compounding-exemption">currently under consultation</a> and a final decision is expected by June this year. If you want to access the drug for weight loss before the shortage is over, be aware that compounded products are not identical to approved Ozempic and have not been evaluated for safety, quality and efficacy. Supply of copycat versions is also likely to be limited, given the ongoing TGA crackdown. <hr /> Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-132745">Ozempic series</a> here.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/224859/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/jessica-pace-1401278">Jessica Pace</a>, Associate Lecturer, Sydney Pharmacy School, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/andrew-bartlett-849104">Andrew Bartlett</a>, Associate Lecturer Pharmacy Practice, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, Associate Professor of the School of Pharmacy, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/ozempic-isnt-approved-for-weight-loss-in-australia-so-how-are-people-accessing-it-224859">original article</a>.

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