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    Time to Say Goodbye to the B.M.I.?

    The body mass index has long been criticized as a flawed indicator of health. A replacement has been gaining support: the body roundness index.Move over, body mass index. Make room for roundness — to be precise, the body roundness index.The body mass index, or B.M.I., is a ratio of height to weight that has long been used as a medical screening tool. It is one of the most widely used health metrics but also one of the most reviled, because it is used to label people overweight, obese or extremely obese.The classifications have been questioned by athletes like the American Olympic rugby player Ilona Maher, whose B.M.I. of 30 technically puts her on the cusp of obesity. “But alas,” she said on Instagram, addressing online trolls who tried to shame her about her weight, “I’m going to the Olympics and you’re not.”Advocates for overweight individuals and people of color note that the formula was developed nearly 200 years ago and based exclusively on data from men, most of them white, and that it was never intended for medical screening. Even physicians have weighed in on the shortcomings of B.M.I. The American Medical Association warned last year that B.M.I. is an imperfect metric that doesn’t account for racial, ethnic, age, sex and gender diversity. It can’t differentiate between individuals who carry a lot of muscle and those with fat in all the wrong places.“Based on B.M.I., Arnold Schwarzenegger when he was a bodybuilder would have been categorized as obese and needing to lose weight,” said Dr. Wajahat Mehal, director of the Metabolic Health and Weight Loss Program at Yale University.“But as soon as you measured his waist, you’d see, ‘Oh, it’s 32 inches.’”So welcome a new metric: the body roundness index. B.R.I. is just what it sounds like — a measure of how round or circlelike you are, using a formula that takes into account height and waist, but not weight.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Do You Have Healthy Brain Habits? Take This Quiz to Find Out.

    What can I do to take good care of my brain and lower my risk for a neurological disease? That’s the No. 1 question neurologist Dr. Jonathan Rosand hears from his patients (and their family members) at the Massachusetts General Hospital McCance Center for Brain Health. To help answer it, he and his colleagues, with […] More

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    Compounded Semaglutide: What to Know About Overdose Risks of Ozempic Alternative

    Some patients say it’s easy to get the do-it-yourself doses of compounded semaglutide wrong.Three hours after Becky Cheairs injected herself with the first dose of compounded semaglutide, she started to vomit. Crouched over the toilet, reeling from nausea, she thought there was no way she would make it on the R.V. trip from Arkansas to San Antonio she had planned that weekend.She was right: She spent the next day throwing up at least once an hour.Like many others, Ms. Cheairs, 66, had taken the drug to lose weight. But she hadn’t taken the brand-name products Ozempic or Wegovy, which come in pens pre-filled with a specific dose. Instead, the medication she was prescribed through a telehealth service came with a vial and a bag of syringes to draw the drug out herself.Ms. Cheairs’ husband asked how much she had taken, then read the instructions. He was shocked: Ms. Cheairs had accidentally given herself five times the amount she was supposed to take.Accidents like this are becoming more common. There have been 159 calls to national poison control centers so far this year involving compounded GLP-1s, the class of medications that includes semaglutide. In 2023, there were only 32.The vast majority of these calls are from people who took too much medication, said Kait Brown, the clinical managing director at America’s Poison Centers. The problem has become so concerning that the Food and Drug Administration issued a warning last month about people overdosing on compounded semaglutide. Some patients have been hospitalized, developed pancreatitis or gallstones, or have fainted or become dehydrated. Some patients had taken 10 or even 20 times more than the intended dose.The demand for Ozempic and similar drugs has pushed compounded medications, once a somewhat niche corner of health care, into the mainstream. There isn’t solid data on how many people take compounded GLP-1s. But some estimates have suggested millions of Americans may be seeking them out, often, because they are looking for a cheaper option or can’t find the brand-name drug in stock.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Some States Say They Can’t Afford Ozempic and Other Weight Loss Drugs

    Public employees in West Virginia who took the drugs lost weight and were healthier, and some are despondent that the state is canceling a program to help pay for them.Joanna Bailey, a family physician and obesity specialist, doesn’t want to tell her patients that they can’t take Wegovy, but she has gotten used to it.Around a quarter of the people she sees in her small clinic in Wyoming County would benefit from the weight-loss medications known as GLP-1s, which also include Ozempic, Zepbound and Mounjaro, she says. The drugs have helped some of them lose 15 to 20 percent of their weight. But most people in the area she serves don’t have insurance that covers the cost, and virtually no one can afford sticker prices of $1,000 to $1,400 a month.“Even my richest patients can’t afford it,” Dr. Bailey said. She then mentioned something that many doctors in West Virginia — among the poorest states in the country, with the highest prevalence of obesity, at 41 percent — say: “We’ve separated between the haves and the have-nots.”Such disparities sharpened in March when West Virginia’s Public Employees Insurance Agency, which pays most of the cost of prescription drugs for more than 75,000 teachers, municipal workers and other public employees and their families, canceled a pilot program to cover weight-loss drugs.Some private insurers help pay for medications to treat obesity, but most Medicaid programs do so only to manage diabetes, and Medicare covers Wegovy and Zepbound only when they are prescribed for heart problems.Over the past year, states have been trying, amid rising demand, to determine how far to extend coverage for public employees. Connecticut is on track to spend more than $35 million this year through a limited weight-loss coverage initiative. In January, North Carolina announced that it would stop paying for weight-loss medications after forking out $100 million for them in 2023 — 10 percent of its spending on prescription drugs.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    How Your Body and Mind Change in Midlife

    Midlife, typically defined as ages 40 to 60, is an inflection point. It’s a time when our past behaviors begin to catch up with us and we start to notice our bodies and minds aging — sometimes in frustrating or disconcerting ways. But it’s also an opportunity: What our older years will look and feel […] More

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    TikTok Attempts to Rein In Diet and Weight Loss Content

    The company said it will work to remove content about drugs like Ozempic, extended fasting and more from the “For You” feed.Emma Lembke did not know what an algorithm was when she started using social media.The then-12-year-old was thrilled when her parents gave her permission to join Instagram. She quickly followed all kinds of accounts — from Kim Kardashian to Olive Garden, she said — and was soon spending five to six hours a day on the app. Then one day she searched for “ab workouts,” and her feed shifted. She started seeing 200-calorie recipes, pro-anorexia posts and exercise routines that “no 12-year-old should be doing in their bedroom,” she said.Ms. Lembke, now 21, testified before the Senate Judiciary Committee in February 2023 about how social media led her to disordered eating, and what she and other advocates see as a dire need for stronger regulation to protect social media’s youngest users.Social media platforms have promised to take more action. On Friday, TikTok enacted what some experts called one of the most well-defined policies by a social media company yet on weight and dieting posts. The company’s updated guidelines, which come as TikTok faces a potential ban in the United States, include new guardrails on posts that show “potentially harmful weight management behaviors” and excessive exercise.TikTok said it will work to ensure the “For You” page, which serves as the main content feed on TikTok and is driven by an algorithm that caters to a user’s interests, no longer shows videos that promote “extended intermittent fasting,” exercises designed for “rapid and significant weight loss” or medications or supplements that promote muscle gain. The new regulations also aim to crack down on posts from influencers and other users promoting products used for weight loss or to suppress appetite, such as drugs like Ozempic. They also aim to curb content promoting anabolic steroid use.Under the new policy, machine learning models will attempt to flag and remove content that is considered potentially dangerous; a human moderation team will then review those posts to see if they need to remain off the For You feed, should be removed from age-restricted feeds or should be removed from the platform altogether, said Tara Wadhwa, TikTok’s director of policy in the United States.The elimination of problematic TikToks from the main feed is meant in part to “interrupt repetitive content patterns,” the new guidelines said. Ms. Wadhwa said the company wants to ensure users aren’t exposed to diet and weight loss content “in sequential order, or repeatedly over and over again.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    What to Know About CKM, the Link Between Heart Health, Diabetes and Kidney Disease

    And they’re increasingly common. Here’s what to know about the shared risk factors for these diseases.Heart disease, diabetes and kidney disease are among the most common chronic illnesses in the United States — and they’re all closely connected.Adults with diabetes are twice as likely to have heart disease or a stroke compared with those who don’t have diabetes. People with diabetes — Type 1 and Type 2 — are also at risk of developing kidney disease. And when the kidneys don’t work well, a person’s heart has to work even harder to pump blood to them, which can then lead to heart disease.The three illnesses overlap so much that last year the American Heart Association coined the term cardiovascular-kidney-metabolic syndrome to describe patients who have two or more of these diseases, or are at risk of developing them. A new study suggests that nearly 90 percent of American adults already show some early signs of these connected conditions.While only 15 percent of Americans meet the criteria for advanced stages of C.K.M. syndrome, meaning they have been diagnosed with diabetes, heart disease or kidney disease or are at high risk of developing them, the numbers are still “astronomically higher than expected” said Dr. Rahul Aggarwal, a cardiology fellow at Brigham and Women’s Hospital in Boston and co-author of the study.The research suggests that people should pay attention to shared risk factors for these diseases early on — including excess body fat, uncontrolled blood sugar, high blood pressure and high cholesterol or triglyceride levels.A Dangerous CycleYour kidneys, heart and metabolic system (which helps process the food you eat into energy and maintains your blood sugar levels) work closely together. If something goes awry with one, it can lead to problems with the others.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Oprah Takes on Weight Stigma in the Ozempic Era in New Weight Loss Special

    In a new special, Ms. Winfrey highlighted how new drugs have changed the way we talk about weight and willpower.Oprah Winfrey, a longtime figure in the national conversation about dieting and weight bias, devoted an hourlong prime-time special on Monday to the rise of weight loss drugs. Her goal, she said, was to “start releasing the stigma and the shame and the judgment” around weight and weight loss — starting with her own, she said.“For 25 years, making fun of my weight was national sport,” Ms. Winfrey said in the show, titled “An Oprah Special: Shame, Blame and the Weight Loss Revolution.”Shame has become a focal point in that conversation as new drugs like Ozempic and Mounjaro, which are widely used for weight loss, shift how people think about treating obesity. When Ms. Winfrey disclosed in December that she was taking a medication to manage her weight, she said she was “done with the shaming” that had followed her through decades of dieting.Many patients who start taking these medications say they have felt shamed for struggling with their weight, and then shamed for taking weight loss drugs, said Dr. Michelle Hauser, the obesity medicine director of the Stanford Lifestyle and Weight Management Center, who was not involved with the special.“People just are constantly getting this message, both internal bias and then external bias from other people,” she said. Some might think, “‘I shouldn’t have to rely on medication, I shouldn’t be dependent on them,’” she added.Dr. Hauser tells patients to instead ask themselves: “Would you tell someone that about their blood pressure medication?”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More