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      TikTok Attempts to Rein In Diet and Weight Loss Content

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      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

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      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

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      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

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      PCOS Diets Are Unlikely to Ease Symptoms

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      Patients were told for years that cutting calories would ease the symptoms of polycystic ovary syndrome. But research suggests dieting may not help at all.For years, people who had polycystic ovary syndrome and were also overweight were told that their symptoms would improve if they lost weight via a restrictive diet. In 2018, a leading group of PCOS experts recommended that overweight or obese women with the hormonal disorder consider reducing their caloric intake by up to 750 calories a day. That guidance helped to spawn questionable diet programs on social media, and reinforced an impression among people with PCOS that if only they could successfully alter their diets, they would feel better.But the recommendations were not based on robust PCOS studies, and researchers now say that there is no solid evidence to suggest that a restrictive diet in the long-term has any significant impact on PCOS symptoms. Dieting rarely leads to sustained weight loss for anyone, and for people with PCOS, losing weight is particularly difficult. Beyond that, the link between sustained weight loss and improved symptoms is not very clear or well-established, said Julie Duffy Dillon, a registered dietitian specializing in PCOS care.In 2023, the same group, called the International PCOS Network, revised its guidance based on a new analysis of the research and dropped all references to caloric restriction. The group now recommends that people with PCOS maintain an “overall balanced and healthy dietary composition” similar to the Mediterranean diet, which is associated with a reduced risk of the health issues that are linked to the disorder, like cardiovascular disease and diabetes. It’s not known whether eating this way might improve symptoms of PCOS. The changes in the guidelines reflect “the PCOS literature and the lived experience of people with the condition,” said Dr. Helena Teede, an endocrinologist at Monash Health in Australia and lead author of the 2023 guidelines. “It’s no longer about blaming people or stigmatizing them, or suggesting that it’s their personal behavioral failure that they have higher weight.”What is PCOS?PCOS is a hormonal disorder that affects as many as five million women in the United States. It’s characterized by irregular periods, infertility, excessive facial hair growth, acne and scalp hair loss — symptoms that are common with other health conditions, too, making diagnosis tricky. People with PCOS usually ovulate less than once a month and often also have higher levels of androgens (male sex hormones) or multiple underdeveloped follicles on their ovaries (not, as the name suggests, cysts) or both.Typically, when a woman is experiencing symptoms, a doctor will either scan the ovaries to look for those follicles or draw blood to test hormone levels. There is no cure for PCOS; the first line of treatment is often some form of birth control to help regulate the menstrual cycle.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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      Are You Starting Ozempic or Another GLP-1? We Want to Hear From You.

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      The New York Times is looking to speak with people who are about to start GLP-1 medications such as Ozempic and are open to allowing us to chronicle their experiences.Have you tried numerous avenues to help your chronic illness, obesity or mental health and turned to Ozempic, Wegovy or another GLP-1 drug to address these issues? The New York Times wants to chronicle the journeys of people who are about to start taking one of these medications or who are losing access to them. We’re especially interested in hearing from groups of people, such as friends or families, that are taking these drugs as a group.We will keep all responses confidential and will reach out to respondents whose stories we’d like to learn more about. We will only use your contact information to follow up with you and will not share it outside the Times newsroom. More

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      6 Reasons That It’s Hard to Get Your Wegovy and Other Weight-Loss Prescriptions

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      An array of obstacles make it difficult for patients to obtain Wegovy or Zepbound. Finding Wegovy is “like winning the lottery,” one nurse practitioner said.Talk to people who have tried to get one of the wildly popular weight-loss drugs, like Wegovy, and they’ll probably have a story about the hoops they had to jump through to get their medication — if they could get it at all.Emily Weaver, a nurse practitioner in Cary, N.C., said she told her patients that finding Wegovy was “like winning the lottery.”Here are six reasons why.1. Demand is very high.Fueled in part by TikTok videos and celebrity testimonials, people are increasingly seeking prescriptions for appetite-suppressing medications. The drugs in this class have long been used to treat diabetes but more recently have been recognized for their extraordinary ability to help patients lose weight. The medications are injected weekly and have sticker prices as high as $16,000 a year.About 3.8 million people in the United States — four times the number two years ago — are now taking the most popular weight-loss drugs, according to the IQVIA Institute for Human Data Science, an industry data provider. Some of these prescriptions are for diabetes. The medicines are Novo Nordisk’s Ozempic and Wegovy (the same drug sold under different brand names), and Eli Lilly’s Mounjaro and Zepbound (also the same drug).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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      An Anti-Obesity Drug and Cultural Stigmas

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      More from our inbox:Seeking More Insight Into Republican VotersScandal at Liberty UniversityFree Analysis? Alice Rosati/Trunk ArchiveTo the Editor:Re “Ozempic Can’t Fix What Our Culture Has Broken,” by Tressie McMillan Cottom (column, Oct. 15):By “broken” in the headline, the column implies that we still perpetuate a cultural bias against obese people.Yes, we do stigmatize fat people. I’m fat. What’s also broken, though, is our habit of blaming society for failing to accept us, and medical institutions for failing to fix us, before we take an honest look at our own choices contributing to becoming unhealthy in the first place.Clearly obesity is an epidemic with complex environmental, economic and genetic factors. But for most, physical activity and healthy eating are still nature’s best prevention and remedy. Unlike Ozempic, they’re not a sexy quick fix. They’re work.Maybe healthy eating and activity are just too simple. But viewing ourselves first as victims of unfair systems is also not the answer.Society will always judge. Institutions will always be profit-driven. Blaming is easy. Honest self-assessment and changing habits are hard.Leslie DunnCarmel, Calif.To the Editor:Tressie McMillan Cottom’s fine column covers almost all the issues that I, as a slightly overweight but not obese woman, have with the new weight-loss drugs.But one issue needs to be addressed: What will we think about and how will we treat people (women) who choose not to take this drug, for whatever reason? Maybe it’s because it’s too expensive; maybe because it’s a commitment to a lifetime of taking the drug; maybe it’s just, amazingly, because they are comfortable in their rounded, plush bodies, and don’t desire to change them. Will they face even more opprobrium for that choice than they already do?I’ve spent the last 66 years (and counting) being told that my body isn’t “right,” by doctors, family and society. I’ve just finally come to terms with the fact that I’m stuck in it, and I’m lucky to be able to wake up every morning and get out of bed. Isn’t that enough?Naomi Weisberg SiegelPittsburghTo the Editor:While I agree with the author on many points, one point she didn’t address effectively is that Ozempic and other weight-loss drugs help cover up a main culprit that is causing our obesity: the U.S. food industry and “ultraprocessed foods.”Up until about the 1980s the U.S. didn’t have such a serious obesity problem. Then sugar began being added to everything, along with other things not found in any garden or kitchen.Dr. McMillan Cottom points out that people can be obese and be healthy, but that is not true of most obese people. Ozempic was created because of rampant diabetes in the U.S., the risk of which is increased by eating ultraprocessed foods.Our food industry is killing us with slow deaths from chronic diseases.Deborah JerardMontpelier, Vt.The writer is a pediatrician.Seeking More Insight Into Republican VotersWhy These 11 Republican Voters Like Trump But Might Bail on HimThe group discusses what it would take for a candidate other than Trump to win their vote.To the Editor:Re “Could These Republican Voters Abandon Trump?” (“America in Focus” series, Opinion, Oct. 22):This piece was disturbing but unenlightening about why voters support Donald Trump.Focus groups are supposed to probe for deeper understanding of participants’ views, yet your moderator accepted answers without delving into how participants reached those views.For example, when Cristian said about Donald Trump that “he does get things done,” the moderator could have asked for specifics. It would have been an interesting answer because Mr. Trump actually got very little done.The most glaring omission was Mr. Trump’s false claims of a stolen 2020 election. Do participants agree with Mr. Trump? Where do they get their news? Does this issue even matter to them?We have known for months that Mr. Trump maintains strong voter support. We might have gotten some insight into why had the moderators asked more clarifying questions.Ann LaubachAustin, TexasTo the Editor:First, I will applaud both Kristen Soltis Anderson for her skilled questions and moderation, as well as Patrick Healy and the Times Opinion team for sticking with your amazing series, most recently “Could These Republican Voters Abandon Trump?” Fascinating stuff.But just like the infamous CNN town hall with Donald Trump, it leaves an urgent set of questions. Mainly these:1. What about the criminal cases against Mr. Trump?2. What about climate change and the green agenda?Without understanding in depth these 11 Republicans on these topics, I just don’t see how I can evaluate. Of course, I recognize that these individuals have most likely completely dismissed these entire areas of thought. Nonetheless, to understand the situation in my country, I need to see what rationales they are using to do that.George OdellNewburyport, Mass.Scandal at Liberty University Julia Rendleman for The New York TimesTo the Editor:Re “The Worst Scandal in American Higher Education,” by David French (column, Oct. 23):Thank you to Mr. French for bringing the truly appalling behavior of Liberty “University” officials to our attention. Yet while he reports that the $37.5 million fine Liberty might face would be “unprecedented,” I can’t help but wonder why the Department of Education wouldn’t strip Liberty of its accreditation altogether, making it ineligible to receive federal money.Such a move is long overdue, and not just because Liberty has lied about campus crime and pressured victims of sexual assault to stay quiet. Liberty, and a host of other Christian institutions, are not colleges in the critical sense. These are places where answers precede questions, where intellectual exploration is hemmed in by theological dogma, and where basic tenets of academic freedom are treated as optional.Why should taxpayers be funding education at such places at all?Steven ConnYellow Springs, OhioThe writer is a professor of history at Miami University.Free Analysis?James AlbonTo the Editor:“How Do You Charge a Friend for a Professional Favor?” (Business, nytimes.com, Oct. 21): Another favor-asking situation that commonly occurs is asking physicians, be they friends or a recent acquaintance at a social event, for free medical opinions or even advice. The many ways of handling those situations would warrant an entire New York Times article.There is another common experience that occurs when one is introduced to someone as a psychiatrist, psychoanalyst or therapist in nonprofessional settings.Such introductions often evoke the question, “Are you analyzing me?” To which I almost always respond, “Not if you’re not paying me.” And we move on.Jack DrescherNew YorkThe writer, a psychiatrist and psychoanalyst, is past president of the Group for Advancement of Psychiatry. More

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      College Athletes and Ideals for Women’s Body Image

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      More from our inbox:Elizabeth Warren’s Election Analysis: We DisagreeEric Adams and the MidtermsSue Republican LiarsA Matter of SpaceAudra Koopman, who ran track and field at Penn State, said she felt pressured to avoid sweets and to trim down. But even as she did, she didn’t feel like she performed better.Rachel Woolf for The New York TimesTo the Editor:Re “Women in College Sports Feel Pressure to Be Lean at Any Cost” (Sports, Nov. 14):Thank you for raising awareness about the risks of scrutinizing body composition in college athletes. I am a clinical psychologist specializing in eating disorders, and the highlighted profiles echo stories I have heard many times over.No evidence suggests that participating in a sport causes eating disorders, but rates of these illnesses among athletes are higher than the national average. Athletes who participate in endurance, weight-class or aesthetic-based sports are at heightened risk.A focus on metrics like body fat percentage and body weight may breed an unhelpful hypervigilance on restrictive eating, body size and burning calories. College-age men and women are often still maturing physically, and by taking drastic measures to change their bodies risk their physical and psychological well-being.They also risk missing out on the greatest pleasures of sports: being a good teammate and finding joy in competition even while competing at a high personal level.Deborah R. GlasoferNew YorkThe writer is an associate professor of clinical medical psychology, Columbia Center for Eating Disorders, New York State Psychiatric Institute.To the Editor:Women in college sports are simply the tip of the spear when it comes to our affluent culture’s widely promoted ideal of thinness for women. I lived in Nigeria for many years, and there plumpness in a woman is seen as a desirable signifier of affluence. So this ideal for women’s bodies is anything but universal or timeless.Athletes and dancers perform in public, and the moves that make up their routines are easier when there is less body fat to contend with.This fact extends into other areas of daily life. But though men perform these activities too, and can also have eating disorders, the fact that women are the focal point of this discussion, as they were when I was a professor of women’s studies at Rutgers, says something about the larger issue of gender ideals in our culture.Katherine EllisNew YorkElizabeth Warren’s Election Analysis: We Disagree Kenny Holston for The New York TimesTo the Editor:In “Democrats, Let’s Seize This Moment” (Opinion guest essay, Nov. 14), Senator Elizabeth Warren claims, “The so-called experts who called Democrats’ messaging incoherent were just plain wrong — and candidates who ignored their advice won.”I beg to differ. Surveys show that a large majority of Americans favor most Democratic policies — legal access to abortion, a fair and progressive tax structure, strong environmental regulations and worker protection, a reasonable minimum wage, not cutting Social Security or Medicare, and the Affordable Care Act. Yet many Democratic candidates barely squeaked by, and the Democrats lost control of the House of Representatives.It’s easy to know what Republicans stand for — even if it’s based on lies. It’s all over the media. I’m not sure that most Americans can say what Democrats stand for, although a large minority of Americans seem to think that we steal elections, and want to curtail the police, open the borders and hand out large sums of money to people who refuse to work. Why? Because the Republican message (often lies) is getting through.Democratic politicians may have great ideas, but they’re terrible at communicating them. Otherwise they’d have a much bigger majority in government.Shaun BreidbartPelham, N.Y.To the Editor:Democrats squeaking by in the midterms is not an overwhelming endorsement of President Biden’s spending and other policies. In many cases it’s voting for the least worst candidate.Has Elizabeth Warren not seen the polls about dissatisfaction with both former President Donald Trump and President Biden? If “none of the above” were a choice, it would likely have won on many ballots.As a centrist, I want elected officials to stop talking and writing about how great they are and how bad their opposition is. Rather, focus on what you will accomplish, bipartisan cooperation and problem solving.Many of my moderate Democratic friends would vote for Liz Cheney if she were a presidential candidate. Sure, she is more conservative, but she has demonstrated integrity, bipartisanship and intelligence. That would be a refreshing change.Gail MacLeodLexington, Va.Eric Adams and the MidtermsMayor Eric Adams views the Democrats’ poor performance in New York as validation of his messaging about crime and his brand of moderate politics.Sarah Blesener for The New York TimesTo the Editor:Re “Democrats See Adams at Root of State Losses” (front page, Nov. 18):Mayor Eric Adams did not lose four New York congressional seats. Asserting that he is to blame says, in essence, that the majority of voters who elected Republicans in swing districts chose poorly and that if voters had not been told crime was a problem, the Democratic candidates in those districts would have won.Mr. Adams has identified crime as a priority for his administration. By virtue of winning election, he is entitled to set his agenda. Whether the current increase in crime is a surge or a blip can be debated, certainly, but the idea that he should soft-pedal concerns about public safety to help other Democratic candidates is inappropriate.On the other hand, the fact that Republicans exploited perceptions about crime for electoral gain may be deplorable, but it is well within the rules of the game.The Democrats’ loss of New York congressional seats resulted from hubris around redistricting and willful ignorance about public perception of issues like bail reform. Eric Adams had nothing to do with either.Rob AbbotCroton-on-Hudson, N.Y.Sue Republican LiarsTo the Editor:Re “Misinformation on Pelosi Attack Spread by G.O.P.” (front page, Nov. 6):The notion seems firmly rooted among Democratic political leaders that since politics is rough and tumble, they should rise above it when the G.O.P.’s fabrication machine spews ominous conspiracy theories and baseless slurs to obscure reality.But since Republican politicians aren’t restrained by shame, common decency or respect for the truth, tolerating their falsehoods only encourages the right wing to wallow in fact-free filth. Instead, the victims of right-wing slanders owe it to themselves — and to us — to seek money damages for defamation from reckless Republican liars.First Amendment law protects scorching invective. But there’s a limit. Under the constitutional principles that govern defamation law, a political speaker is not free to knowingly utter falsehoods or to speak with reckless indifference to truth or falsity.That principle plainly applies to unfounded Republican claims about Paul Pelosi. It likewise applies to Newt Gingrich’s assertion that John Fetterman has “ties to the crips gang,” and to Donald Trump’s lies about a voting machine maker.Multimillion-dollar damage awards might deter Republicans from fouling the political landscape with lies designed to conceal their lack of answers to America’s problems.Mitchell ZimmermanPalo Alto, Calif.The writer is an attorney.A Matter of Space Hiroko Masuike/The New York TimesTo the Editor:Re “Dimming Hope Office Buildings Will Ever Refill” (front page, Nov. 18):Not enough housing? Too much office space? Go figure.Deborah BayerRichmond, Calif. More