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New study suggests weight loss drugs like Ozempic could help with knee pain. Here’s why there may be a link

<p><em><a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/christina-abdel-shaheed-425241">Christina Abdel Shaheed</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>The drug semaglutide, commonly known by the brand names Ozempic or Wegovy, was <a href="https://theconversation.com/the-rise-of-ozempic-how-surprise-discoveries-and-lizard-venom-led-to-a-new-class-of-weight-loss-drugs-219721">originally developed</a> to help people with type 2 diabetes manage their blood sugar levels.</p> <p>However, researchers have discovered it may help with other health issues, too. Clinical trials show semaglutide can be effective for <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2032183">weight loss</a>, and hundreds of thousands of people around the world are using it <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">for this purpose</a>.</p> <p>Evidence has also shown the drug can help manage <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2306963">heart failure</a> and <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403347">chronic kidney disease</a> in people with obesity and type 2 diabetes.</p> <p>Now, a study published in the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403664">New England Journal of Medicine</a> has suggested semaglutide can improve knee pain in people with obesity and osteoarthritis. So what did this study find, and how could semaglutide and osteoarthritis pain be linked?</p> <h2>Osteoarthritis and obesity</h2> <p>Osteoarthritis is a common joint disease, affecting <a href="https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/osteoarthritis">2.1 million Australians</a>. Most people with osteoarthritis <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">have pain</a> and find it difficult to perform common daily activities such as walking. The knee is <a href="https://pubmed.ncbi.nlm.nih.gov/37675071/">the joint most commonly affected</a> by osteoarthritis.</p> <p>Being overweight or obese is a <a href="https://pubmed.ncbi.nlm.nih.gov/25447976/">major risk factor</a> for osteoarthritis in the knee. The link between the two conditions <a href="https://pubmed.ncbi.nlm.nih.gov/26821091/">is complex</a>. It involves a combination of increased load on the knee, <a href="https://www.nature.com/articles/s41413-023-00301-9">metabolic factors</a> such as high cholesterol and high blood sugar, and inflammation.</p> <p>For example, elevated blood sugar levels increase the production of inflammatory molecules in the body, which can damage the cartilage in the knee, and lead to the <a href="https://pubmed.ncbi.nlm.nih.gov/30712918/">development of osteoarthritis</a>.</p> <p>Weight loss is strongly recommended to reduce the pain of knee osteoarthritis in people who are overweight or obese. <a href="https://pubmed.ncbi.nlm.nih.gov/31908149/">International</a> and <a href="https://www.safetyandquality.gov.au/sites/default/files/2024-08/osteoarthritis-knee-clinical-care-standard-2024.pdf">Australian guidelines</a> suggest losing as little as 5% of body weight can help.</p> <p>But losing weight with just diet and exercise can be difficult for many people. <a href="https://pubmed.ncbi.nlm.nih.gov/26180980/">One study</a> from the United Kingdom found the annual probability of people with obesity losing 5% or more of their body weight was less than one in ten.</p> <p>Semaglutide has recently entered the market as a potential alternative route to weight loss. It comes from a class of drugs known as GLP-1 receptor agonists and works by increasing a person’s sense of fullness.</p> <h2>Semaglutide for osteoarthritis?</h2> <p>The rationale for the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2403664">recent study</a> was that while we know weight loss alleviates symptoms of knee osteoarthritis, the effect of GLP-1 receptor agonists was yet to be explored. So the researchers set out to understand what effect semaglutide might have on knee osteoarthritis pain, alongside body weight.</p> <p>They randomly allocated 407 people with obesity and moderate osteoarthritis into one of two groups. One group received semaglutide once a week, while the other group received a placebo. Both groups were treated for 68 weeks and received counselling on diet and physical activity. At the end of the treatment phase, researchers measured changes in knee pain, function, and body weight.</p> <p>As expected, those taking semaglutide lost more weight than those in the placebo group. People on semaglutide lost around 13% of their body weight on average, while those taking the placebo lost around 3% on average. More than 70% of people in the semaglutide group lost at least 10% of their body weight compared to just over 9% of people in the placebo group.</p> <p>The study found semaglutide reduced knee pain significantly more than the placebo. Participants who took semaglutide reported an additional 14-point reduction in pain on a 0–100 scale compared to the placebo group.</p> <p>This is much greater than the pain reduction in another <a href="https://pubmed.ncbi.nlm.nih.gov/36511925/">recent study</a> among people with obesity and knee osteoarthritis. This study investigated the effects of a diet and exercise program compared to an attention control (where participants are provided with information about nutrition and physical activity). The results here saw only a 3-point difference between the intervention group and the control group on the same scale.</p> <p>The amount of pain relief reported in the semaglutide trial is also larger than that reported with commonly used pain medicines such as <a href="https://pubmed.ncbi.nlm.nih.gov/35442752/">anti-inflammatories</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/35137418/">opioids</a> and <a href="https://www.bmj.com/content/372/bmj.m4825">antidepressants</a>.</p> <p>Semaglutide also improved knee function compared to the placebo. For example, people who took semaglutide could walk about 42 meters further than those on the placebo in a six-minute walking test.</p> <h2>How could semaglutide reduce knee pain?</h2> <p>It’s not fully clear how semaglutide helps with knee pain from osteoarthritis. One explanation may be that when a person loses weight, there’s less stress on the joints, which reduces pain.</p> <p>But recent studies have also suggested semaglutide and other GLP-1 receptor agonists might have <a href="https://www.sciencedirect.com/science/article/pii/S1043661822002651">anti-inflammatory</a> properties, and could even protect against <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6731440/">cartilage wear and tear</a>.</p> <p>While the results of this new study are promising, it’s too soon to regard semaglutide as a “miracle drug” for knee osteoarthritis. And as this study was funded by the drug company that makes semaglutide, it will be important to have independent studies in the future, to confirm the findings, or not.</p> <p>The study also had strict criteria, excluding some groups, such as those taking opioids for knee pain. One in seven Australians seeing a GP for their knee osteoarthritis <a href="https://pubmed.ncbi.nlm.nih.gov/34527976/">are prescribed opioids</a>. Most participants in the trial were white (61%) and women (82%). This means the study may not fully represent the average person with knee osteoarthritis and obesity.</p> <p>It’s also important to consider semaglutide can have a range of <a href="https://theconversation.com/considering-taking-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">side effects</a>, including gastrointestinal symptoms and fatigue.</p> <p>There are some concerns that semaglutide could reduce <a href="https://www.sciencealert.com/experts-are-concerned-drugs-like-ozempic-may-cause-muscle-loss">muscle mass</a> and <a href="https://www.healthline.com/health-news/ozempic-muscle-mass-loss">bone density</a>, though we’re still learning more about this.</p> <p>Further, it can be difficult to access.</p> <h2>I have knee osteoarthritis, what should I do?</h2> <p>Osteoarthritis is a disease caused by multiple factors, and it’s important to take <a href="https://www.safetyandquality.gov.au/standards/clinical-care-standards/osteoarthritis-knee-clinical-care-standard/information-consumers-osteoarthritis-knee-clinical-care-standard">a multifaceted approach</a> to managing it. Weight loss is an important component for those who are overweight or obese, but so are other aspects of <a href="https://theconversation.com/do-you-have-knee-pain-from-osteoarthritis-you-might-not-need-surgery-heres-what-to-try-instead-236779">self-management</a>. This might include physical activity, pacing strategies, and other positive lifestyle changes such as improving sleep, healthy eating, and so on.<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/243159/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/giovanni-e-ferreira-1030477">Giovanni E. Ferreira</a>, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/christina-abdel-shaheed-425241">Christina Abdel Shaheed</a>, Associate Professor, School of Public Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Shutterstocl</em></p> <p><em>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/new-study-suggests-weight-loss-drugs-like-ozempic-could-help-with-knee-pain-heres-why-there-may-be-a-link-243159">original article</a>.</em></p>

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Freddy Krueger at 40 – the ultimate horror movie monster (and Halloween costume)

<div class="theconversation-article-body"><em><a href="https://theconversation.com/profiles/adam-daniel-301018">Adam Daniel</a>, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a></em></p> <p>Movie monsters have captivated audiences since the days of early cinema. They evoke fascination and terror, allowing audiences to confront their fears from the safety of the movie theatre or living room.</p> <p>Arguably one of the most enduring and captivating of these monsters is Freddy Krueger, the villain of the <a href="https://www.imdb.com/title/tt0087800/">A Nightmare on Elm Street</a> series who celebrates his 40th screen birthday this November.</p> <p>Memorably played by Robert Englund, Freddy quickly became a cultural icon of the 1980s and 1990s. Beyond his burned face and iconic bladed glove, Freddy’s dark humour and acidic personality set him apart from other silent, faceless killers of the era, such as Michael Myers in <a href="https://www.imdb.com/title/tt0077651/?ref_=nv_sr_srsg_2_tt_6_nm_0_in_0_q_halloween">Halloween</a> or Jason Vorhees in <a href="https://www.imdb.com/title/tt0080761/?ref_=fn_al_tt_1">Friday the 13th</a>.</p> <p>Written and directed by horror maven <a href="https://theconversation.com/wes-craven-the-scream-of-our-times-46915">Wes Craven</a>, 1984’s A Nightmare on Elm Street garnered positive reviews for its innovative concept: Freddy stalked and attacked his victims in their dreams, making him inescapable and allowing him to tap into their deepest fears. The series (seven films plus a 2010 remake and <a href="https://www.imdb.com/title/tt0329101/?ref_=fn_al_tt_1">Freddy vs. Jason</a> spin offs) blended supernatural horror and surrealism with a dark and twisted sense of humour.</p> <h2>Scary … but funny</h2> <p>Humour was key to Freddy’s “popularity”. Both sinister and strangely charismatic, Freddy’s psychological torture of his adolescent victims often oscillated between terrifying and amusing.</p> <p>A famous kill scene from 1987’s <a href="https://www.imdb.com/title/tt0093629/?ref_=fn_al_tt_1">A Nightmare on Elm Street 3: Dream Warriors</a> demonstrates this paradox.</p> <p>Aspiring actress Jennifer drifts off to sleep while watching a talk show on TV. In her dream, the host of the talk show suddenly transforms into Freddy, who attacks his guest before the TV blinks out. When Jennifer timidly approaches the TV set, Freddy’s head and clawed hands emerge from the device, snatching her while delivering an iconic one-liner: “This is it, Jennifer – your big break in TV!”</p> <p>Freddy turns his victims’ fears or aspirations – their dreams – against them.</p> <figure><iframe src="https://www.youtube.com/embed/dCVh4lBfW-c?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">‘Whatever you do, don’t fall asleep.’</span></figcaption></figure> <h2>Creating a monster</h2> <p>Craven has shared how the character of Krueger came to life in <a href="https://www.imdb.com/title/tt1510985/?ref_=fn_al_tt_1">Never Sleep Again: The Elm Street Legacy</a>, an oral history of the series.</p> <p>He described a childhood experience of seeing a strange mumbling man walking past his childhood home. The man stopped, he said, and looked directly at him “with a sick sense of malice”. This deeply unsettling experience helped shape Freddy’s menacing presence.</p> <p>The character’s creation also emerged from the filmmaker’s interest in <a href="https://www.iflscience.com/nightmare-on-elm-street-was-inspired-by-a-real-life-medical-mystery-60527">numerous reports of Southeast Asian refugees dying in their sleep</a> after experiencing vivid nightmares.</p> <p>In the film, Krueger’s origin story reveals him as a child murderer who was apprehended but released due to a technicality in his arrest. Seeking justice, the parents of his victims take matters into their own hands, and form a vigilante mob. They corner him in his boiler room and burn him alive. But Freddy’s spirit survives to haunt and kill the children of his executioners.</p> <h2>Cultural repression, expressed on film</h2> <p>Film critic and essayist <a href="https://www.cineaste.com/summer2019/robin-wood-on-horror-film-collected-essays-and-reviews#:%7E:text=Freudian%20theory%2C%20a%20crucial%20theoretical,the%20horror%20film%20perpetually%20enacts.">Robin Wood argued</a> horror films often bring to the surface elements society has repressed. These fears, desires, or cultural taboos are not openly acknowledged.</p> <p>But movie monsters act as manifestations of what society suppresses, such as sexuality, violence or deviant behaviour. American academic <a href="https://www.tandfonline.com/doi/abs/10.1080/01956051.1995.9943696">Gary Heba</a> argues Freddy is:</p> <blockquote> <p>an example of America’s political unconscious violently unleashed upon itself, manifesting everything that is unspeakable and repressed in the master narrative (perversion, child abuse and murder, vigilantism, the breakdown of rationality, order, and the family, among others), but still always present in the collective unconscious of the dominant culture.</p> </blockquote> <figure><iframe src="https://www.youtube.com/embed/UBrl4H0Uzng?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">Actor Robert Englund calls Freddy Krueger ‘the gift that keeps on giving’.</span></figcaption></figure> <h2>The monster decades</h2> <p>The 1970s and 1980s marked a golden era for the creation of horror film nasties like Krueger, Myers, <a href="https://www.imdb.com/title/tt0072271/?ref_=fn_al_tt_3">The Texas Chainsaw Massacre</a>’s Leatherface and <a href="https://www.imdb.com/title/tt0094862/?ref_=fn_al_tt_19">killer doll Chucky</a>.</p> <p>Since then, the landscape of horror has shifted, with fewer singular monsters emerging. The diversification of horror sub-genres (zombie virus horror, anyone?), the rise of psychological horror (<a href="https://www.imdb.com/title/tt7784604/?ref_=nv_sr_srsg_2_tt_4_nm_2_in_0_q_heredi">Hereditary</a>), and an emphasis on human-driven terror (<a href="https://www.imdb.com/title/tt0416315/?ref_=nv_sr_srsg_1_tt_7_nm_0_in_0_q_wolf%2520creek">Wolf Creek</a>) or supernatural forces all contribute to this shift.</p> <p>While modern horror continues to thrive, few characters have achieved the same iconic status as Freddy – although some would argue Art the Clown from the recent <a href="https://www.imdb.com/title/tt4281724/">Terrifier</a> franchise and the reinvigorated Pennywise from <a href="https://www.imdb.com/title/tt1396484/?ref_=nv_sr_srsg_1_tt_6_nm_1_in_0_q_it">IT</a> could join this exclusive group.</p> <figure><iframe src="https://www.youtube.com/embed/ZuYoEtEI_go?wmode=transparent&amp;start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption><span class="caption">‘Five, six, grab your crucifix.’ A 2010 Nightmare on Elm St reboot failed to fire.</span></figcaption></figure> <h2>Happy Halloween!</h2> <p>Despite a <a href="https://www.imdb.com/title/tt1179056/">failed reboot in 2010</a>, the legacy of A Nightmare on Elm Street is strong, having influenced numerous filmmakers with its skilful mix of surrealism and slasher horror.</p> <p>However, it’s the orchestrator of the titular nightmares whose legacy is perhaps the strongest.</p> <p>With each Halloween, new fans choose Freddy for their costume. All it takes is a tattered striped sweater, a brown fedora hat, and a glove with sharp, finger-lengthening blades. Don’t forget makeup to re-create Krueger’s grisly facial burns. Sweet dreams!<!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/240905/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/adam-daniel-301018"><em>Adam Daniel</em></a><em>, Associate Lecturer in Communications, <a href="https://theconversation.com/institutions/western-sydney-university-1092">Western Sydney University</a></em></p> <p><em>Image credits: New Line Cinema - IMDB</em></p> <p><em>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/freddy-krueger-at-40-the-ultimate-horror-movie-monster-and-halloween-costume-240905">original article</a>.</em></p> </div>

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‘Dark tourism’ is attracting visitors to war zones and sites of atrocities in Israel and Ukraine. Why?

<p><em><a href="https://theconversation.com/profiles/juliet-rogers-333488">Juliet Rogers</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p>There is a disturbing trend of people travelling to the sadder places of the world: sites of military attacks, war zones and disasters. Dark tourism is now a phenomenon, with <a href="https://dark-tourism.com/">its own website</a> and dedicated tour guides. People visit these places to mourn, or to remember and honour the dead. But sometimes they just want to look, and sometimes they want to delight in the pain of others.</p> <p>Of course, people have long visited places like the <a href="https://www.auschwitz.org/en/visiting/guided-tours-for-individual-visitors/">Auschwitz-Birkenau</a> Memorial, <a href="https://www.911memorial.org/911-faqs">the site of the Twin Towers</a> destroyed in the 9/11 attacks, <a href="https://www.robben-island.org.za/tour-types/">Robben Island Prison</a>, where Nelson Mandela and others spent many years, and more recently, <a href="https://chernobyl-tour.com/english/">the Chernobyl nuclear power plant</a>. But there are more recent destinations, connected to active wars and aggression.</p> <p>Since the <a href="https://www.newsweek.com/2024/10/11/one-year-hamas-oct-attack-israel-northern-border-1961816.html">Hamas military attacks</a> of October 7 2023, in which around 1,200 people were killed and more than 250 taken hostage, celebrities and tourists have visited the related sites of the Nova music festival and the Nir Oz Kibbutz in Palestine/Israel.</p> <p>The kibbutz tours, guided by former residents, allow people to view and be guided through houses of the dead, to be shown photographs and bullet holes. Sderot, the biggest city targeted by Hamas, is offering <a href="https://apnews.com/article/israel-gaza-hamas-oct-7-tourism-sderot-8b21f590c37fa6780bf9190d6bfb62b7">what it describes as “resilience tours”</a>, connecting tourists with October 7 survivors.</p> <p>Similar places are visited <a href="https://wartours.in.ua/2023/02/25/dark-tourism-in-ukraine/">in Ukraine</a>. The “popular” Donbas war tour, for instance, takes visitors to the front lines of the conflict and offers “a firsthand look at the impact of the war on the local population”, introducing them to displaced locals, soldiers and volunteer fighters. There’s also <a href="https://wartours.in.ua/en/">a Kyiv tour</a>, which takes in destroyed military equipment and what remains of missile strikes.</p> <h2>Solidarity tours</h2> <p>These tours have various names, but <a href="https://touringisrael.com/tour/october-7-solidarity-tour/">one Israeli company</a> calls them “solidarity tours”. The idea of solidarity lessens the presumption of voyeurism, or the accusation of ghoulish enjoyment of pain or suffering. It suggests an affinity with those who have died or those who have lost loved ones.</p> <p>But solidarity is a political affiliation too. These tours are not only therapeutic. They are not only about “bearing witness”, as many guides and visitors attest. They are also about solidarity with the struggle.</p> <p>What is this struggle? Genocide scholar Dirk Moses <a href="https://www.bostonreview.net/articles/more-than-genocide/">has written thoughtfully</a> on this after October 7. Colonial states seek not just security, but “permanent security”. This makes them hyper-defensive of their borders. Israel was created as a nation <a href="https://www.pbs.org/wgbh/americanexperience/features/truman-israel/">by the newly formed United Nations</a> in 1947, two years after the end of World War II and in the shadow of the Holocaust: it was an inevitable product of the <a href="https://theconversation.com/a-century-on-the-balfour-declaration-still-shapes-palestinians-everyday-lives-86662">Balfour Declaration</a> (1917) that carved up the Middle East.</p> <p>The creation of the Israeli state turned relationships between Palestinians and Jewish people into borders to navigate and police, producing a line of security to defend.</p> <p>These borders have long been sites of humiliation and denigration toward Palestinians, whose homelands have been now occupied for many generations. Israeli Defense Force soldiers themselves <a href="https://www.breakingthesilence.org.il/testimonies/videos/29690">have spoken passionately</a> about the brutal and arbitrary violence that occurs there, <a href="https://link.springer.com/article/10.1007/s10978-016-9195-y">including “creative punishments”</a>. These were the borders that protected the sites targeted by Hamas. The Nova music festival was five kilometres from one of these borders.</p> <p>For many Israelis, any breach of those borders, any sense of loss of control, courts the terrors of the past. It raises the spectre of the Holocaust: the destruction of European Jewry, the loss of sovereignty over family, home, and over life, the loss of millions of lives, again. For Israel, as for any colonial state, security is a permanent aspiration, in Moses’s terms. The stakes are high.</p> <p>Dark tourism, seen in this light, is not only solidarity with those who have lost loved ones on October 7. It is solidarity with the border, with those who have lost that security. And that loss is profound, traumatic and, at least psychologically, can provoke violent reactions in an effort to have the borders – geographical and psychological – reasserted.</p> <h2>‘I stand with you’</h2> <p>Transitional justice mechanisms such as the truth commissions in <a href="https://www.justice.gov.za/trc/">South Africa</a>, <a href="https://www.usip.org/publications/2002/02/truth-commission-timor-leste-east-timor">Timor Leste</a> and <a href="https://www.usip.org/publications/1983/12/truth-commission-argentina">Argentina</a> apply legal frameworks to heal nations from the trauma of crimes against humanity. These mechanisms are one choice after experiences of mass violence. Ironically, their catchphrase is <em>Nunca Mas</em> (never again), which was the title of the 1984 report by Argentina’s <a href="https://www.usip.org/publications/1983/12/truth-commission-argentina">National Commission on the Dissappeared</a>.</p> <p>Permanent security of the kind Israel is seeking is another choice – and its catchphrase might well be the same. Never again will Israel’s borders be breached, never again will Jewish life be subjected to mass destruction with impunity.</p> <p>This is what solidarity can mean: not only grieving alongside those who have suffered, but attachment to an identity and borders, which are reinforced through participation. “I stand with you” is perhaps what the visits are for. I stand with you on this land, at this time, and perhaps for all time.</p> <p>But stand beside you in what now? In grief, yes. But also in rage, in pain, in vengeance and, for some, in making Israel great again.</p> <p>The hashtag #standwithus accompanies some calls for visits to the October 7 sites, for this form of tourism. It means stand with us at Israel’s border. From there, you can hear the sound of bombs falling: <a href="https://inews.co.uk/news/world/israel-7-october-massacre-sites-dark-draw-tourists-3101715">in Gaza</a>, a place where no solidarity tour will go. Yet.</p> <h2>Memorials, grief and understanding</h2> <p>Dark tourism is not always for those associated with the events. Some people visit sites of disaster and loss because they want to understand the greater sadnesses of the world and its formidable brutalities. Some want to show their respect to others. It’s not dissimilar to visiting memorials.</p> <p>Memorials collate the disparate parts of grief and reflect it as public memory. They offer fragments of historical pain that can be borne in more than one mind, to create a shared reality.</p> <p>In Pretoria, South Africa, a memorial called <a href="https://www.freedompark.co.za/">Freedom Park</a> depicts the names of every person who died in every war fought in South Africa, as well as those South Africans who died in the world wars. The names are written on a wall that circles the park. It is impossibly long and circular, and you cannot measure it with your own stride. It is disorientating and interminable, like grief.</p> <p>In this memorial-metaphor, you are unable to comprehend – and at the same time are awash with – a history of loss, represented by the names. The walls contain you, and then they cannot. Grief and even solidarity is not always about comprehension or containment. Sometimes it is about proximity. Sometimes, it is about sitting with not knowing. Sometimes, it is about solidarity with something that cannot be made sense of.</p> <p>Trauma, psychoanalysis tells us, is an experience of what we cannot assimilate. If you sit in proximity to people and places where traumatic events have happened, you can learn something. If you see the bullet holes at a site of loss, you can comprehend something. But not everything. Bullet holes in a wall are the very definition of a partial story.</p> <p>People visit memorials and sites of loss to learn and to unlearn. Dark tourism has this quality.</p> <h2>Obscenity of understanding</h2> <p>In my field, criminology and trauma studies, we try to understand why people do the violent things they do. Holocaust filmmaker and commentator <a href="https://www.jstor.org/stable/26303924">Claude Lanzmann has said</a> we must not indulge in what he calls the “obscenity of the project of understanding” in relation to Nazi perpetrators of the Holocaust.</p> <p>He regards curiosity about the minds of perpetrators and the rationale for violence as a violence in itself. Of the Holocaust, he says you cannot ask “Why were the Jews killed?”. It is the result that matters. But it is also the reaction that matters. The state of Israel itself – permanent security and its attendant horrors – is part of that reaction.</p> <p>But understanding can influence the reaction to violence, and contribute something to the promise of Never Again. Understanding allows us to hold more than one story in mind. It allows us to do more than <a href="https://www.ochaopt.org/">count the more than 1,200 killed</a> in Israel, or the 41,689 (plus) Palestinians killed in Gaza. Bodies are always more than numbers. But explanation is one thing, justification another. Justification is best left to the courts, international or otherwise, after the violence has ceased.</p> <p>It is hard to hear about dark tourism in Israel/Palestine and in Ukraine and try to understand it. It is hard not to condemn the tourists. But we are quick to condemn at this time – and even quicker to demand others do the same. Perhaps we should not be so righteous, and we should resist the urge to easily condemn, from our homes in what <a href="https://www.mup.com.au/books/after-mabo-paperback-softback">Tim Rowse has called</a> the “ongoing colonial encounter sometimes called ‘Australia’”.</p> <p>Indigenous people here speak of the lack of memorials on this land. But every bordered property is a site for dark tourism in Australia. Dark tourism is the effort to seek out destinations of violence and devastation, but it is not hard to see genocide from our front door in this country.<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/240119/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/juliet-rogers-333488"><em>Juliet Rogers</em></a><em>, Associate Professor Criminology, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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/dark-tourism-is-attracting-visitors-to-war-zones-and-sites-of-atrocities-in-israel-and-ukraine-why-240119">original article</a>.</em></p>

Travel Trouble

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New study finds epilepsy drug could reduce sleep apnoea symptoms

<p>New research has found that a drug used for epilepsy could be used to reduce the symptoms of sleep apnoea. </p> <p>Obstructive sleep apnoea, which affects about one in 20 people, according to the National Institute for Health and Care Excellence in England, includes symptoms like snoring and it causes a person's breathing to start and stop during the night, with many requiring an aid to help keep their airways open. </p> <p>An international study has identified that taking sulthiame, a drug sold under the brand name Ospolot in Europe, may help prevent patients' breathing from temporarily stopping. </p> <p>This provides an additional option for those unable to use mechanical breathing aids like the Cpap machines. </p> <p>“The standard treatment for obstructive sleep apnoea is sleeping with a machine that blows air through a face mask to keep the airways open. Unfortunately, many people find these machines hard to use over the long term, so there is a need to find alternative treatments,” Prof Jan Hedner from Sahlgrenska university hospital and the University of Gothenburg in Sweden said. </p> <p>Researchers conducted a randomised controlled trial of almost 300 obstructive sleep apnoea patients across Europe, who did not use Cpap machines. </p> <p>They were divided into four groups and given either a placebo or different strengths of sulthiame. </p> <p>The study measured patients’ breathing, oxygen levels, heart rhythm, eye movements, as well as brain and muscle activity while asleep. </p> <p>It found after 12 weeks, those taking sulthiame had up to 50% fewer occasions where their breathing stopped, and higher levels of oxygen in their blood. However, a bigger study needs to be done to confirm the beneficial effects on a larger group. </p> <p>The findings, were presented at the European Respiratory Society Congress in Vienna, Austria. </p> <p>Erika Radford, the head of health advice at Asthma + Lung UK said the findings were a positive step forward in moving away from having to rely on mechanical breathing equipment.</p> <p>“This potential alternative to the current main treatment would make it easier for people to manage their condition,” she said. </p> <p><em>Image: Shutterstock</em></p> <p> </p>

Body

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Common drug shows potential in reversing ageing

<p>A common medication has been found to have anti-ageing qualities, with scientists finding that the drug can de-age monkeys. </p> <p>Metformin, a cheap and common diabetes drug that has been used since the 1950s, could be an anti-ageing elixir, with scientists from the Chinese Academy of Sciences and Beijing Institute of Genomics using the pill to "markedly" slow down ageing in the animals.</p> <p>According to the experts, the medication reduced deterioration of the brain and boosted cognitive abilities in the primates while also slowing down bone loss and aiding in the "rejuvenation" of several tissues and organs. </p> <p>The most significant improvements were seen in the liver and frontal lobe, the part of the brain responsible for language, reasoning, problem solving, memory, movement and personality. </p> <p>Researchers said all of the findings led to the conclusion that "metformin can reduce biological age indicators" up to six years, with the medication paving the way for ageing reversal in humans.</p> <p>The drug was previously tested on mice, but since testing the medication on Cynomolgus monkeys - that are both physiologically and functionally similar to humans - the tests have shown more promise for potential human trials. </p> <p>The researchers said of the 40-month study, "Our research pioneers the systemic reduction of multi-dimensional biological age in primates through metformin, paving the way for advancing pharmaceutical strategies against human ageing."</p> <p>The scientists added, "[The study] represents an important advance in the quest to delay human ageing, with geriatric medicine research gradually shifting its focus from treating individual chronic diseases to systemic intervention against ageing."</p> <p><em>Image credits: Shutterstock </em></p>

Body

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Five people arrested over Matthew Perry's death

<p>Five people have been arrested in connection with the death of <em>Friends</em> actor Matthew Perry, who died of a drug overdose in October 2023. </p> <p>Matthew Perry’s assistant Kenneth Iwamasa, two doctors, and two alleged drug dealers, including Jasveen Sangha, the so-called “Ketamine Queen of Los Angeles”, have been arrested over the star's death.</p> <p>All five suspectes are facing charges including “conspiracy to distribute ketamine” over allegations they supplied the 54-year-old with the illegal drugs in the final weeks of his life.</p> <p>In the last four days of his life, Mr Perry paid $100,000 AUD for 70 vials of ketamine.</p> <p>Three of the five people charged have pleaded guilty to several drug-related offences, while a licensed doctor and an alleged drug dealer arrested in California on Thursday are the lead defendants in a “broad, underground criminal network” to distribute ketamine to Mr Perry and others.</p> <p>“These defendants took advantage of Mr Perry’s addiction issues to enrich themselves. They knew what they were doing was wrong. They knew what they were doing was risking great danger to Mr Perry, but they did it anyway,” said US Attorney Martin Estrada.</p> <p>Following the arrests, Matthew Perry's stepfather has shared a message of gratitude to law enforcement and hoped justice would be served. </p> <p>Keith Morrison, a Canadian journalist, and other loved ones of the <em>Friends</em> star in a statement issued to NBC News say they are finding some solace in the legal system nine months on from his death.</p> <p>"We were and still are heartbroken by Matthew's death, but it has helped to know law enforcement has taken his case very seriously," they said. "We look forward to justice taking its course."</p> <p><em>Image credits: Matt Baron/BEI/Shutterstock Editorial </em></p>

Legal

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Woman “bullied” on plane over budget seating trick

<p dir="ltr">A young woman has recalled a flight from hell when she was “bullied” by a couple who were trying to utilise a seating hack that went viral on TikTok. </p> <p dir="ltr">The solo traveller took to Reddit to recount the story and ask social media users if she was in the wrong for her action. </p> <p dir="ltr">The woman began by saying she usually pays more to select her plane seat ahead of time, but a medical emergency on another plane had her waiting on standby and left with no option other than to sit in a middle seat.</p> <p dir="ltr">When she was finally able to board, she was greeted by a couple who had purchased both the window and aisle seats in a bid to have more space, utilising a travel “trick” that has been popular on TikTok.</p> <p dir="ltr">The method, which has been dubbed the 'poor man's business class', usually leaves travellers with an empty middle seat and more space, and few travellers opt to pick a middle seat. </p> <p dir="ltr">“When I got to my row the man and woman were chatting and sharing a snack... it was obvious they were together. I mentioned to the man that I'm in the middle, and he got up to let me in,” the unsuspecting traveller wrote on Reddit.  </p> <p dir="ltr">“I asked them if they would prefer to sit together, I said I was totally okay with that. The woman reacted rudely to this and said ‘you're not supposed to be sitting here anyway’.”</p> <p dir="ltr">After noticing how the plane was full, she offered to show the pair her new ticket with the correct seat number on it.</p> <p dir="ltr">“She flicked her hand at my ticket and made a disgusted sound. I offered again if they wanted to sit together to which she didn't reply, her partner said it's okay and... made some small talk,” she continued. </p> <p dir="ltr">The man’s girlfriend then interrupted their conversation to ask,”'Did you use one of those third party websites to book your flight? It's so frustrating when people cheap out to inconvenience others.”</p> <p dir="ltr">The American woman explained that she had booked her flight directly and she had been placed on standby like everyone else and didn't choose the middle seat - she was assigned it.</p> <p dir="ltr">She then tried to keep the peace by refusing to engage with the furious woman.  </p> <p dir="ltr">“I was so done with her attitude, I put my headphones on and attempted to do my own thing,” she explained.</p> <p dir="ltr">But the “entitled” girlfriend wasn't letting it go, as the woman explained, “This woman kept reaching over me and tapping her partner and trying to talk to him in a way that was super intrusive.”</p> <p dir="ltr">“I could tell even her partner was trying to engage her less so that she would hopefully stop, but she didn't.”</p> <p dir="ltr">“I think they tried to pull that tactic where they don't sit together on purpose...hoping no one will sit between them. But on full flights it doesn't work. And even so - it's not the other person's fault.”</p> <p dir="ltr">The traveller's post was met with hundreds of comments slamming the girlfriend’s behaviour, as one person wrote, “It's like a toddler having a tantrum.”</p> <p dir="ltr">“She was disappointed and a total a**hole. Gross entitled people,” another added. </p> <p dir="ltr">Another person applauded the traveller’s level-headed behaviour, writing, “Wow! You are my hero for keeping it classy - I’m afraid I would not have been as kind as you.”</p> <p dir="ltr"><em>Image credits: Shutterstock </em></p>

Travel Trouble

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Boomers vs millennials? Free yourself from the phoney generation wars

<p><em><a href="https://theconversation.com/profiles/bobby-duffy-98570">Bobby Duffy</a>, <a href="https://theconversation.com/institutions/kings-college-london-1196">King's College London</a></em></p> <p>Generational thinking is a big idea that’s been horribly corrupted and devalued by endless myths and stereotypes. These clichés have fuelled fake battles between “snowflake” millennials and “selfish” baby boomers, with younger generations facing a “war on woke” and older generations accused of “stealing” the future from the young.</p> <p>As I argue in my book, <a href="https://atlantic-books.co.uk/book/generations/">Generations</a>, this is a real shame. A more careful understanding of what’s really different between generations is one of the best tools we have to understand change – and predict the future.</p> <p>Some of the great names in sociology and philosophy saw understanding generational change as central to understanding society overall. <a href="http://dhspriory.org/kenny/PhilTexts/Comte/Philosophy2.pdf">Auguste Comte</a>, for example, identified the generation as a key factor in “the basic speed of human development”.</p> <p>He argued that “we should not hide the fact that our social progress rests essentially upon death; which is to say that the successive steps of humanity necessarily require a continuous renovation … from one generation to the next”. We humans get set in our ways once we’re past our formative years, and we need the constant injection of new participants to keep society moving forward.</p> <p>Understanding whether, and how, generations are different is vital to understanding society. The balance between generations is constantly shifting, as older cohorts die out and are replaced by new entrants. If younger generations truly do have different attitudes or behaviours to older generations, this will reshape society, and we can, to some extent, predict how it will develop if we can identify those differences.</p> <p>But in place of this big thinking, today we get clickbait headlines and bad research on millennials “<a href="https://www.businessinsider.com/millennials-hate-napkins-2016-3?r=US&amp;IR=T">killing the napkin industry</a>” or on how baby boomers have “<a href="https://www.theatlantic.com/ideas/archive/2019/06/boomers-are-blame-aging-america/592336/">ruined everything</a>”. We’ve fallen a long way.</p> <h2>Myth busting</h2> <p>To see the true value of generational thinking, we need to identify and discard the many myths. For example, as I outline in the book, gen Z and millennials are not lazy at work or disloyal to their employers. They’re also no more materialistic than previous generations of young: a focus on being rich is something we tend to grow out of.</p> <p>Old people are not uncaring or unwilling to act on climate change: in fact, they are more likely than young people to boycott products for social purpose reasons.</p> <p>And our current generation of young are not a particularly unusual group of “culture warriors”. Young people are always at the leading edge of change in cultural norms, around race, immigration, sexuality and gender equality. The issues have changed, but the gap between young and old is not greater now than in the past.</p> <p>Meanwhile, there are real, and vitally important, generational differences hidden in this mess. To see them, we need to separate the three effects that explain all change in societies. Some patterns are simple “lifecycle effects”, where attitudes and behaviours are to do with our age, not which generation we are born into. Some are “period effects” – where everyone is affected, such as in a war, economic crisis or a pandemic.</p> <p>And finally, there are “cohort effects”, which is where a new generation is different from others at the same age, and they stay different. It’s impossible to entirely separate these distinct forces, but we can often get some way towards it – and when we do, we can predict the future in a much more meaningful way.</p> <p>There are many real generational differences, in vitally important areas of life. For example, the probability of you owning your own home is hugely affected by when you were born. Millennials are around half as likely to be a homeowner than generations born only a couple of decades earlier.</p> <p>There is also a real cohort effect in experience of mental health disorders, particularly among recent generations of young women. Our relationship with alcohol and likelihood of smoking is also tied to our cohort, with huge generational declines in very regular drinking and smoking. Each of these point to different futures, from increased strain on mental health services to declining alcohol sales.</p> <p>But lifecycle and period effects are vitally important too. For example, there is truth in the idea that we grow more conservative as we age. One analysis suggests that this ageing effect is worth around <a href="https://www.sciencedirect.com/science/article/abs/pii/S0261379413000875">0.35% to the Conservatives each year</a>, which may not sound like a lot, but is very valuable over the course of a political lifetime.</p> <p>And, of course, the pandemic provides a very powerful example of how period effects can dramatically change things for us all.</p> <h2>Reaching beyond the avocado</h2> <p>When there is such richness in the realities, why are there so many myths? It’s partly down to bad marketing and workplace research – that is, people jumping on the generation bandwagon to get media coverage for their products or to sell consultancy to businesses on how to engage young employees.</p> <p>This has become its own mini-industry. In 2015, US companies spent up to US$70 million (£51 million) on this sort of “advice” <a href="https://www.wsj.com/articles/helping-bosses-decode-millennialsfor-20-000-an-hour-1463505666">according to the Wall Street Journal</a>, with some experts making as much as US$20,000 an hour. Over 400 LinkedIn users now describe themselves solely as a “millennial expert” or “millennial consultant”.</p> <p>Campaigners and politicians also play to these imagined differences. Our increasing focus on “<a href="https://www.kcl.ac.uk/policy-institute/assets/culture-wars-in-the-uk.pdf">culture wars</a>” often involves picking out particular incidents in universities, such as the <a href="https://www.bbc.co.uk/news/uk-england-manchester-45717841">banning of clapping</a> at events or the <a href="https://www.bbc.co.uk/news/uk-england-oxfordshire-57409743">removal of a portrait of the Queen</a> to exaggerate how culturally different young people today are.</p> <p>Maybe less obviously, politicians such as former US President Barack Obama repeatedly lionise coming generations as more focused on equality, when the evidence shows they’re often not that different. These assertions are not only wrong, but create false expectations and divides.</p> <p>Some have had enough, calling on the Pew Research Center in the US, which has been a champion of generational groups, to <a href="https://www.washingtonpost.com/opinions/2021/07/07/generation-labels-mean-nothing-retire-them/&amp;data=04%257C01%257C">stop conducting this type of analysis</a>. I think that misses the point: it’s how it’s applied rather than the idea of generations that’s wrong.</p> <p>We should defend the big idea and call out the myths, not abandon the field to the “millennial consultants”.<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/167138/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/bobby-duffy-98570">Bobby Duffy</a>, Professor of Public Policy and Director of the Policy Institute, <a href="https://theconversation.com/institutions/kings-college-london-1196">King's College London</a></em></p> <p><em>Image credits: Shutterstock </em></p> <p><em>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/boomers-vs-millennials-free-yourself-from-the-phoney-generation-wars-167138">original article</a>.</em></p>

Mind

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To tackle gendered violence, we also need to look at drugs, trauma and mental health

<p><em><a href="https://theconversation.com/profiles/siobhan-odean-1356613">Siobhan O'Dean</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/lucinda-grummitt-1531503">Lucinda Grummitt</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/steph-kershaw-1466426">Steph Kershaw</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p>After several highly publicised alleged murders of women in Australia, the Albanese government this week pledged <a href="https://ministers.pmc.gov.au/gallagher/2024/helping-women-leave-violent-partner-payment">more than A$925 million</a> over five years to address men’s violence towards women. This includes up to $5,000 to support those escaping violent relationships.</p> <p>However, to reduce and prevent gender-based and intimate partner violence we also need to address the root causes and contributors. These include alcohol and other drugs, trauma and mental health issues.</p> <h2>Why is this crucial?</h2> <p>The World Health Organization estimates <a href="https://iris.who.int/bitstream/handle/10665/341604/WHO-SRH-21.6-eng.pdf?sequence=1">30% of women</a> globally have experienced intimate partner violence, gender-based violence or both. In Australia, <a href="https://www.abs.gov.au/statistics/people/crime-and-justice/partner-violence/latest-release#key-statistics">27% of women</a> have experienced intimate partner violence by a co-habiting partner; <a href="https://pubmed.ncbi.nlm.nih.gov/37004184/">almost 40%</a> of Australian children are exposed to domestic violence.</p> <p>By gender-based violence we mean violence or intentionally harmful behaviour directed at someone due to their gender. But intimate partner violence specifically refers to violence and abuse occurring between current (or former) romantic partners. Domestic violence can extend beyond intimate partners, to include other family members.</p> <p>These statistics highlight the urgent need to address not just the aftermath of such violence, but also its roots, including the experiences and behaviours of perpetrators.</p> <h2>What’s the link with mental health, trauma and drugs?</h2> <p>The relationships between mental illness, drug use, traumatic experiences and violence are complex.</p> <p>When we look specifically at the link between mental illness and violence, most people with mental illness will not become violent. But there <a href="https://theconversation.com/bondi-attacker-had-mental-health-issues-but-most-people-with-mental-illness-arent-violent-227868">is evidence</a> people with serious mental illness can be more likely to become violent.</p> <p>The use of alcohol and other drugs also <a href="https://theconversation.com/alcohol-and-drug-use-exacerbate-family-violence-and-can-be-dealt-with-69986">increases the risk</a> of domestic violence, including intimate partner violence.</p> <p>About <a href="https://www.aihw.gov.au/family-domestic-and-sexual-violence/understanding-fdsv/factors-associated-with-fdsv">one in three</a> intimate partner violence incidents involve alcohol. These are more likely to result in physical injury and hospitalisation. The risk of perpetrating violence is even higher for people with mental ill health who are also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1525086/">using alcohol or other drugs</a>.</p> <p>It’s also important to consider traumatic experiences. Most people who experience trauma do not commit violent acts, but there are <a href="https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00075-0/fulltext">high rates</a> of trauma among people who become violent.</p> <p>For example, experiences of childhood trauma (such as witnessing physical abuse) <a href="https://www.sciencedirect.com/science/article/pii/S1359178915000828?via%3Dihub">can increase the risk</a> of perpetrating domestic violence as an adult.</p> <p>Early traumatic experiences can affect the brain and body’s <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-017-0895-4">stress response</a>, leading to heightened fear and perception of threat, and difficulty regulating emotions. This can result in aggressive responses when faced with conflict or stress.</p> <p>This response to stress increases the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9675346/">alcohol and drug problems</a>, developing <a href="https://pubmed.ncbi.nlm.nih.gov/30798897/">PTSD</a> (post-traumatic stress disorder), and <a href="https://psycnet.apa.org/record/2015-17349-001">increases the risk</a> of perpetrating intimate partner violence.</p> <h2>How can we address these overlapping issues?</h2> <p>We can reduce intimate partner violence by addressing these overlapping issues and tackling the root causes and contributors.</p> <p>The early intervention and treatment of <a href="https://doi.org/10.1186/s12905-019-0728-z">mental illness</a>, <a href="https://doi.org/10.1177/1541204020939645">trauma</a> (including PTSD), and <a href="https://doi.org/10.1016/j.avb.2015.06.001">alcohol and other drug use</a>, could help reduce violence. So extra investment for these are needed. We also need more investment to <a href="https://www.sciencedirect.com/science/article/pii/S2212657023000508">prevent mental health issues</a>, and preventing alcohol and drug use disorders from developing in the first place.</p> <p><a href="https://www.sciencedirect.com/science/article/pii/S074937972200023X?via%3Dihub">Preventing trauma</a> from occuring and supporting those exposed is crucial to end what can often become a vicious cycle of intergenerational trauma and violence. <a href="https://journals.sagepub.com/doi/10.1177/070674371105600505">Safe and supportive</a> environments and relationships can protect children against mental health problems or further violence as they grow up and engage in their own intimate relationships.</p> <p>We also need to acknowledge the widespread <a href="https://store.samhsa.gov/product/practical-guide-implementing-trauma-informed-approach/pep23-06-05-005">impact of trauma</a> and its effects on mental health, drug use and violence. This needs to be integrated into policies and practices to reduce re-traumatising individuals.</p> <h2>How about programs for perpetrators?</h2> <p>Most existing standard intervention programs for perpetrators <a href="https://journals.sagepub.com/doi/10.1177/1524838018791268">do not consider</a> the links between trauma, mental health and perpetrating intimate partner violence. Such programs tend to have <a href="https://psycnet.apa.org/doi/10.1037/a0012718">little</a> or <a href="https://doi.org/10.1016/j.cpr.2021.101974">mixed effects</a> on the behaviour of perpetrators.</p> <p>But we could improve these programs with a <a href="http://rcfv.archive.royalcommission.vic.gov.au/MediaLibraries/RCFamilyViolence/Reports/RCFV_Full_Report_Interactive.pdf">coordinated approach</a> including treating mental illness, drug use and trauma at the same time.</p> <p>Such “<a href="https://www.sciencedirect.com/science/article/pii/S014976341930449X?via%3Dihub">multicomponent</a>” programs show promise in meaningfully reducing violent behaviour. However, we need more rigorous and large-scale evaluations of how well they work.</p> <h2>What needs to happen next?</h2> <p>Supporting victim-survivors and improving interventions for perpetrators are both needed. However, intervening once violence has occurred is arguably too late.</p> <p>We need to direct our efforts towards broader, holistic approaches to prevent and reduce intimate partner violence, including addressing the underlying contributors to violence we’ve outlined.</p> <p>We also need to look more widely at preventing intimate partner violence and gendered violence.</p> <p>We need developmentally appropriate <a href="https://theconversation.com/4-things-our-schools-should-do-now-to-help-prevent-gender-based-violence-228993">education and skills-based programs</a> for adolescents to prevent the emergence of unhealthy relationship patterns before they become established.</p> <p>We also need to address the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7278040/">social determinants of health</a> that contribute to violence. This includes improving access to affordable housing, employment opportunities and accessible health-care support and treatment options.</p> <p>All these will be critical if we are to break the cycle of intimate partner violence and improve outcomes for victim-survivors.</p> <hr /> <p><em>The National Sexual Assault, Family and Domestic Violence Counselling Line – 1800 RESPECT (1800 737 732) – is available 24 hours a day, seven days a week for any Australian who has experienced, or is at risk of, family and domestic violence and/or sexual assault.</em></p> <p><em>If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14. In an emergency, call 000.</em><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/229182/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/siobhan-odean-1356613">Siobhan O'Dean</a>, Postdoctoral Research Associate, The Matilda Centre for Research in Mental Health and Substance Use, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>; <a href="https://theconversation.com/profiles/lucinda-grummitt-1531503">Lucinda Grummitt</a>, Postdoctoral Research Fellow, The Matilda Centre for Research in Mental Health and Substance Use, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/steph-kershaw-1466426">Steph Kershaw</a>, Research Fellow, The Matilda Centre for Research in Mental Health and Substance Use, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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/to-tackle-gendered-violence-we-also-need-to-look-at-drugs-trauma-and-mental-health-229182">original article</a>.</em></p>

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

<p><em><a href="https://theconversation.com/profiles/natasha-yates-1213624">Natasha Yates</a>, <a href="https://theconversation.com/institutions/bond-university-863">Bond University</a></em></p> <p>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.</p> <p>But does weight come back when you stop using it?</p> <p>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.</p> <p>So are these medications simply another (expensive) form of yo-yo dieting? Let’s look at what the evidence shows so far.</p> <h2>It’s a long-term treatment, not a short course</h2> <p>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.</p> <p>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.</p> <p>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.)</p> <p>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.</p> <h2>Why do people stop?</h2> <p>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>.</p> <p>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.</p> <p>Understanding what stopping does to the body is therefore important.</p> <h2>So what happens when you stop?</h2> <p>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:</p> <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> <p>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</p> </li> <li> <p>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</p> </li> <li> <p>weight regain will mostly be in the form of fat, because it will be gained faster than skeletal muscle.</p> </li> </ul> <p>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.</p> <h2>Is stopping and starting the medications a problem?</h2> <p>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>.</p> <p>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.</p> <p>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.</p> <h2>How can you avoid gaining weight when you stop?</h2> <p>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:</p> <ul> <li> <p>getting quality <a href="https://www.hindawi.com/journals/ije/2010/270832/">sleep</a></p> </li> <li> <p>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</p> </li> </ul> <ul> <li> <p>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</p> </li> <li> <p>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.</p> </li> </ul> <p>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.</p> <hr /> <p><em>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" /></em></p> <p><em><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></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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>.</em></p>

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

<p><em><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></em></p> <p>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>”.</p> <p>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”.</p> <p>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.</p> <p>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.</p> <h2>How does it work?</h2> <p>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.</p> <p>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.</p> <p>GLP-1 also slows gastric emptying, which makes you feel full, and reduces hunger and feelings of reward after eating.</p> <p><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></p> <p>GLP-1 receptor agonist (GLP-1RA) medications like Ozempic help the body’s own GLP-1 work better by mimicking and extending its action.</p> <p>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.</p> <p>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.</p> <h2>What can users expect? What does the research say?</h2> <p>Higher doses of semaglutide are prescribed to treat obesity compared to type 2 diabetes management (up to 2.4mg versus 2.0mg weekly).</p> <p>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.</p> <p>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.</p> <p>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>.</p> <p>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.</p> <h2>Who is eligible for semaglutide?</h2> <p>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.</p> <p>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.</p> <p>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.</p> <p>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.</p> <h2>What else do you need to do during Ozempic treatment?</h2> <p>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.</p> <p>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.</p> <p>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.</p> <p>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>.</p> <h2>But what are the side effects?</h2> <p>Semaglutide’s side-effects <a href="https://pubmed.ncbi.nlm.nih.gov/38041774/">include</a> nausea, diarrhoea, vomiting, constipation, indigestion and abdominal pain.</p> <p>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.</p> <p>More severe side-effects included gallbladder disease, acute pancreatitis, hypoglycaemia, acute kidney disease and injection site reactions.</p> <p>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.</p> <p>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”.</p> <hr /> <p><em>Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-series-154673">Ozempic series</a> here.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><a href="https://theconversation.com/profiles/clare-collins-7316"><em>Clare Collins</em></a><em>, Laureate Professor in Nutrition and Dietetics, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a></em></p> <p><em>Image credits: </em><em>Getty Images </em></p> <p><em>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>.</em></p>

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Drugs like Ozempic won’t ‘cure’ obesity but they might make us more fat-phobic

<p><em><a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p>Many have <a href="https://www.economist.com/leaders/2023/03/02/new-drugs-could-spell-an-end-to-the-worlds-obesity-epidemic">declared</a> drugs like Ozempic could “end obesity” by reducing the appetite and waistlines of millions of people around the world.</p> <p>When we look past the hype, this isn’t just untrue – it can also be harmful. The focus on weight, as opposed to health, is a feature of <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277539521001217">diet culture</a>. This frames the pursuit of thinness as more important than other aspects of physical and cultural wellbeing.</p> <p>The Ozempic buzz isn’t just rooted in health and medicine but plays into ideas of <a href="https://butterfly.org.au/weight-bias-fatphobia-diet-culture/#:%7E:text=Weight%20bias%2C%20sometimes%20also%20called,or%20being%20around%20fat%20people.">fat stigma and fat phobia</a>. This can perpetuate fears of fatness and fat people, and the behaviours that <a href="https://link.springer.com/article/10.1186/S12916-018-1116-5">harm people who live in larger bodies</a>.</p> <h2>Not the first ‘miracle’ weight-loss drug</h2> <p>This isn’t the first time we have heard that weight-loss drugs will change the world. Ozempic and <a href="https://www.ncbi.nlm.nih.gov/books/NBK551568/">its family</a> of GLP-1-mimicking drugs are the <a href="https://theconversation.com/ozempic-is-in-the-spotlight-but-its-just-the-latest-in-a-long-and-strange-history-of-weight-loss-drugs-209324">latest in a long line of weight loss drugs</a>. Each looked promising at the time. But none have lived up to the hype in the long term. Some have even been withdrawn from sale due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5126837/">severe side effects</a>.</p> <p>Science does improve <a href="https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30028-8/fulltext">incrementally</a>, but diet culture also keeps us on a cycle of hope for the next <a href="https://sahrc.org/2022/04/diet-culture-a-brief-history/">miracle cure</a>. So drugs like Ozempic might not deliver the results individuals expect, continuing the cycle of hope and shame.</p> <h2>Ozempic doesn’t work the same for everyone</h2> <p>When we talk about the results of studies using Ozempic, we often <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3719041/">focus on the average</a> (also known as the mean) results or the maximum (or peak) results. So, studies might <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">show</a> those using the drug lost an average of 10.9% of their body weight, but some lost more than 20% and others less than 5%</p> <p>What we don’t talk about as much is that responses are variable. Some people are “<a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769">non-responders</a>”. This means not everyone loses as much weight as the average, and some don’t lose weight at all. For some people, the side-effects will outweigh the benefits.</p> <p>When people are on drugs like Ozempic, their blood sugar is better controlled by enhancing the release of insulin and reducing the levels of another hormone called glucagon.</p> <p>But there is greater variability in the amount of <a href="https://www.sciencedirect.com/science/article/pii/S2212877820301769#bib88">weight lost</a> than the variability in blood sugar control. It isn’t clear why, but is likely due to differences in genetics and lifestyles, and weight being more complex to regulate.</p> <h2>Treatment needs to be ongoing. What will this mean?</h2> <p>When weight-loss drugs do work, they are only effective while they’re being taken. This means that to keep the weight off people need to keep taking them long term. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9542252/">One study found</a> an average weight loss of more than 17% after a year on Ozempic became an average net weight loss of 5.6% more than two years after stopping treatment.</p> <p>Short-term side effects of drugs like Ozempic include dizziness, nausea, vomiting and other gastrointestinal upsets. But because these are new drugs, we simply don’t have data to tell us if side effects will increase as people take them for longer periods.</p> <p>Nor do we know if <a href="https://www.medicalnewstoday.com/articles/why-weight-loss-drugs-stop-working-how-to-break-past-ozempic-plateau#:%7E:text=A%20lifetime%20commitment%20to%20Ozempic&amp;text=By%20these%20standards%2C%20such%20drugs,long%2Dterm%20risk%20is%20unknown.">effectiveness will be reduced</a> in the long term. This is called <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/drug-tolerance#:%7E:text=A%20condition%20that%20occurs%20when,or%20different%20medicine%20is%20needed.">drug tolerance</a> and is documented for other long-term treatments such as antidepressants and chemotherapies.</p> <h2>Biology is only part of the story</h2> <p>For some people, using GLP-1-mimicking drugs like Ozempic will be validating and empowering. They will feel like their biology has been “normalised” in the same way that blood pressure or cholesterol medication can return people to the “normal” range of measures.</p> <p>But biologically, obesity <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202176/#:%7E:text=Obesity%20behaves%20as%20complex%20polygenic,about%2080%25%20(3).">isn’t solely about GLP-1 activity</a> with <a href="https://www.worldobesity.org/what-we-do/our-policy-priorities/the-roots-of-obesity">many other</a> hormones, physical activity, and even our gut microbes involved.</p> <p>Overall, <a href="https://www.ncbi.nlm.nih.gov/books/NBK278977/">obesity is complex and multifaceted</a>. Obesity isn’t just driven by personal biology and choice; it has social, cultural, political, environmental and economic determinants.</p> <h2>A weight-centred approach misses the rest of the story</h2> <p>The weight-centred approach <a href="https://butterfly.org.au/body-image/health-not-weight/#:%7E:text=Health%20and%20wellbeing%20are%20multi,on%20their%20size%20or%20appearance.">suggests that leading with thinness means health will follow</a>. But changing appetite is only part of the story when it comes to health.</p> <p>Obesity often <a href="https://www.sciencedirect.com/science/article/pii/S2667368123000335#:%7E:text=Obesity%20related%20malnutrition%20can%20also,%5D%2C%20%5B7%5D%5D.">co-exists with malnutrition</a>. We try to separate the effects in research using statistics, but focusing on the benefits of weight-loss drugs without addressing the underlying malnutrition means we aren’t likely to see the <a href="https://www.wsj.com/articles/ozempic-diet-exercise-healthy-43eee86c">improved health outcomes in everyone who loses weight</a>.</p> <h2>Obesity isn’t an issue detached from people</h2> <p>Even when it is well-intentioned, the rhetoric around the joy of “ending the obesity epidemic” can <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">harm people</a>. Obesity doesn’t occur in isolation. It is people who are obese. And the celebration and hype of these weight-loss drugs can reinforce harmful fat stigma.</p> <p>The framing of these drugs as a “cure” exacerbates the binary view of thin versus fat, and healthy versus unhealthy. These are not binary outcomes that are good or bad. Weight and health exist on a spectrum.</p> <p>Ironically, while fat people are told they need to lose weight for their health, they are also <a href="https://www.dailytelegraph.com.au/news/nsw/ozempic-shame-why-users-are-embarrassed-to-admit-using-weight-loss-wonder-drug/news-story/ee52a819c69459afe6576d25988f9bd6">shamed for “cheating” or taking shortcuts</a> by using medication.</p> <h2>Drugs are tools, not silver bullets</h2> <p>The creation of these drugs is a start, but they remain expensive, and the hype has been followed by <a href="https://www.tga.gov.au/safety/shortages/information-about-major-medicine-shortages/about-ozempic-semaglutide-shortage-2022-and-2023#:%7E:text=Consumer%20Medicine%20Information%20.-,Why%20the%20Ozempic%20shortage%20happened,label%20prescribing%20for%20weight%20loss.">shortages</a>. Ultimately, complex challenges aren’t addressed with simple solutions. This is particularly true when people are involved, and even more so when there isn’t even an agreement on what the challenge is.</p> <p>Many organisations and individuals see obesity is a disease and believe this framing helps people to seek treatment.</p> <p>Others think it’s unnecessary to attach medical labels to body types and <a href="https://www.forbes.com/sites/geoffreykabat/2013/07/09/why-labeling-obesity-as-a-disease-is-a-big-mistake/?sh=5ca95cc2103b">argue</a> it confuses risk factors (things that are linked to increased risk of illness) with illness itself.</p> <p>Regardless, two things will always remain true. Drugs can only ever be tools, and those tools need to be applied in a context. To use these tools ethically, we need to remain mindful of who this application harms along the way.</p> <hr /> <p><em>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/219309/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></em></p> <p><em><a href="https://theconversation.com/profiles/emma-beckett-22673">Emma Beckett</a>, Adjunct Senior Lecturer, Nutrition, Dietetics &amp; Food Innovation - School of Health Sciences, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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/drugs-like-ozempic-wont-cure-obesity-but-they-might-make-us-more-fat-phobic-219309">original article</a>.</em></p>

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Considering taking a weight-loss drug like Ozempic? Here are some potential risks and benefits

<p><a href="https://theconversation.com/profiles/lauren-ball-14718">Lauren Ball</a>, <em><a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a></em> and <a href="https://theconversation.com/profiles/emily-burch-438717">Emily Burch</a>, <em><a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a></em></p> <p>After weight-loss drugs like Ozempic exploded onto the market, celebrities and social media influencers were quick to spruik their benefits, leading to their rapid rise in use. In the last three months of 2022, clinicians in the United States alone wrote <a href="https://www.washingtonpost.com/business/2023/09/27/ozempic-prescriptions-data-analysis/">more than nine million prescriptions</a> for these drugs.</p> <p>As they’ve grown in popularity, we’ve also heard more about the potential side effects – from common gastrointestinal discomforts, to more serious mental health concerns.</p> <p>But what does the science say about how well Ozempic and Wegovy (which are both brand names of the drug semaglutide) work for weight loss? And what are the potential side effects? Here’s what to consider if you or a loved one are thinking of taking the drug.</p> <h2>Potential benefits</h2> <p><strong>1) It’s likely to help you lose weight</strong></p> <p>The largest, well-conducted <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">research study</a> of semaglutide was from United Kingdom in 2021. Some 1,961 people who were classified as “overweight” or “obese” were randomly assigned to have either semaglutide or a placebo and followed for 68 weeks (about 1.3 years). All participants also had free access to advice about healthy eating and physical activity.</p> <p>The study found those taking semaglutide lost weight – significantly more than people who had the placebo (-14.9% of their body weight compared with -2.4% of body weight).</p> <p>In another <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">study</a> in the United States, one health-care clinic gave 408 people weekly injections of semaglutide. Over the first three months, those included in the final analysis (175 people) lost an average of 6.7kg. Over the first six months, they lost an average of 12.3kg.</p> <p>Large weight losses have been found in a more <a href="https://www.nature.com/articles/s41591-022-02026-4">recent trial</a> of semaglutide, suggesting weight loss is a very likely outcome of ongoing use of the medication.</p> <p><strong>2) It may reduce your chronic disease risk factors</strong></p> <p>When people in the overweight or obese weight categories lose <a href="https://www.sciencedirect.com/science/article/pii/S1550413116300535">at least 5%</a> of their body weight, physiological changes often occur beyond a change in weight or shape. This <a href="https://www.nih.gov/news-events/nih-research-matters/research-context-obesity-metabolic-health">might include</a> lowered cholesterol levels, lowered blood pressure and lowered blood glucose levels, which all reduce the risk of chronic diseases.</p> <p>In one of the semaglutide <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">trials</a>, most people (87.3%) lost at least 5% of their body weight. Although most of the large studies of semaglutide excluded people with metabolic health conditions such as type 2 diabetes, metabolic health gains were <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">observed</a>, including lowered blood pressure, blood glucose levels and fasting blood lipid (fat) levels.</p> <p>In the UK <a href="https://pubmed.ncbi.nlm.nih.gov/33567185/">study</a> from 2021, people taking semaglutide had greater improvements in physical capabilities and risk factors for heart disease and diabetes, including reductions in waist circumference, markers of inflammation, blood pressure and blood glucose levels.</p> <p><strong>3) It might improve your quality of life, emotional wellbeing or sense of achievement</strong></p> <p>The original trial of semaglutide did not focus on this bundle of benefits, but further follow-ups show additional benefits associated with the medication. Compared to the placebo, people taking semaglutide saw significant <a href="https://www.tandfonline.com/doi/full/10.1080/00325481.2022.2150006">improvements</a> in their physical functioning and perceptions of their general health, social functioning and mental health.</p> <p>Anecdotally (not based on scientific research), people using semaglutide, such as <a href="https://people.com/oprah-winfrey-reveals-weight-loss-medication-exclusive-8414552">Oprah Winfrey</a>, report a reclaiming or turning point of their life, social situation and body image.</p> <h2>What about the risks?</h2> <p><strong>1) You may experience gastrointestinal symptoms</strong></p> <p>In the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">US clinical trial</a>, nearly half (48.6%) of people taking semaglutide reported experiencing adverse effects. Nausea and vomiting were the most frequently experienced (36.6%) followed by diarrhea (8.6%), fatigue (6.3%) and constipation (5.7%).</p> <p>In the UK study, nausea and diarrhoea were also commonly reported.</p> <p>In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">another trial</a>, many participants (74.2%) using semaglutide reported gastrointestinal symptoms. However, nearly half (47.9%) using the placebo also reported gastrointestinal symptoms, indicating that symptoms may be similar to those experienced during normal daily living.</p> <p>Most gastrointestinal symptoms were mild to moderate in severity, and resolved for most people without the need to stop participating in the study.</p> <p><strong>2) You might feel fatigued</strong></p> <p>Fatigue was the second most common side effect for participants in the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, affecting 6.3% of participants.</p> <p><strong>3) You might be among the minority who don’t tolerate the drug</strong></p> <p>Australia’s Therapeutic Goods Administration (TGA) has <a href="https://www.tga.gov.au/news/safety-alerts/compounding-safety-information-semaglutide-products">approved</a> Ozempic as safe to use, for the treatment of type 2 diabetes but it has not yet been approved for weight loss. The TGA has also <a href="https://www.tga.gov.au/resources/prescription-medicines-registrations/wegovy-novo-nordisk-pharmaceuticals-pty-ltd">approved Wegovy</a> (a higher dose of semagtlutide) for weight loss, however it’s not yet available in Australia.</p> <p>In the US <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/">clinical trial</a>, no unexpected safety issues were reported. However, five patients (2.9%) had to stop taking the medication because they could not tolerate the adverse effects. Fifteen (8.6%) had to either reduce the dose or remain on the same dose to avoid the adverse effects.</p> <p>In <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">other studies</a>, some patients stopped the trial due to gastrointestinal symptoms being so severe they could not tolerate continuing.</p> <p>More severe safety concerns reported in <a href="https://www.nejm.org/doi/10.1056/NEJMoa2032183?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%20%200pubmed">studies</a> include gallbladder-related disorders (mostly cholelithiasis, also known as gallstones) in 34 patients (2.6%) and mild acute pancreatitis in three patients (0.2%). All people recovered during the trial period.</p> <p>A 2024 European <a href="https://link.springer.com/article/10.1007/s11096-023-01694-7">study</a> analysed psychiatric adverse events associated with semaglutide, liraglutide and tirzepatide (which work in a similar way to semaglutide). Between January 2021 and May 2023, the drug database recorded 481 psychiatric events (about 1.2% of the total reported) associated with these drugs. About half of these events were reported as depression, followed by anxiety (39%) and suicidal ideation (19.6%). Nine deaths and 11 life-threatening outcomes were reported during the study period.</p> <p>Due to the severity and fatal outcomes of some of these reports, <a href="https://www.fda.gov/drugs/drug-safety-and-availability/update-fdas-ongoing-evaluation-reports-suicidal-thoughts-or-actions-patients-taking-certain-type">the US Food and Drug Administration</a> investigated further but did not find evidence that use of these medicines caused suicidal thoughts or actions.</p> <p><strong>4) It might be difficult to access</strong></p> <p>Despite being considered safe, the TGA has <a href="https://www.tga.gov.au/safety/shortages/medicine-shortage-alerts/update-prescribers-advised-not-start-new-patients-ozempic#:%7E:text=Ozempic%27s%20TGA%2Dapproved%20indication%20is,consult%20the%20appropriate%20prescribing%20guidelines.">warned</a> significant Ozempic access barriers are likely to continue throughout 2024.</p> <p>To manage the shortage, pharmacists are instructed to give preference to people with type 2 diabetes who are seeking the medication.</p> <p><strong>5) You might not always get clear information from vested interests</strong></p> <p>Given the popularity of Ozempic and Wegovy, health organisations such as the World Obesity Federation have expressed <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">concern</a> about the medication’s marketing, PR and strong <a href="https://www.theguardian.com/australia-news/2023/jan/06/tga-investigates-influencers-after-diabetes-drug-ozempic-promoted-as-weight-loss-treatment">social media presence</a>.</p> <p>Some journalists have <a href="https://www.theguardian.com/society/2023/mar/12/orchestrated-pr-campaign-how-skinny-jab-drug-firm-sought-to-shape-obesity-debate">raised conflict of interest concerns</a> about the relationship between some obesity researchers and Novo Nordrisk, Ozempic and Wegovy’s manufacturer. The worry is that researchers might be influenced by their relationship with Novo Nordrisk to produce study results that are more favourable to the medications.</p> <h2>Bottom line</h2> <p>Ozempic is a medication that should be used in conjunction with your health care provider. But remember, weight is only one aspect of your health and wellbeing. It’s important to take a holistic view of your health and prioritise eating well, moving more and getting enough sleep.</p> <hr /> <p><em>Read the other articles in The Conversation’s <a href="https://theconversation.com/au/topics/ozempic-132745">Ozempic series</a> here.</em><!-- Below is The Conversation's page counter tag. Please DO NOT REMOVE. --><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/219312/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /><!-- End of code. If you don't see any code above, please get new code from the Advanced tab after you click the republish button. The page counter does not collect any personal data. More info: https://theconversation.com/republishing-guidelines --></p> <p><em><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>, Lecturer, <a href="https://theconversation.com/institutions/southern-cross-university-1160">Southern Cross University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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-a-weight-loss-drug-like-ozempic-here-are-some-potential-risks-and-benefits-219312">original article</a>.</em></p>

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Legendary Star Wars and James Bond actor passes away

<p>The galaxy far, far away has dimmed a little with the passing of Michael Culver, a distinguished British actor whose name became etched in the annals of cinematic history, particularly for his role in the iconic 1980 film <em>Star Wars: Episode V - The Empire Strikes Back</em>.</p> <p>Culver, who portrayed Captain Needa, the unfortunate Imperial officer, met his demise in one of the franchise's most memorable scenes at the hands of Darth Vader. However, his legacy extends far beyond the realms of science fiction, encompassing a career spanning over five decades of stage, screen and political activism.</p> <p>Born in 1938 in Hempstead, North London, to esteemed parents within the theatre industry, Culver was destined for a life under the spotlight. His father, Roland Culver, was a notable West End stage actor, while his mother, Daphne Rye, served as a casting director in London-based theatre. Following in their footsteps, Culver honed his craft at the London Academy of Music and Dramatic Art, laying the foundation for a prolific acting career.</p> <p>Culver's journey in the performing arts began in the late 1950s, with appearances on Broadway in Shakespearean classics such as <em>King Henry V</em>, <em>Hamlet</em>, and <em>Twelfth Night</em>. His talent soon graced the West End stage in 1962, marking the start of a distinguished theatrical career. Transitioning to the small screen, Culver made his onscreen debut in 1961, captivating audiences with his versatile performances in British television series and movies.</p> <p>However, it was Culver's portrayal of Captain Needa in <em>The Empire Strikes Back</em> that solidified his status as a cultural icon. Despite his character's brief appearance, Culver left an indelible mark on audiences worldwide, immortalised in one of cinema's most unforgettable moments. His confrontation with Vader, culminating in a chilling demise, remains etched in the memories of countless fans, a testament to Culver's ability to captivate audiences with his presence.</p> <p>Beyond his intergalactic exploits, Culver's talents graced a multitude of productions, including notable roles in <em>Sherlock Holmes, A Passage to India</em>, <em>Secret Army, </em>and even appearing in two James Bond movies – <em>From Russia With Love </em>and <em>Thunderball</em> – in uncredited roles. His versatility and dedication to his craft earned him admiration and respect from peers and audiences alike. Yet, Culver's contributions extended beyond the realms of entertainment; in the early 2000s, he shifted his focus to political activism, leveraging his platform to advocate for causes close to his heart.</p> <p>Despite bidding farewell to the limelight, Culver's legacy endures through the countless lives he touched and the memories he forged on stage and screen.</p> <p>An extended message on the Alliance Agents Facebook page, who represented Culver, read as follows:</p> <p>"We are very sad to confirm the passing of our friend and client Michael Culver. A career spanning over 50 years with notable roles in Sherlock Holmes, A Passage to India, Secret Army and of course one of the most memorable death scenes in the Star Wars franchise. Michael largely gave up acting in the early 2000's to concentrate his efforts into his political activism. It's been an honor to have represented Michael for for the last decade and to have taken him to some of the best Star Wars events in the UK and Europe.  A real highlight was taking Michael to Celebration in Chicago in 2019.  He was lost for words when he saw his queue line with nearly 200 people waiting to see him. We worked with Michael just 3 weeks ago at his last home signing with our friends at Elite Signatures. Michel died on Tuesday 27th February at the age of 85."  </p> <p>"We miss him."</p> <p>His passing leaves a void in the hearts of fans and colleagues, a reminder of the fleeting nature of life's curtain call. As we reflect on his remarkable journey, let us celebrate the life and legacy of Michael Culver, an actor whose talents transcended galaxies and whose spirit will continue to inspire generations to come.</p> <p>In his memory, let us heed the timeless words of Captain Needa himself: "We shall double our efforts."</p> <p>Rest in peace, Michael Culver. The force will always be with you.</p> <p><em>Images: IMDB / Wookiepedia</em></p>

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War in Ukraine affected wellbeing worldwide, but people’s speed of recovery depended on their personality

<p><em><a href="https://theconversation.com/profiles/luke-smillie-7502">Luke Smillie</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p>The war in Ukraine has had impacts around the world. <a href="https://mitsloan.mit.edu/ideas-made-to-matter/ripple-effects-russia-ukraine-war-test-global-economies">Supply chains</a> have been disrupted, the <a href="https://news.un.org/pages/wp-content/uploads/2022/06/GCRG_2nd-Brief_Jun8_2022_FINAL.pdf?utm_source=United+Nations&amp;utm_medium=Brief&amp;utm_campaign=Global+Crisis+Response">cost of living</a> has soared and we’ve seen the <a href="https://www.unhcr.org/hk/en/73141-ukraine-fastest-growing-refugee-crisis-in-europe-since-wwii.html">fastest-growing refugee crisis since World War II</a>. All of these are in addition to the devastating humanitarian and economic impacts within Ukraine.</p> <p>Our international team was conducting a global study on wellbeing in the lead up to and after the Russian invasion. This provided a unique opportunity to examine the psychological impact of the outbreak of war.</p> <p>As we explain in a new study published in <a href="https://www.nature.com/articles/s41467-024-44693-6">Nature Communications</a>, we learned the toll on people’s wellbeing was evident across nations, not just <a href="https://ijmhs.biomedcentral.com/articles/10.1186/s13033-023-00598-3">in Ukraine</a>. These effects appear to have been temporary – at least for the average person.</p> <p>But people with certain psychological vulnerabilities struggled to recover from the shock of the war.</p> <h2>Tracking wellbeing during the outbreak of war</h2> <p>People who took part in our study completed a rigorous “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2773515/">experience-sampling</a>” protocol. Specifically, we asked them to report their momentary wellbeing four times per day for a whole month.</p> <p>Data collection began in October 2021 and continued throughout 2022. So we had been tracking wellbeing around the world during the weeks surrounding the outbreak of war in February 2022.</p> <p>We also collected measures of personality, along with various sociodemographic variables (including age, gender, political views). This enabled us to assess whether different people responded differently to the crisis. We could also compare these effects across countries.</p> <p>Our analyses focused primarily on 1,341 participants living in 17 European countries, excluding Ukraine itself (44,894 experience-sampling reports in total). We also expanded these analyses to capture the experiences of 1,735 people living in 43 countries around the world (54,851 experience-sampling reports) – including in Australia.</p> <h2>A global dip in wellbeing</h2> <p>On February 24 2022, the day Russia invaded Ukraine, there was a sharp decline in wellbeing around the world. There was no decline in the month leading up to the outbreak of war, suggesting the change in wellbeing was not already occurring for some other reason.</p> <p>However, there was a gradual increase in wellbeing during the month <em>after</em> the Russian invasion, suggestive of a “return to baseline” effect. Such effects are commonly reported in psychological research: situations and events that impact our wellbeing often (<a href="https://www.researchgate.net/publication/237535630_Adaptation_and_the_Set-Point_Model_of_Subjective_Well-BeingDoes_Happiness_Change_After_Major_Life_Events">though not always</a>) do so <a href="https://www.researchgate.net/publication/7062343_Beyond_the_Hedonic_Treadmill_Revising_the_Adaptation_Theory_of_Well-Being">temporarily</a>.</p> <p>Unsurprisingly, people in Europe experienced a sharper dip in wellbeing compared to people living elsewhere around the world. Presumably the war was much more salient for those closest to the conflict, compared to those living on an entirely different continent.</p> <p>Interestingly, day-to-day fluctuations in wellbeing mirrored the salience of the war on social media as events unfolded. Specifically, wellbeing was lower on days when there were more tweets mentioning Ukraine on Twitter/X.</p> <p>Our results indicate that, on average, it took around two months for people to return to their baseline levels of wellbeing after the invasion.</p> <h2>Different people, different recoveries</h2> <p>There are <a href="https://pubmed.ncbi.nlm.nih.gov/31944795/">strong links</a> between our wellbeing and our individual personalities.</p> <p>However, the dip in wellbeing following the Russian invasion was fairly uniform across individuals. None of the individual factors assessed in our study, including personality and sociodemographic factors, predicted people’s response to the outbreak of war.</p> <p>On the other hand, personality did play a role in how quickly people recovered. Individual differences in people’s recovery were linked to a personality trait called “stability”. Stability is a broad dimension of personality that combines low neuroticism with high agreeableness and conscientiousness (three traits from the <a href="https://www.sciencedirect.com/topics/social-sciences/big-five">Big Five</a> personality framework).</p> <p>Stability is so named because it reflects the stability of one’s overall psychological functioning. This can be illustrated by breaking stability down into its three components:</p> <ol> <li> <p>low neuroticism describes <a href="https://www.pnas.org/doi/full/10.1073/pnas.2212154120">emotional stability</a>. People low in this trait experience less intense negative emotions such as anxiety, fear or anger, in response to negative events</p> </li> <li> <p>high agreeableness describes <a href="https://psycnet.apa.org/record/2018-63285-010">social stability</a>. People high in this trait are generally more cooperative, kind, and motivated to maintain social harmony</p> </li> <li> <p>high conscientiousness describes <a href="https://doi.org/10.1016/j.paid.2023.112331">motivational stability</a>. People high in this trait show more effective patterns of goal-directed self-regulation.</p> </li> </ol> <p>So, our data show that people with less stable personalities fared worse in terms of recovering from the impact the war in Ukraine had on wellbeing.</p> <p>In a supplementary analysis, we found the effect of stability was driven specifically by neuroticism and agreeableness. The fact that people higher in neuroticism recovered more slowly accords with a wealth of research linking this trait with <a href="https://pubmed.ncbi.nlm.nih.gov/10573882/">coping difficulties</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5428182/">poor mental health</a>.</p> <p>These effects of personality on recovery were stronger than those of sociodemographic factors, such as age, gender or political views, which were not statistically significant.</p> <p>Overall, our findings suggest that people with certain psychological vulnerabilities will often struggle to recover from the shock of global events such as the outbreak of war in Ukraine.<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/224147/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/luke-smillie-7502">Luke Smillie</a>, Professor in Personality Psychology, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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/war-in-ukraine-affected-wellbeing-worldwide-but-peoples-speed-of-recovery-depended-on-their-personality-224147">original article</a>.</em></p>

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How dieting, weight suppression and even misuse of drugs like Ozempic can contribute to eating disorders

<p><em><a href="https://theconversation.com/profiles/samantha-withnell-1504436">Samantha Withnell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, <a href="https://theconversation.com/institutions/western-university-882">Western University</a></em></p> <p>Up to 72 per cent of women and 61 per cent of men are dissatisfied with their weight or <a href="https://doi.org/10.1016/j.eatbeh.2014.04.010">body image</a>, according to a U.S. study. Globally, millions of people <a href="https://doi.org/10.1111%2Fobr.12466">attempt to lose weight</a> every year with the hope that weight loss will have positive effects on their body image, health and quality of life.</p> <p>However, these motivated individuals often struggle to maintain new diets or exercise regimens. The rise of medications such as semaglutides, like <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101298">Ozempic</a> or <a href="https://dhpp.hpfb-dgpsa.ca/dhpp/resource/101765">Wegovy</a>, <a href="https://www.cbc.ca/news/health/ozempic-weight-loss-1.6772021">might be viewed as an appealing “quick fix”</a> alternative to meet weight loss goals.</p> <p>Research led by our team and others suggests that such attempts to lose weight often do more harm than good, and even increase the risk of <a href="https://osf.io/9stq2">developing an eating disorder</a>.</p> <h2>Weight loss and eating disorders</h2> <p>Eating disorders are <a href="https://doi.org/10.1002/eat.20589">serious mental health conditions</a> primarily characterized by extreme patterns of under- or over-eating, concerns about one’s shape or body weight or other behaviours intended to influence body shape or weight such as exercising excessively or self-inducing vomiting.</p> <p>Although once thought to only affect young, white adolescent girls, eating disorders do not discriminate; eating disorders can develop in people of <a href="https://doi.org/10.1002/erv.2553">any age, sex, gender or racial/ethnic background</a>, with an estimated <a href="https://nedic.ca/general-information/">one million Canadians</a> suffering from an eating disorder at any given time. Feb. 1 to 7 is <a href="https://nedic.ca/edaw/">National Eating Disorders Awareness Week</a>.</p> <p>As a clinical psychologist and clinical psychology graduate student, our research has focused on how eating disorders develop and what keeps them going. Pertinent to society’s focus on weight-related goals, our research has examined associations between weight loss and eating disorder symptoms.</p> <h2>Eating disorders and ‘weight suppression’</h2> <p>In eating disorders research, the state of maintaining weight loss is referred to as “weight suppression.” Weight suppression is typically defined as the difference between a person’s current weight and their highest lifetime weight (excluding pregnancy).</p> <p>Despite the belief that weight loss will improve body satisfaction, we found that in a sample of over 600 men and women, weight loss had no impact on women’s negative body image and was associated with increased body dissatisfaction in <a href="https://doi.org/10.1016/j.bodyim.2023.01.011">men</a>. Importantly, being more weight suppressed has been associated with the <a href="https://doi.org/10.1093/ajcn/nqaa146">onset of eating disorders</a>, including anorexia nervosa and bulimia nervosa.</p> <p><a href="https://doi.org/10.1007/s11920-018-0955-2">One proposed explanation</a> for the relationship between weight suppression and eating disorders is that maintaining weight loss becomes increasingly difficult as body systems that <a href="https://doi.org/10.3945/ajcn.110.010025">reduce metabolic rate and energy expenditure, and increase appetite</a>, are activated to promote weight gain.</p> <p>There is growing awareness that <a href="https://doi.org/10.1136/bmj.g2646">weight regain is highly likely following conventional diet programs</a>. This might lead people to engage in more and more extreme behaviours to control their weight, or they might shift between extreme restriction of food intake and episodes of overeating or binge eating, the characteristic symptoms of bulimia nervosa.</p> <h2>Ozempic and other semaglutide drugs</h2> <p>Semaglutide drugs like Ozempic and Wegovy are part of a class of drug called <a href="https://pdf.hres.ca/dpd_pm/00067924.PDF">glucagon-like peptide-1 agonists (GLP-1As)</a>. These drugs work by mimicking the hormone GLP-1 to interact with neural pathways that signal satiety (fullness) and slow stomach emptying, leading to reduced food intake.</p> <p>Although GLP-1As are indicated to treat Type 2 diabetes, <a href="https://www.cbc.ca/news/canada/london/ozempic-off-label-1.6884141">they are increasingly prescribed off-label</a> or being <a href="https://www.bbc.com/news/health-67414203">illegally purchased</a> without a prescription because of their observed effectiveness at inducing weight loss. Although medications like Ozempic do often lead to weight loss, the rate of weight loss may <a href="https://doi.org/10.1001/jama.2021.3224">slow down or stop over time</a>.</p> <p>Research by Lindsay Bodell, one of the authors of this story, and her colleagues on weight suppression may help explain why effects of semaglutides diminish over time, as <a href="https://doi.org/10.1016/j.physbeh.2019.112565">weight suppression is associated with reduced GLP-1 response</a>. This means those suppressing their weight could become less responsive to the satiety signals activated by GLP-1As.</p> <p>Additionally, weight loss effects are only seen for as long as the medication is taken, meaning those who take these drugs to achieve some weight loss goal are <a href="https://doi.org/10.1111/dom.14725">likely to regain most, if not all, weight lost</a> when they stop taking the medication.</p> <h2>Risks of dieting and weight-loss drugs</h2> <p>The growing market for off-label weight loss drugs is concerning, because of the exacerbation of <a href="https://theconversation.com/ozempic-the-miracle-drug-and-the-harmful-idea-of-a-future-without-fat-211661">weight stigma</a> and the serious <a href="https://doi.org/10.1016/j.jand.2022.01.004">health risks</a> associated with unsupervised weight loss, including developing eating disorders.</p> <p>Researchers and health professionals are already raising the alarm about the use of GLP-1As in children and adolescents, due to concerns about their possible <a href="https://doi.org/10.1017/cts.2023.612">impact on growth and development</a>.</p> <p>Moreover, popular weight-loss methods, whether they involve pills or “crash diets,” often mimic symptoms of eating disorders. For example, intermittent fasting diets that involve long periods of fasting followed by short periods of food consumption may mimic and <a href="https://doi.org/10.1016/j.eatbeh.2022.101681">increase the risk of developing binge eating problems</a>.</p> <p>The use of diet pills or laxatives to lose weight has been found to increase the risk of <a href="https://doi.org/10.2105/AJPH.2019.305390">being diagnosed with an eating disorder in the next one to three years</a>. Drugs like Ozempic may also be <a href="https://doi.org/10.1002/eat.24109">misused by individuals already struggling with an eating disorder</a> to suppress their appetite, compensate for binge eating episodes or manage fear of weight gain.</p> <p>Individuals who are already showing signs of an eating disorder, such as limiting their food intake and intense concerns about their weight, may be most at risk of spiralling from a weight loss diet or medication into an eating disorder, <a href="https://doi.org/10.1002/eat.24116">even if they only lose a moderate amount of weight</a>.</p> <p>People who are dissatisfied with their weight or have made multiple attempts to lose weight often feel pressured to try increasingly drastic methods. However, any diet, exercise program or weight-loss medication promising a quick fix for weight loss should be treated with extreme caution. At best, you may gain the weight back; at worst, you put yourself at risk for much more serious eating disorders and other health problems.<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/221514/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><a href="https://theconversation.com/profiles/samantha-withnell-1504436"><em>Samantha Withnell</em></a><em>, PhD Candidate, Clinical Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a> and <a href="https://theconversation.com/profiles/lindsay-bodell-1504260">Lindsay Bodell</a>, Assistant Professor of Psychology, <a href="https://theconversation.com/institutions/western-university-882">Western University</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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-dieting-weight-suppression-and-even-misuse-of-drugs-like-ozempic-can-contribute-to-eating-disorders-221514">original article</a>.</em></p>

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After 3 months of devastation in the Israel-Hamas war, is anyone ‘winning’?

<p><a href="https://theconversation.com/profiles/ian-parmeter-932739"><em>Ian Parmeter</em></a><em>, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a></em></p> <p>The 19th century German war strategist and field marshal Helmuth von Moltke famously <a href="https://global.oup.com/academic/product/strategy-9780199325153?cc=us&amp;lang=en&amp;">coined</a> the aphorism “No battle plan survives first contact with the enemy”. His observation might well be applied to the tragedy we are witnessing in Gaza.</p> <p>Three months after the current conflict began, civilians have borne the brunt of the violence on both sides, with the deaths of more than 22,000 Palestinians in Gaza and 1,200 Israelis. Some 85% of Gazans <a href="https://apnews.com/article/israel-hamas-war-news-01-03-2024-3b77b0c36bf2cd9922b7a484234bef5f">have also been displaced</a> and a quarter of the population is facing a famine, according to the United Nations.</p> <p>The conflict still has a long way to run and may be headed towards stalemate. From a geopolitical perspective, here’s where the main players stand at the start of the new year.</p> <h2>Israel: limited success …</h2> <p>Israel has so far failed to achieve either of its primary war aims: the destruction of Hamas and freedom for the remainder of the 240 Israelis taken hostage on October 7.</p> <p>Hamas fighters continue to use their tunnel network to ambush Israeli soldiers and are firing rockets at Israel, albeit in much lower volumes: 27 were <a href="https://www.timesofisrael.com/at-stroke-of-midnight-hamas-attacks-israel-with-heavy-new-year-rocket-barrage/">fired</a> at the start of the new year, <a href="https://www.timesofisrael.com/liveblog_entry/idf-9500-rockets-fired-at-israel-since-oct-7-including-3000-in-1st-hours-of-onslaught/">compared</a> with 3,000 in the first hours of the conflict on October 7.</p> <p>There are still around <a href="https://www.economist.com/middle-east-and-africa/2023/12/20/israel-isnt-sure-what-to-do-about-the-hostages-in-gaza">130 Israelis</a> being held hostage, and only <a href="https://www.rand.org/pubs/commentary/2023/12/five-potential-next-steps-for-the-hostage-situation.html">one hostage</a> has been freed by the Israeli Defence Forces (IDF), as opposed to releases arranged through Qatari and Egyptian mediators. Israeli society is divided between those who want to prioritise negotiations to release the hostages and those who want to prioritise the elimination of Hamas.</p> <p>Israel achieved an important symbolic success with the apparent targeted killing of Hamas deputy leader <a href="https://www.cbsnews.com/news/israel-lebanon-hamas-saleh-al-arouri-fears-widening-regional-conflict/">Saleh al-Arouri</a> in Beirut on January 2. Though Israel has not formally claimed responsibility, there is little doubt it was <a href="https://www.axios.com/2024/01/02/hamas-saleh-arouri-killed-beirut-hezbollah-israel-gaza">behind</a> the killing.</p> <p>But the two Gaza–based Hamas leaders Israel most wants to eliminate, political leader Yahya Sinwar and military leader Mohammed Deif, are still at large.</p> <p>Israel still has US support in the UN Security Council, which has <a href="https://www.cnn.com/2023/12/22/politics/un-security-council-resolution-israel-gaza-resolution/index.html">managed to pass</a> only one toothless resolution since the war began. But the Biden administration is <a href="https://apnews.com/article/biden-israel-hamas-oct-7-44c4229d4c1270d9cfa484b664a22071">publicly pressuring</a> Israel to change its tactics to minimise Palestinian casualties.</p> <h2>…and facing a ‘day after’ conundrum</h2> <p>The Israeli government is also divided on how Gaza should be run when the fighting stops.</p> <p>Prime Minister Benjamin Netanyahu has <a href="https://www.jpost.com/breaking-news/article-777731">said</a> he won’t accept Gaza remaining “Hamastan” (Hamas-controlled) or becoming “Fatahstan” (ruled by the Palestinian Authority, which is dominated by the secular Fatah party). US President Joe Biden <a href="https://www.reuters.com/world/middle-east/biden-says-palestinian-authority-should-ultimately-govern-gaza-west-bank-2023-11-18/">prefers</a> a Gaza government led by a reformed Palestinian Authority, but Netanyahu has rejected this and has not articulated an alternative plan.</p> <p>Defence Minister Yoav Gallant this week <a href="https://www.timesofisrael.com/gallants-post-war-gaza-plan-palestinians-to-run-civil-affairs-with-global-task-force/">outlined</a> what seems to be his own plan for Gaza, involving governance by unspecified Palestinian authorities. His plan did not immediately have Israeli cabinet approval and has been <a href="https://thehill.com/opinion/international/4391112-dangerous-ideas-about-the-day-after-in-gaza/">slammed</a> by hard-right ministers.</p> <p>Two of these, Finance Minister Bezalel Smotrich and National Security Minister Itamar Ben–Gvir, have <a href="https://www.timesofisrael.com/likud-minister-slams-smotrich-ben-gvirs-unrealistic-call-for-gazan-emigration/#:%7E:text=Ben%20Gvir%20hit%20back%20at,will%20protect%20the%20IDF%20soldiers.%E2%80%9D">called</a> for a solution that encourages the Palestinian population to emigrate and for Israeli settlers to return to the strip. That would be <a href="https://www.france24.com/en/middle-east/20240103-us-condemns-far-right-israeli-ministers-call-for-palestinians-to-emigrate-from-gaza">unacceptable</a> to the Biden administration.</p> <p>Israel’s massive bombing campaign has also slowly turned international opinion against it, as expressed in the UN General Assembly <a href="https://apnews.com/article/un-assembly-israel-palestinians-hamas-vote-resolution-bffc37b2ecc444d906492008cde0aaf6">vote</a> last month in which 153 of the 193 member states called for a ceasefire.</p> <p>Are Netanyahu’s days now numbered? The current issue of The Economist <a href="https://www.economist.com/leaders/2024/01/03/binyamin-netanyahu-is-botching-the-war-time-to-sack-him">features a headline</a> that reads “Binyamin Netanyahu is botching the war. Time to sack him”. Whether or not that’s a fair judgement, it’s clear that internal divisions and indecision within his government are hindering Israel’s prosecution of the war.</p> <h2>Hamas – still standing</h2> <p>The militant group has obviously been hurt. Israel claims to have <a href="https://news.sky.com/story/israel-gaza-latest-hamas-war-sky-news-blog-12978800?postid=6736630">killed or captured</a> between 8,000 and 9,000 of Hamas’ approximately 30,000–strong fighting force – though it has not explained how it calculates militant deaths.</p> <p>Hamas’ main achievement is that it is still standing. To win, the militant group does not have to defeat Israel – it needs merely to survive the IDF onslaught.</p> <p>Hamas can claim some positives. Its attack on October 7 has put the Palestinian issue at the top of the Middle East agenda.</p> <p>Citizens in the Arab states that have signed peace agreements with Israel are clearly angry. And an Israeli-Saudi agreement to normalise relations between the countries, which had been imminent before the conflict, is off the table for now.</p> <p>Opinion polling also <a href="https://apnews.com/article/israel-hamas-palestinians-opinion-poll-wartime-views-a0baade915619cd070b5393844bc4514">shows support</a> for Hamas has risen from 12% to 44% in the West Bank and from 38% to 42% in Gaza in the past three months. If it were possible to hold fair Palestinian elections now, they could produce results Israel and the US would not like.</p> <h2>United States – weakness in dealing with Israel</h2> <p>Biden embraced Netanyahu immediately after the Hamas attack, but US efforts since then to influence Israel’s war plans have not yielded any results.</p> <p>Secretary of State Antony Blinken failed in his effort to persuade Israel to end the war by the start of the new year. His <a href="https://apnews.com/article/us-turkey-israel-greece-gaza-hamas-jordan-36e5e1be205d5200916fd447c8c8e455">current visit</a> to the region is unlikely to yield any major changes.</p> <p>Moreover, divisions in the US may hurt Biden in the lead–up to the presidential election in November. Young, college–educated progressives, who tend to vote Democratic, have taken part in demonstrations against Biden’s public support for Israel’s right to defend itself, if not its way of doing so.</p> <p>These progressives won’t vote for the almost–certain Republican candidate, Donald Trump. But they could stay home on election day, handing the election to Trump.</p> <p>US support for Ukraine has also become a casualty of the war. Republicans, taking their cue from Trump, are prioritising support for Israel and stopping the flow of migrants across the US-Mexico border. They are losing interest in Ukraine – which clearly benefits Russian President Vladimir Putin. Those benefits will be reinforced if Trump wins the presidency again.</p> <h2>United Nations – irrelevant</h2> <p>The UN has also failed in its mission of maintaining world peace. The only Security Council resolution on the war meant nothing, as Russia was pleased to <a href="https://www.politico.com/news/2023/12/22/un-security-council-gaza-aid-00133112">point out</a>.</p> <p>The recent UN General Assembly resolution illustrated Israel’s growing isolation, but has done nothing to change the course of the war. UN Secretary–General Antonio Guterres has been powerless to influence either Israel or Hamas.</p> <h2>Iran – watching for opportunities</h2> <p>The Hezbollah militant group will do a lot of huffing and puffing over the killing of al-Arouri in a Hezbollah-controlled part of Beirut. But it takes its orders from Tehran, which still shows no sign of wanting to become directly involved in the war.</p> <p>That said, Iran appears to have no problem with its proxies – Hezbollah in Lebanon and the <a href="https://theconversation.com/why-yemens-houthis-are-getting-involved-in-the-israel-hamas-war-and-how-it-could-disrupt-global-shipping-219220">Houthis in Yemen</a> – providing token support for Hamas through limited rocket, drone and artillery attacks.</p> <p>Iran is likely to be reinforced in this approach by the bombings at the tomb of former Quds Force commander <a href="https://theconversation.com/iran-vows-revenge-for-soleimanis-killing-but-heres-why-it-wont-seek-direct-confrontation-with-the-us-129440">Qassem Soleimani</a> last week, which killed almost 100 Iranians. The bombings have been claimed by the Islamic State, which will likely make Iran more focused on its internal security than on assisting Hamas.<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/220644/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/ian-parmeter-932739">Ian Parmeter</a>, Research Scholar, Centre for Arab and Islamic Studies, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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/after-3-months-of-devastation-in-the-israel-hamas-war-is-anyone-winning-220644">original article</a>.</em></p>

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Do you really need antibiotics? Curbing our use helps fight drug-resistant bacteria

<p><em><a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a></em></p> <p>Antibiotic resistance occurs when a microorganism changes and no longer responds to an antibiotic that was previously effective. It’s <a href="https://thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00502-2/fulltext">associated with</a> poorer outcomes, a greater chance of death and higher health-care costs.</p> <p>In Australia, antibiotic resistance means some patients are admitted to hospital because oral antibiotics are <a href="https://www.who.int/news-room/fact-sheets/detail/antibiotic-resistance">no longer effective</a> and they need to receive intravenous therapy via a drip.</p> <p>Antibiotic resistance is rising to high levels in certain parts of the world. Some hospitals <a href="https://www.reactgroup.org/news-and-views/news-and-opinions/year-2022/the-impact-of-antibiotic-resistance-on-cancer-treatment-especially-in-low-and-middle-income-countries-and-the-way-forward/">have to consider</a> whether it’s even viable to treat cancers or perform surgery due to the risk of antibiotic-resistant infections.</p> <p>Australia is <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-aura/aura-2023-fifth-australian-report-antimicrobial-use-and-resistance-human-health">one of the highest users</a> of antibiotics in the developed world. We need to use this precious resource wisely, or we risk a future where a simple infection could kill you because there isn’t an effective antibiotic.</p> <h2>When should antibiotics not be used?</h2> <p>Antibiotics only work for some infections. They work against bacteria but <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/do-i-really-need-antibiotics">don’t treat</a> infections caused by viruses.</p> <p>Most community acquired infections, even those caused by bacteria, are likely to get better without antibiotics.</p> <p>Taking an antibiotic when you don’t need it won’t make you feel better or recover sooner. But it can increase your chance of side effects like nausea and diarrhoea.</p> <p>Some people think green mucus (or snot) is a sign of bacterial infection, requiring antibiotics. But it’s actually <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-11/aura_2023_do_i_really_need_antibiotics.pdf">a sign</a> your immune system is working to fight your infection.</p> <h2>If you wait, you’ll often get better</h2> <p><a href="https://www.tg.org.au/">Clinical practice guidelines</a> for antibiotic use aim to ensure patients receive antibiotics when appropriate. Yet 40% of GPs say they prescribe antibiotics <a href="https://doi.org/10.1071/HI13019">to meet patient expectations</a>. And <a href="https://pubmed.ncbi.nlm.nih.gov/35973750/">one in five</a> patients expect antibiotics for respiratory infections.</p> <p>It can be difficult for doctors to decide if a patient has a viral respiratory infection or are at an early stage of serious bacterial infection, particularly in children. One option is to “watch and wait” and ask patients to return if there is clinical deterioration.</p> <p>An alternative is to prescribe an antibiotic but advise the patient to not have it dispensed unless specific symptoms occur. This can <a href="https://doi.org/10.1002/14651858.CD004417.pub5">reduce antibiotic use by 50%</a> with no decrease in patient satisfaction, and no increase in complication rates.</p> <h2>Sometimes antibiotics are life-savers</h2> <p>For some people – particularly those with a weakened immune system – a simple infection can become more serious.</p> <p>Patients with life-threatening suspected infections should receive an appropriate antibiotic <a href="https://www.safetyandquality.gov.au/our-work/clinical-care-standards/antimicrobial-stewardship-clinical-care-standard">immediately</a>. This includes serious infections such as <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/bacterial-meningitis#:%7E:text=What%20is%20bacterial%20meningitis%3F,can%20cause%20life%2Dthreatening%20problems.">bacterial meningitis</a> (infection of the membranes surrounding the brain) and <a href="https://clinicalexcellence.qld.gov.au/priority-areas/safety-and-quality/sepsis/adult-sepsis#:%7E:text=Adult%20patients%20with%20sepsis%20also,adult%20emergency%20department%20sepsis%20pathway.">sepsis</a> (which can lead to organ failure and even death).</p> <h2>When else might antibiotics be used?</h2> <p>Antibiotics are sometimes used to prevent infections in patients who are undergoing surgery and are at significant risk of infection, such as those undergoing bowel resection. These patients will <a href="https://www.tg.org.au">generally receive</a> a single dose before the procedure.</p> <p>Antibiotics may also <a href="https://www.tg.org.au">be given</a> to patients undergoing chemotherapy for solid organ cancers (of the breast or prostate, for example), if they are at high risk of infection.</p> <p>While most sore throats are caused by a virus and usually resolve on their own, some high risk patients with a bacterial strep A infection which can cause “scarlet fever” are given antibiotics to prevent a more serious infection like <a href="https://www.rhdaustralia.org.au/">acute rheumatic fever</a>.</p> <h2>How long is a course of antibiotics?</h2> <p>The recommended duration of a course of antibiotics depends on the type of infection, the likely cause, where it is in your body and how effective the antibiotics are at killing the bacteria.</p> <p>In the past, courses were largely arbitrary and based on assumptions that antibiotics should be taken for long enough to eliminate the infecting bacteria.</p> <p>More recent research does not support this and shorter courses are <a href="https://www.acpjournals.org/doi/full/10.7326/M19-1509">nearly always as effective as longer ones</a>, particularly for community acquired respiratory infections.</p> <p>For <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736742/">community acquired pneumonia</a>, for example, research shows a three- to five-day course of antibiotics is at least as effective as a seven- to 14-day course.</p> <p>The “take until all finished” approach is no longer recommended, as the longer the antibiotic exposure, the greater the chance the bacteria will develop resistance.</p> <p>However, for infections where it is more difficult to eradicate the bacteria, such as tuberculosis and bone infections, a combination of antibiotics for many months is usually required.</p> <h2>What if your infection is drug-resistant?</h2> <p>You may have an antibiotic-resistant infection if you don’t get better after treatment with standard antibiotics.</p> <p>Your clinician will collect samples for lab testing if they suspect you have antibiotic-resistant infection, based on your travel history (especially if you’ve been hospitalised in a country with high rates of antibiotic resistance) and if you’ve had a recent course of antibiotics that hasn’t cleared your infection.</p> <p>Antibiotic-resistant infections are managed by prescribing broad-spectrum antibiotics. These are like a sledgehammer, wiping out many different species of bacteria. (Narrow-spectrum antibiotics conversely can be thought of as a scalpel, more targeted and only affecting one or two kinds of bacteria.)</p> <p>Broad-spectrum antibiotics are usually more expensive and come with more severe side effects.</p> <h2>What can patients do?</h2> <p>Decisions about antibiotic prescriptions should be made using <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-specific-conditions">shared decision aids</a>, where patients and prescribers discuss the risks and benefits of antibiotics for conditions like a sore throat, middle ear infection or acute bronchitis.</p> <p>Consider asking your doctor questions such as:</p> <ul> <li>do we need to test the cause of my infection?</li> <li>how long should my recovery take?</li> <li>what are the risks and benefits of me taking antibiotics?</li> <li>will the antibiotic affect my regular medicines?</li> <li>how should I take the antibiotic (how often, for how long)?</li> </ul> <p>Other ways to fight antibiotic resistance include:</p> <ul> <li>returning leftover antibiotics to a pharmacy for safe disposal</li> <li>never consuming leftover antibiotics or giving them to anyone else</li> <li>not keeping prescription repeats for antibiotics “in case” you become sick again</li> <li>asking your doctor or pharmacist what you can do to feel better and ease your symptoms rather than asking for antibiotics.</li> </ul> <p><em><a href="https://theconversation.com/profiles/minyon-avent-1486987">Minyon Avent</a>, Antimicrobial Stewardship Pharmacist, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a>; <a href="https://theconversation.com/profiles/fiona-doukas-1157050">Fiona Doukas</a>, PhD candidate, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a>, and <a href="https://theconversation.com/profiles/kristin-xenos-1491653">Kristin Xenos</a>, Research Assistant, College of Health, Medicine and Wellbeing, School of Biomedical Science and Pharmacy, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a></em></p> <p><em>Image credits: Shutterstock</em></p> <p><em>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/do-you-really-need-antibiotics-curbing-our-use-helps-fight-drug-resistant-bacteria-217920">original article</a>.</em></p>

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Drug resistance may make common infections like thrush untreatable

<p><em><a href="https://theconversation.com/profiles/christine-carson-109004">Christine Carson</a>, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a></em></p> <p>We’ve all heard about antibiotic resistance. This happens when bacteria develop strategies to avoid being destroyed by an antibiotic.</p> <p>The consequences of antibiotic resistance mean an antibiotic previously used to cure bacterial infections no longer works effectively because the bacteria have become resistant to the drug. This means it’s getting harder to cure the infections some bacteria cause.</p> <p>But unfortunately, it’s only one part of the problem. The same phenomenon is also happening with other causes of infections in humans: fungi, viruses and parasites.</p> <p>“Antimicrobial resistance” means the drugs used to treat diseases caused by microbes (bugs that cause infection) no longer work. This occurs with antibacterial agents used against bacteria, antifungal agents used against fungi, anti-parasitic agents used against parasites and antiviral agents used against viruses.</p> <p>This means a wide range of previously controllable infections are becoming difficult to treat – and may become untreatable.</p> <h2>Fighting fungi</h2> <p>Fungi are responsible for a range of infections in humans. Tinea, ringworm and vulvovaginal candidiasis (thrush) are some of the more familiar and common superficial fungal infections.</p> <p>There are also life-threatening fungal infections such as aspergillosis, cryptococcosis and invasive fungal bloodstream infections including those caused by <em>Candida albicans</em> and <em>Candida auris</em>.</p> <p>Fungal resistance to antifungal agents is a problem for several reasons.</p> <p>First, the range of antifungal agents available to treat fungal infections is limited, especially compared to the range of antibiotics available to treat bacterial infections. There are only four broad families of antifungal agents, with a small number of drugs in each category. Antifungal resistance further restricts already limited options.</p> <p>Life-threatening fungal infections happen less frequently than life-threatening bacterial infections. But they’re rising in frequency, especially among people whose immune systems are compromised, including by <a href="https://7news.com.au/news/qld/first-heart-transplant-patient-to-die-from-fungal-infection-at-brisbanes-prince-charles-hospital-identified-as-mango-hill-gp-muhammad-hussain-c-12551559">organ transplants</a> and chemotherapy or immunotherapy for cancer. The threat of getting a drug-resistant fungal infection makes all of these health interventions riskier.</p> <p>The greatest <a href="https://www.frontiersin.org/articles/10.3389/fimmu.2017.00735/full">burden of serious fungal disease</a> occurs in places with limited health-care resources available for diagnosing and treating the infections. Even if infections are diagnosed and antifungal treatment is available, antifungal resistance reduces the treatment options that will work.</p> <p>But even in Australia, common fungal infections are impacted by resistance to antifungal agents. Vulvovaginal candidiasis, known as thrush and caused by <em>Candida</em> species and some closely related fungi, is usually reliably treated by a topical antifungal cream, sometimes supplemented with an oral tablet. However, instances of <a href="https://www.theage.com.au/national/victoria/they-can-t-sit-properly-doctors-treat-growing-number-of-women-with-chronic-thrush-20230913-p5e499.html">drug-resistant thrush</a> are increasing, and new treatments are needed.</p> <h2>Targeting viruses</h2> <p>Even <a href="https://theconversation.com/why-are-there-so-many-drugs-to-kill-bacteria-but-so-few-to-tackle-viruses-137480">fewer antivirals</a> are available than antibacterial and antifungal agents.</p> <p>Most antimicrobial treatments work by exploiting differences between the microbe causing the infection and the host (us) experiencing the infection. Since viruses use our cells to replicate and cause their infection, it’s difficult to find antiviral treatments that selectively target the virus without damaging us.</p> <p>With so few antiviral drugs available, any resistance that develops to one of them significantly reduces the treatment options available.</p> <p>Take COVID, for example. Two antiviral medicines are in widespread use to treat this viral infection: Paxlovid (containing nirmatrelvir and ritonavir) and Lagevrio (molnupiravir). So far, SARS-CoV-2, the virus that causes COVID, has not developed significant resistance to either of these <a href="https://www.cidrap.umn.edu/covid-19/low-levels-resistance-paxlovid-seen-sars-cov-2-isolates">treatments</a>.</p> <p>But if SARS-CoV-2 develops resistance to either one of them, it halves the treatment options. Subsequently relying on one would likely lead to its increased use, which may heighten the risk that resistance to the second agent will develop, leaving us with no antiviral agents to treat COVID.</p> <p>The threat of antimicrobial resistance makes our ability to treat serious COVID infections rather precarious.</p> <h2>Stopping parasites</h2> <p>Another group of microbes that cause infections in humans are single-celled microbes such as <em>Plasmodium</em>, <em>Giardia</em>, <em>Leishmania</em>, and <em>Trypanosoma</em>. These microbes are sometimes referred to as parasites, and they are becoming increasingly resistant to the very limited range of anti-parasitic agents used to treat the infections they cause.</p> <p>Several <em>Plasmodium</em> species cause malaria and anti-parasitic drugs have been the cornerstone of malaria treatment for decades. But their usefulness has been significantly reduced by the <a href="https://www.mmv.org/our-work/mmvs-pipeline-antimalarial-drugs/antimalarial-drug-resistance">development of resistance</a>.</p> <p><em>Giardia</em> parasites cause an infection called giardiasis. This can resolve on its own, but it can also cause severe gastrointestinal symptoms such as diarrhea, nausea, and bloating. These microbes have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207226/">developed resistance</a> to the main treatments and patients infected with drug-resistant parasites can have protracted, unpleasant infections.</p> <h2>Resistance is a natural consequence</h2> <p>Treating infections influences microbes’ evolutionary processes. Exposure to drugs that stop or kill them pushes microbes to either evolve or die. The exposure to antimicrobial agents provokes the evolutionary process, selecting for microbes that are resistant and can survive the exposure.</p> <p>The pressure to evolve, provoked by the antimicrobial treatment, is called “selection pressure”. While most microbes will die, a few will evolve in time to overcome the antimicrobial drugs used against them.</p> <p>The evolutionary process that leads to the emergence of resistance is inevitable. But some things can be done to minimise this and the problems it brings.</p> <p>Limiting the use of antimicrobial agents is one approach. This means reserving antimicrobial agents for when their use is known to be necessary, rather than using them “just in case”.</p> <p>Antimicrobial agents are precious resources, holding at bay many infectious diseases that would otherwise sicken and kill millions. It is imperative we do all we can to preserve the effectiveness of those that remain, and give ourselves more options by working to discover and develop new ones.<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/213460/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/christine-carson-109004">Christine Carson</a>, Senior Research Fellow, School of Medicine, <a href="https://theconversation.com/institutions/the-university-of-western-australia-1067">The University of Western Australia</a></em></p> <p><em>Image credits: Getty Images</em></p> <p><em>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/drug-resistance-may-make-common-infections-like-thrush-untreatable-213460">original article</a>.</em></p>

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5 reasons why climate change may see more of us turn to alcohol and other drugs

<p><em><a href="https://theconversation.com/profiles/helen-louise-berry-8608">Helen Louise Berry</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/francis-vergunst-230743">Francis Vergunst</a>, <a href="https://theconversation.com/institutions/university-of-oslo-934">University of Oslo</a></em></p> <p>Climate change will affect every aspect of our <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01859-7/fulltext">health and wellbeing</a>. But its potential harms go beyond the body’s ability to handle extreme heat, important as this is.</p> <p>Extreme weather events, such as floods, droughts, storms and wildfires, are becoming more frequent and severe. These affect our <a href="https://pubmed.ncbi.nlm.nih.gov/36165756/">mental health</a> in a multitude of <a href="https://www.nature.com/articles/s41558-018-0102-4">ways</a>.</p> <p>Coping with climate change can be overwhelming. Sometimes, the best someone can do is to seek refuge in alcohol, tobacco, over-the-counter and prescription drugs, or other psychoactive substances. This is understandable, but dangerous, and can have serious consequences.</p> <p>We outline <a href="https://journals.sagepub.com/doi/full/10.1177/17456916221132739">five ways</a> climate change could increase the risk of harmful substance use.</p> <h2>1. Mental health is harmed</h2> <p>Perhaps the most obvious way climate change can be linked to harmful substance use is by damaging mental health. This <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.12448">increases the risk</a> of new or worsened substance use.</p> <p>People with a mental disorder are <a href="https://www.hindawi.com/journals/psychiatry/2018/5697103/">at high risk</a> of also having a <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-11-25#:%7E:text=Prevalence%20of%20comorbidity%20in%20epidemiological%20studies&amp;text=Among%20subjects%20with%20an%20alcohol,a%20comorbid%20SUD%20%5B39%5D.">substance-use disorder</a>. This often precedes their mental health problems. Climate change-related increases in the number and nature of extreme events, in turn, are escalating risks to mental health.</p> <p>For example, extreme heat is linked to increased <a href="https://pubmed.ncbi.nlm.nih.gov/27727320/">distress</a> across the whole population. In extreme heat, more people go to the <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2789481">emergency department</a> for psychiatric problems, including for <a href="https://www.sciencedirect.com/science/article/abs/pii/S0048969720338249">alcohol</a> and <a href="https://www.nature.com/articles/s43856-023-00346-1">substance use</a> generally. This is even true for <a href="https://www.sciencedirect.com/science/article/pii/S0048969720325572">a single very hot day</a>.</p> <p>Post-traumatic stress disorder, depression, anxiety and <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja13.10307">other mental health</a> problems are <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2019.00367/full">common</a> at the time of extreme weather events and can persist for months, even years afterwards, especially if people are exposed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9116266/">multiple events</a>. This can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101235/">increase</a> the likelihood of using substances as a way to cope.</p> <h2>2. Worry increases</h2> <p>With <a href="https://climatecommunication.yale.edu/publications/climate-change-in-the-american-mind-beliefs-attitudes-december-2022/">increasing public awareness</a> of how climate change is endangering wellbeing, people are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/worriesaboutclimatechangegreatbritain/septembertooctober2022#:%7E:text=The%20level%20of%20worry%20about,lives%20right%20now%20(29%25).">increasingly worried</a> about what will happen if it remains unchecked.</p> <p>Worrying isn’t the same as meeting the criteria for a mental disorder. But <a href="https://www.undp.org/publications/peoples-climate-vote">surveys</a> show climate change generates complex emotional responses, <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00278-3/fulltext">especially in children</a>. As well as feelings of worry, there is anxiety, fear, guilt, anger, grief and helplessness.</p> <p>Some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904966/">emotional states</a>, such as <a href="https://www.pnas.org/doi/full/10.1073/pnas.1909888116">sadness</a>, are linked with long-term tobacco use and also make substance use <a href="https://pubmed.ncbi.nlm.nih.gov/16011392/">relapse</a> more likely.</p> <h2>3. Physical injuries hurt us in many ways</h2> <p>Physical injuries caused by extreme weather events – such as smoke inhalation, burns and flood-related cuts and infections – increase the risk of harmful substance use. That’s partly because they <a href="https://pubmed.ncbi.nlm.nih.gov/20033251/">increase</a> the risk of psychological distress. If injuries cause long-term illness or disability, consequent feelings of hopelessness and depression can dispose some people to self-medicate with alcohol or other drugs.</p> <p>Substance use itself can also generate long-term physiological harm, disabilities or other chronic health problems. These are <a href="https://www.tandfonline.com/doi/abs/10.3109/00952999609001655">linked with</a> higher rates of harmful substance use.</p> <h2>4. Our day-to-day lives change</h2> <p>A single catastrophic event, such as a storm or flood, can devastate lives overnight and change the way we live. So, too, can the more subtle changes in climate and day-to-day weather. Both can disrupt behaviour and routines in ways that risk new or worsened substance use, for example, using stimulants to cope with fatigue.</p> <p>Take, for example, hotter temperatures, which disrupt <a href="https://www.cell.com/one-earth/fulltext/S2590-3322(22)00209-3?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2590332222002093%3Fshowall%3Dtrue">sleep</a>, undermine <a href="https://jhr.uwpress.org/content/57/2/400">academic performance</a>, <a href="https://www.nature.com/articles/s41562-017-0097">reduce physical activity</a>, and promote <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00173-5/fulltext">hostile language</a> and <a href="https://www.cambridge.org/core/elements/abs/climate-change-and-human-behavior/F64471FA47B8A6F5524E7DDDDE571D57">violent behaviour</a>.</p> <h2>5. It destabilises communities</h2> <p>Finally, climate change is destabilising the socioeconomic, natural, built and geopolitical <a href="https://www.nature.com/articles/s41558-018-0102-4">systems</a> on which human wellbeing – <a href="https://theconversation.com/climate-change-and-health-ipcc-reports-emerging-risks-emerging-consensus-24213">indeed survival</a> – depends.</p> <p>Damaged infrastructure, agricultural losses, school closures, homelessness and displacement are significant <a href="https://www.nature.com/articles/s41558-018-0102-4">sources of psychosocial distress</a> that prompt acute (short-term) and chronic (long-term) stress responses.</p> <p><a href="https://doi.org/10.1196/annals.1441.030">Stress</a>, in turn, can <a href="https://doi.org/10.1007/s002130100917">increase</a> the risk of <a href="https://link.springer.com/article/10.1007/s002130100917">harmful substance use</a> and make people more likely to relapse.</p> <h2>Why are we so concerned?</h2> <p>Substance-use disorders are economically and socially <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30337-7/fulltext">very costly</a>. Risky substance use that doesn’t meet the criteria for a formal diagnosis <a href="https://digitalcommons.fiu.edu/srhreports/health/health/32/">can also harm</a>.</p> <p>Aside from its direct physical harm, harmful substance use disrupts <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843305/">education</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234116/">employment</a>. It increases the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676144/">accidents</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/09595230600944479">crime</a>, and it undermines social relationships, intimate <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795906/#:%7E:text=Results%20indicated%20that%20alcohol%20use,drinkers%20with%20low%20relationship%20satisfaction.">partnerships</a> and <a href="https://www.cambridge.org/core/journals/development-and-psychopathology/article/abs/longitudinal-relations-between-parental-drinking-problems-family-functioning-and-child-adjustment/CE508589A9E799FD6DC9E23DF364FB8F">family functioning</a>.</p> <h2>Politicians take note</h2> <p>As we head towards the <a href="https://www.cop28.com">COP28 global climate talks</a> in Dubai, climate change is set to hit the headlines once more. Politicians know climate change is undermining human health and wellbeing. It’s well past time to insist they act.</p> <p>As we have seen for populations as a whole, there are multiple possible ways for climate change to cause a rise in harmful substance use. This means multidimensional <a href="https://www.nature.com/articles/s41558-018-0102-4">prevention strategies</a> are needed. As well as addressing climate change more broadly, we need strategies including:</p> <ul> <li> <p>supporting vulnerable individuals, especially <a href="https://journals.sagepub.com/doi/full/10.1177/21677026211040787">young people</a>, and marginalised commmunities, who are <a href="https://www.nature.com/articles/s41558-018-0102-4">hit hardest</a> by extreme weather-related events</p> </li> <li> <p>focusing health-related policies more on broadscale health promotion, for example, healthier eating, active transport and community-led mental health support</p> </li> <li> <p>investing in climate-resilient infrastructure, such as heat-proofing buildings and greening cities, to prevent more of the destabilising effects and stress we know contributes to mental health problems and harmful substance use.</p> </li> </ul> <p>There is now <a href="https://news.un.org/en/story/2022/10/1129912">no credible pathway</a> to avoiding dangerous climate change. However, if <a href="https://carnegieendowment.org/2023/01/12/climate-protests-tracking-growing-unrest-pub-88778#:%7E:text=These%20are%20just%20a%20few,even%20more%20numerous%20and%20influential.">increasing rates</a> of climate protests are anything to go by, the world may finally be ready for radical change – and perhaps for reduced harmful substance use.<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/217894/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /></p> <p><em><a href="https://theconversation.com/profiles/helen-louise-berry-8608">Helen Louise Berry</a>, Honorary Professor, Centre for Health Systems and Safety Research, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> and <a href="https://theconversation.com/profiles/francis-vergunst-230743">Francis Vergunst</a>, Associate Professor, Psychosocial Difficulties, <a href="https://theconversation.com/institutions/university-of-oslo-934">University of Oslo</a></em></p> <p><em>Image credits: Getty Images </em></p> <p><em>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/5-reasons-why-climate-change-may-see-more-of-us-turn-to-alcohol-and-other-drugs-217894">original article</a>.</em></p>

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