Tagged Weight

‘How Did You Qualify?’ For the Young and Vaccinated, Rude Questions and Raised Eyebrows

Medical privacy has become the latest casualty of vaccination efforts, as friends, co-workers and even total strangers ask intrusive questions about personal health conditions.

Peter Gamlen

When Helena Jenkins, 23, recently asked to leave work early for a vaccination appointment, her boss at a Nashville retail store was incredulous.

“Well how did you get that?” he asked.

Ms. Jenkins was embarrassed, but answered truthfully. “Um, my weight,” she stammered, referring to the fact that, in Tennessee, a body mass index of 30 qualified her for vaccination in early March. “I had a moment of ‘ugh,’” she said later. “It made me so uncomfortable, but it didn’t click until afterward that I definitely didn’t have to answer that.”

As public health officials push to get more at-risk people vaccinated, many of the newly qualified are discovering an unwelcome side effect of vaccination: Intrusive questions about their personal health.

The majority of states now have expanded vaccine eligibility to include people with underlying health conditions that put them at risk for complications from Covid-19, such as high blood pressure, a compromised immune system or obesity. As a result, the demographics of the vaccine waiting lines have shifted from mostly older people and now include many seemingly healthy people in their 20s, 30s and 40s. Young vaccine recipients say their friends and co-workers are intensely curious about the appointment process, and as a result, often ignore boundaries about personal health that they never would have crossed in the past. Some of them ask directly: “What health problem allowed you to qualify?”

When Amy Coody, 43, a mental health worker in Montgomery, Ala., told her friends and colleagues she had a vaccine appointment, she was shocked when it felt like people were judging her and assuming she had taken another person’s spot in line. Ms. Coody knows that she looks young and healthy, but she qualifies for two reasons — her work takes her into hospital settings, and she also has an underlying health condition that puts her at high risk.

“The hostility was definitely there,” she said. “They’d be like, ‘Wait, how did you get an appointment?’ I wasn’t prepared for that kind of reaction. It took me off guard so I eventually stopped telling people I planned to get the vaccine.”

Vaccine supply issues resulted in the cancellation of two of her appointments, and the shaming even made her debate rescheduling. “I would never want to step in front of somebody who needed it,” said Ms. Coody. “Then I realized, I do need it. There are a lot of patients in hospitals waiting for care. I thought, it’s about them. It’s not about me and my shame or anybody else who doesn’t understand the situation.”

Getting policed about a hidden health issue isn’t new to Ms. Coody, who has a condition called dysautonomia, a disorder of the autonomic nervous system that can cause her to suddenly pass out. She said the vaccine shaming she has experienced was similar to when she’s been confronted after parking in a handicapped space, even though she has a tag that allows her to park there.

“People come up to me and say, ‘You’re young and you obviously don’t have an illness so why are you taking a handicap spot?’” Ms. Coody said. “Even though it’s none of their business, I feel the need to defend myself. If more people realized there are invisible illnesses out there, maybe they might be a little more respectful about it.”

Even total strangers waiting in vaccine lines have felt justified in interrogating someone who looks young and healthy. Those on the receiving end of the questions say the implication is that they must have cheated and jumped the line.

Joanna Hua, 23 and a graduate student at Georgetown University, was standing in line for her second dose recently when an older woman she’d never met confronted her. “She looked at me and said, ‘You look very young to be getting the vaccine,’” Ms. Hua recounted. “She asked me, ‘How did you end up being able to qualify for one?’”

Ms. Hua said she was taken aback by the question. She told the woman truthfully that she qualified because she worked in a grocery store, but she didn’t mention that she also qualified based on her weight. She said another young woman in line near her also nervously explained her reasons for qualifying.

“I felt an instinctive need to justify myself,” said Ms. Hua. “It felt almost accusatory and invasive to ask about it. I think there is some sort of idea going around that people are just taking advantage and trying to get a vaccine whenever possible. I don’t doubt that some people do that. But to have a stranger come up and ask you?”

Tanmoy Lala Das, a medical and doctoral student in New York City, has been helping with vaccination efforts in Manhattan, giving shots to patients and helping as a patient navigator. He said overall the experience at vaccination centers has been upbeat, and everyone is collegial and happy to be there. But he has, on occasion, heard people asking others about personal health issues while waiting in line for their shots.

“I’ve overheard people ask, ‘So what brings you in today?’” Mr. Das said. “The less stigmatized conditions people are open to talking about. They’d laugh and say, “Oh, you know, diabetes.’ I think the ones who are more sensitive, they say, ‘Oh, I just got a spot.’”

It doesn’t help that many people know someone who has jumped the line by claiming to be a teacher or a smoker or lying about a health condition. In New York a fitness instructor got vaccinated by claiming to be an educator, and in Florida two women even “dressed up as grannies” to get the vaccine.

“I think in New York, people are trying to figure out these dynamics of are you getting the dose because it was left over, or a condition that qualifies you or did you lie about something,” said Mr. Das. “The honest reality is I know people who have cut the line and lied about things — 29-year-old people who have gotten vaccines who don’t have pre-existing conditions. But I think most people are not lying. The goal is to vaccinate everyone.”

Rhonda Wolfson, who lives in Toronto, said that in places where the vaccination process still is age-restricted, it has created a different privacy problem, casting light on the fact that a person is above a certain age. Ms. Wolfson qualified for a pilot vaccination program in Ontario for people aged 60 to 64, and she realized that talking about her vaccination would reveal her as a sexagenarian to people who thought she was younger.

“I have one friend in her 40s, and she knows I’m older, but she doesn’t know my exact age,” said Ms. Wolfson. “She’s never asked, and I’ve never offered. I spoke to her last week and in my excitement I mentioned, ‘OMG, I got vaccinated.’ I could almost hear her pause, ‘Oh, you’re that age.’”

In some circles, the stigma of early vaccination is even more concerning because it could dissuade at-risk people from getting the shot. In the gay community, for instance, a young person who gets vaccinated in the early group might be seen to be immunocompromised.

“In the gay community there is this assumption that if you are getting the vaccine right now you must be secretly H.I.V. positive,” said Mr. Das, who is gay. “It has become an assumption in the community that if you’re a gay and you post a picture of the vaccine card, you’re positive and haven’t told us. I always talk to my friends and tell them, ‘Don’t assume things.’”

Mr. Das said he is hopeful that any stigma or medical privacy issues associated with early vaccination will disappear once vaccine appointments are open to everyone. President Biden has urged all states to expand medical eligibility to the general population by May 1, and many states, including Alaska, Arizona, Georgia and Mississippi, have already made the change.

“The sooner we get to vaccinating everyone, I think this question of ‘Oh, what qualified you?’ will stop,” Mr. Das said. “Once that goes away hopefully these barriers will break down, and people won’t keep asking these very personal questions.”

Weekly Health Quiz: Weight Gain, Covid and Exercise

1 of 7

During pandemic lockdowns, Americans gained, on average, about how many pounds a month?

Half a pound

1 pound

2 pounds

4 pounds

2 of 7

Spread of coronavirus at the gym would likely be highest among people attending this type of group exercise class:

Pilates

Yoga

Strength training

Spin class

3 of 7

Too much high-intensity exercise resulted in signs of damage to these cell structures, the energy generators found in every cell:

Ribosomes

Mitochondria

Lysozymes

Centrioles

4 of 7

Doctors are exploring a possible link between Covid-19 and ringing in the ears, a medical condition known as:

Anosmia

Dysgeusia

Tinnitus

Otitis

5 of 7

True or false? Once you’ve been fully vaccinated against coronavirus, you are fully protected against symptoms of Covid.

True

False

6 of 7

A study of patients in California who suffered from long-haul Covid found that this proportion had no cough, fever or other symptoms in the first 10 days after testing positive for coronavirus:

A tenth

A quarter

A third

Half

7 of 7

This psychiatric condition, formerly known as multiple personality disorder and depicted in films like “Sybil” and “The Three Faces of Eve,” now goes by this name:

Schizoaffective disorder

Borderline personality disorder

Dissociative identity disorder

Post-traumatic stress disorder

How Much Weight Did We Gain During Lockdowns? 2 Pounds a Month, Study Hints

Many Americans know they’ve put on weight during the pandemic, but it’s been difficult for experts to detail the scope of the problem.

Soon after the pandemic started over a year ago, Americans started joking about the dreaded “quarantine 15,” worried they might gain weight while shut in homes with stockpiles of food, glued to computer screens and binge-watching Netflix.

The concern is real, but assessing the problem’s scope has been a challenge. Surveys that simply ask people about their weight are notoriously unreliable, and many medical visits have been virtual.

Now a very small study using objective measures — weight measurements from Bluetooth-connected smart scales — suggests that adults under shelter-in-place orders gained more than half a pound every 10 days.

That translates to nearly two pounds a month, said Dr. Gregory M. Marcus, senior author of the research letter, published on Monday in the peer-reviewed JAMA Network Open. Americans who kept up their lockdown habits could easily have gained 20 pounds over the course of a year, he added.

“We know that weight gain is a public health problem in the U.S. already, so anything making it worse is definitely concerning, and shelter-in-place orders are so ubiquitous that the sheer number of people affected by this makes it extremely relevant,” said Dr. Marcus, a cardiologist and professor of medicine at University of California, San Francisco.

While it is almost impossible to make generalizations based on the study — which included fewer than 300 people scattered across the United States — all participants were tracking their weight regularly.

Many of these people were losing weight before shelter-in-place orders were issued in their states, Dr. Marcus noted. “It’s reasonable to assume these individuals are more engaged with their health in general, and more disciplined and on top of things,” he said. “That suggests we could be underestimating — that this is the tip of the iceberg.”

Excess weight has been linked to a greater risk of developing more severe Covid-19 disease, and the United States already has among the highest rates of overweight and obesity in the world. Some 42 percent of American adults over age 20 have obesity, as defined by body mass index, while another 32 percent of Americans are simply overweight.

The risk of severe illness has been documented among young adults who are overweight or obese, as well. Many states are prioritizing people who are overweight or obese for vaccination, along with those who have other chronic conditions like diabetes or hypertension.

The new study analyzed data obtained from 269 participants who were involved in an ongoing cardiology study, the Health eHeart Study. They volunteered to report weight measurements from Bluetooth-connected smart scales and weighed themselves regularly; the researchers gathered 7,444 weight measurements over a four-month period, an average of 28 weight measurements from each participant.

The group was not nationally representative, by any means, so the results are not generalizable: About three-quarters were white, and just 3.5 percent identified as Black or African-American; about 3 percent identified as Asian-American. The average age was 51, and they were split almost evenly among men and women.

The participants were from 37 states and the District of Columbia. The researchers analyzed weight measurements taken between Feb. 1, 2020, and June 1, 2020, in order to look at weight changes both before and after shelter-in-place orders were issued for each state.

While the participants mostly had been losing pounds before the orders were issued, their weights rose steadily at a rate of about six-tenths of a pound every 10 days after the orders were issued, regardless of where they were in the country and regardless of chronic medical conditions.

The lockdowns have certainly had an effect on dietary patterns, on what people eat and how often they eat. But the restrictions also curtailed the humdrum physical activity that is part and parcel of daily living, the researchers said.

“If you think about people commuting, even running to the subway or bus stop, or stepping in at the post office to mail a letter, or stopping at the store — we burn a lot of calories in non-exercise activities of daily living,” said Leanne Redman, a professor of clinical physiology at the Pennington Biomedical Research Center, part of Louisiana State University.

Her research had found that people were eating a healthier diet during the initial days of the shutdown but were more sedentary.

An earlier study by U.C.S.F. researchers looked at daily step counts, as tracked by smartphones, among nearly half a million people in nearly 200 countries. The number of steps people took declined by 27 percent a month after the World Health Organization declared the pandemic.

The concern about exercise also extends to children, who are known to pack on unhealthy pounds during the summer recess months when they are not in school. The risk is even greater for Hispanic and Black children than for white children, said Andrew G. Rundle, an associate professor of epidemiology at Columbia University’s Mailman School of Public Health, author of a recent paper that expressed concern that school closings would exacerbate existing racial health disparities.

“We argued that being out of school, which we thought would go on for six months and has gone on longer, was going to be like the summer recess but even worse, because everyone would be loading up on shelf-stable calorie-laden food, and staying indoors and not going out,” he said. “Everything that makes the summer dangerous for kids would be magnified by the lockdown.”

The Pandemic as a Wake-Up Call for Personal Health

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Personal Health

The Pandemic as a Wake-Up Call for Personal Health

Too many Americans fail to take measures to combat obesity, the second leading risk factor for death from Covid-19.

Credit…Gracia Lam
Jane E. Brody

  • March 15, 2021, 5:00 a.m. ET

The pandemic has shed a blinding light on too many Americans’ failure to follow the well-established scientific principles of personal health and well-being. There are several reasons this country, one of the world’s richest and most highly developed, has suffered much higher rates of Covid-19 infections and deaths than many poorer and less well-equipped populations.

Older Americans have been particularly hard hit by this novel coronavirus. When cases surged at the end of last year, Covid-19 became the nation’s leading cause of death, deadlier than heart disease and cancer.

But while there’s nothing anyone can do to stop the march of time, several leading risk factors for Covid-19 infections and deaths stem from how many Americans conduct their lives from childhood on and their misguided reliance on medicine to patch up their self-inflicted wounds.

After old age, obesity is the second leading risk factor for death among those who become infected and critically ill with Covid-19. Seventy percent of Americans adults are now overweight, and more than a third are obese. Two other major risks for Covid, Type 2 diabetes and high blood pressure, are most often the result of excess weight, which in turn reflects unhealthy dietary and exercise habits. These conditions may be particularly prevalent in communities of color, who are likewise disproportionately affected by the pandemic.

Several people I know packed on quite a few pounds of health-robbing body fat this past year, and not because they lacked the ability to purchase and consume a more nutritious plant-based diet or to exercise regularly within or outside their homes. One male friend in his 50s unexpectedly qualified for the Covid vaccine by having an underlying health condition when his doctor found he’d become obese since the pandemic began.

A Harris Poll, conducted for the American Psychological Association in late February, revealed that 42 percent of respondents had gained an average of 29 “pandemic pounds,” increasing their Covid risk.

So what can we learn from these trends? Tom Vilsack, the new Secretary of Agriculture, put it bluntly a week ago in Politico Pro’s Morning Agriculture newsletter: “We cannot have the level of obesity. We cannot have the level of diabetes we have. We cannot have the level of chronic disease … It will literally cripple our country.”

Of course, in recent decades many of the policies of the department Mr. Vilsack now heads have contributed mightily to Americans’ access to inexpensive foods that flesh out their bones with unwholesome calories and undermine their health. Two telling examples: The government subsidizes the production of both soybeans and corn, most of which is used to feed livestock.

Not only does livestock production make a major contribution to global warming, much of its output ends up as inexpensive, often highly processed fast foods that can prompt people to overeat and raise their risk of developing heart disease, diabetes, high blood pressure and kidney disease. But there are no subsidies for the kinds of fruits and vegetables that can counter the disorders that render people more vulnerable to the coronavirus.

As Mr. Vilsack said, “The time has come for us to transform the food system in this country in an accelerated way.”

Early in the pandemic, when most businesses and entertainment venues were forced to close, toilet paper was not the only commodity stripped from market shelves. The country was suddenly faced with a shortage of flour and yeast as millions of Americans “stuck” at home went on a baking frenzy. While I understood their need to relieve stress, feel productive and perhaps help others less able or so inclined, bread, muffins and cookies were not the most wholesome products that might have emerged from pandemic kitchens.

When calorie-rich foods and snacks are in the home, they can be hard to resist when there’s little else to prompt the release of pleasure-enhancing brain chemicals. To no one’s great surprise, smoking rates also rose during the pandemic, introducing yet another risk to Covid susceptibility.

And there’s been a run on alcoholic beverages. National sales of alcohol during one week in March 2020 were 54 percent higher than the comparable week the year before. The Harris Poll corroborated that nearly one adult in four drank more alcohol than usual to cope with pandemic-related stress. Not only is alcohol a source of nutritionally empty calories, its wanton consumption can result in reckless behavior that further raises susceptibility to Covid.

Well before the pandemic prompted a rise in calorie consumption, Americans were eating significantly more calories each day than they realized, thanks in large part to the ready availability of ultra-processed foods, especially those that tease, “you can’t eat just one.” (Example: Corn on the cob is unprocessed, canned corn is minimally processed, but Doritos are ultra-processed).

In a brief but carefully designed diet study, Kevin D. Hall and colleagues at the National Institutes of Health surreptitiously gave 20 adults diets that were rich in either ultra-processed foods or unprocessed foods matched for calorie, sugar, fat, sodium, fiber and protein content. Told to eat as much as they wanted, the unsuspecting participants consumed 500 calories a day more on the ultra-processed diet.

If you’ve been reading my column for years, you already know that I’m not a fanatic when it comes to food. I have many containers of ice cream in my freezer; cookies, crackers and even chips in my cupboard; and I enjoy a burger now and then. But my daily diet is based primarily on vegetables, with fish, beans and nonfat milk my main sources of protein. My consumption of snacks and ice cream is portion-controlled and, along with daily exercise, has enabled me to remain weight-stable despite yearlong pandemic stress and occasional despair.

As Marion Nestle, professor emerita of nutrition, food studies and public health at New York University, says, “This is not rocket science.” She does not preach deprivation, only moderation (except perhaps for a total ban on soda). “We need a national policy aimed at preventing obesity,” she told me, “a national campaign to help all Americans get healthier.”

Severe Obesity Raises Risk of Covid-19 Hospitalization and Death, Study Finds

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Severe Obesity Raises Risk of Covid-19 Hospitalization and Death, Study Finds

A large new study has confirmed an association between obesity and patient outcomes among people who contract the coronavirus.

A Covid-19 patient in the intensive care unit at Sharp Coronado Hospital in Southern California in January.
A Covid-19 patient in the intensive care unit at Sharp Coronado Hospital in Southern California in January.Credit…Etienne Laurent/EPA, via Shutterstock

  • March 8, 2021, 6:56 p.m. ET

Over the past year, many scientific teams around the world have reported that obese people who contract the coronavirus are especially likely to become dangerously ill.

Now, a large new study, of nearly 150,000 adults at more than 200 hospitals across the United States, paints a more detailed picture of the connection between weight and Covid-19 outcomes.

The study, performed by a team of researchers as the Centers for Disease Control and Prevention, has confirmed that obesity significantly increases the risk for hospitalization and death among those who contract the virus. And among those who are obese, the risk increases as a patient’s body mass index, or B.M.I., a ratio of weight to height, increases. Patients with a B.M.I. of 45 or higher, which corresponds to severe obesity, were 33 percent more likely to be hospitalized and 61 percent more likely to die than those who were at a healthy weight, the researchers found.

“The findings of the study highlight the serious clinical public health implications of elevated B.M.I., and they suggest the continued need for intensive management of Covid-19 illness, especially among patients affected by severe obesity,” said the lead author, Lyudmyla Kompaniyets, a health economist at the Division of Nutrition, Physical Activity and Obesity at the C.D.C.

But the relationship between weight and outcomes is nuanced. Covid-19 patients who were underweight were also more likely to be hospitalized than those who were at a healthy weight, although they were not more likely to be admitted to the intensive care unit or to die.

Dr. Kompaniyets and her colleagues used a database of Covid-19 cases to identify 148,494 adults who received a diagnosis of the disease at American hospitals from last March to December. They calculated the B.M.I. of each patient and looked for correlations between B.M.I. and a variety of serious outcomes, including hospitalization, I.C.U. admission, mechanical ventilation and death.

They found that obesity, which is defined as a B.M.I. of 30 or higher, increased the risk of both hospitalization and death. Patients with a B.M.I. of 30 to 34.9 were just 7 percent more likely to be hospitalized and 8 percent more likely to die than people who were at a healthy weight, but the risks increased sharply as B.M.I. rose.

Providing evidence for this kind of “dose response” relationship makes the study particularly compelling, said Dr. Anne Dixon, the director of pulmonary and critical care medicine at the University of Vermont Medical Center, who was not involved in the research. “What it shows is the more severe your obesity, the worse the effect is. And the fact that goes up stepwise with increasing levels of obesity, I think, adds sort of biological plausibility to the relationship between obesity and the outcome.”

The connection between obesity and poor outcomes was strongest among patients under 65, but it held even for older adults. Previous, smaller studies have not found strong links between obesity and severity of Covid-19 in older adults.

“Potentially because they had more power from this large sample size, they’ve demonstrated that obesity remains an important risk factor for death in older adults as well,” said Dr. Michaela R. Anderson, an expert in pulmonary and critical care medicine at Columbia University Medical Center, who was not involved in the study. “It’s a beautifully done study with a massive population.”

Dr. Kompaniyets and her colleagues also documented a linear relationship between B.M.I. and the likelihood of needing mechanical ventilation; the higher the B.M.I., the more likely a patient was to require such intervention, which is invasive and can come with serious complications.

The study also found that patients who were underweight, with a B.M.I. below 18.5, were 20 percent more likely to be hospitalized than those who had a healthy weight. The reasons are not entirely clear, but may stem from the fact that some of these patients were malnourished or frail or had other diseases.

The B.M.I. range associated with the best outcomes, the researchers found, was near the dividing line between what is considered healthy and overweight, consistent with some prior research suggesting that a few extra pounds might help protect people when they contract an infectious disease.

“Exactly why that association exists is currently unknown,” said Dr. Alyson Goodman, a pediatrician and medical epidemiologist at the C.D.C. and a co-author of the study. One possibility is that having a bit of extra fat may provide much needed energy reserves over the course of a long illness.

The findings highlight the importance of carefully managing the care of patients who are severely obese and of ensuring that people who are obese have access to vaccines and other preventive measures.

“This just provides further evidence for the recommendation to vaccinate those with a high B.M.I. as early as feasible,” said Sara Y. Tartof, an infectious disease epidemiologist at the Department of Research & Evaluation at Kaiser Permanente, who was not involved in the study.

Coronavirus Vaccine and BMI? Yes You Should Get Vaccinated.

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A High B.M.I. Can Get You Vaccinated Earlier, Junk Science or Not

A body mass index, or B.M.I., that indicates a risk for obesity can qualify someone for the Covid-19 vaccine, even if the measurement is outdated.

Credit…William Antonelli
Sandra E. Garcia

  • March 5, 2021, 11:01 a.m. ET

Rebecca O’Neal didn’t believe she qualified for a Covid-19 vaccine. She had not realized that her turn had come. Last week, when she scrolled through the eligibility requirements for the state of New York, she noticed body mass index on the list.

Body mass index, or B.M.I., is technically a measure of obesity. The quantifier was drawn up in the 1930s by the Metropolitan Life Insurance Company to assess risk. Since a B.M.I. is a formula that does not consider several important factors like where the body fat is or if any vital organs are surrounded by fat, experts say to take the indicator with a grain of salt. But even so, a B.M.I. that indicates obesity has been a source of agitation for people who believe their doctors have used it to discriminate against them because of their weight.

Ms. O’Neal, a 34-year-old comedian and writer in Brooklyn, didn’t worry about that in the moment. She calculated her B.M.I. (it’s essentially your weight compared to your height), found that she met this technical threshold for obesity, and booked a vaccine appointment for the same day. She received the first dose later that afternoon.

“I didn’t know that my B.M.I. was 30,” Ms. O’Neal said in a phone interview. “I cracked a lot of jokes about it on Twitter, but it was a relief that I was eligible at all.”

Ms. O’Neal is one of millions of Americans, in states like New York, Utah and Texas, who are qualified to be vaccinated based on their B.M.I. While obesity has been linked to more severe cases of Covid-19, of the 500,000 Americans who have died from the coronavirus, 17,770 were overweight and had obesity listed as a contributing factor in their death, according to the Centers for Disease Control and Prevention.

Relying on a B.M.I. to judge one’s risk of serious health conditions is complicated. Many healthy people still fall in the “overweight” category based on their body proportions, with no distinction made between bone density, muscle mass and body fat.

This is particularly the case for women, Black adults and people with low incomes who make up the majority of Americans who have been diagnosed with obesity by such standards. That has a lot to do with the fact that the original calculus was developed by and for white men.

For many, using their misleading high B.M.I. to get inoculated is a fraught decision.

As Emma Specter put it in Vogue, writing about her decision to get a vaccine based on the B.M.I. qualification: “A metric of health that has long been called into question by fat activists and medical experts alike could stand to actively benefit fat people for the first time.”

Many other people are making the same decision — and posting about it online.

Some wrestled with whether it was ethical to receive a vaccine based on a metric that could have little bearing on their risk of serious illness.

“Taking care of the sick and the elderly and the health care workers, I understand all that — but at some point they should have open it to whoever can grab,” Raffaele Rispo, 38, a barber from Saratoga Springs, N.Y. who received a vaccine recently because of his B.M.I., said in an interview. “I understood that the older, more sick should get it first — but when they changed it, I was happy.”

Mr. Rispo has not seen his parents, who live two-and-a-half hours away from him, or his 15-year-old son who also lives a few hours away, in a year. He was ready to return to “some normalcy,” even though he understood B.M.I.’s are unreliable, he said.

While unreliable, a B.M.I. can serve a purpose; it can be used to screen for weight categories that may lead to health problems, according to the C.D.C., but it is not diagnostic of the person’s body fat or health.

“B.M.I. by itself is not a great measure,” said Dr. Fatima Cody Stanford, an expert in obesity medicine and nutrition at Harvard Medical School. “It doesn’t tell me if that’s fat mass that’s causing inflammation. It doesn’t tell me if that’s water weight, it doesn’t give me those types of specific details.”

For those who do meet the B.M.I. requirement for the vaccine, that measurement has presented a rare opportunity. William Antonelli said that once his sister realized that she qualified for the vaccine because of her B.M.I., she set up an appointment for him, too. A few days later, Mr. Antonelli, 24, an editor at Insider, received his first vaccine jab.

“When it comes to a disease like this, there really is not a wrong person to vaccinate,” he said. “The problem is not me applying for something I am eligible for, it’s the rollout. The issue lies with the government system that has led us to this point.”

Weekly Health Quiz: Diet, Weight and Covid

1 of 7

A study of Shuar children in Amazonian Ecuador suggests that this factor is the most important contributor to weight gain:

Diet

Exercise

Hormones

Socioeconomic status

2 of 7

The Centers for Disease Control and Prevention linked an outbreak of coronavirus cases in Chicago and Honolulu to carelessness about masks and symptoms in these venues:

Restaurants

Concert halls

Gyms

Churches

3 of 7

These masks, made in South Korea, are a good option for the general public for protection against coronavirus, with a high filtration rate and moldable nose bridge providing a good fit:

N95 masks

KN95 masks

KF94 masks

Surgical masks

4 of 7

A new variant of the coronavirus called B.1.526 is spreading rapidly in this city, worrying experts because it may have added resistance to vaccines:

Los Angeles

New York

Seattle

Miami

5 of 7

Shoe soles embedded with this substance were effective in preventing slipping and sliding on snow and ice:

Asbestos

Grit and glass fibers

Chalk

Salt crystals

6 of 7

The potentially dangerous Covid-related disorder known as multisystem inflammatory syndrome in children, or MIS-C, appears to be most common in children of this age:

Birth to 3 years

3 to 6 years

6 to 12 years

Over 12 years

7 of 7

A transplant patient died after receiving a donation of this organ infected with coronavirus:

Heart

Lungs

Liver

Kidney

Exercise vs. Diet? What Children of the Amazon Can Teach Us About Weight Gain

A young girl carries harvested food, part of the traditional hunting and gathering lifestyle of the Shuar of Amazonian Ecuador.
A young girl carries harvested food, part of the traditional hunting and gathering lifestyle of the Shuar of Amazonian Ecuador.Credit…Samuel S. Urlacher, Ph.D.

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Phys Ed

Exercise vs. Diet? What Children of the Amazon Can Teach Us About Weight Gain

What we eat may be more important than how much we move when it comes to fighting obesity.

A young girl carries harvested food, part of the traditional hunting and gathering lifestyle of the Shuar of Amazonian Ecuador.Credit…Samuel S. Urlacher, Ph.D.

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Gretchen Reynolds

  • Feb. 24, 2021, 5:00 a.m. ET

When children gain excess weight, the culprit is more likely to be eating too much than moving too little, according to a fascinating new study of children in Ecuador. The study compared the lifestyles, diets and body compositions of Amazonian children who live in rural, foraging communities with those of other Indigenous children living in nearby towns, and the results have implications for the rising rates of obesity in both children and adults worldwide.

The in-depth study found that the rural children, who run, play and forage for hours, are leaner and more active than their urban counterparts. But they do not burn more calories day-to-day, a surprising finding that implicates the urban children’s modernized diets in their weight gain. The findings also raise provocative questions about the interplay of physical activity and metabolism and why exercise helps so little with weight loss, not only in children but the rest of us, too.

The issue of childhood obesity is of pressing global interest, since the incidence keeps rising, including in communities where it once was uncommon. Researchers variously point to increasing childhood inactivity and junk food diets as drivers of youthful weight gain. But which of those concerns might be more important — inactivity or overeating — remains murky and matters, as obesity researchers point out, because we cannot effectively respond to a health crisis unless we know its causes.

That question drew the interest of Sam Urlacher, an assistant professor of anthropology at Baylor University in Waco, Texas, who for some time has been working among and studying the Shuar people. An Indigenous population in Amazonian Ecuador, the traditional Shuar live primarily by foraging, hunting, fishing and subsistence farming. Their days are hardscrabble and physically demanding, their diets heavy on bananas, plantains and similar starches, and their bodies slight. The Shuar, especially the children, are rarely overweight. They also are not often malnourished.

But were their wiry frames a result mostly of their active lives, Dr. Urlacher wondered? As a postgraduate student, he had worked with Herman Pontzer, an associate professor of evolutionary anthropology at Duke University, whose research focuses on how evolution may have shaped our metabolisms and vice versa.

In Dr. Pontzer’s pioneering research with the Hadza, a tribe of hunter-gatherers in Tanzania, he found that, although the tribespeople moved frequently during the day, hunting, digging, dragging, carrying and cooking, they burned about the same number of total calories daily as much-more-sedentary Westerners.

Dr. Pontzer concluded that, during evolution, we humans must have developed an innate, unconscious ability to reallocate our body’s energy usage. If we burn lots of calories with, for instance, physical activity, we burn fewer with some other biological system, such as reproduction or immune responses. The result is that our average, daily energy expenditure remains within a narrow band of total calories, helpful for avoiding starvation among active hunter-gatherers, but disheartening for those of us in the modern world who find that more exercise does not equate to much, if any, weight loss. (Dr. Pontzer’s highly readable new book on this topic, “Burn,” will be published on March 2. )

A young Shuar boy fills a water gourd in the river.
A young Shuar boy fills a water gourd in the river.Credit…Samuel S. Urlacher, Ph.D.

Dr. Pontzer’s work focuses primarily on Hadza adults, but Dr. Urlacher wondered if similar metabolic trade-offs might also exist in children, including among the traditional Shuar. So, for a 2019 study, he precisely measured energy expenditure in some of the young Shuar and compared the total number of calories they incinerated with existing data about the daily calories burned by relatively sedentary (and much heavier) children in the United States and Britain. And the totals matched. Although the young Shuar were far more active, they did not burn more calories, over all.

Young Shuar differ from most Western children in so many ways, though, including their genetics, that interpreting that study’s findings was challenging, Dr. Urlacher knew. But he also was aware of a more-comparable group of children only a longish canoe ride away, among Shuar families that had moved to a nearby market town. Their children regularly attended school and ate purchased foods but remained Shuar.

So, for the newest study, which was published in January in The Journal of Nutrition, he and his colleagues gained permission from Shuar families, both rural and relatively urban, to precisely measure the body compositions and energy expenditure of 77 of their children between the ages of 4 and 12, while also tracking their activities with accelerometers and gathering data about what they ate.

The urban Shuar children proved to be considerably heavier than their rural counterparts. About a third were overweight by World Health Organization criteria. None of the rural children were. The urban kids also generally were more sedentary. But all of the children, rural or urban, active or not, burned about the same number of calories every day.

What differed most were their diets. The children in the market town ate far more meat and dairy products than the rural children, along with new starches, like white rice, and highly processed foods, like candy. In general, they ate more and in a more-modern way than the rural children, and it was this diet, Dr. Urlacher and his colleagues conclude, that contributed most to their higher weight.

These findings should not romanticize the forager or hunter-gatherer lifestyle, Dr. Urlacher cautions. Rural, traditional Shuar children face frequent parasitic and other infections, as well as stunted growth, in large part because their bodies seem to shunt available calories to other vital functions and away from growing, Dr. Urlacher believes.

But the results do indicate that how much children eat influences their body weight more than how much they move, he says, an insight that should start to guide any efforts to confront childhood obesity.

“Exercise is still very important for children, for all sorts of reasons,” Dr. Urlacher says. “But keeping physical activity up may not be enough to deal with childhood obesity.”

Are Some Foods Addictive

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Are Addictive Foods Making Us Fat?

Food researchers debate whether highly processed foods like potato chips and ice cream are addictive, triggering our brains to overeat.

Credit…Richard A. Chance
Anahad O’Connor

  • Feb. 18, 2021, 5:00 a.m. ET

Five years ago, a group of nutrition scientists studied what Americans eat and reached a striking conclusion: More than half of all the calories that the average American consumes comes from ultra-processed foods, which they defined as “industrial formulations” that combine large amounts of sugar, salt, oils, fats and other additives.

Highly processed foods continue to dominate the American diet, despite being linked to obesity, heart disease, Type 2 diabetes and other health problems. They are cheap and convenient, and engineered to taste good. They are aggressively marketed by the food industry. But a growing number of scientists say another reason these foods are so heavily consumed is that for many people they are not just tempting but addictive, a notion that has sparked controversy among researchers.

Recently, the American Journal of Clinical Nutrition explored the science behind food addiction and whether ultra-processed foods might be contributing to overeating and obesity. It featured a debate between two of the leading experts on the subject, Ashley Gearhardt, associate professor in the psychology department at the University of Michigan, and Dr. Johannes Hebebrand, head of the department of child and adolescent psychiatry, psychosomatics and psychotherapy at the University of Duisburg-Essen in Germany.

Dr. Gearhardt, a clinical psychologist, helped develop the Yale Food Addiction Scale, a survey that is used to determine whether a person shows signs of addictive behavior toward food. In one study involving more than 500 people, she and her colleagues found that certain foods were especially likely to elicit “addictive-like” eating behaviors, such as intense cravings, a loss of control, and an inability to cut back despite experiencing harmful consequences and a strong desire to stop eating them.

At the top of the list were pizza, chocolate, potato chips, cookies, ice cream, French fries and cheeseburgers. Dr. Gearhardt has found in her research that these highly processed foods share much in common with addictive substances. Like cigarettes and cocaine, their ingredients are derived from naturally occurring plants and foods that are stripped of components that slow their absorption, such as fiber, water and protein. Then their most pleasurable ingredients are refined and processed into products that are rapidly absorbed into the bloodstream, enhancing their ability to light up regions of the brain that regulate reward, emotion and motivation.

Salt, thickeners, artificial flavors and other additives in highly processed foods strengthen their pull by enhancing properties like texture and mouth-feel, similar to the way that cigarettes contain an array of additives designed to increase their addictive potential, said Dr. Gearhardt. Menthol helps to mask the bitter flavor of nicotine, for example, while another ingredient used in some cigarettes, cocoa, dilates the airways and increases nicotine’s absorption.

A common denominator among the most irresistible ultra-processed foods is that they contain large amounts of fat and refined carbohydrates, a potent combination that is rarely seen in naturally occurring foods that humans evolved to eat, such as fruits, vegetables, meat, nuts, honey, beans and seeds, said Dr. Gearhardt. Many foods found in nature are rich in either fat or carbs, but typically they are not high in both.

“People don’t experience an addictive behavioral response to naturally occurring foods that are good for our health, like strawberries,” said Dr. Gearhardt, director of the Food and Addiction Science and Treatment lab at the University of Michigan. “It’s this subset of highly processed foods that are engineered in a way that’s so similar to how we create other addictive substances. These are the foods that can trigger a loss of control and compulsive, problematic behaviors that parallel what we see with alcohol and cigarettes.”

In one study, Dr. Gearhardt found that when people cut back on highly processed foods, they experienced symptoms that were comparable to the withdrawal seen in drug abusers, such as irritability, fatigue, feelings of sadness and cravings. Other researchers have found in brain imaging studies that people who frequently consume junk foods can develop a tolerance to them over time, leading them to require larger and larger amounts to get the same enjoyment.

In her clinical practice, Dr. Gearhardt has encountered patients — some obese and some not — who struggle in vain to control their intake of highly processed foods. Some attempt to eat them in moderation, only to find that they lose control and eat to the point of feeling ill and distraught. Many of her patients find that they cannot quit these foods despite struggling with uncontrolled diabetes, excessive weight gain and other health problems.

“The striking thing is that my clients are almost always acutely aware of the negative consequences of their highly processed food consumption, and they have typically tried dozens of strategies like crash diets and cleanses to try and get their relationship with these foods under control,” she said. “While these attempts might work for a short time, they almost always end up relapsing.”

But Dr. Hebebrand disputes the notion that any food is addictive. While potato chips and pizza can seem irresistible to some, he argues that they do not cause an altered state of mind, a hallmark of addictive substances. Smoking a cigarette, drinking a glass of wine or taking a hit of heroin, for instance, causes an immediate sensation in the brain that foods do not, he says.

“You can take any addictive drug, and it’s always the same story that almost everyone will have an altered state of mind after ingesting it,” said Dr. Hebebrand. “That indicates that the substance is having an effect on your central nervous system. But we are all ingesting highly processed foods, and none of us is experiencing this altered state of mind because there’s no direct hit of a substance in the brain.”

In substance use disorders, people become dependent on a specific chemical that acts on the brain, like the nicotine in cigarettes or the ethanol in wine and liquor. They initially seek out this chemical to get a high, and then become dependent on it to alleviate depressed and negative emotions. But in highly processed foods, there is no one compound that can be singled out as addictive, Dr. Hebebrand said. In fact, evidence suggests that obese people who overeat tend to consume a wide range of foods with different textures, flavors and compositions. Dr. Hebebrand argued that overeating is driven in part by the food industry marketing more than 20,000 new products every year, giving people access to a seemingly endless variety of foods and beverages.

“It’s the diversity of foods that is so appealing and causing the problem, not a single substance in these foods,” he added.

Those who argue against food addiction also point out that most people consume highly processed foods on a daily basis without showing any signs of addiction. But Dr. Gearhardt notes that addictive substances do not hook everyone who consumes them. According to research, about two-thirds of people who smoke cigarettes go on to become addicted, while a third do not. Only about 21 percent of people who use cocaine in their lifetimes become addicted, while just 23 percent of people who drink alcohol develop a dependence on it. Studies suggests that a wide range of factors determine whether people become addicted, including their genetics, family histories, exposure to trauma, and environmental and socioeconomic backgrounds.

“Most people try addictive substances and they don’t become addicted,” Dr. Gearhardt said. “So if these foods are addictive, we wouldn’t expect that 100 percent of society is going to be addicted to them.”

For people who struggle with limiting their intake of highly processed foods, Dr. Gearhardt recommends keeping a journal of what you eat so you can identify the foods that have the most pull — the ones that cause intense cravings and that you can’t stop eating once you start. Keep those foods out of your home, while stocking your fridge and pantry with healthier alternatives that you enjoy, she said.

Keep track of the triggers that lead to cravings and binges. They could be emotions like stress, boredom and loneliness. Or it could be the Dunkin’ Donuts that you drive by three times a week. Make a plan to manage those triggers by a taking a different route home, for example, or by using nonfood activities to alleviate stress and boredom. And avoid skipping meals, because hunger can set off cravings that lead to regrettable decisions, she said.

“Making sure you are regularly fueling your body with nutritious, minimally processed foods that you enjoy can be important for helping you navigate a very challenging food environment,” said Dr. Gearhardt.

Weekly Health Quiz: Weight Loss, Masks and Covid Vaccines

1 of 7

For the first time, a clinical trial suggested that a drug may be highly effective in promoting weight loss, with obese participants losing, on average, 15 percent of their body weight. The drug tested is called:

Orlistat

Semaglutide

Lorcaserin

Phentermine-topiramate

2 of 7

The percentage of Americans who have received at least one Covid vaccine shot is now around:

5 percent

10 percent

20 percent

30 percent

3 of 7

Dr. Anthony Fauci predicted that most Americans would be eligible to get a Covid vaccine as early as:

March

April

May

June

4 of 7

This state surpassed New York with the highest number of Covid deaths since the start of the pandemic:

Florida

New Jersey

California

Texas

5 of 7

This state has had the lowest total number of Covid deaths overall:

Alaska

Hawaii

Maine

Vermont

6 of 7

The Centers for Disease Control and Prevention urged Americans to wear this type of mask to protect against the spread of coronavirus:

A well fitting surgical mask, or a cloth mask over a surgical mask

An N95 mask

A KN94 mask

The C.D.C. does not endorse the use of masks

7 of 7

A large study found that people with this condition were twice as likely to get Covid:

Asthma

Autoimmune conditions

Hypertension

Dementia

Baking as a Mindful Break From Zoom School

Sadie Radinsky uses baking as an opportunity for mindfulness.
Sadie Radinsky uses baking as an opportunity for mindfulness.Credit…Jackie Radinsky

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Baking as a Mindful Break From Zoom School

How making healthful treats helped me enjoy desserts again.

Sadie Radinsky uses baking as an opportunity for mindfulness.Credit…Jackie Radinsky

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  • Feb. 9, 2021, 5:00 a.m. ET

Have you ever watched the face of a toddler with an ice cream cone? The first bite, cold and messy and sweet, is a pure delight.

Desserts bring joy. But for many girls, somewhere along the line, that joy gets squelched — replaced by stress and fear.

“This shift usually begins around middle school,” says Lucie Hemmen, a psychologist based in Santa Cruz, Calif., who specializes in my demographic: teenage girls. By that age, she said, we start absorbing our culture’s weird tension around eating, especially with desserts.

The negative messages bombard us from every direction. On TV, female characters say they shouldn’t eat dessert. Ads show women denying themselves the treats they want because they’re “sinful.” Friends and family members comment on our appetite. Boys are affected by cultural messages, too, but girls especially seem to be told that we’re either eating too much or too little, or the wrong foods, or that we should be “detoxing” instead.

This is like shaming us for breathing.

But I’ve stumbled onto a powerful secret: Some treats can actually be our friends, and not just because they are the only ones we can safely hang out with during a lockdown. We can bake our own delicious desserts that are good for us, in every sense — nourishing our bodies and spirits.

I discovered healthful baking when I was 9. I had started getting mysterious stomach aches that often kept me in bed all day. After missing half of fourth grade and visiting doctor after doctor, I still didn’t know what was wrong. As a last resort, my parents decided I should try going gluten-free. It worked. Within a few months, all my symptoms were gone. But there was one major problem. At the time, there were no good gluten-free desserts in stores. This meant I was missing out on my favorite food group: baked goods.

So, I started creating my own, using ingredients like almond flour, dark chocolate and coconut milk. They were grain-free, and low in sugar. Much to my surprise — and my family’s — these treats tasted better than conventional desserts. Because they were less sweet, more flavor came through. We could truly taste the strawberry, the chocolate or the cinnamon when they weren’t overwhelmed by sugar. And I actually felt good after eating them! It was a revelation.

The grain-free, low-sugar baked goods I make are filled with protein and saturated fats like butter and coconut oil. Although the conventional wisdom is that butter is associated with cardiovascular disease, some experts argue that butter is actually nutritious, and that it’s sugar that we should be avoiding.

The author mixes arrowroot starch and a little coconut sugar into cookie dough.
The author mixes arrowroot starch and a little coconut sugar into cookie dough.Credit…Jackie Radinsky

Nina Teicholz, author of “The Big Fat Surprise,” maintains that the usual thinking about saturated fat is “completely upside-down and backward.” Studies show that foods high in protein and fat leave us feeling satiated, Ms. Teicholz says. Ideally, we should tune in to our hunger levels and stop eating when we’re full. But traditional treats are high in sugar — which can have the opposite effect, leaving us more hungry and craving more sweets after eating them, according to Gary Taubes, author of “The Case Against Sugar.”

But after having a low-sugar dessert, we feel satisfied.

Creating — and eating — these new treats became my favorite part of life. And as I have blogged and posted about baking on social media, I’ve found that many others — especially young women — share my joy.

In the pandemic in particular, baking is an opportunity for mindfulness.

The gentle clinking of my whisk on the mixing bowl pulls me into the present moment. This is my meditation. In the kitchen, surrounded by scattered chocolate chips and splashes of melted butter, there are no screens to grab my attention. I am attuned to the sensations of the process. Rolling the cookie dough into balls. Flattening them out with my palm. I am here, now, and everything else drops away.

As a freshman at “Zoom University,” I know how exhausting it is to spend hour after hour online, every day, eyes glued to the bright screen. Dr. Hemmen points out that this can make us feel disconnected from ourselves. Many of her teen clients “don’t feel real, because they’re so overstimulated by the technology.”

When we crack our eggs into the mixing bowl and beat them to a froth, we feel real again. We are drawn back into the physical world, back into our bodies.

Because we’re in the moment while baking, it also gets us in touch with our emotions. A few days ago, I was creating a new brownie recipe. While chopping up chocolate, I realized there were tears rolling down my cheeks. I’d just finished reading a news article that had really upset me. The emotion seeped into the brownies as I added more cocoa and a spoonful of strong coffee.

You know how an intense shared experience with a friend always brings the two of you closer together? Baking is like that. Getting our hands in ingredients, infusing them with our emotions, and turning them into something delicious creates a bond between us and the food. The finished product becomes more than an item on a plate.

After this slow, mindful process in the kitchen, the experience of eating becomes mindful, too. When we sit down to our desserts, we receive them as gift. We savor every part of that gift bec­ause we feel all the care we put into it.

The other day, I made a grain-free peanut butter chocolate chip skillet cookie. As I pulled it out of the oven, the scent of vanilla wafted up. I sank my spoon into the center of the giant cookie and took a bite. The nuttiness mingled with the bittersweet chocolate chips, which melted on my tongue. My stomach was happy and so were my spirits.

Sadie Radinsky is a freshman at the University of California, Berkeley, and the author of “Whole Girl: Live Vibrantly, Love Your Entire Self, and Make Friends with Food.”

The Best Time of Day to Exercise

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Phys Ed

The Best Time of Day to Exercise

Men at risk for diabetes had greater blood sugar control and lost more belly fat when they exercised in the afternoon than in the morning.

Credit…Getty Images
Gretchen Reynolds

  • Jan. 27, 2021, 5:00 a.m. ET

Is it better for our bodies to work out at certain times of day?

A useful new study of exercise timing and metabolic health suggests that, at least for some people, the answer is a qualified yes. The study, which looked at men at high risk for Type 2 diabetes, found that those who completed afternoon workouts upped their metabolic health far more than those who performed the same exercise earlier in the day. The results add to growing evidence that when we exercise may alter how we benefit from that exercise.

Scientists have known for some time that the chronology of our days influences the quality of our health. Studies in both animals and people indicate that every tissue in our bodies contains a kind of molecular clock that chimes, in part, in response to biological messages related to our daily exposure to light, food and sleep.

These cellular clocks then help to calibrate when our cells divide, fuel up, express genes and otherwise go about their normal biological work. Tuned by our lifestyles, these clocks create multiple circadian rhythms inside of us that prompt our bodies’ temperatures, hormone levels, blood sugar, blood pressure, muscular strength and other biological systems to dip and crest throughout the day.

Circadian science also shows that disrupting normal, 24-hour circadian patterns can impair our health. People working overnight shifts, for instance, whose sleep habits are upended, tend to be at high risk for metabolic problems such as obesity and Type 2 diabetes. The same is true for people who eat late at night, outside usual dinner hours. More encouraging research suggests, though, that manipulating the timing of sleep and meals can improve metabolic health.

But much of this research focused on when we eat or go to bed. Whether, and how, exercise timing might influence metabolic health has been less clear, and the results of past experiments have not always agreed. Some suggest that morning workouts, for instance, amplify fat burning and weight loss.

But those experiments often manipulated the timing of breakfast and other meals, as well as exercise, making it difficult to tease out the particular, circadian effects of workouts. They also typically involved healthy volunteers, without metabolic problems.

A much-discussed 2019 study, on the other hand, found that men with Type 2 diabetes who completed a few minutes of high-intensity interval sessions in the afternoon substantially improved their blood-sugar control after two weeks. If they did the same, intense workouts in the morning, however, their blood-sugar levels actually spiked in an unhealthy fashion.

Patrick Schrauwen, a professor of nutrition and movement sciences at Maastricht University Medical Center in the Netherlands, read that 2019 study with interest. He and his colleagues had been studying moderate exercise in people with Type 2 diabetes, but in their research, they had not considered the possible role of timing. Now, seeing the varying impacts of the intense workouts, he wondered if the timing of moderate workouts might likewise affect how the workouts changed people’s metabolisms.

Fortuitously, he and his colleagues had a ready-made source of data, in their own prior experiment. Several years earlier, they had asked adult men at high risk for Type 2 diabetes to ride stationary bicycles at the lab three times a week for 12 weeks, while the researchers tracked their metabolic health. The scientists also, incidentally, had noted when the riders showed up for their workouts.

Now, Dr. Schrauwen and his colleagues pulled data for the 12 men who consistently had worked out between 8 and 10 a.m. and compared them with another 20 who always exercised between 3 and 6 p.m. They found that the benefits of afternoon workouts decisively trumped those of morning exercise.

After 12 weeks, the men who had pedaled in the afternoon displayed significantly better average insulin sensitivity than the morning exercisers, resulting in a greater ability to control blood sugar. They also had dropped somewhat more fat from around their middles than the morning riders, even though everyone’s exercise routines had been identical.

“I believe that doing exercise is better than not doing exercise, irrespective of timing,” Dr. Schrauwen says. “However, this study does suggest that afternoon exercise may be more beneficial” for people with disrupted metabolisms than the same exercise done earlier.

The study, in Physiological Reports, involved only men, though. Women’s metabolisms might respond differently.

The researchers also did not delve into why the later workouts might affect metabolism differently than earlier ones. But Dr. Schrauwen says he believes moderate afternoon exercise may have an impact on the foods we consume later in the evening and “help to faster metabolize people’s last meals” before they go to sleep. This effect could leave our bodies in a fasted state overnight, which may better synchronize body clocks and metabolisms and fine-tune health.

He and his colleagues hope to explore the underlying molecular effects in future studies, as well as whether the timing of lunch and dinner alters those results. The team also hopes to look into whether evening workouts might amplify the benefits of afternoon exertion, or perhaps undercut them, by worsening sleep.

Ultimately, Dr. Schrauwen says, the particular, most effective exercise regimen for each of us will align “with our daily routines” and exercise inclinations. Because exercise is good for us at any time of day — but only if we opt to keep doing it.

There’s No Easy Fix for Children’s Weight Gain

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The Checkup

There’s No Easy Fix for Children’s Weight Gain

Experts advise families to avoid blaming themselves and to look for opportunities to congratulate children for healthy behaviors and good decisions.

Credit…Simone Noronha

  • Jan. 25, 2021, 5:00 a.m. ET

Even when we’re not in the middle of a terrible pandemic, there are a great many tensions around what to say and do at pediatric visits when a child’s weight is increasing too quickly.

There’s the issue of self-image and fat stigma; some people remember forever the moment when a doctor first called their weight a problem, ripping the child out of the happy innocence of feeling comfortable in his or her body.

The pandemic has raised worries about children’s weight gain, perhaps exacerbated by the absence of school, not to mention sports and other activities that used to give structure to the day and mark off some no-eating zones. Economic hardships and curtailed grocery shopping may be limiting some families’ ability to make healthy food choices.

“Parents should allow themselves some grace,” said Dr. Eliana Perrin, professor of pediatrics and director of the Duke Center for Childhood Obesity Research. “Families are having a tough time, kids are having a tough time, there’s increased food insecurity, people have lost their jobs, kids may have lost school meals.”

Dr. Sandy Hassink, a pediatrician who devoted her career to taking care of children with obesity and now works with the American Academy of Pediatrics at the Institute for Healthy Childhood Weight, and who worked on the academy’s interim guidance on obesity, said, “Even in pre-Covid times, I noticed as a clinician that nutrition and activity tend to go out the window in a time of stress.”

[Click here for the recent A.A.P. statement on healthy nutrition and physical activity during the pandemic, and here for its statement on obesity management during the pandemic.]

There are so many factors that have made it more difficult for families to maintain a healthy lifestyle during the pandemic, Dr. Hassink said, from increased sedentary time and screen time to the increased snacking and dysregulated sleep which sometimes come with being at home. Families may have less access to fresh food, she said, and then, of course, there’s stress eating.

Pediatricians often find themselves struggling to find the right balance in what to say to a family in these situations. Somehow, in those fraught moments in the exam room, real or virtual, you have to find words to acknowledge the complexity of the problem but also, most pediatricians feel, to recognize that parents do have some power and some agency, and to offer them hope and encouragement for making at least small adjustments to help the family establish healthier patterns.

Dr. Perrin and her colleagues at Duke pediatrics collected a set of suggestions for families, but before they got to the specifics of dietary change, increased activity, screen time and sleep, they started with a category they called “Survival,” advising families to pay attention to “mind, heart, body, spirit,” to avoid blaming themselves, to look for opportunities to congratulate their children for healthy behaviors and good decisions.

“Forget what ‘needs’ to get done for physical activity goals and ‘perfect’ meal goals,” Dr. Perrin wrote. “Do their best to eat at home and just ‘show up’ every day in terms of physical activity.” Specific suggestions around food include involving children in the cooking, and using the government MyPlate site to plan healthy meals on a budget. For physical activity, find some way to get moving, even a little, every day.

“As always, try to focus on behaviors, not weight,” Dr. Perrin wrote. “What’s important is making sure families are eating as well as they can — whole grains, proteins, fruits and vegetables, drinking water — rather than a ton of fast foods or sugar-sweetened beverages, and making sure they are staying active.”

Among the harshest lessons of this terrible pandemic year has been how health disparities play out across the life course, as we’ve watched higher death and disease rates in Black and brown communities. There are many issues to tackle here in terms of health equity, but for children growing up in at-risk populations, childhood obesity is yet another serious health disparity, linked to some of the underlying conditions that put people at higher risk for severe Covid-19 disease.

These disparities require complex systemic fixes — from access to healthy food, to safe places for outdoor activity, to improved mental health services, to other supports that can reduce stress on families. Instead, parents and children often encounter blame and stigma.

“Obesity itself as a disease presents a risk for more severe Covid infection,” Dr. Hassink said. “If I substituted the word asthma for obesity, people would not be blaming people for having asthma, they would be saying, let’s make sure your environment doesn’t have allergens, let’s make sure you get the right meds, the right medical care, but not blaming the child.”

Dr. Michelle White, an assistant professor of pediatrics at Duke, is a health services researcher who studies what might be protective for families at high risk of obesity, looking at environmental and family factors, including the ways that neighborhoods can contribute to obesity risks — or solutions. “Some families reporting significant impact by Covid-19 are still able to demonstrate resilience to stress and behaviors such as physical activity and healthy diet,” she said. “I think we have a lot to learn from these families.”

Dr. White said it was important not to view pandemic weight gain as a product only of diet and exercise behaviors. “The social context and the physical context of our families is so incredibly important in terms of their risk of weight gain,” she said.

My colleague Dr. Mary Jo Messito, who directs the pediatric weight management program at N.Y.U. School of Medicine and Bellevue Hospital, said, “My patients are suffering terribly.” They face many barriers to exercise because of fears of being exposed to Covid, she said, and also food insecurity and a very high level of stress. “So many people don’t meet their goals because they have unaddressed mental health needs,” Dr. Messito said, pointing to the need for more mental health resources for low-income communities.

“I work to try to give people resources where they are,” she said, offering handouts and information about healthy food for people on limited budgets, but acknowledging, “it’s not going to compete with fast food for calories for dollar.” She recommends in-home exercise programs or talks about how to mask up and go outside safely, and she talks about avoiding sugary drinks.

Dr. Elsie Taveras, a professor of nutrition in the department of pediatrics at Harvard Medical School and the chief of general pediatrics at Massachusetts General Hospital, said that the challenge ahead will be to find ways to “go beyond surface counseling,” to help families find ways to turn this around, perhaps looking for help from experts in mental and behavioral health. Doctors will need to think about the dual burden of weight gain combined with the social risks brought on by the pandemic.

“If a patient with obesity comes in for a visit and I also know the family is living in a motel or they’re food insecure,” she said, “I need to adapt my plan to circumstances rather than say, ‘increase fruits and vegetables.’”

Pandemic weight gain is a problem for adults as well as children, Dr. Taveras said. “We’re home more, have more access to our beds, our refrigerators, our screens, we are experiencing extreme stress and uncertainty, and food and rest are things people turn to for comfort.”

“It’s important for people to have self-compassion here,” Dr. Hassink said. And it’s overwhelming to tackle all of this at once. “Maybe we should be helping people pick one thing they think they could change to make it healthier, strategize about how they might make progress on one thing.”

A parent might try to keep healthier food in the house, thereby eliminating all the individual decisions that have to be made “when your child starts to grab for that unhealthy snack.”

Maybe start by setting a time for a particular meal, she said. Maybe make a deal with a child to stand up and walk around the house for five minutes for every so much screen time.

“Take it one thing at a time that you might want to change, get help from your pediatrician about what resources might be available in your community for food and physical activity, and don’t beat yourself up,” Dr. Hassink said. “Take one small step and then be encouraged to take the next step.”

Weekly Health Quiz: Covid Variants, Moderate Exercise and Coffee

1 of 7

A new variant of coronavirus, first identified in Britain, is spreading through the United States. Which statement about the new variant is not true?

The new variant is much more contagious than earlier forms of the coronavirus

The new variant is much more deadly than earlier forms of the virus

The new variant is expected to be the dominant form of the virus in the United States by March

Scientists believe current vaccines will be effective against the new variant

2 of 7

A new study compared high-intensity interval training with moderate workouts in sedentary, overweight men. Men who did moderate workouts showed this benefit:

They shed more body fat

They showed greater improvements in blood pressure

They were better able to metabolize fats in the diet

All of the above

3 of 7

Robotic-assisted surgery has shown the most gains in replacement of this joint:

Hip

Shoulder

Knee

Elbow

4 of 7

The United States reached a grim milestone in Covid-related deaths, which now exceed:

100,000

200,000

400,000

1 million

5 of 7

Men and women with pain and stiffness from knee arthritis showed the most improvements when they wore shoes that were:

Flat-soled and flexible

Stable, supportive and well-cushioned

Tightly laced with a low, broad heel

The type of footwear had little impact on symptoms of arthritis

6 of 7

Just one alcoholic drink a day was tied to an increased risk of this heart disorder:

Atrial fibrillation

Heart failure

Heart attack

High blood pressure

7 of 7

Men who drank coffee were at lower risk of this condition:

Erectile dysfunction

Prostate cancer

Amyotrophic lateral sclerosis

Dementia

Weekly Health Quiz: Exercise, Body Temperature and a Covid Vaccine Mystery

1 of 7

An 11-minute program of calisthenics and rest, done three times a week for six weeeks, had this effect on out-of-shape young men and women:

It increased their fitness levels

It improved their endurance by 7 percent

It increased their leg power slightly

All of the above

2 of 7

Which statement about body temperatures is not true?

Worldwide, average body temperatures seem to be decreasing

Body temperatures tend to rise during and after exercise

Older people tend to have lower body temperatures than younger people

Body temperature tends to be higher in the morning than in the evening

3 of 7

Health authorities are investigating the death of a 56-year-old doctor in Florida who developed this blood clotting disorder days after receiving the Covid vaccine:

Hemophilia

Pernicious anemia

Acute immune thrombocytopenia

Myelodysplastic syndrome

4 of 7

Creutzfeldt-Jakob disease, sometimes called mad cow disease, is thought to be caused by this type of infectious organism:

Bacteria

Virus

Fungus

Prion

5 of 7

Which statement about throat cancers is not true?

Most throat cancers are caused by human papillomavirus, or HPV

Having oral sex at a young age increases the risk of developing throat cancer

HPV-associated throat cancers are more common in women than men

HPV-associated throat cancers are more common in whites than in African-Americans

6 of 7

Being overweight during pregnancy was tied to this fertility issue, Danish researchers report:

Mothers who are overweight during their first pregnancy are at increased risk of fertility problems during subsequent pregnancies

Daughters born to overweight mothers were at increased risk of having fertility problems

Sons born to overweight mothers were at increased risk of being infertile

All of the above

7 of 7

Diets rich in this vitamin were tied to a lower risk of developing Parkinson’s disease:

Vitamin A

B vitamins

Vitamins C and E

Vitamin D

How the Right Foods May Lead to a Healthier Gut, and Better Health

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How the Right Foods May Lead to a Healthier Gut, and Better Health

A diet full of highly processed foods with added sugars and salt promoted gut microbes linked to obesity, heart disease and diabetes.

Credit…Getty Images
Anahad O’Connor

  • Jan. 11, 2021, 11:00 a.m. ET

Scientists know that the trillions of bacteria and other microbes that live in our guts play an important role in health, influencing our risk of developing obesity, heart disease, Type 2 diabetes and a wide range of other conditions. But now a large new international study has found that the composition of these microorganisms, collectively known as our microbiomes, is largely shaped by what we eat.

By analyzing the diets, health and microbiomes of more than a thousand people, researchers found that a diet rich in nutrient-dense, whole foods supported the growth of beneficial microbes that promoted good health. But eating a diet full of highly processed foods with added sugars, salt and other additives had the opposite effect, promoting gut microbes that were linked to worse cardiovascular and metabolic health.

The researchers found that what people ate had a more powerful impact on the makeup of their microbiomes than their genes. They also discovered that a variety of plant and animal foods were linked to a more favorable microbiome.

One critical factor was whether people ate foods that were highly processed or not. People who tended to eat minimally processed foods like vegetables, nuts, eggs and seafood were more likely to harbor beneficial gut bacteria. Consuming large amounts of juices, sweetened beverages, white bread, refined grains, and processed meats, on the other hand, was associated with microbes linked to poor metabolic health.

“It goes back to the age-old message of eating as many whole and unprocessed foods as possible,” said Dr. Sarah E. Berry, a nutrition scientist at King’s College London and a co-author of the new study, which was published Monday in Nature Medicine. “What this research shows for the first time is the link between the quality of the food we’re eating, the quality of our microbiomes and ultimately our health outcomes.”

The findings could one day help doctors and nutritionists prevent or perhaps even treat some diet-related diseases, allowing them to prescribe personalized diets to people based on the unique makeup of their microbiomes and other factors.

Many studies suggest that there is no one-size-fits-all diet that works for everyone. The new study, for example, found that while some foods were generally better for health than others, different people could have wildly different metabolic responses to the same foods, mediated in part by the kinds of microbes residing in their guts.

“What we found in our study was that the same diet in two different individuals does not lead to the same microbiome, and it does not lead to the same metabolic response,” said Dr. Andrew T. Chan, a co-author of the study and a professor of medicine at Harvard Medical School and Massachusetts General Hospital. “There is a lot of variation.”

The new findings stem from an international study of personalized nutrition called Predict, which is the world’s largest research project designed to look at individual responses to food. Started in 2018 by the British epidemiologist Tim Spector, the study has followed over 1,100 mostly healthy adults in the United States and Britain, including hundreds of identical and nonidentical twins.

The researchers collected data on a wide range of factors that influence metabolism and disease risk. They analyzed the participants’ diets, microbiomes and body fat. They took blood samples before and after meals to look at their blood sugar, hormones, cholesterol and inflammation levels. They monitored their sleep and physical activity. And for two weeks they had them wear continuous glucose monitors that tracked their blood sugar responses to different meals.

The researchers were surprised to discover that genetics played only a minor role in shaping a person’s microbiome. Identical twins were found to share just 34 percent of the same gut microbes, while people who were unrelated shared about 30 percent of the same microbes. The composition of each person’s microbiome appeared instead to be driven more by what they ate, and the types of microbes in their guts played a strong role in their metabolic health.

The researchers identified clusters of so-called good gut bugs, which were more common in people who ate a diverse diet rich in high-fiber plants — like spinach, broccoli, tomatoes, nuts and seeds — as well as minimally processed animal foods such as fish and full-fat yogurt. They also found clusters of “bad” gut bugs that were common in people who regularly consumed foods that were highly processed. One common denominator among heavily processed foods is that they tend to contain very little fiber, a macronutrient that helps to nourish good microbes in the gut, the researchers said.

Among the “good” strains of gut microbes were Prevotella copri and Blastocystis, both of which were associated with lower levels of visceral fat, the kind that accumulates around internal organs and that increases the risk of heart disease. These microbes also appeared to improve blood sugar control, an indicator of diabetes risk. Other beneficial microbes were associated with reduced inflammation and lower spikes in blood fat and cholesterol levels after meals, all of which play a role in cardiovascular health.

The new study was funded and supported by Zoe Global, a health science company, as well as by the Wellcome Trust, a British nonprofit, and several public health groups.

Dr. Berry said the findings suggest that by looking at microbiome profiles they can identify people at high risk of developing metabolic diseases and intervene early on. She and her colleagues are now planning a clinical trial that will test whether telling people to change specific foods in their diets can alter levels of good and bad microbes in their guts and subsequently improve their health.

“We think there are lots of small changes that people can make that can have a big impact on their health that might be mediated through the microbiome,” she said.

To Create a Healthy Habit, Find an Accountability Buddy

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Well Challenge Day 6

To Create a Healthy Habit, Find an Accountability Buddy

Whether it’s a person or an app that sends us reminders, we make better choices when we’re being watched (even by ourselves.)

Credit…Andrew B Myers
Tara Parker-Pope

  • Jan. 8, 2021, 5:00 a.m. ET

If you want to make positive changes in your life, try building on a lesson many of us learned in 2020: Hold yourself accountable.

The notion of accountability — to yourself and to others — has been an important part of pandemic living. To avoid spreading the virus, we’ve needed to be accountable for wearing a mask, limiting our contacts and keeping our distance.

But accountability can also help you achieve your health goals. Gretchen Rubin, author of “Better Than Before,” a book about forming healthy habits, says that accountability is an important tool for making and breaking habits.

Accountability works best when it comes from the outside. You can create accountability by checking in with a friend every day to talk about healthful eating. You’re more likely to exercise if you’ve made a plan to walk with a friend or scheduled a workout with a personal trainer. You can create public accountability by declaring your intention on social media.

If you prefer to stay accountable only to yourself, you can create accountability by using an app that sends you daily reminders or by wearing a Fitbit or smart watch to track your exercise habits. You can even hold yourself accountable through a daily journal entry.

“We do better when someone’s watching,” Ms. Rubin said. “Even when we’re the ones doing the watching!”

A 2018 North Carolina State University study of 704 people enrolled in a 15-week online weight-loss program found that participants with buddies lost more weight and waist inches than those who took the course without buddy support.

So for today’s Well challenge, think about a health goal you want to achieve and focus on how you can hold yourself accountable. I’ve included a few suggestions for how to do it. Sign up for the Well newsletter to get the 7-Day Well Challenge in your inbox.

Day 6

Create an Accountability Plan

What is your goal for 2021? Do you want to improve your eating habits, lose weight or exercise more? Or maybe you just want to finish that screenplay you’ve been working on? You’re more likely to succeed if you get some help.

Find an accountability buddy. Choose a friend who wants to achieve a similar goal and make a plan. Accountability might mean meeting each other once or twice a week for a walking date. Or it could be a daily text check-in to see how you’re doing on a diet or a Zoom call to work on a decluttering project together.

“Some people are very accountable to themselves, but not most people,” said Dr. Tim Church, a well-known exercise and obesity expert and chief medical officer for Naturally Slim, an app-based behavioral health program in Dallas. “In my years of working with thousands of people, there’s one thing that drives accountability more than anything else: If you want to keep people doing a behavior, get a buddy.”

While the presence of an accountability buddy adds some gentle peer pressure, the key is to focus on the behavior, not success or failure. For instance, if a person is trying to lose weight, don’t focus on the scale. Instead, check in and remind them to log what they ate, encourage them to eat more fruits and vegetables and remind them of the benefits of a regular weigh-in (but you don’t need to ask them the result). If they’re beating themselves up for eating two desserts, talk about what might have triggered an emotional eating binge.

“An accountability partner is there to support you, to problem-solve and to celebrate even the small victories,” Dr. Church said. “Judgment is the quickest way to destroy all that. People are so hard on themselves. You don’t need to be hard on them.”

Use an app. An app is a great way to add accountability to your day. Meditation apps like Headspace and Calm will send daily reminders and track your progress. The weight-loss app Noom asks you to check in for a few minutes each day, complete mini-health courses and track what you’ve eaten. The Fitbit app counts your steps, will sync with your smart scale and vibrates to remind you to get up and move.

Set reminders. Once you set a health goal, hold yourself accountable by creating calendar reminders to help you achieve it. Schedule walk breaks or daily or weekly check-ins with your accountability buddy.

Declare it on social media. Telling your friends on social media that you’re cutting back on packaged foods, or sending a tweet every time you finish a class on your exercise bike creates virtual accountability. Commit to posting on Facebook, Instagram, Twitter or another platform every time you complete a goal, or share your feelings on days you’re struggling. When you declare your goals on social media, you’re likely to find a like-minded friend who will want to join your journey and offer words of support.

Weekly Health Quiz: Body Fat, Pulse Oximeters and a New Strain of Coronavirus

1 of 7

Cold weather is hitting many parts of the country, posing challenges for social distancing during the pandemic. Which statement about acclimating to cold weather is not true?

People over 60 tend to be less tolerant of cold than younger people

Carrying extra body fat helps protect against cold

Heat loss tends to be greater in men than women

Being physically active helps protect against cold

2 of 7

A new variant of the novel coronavirus that is sweeping through the United Kingdom appears to be:

Far deadlier than existing strains

Resistant to current vaccines

More contagious than existing strains

All of the above

3 of 7

Pulse oximeters, which measure blood oxygen levels and can be a lifesaving tool for monitoring Covid-19 symptoms, may be less accurate in this group:

People who are sedentary

Athletes

Adults over 70

People with darker skin

4 of 7

A Norweigan study found that older men and women were less likely to die prematurely when they incorporated which of the following into their weekly workouts?

A moderate 50-minute walk

Strength training

Short bursts of intense exercise

All types of exercise showed a similar impact on longevity

5 of 7

Some localities are banning elective surgery because of rising coronavirus case counts. Elective surgery refers to surgery that is:

Optional

Not urgent

Performed in a non-hospital setting

All of the above

6 of 7

Prospective fathers with this medical condition were more likely to sire a pregnancy that did not reach full term:

Diabetes

Hypertension

Obesity

All of the above

7 of 7

Consumption of this beverage was tied to an increased risk of frailty in older women:

Coffee

Tea

Wine

Sugary or artificially sweetened drinks

Weekly Health Quiz: Exercise, Weight and Covid Deaths

1 of 7

Overweight men and women had to work out about this many minutes a week to lose weight, researchers at the University of Kentucky report:

100 minutes

200 minutes

300 minutes

600 minutes

2 of 7

Karl A. Pillemer, a family sociologist and professor at Cornell, found that about this percentage of the population was living with an active family rift:

5 percent

10 percent

25 percent

50 percent

3 of 7

A global survey found that in the early months of the pandemic, many of us were stress eating, gaining weight and sleeping poorly, with this group particularly affected:

Children

People over 65

Obese people

Unmarried people

4 of 7

The United States saw a shocking new milestone, exceeding this many deaths per day from Covid:

1,000

2,000

3,000

6,000

5 of 7

Total reported deaths from Covid are approaching 300,000 in the United States. This country has the second highest number of reported Covid deaths, with nearly 200,000:

Brazil

India

Russia

China

6 of 7

A single dose of Pfizer’s coronavirus vaccine appeared to offer good protection regardless of age, race or weight after about how many days?

One day

Five days

10 days

30 days

7 of 7

Young women who used tanning beds were at increased risk of this disorder, which can sometimes lead to infertility:

Amenorrhea

Ovarian cysts

Endometriosis

Type 1 diabetes

Amazon Halo Review: The Fitness Gadget We Don’t Deserve or Need

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tech fix

Amazon Halo Review: The Fitness Gadget We Don’t Deserve or Need

The retail giant claims that its health product is extremely precise at scanning body fat. I found otherwise.

Credit…Glenn Harvey
Brian X. Chen

By

  • Dec. 9, 2020, 5:00 a.m. ET

Many of us are in the same boat these days. With the coronavirus killing more people by the day, we are increasingly stress-eating and drinking more alcohol. At the same time, with gyms shut down, we are sitting around more and glued to screens.

So you may be wondering what I’m wondering: How is the pandemic affecting my body? Because we can’t easily leave the house to see doctors for nonemergencies, we are largely left to figure this out on our own.

Enter the Halo, a new fitness-tracking bracelet from Amazon with a novel twist: It claims that by using a smartphone app to scan images of your body, it can tell you how much body fat you have much more precisely than past technologies. The bracelet also has a microphone to listen to your tone of voice and tell you how your mood sounds to other people. (The masochist inside me said, “Sign me up!”)

The Halo is Amazon’s foray into so-called wearable computers that keep an eye on our health, following in the footsteps of Apple and Fitbit. Amazon is selling the Halo for $65 on an invitation-only basis, meaning you have to get on a waiting list to buy it. I volunteered to be a guinea pig and received mine in October.

When the Halo arrived, I installed the app, removed my T-shirt and propped up my phone camera. Here’s what happened next: The Halo said I was fatter than I thought — with 25 percent body fat, which the app said was “too high.”

I was skeptical. I’m a relatively slim person who has put on two pounds since last year. I usually cook healthy meals and do light exercises outdoors. My clothes still fit.

I felt body-shamed and confused by the Halo. So I sent my Halo data and body scans to Dr. Lawrence Cheskin, a professor of nutrition and food studies at George Mason University and founder of the Johns Hopkins Weight Management Center.

After reviewing my results, Dr. Cheskin jotted down my height and weight to calculate my body mass index, which is a metric used to estimate obesity. A man my age (36) with my body mass index, he said, is highly unlikely to have 25 percent body fat.

“Unless you were a couch potato and ate a very poor diet, I have my doubts about the Halo’s diagnosis,” he said.

Dr. Cheskin encouraged me to gather more data by measuring my body fat with other devices, and to do the same with at least one other person. So I did and found that the Halo’s body fat readings consistently skewed higher than other tools for myself and my test subject.

I concluded that the Halo’s body analysis was questionable. More important, it felt like a negative experience that failed to motivate me to get fit. I’ve had much more uplifting experiences with other products like the Apple Watch and Fitbit bands, as laid out below.

Measuring Body Fat

The Amazon Halo bracelet and app.
The Amazon Halo bracelet and app.Credit…Amazon

Body fat measurement can be complicated because the traditional methods available to consumers are not always accurate.

Smart bathroom scales that measure body fat use bioelectrical impedance analysis, which sends a small current through your bare feet. Skin calipers, a more dated method, are essentially rulers that pinch down on skin folds to measure thickness.

These techniques are not perfectly reliable. If people step on smart scales at different times of day or with different levels of hydration, their results may vary. Calipers can measure skin folds incorrectly if you pinch in the wrong areas.

Amazon said the Halo’s technology was much more precise. To scan your body, you use the smartphone’s front-facing camera to take photos of your body from the front, sides and rear. Then Amazon stitches the images together into a 3-D model to analyze your body composition and calculate the percentage of fat.

I decided to record consistent body fat measurements for myself and a friend using the Halo, a Fitbit bathroom scale and a highly rated skin caliper. In November and December, I took early-morning measurements with the Halo and bathroom scale; my wife pinched my skin folds in four areas with the caliper. I measured my test subject’s body fat once with each device.

Our results were remarkably similar for two men with very different body compositions:

  • The Amazon product estimated that my friend, a 6-foot-3 man weighing 198 pounds, had 24 percent body fat, the Fitbit scale read 19 percent, and the skin-fold measurements added up to 20 percent.

  • For myself — 5-foot-6 and about 140 pounds — the Halo said in November that I had 25 percent body fat, the Fitbit scale said 19 percent, and the skin-fold measurements added up to 20 percent. In December, the Halo said I had 26 percent body fat (alas, I had more Thanksgiving leftovers than usual), the Fitbit scale said 20 percent, and the skin-fold measurements added up to 21 percent.

Dr. Cheskin speculated that the Halo might have an overestimating bias in its algorithm because underestimating body fat for an obese person would be more problematic.

Dr. Maulik Majmudar, Amazon’s medical officer, who worked on the Halo, said people should expect the device’s results to be different because the method was more accurate than body fat scales and calipers.

Amazon developed its body-measuring algorithm from a sample set of tens of thousands of images of people’s bodies from across a wide range of demographics, he said. Amazon then did internal tests measuring people’s body fat using the Halo scanner, smart bathroom scales and DEXA, a technique that uses X-rays to scan for bone density, which studies have found to be a reliable measure for body fat. It found that the Halo method was twice as accurate as bathroom scales.

Still, Dr. Cheskin was unconvinced by Amazon’s accuracy claims. He said a valid study would involve a clinical trial measuring body fat of many human subjects with each method — the Halo, DEXA, bioelectrical impedance scales and calipers — and comparing the results side by side.

Accurate or not, the most disappointing part of Amazon’s body fat analysis was that it lacked important context. Even though the app asked for my ethnicity, age and sex, it said my 25 percent body fat level was too high and well outside the “Healthy” zone (roughly 12 to 18 percent). It also said healthy results were associated with longer life and lower risks of heart disease.

Dr. Cheskin offered a more nuanced analysis. Body fat levels may have different health implications depending on your age, ethnicity, sex, cholesterol levels and family history. Waist circumference matters, too, because severe abdominal fat can be associated with health problems.

For an Asian man my age with a 34-inch waistline, whose family has not had a history of diabetes or heart problems, and whose blood tests recently showed normal cholesterol levels, even a 25 percent body fat reading would probably not be alarming, he said.

That context, combined with my body mass index along with the measurements taken with a body fat scale and caliper, led Dr. Cheskin to doubt Halo’s analysis.

He worried about the technology’s potential consequences.

“Does it potentially create eating disorders?” he said. “You’re taking a bunch of people with normal weight and B.M.I. and telling them they’re too fatty. What are they going to do with that? Some of them are going to be more compulsive and start doing things that are going to be inappropriate.”

Bottom Line

This experiment raised another question: What in the world was Amazon thinking releasing a product like this now? It has been impossible for us to move around as much as we used to this year. If anything, we should accept that our bodies will be imperfect during this time.

Dr. Majmudar said he felt the opposite. As a clinician, he said, he would encourage patients to mitigate the health risks of gaining weight and being more sedentary in the pandemic. The goal of the Halo was to drive behavioral change with education and awareness, he said.

“The desire or intention was never to body-shame people,” he added.

In my experience, there are better fitness-tracking products that offer more positive motivation.

The Apple Watch, for one, lets you set goals for how much you want to move or exercise each day, and those goals are symbolized by colorful rings that are shown on the watch face. Once a ring is completed, you have met your goal. Fitbit devices send notifications to your phone, egging you on when you are nearing your step goal. Neither device comes anywhere close to giving you body dysmorphia.

Another of Halo’s unique features is Tone, which uses the bracelet’s microphone to periodically eavesdrop on your conversations to tell you what your mood sounds like. I turned the feature off after two days because it felt like a creepy invasion of privacy. But I left it on long enough to complain to my wife about what a bad idea it was.

After analyzing the conversation, the Halo app said I sounded irritated and disgusted. That, at least, was accurate.

Exercise for Weight Loss: Aim for 300 Minutes a Week

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Phys Ed

To Lose Weight With Exercise, Aim for 300 Minutes a Week

Overweight men and women who exercised six days a week lost weight; those who worked out twice a week did not.

Credit…Getty Images
Gretchen Reynolds

By

  • Dec. 9, 2020, 5:00 a.m. ET

Can exercise help us shed pounds? An interesting new study involving overweight men and women found that working out can help us lose weight, in part by remodeling appetite hormones. But to benefit, the study suggests, we most likely have to exercise a lot — burning at least 3,000 calories a week. In the study, that meant working out six days a week for up to an hour, or around 300 minutes a week.

The relationship between working out and our waistlines is famously snarled. The process seems as if it should straightforward: We exercise, expend calories and, if life and metabolisms were just, develop an energy deficit. At that point, we would start to use stored fat to fuel our bodies’ continuing operations, leaving us leaner.

But our bodies are not always cooperative. Primed by evolution to maintain energy stores in case of famine, our bodies tend to undermine our attempts to drop pounds. Start working out and your appetite rises, so you consume more calories, compensating for those lost.

The upshot, according to many past studies of exercise and weight loss, is that most people who start a new exercise program without also strictly monitoring what they eat do not lose as much weight as they expect — and some pack on pounds.

But Kyle Flack, an assistant professor of nutrition at the University of Kentucky, began to wonder a few years ago if this outcome was inevitable. Maybe, he speculated, there was a ceiling to people’s caloric compensations after exercise, meaning that if they upped their exercise hours, they would compensate for fewer of the lost calories and lose weight.

For a study published in 2018, he and his colleagues explored that idea, asking overweight, sedentary men and women to start exercising enough that they burned either 1,500 or 3,000 calories a week during their workouts. After three months, the researchers checked everyone’s weight loss, if any, and used metabolic calculations to determine how many calories the volunteers had consumed in compensation for their exertions.

The total, it turned out, was an average of about 1,000 calories a week of compensatory eating, no matter how much people had worked out. By that math, the men and women who had burned 1,500 calories a week with exercise had clawed back all but about 500 calories a week of their expenditures, while those burning through 3,000 calories with exercise ended up with a net weekly deficit of about 2,000 calories. (No one’s overall metabolic rate changed much.)

Unsurprisingly, the group exercising the most lost weight; the others did not.

But that study left many questions unanswered, Dr. Flack felt. The participants had performed similar, supervised workouts, walking moderately for 30 or 60 minutes, five times a week. Would varying lengths or frequencies of workouts matter to people’s caloric compensation? And what was driving people’s eating? Did the differing amounts of exercise affect people’s appetite hormones differently?

To find out, he and his colleagues decided to repeat much of the earlier experiment, but with novel exercise schedules this time. So, for the new study, which was published in November in Medicine & Science in Sports & Exercise, they gathered another group of 44 sedentary, overweight men and women, checked their body compositions, and asked half of them to start exercising twice a week, for at least 90 minutes, until they had burned about 750 calories a session, or 1,500 for the week. They could work out however they wished — many chose to walk, but some chose other activities — and they wore a heart rate monitor to track their efforts.

The rest of the volunteers began exercising six times a week for about 40 to 60 minutes, burning close to 500 calories a session, for a weekly total of about 3,000 a week. The researchers also drew blood, to check on the levels of certain hormones that can affect people’s appetites.

After 12 weeks, everyone returned to the lab, where the researchers refigured body compositions, repeated the blood draws and began calculating compensations.

And again, they found a compensatory threshold of about 1,000 calories. As a consequence, only the men and women in the group that had exercised the most — six days a week, for a total of 3,000 calories — had shed much weight, dropping about four pounds of body fat.

Interestingly, the researchers did uncover one unexpected difference between the groups. Those burning about 3,000 calories a week showed changes now in their bodies’ levels of leptin, an appetite hormone that can reduce appetite. These alterations suggested that exercise had increased the exercisers’ sensitivity to the hormone, enabling them to better regulate their desire to eat. There were no comparable hormonal changes in the men and women working out less.

In essence, Dr. Flack says, the new experiment “reinforces the earlier finding” that most of us will eat more if we exercise, but only up to about the 1,000-calories-a-week inflection point. If we somehow can manage to burn more than that amount with exercise, we probably can drop weight.

But, of course, burning thousands of calories a week with exercise is daunting, Dr. Flack says. Plus, this study lasted only a few months, and cannot tell us whether later changes to our appetites or metabolisms would augment or undercut any subsequent fat declines.

Still, for those of us hoping that exercise might help us trim our waistlines during the coming holidays, the more we can move, it seems, the better.

Yes, Many of Us Are Stress-Eating and Gaining Weight in the Pandemic

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Yes, Many of Us Are Stress-Eating and Gaining Weight in the Pandemic

A global study confirms that during the pandemic, many of us ate more junk food, exercised less, were more anxious and got less sleep.

Credit…Lorenzo Gritti
Anahad O’Connor

By

  • Dec. 4, 2020, 5:00 a.m. ET

Not long ago, Stephen Loy had a lot of healthy habits. He went to exercise classes three or four times a week, cooked nutritious dinners for his family, and snacked on healthy foods like hummus and bell peppers.

But that all changed when the pandemic struck. During the lockdowns, when he was stuck at home, his anxiety levels went up. He stopped exercising and started stress eating. Gone were the hummus and vegetables; instead, he snacked on cookies, sweets and Lay’s potato chips. He ate more fried foods and ordered takeout from local restaurants.

“We were feeding the soul more than feeding the stomach,” said Mr. Loy, 49, who lives in Baton Rouge and is the executive director of a tech incubator. “We were making sure to eat things that made us feel better — not just nutritional items.”

Now a global survey conducted earlier this year confirms what Mr. Loy and many others experienced firsthand: The coronavirus pandemic and resulting lockdowns led to dramatic changes in health behaviors, prompting people around the world to cut back on physical activity and eat more junk foods. It drove anxiety levels higher and disrupted sleep. And those who are obese, who already face increased health risks, may have fared the worst, the researchers found. While they tended to experience improvements in some aspects of their diets, such as cooking at home more and eating out less, they were also the most likely to report struggling with their weight and mental health.

The findings, published in the journal Obesity, offer a cautionary lesson for many of us as coronavirus cases continue to surge and renewed calls for lockdowns and other restrictions again take hold. With months to go before a vaccine becomes widely available and we can safely resume our pre-pandemic routines, now might be a good time to assess the healthy habits we may have let slip and to find new ways to be proactive about our physical and mental health.

The study, carried out by researchers at the Pennington Biomedical Research Center in Louisiana, surveyed almost 8,000 adults across the globe, including people from 50 different countries and every state in America. The researchers found that the decline in healthy behaviors during the pandemic and widespread lockdowns was fairly common regardless of geography.

“Individuals with obesity were impacted the most — and that’s what we were afraid of,” said Emily Flanagan, an author of the study and postdoctoral fellow at the Pennington Biomedical Research Center. “They not only started off with higher anxiety levels before the pandemic, but they also had the largest increase in anxiety levels throughout the pandemic.”

The findings shed light on exactly how people altered their routines and behaviors in response to the lockdowns that were implemented in countries around the world this year to slow the spread of the virus. The pandemic disrupted everyday life, isolated people from friends and family, and spawned an economic crisis, with tens of millions of people losing jobs or finding their incomes sharply reduced.

Dr. Flanagan and her colleagues assumed many people were experiencing enormous levels of stress. But they were not sure how the pandemic and stay-at-home orders were impacting how people slept, how much they exercised and what they ate. So they designed an extensive survey and recruited people on social media to answer questions about how their mental and physical health had been affected.

“This was such a drastic and abrupt change to everyone’s daily life that we needed to see what was going on,” said Dr. Flanagan. “We wanted to put some data to the anecdotal behaviors we were seeing.”

From April through early May, about 7,750 people, most of them from the United States but also from countries such as Canada, Australia and Britain, completed the survey. The average age of the respondents was 51, and a majority were women. Based on their body mass indexes, about a third of the people were overweight, a third were obese, and a third were considered normal weight.

The researchers found that most people became more sedentary, which they said was probably related to less daily commuting and more time spent indoors. But even when people did engage in structured exercise, it tended to be at lower intensity levels compared to before the pandemic. Many people also said they had given in to their food cravings: Consumption of sugar sweetened beverages and other sugary snack foods, for example, went up.

That might explain another finding: About 27 percent of people said they had gained weight after the initial lockdowns went into effect. The figure was even higher among people classified as obese: About 33 percent said that they had gained weight, compared to 24.7 percent of people considered normal weight. People who gained weight also had the largest declines in physical activity.

There were some bright spots in the findings. About 17 percent of the study population actually lost weight during the pandemic; perhaps not surprisingly, they tended to be people who increased their physical activity levels and improved their diets. And despite snacking on more junk foods, many people showed an increase in their “healthy eating scores,” a measure of their overall diet quality, which includes things like eating more fruits and fewer fried foods. The researchers said that the overall improvements in diet appeared to be driven by the fact that the lockdowns prompted people to cook, bake and prepare more food at home. Other recent surveys have also shown a sharp rise in home cooking and baking this year, with many people saying they are discovering new ingredients and looking for ways to make healthier foods.

But social isolation can take a toll on mental wellness, and that was evident in the findings. On average, people reported significantly higher anxiety levels. About 20 percent said that their symptoms, such as experiencing dread and not being able to control or stop their worrying, were severe enough to interfere with their daily activities. About 44 percent of people said that their sleep had also worsened during the pandemic. People on average reported going to bed about an hour later than usual and waking up roughly an hour later than usual. Only 10 percent of people said that their sleep had improved since the pandemic began.

The greatest spikes in anxiety occurred among people who are obese. It was unclear why exactly, but one reason may have been concerns about the virus. The survey took place at a time when studies were first beginning to show that excess weight puts people at a much higher risk of being hospitalized with Covid-19. “We don’t have data to back this up, but our hypothesis is there was a lot more anxiety about their own health,” Dr. Flanagan said. “A heightened fear of the virus would most certainly increase their anxiety levels.”

Dr. Flanagan said it was perhaps not surprising that people tended to engage in less healthful habits during the pandemic, as so many aspects of health are intertwined. Stress can lead to poor sleep, which can cause people to exercise less, consume more junk foods, and then gain weight, and so on. But she said she hoped that the findings might inspire people to take steps to be more proactive about their health, such as seeking out mental health specialists, prioritizing sleep and finding ways to exercise at home and cook more, in the event of future lockdowns.

“Being aware of how our health behaviors change during these stay-at-home orders could help us combat that if another lockdown is enforced,” she said. “Being aware is really the No. 1 thing here.”