Moving to wellness while practicing body neutrality

view from behind of two women exercising along a city waterfront, passing under a bridge, woman on the left is jogging while woman on the right is using a wheelchair

Most people want to feel energized and experience a sense of vitality. In the 1970s, Dr. John Travis created a spectrum of wellness, with illness on one side, a point of neutrality in the middle (when a person has no signs or symptoms of disease), and on the other side wellness.

Wellness is a state of health and flourishing beyond simply not experiencing illness. In this state people feel confident, open to challenges, curious, and thirsty for action. They are thriving. People who experience wellness may seek to hike a mountain, read a new book, learn how to play a new instrument, or actively connect with new people.

The most common health conditions facing people today include heart disease, stroke, diabetes, and cancer. When people are experiencing these (and other) conditions, they fall into the illness side of the spectrum. Lifestyle factors that put you at risk for developing these conditions include smoking, alcohol substance use disorder, lack of exercise, sleep deprivation, and a diet rich in processed foods, sugar, saturated fat, and artificial flavors. An unhealthy weight is another factor that can put one at risk for these conditions, especially carrying extra weight around your midsection.

To move to the wellness side of the spectrum, you can include more movement in your day; enjoy a whole-food (unprocessed), plant-predominant style of eating; avoid smoking; sleep seven to nine hours a night; practice stress reduction techniques like deep breathing, yoga, meditation, tai chi, and mindfulness; and spend time with family and friends.

Think about what your body can do for you — and what you can do for your body

People of many sizes and shapes can be healthy and well, especially when they are connected to a calm mind that is practicing mindfulness, self-compassion, and a growth mindset. A body that is in the neutral point on the wellness spectrum can move to the side of thriving and flourishing when healthy lifestyle habits are adopted and sustained, and that has little to do with your body’s shape or size.

The body neutrality movement emphasizes the incredible functions, actions, and physiology of our bodies without regard for how our bodies look. We can see, hear, smell, taste, and feel. We can jump, skip, sing, hug, and dance. Our muscles have mitochondria that give us energy.

Our digestive system is one example of the wondrous process of the body. The digestive system has billions of microbes living in it that help us to ferment fiber from vegetables, fruits, and whole grains, and create short-chain fatty acids that help us with energy metabolism, glucose metabolism, lipid metabolism, inflammation, immunity, and more. This is why it’s important to eat fiber, including whole grains, vegetables, and fruits.

Connected to our bodies are our brains, and they are full of neurons (brain cells), synapses (connections), neurochemicals, and hormones that help to protect brain cells and make new ones. Moving our bodies helps to increase these chemicals. In addition, moving our bodies regularly helps us to increase serotonin, which may help us feel less anxious and depressed. Hugging increases oxytocin in the brain, and this “love hormone” helps us feel a sense of belonging and bonding. The body’s actions have a powerful impact on the brain, and vice versa.

Body positivity versus body neutrality

Body positivity is a movement that invites people to appreciate the body size and shape they have now without worrying about unrealistic body standards. With body positivity, society’s unhealthy standards for body shapes and sizes are challenged. It’s also important to remember that cultural norms and what’s considered an ideal body change with time.

The goal with body positivity is to honor and appreciate all body types, especially your own body. Feeling confident about the way you look feels good and can be empowering.

With body neutrality, the focus is on the function of your body: finding happiness and fulfillment, appreciating the power of our muscles, the strength of our bones, the protection our skin offers, and the rewards of the dopamine system in our brains. Connecting with friends and family, reaching small, meaningful goals, and enjoying physical activity are healthy ways to approach your body. A focus on finding pleasure in the wellness journey will serve your body — at any size — and your brain.

Remember all the things your body can do for you

  • Transport you from one place to another (quickly or slowly)
  • Release neurochemicals that give you pleasure, like from hugging a loved one
  • Move your arms and/or legs with joy following the rhythm and beat of music
  • Take deep breaths to calm your mind
  • Perform stretches that release endorphins
  • Practice yoga, tai chi, or qigong, which can help calm the body and mind.

New Harvard tool helps fact-check cancer claims

A word cloud illustrating "myth" and "reality" in blue words against white background with silver pen; contrasting phrases include "urban legend," "data, "fake," and "proof"

The internet is full of warnings about things that cause cancer. Watch out for antiperspirants, scented candles, and bras, dubious web sites or sensational posts on social media warn. Steer clear of disposable chopsticks, microwaves, radon gas, and more. Scary or misleading claims are so plentiful that it’s hard to know which ones to take seriously. "We’ve seen that a lot of people have unnecessary fears about things that might cause cancer, or they’re overly cautious about things that aren’t based on science," notes Timothy Rebbeck, a cancer researcher and the Vincent L. Gregory, Jr., Professor of Cancer Prevention at the Harvard T.H. Chan School of Public Health.

To cut through the confusion, Rebbeck and his colleagues have developed a free tool to help.

What is the Cancer FactFinder?

The Cancer FactFinder was developed jointly by experts at the Zhu Family Center for Global Cancer Prevention at Harvard T.H. Chan School of Public Health and the Center for Cancer Equity and Engagement at the Dana-Farber/Harvard Cancer Center. It offers reliable information about whether certain cancer claims are true. "It’s a place to go when you’ve heard something and you’re not sure what to make of it," Rebbeck says.

Log on to Cancer FactFinder and you can:

  • Search cancer claims. Type in a particular term (such as "scented candles") or simply scroll through all of the claims the team has investigated. "We have about 70 right now. We’ll continue to update them and add more over time," Rebbeck says.
  • Learn how claims are fact-checked. The Cancer FactFinder team uses expert opinion from leading scientists and health organizations, as well as scientific evidence from human studies. Note: animal studies are not considered. "It could be that cancer is induced in lab animals by feeding them a particular compound or rubbing it on them. That doesn’t mean it causes cancer in humans," Rebbeck says.
  • Learn who’s on the Cancer FactFinder team. In addition to Rebbeck and his colleagues, there’s a mix of scientific experts and community advocates from groups including
    • BayState Health
    • Boston Cancer Support
    • Boston University
    • Men of Color Health Awareness
    • Silent Spring Institute
    • Yale University.

What can you look up?

Vetted claims on Cancer FactFinder range from A to almost Z — from an acidic diet to wax that’s sprayed onto fruit and vegetables.

Each listing gives you an immediate idea if there’s something to the claim, based on the balance of evidence in humans. A green checkmark means the claim is most likely true. A red X means the claim is probably false. A question mark indicates that there isn’t enough evidence yet to determine if there’s a cancer link. You’ll learn what the science says, how to reduce risk for a particular cancer, and where you can get additional trustworthy information on a topic.

A cancer fact-check in action

Let’s say, for instance, that you plan to join friends on a hike through a park, and you stop by the store for bug spray to ward off mosquitoes and ticks, which you know can cause illnesses like West Nile disease and Lyme disease. As you peruse the options, you remember someone mentioning that bug spray is linked to cancer.

Instead of worrying, you can go to Cancer FactFinder and type in "bug spray." You’ll see a red X signaling that bug spray hasn’t been found to cause cancer in humans. You’ll also see

  • which chemicals have sparked bug spray concerns
  • how to use bug spray properly
  • how to avoid concerns about certain ingredients by using alternative repellents.

Or say you just want to educate yourself about various cancer claims. Remember the ones mentioned so far? Turns out that claims of cancer linked to bras, antiperspirants, disposable chopsticks, microwaves, acidic diets, and wax sprayed on fruits and vegetables are false. Claims of cancer from radon gas and the frequent use of scented candles are true.

The ultimate goal, Rebbeck says, is empowerment.

"We want everyone to start asking questions, learn how to get reliable information, think about what it means for them, and talk to their families and doctors about lifestyle choices. We’re hoping that’s the endpoint of this."

Eating disorders spike among children and teens: What parents should know

A small wooden pawn sees itself reflected in a round mirror in a distorted way as much heavier; concept of eating disorders

During the pandemic, we have seen many more children and teens go to the emergency room with mental health problems. And there has been a notable rise in eating disorders, particularly among adolescent girls. Eating disorders include a range of unhealthy relationships with food and concerns about weight.

Unfortunately, eating disorders are common. In fact, one in seven men and one in five women experiences an eating disorder by age 40, and in 95% of those cases, the disorder begins by age 25. Many kinds of eating disorders may affect children and teens:

  • Anorexia nervosa is an eating disorder characterized by an extreme fear of gaining weight. People with anorexia nervosa often see themselves as overweight when they are at a healthy weight, and even when they are greatly underweight. There are two forms of anorexia nervosa: The restrictive form is when people greatly limit what and how much they eat in order to control their weight. In the binge-purge type, people limit what and how much they eat, but also binge and purge — that is, they will eat a large amount at once and try to get rid of the extra calories through vomiting, laxatives, diuretics, or excessive exercise.
  • Bulimia nervosa involves binging and purging but without limiting what and how much a person eats.
  • Binge eating disorder is when people binge eat but don’t purge or restrict. This is actually the most common eating disorder in the United States.
  • Avoidant restrictive food intake disorder is most common in childhood. The person limits the amount or type of food they eat, but not because they are worried about their weight. For example, someone with inflammatory bowel disease may associate eating with pain and discomfort, and so may avoid eating. Children with sensory issues may find the smell, texture, or taste of certain foods deeply unpleasant, and so will refuse to eat them. This is more than just “picky eating” and can lead to malnutrition.

Misunderstandings about eating disorders

When most people think of eating disorders, they think of someone who is overly thin. However, you can have an eating disorder and have a normal weight, or even be overweight. The most important thing that many people don’t realize about eating disorders is that they are a serious mental health issue and can be very dangerous. They can affect and damage many parts of the body — and can even be lethal. Of all the kinds of eating disorders, anorexia nervosa is the one that is most likely to lead to death.

What parents need to know: Signs of eating disorders

It’s not surprising that eating disorders have been on the rise in children and teens during the pandemic, given the disruption, isolation, and stress — and excessive time on social media — that it has brought. It’s important that parents watch for possible signs that their child or teen could have an eating disorder, including:

  • changes in what, when, and how much they eat
  • being restrictive or regimented about their eating
  • unusual weight fluctuations
  • expressing unhappiness with their body or their weight
  • exercising much more than usual
  • spending a lot of time in the bathroom.

If it even crosses your mind that your child might have an eating disorder, remember that eating disorders are not about choice. Mental health problems such as anxiety and depression play a big role; emotional suffering often underlies eating disorders. And research shows that when you undereat or overeat, it affects the brain processes that control hunger and food intake, reinforcing the eating disorder.

If you have concerns, talk to your child — and talk to your doctor. Even if you are wrong, it may lead to an important conversation about healthy eating and body image that could help prevent a future eating disorder. And if you are right, the sooner your child gets help, the better.

Summer camp 2022: Having fun and staying safe

A boy and three girls walking in the woods with hiking sticks; out of focus trees are leafy green, suggesting summertime

It’s time to make summer plans, and for many families those plans include summer camp. After the past couple of years, the idea of getting out of the house, being active, and seeing other children sounds very appealing.

While COVID-19 is still with us, vaccines and the fact that so many people have gotten sick and developed some natural immunity has made activities like summer camp less treacherous. Unfortunately, this doesn’t mean that families don’t need to think about COVID-19 as they make their plans, because they still do.

What to do before signing up for summer camp this year

Before even thinking about camp, take into account your family’s particular risk factors. If children are 5 or older and haven’t been vaccinated, now is the time to get the vaccine. If you have any questions or concerns about the vaccine, please talk to your doctor. While you are at it, make sure that children are up to date on routine childhood vaccinations. Many children have gotten behind because of the pandemic.

Talk to your doctor about the pros and cons of camp if your child

  • isn’t or can’t be vaccinated, since it’s important to think about factors that might make getting COVID riskier.
  • has health problems like asthma or congenital heart disease that put them at higher risk of complications of COVID-19.
  • has a weakened immune system for any reason. Whether or not your child is vaccinated, it’s always important to check in with their doctor before sending them to camp, or any group activity.

Questions to ask any camp you’re considering

These days, most communities have dropped mask mandates. While it’s certainly nice to not have to wear one — and to see people’s faces — masks do make a difference when it comes to preventing the spread of infection. COVID-19 is still causing illness and is likely to be with us beyond this summer. Before signing up for camp there are things parents should think about — and questions they should ask.

Where is the camp, and where are the campers and staff from? A local day camp with children and staff mostly from a town with low numbers of COVID cases is going to be lower-risk than one in a community with higher numbers, or one that draws from many different communities, including some with higher numbers. The Centers for Disease Control and Prevention has a database of case numbers by county.

What is the vaccination status of the staff and campers? Ideally, all eligible staff and campers should be vaccinated — with not just their primary series, but any booster doses they are eligible to receive.

How is the camp screening for symptoms or exposures, and what guidelines do they have in place? This is most important when there are unvaccinated staff or campers, or in areas of higher case counts. The camp should have a plan for screening campers and staff for symptoms, with appropriate plans for staying home, testing, and quarantine based on the results of those screenings. Find out how exposures outside of camp will be handled for campers and staff. Sleepaway camps should have designated quarantine space, and access to testing. Ask about their testing requirements, as well.

Are activities mostly indoors or mostly outdoors? The more outdoor activities, the better. Indoor activities are safest in well-ventilated spaces.

What is the policy on wearing masks? Wearing a mask for 10 days after testing positive for COVID or being in close contact with someone who has it is essential to help others stay healthy. (Also follow recommendations for quarantine or isolation described in this tool from the CDC.) Masks may also be a good idea for indoor situations where people are close together — and some staff and campers might simply feel more comfortable wearing a mask. The camp should have a culture that allows those who choose to wear masks to feel comfortable doing so.

What is the plan for shared equipment and surfaces? One is far more likely to catch an infection from a person than a surface, but it’s important that anything that multiple people touch be wiped down regularly.

What is the plan for hand washing? Regular hand washing with soap and water or hand sanitizer is important to limit the spread of germs, including the virus that causes COVID-19. Parents should ask how often campers will be washing their hands, and about the availability of hand sanitizer.

What is the plan for meals? Eating together increases the risk of transmission of COVID-19. The risk is lower if people eat outdoors or have some space to spread out — and if they bring their own food rather than sharing.

As much as we may all feel done with COVID-19, the reality is that COVID-19 isn’t done with us. Children need the experiences camp can bring, especially after their lives have been so disrupted — and with just a few precautions, they can have fun and be safe too.

Follow me on Twitter @drClaire

Strong legs help power summer activities: Hiking, biking, swimming, and more

Older woman wearing black cycling clothes and a blue helmet riding a bicycle on a roadway with flowering trees bushes and tress lining the roadside

My favorite summer activities officially kick in when the calendar flips to May. It’s prime time for open water swimming, running, cycling, hiking, and anything else that gets me outside and moving. Yet, my first step is to get my legs in shape.

“Legs are the foundation for most activities,” says Vijay Daryanani, a physical therapist at Harvard-affiliated Spaulding Rehabilitation Hospital. “They’re home to some of the body’s largest muscles, and building healthy legs can improve one’s performance, reduce injury, and increase endurance.”

Four leg muscle groups to build for summer activities

Four muscles do the most leg work: quadriceps, gluteus maximus (glutes), hamstrings, and calves. Here is a look at each.

Quadriceps (quads). Also known as the thigh muscles, the quads are a group of four muscles (hence the prefix “quad’). They extend your leg at the knee and power every leg action: stand, walk, run, kick, and climb.

Glutes. The body’s largest muscles, the glutes (your buttock muscles) keep you upright and help the hips and thighs propel your body forward.

Hamstrings. The hamstrings are a group of three muscles that run along the back of your thighs from the hip to just below the knee. They allow you to extend your leg straight behind your body and support hip and knee movements.

Calves. Three muscles make up the calf, which sits in the back of the lower leg, beginning below the knee and extending to the ankle. They work together to move your foot and lower leg and push you forward when you walk or run.

Spotlight muscle strength and length

Strength and length are the most important focus for building summer-ready legs, says Daryanani. “Strengthening leg muscles increases power and endurance, and lengthening them improves flexibility to protect against injury.”

If you are new to exercise or returning to it after time off, first get your legs accustomed to daily movement. “Start simply by walking around your home nonstop for several minutes each day, or climbing up and down stairs,” says Daryanani.

After that, adopt a walking routine. Every day, walk at a moderate pace for 20 to 30 minutes. You can focus on covering a specific distance (like one or two miles) or taking a certain number of steps by tracking them on your smartphone or fitness tracker. You won’t just build leg strength — you’ll reap a wide range of health benefits.

There are many different leg muscle-building exercises, some focused on specific activities or sports. Below is a three-move routine that targets the four key leg muscles. Add them to your regular workout or do them as a leg-only routine several times a week. (If you have any mobility issues, especially knee or ankle problems, check with your doctor before starting.)

To help lengthen your leg muscles and increase flexibility, try this daily stretching routine that includes several lower-body stretches.

Dumbbell squats

Muscles worked: glutes and quads

Reps: 8-12

Sets: 1-2

Rest: 30-90 seconds between sets

Starting position: Stand with your feet apart. Hold a weight in each hand with your arms at your sides and palms facing inward.

Movement: Slowly bend your hips and knees, leaning forward no more than 45 degrees and lowering your buttocks down and back about eight inches. Pause. Slowly rise to an upright position.

Tips and techniques:

  • Don’t round or excessively arch your back

Make it easier: Do the move without holding weights.

Make it harder: Lower yourself at a normal pace. Hold briefly. Stand up quickly.

Reverse lunge

Muscles worked: quads, glutes, hamstrings

Reps: 8-12

Sets: 1-3

Rest: 30-90 seconds between sets

Starting position: Stand straight with your feet together and your arms at your sides, holding dumbbells.

Movement: Step back onto the ball of your left foot, bend your knees, and lower into a lunge. Your right knee should align over your right ankle, and your left knee should point toward (but not touch) the floor. Push off your left foot to stand and return to the starting position. Repeat, stepping back with your right foot to do the lunge on the opposite side. This is one rep.

Tips and techniques:

  • Keep your spine neutral when lowering into the lunge.
  • Don’t lean forward or back.
  • As you bend your knees, lower the back knee directly down toward the floor with the thigh perpendicular to the floor.

Make it easier: Do lunges without weights.

Make it harder: Step forward into the lunges, or use heavier weights.

Calf raises

Muscles worked: calves

Reps: 8-12

Sets: 1-2

Rest: 30 seconds between sets

Starting position: Stand with your feet flat on the floor. Hold on to the back of a chair for balance.

Movement: Raise yourself up on the balls of your feet as high as possible. Hold briefly, then lower yourself.

Make it easier: Lift your heels less high off the floor.

Make it harder: Do one-leg calf raises. Tuck one foot behind the other calf before rising on the ball of your foot; do sets for each leg. Or try doing calf raises without holding on to a chair.

Power your paddle sports with three great exercises

two kayaks and a paddle board on the beach adjacent to a lake

For my birthday last year, I received paddleboard lessons. I was always curious about the popular water sport and watched in fascination as people stood on almost-invisible boards, paddling along as if walking on water.

Paddleboarding was everything I expected and then some. Still, I quickly realized that it is a serious workout, like all paddle sports, such as kayaking and canoeing. It may look effortless, floating along and casually dipping a paddle in water. But much goes on beneath the surface, so to speak. As warmer weather beckons and paddle season arrives, it pays to get key muscles in shape before heading out on the water.

Tuning up muscles: Focus on core, back, arms, and shoulders

“Paddling a kayak, canoe, or paddleboard relies on muscles that we likely haven’t used much during winter,” says Kathleen Salas, a physical therapist with Spaulding Adaptive Sports Centers at Harvard-affiliated Spaulding Rehabilitation Network. “Even if you regularly weight train, the continuous and repetitive motions involved in paddling require endurance and control of specific muscles that need to be properly stretched and strengthened.”

While paddling can be a whole-body effort (even your legs contribute), three areas do the most work and thus need the most conditioning: the core, back, and arms and shoulders.

  • Core. Your core comprises several muscles, but the main ones for paddling include the rectus abdominis (that famed “six-pack”) and the obliques, located on the side and front of your abdomen. The core acts as the epicenter around which every movement revolves — from twisting to bending to stabilizing your trunk to generate power.
  • Back: Paddling engages most of the back muscles, but the ones that carry the most load are the latissimus dorsi muscles, also known as the lats, and the erector spinae. The lats are the large V-shaped muscles that connect your arms to your vertebral column. They help protect and stabilize your spine while providing shoulder and back strength. The erector spinae, a group of muscles that runs the length of the spine on the left and right, helps with rotation.
  • Arms and shoulders: Every paddle stroke engages the muscles in your arms (biceps) and the top of your shoulder (deltoids).

Many exercises specifically target these muscles, but here are three that can work multiple paddling muscles in one move. Add them to your workouts to help you get ready for paddling season. If you haven’t done these exercises before, try the first two without weights until you can do the movement smoothly and with good form.

Three great exercises to prep for paddling

Wood chop

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Muscles worked: Deltoids, obliques, rectus abdominis, erector spinae
Reps: 8–12 on each side
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Stand with your feet about shoulder-width apart and hold a dumbbell with both hands. Hinge forward at your hips and bend your knees to sit back into a slight squat. Rotate your torso to the right and extend your arms to hold the dumbbell on the outside of your right knee.

Movement: Straighten your legs to stand up as you rotate your torso to the left and raise the weight diagonally across your body and up to the left, above your shoulder, while keeping your arms extended. In a chopping motion, slowly bring the dumbbell down and across your body toward the outside of your right knee. This is one rep. Finish all reps, then repeat on the other side. This completes one set.

Tips and techniques:

  • Keep your spine neutral and your shoulders down and back
  • Reach only as far as is comfortable.
  • Keep your knees no farther forward than your toes when you squat.

Make it easier: Do the exercise without a dumbbell.

Make it harder: Use a heavier dumbbell.

Bent-over row

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Muscles worked: Latissimus dorsi, deltoids, biceps
Reps: 8–12
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Stand with a weight in your left hand and a bench or sturdy chair on your right side. Place your right hand and knee on the bench or chair seat. Let your left arm hang directly under your left shoulder, fully extended toward the floor. Your spine should be neutral, and your shoulders and hips squared.

Movement: Squeeze your shoulder blades together, then bend your elbow to slowly lift the weight toward your ribs. Return to the starting position. Finish all reps, then repeat with the opposite arm. This completes one set.

Tips and techniques:

  • Keep your shoulders squared throughout.
  • Keep your elbow close to your side as you lift the weight.
  • Keep your head in line with your spine.

Make it easier: Use a lighter weight.

Make it harder: Use a heavier weight.

Superman

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Muscles worked: Deltoids, latissimus dorsi, erector spinae
Reps: 8–12
Sets: 1–3
Rest: 30–90 seconds between sets

Starting position: Lie face down on the floor with your arms extended, palms down, and legs extended.

Movement: Simultaneously lift your arms, head, chest, and legs off the floor as high as is comfortable. Hold. Return to the starting position.

Tips and techniques:

  • Tighten your buttocks before lifting.
  • Don’t look up.
  • Keep your shoulders down, away from your ears.

Make it easier: Lift your right arm and left leg while keeping the opposite arm and leg on the floor. Switch sides with each rep.

Make it harder: Hold in the “up” position for three to five seconds before lowering.

What is a successful mindset for weight loss maintenance?

older man being weighed in a medical setting

In today’s calorie-rich, ultra-processed, movement-sparing, chronic stress-inducing, so-called “toxic” environment, losing weight is hard work. But implementing a healthy and sustainable approach that keeps the weight off is even harder.

Short-term weight loss can be easier than long-term weight maintenance

Most of us can successfully achieve weight loss in the short term. But those who hop from one fad diet to the next often experience the metabolic roller coaster known as yo-yo dieting that jacks up our hunger hormones, plummets our metabolic rates, and causes a vicious spiral of weight loss followed by regain. Even most medical interventions to help treat obesity produce the typical trajectory of rapid weight loss followed by weight plateau and then progressive weight regain. In a meta-analysis of 29 long-term weight loss studies, more than half of the lost weight was regained within two years, and by five years more than 80% of lost weight was regained. This means that based on our best estimates, only one in five individuals who is overweight is successful in long-term weight loss.

What is so special about weight loss maintainers?

Based on studies from the National Weight Control Registry, a database of more than 4,000 individuals who have maintained at least 10% body weight loss for at least one year, we have insight into some tried and true tactics. These include various energy intake-reducing behaviors — limiting calorie-dense foods and sugar-sweetened beverages, portion control and a consistent eating pattern across days, increased fruit and vegetable consumption — as well as being physically active for at least an hour per day.

This makes sense and is consistent across the scientific literature. Any successful weight loss necessitates tipping and keeping the scale toward greater energy expenditure and less energy intake (a net negative energy balance). But how do these people actually sustain those weight loss-promoting behaviors over time, in order to build a lifestyle that does not leave them feeling persistently deprived, lethargic, and hangry (hungry + angry)?

The most important determinants of weight loss maintenance are those that cement changes in behavior. As more recent evidence confirms, the proper psychology for weight loss is critical for regulating the physiology that supports weight loss.

Self-regulation and self-efficacy are key to long-term success

Only recently have we started to evaluate the psychological and cognitive determinants of weight loss maintenance. We all have anecdotal evidence from family, friends, and colleagues. But systematically collecting, processing, and analyzing the qualitative experiences, strategies, and challenges from successful weight loss maintainers is difficult.

The data to date confirm the importance of self-regulation, and in particular self-monitoring of the day-to-day behaviors that drive energy intake and energy expenditure, especially eating behaviors. Those who have high self-efficacy (belief in your capacity to execute certain behaviors) for exercise in particular are more successful at sustaining weight loss. And more recently, researchers have been decoding elements of the proper mindset that instills high self-efficacy for the larger constellation of important weight management behaviors.

One recent study used machine learning and natural language processing to identify the major behavioral themes — motivations, strategies, struggles, and successes — that were consistent across a group of over 6,000 people who had successfully lost and maintained over 9 kilograms (about 20 pounds) of weight for at least a year. Among this large group, they consistently advised perseverance in the face of setbacks, and consistency in food tracking and monitoring eating behaviors, as key behavior strategies. And most of them stayed motivated by reflecting on their improved health and appearance at their lower weight.

Studies about successful weight loss miss many people

The evidence suggests that age, gender, and socioeconomic status are not significant factors in predicting weight loss maintenance. But most weight loss studies oversubscribe white, educated, and midlevel income-earning females. Given that the prevalence of obesity and its related comorbidities is disproportionately higher in more socially disadvantaged and historically marginalized populations, we need richer, more representative data to paint a full and inclusive picture of a successful weight loss psychology. We need to better understand the lived experience of all people so that we can determine the most powerful and unique motivations, effective behavioral strategies, and likely challenges and setbacks, particularly the environmental determinants that dictate the opportunities and barriers for engaging in and maintaining a healthier lifestyle.

Maintaining weight requires multiple tools, training, and support

What we can say for certain is that for any and all of us, maintaining weight loss necessitates getting comfortable with discomfort — the discomfort of occasionally feeling hungry, of exercising instead of stress eating, of honestly deciphering reward-seeking versus real hunger, and resisting the ubiquitous lure of ultrapalatable foods. This is no easy task, as it often goes against environmental cues, cultural customs, family upbringing, social influences, and our genetic wiring. In order to help each other achieve health and weight loss in our modern environment, we need to learn and practice the psychological tools that help us not only accept, but eventually embrace, this inevitable discomfort.

Healthy oils at home and when eating out

photo of an assortment of different types of plant-based oils in bottles against a light background

Some people may be cautious when it comes to using oils in cooking or with their food. Eating fat with meals conjures thoughts of high cholesterol and, well, getting fat. The fact that some fats are labeled as “bad” adds to the confusion and misconception that all fats are unhealthy.

But that isn’t the case.

“It’s important to consume oils,” says Shilpa Bhupathiraju, assistant professor of medicine at Harvard Medical School and assistant professor of nutrition at Harvard’s T.H. Chan School of Public Health.

Oils and fats contain essential fatty acids — omega 3s and 6s, in particular — that are part of the structure of every single cell in the body, says Walter Willett, professor or epidemiology and nutrition at the Harvard T.H. Chan School of Public Health. They’re the building blocks of hormones, help decrease inflammation, and lower bad cholesterol and blood pressure. Oil also provides taste and satiety.

The key is knowing the right kind to use. It’s easier when you’re cooking at home, a little trickier when you’re eating out and you can’t control every step in the process. But it’s not just about picking the healthiest oils. They play a part in a healthy diet when they’re part of an eating plan that minimizes processed foods, simple carbohydrates, and sugar.

Healthy and not-so-healthy oils

In general, Willett says that the healthiest oils are liquid and plant-based. The one that comes to mind first is olive oil, and for good reason. “It’s stood the test of time,” he says. It helps lower blood cholesterol and provides antioxidants, and extra virgin is the ideal version, as it’s the first pressing and least refined.

After that, corn, canola, sunflower, safflower, and soybean all fall into the healthy column. The last one wasn’t always considered a healthy choice because it used to be hydrogenated, but now it’s in a natural state and a good source, says Willett.

On the unhealthy side, there’s lard, butter, palm oil, and coconut oil. The commonality is that they come in a semi-solid state and have a high level of saturated fat. The consumption of that fat increases LDL cholesterol (the bad kind), and has been associated with increased risk for cardiovascular disease and diabetes.

Willett says part of the challenge is cultural. Northern European tradition is based on eating animals and animal fats, and those fats, like butter and lard, come in solid form. The Southern European approach, like the Mediterranean diet, is based on plant-based oils, particularly olive.

While saturated fats provide none of the above-mentioned health benefits, they don’t have to be avoided entirely, just minimized to 5% of your diet, says Willett. For example, if you typically consume 2,000 calories a day, only 100 should come from saturated fats.

Eating out versus at home

If you’re eating at home and you’re using healthy oils, there is less concern about consuming the wrong fats or too much. Whether you’re frying, sautéing, or dressing a salad, you’re in control of all the factors. Using too much oil isn’t such a concern, Bhupathiraju says, since people usually regulate their intake through knowing when something will taste too oily.

Frying, in general, is often a worry, but it’s not necessarily unhealthy. It’s more about what’s being fried. Cheese, a saturated fat, wouldn’t be a great choice, but zucchini wouldn’t be bad, as Bhupathiraju says.

The concern with fried foods, and eating out in general, is what kind of oil is being used and how. With deep fryers, if the oil isn’t regularly changed, it repeatedly gets reheated and trans fats are created. These can produce inflammation in the body, which can lead to heart disease, type 2 diabetes, and contributes to the breakdown of cell membranes.

The easiest move is to avoid eating all fried foods. But Willett says that, again, that’s not always necessary. The use of trans fats was prohibited in 2018, so it’s likely a restaurant is using a healthier oil. Even so, eating fried foods occasionally isn’t too harmful.

Focus on maintaining a healthy diet, with good oils

Willett says that people get the majority of their calories from two sources — fats and carbohydrates — and “what’s important is both should be healthy,” he says.

When you eat healthy carbs and fats, you don’t have to worry about how much you’re eating of either. “The ratio doesn’t make much difference. They’re both healthy,” he says. The focus in on overall eating. A healthy diet can consist of mostly whole grains like brown rice, steel-cut oats, wheat berries, and quinoa. The less something is milled and made into a powder, the more slowly it will release into the body, preventing sudden spikes in blood sugar.

While low-fat diets had some popularity in the 1990s, low-fat products aren’t healthier. Willett says that research has shown that low-carb diets are more effective for weight loss than low-fat ones, and that low-fat diets are not more effective for weight loss than higher-fat ones.

The best approach to eating well is the science-backed recommendation of having lots of colors on your plate. Orange, yellow, green, and red foods supply various antioxidants and phytochemicals that may be protective to the body. When you compose your diet like this, chances are you’ll eat more slowly and consume fewer empty calories, Bhupathiraju says.

“Enjoy fats,” Willett says. “Good olive oil is good for you. It will help you enjoy the salad and make the eating experience and eating of vegetables more enjoyable.”

A common virus may be one contributing cause of multiple sclerosis

Enlarged particles of the common human Epstein-Barr Virus (EBV) shown in bright green, spiky blue, orange, and pink against a dark blue background

Discovering the cause of a disease is not easy. One reason is that the vast majority of diseases do not have a single cause. Instead, most diseases occur because multiple factors combine to cause the disease.

One factor is genes. Some people are born with one or more genes that make them vulnerable to a disease. Other factors come from your environment and behavior: what you eat, the air you breathe, the amount of physical activity you engage in, and habits such as smoking. Recent research finds that certain viruses may also be important contributing factors in causing multiple sclerosis (MS).

Multiple sclerosis harms cells in the brain and spinal cord — but why?

Multiple sclerosis is a disease of the brain and spinal cord that can cause many neurological symptoms, including arm and leg weakness, loss of vision, and difficulty thinking, as well as severe fatigue. Over the past 50 years we’ve learned that MS is an autoimmune disease: in various ways, the immune system attacks the brain and/or the spinal cord, leading to the symptoms of the illness.

However, we haven’t figured out why: what causes the immune system to go on the attack? Over the years, several viruses have been proposed as causes of MS, only to have subsequent research show that they were not. That led some MS doctors and scientists to discount viruses as possible causes.

Yet growing evidence in recent years points to several viruses that may be triggers of MS. The strongest evidence is for Epstein-Barr virus (EBV). This virus infects most people in developed nations like the US in their teen or young adult years.

Once a person is infected, the virus quietly remains alive in the body for the rest of a person’s life. In most people, it causes no health problems. But, rarely, it can cause certain cancers. Now, it has been linked to multiple sclerosis.

Delving deeper into a link between Epstein-Barr virus and MS

A large, long-term study from Harvard, published in the prestigious journal Science, attracted a lot of attention. Blood samples were repeatedly collected from 10 million US military personnel over 20 years. The samples were tested for evidence of infection with EBV.

Over the 20 years, some people in the study developed MS. The researchers compared two groups: people who were not infected with EBV when they entered military service, but then became infected later on; and people who remained uninfected by the virus. Those in the first group were 32 times more likely to develop MS than those in the second group. On average, symptoms of MS began about five years after a person became infected with EBV.

What do these findings tell us? The study provides strong evidence that a new infection with EBV is one important factor — maybe even a necessary factor — in causing MS. But the story is more complicated than that. Think about this: About 95% of all humans become permanently infected with EBV by early adulthood, but fewer than 1% of people develop MS. So, just being infected with EBV doesn’t mean a person will get MS — far from it. Indeed, other factors besides EBV infection also must be involved in causing MS.

Those other factors almost certainly include being born with certain genes that make you vulnerable to getting MS. Being infected with other viruses, as well as EBV, also may be important factors.

But which viruses? In my opinion, growing evidence indicates that a “cousin” of EBV, called human herpesvirus-6A, also may be important in triggering MS. And the genes of endogenous retroviruses also may be factors.

What are endogenous retroviruses?

About 8% of the genes that we are born with come from ancient viruses called retroviruses. These viral organisms successfully inserted their genes into the genes of the animals that preceded, and led to, humans. Some of those genes can be turned on to make proteins that affect our immune systems. Finally, there is evidence that each of these viruses — EBV, human herpesvirus-6A, and endogenous retroviruses — can activate one another, and gang up to cause a disease.

Going forward: New research may offer new leads for prevention

If the Epstein-Barr virus is one important factor in causing multiple sclerosis, then it is possible that vaccines against EBV might lead to fewer cases of MS. Indeed, several scientific groups around the world are working on such vaccines.

One company that made the mRNA vaccine for COVID-19 is working on an mRNA EBV vaccine. The National Institutes of Health also is developing a vaccine. However, it is unlikely we will know if they are effective against EBV, or against the development of MS, for at least a decade. Still, the linkage with this virus may prove to be an important milestone in ultimately conquering multiple sclerosis.

Primary progressive aphasia involves many losses: Here’s what you need to know

illustration of a woman holding a hand to her forehead, with pixelated squares scattered around her head representing a memory problem

When you think about progressive brain disorders that cause dementia, you usually think of memory problems. But sometimes language problems — also known as aphasia — are the first symptom.

What’s aphasia?

Aphasia is a disorder of language because of injury to the brain. Strokes (when a blood clot blocks off an artery and a part of the brain dies) are the most common cause, although aphasia may also be caused by traumatic brain injuries, brain tumors, encephalitis, and almost anything else that damages the brain, including neurodegenerative diseases.

How neurodegenerative diseases cause aphasia

Neurodegenerative diseases are disorders that slowly and relentlessly damage the brain. After ruling out a brain tumor with an MRI scan, you can usually tell when aphasia is from a neurodegenerative disease, rather than a stroke or other cause, by its time course: Strokes happen within seconds to minutes. Encephalitis presents over hours to days. Neurodegenerative diseases cause symptoms over months to years.

Alzheimer’s disease is the most common neurodegenerative disease, but there are other types as well, such as frontotemporal lobar degeneration. Different neurodegenerative diseases damage different parts of the brain and cause different symptoms. When a neurodegenerative disease causes problems with language first and foremost, it is called primary progressive aphasia.

How is primary progressive aphasia diagnosed?

Primary progressive aphasia is generally diagnosed by a cognitive behavioral neurologist and/or a neuropsychologist who specializes in late-life disorders. The evaluation should include a careful history of any language and other problems that are present; a neurological examination; pencil-and-paper testing of thinking, memory, and language; blood tests to rule out vitamin deficiencies, thyroid disorders, infections, and other medical problems; and an MRI scan to look for strokes, tumors, and other abnormalities that can affect the brain’s structure.

The general criteria for primary progressive aphasia include:

  • difficulty with language is the most prominent clinical feature at the onset and initial phases of the neurodegenerative disease
  • these language problems are severe enough to cause impaired day-to-day functioning
  • other disorders that could cause the language problems have been looked for and are not present.

There are three major variants of primary progressive aphasia

Primary progressive aphasia is divided into different variants based on which aspect of language is disrupted.

Logopenic variant primary progressive aphasia causes word-finding difficulties. Individuals with this variant have trouble finding common, everyday words such as table, chair, blue, knee, celery, and honesty. They know what these words mean, however.

Semantic variant primary progressive aphasia causes difficulty in understanding what words mean. When given the word, individuals with this variant may not understand what a table or chair is, which color is blue, where to find their knee, what celery is good for, and what honesty means.

Nonfluent/agrammatic variant primary progressive aphasia causes effortful, halting speech in which individuals know what they want to say but cannot get the words out. When they can get words out, their sentences often have incorrect grammar. Although they know what the individual words mean, they may have trouble understanding a sentence with complex grammar, such as, “The lion was eaten by the tiger.”

Different primary progressive aphasia variants are caused by different diseases

These primary progressive aphasia variants are not diseases themselves. They are symptoms of brain problems. Not sure what I mean? Consider three other symptoms: fever, headache, and chest pain. As you know, each of these symptoms may be caused by different underlying diseases.

The logopenic variant of primary progressive aphasia is usually caused by Alzheimer’s disease. Does that surprise you? What this means is that although Alzheimer’s disease typically begins with memory loss, in some individuals it can start with trouble finding words. Memory problems typically begin a few years later. (Why do we call it Alzheimer’s disease if it doesn’t start with memory problems? Because Alzheimer’s disease is defined by the pathology that we see under the microscope when we examine the brain tissue, not by its symptoms.)

The semantic variant of primary progressive aphasia is usually caused by frontotemporal lobar degeneration, and specifically by accumulation of TDP-43. TDP-43 is an abnormal protein that accumulates in — and ultimately kills — brain cells.

The nonfluent/agrammatic variant of primary progressive is also usually caused by frontotemporal lobar degeneration, but this time it is most often due to tau pathology. Tau accumulation leads to tangles inside cells that damage and then destroy them.

Can primary progressive aphasia be treated?

The treatments available for primary progressive aphasia are generally strategies and systems to help individuals with these disorders communicate better.

  • Thinking of information related to the word they are looking for can sometimes help individuals with logopenic variant primary progressive aphasia. For example, if they are searching for the word lion, thinking of yellow, Africa, big cat, mane, and similar words may help.
  • Using your tone of voice, facial expression, and body language can be helpful to communicate with individuals with semantic variant primary progressive aphasia, as can pantomiming the message you are trying to convey.
  • Using pictures, either on paper or in a tablet-based application, can be helpful to individuals with all variants of primary progressive aphasia.

Unfortunately, there are no cures for primary progressive aphasia, and no medications that have been shown to be effective. Most patients with primary progressive aphasia develop other cognitive problems over time, leading to a more general dementia.

If you suspect that you (or your loved one) may have primary progressive aphasia, start by meeting with your doctor. If your doctor is concerned, they will send you (or your loved one) to the right specialist.