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Dear Vice President Pence,

I was scrolling Twitter a few nights ago and came across this tweet. And, Im going to be honest, it triggered something in me. You see, Ive been angry for a long time now, about a lot of things happening in our country. But my anger has been simmering, controlled. Saturday night though, it reached a boiling point. I realize I no longer live in a country with values I recognize, or with leadership I trust. And thats infuriating.

Personal responsibility, Mr. Pence? What exactly are you referring to here? Because I really dont know how my six-year-old Grayson, who is non-verbal, non-ambulatory, exclusively tube fed, vision impaired and medically fragile, who relies on me and a handful of other caregivers for literally everything, is supposed to take personal responsibility for his own health. You know, since it was his fault he was born with an incurable genetic disease. I dont know, maybe if he had just worked a little harder to eat as a baby, instead of throwing up every ounce we gave him, he wouldnt have needed that feeding tube. I guess the hours weve spent in therapy trying to get him to achieve milestones like sitting up and crawling just werent enough. He should have tried harder, right?

Regardless of how much hes slacked off in the personal responsibility game, here we are. I have a child who is not, and will not ever be healthy, and you and I both know thats no ones fault, especially not his. But seriously, answer this question for me. If lifetime caps on insurance are allowed to be re-instated, and Medicaid is gutted, how is Grayson supposed to get the thousands upon thousands upon thousands of dollars (and honestly, its likely millions) worth of health care products and services he needs to LIVE? Without access to the health care our private insurance and Medicaid provides, he will die. If I sound a little shrill and dramatic, its because I am. Put yourself in my shoes, and the shoes of my friends with medically fragile kids.

Hundreds of miles away from where I tucked my little boy in bed last night, positioning him to ensure he sleeps safely and comfortably, there are a group of white men (no women or people of color, really?) who secretly wrote a bill that makes it clear that the value of my sons life has a limit. Youre a father. Think about that what if someone told you that about one of your kids? Would you not fight like hell and maybe get a little dramatic and shrill?

Oh wait, you say you arent talking about Grayson himself not having any personal responsibility for his health? OK, so you mean me? And my husband? Well, my husband works really long hours as a high school teacher and coach, pouring into teenagers and trying to teach them that personal responsibility you seem so fond of. But its no secret teaching doesnt make one wealthy, and it certainly isnt going to provide the funds necessary to keep my child from dying if we lose insurance and/or Medicaid for him.

And me? You want to know the weight of my personal responsibility? The crushing weight that every single special needs mother feels, and cant unload? How I lie awake at night wondering, and worrying, about a childs future who has no future apart from me. How sometimes I feel more like his nurse than his mom, or his manager, with all the phone calls and paperwork I have to do on his behalf. How keeping myself healthy (physically and mentally) is so crucial, mainly because how would I take care of Grayson if I were sick or dead? What would happen to him? Dont you dare suggest that I havent felt, or acted, responsibly.

Mr. Pence, I know a lot of people who really like you, especially where I live. They voted for and tolerate that moron who picked you as his running mate, but you are the one they think is going to turn this country around, and make it great again. Why? Because youre a Christian, and are pro-life. You claim to have Christian values and are going to bring God back into our country. Ok, great. Im a Christian too. And I love Jesus. But like Ghandi, I dont really like a lot of Christians these days, because they are so unlike my Christ. And honestly, Im sticking you in that category too. There is absolutely nothing Christ-like or pro-life about gutting Medicaid and making the sick and the poor suffer while the rich get richer. Your brand of Christianity is the prosperity gospel- work hard enough, and be the right kind of person, and you will be rewarded. Real life, REALITY, doesnt work like that. Good, hard working people get sick all the time and need expensive care, care that is often the reason they are poor. You think Jesus would agree that the value of Graysons, or anyones life, has a monetary limit?

I noticed you tweeted again the following statement, referring to the original tweet:

You may be right, that may be the Republican way, but I sure as hell hope you're wrong about it being the American way. This is not the America I want to raise my children in, and they surely won't be taught to embrace these values. Being sick or poor is not a character flaw. We are supposed to take care of each other; instead, you want only those who are rich, able-bodied, or have lived up to some arbitrary measure of "personal responsibility" to have the America you are making to be "great". Well fuck that, Mr. Pence. I am angry, and I will stay angry and fight like hell for my child and all the children and Americans who are being screwed by this inhumane, ridiculous bill. That, I believe, is MY personal responsibility.

So You Want To Raise A Feminist?

Start here, with the latest stories and news in parenting.

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Dear Vice President Pence, What Exactly Do You Mean By 'Personal Responsibility'? - HuffPost

Studies show that excess weight gain in pregnancy poses a host of health issues for both the mother and her child.

Nearly half of women gain more weight than they should while pregnant.

Thats according to a recent global review.

And thats a big problem.

Researchers say thats because these mothers-to-be are setting themselves up to be heavier throughout their lives and increasing the health risks for their children.

For starters, a baby is likely to be born too big if the mother gains excessive weight during pregnancy.

Bigger babies may have a higher risk of heart disease and obesity later in life. The same is true for babies born quite small.

Among Americans, earlier research found 70 percent of overweight women, and 64 percent of obese women gain more than recommended while pregnant. Overall, 53 percent of all women.

The new review, published in the Journal of the American Medical Association (JAMA), analyzed data from 23 studies that included more than 1.3 million women in all.

If a woman gained too much weight, the risk of bearing a baby considered oversize larger than 8 pounds, 3 ounces nearly doubled. These same women increased their risk of a surgical delivery by 30 percent.

They were less likely, however, to have preterm babies or small ones.

Read more: Does being around a baby help boost fertility?

The analysis didnt contain surprises, observers say, but it feeds into the debate about the best pregnancy strategy for overweight and obese women.

So many women are entering pregnancy above a healthy weight, Helena Teede, an endocrinologist in Australia and a study lead author, told Healthline in an email.

Ten of the studies were from the United States, where women tended to be heavier than in the overall sample, she noted.

Current guidelines from the Institute of Medicine, which are supported by the American Congress of Obstetricians and Gynecologists (ACOG), advise obese women to gain 11 to 20 pounds while pregnant.

Some experts say thats too much, and that the most obese might even try to lose weight while carrying.

Teede disagrees.

The results affirm that women, no matter how unhealthy their weight, shouldn't lose weight in pregnancy, she said.

In the new analysis, gaining less than recommended increased the risk of a preterm birth or undersize baby for women of all weights, including obese women.

The better goal for obese women: Lose weight before conceiving.

Its incredibly important, Aaron Caughey, MD, PhD, who treats at-risk pregnant women at Oregon Health & Science University, told Healthline.

Read more: More new mothers are asking for long-term birth control

Youll hear while pregnant that youre eating for two.

Actually, in the first trimester its best to eat normally. Women can eat 350-450 extra calories per day during the next two trimesters, depending on their starting weight.

Under the Institute of Medicine guidelines, underweight women should gain around a pound a week in the second and third trimesters, up to 28 to 40 pounds in all.

If you start off at a normal weight, aim to gain 25 to 35 pounds.

Overweight women should aim for 15 to 25 pounds, and obese women no more than 20, which averages out to half a pound a week.

The totals roughly double for twins, if youre overweight or obese.

Line up support to eat healthily, too.

If we see a pregnant woman drinking alcohol, we say, Oh my God, dont drink alcohol pregnant, Caughey noted. But when we see a woman drinking a giant Slurpee, we dont say anything. Its potentially just as harmful as a little bit of alcohol.

Read more: Why is the maternal death rate in the US so high?

Instead of being sedentary, pregnancy is a time when women may be most open to picking up new good health habits, and exercise during pregnancy is a good idea, experts say.

The easiest thing is to walk, Diana Ramos, an OB-GYN in the Los Angeles area, told Healthline.

She urges pregnant women who cant get out to get exercise at home.

Instead of sitting down after dinner and watching TV, stand up and walk in place, she suggested.

ACOG recommends that women without major medical or obstetric complications get at least 20 to 30 minutes of moderate-intensity aerobic exercise on most days of the week, but research suggests most American women are getting less.

Especially combined with careful eating, exercise may help women avoid gaining too much, reduce surgical deliveries and hypertension, and cut the chances of an oversize newborn or a baby with breathing problems, according to a 2015 research review reported by the Cochrane Library.

Even obese women and women with high blood pressure or gestational diabetes may safely exercise, according to a jointly-authored opinion piece published in JAMA in March.

In fact, the authors pointed out that mistaken advice not to exercise combined with gaining weight had turned pregnancy into a major contributor to the worldwide obesity epidemic, with post-birth health risks for mothers and babies.

Read more: Are opioids over-prescribed for women whove had C-sections?

One big reason pregnancy is contributing to the obesity epidemic is that too many women arent losing their pregnancy gain.

In a five-site U.S. study reported in 2015 in the journal Obstetrics and Gynecology, about 75 percent of the participants were heavier a year after giving birth than before their pregnancy.

Nearly half had kept 10 extra pounds, and 24 percent had kept 20 pounds. In this group, 40 percent of the participants were of normal weight before pregnancy, but a third of them had become obese or overweight a year later.

This also sets up the children for future obesity.

Theres evidence that a set point for weight is established in the womb, Caughey observed, with lingering effects.

For example, a 2012 German study published in PLOS ONE found that women who gained too much pregnancy weight linked to a 28 percent increase in the chance that their 5-year-old or 6-year-old was overweight, even if these women were of a normal weight.

The children of mothers who are obese are much more likely to become obese and stay that way.

Its important as parents to set a role model for children of healthy habits, Ramos told Healthline.

The best idea is to improve your habits before you conceive, Caughey said.

If youre even thinking of becoming pregnant in a year or two, eat better and exercise, he said.

After you give birth, keep up the exercise.

Ramos founded a program in Los Angeles called Choose Health LA Moms that texted new mothers three times a week for three months, urging them to breastfeed, walk, and drink water.

On average, moms in the program lost nearly all their pregnancy gain and the whole family ended up walking more, Ramos told Healthline.

Read more:
Don't 'Eat for Two' While Pregnant - Healthline

Quick facts:

Death loss from nitrate is an occasional problem in cattle consuming certain annual forages, particularly sorghum hybrids.

Cattle producers should be concerned if rations contain over 5,000 ppm nitrate on a dry matter basis.

Avoid poisoning with good management practices.

A qualitative check called the diphenylamine test can be used to screen forages for potential harm.

High nitrate forages can be used if diluted with other feedstuffs and supplemented with energy.

Brian Kailey Logan County Extension agent

Nitrate toxicity is sometimes a lethal problem for livestock especially during the fall. The amount of nitrate accumulated within the plant depends on two factors: the rate of uptake by the plant from the soil, and the rate the plant reduces it. If uptake exceeds the rate of reduction, large amounts of nitrate can accumulate. If the rate of reduction equals the rate of uptake, there is no accumulation.

Nitrate accumulation usually results from plant stress, such as drought, and is accentuated by excessive soil nitrogen. Most nitrate accumulates in plant stems rather than leaves, and concentration tends to be highest in immature forage. A characteristic symptom of nitrate toxicity in the animal is a chocolate-brown color to the blood.

Use good management practices to avoid poisoning. Fertility programs consistent with plant needs and growing conditions minimize the problem. Test potentially dangerous forage before feeding. Often hay containing excessive nitrate can be fed safely when diluted with other feed, particularly concentrates.

Nitrate accumulation

Nitrate is the primary nutrient form of nitrogen in most soils and is a normal constituent of plants. Normally nitrate is assimilated so rapidly following absorption from soil that its concentration in plant tissues is low. Occasionally, excessive levels in plants occur. In Colorado, the most notorious accumulators of nitrate are the sorghums. Other annuals that less frequently accumulate nitrate are small grains (wheat, oats, rye and barley) and millet.

Some perennial grasses (fescue and johnsongrass) and weeds (pigweed, mustard, kochia, nightshade and lamb's quarters) also can contain dangerous levels. The corn may be safe but weeds harvested with it may be poisonous. Stinging nettle, elderberry, burdock and Canadian thistle are a few of the known nitrate accumulators. In fact, some of these will accumulate nitrate to such a high concentration that they literally explode when burned - nitrate is explosive.

Accumulation usually is triggered by some environmental stress where plant growth is restricted but absorption of nitrate from soil continues. The most common stress of summer annuals is drought. Lack of moisture, together with excessive soil nitrogen for existing growing conditions, is a frequent cause of toxic levels of nitrate in sorghums. Other stress factors that favor buildup are reduced sunlight from cloudiness or shading, frost, certain herbicides including 2,4-D, acid soils, low growing temperatures, and deficiencies of essential nutrients like phosphorus, sulfur and molybdenum.

When more soil nitrogen is present than needed for maximum growth, some plants tend to accumulate nitrate even without environmental stress. This response is particularly true with hardy soil feeders like sorghum, noted for "luxury consumption" of certain nutrients.

When accumulation occurs, the concentration of nitrate is greater in stems than leaves. Seeds seldom contain significant amounts. Rate of uptake diminishes with maturity; mature plants usually contain less nitrate than immature ones. Differences in potential for accumulation exist among species and varieties.

Toxic Levels of Nitrate

The level of nitrate that causes toxicity in ruminants varies depending on rate of intake, diet, acclimation to nitrate and nutritional status. As a rule, forage containing less than 5,000 ppm NO3 on a dry matter basis is safe. Forage containing 5,000 to 10,000 ppm NO3 is considered potentially toxic when provided as the only feed. Forage containing over 10,000 ppm NO3 is considered dangerous but often can be fed safely after proper dilution with other feeds.

Various methods of reporting nitrates in feed are used by laboratories. Use the formulas in Table 1 to convert nitrate reporting to a common basis.

Table 1: Formulas for converting methods of reporting nitrates.

Potassium nitrate:

= Nitrate x 1.6

= Nitrate nitrogen x 7.0

Nitrate:

= Potassium nitrate x 0.6

= Nitrate nitrogen x 4.4

Nitrate nitrogen:

= Potassium nitrate x 0.14

= Nitrate x 0.23

The effects of feed and water levels are additive. Consider both in avoiding or assessing nitrate problems. Common causes of high nitrate levels in water include shallow wells contaminated with surface water, water containing animal wastes, and surface runoff from heavy rain after fertilization with ammonium nitrate. Water containing more than 200 ppm NO3 is potentially toxic, especially when feed also contains an excessive level.

Laboratories report nitrate content of feed and water in different forms. Consider the form for expressing nitrate levels to avoid errors in determining the potential for toxicity. Table 2 should aid in interpreting laboratory results.

Although the term "nitrate toxicity" is commonly used, the toxic principle is actually nitrite. Nitrate is converted to nitrite in the rumen. Nitrite is absorbed from the rumen and converts blood hemoglobin to methemoglobin. Methemoglobin cannot transport oxygen to body tissues, so animals die from oxygen insufficiency.

The first symptom to appear is a grayish to brownish discoloration of nonpigmented skin and mucous membranes of the mouth, nose, eyes and vulva. This discoloration results from the chocolate-brown color of the blood, a distinct characteristic of nitrate toxicity that persists several hours after death. As the syndrome progresses, a staggering gait, rapid pulse, labored breathing and frequent urination develop, followed by collapse, coma and death. Symptoms often occur rapidly, within one-half to four hours after ingestion of a toxic dose. Some animals exhibit symptoms but recover spontaneously and completely. Pregnant animals may abort a few days later.

Treatment of nitrate poisoning with 4 percent methylene blue at the rate of 100 cubic centimeters per 1,000 pounds live weight (intravenously) is effective if administered soon after symptoms appear.

Table 2: Equivalent levels of nitrate.

Potassium nitrate (KNO3)

%

.0326

.815

1.63

*parts per million

Preventing Nitrate Poisoning

Problems with nitrate toxicity can be avoided with proper management of forage and livestock. Nitrate accumulation can be minimized by analyzing soil and using a balanced fertility program consistent with plant needs and moisture conditions. For sorghum hays, split nitrogen into two or three applications, with a maximum of about 50 pounds of actual nitrogen applied per cutting. In situations where tests indicate soil is laden with nitrogen, reduce rates accordingly.

Use of true sudans or sudan-sudan hybrids instead of sorghum-sudan or sorgo-sudan hybrids may be warranted to reduce potential for accumulating nitrate. Usually the potential for problems is only reduced, not eliminated. Do not ignore differences in yield, quality, drought tolerance and insect and disease resistance.

Take extra care when moisture stress occurs in sorghums before harvest or grazing. Test samples of plants from different areas of the field, particularly those showing the most stress, for nitrate content. If the level is dangerous, delay harvest until rain comes and the plant increases in maturity. Occasionally forage that is questionable as hay can be grazed safely when forage is abundant, because animals tend to select leaves and refuse stalks. Silage also may be a good alternative since appreciable reduction in nitrate levels occurs during ensiling. Forages that are high in nitrate will normally lose 40 to 60 percent of their nitrate content during fermentation.

Testing for Nitrates

Avoid poisoning by routinely testing any forage pasture, hay or silage suspected of containing excessive nitrate. A qualitative check called the diphenylamine test can be used to screen forages for potential harm. Positive results indicate more than 5,000 ppm NO3 and possible danger.

If results of the diphenylamine test are positive, send forage samples to a laboratory for quantitative analysis.

When forage is collected for analysis, it is essential that representative samples be taken. Although samples often are pooled for other laboratory analyses like moisture and protein, nitrate tests often are required on individual bales or from specific areas of a field to accurately assess the potential for toxicity. To illustrate this point, an evaluation of 15 large round bales of sorghum hybrid hay from one cutting showed considerable variation from bale to bale, with nitrate levels ranging from 17,500 to 39,000 ppm.

Diphenylamine Test

This is a qualitative test to evaluate forages (hay, pasture, silage) for nitrate levels that are potentially dangerous to ruminants.

1. Prepare the test solution by mixing 0.5 grams diphenylamine with 20 milliliters of distilled water, then bringing the total to 100 milliliters with concentrated sulfuric acid. Caution: The solution contains a strong acid. Avoid contact with skin, eyes and clothing. Store in a cool dark place. Do not add water or any other material to the solution.

2. Carefully place a drop of the solution at various locations on the inner tissue of the plant stem; repeat for several stems in each sample.

3. If an intense blue color appears in a few seconds, the forage contains potentially dangerous levels of nitrate.

4. If the results are positive (blue color), send the forage to a laboratory for quantitative analysis before feeding.

5. Occasionally, false positive reactions occur. However, any sample resulting in a positive reaction should be tested in the laboratory.

6. Avoid contaminating the solution in the bottle with plant tissue or other material. Discard any solution that is not clear.

Feeding High Nitrate Forages

In most instances, hay high in nitrate can be fed safely with adequate laboratory testing and good management. The best alternative is to dilute dangerous forage with feeds low in nitrate, preferably concentrates. Unfortunately for many producers, proper dilution makes it necessary to grind and mix. Gradual acclimation to questionable feed is a good practice to minimize risk. Animals should be healthy, on a good nutrition plane, and filled with low nitrate feed before they are allowed access to nitrate-containing forage. With respect to supplementary rations, those containing urea result in less toxicity than soybean meal, and the presence of readily available carbohydrate (corn, sugar, etc.) offers a considerable degree of protection. This may be due to lower pH in the rumen that facilitates reduction of nitrate.

Nitrates have been reported to increase the need for vitamin A in the ration. Recent information indicates that a relationship of this kind may not be of practical importance under most feeding conditions. Formulate rations to be adequate in vitamin A as well as other nutrients. Excessive vitamin A fortification does not appear to be needed.

Hay, straw or fodder suspected of being high in nitrate should not be fed when damp. Damp feed seems to be more toxic. The probable explanation is that some of the nitrate is converted to the more toxic nitrite before being consumed.

Chemical Formulas

NO3- = nitrate ion

NO2- = nitrite ion

NH3 = ammonia

NH4+ = ammonium cation

Summary

Nitrate poisoning can be a serious problem for livestock producers if not considered in their management plan. Drought, excessive soil nitrogen, shade, frost, certain herbicides, acid soils, low growing temperatures and nutrient deficiencies can contribute to high nitrate levels in plants. Stems usually have higher nitrate content than leaves. Do not overlook the nitrate content of water when a nitrate problem arises. Avoid poisoning by routinely testing any forage suspected of containing excessive nitrate. High nitrate forages can be used by diluting it with other feedstuffs and supplementing it with energy.

*J.C. Whittier, Colorado State University professor, department of animal sciences. 9/92. Revised 6/11.

View original post here:
Nitrate poisoning - Journal Advocate

ANN ARBOR Michigan starts off an important recruiting weekend Friday as it hosts its 1-Day Elite camp. That will be followed on Saturday with the Big Man Big House camp.

Fridays 1-day Elite Camp is expected to draw several big names from the 2019 and 2020 recruiting classes, while Saturdays Big Man Big House camp is designedsolely foroffensive and defensive linemen.

Land of 10s Rachel Lenzi and Kevin Goheen will be on hand both days to bring you updates on recruits for the 2018 class and beyond.

7:04 p.m.: Jim Harbaugh spoke with reporters after a thorough meet-and-greet with players and parents. Here are some of the highlights of his discussion:

All 19 players in the freshman class who werent January enrollees are expected to be on campus by Saturday. A few such as DT Aubrey Solomon, DE Luiji Vilain, S Brad Hawkins and WR Nico Collins arrived a week or more ago.

Theyve got to be here tomorrow when orientation starts, Harbaugh said. Say a prayer that all the cars and planes operate effectively. God willing theyll get here safely.

If a player wants to participate in another sport as well as football, Harbaugh is all for it.

Incoming freshman LB Jordan Anthony also played baseball at IMG Academy and has expressed interest in joining manager Erik Bakichs team.

Very much we would embrace it., Harbaugh said. He is an elite football player and an elite baseball player. When theyre elite at two sports, right when football season is over, well let them go to another sport.

Harbaugh stressed that a player couldnt go play another sport if he was just going to another player. The player needs to be, Harbaugh said: elite-elite.

He mentioned WR Oliver Martin as another possible two-sport athlete. Martins second sport, however, would be swimming.

[Martin]s that elite-elite. Jordan Anthony is elite-elite. We may have somebody who wants to wrestle, too. Thats a possibility, Harbaugh said.

We feel that the athletic reps that they get when theyre competing in the other sports are really valuable, and we encourage it.

Senior fullback Khalid Hill and sophomore offensive lineman Michael Onwenu were put on notice this offseason that they needed to lose weight before the start of training camp. Hill was listed at 263 pounds and Onwenu 350 pounds on last seasons roster. Offensive coordinator/offensive line coach Tim Drevno mentioned in April that Onwenu was up to372 pounds.

Harbaugh said Friday that each is getting to their weight goals (which are being kept in-house) but theyre not there yet.

As a coach youd like to see it happen faster but I think they understand now that things have amped up, Harbaugh said.

There could be some roster subtractionsby the time camp begins on July 31 but Harbaugh isnt ready to what those possible attritions would be.

Its been my experience that those usually happen right before [camp], Harbaugh said. They usually happen, historically, the day before winter conditioning starts and the day before training camp starts. I usually sit at my desk by my phone and wait for it to ring.

5:01 p.m.: Michigans 1-day elite camp has officially closed, and Jim Harbaugh has bid the campers farewell. But before he left, he gave them some advice:

Avoid the fun stuff! Harbaugh said. If something looks fun, dont do it. Say no. For every three nos, say one yes.

Watch more here:

3:29 p.m.: Get a closerlook into Michigans 1-Day Elite Camp here:

1:01 p.m.: Theyre about to return from lunch at todays camp; about an hour ago, Michigan passing game coordinator Pep Hamilton offered the campers some good advice:

During the lunch break, several of Michigans current players and incoming freshmen and early enrollees discussed offseason workouts. Josh Metellus, who will play at safety this fall, said his experience playing at the Viper position in the Orange Bowl prepared him for playing safety.

It got me comfortable and showed me that I can play with the best guys in the country, Metellus said.

11:48 a.m.: Among the confirmed campers today is 2019 running back Noah Cain of IMG Academy in Bradenton, Fla. Allen Trieu of Scout.com reported that Cain is making his first visit to Michigan.Camp is about to break for lunch in the next 15 minutes.

11:03 a.m.: Some of Michigans players are coaching at todays camp. Heres offensive lineman Ben Bredeson leading drills.

And heres incoming freshman Cesar Ruiz.

10:24 a.m.: Cant start a camp without warming up. Jim Harbaugh had his bullhorn working as he led players through sprints. Little by little, he was engulfed.

9:16 a.m.: And heres a first look at the inside of Michigan Stadium, where Jim Harbaugh opened the camp.

9:15 a.m.: Heres a first look at the 1-Day Elite Camp attendees, taken about an hour before the start of the camp.

Originally posted here:
LIVE BLOG: Michigan 1-Day Elite camp - Landof10.com

Prevention.com

Yes, That's Acne On Your Vagina. Here's How To Treat It. Prevention.com No matter how diligent you are about keeping your skin squeaky clean and your pores clear, acne has a way of showing up at the worst possible timesand sometimes, in the worst possible places. Like on your vagina. Don't freak out, though: Vaginal acne ...

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Yes, That's Acne On Your Vagina. Here's How To Treat It. - Prevention.com

Just before Stefan Seltz-Axmacher offers a job to an engineer at Starsky Robotics Inc., a driverless trucking startup in San Francisco, he gives them the talk.

This is a company that employs truck drivers, is how the talk begins. The coders are sometimes taken abackthis differs from the usual change-the-world spiel deployed in hiring meetings. Truckers have very different ideas and different experiences from people like you, Seltz-Axmacher continues. Statistically speaking, many of them are Trump voters. They will say things that you may find startling. Not in a malicious way, but because people from, say, rural West Virginia talk differently than people from San Francisco. Can you handle that?

Not everybody can, Seltz-Axmacher says over beers in Fort Lauderdale, where Starsky does some of its testing. And thats OK.

Most driverless vehicle operations, including those at Ford Motor Co. and Alphabet Inc.s Waymo, are focused on developing cars or trucks that operate with no human oversight at all, or level 4 autonomy. The idea is that a passenger could safely take a nap, send a text, or tie one on while the software worries about the road, but that kind of freedom could be decades away. Seltz-Axmacher, Starskys co-founder and chief executive officer, whos featured in this weeks Decrypted podcast, is attempting something thats both more modest and, potentially, more disruptive to U.S. employment. His company has designed an artificial intelligence system for big-rig trucks that makes them mostly self-sufficient on highways, and then, when its time to exit onto local roads, allows them to be taken over and driven from a remote operations center. The plan is to eventually employ dozens of drivers, each of whom will keep an eye on a few trucks at once, sitting before arrays of monitors livestreaming views of windshields and mirrors. The companys name is a reference to a CB radio slang term for when drivers work in teamsthat is, like the title characters of the 1970s TV series Starsky & Hutch.

Most of Starskys AI rivals are focusing exclusively on research, logging as many miles and as much performance data as possible. Seltz-Axmachers trucks are still in beta, toobut theyre already earning revenue, carrying containers full of goods along U.S. highways. While the remote-control system develops, two Starsky employees ride in each cab: a software engineer in the passenger seat, keeping an eye on the algorithms, and a truck driver behind the wheel. This proximity is why theres a second talk.

Mixing blue-collar workers with people who have postdocs is hard

We hire truckers, Seltz-Axmacher tells prospective drivers right before offering them a job. But we also have a lot of engineers in Silicon Valley. Everything youve heard about San Franciscoits all basically true. There is something called raw denim, and in San Francisco people wear it, which means that some of your colleagues will pay up to $300 for a pair of blue jeans. They sometimes drink $7 lattes, too. Many of your co-workers will not be from the U.S. They will have accents. Can you handle that?

The drivers all say yes, but really, not everyone can. Since Starskys founding in 2015, Seltz-Axmacher has parted ways with two of the eight drivers hes hired. One used an anti-gay slur to refer to a fellow driver, which worried Seltz-Axmacher because Starsky headquarters is on Folsom Streethome to the Folsom Street Fair, the famous leather festival held every September. His first day was Wednesday, and his last day was Thursday, Seltz-Axmacher says. Mixing blue-collar workers with people who have postdocs is hard.

Jeff Runions, head driver for Starsky Robotics.

Photographer: Damien Maloney for Bloomberg Businessweek

Economically speakingthat is, in the most brutal termstruckers are disposable. Almost anyone can become a professional driver with a month or so of training, and most dont stick around for long; median pay is about $40,000 per year, and the work is often unhealthy, painful, and lonely. Software engineers, on the other hand, are some of the best-paid, hardest-to-hire employees in the modern economy. The variety that Seltz-Axmacher employsspecialists in AI and machine learningare even better paid and even harder to hire. Google has been known to pay its self-driving car engineers millions or even tens of millions. Starskys coders dont make that much, but the point remains: In its cabs, side by side, are representatives of some of the most and least promising careers in America.

Starskys offices have high ceilings and two dozen open-plan desks. Its not fancythe furniture is cheap, the carpets look old, and the coffee comes out of plastic podsbut the companys engineers come from some of the worlds top research universities, including Carnegie Mellon, Stanford, and the University of California at Berkeley. Of the six truckers on staff, one or two are usually in San Francisco, and the rest are on the highway. We basically have people from two worlds, neither of which has ever talked to each other, says Seltz-Axmacher, who grew up in suburban Maryland. Thats kind of whats wrong with this country. His hope is that Starsky, by employing truckers who oversee trucks from offices and work alongside engineers, can help bridge the divide.

Of course, Starsky is a for-profit business, not a truth and reconciliation commission. Its one of a handful of companies trying to seize a piece of the trucking industrys $700 billion in annual revenue. Starsky has raised $5 million in seed capital from, among others, Y Combinator, the Silicon Valley venture fund and incubator. Its competitors include Embark, which is also backed by Y Combinator, and Otto, a startup that raised no outside capital and had fewer than 100 employees when Uber Technologies Inc. acquired it for $700 million. (Otto is the subject of a lawsuit that claims its co-founder stole technology from Alphabet, Googles parent.) A fourth company, Peloton Technology, has raised $78 million to pursue adding some autonomous capabilities to conventional trucks. There are also self-driving big-rig programs inside Alphabet, Tesla, Volvo, and Daimler. All of these companies want to avoid alarming truckers, their employers, and regulators. But if any of them succeed, they will drastically reshape the labor market in one of the countrys most important industries.

Three and a half million Americans drive trucks for a living, making it one of the most common jobs in America. The larger trucking economyincluding cargo brokers, truck manufacturers, truck stop waitresses, and so onaccounts for an additional 4 million jobs, according to the American Trucking Associations (ATA), a trade group. A huge proportion of them are threatened by a decade of driverless research coming out of universities and Silicon Valley companies.

Marie Porter, a member of Starskys small driver crew.

Photographer: Damien Maloney for Bloomberg Businessweek

A truck traveling hundreds of miles to make a delivery represents an almost ideal application for the latest autonomous driving technologies. Long-haul truckers spend much of their time on interstate highways, where curves are gentle, lanes are well-defined, and pedestrians and bicyclesthe bane of any AI vehicle engineerare prohibited. Trucks are big and heavy, so theyre easier to outfit with special sensors needed to control them. All of this has caused trucking to be seen by automation experts, and in the popular press, as a test case for the impact of AI on employment. If a lot of long-haul truckers lose their jobs, then maybe lawyers and accountantswhose work is often repetitiveshould be worried, too. But a major difference between trucking and those fields is that its a job few Americans seem to actually want to do.

Truck tonnagethe weight of freight carriedis up by more than 30 percent in the U.S. since 2009, according to the ATA, while the industrys labor force has grown by about 10 percent. The trade group has estimated there are 48,000 open jobs, a figure thats expected to more than triple over the next decade. Its just more and more demand on the industry, and fewer people coming into it to drive the trucks, says Chris Spear, the ATAs CEO.

Theres a shortage, in part, because the industry wants it

Federal law limits truckers to 70 driving hours over eight consecutive days. But because drivers are paid by the mile rather than the hour, many fudge their time sheets to drive more hours. On a good day, an entry-level driver might make about $15 an hour. On a bad dayone spent in traffic or sitting in a port waiting for paperworkhe might make just a few dollars an hour. Drivers generally spend several weeks on the road at a time, sleeping in their cabs at rest areas. They gain weight and get lonely. The annualized turnover rate among drivers at large truckload fleets is 71 percent, the ATA says. Most people who try it out decide, given the pay and the conditions, its not a very good job, says Stephen Burks, an economist at the University of Minnesota at Morris and a former trucker himself. People are voting with their feet.

Photographers (clockwise from top left): Damien Maloney, Laurel Golio, Lucas Foglia, and Carlos Saavedra, all for Bloomberg Businessweek

Many of us, when we think of trucking, dont see the industry this way. We think of freedom and the open road. We think of Convoy, the novelty country song that made it to No.1 on the Billboard pop chart in 1976, or of Smokey and the Bandit, which would have been the nations highest-grossing film of 1977 if not for Star Wars. We think of a job thats necessary and steeped in Americana.

Whatever truth these ideas once possessed has faded. The union-friendly rules that once helped make trucking a well-paid blue-collar job were dismantled by a series of reforms, culminating when Jimmy Carter signed the Motor Carrier Act and deregulated the industry in 1980. Membership in the mighty Teamsters union plummeted, and the short, regular routes that allowed truckers to go home most nights were replaced by a system in which truckers are treated a lot like Uber drivers. The amount that theyre getting paid per mile is really a small fraction of what they were getting, says Michael Belzer, an economist at Wayne State University and a former driver who wrote a book on the industry called Sweatshops on Wheels. Its not an exaggeration at this point to suggest that its half the pay.

Thanks in part to the advent of mundane technologies, such as automatic transmissions, that make driving easier to learn, the industry has moved away from employing career truckers and toward a model of paying little more than minimum wage and constantly replacing the drivers the industry churns out. Commercial licensing schools charge about $5,000 for a five-week course, but trucking companies will advance applicants the fees and then deduct the tuition from the new hires salary. Theres a shortage, in part, because the industry wants it, says Steve Viscelli, a sociologist at the University of Pennsylvania who studies the industry. Its cheaper and easier to manage the problem through high turnover.

This has turned trucking into a kind of economic safety valvework you do when youre out of options. The industry puts a more positive spin on this. Theres a lot of pride that goes into moving the nations freight, says Spear. But in a 2015 video produced by the ATA, the groups chief economist Bob Costello suggested lowering the interstate truck driving age, currently 21, as a way to better compete for young people who would otherwise choose military service. Often its a job of last resort, he acknowledged. In other words, its pretty much the opposite of being a coder.

View from the drivers seat of the remote driving console.

Photographer: Damien Maloney for Bloomberg Businessweek

Ready?

Jeff Runions, a Starsky truck driver, is sitting in the front seat of Buster, a late-model Freightliner Cascadia that Starsky leases and has modded out with cameras and sensors. He glances at Kevin Keogh, an Irish-born AI specialist who previously worked at Jaguar Land Rover and whos been tapping out a few last-minute adjustments to the Starsky code while Runions does the driving.

Good when you are.

Runions flips a blue switch on a little panel bolted onto the center console. All right, he says. Shes hot. Runions cautiously takes his hands off the wheel and slides his foot off the accelerator. We are just west of Fort Lauderdale, cruising up Floridas Highway 27 on a windy morning in late May, with the Everglades stretching out on either side. Runions says were near a stretch of road truckers call Alligator Alley, and sure enough we soon see an enormous dead gator on the shoulder.

Starsky is testing in other states, but Florida is an attractive proving ground, because its especially relaxed about driverless vehicles. Unlike Nevada and California, for example, Florida doesnt require a special permit to conduct tests on public roads, or any additional insurance, or even a human being behind the wheel, as long as a licensed driver is operating the vehicle by remote control. Nevada laws are written so the state could allow remote-control driving in the future; in Florida, any licensed driver can do it today without asking permission, which is exactly what Starsky intends to do later this year.

In the meantime, there are still lots of problems to solvelike wind. Not long into our drive, a gust hits our left side, and the truck lurches toward the shoulder; the wheel turns left, overcorrecting and sending us drifting into the next lane. The experience is terrifying, although Runions and Keogh seem unfazed.

Its got to adjust, thats all, Runions says, explaining that the combination of wind and weighttodays load is 20 tons, more than in other testsrepresents a novel challenge. He keeps his hand on the blue switch and his eyes on his side mirror to make sure we dont cut off anyone. He looks tense, but the truck finds the right lane after a few seconds.

Keogh says everything is normal. Starskys software is written to determine how hard the wind is blowing, he says, and then to steer against the wind and stay in the lane. But early on in a session, the computer isnt fully calibrated yet. Runions offers a comparison: You know how you are in the morning before you have your coffee?

A few minutes later, he and Keogh seem comfortable, cracking jokes about the size of the alligators near the farm where Keogh grew up in Ireland. At another point, Keogh says, I think weve zoned in on the correct control parameters.

Have you, now? Runions shoots back, and then adds, Im learning to speak Irish.

Remote driving console at Starskys San Francisco office.

Photographer: Damien Maloney for Bloomberg Businessweek

The two men have a good rapport, but they couldnt be more different. Keogh is 27, graduated from Dublins prestigious Trinity College, and got a masters degree studying robotics. Runions, who has a shaved head and a salt-and-pepper goatee, is 58 and didnt graduate high school. When asked how he got into long-haul trucking, he responds instantly. White Line Fever, he says, without taking his eyes off the road. Watch that movie. In the film, Carrol Jo CJ Hummer leads a strike against an abusive transportation conglomerate, Glass House, that culminates when CJ drives a bullet-riddled truck straight into corporate headquarters, a literal glass house, and is shot in the face.

Runions had a rough childhood. He grew up in the foster care system in Wrigleyville, in Chicago, back when it was a bad neighborhood. He partied a lot, got into trouble, and then, at 16, got kicked out of the house. Ive been on my own since then, he says. He took a job doing construction work in Savannah, Ga., and eventually found his way to a job at Great Dane, the trailer manufacturer.

Runions started driving full time in 1979 and eventually married a truck driverhe and his wife, Marlene, met at a truck stop in Atlantain 1999and has had pretty much every job you can have in the business. It sucks, he says about life on the road. I was gone 21 days a month. If you stayed here for a couple days, youd know what Im talking about. He barely saw Marlene and put on 75 pounds.

Starsky pays its truckers about $55,000 per year and gives them benefits and stock. Runions, as the companys top driver, earns more and has fairly sane hours. He sleeps in his own bed, in a small house outside of Jacksonville, most nights. Some people are really negative about driverless trucks, says Runions, who read about Starskys technology and applied for the job online. Then you tell them theyre going to have 40 hours a week instead of being gone all the time. People think youre taking their jobs, but youre not.

Seltz-Axmacher, who is watching us from the back of the cab, nods in agreement. He envisions climate-controlled driver centers, in towns like Jacksonville, where people like Runions will work regular shifts in front of computers, without the greasy food or loneliness that has traditionally gone along with being a trucker. Starsky, he believes, has the ability to make 3.5 million peoples lives a lot better.

Not everyone agrees, of course. In May, drivers for Airgas Inc., which distributes industrial gases, went on strike in part because of a proposed contract provision that could allow the company, a subsidiary of the Paris-based Air Liquide, to use autonomous trucks. And in New York City, the union-backed group New York Communities for Change is mounting a campaign to urge the federal Department of Transportation to cease all funding for autonomous vehicle research until a plan is put in place to protect any displaced drivers.

If Silicon Valley companies arent forced to consider what happens to todays drivers, we will all lose our jobs, says Rolando Perdono, one of the activists. We wont have anything to hold on to. Perdono, 45, was born in the Dominican Republic. His English isnt great, he didnt make it through high school, and he has five kids to support. Hes been behind a wheel since he came to the U.S. 16 years ago and currently works as a local delivery driver for a cleaning-supply company. Perdono doesnt love what he does for a living and would be game to be trained for a job working with driverless trucks. But in the meantime he argues that his current job is worth defending. Being a driver is what I know, he says. Thats what I like about it.

One of Starskys semi-autonomous trucks.

Photographer: Damien Maloney for Bloomberg Businessweek

There are three schools of thought about the long-term effects of AI on employment. The first argues that advances in robotics will lead to improvements in productivity similar to those that occurred after other inventionssuch as sewing machines, combine tractors, and washing machines, which freed up workers to do less repetitive (and better-paid) labor. The second school worries that the same technologies will require so few jobs that theyll create a permanent underclass. The third school argues that its all hype and the advances are decades away.

Most people in Silicon Valley subscribe to either the first or second school. Much of the rest of the country, including many truckers, favor the third. I can tell the difference between a dead porcupine and a dead raccoon, and I know I can hit a raccoon, but if I hit a porcupine, Im going to lose all the tires on the truck on that side, says Tom George, a veteran driver who now trains other Teamsters for the unions Washington-Idaho AGC Training Trust. It will take a long time and a lot of software to program that competence into a computer.

The raccoon-porcupine divide is one of many in which computers may not work particularly well. But that doesnt mean a system couldnt be designed that would allow trucks to drive themselves most of the time. Viscelli, the University of Pennsylvania expert, says self-driving trucks will hit the road in a matter of single-digit years, and believes that theyll allow the industry to eventually shed a few hundred thousand jobs.

Seltz-Axmacher acknowledges that companies such as his could ultimately make traditional trucking jobs a thing of the past, and hes not sure what he or anyone else should do about it, beyond trying to be decent to the workers he employs now. Hes been reading about universal basic incomethe idea, popular in techie circles, of simply paying everyone enough to live on.

But ultimately, Seltz-Axmacher believes, the tools hes developing will be good for truckers. He cites a new book by Garry Kasparov, Deep Thinking, in which the chess great observes that middling chess players who play with the help of a standard computer are reliably better than either grandmasters or supercomputers by themselves. I think humans and technology working together are always going to be better than either one alone, Seltz-Axmacher says. But maybe thats just because I like humans.

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These Truckers Work Alongside the Coders Trying to Eliminate Their Jobs - Bloomberg

The formula for losing weight is simple: Eat fewer calories than you burn. But the methods of doing this can vary. In truth, there is no one "best" way to lose weight what works for you might not work for someone else. To get the lowdown on the latest science on weight loss, Live Science conducted a months-long search for the best information. We contacted nearly a dozen experts who have researched weight loss, and looked at the most well-regarded studies of weight loss done to date.

We wanted to know what these studies found and, most importantly, when all the science and evidence were boiled down, what experts recommend for people who would like to shed pounds in a safe, healthy manner. All of the experts emphasized one thing: A person's approach to weight loss should be one that is enjoyable and can be maintained over the long term. Weight loss shouldn't be about deprivation, because diets that deprive people of their favorite foods tend to be short-lived, said Dr. Pieter Cohen, an assistant professor of medicine at Harvard Medical School andgeneral internist at Cambridge Health Alliance.

"If you make this commitment to lifestyle changes, then maybe five years from now, you're 10 pounds [4.5 kilograms] lighter," Cohen said. "If you're doing crash diets, you would probably be 10 pounds more."

People should focus on making lifestyle changes sometimes even small ones, like cutting down on the sugar in coffee to reduce their overall calorie intake. While these changes might not lead to drastic amounts of weight loss in short periods, they can produce healthy, gradual weight loss that will counter the natural tendency for people to gain weight as they age, Cohen said.

As we'll describe in detail below, a successful weight loss program usually involves cutting back on your calories, increasing your physical activity and making behavioral changes to help you stick with a diet and exercise regimen over the long term. [How to Get Started on a Weight Loss Program]

Should you lose weight? Find out below how to calculate your BMI.

Who should lose weight?

Obesity is a growing problem in the United States. Over the past 15 years, the nation's obesity rate rose by 24 percent (7.2 percentage points) amongadults, from 30.5 percent in the years 1999-2000 to 37.7 percent in 2013-2014, according to a report from the Centers for Disease Control and Prevention published in November 2015. The adult obesity rate in 2013-2014 was the highest ever for the nation, and equates to more than 78 million people.

The extra pounds come with baggage; they increase the likelihood of many health conditions, including the following:

Though science has yet to establish a surefire link between obesity and each health risk, the extra fat tissue seems to be the biggest culprit. More fat in the neck has been tied to sleep apnea, while compounds released by fat cells may increase the chances of developing type 2 diabetes. In addition, the more body fat a person carries, the more blood is needed to provide the tissue with oxygen and nutrients, resulting in higher blood pressure. (On the other hand, losing weight can relieve such burdens on the body, leading to health benefits, including reduced blood pressure, cholesterol and blood sugar.)

Chart shows relationship of healthy weight and height.

That's why one of the most widely used gauges of whether a person needs to shed pounds is body mass index (BMI) an indicator of body fatness developed by Belgian statistician Adolphe Queteletin 1832 that's based on the ratio of height to weight. For example, a person who is 5 feet 7 inches (1.7 meters) and weighs 172 lbs. (78 kg) would have a BMI of 27. [BMI Calculator: What's My BMI]

The goal with BMI is to be what the National Institutes of Health considers "normal." The lowest risk for health conditions related to weight has been tied to a BMI between 18.5 and 24.9 (labeled "normal weight"). Risks go up as a person climbs this BMI ladder, with numbers between 25 and 29.9 considered overweight, and BMIs of 30 or greater considered obese, according to the NIH.

Although BMI is easy to calculate, it is not a perfect measure of body fatness. For example, people with a high amount of muscle mass can have a high BMI without being overweight or obese.

If your BMI places you in the obese category, it's time to lose weight, according to the most recent (2013) weight management guidelines from the American Heart Association and other professional organizations. Weight loss is also recommended if you're overweight and have other risk factors for heart disease, such as diabetes, high blood pressure, high cholesterol levels, or a waist circumference greater than 35 inches (88 centimeters) for women and 40 inches (102 centimeters) for men.

The 2013 guidelines were put together by an expert panel from the American Heart Association, the American College of Cardiology, and the Obesity Society, and were reviewed by the National Heart, Lung, and Blood Institute. The guidelines are based on a rigorous review of recent scientific studies.

People who are normal weight, or overweight and do not have any additional risk factors for heart disease, should focus on avoiding weight gain, rather than losing weight, the guidelines say, because there is no strong evidence that weight loss provides health benefits for these people. However, additional weight gain could lead to problems, experts said.

"It's common to gain weight with age, and weight maintenance is much easier than weight loss, so the best plan for these patients is to maintain their weight, eat healthier and exercise more but not to focus on weight loss," Cohen said.

How much weight should you aim to lose?

Obese people who lose as little as 3 to 5 percent of their body weight improve their health. Research suggests that losing 5 percent of body weight results in a 3-mmHg drop in systolic blood pressure (the top number in a blood pressure reading, which is a measure of the pressure in the arteries when the heart beats) and a 2-mmHg drop in diastolic blood pressure (the bottom number in a blood pressure reading, which is a measure of the pressure in the arteries between heartbeats), according to the 2013 guidelines. Losing even more weight is associated with greater health benefits, so the guidelines recommend that people start out with a goal of losing 5 to 10 percent of their body weight over six months.

To accomplish this weight loss, most experts interviewed by Live Science recommended that you shed 0.5 to 2 lbs. (0.23 to 0.9 kg) every week. This usually means cutting 250 to 1,000 calories out of your daily diet. (If you cut 500 daily calories, you'll lose about a pound per week.)

For women, that means consuming about 1,200 to 1,500 calories a day. For men, it means a daily intake of about 1,500 to 1,800 calories. However, the number of calories you should consume can vary depending on your current weight and activity level.

Chart shows daily calorie range for a 40-year-old woman.

To figure out how many calories to consume, you may want to use a calculator, such as the National Institutes of Health Body Weight Planner, which takes into account your current weight and activity level to determine how many calories a day are needed to maintain your current weight and how many are needed to achieve your desired weight loss.

You'll lose more weight if you cut even more calories. However, trimming too many calories will likely backfire and can even kill you.

Experts warn that severely restrictive diets which cut more than 1,000 calories per day tend to be unsustainable. You might see a rapid weight loss at first, but you'll likely regain much of the weight. For example, Oprah Winfrey famously lost 67 lbs. (30 kg) on a diet that allowed her to consume just 420 calories a day, only to later regain the weight.

Over the long term, severely restrictive diets tend to result in about the same amount of weight loss as diets that are less restrictive, said Robert Jeffery, director of the University of Minnesota Obesity Prevention Center.

For example, researchers reviewed data from six trials of very-low-calorie diets (fewer than 800 calories a day) and found that, after about 26 weeks, participants lost 16 percent of their initial body weight, whereas participants on a typical low-calorie diet (1,000 to 1,800 calories a day) lost about 10 percent of their body weight. But after about two years, both groups retained about the same amount of weight loss around 5 to 6 percent of their initial body weight, according to the 2012 study.

The study is notable because it looked at data from clinical trials that directly compared very-low-calorie diets with typical low-calorie diets, which is a better method than looking at studies that do not involve a comparison, and instead include only a single diet.

Even the weight you lose on these restrictive diets may not be the right kind of weight, as cutting too many calories can cause you to lose muscle instead of fat, said Dr. Louis Aronne, director of the Comprehensive Weight Control Center at Weill-Cornell Medical College in New York.

"If you lose weight very rapidly, on a diet like a cleanse, then you're going to lose excess muscle," Aronne said. Muscle loss can be detrimental, because muscle tissue burns more calories than fat tissue; therefore, keeping muscle tissue can help with weight loss and maintenance, said Aronne, who is the author of the upcoming book "The Change Your Biology Diet" (Houghton Mifflin Harcourt, 2016).

Finally, any adult diet that allows fewer than 800 calories per day can be harmful and should only be undertaken under the supervision of a medical professional, according to the 2013 guidelines. People who follow such a diet may experience dehydration, irregular periods (for women), kidney infections and even sudden death, among other health problems, according to the Michigan Department of Health and Human Services. Such diets also increase the risk of developing gallstones.

It's important to have realistic expectations for weight loss with a reduced-calorie diet over the long term. Studies suggest that people can lose about 9 to 26 lbs. (4 to 12 kg) after six months of a typical reduced-calorie diet. Afterward, people usually gain back some of that weight, so they end up with a total of 9 to 22 lbs. (4 to 10 kg) of weight loss after one year, and 6 to 9 lbs. (3 to 4 kg) of weight loss after two years, according to the 2013 guidelines. [2016 Best Bathroom Scales]

Is there a "best" diet for weight loss?

People can lose weight on a number of different diets, as long as they consume fewer calories than they burn. "There's no one diet that's superior to other diets for long-term weight loss and maintenance," said Kathy McManus, director of the Department of Nutrition at Brigham and Women's Hospital in Boston.

A successful plan for weight loss is often one that is tailored to an individual's lifestyle and other personal factors. McManus and her colleagues found that the breakdown of calories from protein, fat and carbohydrates doesn't matter for weight loss. They followed 800 people assigned to different calorie amounts from these food categories. After two years, the participants had dropped about 9 lbs. (4 kg), on average. Few diet studies have followed such a diverse group the McManus study involved people ages 30 to 70 with a wide range of incomes, from cities in the northern and southern United States for more than a year.

Often, even small changes in your diet can help you lose weight. For instance, just replacing an unhealthy snack every day with fruits and vegetables, or eliminating an evening snack, can result in weight loss, said Katherine Tallmadge, a registered dietitian and an op-ed contributor to Live Science. "If people make minor changes that they can live with, it's more likely that they can lose the weight and keep it off," Tallmadge said. [ 4 Calorie-Cutting Tips That Won't Leave You Hungry]

Moreover, nothing magical happens when you cut fat it doesn't result in extra weight loss, studies have shown. A recent study, published in October 2015, found that people on a low-fat diet lost about the same amount of weight as people on diets with more of their calories from fat.

Which foods keep you full for longer? Find out below.

But what if you're the type of person who "cheats" because you feel hungry? That's where the type of calories and a few other tricks come in.

Though not foolproof, a low-glycemic diet that's chock-full of protein, fiber and healthy oils, and low in starches and other sugars, may help combat feelings of hunger. Researchers think that nutrients like protein and fiber help to create the "I'm full" feeling, while sugars and refined carbohydrates cause spikes in blood sugar that may increase hunger later, Aronne said. In that way, people on a low-glycemic diet may feel more satisfied while cutting back on overall calories and thus may be more likely to stick with the diet.

Liz Applegate, director of sports nutrition at the University of California, Davis, said she recommends a diet that is about 20 percent protein (about 60 to 70 grams, or 2 to 2.5 ounces, per day), spread across all three meals. This recommendation agrees with findings from a study of people in the National Weight Control Registry who have lost at least 30 lbs. (13.6 kg) and kept it off for at least a year. An analysis of 900 people in this registry showed that about 18 to 20 percent of their daily calories came from protein. This would be the equivalent of eating 6 ounces of Greek yogurt at breakfast (17 grams of protein), 3 ounces of salmon for lunch (21 grams of protein) 1 ounce of nuts for a snack (7 grams of protein) and 3 ounces of chicken for dinner (19 grams of protein).

Applegate also encourages people not to skip meals, because that deprivation often causes people to overeat later in the day. In particular, studies show that people who skip breakfast tend to weigh more than people who eat a healthy morning meal, according to the NIH.

According to a 2015 report from the Dietary Guidelines Advisory Committee, which advises on the nation's diet recommendations, people tend to have a healthy body weight if they eat a diet high in fruits, vegetables and whole grains; moderate in dairy products; and low in meats and sugar-sweetened foods and beverages.

In addition, since alcoholic drinks are essentially "empty" calories they don't contribute towards you're daily nutrition cutting back on alcohol may be one way to help you lose weight, experts said.

Surprise! Alcohol contains calories.

As an alternative to eating a reduced-calorie diet every day, some people try to do "intermittent fasting." This means they significantly cut their calories on a few days per week and eat normally the other days. This diet is generally not recommended, but early research suggests that some people may find it easier to follow this diet than a traditional one, Tallmadge said. A review study published in April 2015 found that people on intermittent-fasting diets lost about 9 percent of their body weight over six months, and about 80 percent of the participants were able to stick with the diet.

Still, studies on this type of dieting are limited, and more research is needed to confirm the findings, the researchers said.

As for commercial weight loss programs, the most effective programs are in-person ones, where people regularly meet with a trained health professional, according to the 2013 guidelines. People should look for a program that lets them meet with a registered dietitian, psychologist, exercise specialist or health counselor at least 14 times over a six-month period, the guidelines say. If you can't attend an in-person program, some studies show that programs that use telephone calls, email or text messages to provide feedback on your progress can also help with weight loss.

How much exercise do you need?

You've worked on the calorie intake part of the equation. Now what about the "calories out?" Studies show that people who exercise while dieting lose more weight, and are better able to keep it off, than people who diet and do not exercise, said Wayne Miller, programs director at West Virginia School of Osteopathic Medicine's Center for Rural and Community Health.

Miller and his colleagues reviewed 25 years' worth of weight loss research and found that, during a typical 15-week weight loss program, people lost, on average, 23 lbs. (10.4 kg) by only dieting and 24 lbs. (10.9 kg) by dieting and exercising, they reported in 1997. That difference may seem small, but after one year, the people who only dieted kept off 14 lbs. (6.4 kg), on average, whereas those who dieted and exercised kept off 19 lbs. (8.6 kg). [2016 Best Heart Rate Monitor Watches]

As for how strenuous the exercise has to be, experts recommend that people who want to lose weight meet the government's guidelines of at least 150 minutes of moderate physical activity (such as brisk walking) every week, or about 30 minutes a day for five days a week.

But those who want to maintain weight loss over the long term may need to do more exercise. A 2008 study of the National Weight Control Registry involving 3,600 people who lost at least 30 lbs. (13.6 kg) and kept it off for a year or longer found that they reported at least 60 minutes of moderate physical activity per day. [Best GPS Watches]

The National Institutes of Health also recommends resistance training to strengthen muscles at least twice a week. These activities include lifting weights and doing push-ups and crunches, which can help build muscle. Resistance training exercises are important for weight loss maintenance because muscle tissue requires more calories to maintain itself, meaning you will burn more calories just by having more muscle. [ 4 Easy Ways to Get More Exercise]

Do diet pills and supplements work?

If weight loss sounds like a lot of physical and mental work, that's because it is. And there's no magic pill: Dietary supplements that claim to help people lose weight have not been proven to work, and they have the potential to be dangerous, Cohen said. Many nutritionists and researchers agree that such supplements can do more harm than good. Supplements can contain drugs that are not listed on the label, and may have harmful side effects. In 2014, the Food and Drug Administration identified more than 30 weight loss supplements that contained hidden drugs, but only seven of these were recalled by their manufacturers.

Weight loss supplements send more than 4,600 people to the emergency room every year, often due to heart symptoms, such as chest pain and a rapid heart rate, according to an estimate by a study published in October 2015.

The bottom line, many experts told Live Science, is that there is often no scientific evidence supporting a supplement's claims. The makers of diet supplements do not need to prove that their supplements actually help people lose weight in order to sell them in stores.

In contrast, makers of prescription and over-the-counter weight loss drugs, such as orlistat (brand names: Alli and Xenical) and lorcaserin (brand name: Belviq), must conduct studies showing that the drugs can lead to weight loss before the pills are approved by the FDA for use in obese individuals and those considered overweight (BMI of 27 or greater) who also have obesity-related risk factors.

Generally, people who take weight loss drugs which often work by decreasing appetite and increasing feelings of satiety can lose an average of 5 to 10 percent of their body weight in a year, according to the Mayo Clinic. However, these drugs still need to be used along with diet and exercise for people to achieve this level of weight loss. (Studies of these drugs involve people who have also made changes to their diet and activity level.)

According to the 2013 guidelines, the drugs might be helpful for people who aren't able to lose weight with diet and exercise alone, but people should consider discontinuing the drugs if they don't lose at least 5 percent of their body weight within 12 weeks of starting them.

However, Cohen cautioned that the long-term safety of weight loss drugs hasn't been studied. Most of the studies look at these drugs' safety after just one year, he said, and some earlier drugs that were approved by the FDA were later taken off the market because of their side effects. For example, in 2010, the weight loss drug sibutramine (sold under the brand name Meridia) was removed from the market even though it had originally been approved because it was later linked with an increased risk of heart attack and stroke.

In any case, weight loss drugs may not be a long-term method for keeping weight off, because people may regain the weight when they stop taking the drugs, Cohen said.

Lack of sleep increases the odds youll gain weight. Find out below how much shuteye you need.

Can a lack of sleep cause weight gain?

Here's a bit of advice that may make a dieter smile, or yawn: Get more sleep. A growing body of evidence suggests that getting insufficient sleep increases the risk of obesity. However, most of these studies have been conducted at a single point in time, which makes it hard to determine whether a small amount of sleep was a cause or an effect of weight gain.

The longest-running study on the link between short sleep and weight gain followed about 68,000 women for 16 years. It found that women who slept 5 hours or less per night gained about 2.5 lbs. (1.1 kg) more, on average, than those who slept at least 7 hours per night, over 16 years. In addition, those who got 5 hours or less were 15 percent more likely to become obese during the study period than those who got at least 7 hours of sleep.

Getting too little sleep, which most experts define as less than 7 hours of shut-eye per night, may increase levels of an appetite-stimulating hormone called ghrelin, and decrease levels of the hormone leptin, which makes you feel full, according to the NIH. This may lead to an increase in hunger. In addition, people who sleep less could have more time to eat. In a small study of 11 people who stayed in a sleep lab, participants ate more snacks when they slept for just 5.5 hours than when they slept for 8.5 hours. This increase in snacking occurred mostly during the late-night hours.

Still, it's not clear if getting more sleep actually helps people lose weight. However, studies are now being conducted to answer that question. In one study, researchers from the National Institute of Diabetes and Digestive and Kidney Diseases will look at whether obese people who usually sleep less than 6.5 hours a night see changes in their weight if they increase their sleep by an hour per night. [Best Fitness Trackers]

Should you consider bariatric surgery?

Bariatric surgery, an operation on the stomach and intestine used to treat obesity, may be an option for people who are still severely obese after attempting to lose weight through other methods, such as diet and exercise. People with a BMI of 40 or greater, or those with a BMI of 35 or greater who also have obesity-related health conditions (such as type 2 diabetes), are candidates for this invasive surgery, according to the NIH.

People who have bariatric surgery will still need to make lifestyle changes, including following a healthy diet and engaging in regular exercise, to lose weight and keep it off.

A 2009 study that reviewed outcomes for more than 11,000 bariatric surgery patients found that patients typically lost about 56 percent of their excess body weight, or nearly 85 lbs. (38.5 kg), and maintained it for at least two years. Scientists who reviewed 89 studies on weight loss after bariatric surgery found that patients with a BMI of 40 or higher benefited most from the surgery, losing 44 to 66 lbs. (20 to 30 kg), on average, and maintained that weight loss for up to 10 years, they reported in 2005 in the Annals of Internal Medicine.

The operation has the following side effects:

How can you keep weight off?

It's typically harder to keep weight off than it is to lose it, the experts agreed. Many studies show that people usually experience their maximum weight loss after about six months of a diet-and-exercise program. After that, the pounds come creeping back, although most people don't regain all of the weight. For example, a 2007 review of 80 diet studies involving more than 26,000 people found that dieters lost about 11 to 19 lbs. (5 to 8.5 kg) after six months, but then their weight loss plateaued, and after four years, they maintained about 6.5 to 13 lbs. (3 to 6 kg) of weight loss.

Chart of the habits of those who successfully keep weight off.

Participating in a program that focuses on maintaining weight loss one that meets at least once per month for a year or more can increase the chances that you'll keep the weight off. A 2008 study of more than 1,000 people who lost about 19 lbs. found that people who participated in a weight loss maintenance program that met in-person once a month kept off about 3 lbs. (1.4 kg) more over a 2.5-year period than people who didn't participate in the program.

To assist any weight loss effort, weigh yourself twice a week, continue the lower-calorie approach indefinitely and exercise at least 200 minutes per week, according to the 2013 guidelines. The Centers for Disease Control and Prevention recommends that you make a plan for how to keep up your healthy eating pattern, even on weekends, vacations and special occasions. [2016 Best Pedometers]

Eating breakfast may also stave off hunger later in the day. In a 2002 National Weight Control Registry study of nearly 3,000 people who kept off 30 lbs. (13.6 kg) for at least a year, researchers concluded that one habit that stood out was eating a morning meal: 78 percent of the participants ate breakfast every day.

Once you've lost weight, keeping it off can seem like a never-ending battle. But it's a battle worth fighting, even if you slip sometimes. Trying, even if you don't always succeed, is better than not doing so, scientists say. There's no clear evidence that "yo-yo dieting" or weight cycling, as researchers call it is linked with an increased risk of early death or disease, compared with remaining obese, McManus noted. And very few studies report harmful effects of yo-yo dieting.

"Weight loss intervention should not be discouraged because of a person's tendency to be a weight cycler," McManus said.

In a nutshell, the bulk of the evidence says that maintaining your weight loss is achievable if you do the following: keep up your healthy diet, continue to exercise and monitor your weight so you notice when your regimen needs adjusting.

This article is part of a Live Science Special Report on the Science of Weight Loss. Itwill be updated whenever significant new research warrants. Note that any significant change in diet should be undertaken only after consultation with a physician.

Follow Rachael Rettner @RachaelRettner. FollowLive Science @livescience, Facebook& Google+. Original article on Live Science.

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The Best Way to Lose Weight Safely - livescience.com

Their quick response can make all the difference in the case of a crash like the one Sebastien Bourdais went through at IMS. IndyCar

Sebastien Bourdais struck a wall during qualifying for the Indianapolis 500 this year. He suffered a broken pelvis, but acknowledges that without numerous safety improvements over the years, such a crash could have been fatal.(Photo: Tom Figura/for the Star)Buy Photo

The car straightened out around the turn at full throttle and Sebastien Bourdais lost control of the steering wheel. He didnt have time to react. The No. 18 car went into the wall at 227 mph.

He lost consciousness fortwo or three seconds but was conscious by the time the flaming vehicle reached a stop. As soon as Bourdais was alert, it was clear to him: He was broken.

Holmatro Safety Team members at Indianapolis Motor Speedwaywere talking and keeping things light beforeit happened, but they were ready.

They were listening for sounds that didnt quite seem right. Watching for smoke or sprays that didnt quite look right. It took milliseconds for them to react when Bourdais went into the wall during Indianapolis 500 qualifying.

Twelve emergencyworkers jumped into three trucks, four in each. Bourdais team asked him on the radio whether he was OK Kind of. The first paramedic arrived about 20 seconds after the initial hit and started to help Bourdais with his helmet. Bourdais predicted it right away.

Bourdais blacked out momentarily after the crash. As soon as he was alert, it was clear to him: He was broken.(Photo: Bob Goshert/for the Star)

I broke my pelvis, he said.

Are you sure?

Believe me, Im sure.

Two men sprayed the sides and bottom of the car with fire extinguishers. The crew commander spoke with Bourdais and communicated with fire control. The second truck was there 50 seconds after the crash. Soon five trucks surrounded him.

Eventually, Bourdais was strapped to a foot-wide board and placed in an ambulance. Straps wrapped around him in what he later called "not very pleasant places" and the safety workers cut off his fire suit and soon Bourdais was naked and feeling very small.

But he was alive. His car, the response teams and the SAFER barriers around the track kept Sbastien Bourdais alive. That might not have been the case 20 years ago.

Its pretty straightforward simple that Id be dead.

* * *

Dr. Terry Trammell, center, is IndyCars safety consultant and one of the founding fathers of the safety initiatives implemented in racing across the past few decades.(Photo: Provided by OrthoIndy)

When Terry Trammell heard Bourdais had fractured his pelvis and hip, he stormed into the engineering office livid. Jeff Horton, IndyCars director of engineering and the calmer of the two, was confused. The car and SAFER barrier did exactly what they were designed to do. Why was Trammell so upset?

Because Ive got to go talk to Sebastien and say'We kind of let you down,' Trammell said.

No, you didnt let him down, Hortonsaid. Hed be dead.

Trammell known as Dr. T is IndyCars safety consultant. That title downplays his significance a bit. Hes one of the founding fathers of the safety initiatives implemented in racing across the past few decades. He was one of the most renowned orthopedic surgeons in racing in the 1970s and '80s, but eventually pivoted from what he called the repair business to the prevention business.

He had a hand in the development of the Head and Neck Support system (HANS), the Holmatro Safety Teams, crash data tracking, impact foams in the cars, the SAFER (Steel and Foam Energy Reduction) barriers and so on.

Trammell takes it personally when a driver gets hurt. So does Mike Yates, the IndyCar manager of track safety operations.

They become friends with the drivers. They see each other every day. Yates almost walked away after seeing one too many friends die in the car. Trammell married a racer. Back in his surgeon days, the drivers would stay at his home while they rehabbed.

Theres a responsibility involved in keeping these drivers safe, and theres a weight. Trammell and Yates and so many others have done plenty to lessen the dangers drivers face, but there will always be risk. They keep fighting to reduce that risk.

If you get hurt," Trammell says to the drivers during an annual talk about safety, "I take it very personally, because I should have thought about how this could happen and taken measures to prevent it. On the other hand, if theres something we tell you that you can do to make your car safer, and you choose not to do it and get hurt, I take that equally personally, and I will be in your face.

* * *

Trammell felt like the grim reaper walking down the pits when he first started out in racing.The seas would part as he passed through.

No driver wanted to talk to the doctor. Somebody might think something was wrong with him.

The Holmatro safety team was ready to roll if needed on May 21, 2017, at Indianapolis Motor Speedway.(Photo: Randy Crist/for the Star)

When Yates started with the safety teams in 1985 after years as a firefighter, his team would jump in the back of a pickup with no seats. Their equipment lay unsecured in the bed of the truck. Team members held on to what they could.

There was no real plan, there were no set roles for each person.

We got to the scene and just did what we had to do, Yates said.

Now they have a system down. Three primary trucks, four seats in each, each seat holding a crew member with a specific role. If safety team members in a rush ever have to jump into the wrong seats, they take on that seats responsibility.

Seatbelts werent used in IndyCar until 1922. Helmets werent required until the 1930s. Fire suits came in the 1960s. Safety didnt really become a science until the 1980s and '90s.

Trammell and his medical partner Steve Olvey started cataloging every racing injury they could find. Drivers would come in for their physicals and the two played 20 questions with them.

Have you ever been seriously injured? No. What about that time we operated on you? That wasnt serious? No. Drivers had their own ways of looking at injuries.

Trammell and Olvey went back to the drawing board. They brought in printouts of a skeleton and had drivers circle every broken bone they had suffered for any reason. It looked as if the skeletons had chicken pox.

* * *

Holmatro Safety responds to a crash at IMS during a 2009 practice. The first person to approach the vehicle is a paramedic, who is ultimately responsible for the driver. IndyCar

Then came the 1992 month of May at the Speedway when 12 drivers were injured and Jovy Marcelo died. Trammell and John Melvin of General Motors went out to the track a few days after the 500 and measured every inch of the track to begin collecting crash records.

They took that data to General Motorsand it played a large part in engineer Robert Hubbard and driver Jim Downings development of the HANS, which restricts the head and neck from whipping around excessively in a crash.

Drivers were slow to embrace the HANS until the 1999 death of Gonzalo Rodriguez from a basilar skull fracture. Ananalysis found the HANS likely would have saved his life.Soon the HANS became mandatory in CART and Formula One.

The moment Trammell remembers as a sort of breakthrough was a mandatory Formula One driver meeting to introduce the HANS in Sao Paolo, Brazil, in the early 2000s. The meeting wasn't starting, so Trammell went up to the podium and asked why.

Well start when Mr. Schumacher gets here, aman said bluntly.

Trammell sat back downand eventually Formula One surgeon Sid Watkins came in dragging driverMichael Schumacher by the ear. You may begin, Watkins said.

After the presentation, Schumacher stood and asked a few questions. Ill take three, he said before walking out.

All the other drivers lined up. If Schumacher was wearing it, they wanted one, too.

* * *

Mike Yates didnt know whether he could keep going after Dan Wheldon died in a 2011 crash. Hed been doing the job so long, and hed seen so many drivers die, he thought it was time to walk away. He and Wheldon were good friends.

I didnt want to see another buddy go through that, Yates said.

A few weeks later he was in Sebring, Fla., talking to drivers. He told them he was thinking about leaving.

You need closure, one said. If you walk away now, you wont get that closure.

So Yates stayed on, and maybe he truly got that closure when James Hinchcliffe's life was saved during 500 practice in 2015. Hinchcliffe went into a walland a Code 05 was called, meaning a seriously injured driver.

Hinchcliffe was stuck, and they struggled to get him out.

Then they noticed the pool of blood between his legs.

A piece of the suspension had broken through the chasis and impaled his leg. Hinchcliffe was hemorrhaging. They had to move quickly.

They pulled him out and got him in the ambulance.

The bloodkept coming.

They tried packing the holes,wrapping a compression diaper around his stomach to limit the bleeding. Yates said they lost Hinchcliffe's pulse at one point.

Luckily the surgeons were able to hop in the ambulance,evaluate the situation and create a game plan for the moment they reached the hospital. Hinchcliffe is still racing two years later.

Hinchcliffe told Yates he was glad the track safety directorhad stayed on after Wheldons death. Maybe if Yates hadn't been there, things would have gone differently for him.

Hinchcliffe later took the Holmatro Safety Team to dinner in St. Petersburg as a thank you. He brought his parents along, as well. They talked about life and discussed beer.

It was a reminder of why the safety team fights to save lives. Yates is retiring this year.

* * *

When Scott Dixon went into the air and his car shattered into pieces at the 500 this year, Trammell said it looked far worse than it was. The chassis held up pretty well with only a little break on the bottom.

Bourdais crash was as bad it looked. He smashed into the SAFER barrier at 114 G's, three times as much force as Dixons crash. Bourdais pushed the wall back 40 feet, nine inches at the apex, five layers into the foam.

Cars have foam side panels in the door to protect drivers as well, but they canbecome a danger themselveswhen theres too much force. The foam panel can absorb up to 2,000 pounds of pressure before it becomes activated. In the Bourdais crash, the forces were so high, the foamfractured his pelvis.

Safety work is constantly evolving. The 2012 chassis, which Trammell calls the safest race car ever made, has front and side foam protections. The head surrounds can withstand 70 G'sof impact to the point drivers genuinely dont know they hit their head after taking on 50 G's.

But more can always be done.

Trammell said the biggest issue right now is protecting drivers spines in frontal impacts. Theres an epidemic, he said, of spinal fractures in Europe. IndyCar has lessened the risk for rear and vertical impacts, but frontal impacts are still a concern.

They are still working to prevent the kind of contact from a loose part that killed Justin Wilson in 2015. They are trying to tether parts to the car so the nose, wheels, wings, nose cones, etc., dont fly off. Trammell said they have reduced the riskbut cant eliminate it.

One of the issues all over the world about open cockpit cars is, should they exist? Trammell said. Should they have a total enclosure?

IndyCar is set to take delivery of a prototype windscreen in July. He said the pre-testing is done;now its time for ballistic testing. The windscreens are remarkably simple and look like '70s-style Indy-car windshields.

The other large issue is fencing. It costs a fortune to replacebut is needed to make sure cars stay on the track and spectators stay safe.

Dario Franchitti suffered a career-ending injury in Houston in 2013 when his car hit a fence post and the webbing was torn off the post, exposing fans to the damage and adding flying pieces of the fence tothe danger.

Thats a much bigger project thats going to require a lot of time, effort and money, Trammell said.

* * *

Bourdais went swimming last week. Scott Dixon raced at Le Mans. The worst can still happen to these drivers, but they are emerging from crashes safely more and more often.

The 2017 Indianapolis 500 was Yates last. After working more than 30 Indy 500s in his career, it was time. Six years after almost walking away on painful terms, he is walking away for reasons that sit better with him.

At the 500, the team got Yates a Holmatro helmet and had everybody sign it. He admits that caused a little catch in his throat. He took in the straightaway one last time.

Then he watched Dixon do his little flying act, and it reminded himit was time to go. That was scary, he said.

Yates said the Holmatro Safety Team is in better hands with guys such as Jim Norman, Matt Stewart, Tim Baughman and others. He loves the changes they are already making.

Trammell doesnt appear to be going anywhere. What makes him happy is how the culture of safety has changed in his decades at tracks. No longer is he the grim reaper walking the pits.

Now, he has people approaching him looking for help. Like in Sao Paolo in 2012, when Kanaan came up to him displaying his phone. Kanaan was showing photos of how the steering wheels were breaking drivers' fingers and hurting their thumbs.

Within 10 minutes, nine drivers were at his breakfast table saying their fingers were hurt. The problem was fixed by 2014.

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Sebastien Bourdais: 'It's pretty straightforward simple that I'd be dead' - Indianapolis Star

With obesity still rising among certain groups of kids, a government panel is renewing its advice that all children and adolescents ages 6 to 18 be screened for obesity.

Screening is just the first step. Kids who are obese should then be referred to treatment programs that use a variety of approaches to change their behavior and help them slim down.

The recommendations were issued Tuesday by the U.S. Preventive Services Task Force, a group of experts appointed by the Department of Health and Human Services Agency for Healthcare Research and Quality. The task forces advice influences healthcare providers and the coverage offered by health insurers.

The new recommendations, which were published in the Journal of the American Medical Assn., earned a B grade from the task force. That means the experts determined with moderate certainty that the overall benefit of obesity screening and treatment referral is moderate.

Read on for more details about the new recommendations.

Not necessarily. As extra pounds become the new normal, fewer parents are able to recognize when their childs weight is too high.

Besides, the medical definition of childhood obesity is pretty specific. You start by measuring a childs height and weight and using that to calculate his or her body mass index. Thats weight (measured in kilograms) divided by height (measured in meters) squared. There are online calculators to help you, like this one from the Centers for Disease Control and Prevention.

To determine if a child meets the criteria for obesity, you compare his or her BMI to the BMIs of other kids who are the same age. Doctors use growth charts from 2000 as a baseline for these comparisons. If a childs BMI is high enough to land him or her in the top 5%, he or she is considered obese. Today, about 17% of Americans ages 2 to 19 are in this category, according to the CDC.

Children with obesity are at greater risk for a variety of health conditions. These include asthma, high blood pressure, insulin resistance, high cholesterol, orthopedic problems and obstructive sleep apnea.

The task force also noted that obese children are more likely to experience mental health and psychological issues, as well as to be teased or be targeted by bullies.

Not necessarily. Tracking studies show that about 64% of pre-teens who are obese grow up to become obese adults. By the time kids become teenagers, the odds are even more stacked against them nearly 80% of obese teens go on to become obese adults.

Adults who are obese (defined as having a body mass index of 30 or higher) are more likely to develop serious chronic diseases like Type 2 diabetes and heart disease as well as certain types of cancer.

The task force advises doctors to help their patients find a comprehensive, intensive behavioral intervention. Thats a fancy way of describing a weight-loss counseling program.

In clinical trials, the programs that were most effective shared several features:

They included at least 26 contact hours with patients, spread out over a period of months. The ones with the best results had 52 contact hours, enough for one hour per week for an entire year.

They involved not just the child but his or her parents and siblings.

They included instruction on healthful eating, including steps like how to read nutrition information on food labels.

They showed kids how to exercise safely and supervised some of their workouts.

They taught kids the value of reducing their access to junk food, limiting their screen time and steering clear of other triggers that could undermine their progress.

They helped kids learn how to set goals for themselves, monitor their progress and reward themselves when appropriate.

A program like this can involve not just doctors but dietitians, psychologists, exercise physiologists and other kinds of specialists. The task force acknowledged that some families would have limited access to programs like this, but it didnt dwell on this problem.

Others did. In an editorial published Tuesday in JAMA Internal Medicine, Drs. Jason Block and Emily Oken of Harvard Medical School pointed out that in most areas of the United States, programs like this simply arent available. Among childrens hospitals, for instance, only 60% have something that meets the task forces criteria, and only 25% have a program that lasts a full year.

Even if a kid is fortunate enough to live near one of these hospitals, his or her family might not be able to afford to use it, Block and Oken added.

Three other doctors from Johns Hopkins University School of Medicine were even more critical. In a JAMA editorial, Drs. Rachel Thornton, Raquel Hernandez and Tina Cheng wrote that the task forces recommendations could wind up diverting resources from more practical public health measures that would probably do more to reduce childhood obesity.

Thornton, Hernandez and Cheng touted efforts to keep junk foods out of schools and prevent companies from marketing sugary drinks to kids.

Block and Oken mentioned some other policies that have been shown to improve kids eating habits, such as taxes on sugar-sweetened beverages or changes in the rules governing the Special Supplemental Nutrition Program for Women, Infants, and Children.

Greater focus on policies that support healthful behaviors across all settings will be essential not only in ensuring the sustained success of treatment for established obesity, but also in preventing its onset, the Harvard pair wrote.

The task force considered two medications that are sometimes used to help kids lose weight, orlistat and metformin. Clinical trials have found that both drugs helped children lose about five to seven pounds. But that wasnt enough to reduce their BMIs by even 1 point. However, the drugs did cause side effects, such as vomiting, cramping and uncontrolled passage of stool, according to the panels report.

Overall, the experts concluded that the clinical benefit of these drugs was uncertain.

Thats true for American kids overall its been around 17% for about the past decade, according to data from the CDCs National Health and Nutrition Examination Surveys. At the turn of the century, that figure was about 14%; in the 1970s, it was under 6%.

But some groups of kids are still getting fatter. For instance, obesity rates are still rising among African American girls and Latino boys. Also, the proportion of kids who are severely obese continues to grow.

karen.kaplan@latimes.com

Follow me on Twitter @LATkarenkaplan and "like" Los Angeles Times Science & Health on Facebook.

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Here's why experts say all kids ages 6 and up should be screened for obesity - Los Angeles Times

Heart disease, which includes coronary heart disease, hypertension (high blood pressure) and stroke, is the number one cause of death in the United States.

And yet, the American Heart Association and American Stroke Association both assert that a whopping 80 percent never have to happen.

Thats because prevention can reverse these numbers and improve your life and life expectancy.

If youre not sure of your risk level for heart disease or stroke, the AHA has a simple (and free) online Lifes Simple 7 risk assessment tool.

But regardless of your risk level, these seven ways to reduce heart attack and stroke risk can get you on the right path

Lucky #7 Seven is a widely popular lucky number in many cultures and religions. Its also what you want to see when playing the slots in Vegas. But when it comes to promoting health and preventing illness theres no room to gamble.

Heart disease and stroke share many of the same causes, including high blood pressure, smoking, obesity, diabetes, lack of exercise, poor diet and high cholesterol.

But turning these unlucky risk factors around with these 7 lifesaving habits can reduce your risk by 80% and thats a win you can take to the bank

1 Get Active Increasing physical exercises is the first step because it can reduce blood sugar, lower cholesterol, lower weight and makes you feel great! You can begin by taking walks, parking further form the store and taking the stairs instead of the elevator.

The AHA recommends the following programs:

1) Moderate-to-high-intensity muscle-strengthening activity, at least two days per week.

2) 150 minutes per week total of moderate-intensity exercise (30 mins a day, 5 days a week);

3) OR 75 minutes of vigorous aerobic activity per week (25 minutes, 3 days per week).

Examples of moderate intensity activity include:

Walking briskly (3 miles per hour or faster, but not race-walking) Water aerobics Bicycling slower than 10 miles per hour Tennis (doubles) Ballroom dancing General gardening Vigorous activity would include something like:

Race walking, jogging, or running Swimming laps Tennis (singles) Aerobic dancing Bicycling 10 miles per hour or faster Jumping rope Heavy gardening (continuous digging or hoeing) Hiking uphill or with a heavy backpack

2 Balance Your Cholesterol While statin drugs are the mainstay of modern medicine for lowering LDL (bad) cholesterol, they may be doing more harm than good. Thats why I believe when it comes to balancing cholesterol, natural solutions are the most gentle and are effective.

If your LDL (bad) cholesterol is too high it may increase your risk of heart attack and stroke. You need to keep the LDL in check and increase the HLD (good) cholesterol, which helps shuttle the bad out of your body.

Its well established that simply losing weight has cholesterol lessening effects. Much of this success could be due to the nature of how weight is lost: through exercise (above) and diet (see below). Exercise metabolizes fats in the body and a healthy diet should decrease inflammation-causing processed foods from entering your body.

3 Control Your Blood Pressure Keeping an eye on blood pressure is key to preventing it from getting too high and being a risk factor in heart disease and stroke. Again, exercise and diet are your friends here. Get up and move more to reduce HBP and lose weight. You can also limit your alcohol consumption and eat a heart-healthy diet. You might consider these 5 supplements for healthy blood pressure, start drinking beet juice and be sure to eat these 20 foods for a strong heart.

4 Eat Better Along with exercise, diet is a pillar of any wellness program and certainly has direct effects on many facets of the causes and prevention of heart disease and stroke. This is often difficult for people to change because we are creatures of habit. But making a change to a heart healthy diet is essential.

East more fresh fruit and vegetables. Choose lean proteins over fatty meats. Eat more whole grains and less processed ones. Avoid added salts, fats and sugars. Eat more wild Alaskan salmon. Limit your intake of saturated fat and full-fat dairy and avoid trans fats (found mostly in processed, packaged foods).

5 Lose Weight Losing weight is important for controlling diabetes and risk of stroke and heart attack. With heart disease being the No. 1 killer, its no surprise that 70% of Americas are overweight or obese. The AHA recommends losing 2 pounds a month to total 24 pounds per year to get you there safely and avoid the rebound weight gain of many fad diets.

Increasing exercise, making healthier eating choices, and increasing fiber intake will all help you lose weight. But also consider portion control. Researchers at Cornell University found that junk food is not the cause of obesity in America. In fact, it is simply our lack of portion control; that is, the vast quantity of food we eat daily.

6 Reduce Blood Sugar Dropping your blood sugar is essential to reducing your risk of diabetes, heart disease and stroke. Not only that, but elevated blood sugar can increase your risk of heart disease and stroke by 4 times! Exercise and diet are the key to reducing blood sugar. Click here for more tips on naturally lowering your blood sugar.

7 Stop Smoking A no-brainer Smoking causes one in five deaths and these are all preventable by quitting. Quitting smoking can help prevent heart disease, stroke, cancer and lung disease. There are several methods to help you quit, and this Free Guide can help you!

Motivation So, Americas No. 1 disease is preventable in 80% of cases. And the prevention model is steeped in making healthier choices in these seven areas weve just outlined. But these seven areas all are affected directly by exercising more and adopting a healthier diet. So what more do you need to get started?

How about a little motivation

The chilling statistics from the AHA and ASA are a scary wake-up call to everyone. Have a look at these deadly 7 deadly facts, then, get busy turning your 7 risk factors into 7 lucky lifesaving habits:

Coronary heart disease accounts for 1 in 7 deaths in the US, killing over 360,000 people a year. About 790,000 people in the US have heart attacks each year. Of those, about 114,000 will die. There are 580,000 new attacks and 210,000 recurrent attacks each year in the US. Each year, about 795,000 people experience a new or recurrent stroke. Approximately 610,000 of these are first attacks, and 185,000 are recurrent attacks. Stroke is a leading cause of serious long-term disability in the US. In 2013, worldwide prevalence of stroke was 25.7 million, with 10.3 million people having a first stroke. Stroke was the second-leading global cause of death behind heart disease in 2013, accounting for 11.8 percent of total deaths worldwide.

source: Easyhealthoptions

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7 Lifesaving Habits To Keep Heart Disease Away - Information Nigeria

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