• GLP-1 medications like Ozempic and Wegovy are meant for long-term use. However, some patients may stop because of side effects, cost, and accessibility.
• Research suggests regaining weight is common after cessation.
• Experts recommend staying on the medications long-term. However, they shared tips for reducing weight regain after ceasing use should a person need to stop.

GLP-1 medications like Ozempic and Mounjaro (which have been approved for treating type 2 diabetes but are sometimes used off-label for weight loss), as well as Wegovy and Zepbound (which have been approved to treat overweight and obesity), have soared in popularity due to their effectiveness as weight loss aids.

While many people find they do lose a significant amount of weight while taking these drugs, a large number of people who stop taking them discover they can quickly regain the weight they’ve lost and more — commonly referred to as Ozempic rebound.

In fact, a clinical trial published in 2022 indicated that people regained two-thirds of their body weight a year after ceasing to take 2.4 mg of semaglutide (the maximum Wegovy dose).

“Anti-obesity medications like Wegovy should not be used for short-term weight loss, but rather long-term treatment of obesity, which is a chronic disease requiring lifelong intervention,” says Dr. Katherine H. Saunders, MD, DABOM, the co-founder of Intellihealth and a physician at Weill Cornell Medicine. 

However, there are a number of reasons why people may stop taking these drugs.

“Cost is a big factor,” explains Dr. Mir Ali, MD, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California. “Often, these medications, even when covered by insurance, can have significant out-of-pocket expenses. Due to their popularity, these medications can often be in short supply. Many people stop these medications when they achieve their desired goal.”

But is weight gain inevitable after you stop taking a GLP-1 drug?

Health experts say it’s complicated, and though people generally do, they can take steps to significantly reduce their risk and keep the weight off.

Why people regain weight after stopping drugs like Ozempic 

Obesity is now thought of as a chronic condition, much like diabetes or hypertension.

“Therefore,  it should be treated like a chronic disease, and patients need to continue the medication long-term,” Ali says.

In other words, stopping insulin might cause a spike in a patient’s A1C levels, and a person who ceases use of beta blockers for hypertension could see elevated blood pressure. It’s the same with a GLP-1. 

And, like diabetes, there is no “cure” for obesity.

“These medications are treatments and not cures,” says Dr. Daniel B. Maselli, MD, ABOM, a bariatric endoscopist and obesity medicine physician at True You Weight Loss in Georgia.

As with other medications, GLP-1s like Ozempic affect a person’s biochemistry. 

“These medications bind to and activate receptors in the body — GLP-1 for semaglutide,” says Maselli. “These receptors promote downstream pathways that are important for appetite regulation, insulin sensitivity, and metabolism, among other benefits, and so lead to improvements in weight and metabolic health.”

Ali adds that the stimulation slows stomach emptying, increasing the chance a patient is satiated longer (and therefore eats less).

“While these GLP-1 medications can mute those obesity-promoting pathways or heighten obesity-fighting pathways, those pathways, fundamentally, still exist,” Maselli says. “So when you remove the GLP-1 medication, that patient is set back on a course of weight increase.”

In other words, without the medication to block and promote pathways that can affect a body’s biochemistry, a person is more likely to return to consuming more calories and regaining weight.

“This is not a unique phenomenon to GLP-1 medications and is similar to what we observe with medications that treat other chronic conditions, like high blood pressure, asthma, or inflammatory bowel disease,” Maselli says.

How to reduce your risk of weight gain after stopping drugs like Ozempic

These drugs may be meant for long-term use, but as Ali pointed out, that’s not in the cards for every patient. Even though it’s not recommended, people cease taking GLP-1 drugs for a number of reasons, including the severity of side effects, medication access issues, and cost.

Yet, GLP-1 drugs aren’t a cure-all to begin with, and even clinical trials found that patients lost weight while taking these medications in conjunction with making lifestyle habit changes.

Experts shared the following tips on how to keep weight off long-term, even if you took a GLP-1 medication for a short time.

Seek support

Even if a provider doesn’t recommend going off of a medication, they can still provide support and answer questions. Use them as a sounding board.

“Everyone who has lost a significant amount of weight inevitably hits bumps in the road,” Saunders says. While Saunders feels that stopping an anti-obesity medication is a huge hurdle for a person to climb, life changes and new medications can also present challenges.

“The patients who fare best are those who reach out early to their care team for help,” Saunders says.

If possible – and you don’t have one already — add a member to your support team, like a weight-inclusive registered dietitian. 

“This support system can help you navigate the mental and emotional aspects of weight fluctuations while offering health-promoting strategies that don’t rely upon a return to restrictive dieting,” says Cara Harbstreet, MS RD LD of Street Smart Nutrition.

Eat mindfully

Maselli says that no diet can perfectly mimic the biochemical effects of drugs like Ozempic and Wegovy. However, some foods can help a person feel fuller longer.

“Fiber and protein, for instance, take more time to move through the stomach and digestive tract — similar to how GLP-1 medications delay stomach emptying — and so are more filling than other types of foods,” he says.

Harbstreet agrees that foods rich in fiber and protein are beneficial. The timing of consumption also matters.

“Since protein has a similar effect for satiety, spread your protein intake throughout the day,” says Harbstreet. “In other words, avoid a pattern of small meals or lower protein foods all day before filling up on tons of protein at dinnertime.”

Harbstreet says legumes like beans offer both fiber and protein.

Whole grains and leafy green vegetables are packed with fiber. Additionally, she says that foods like avocado with healthy fats can increase and prolong full feelings.

Exercise regularly 

Consistent physical activity is a hallmark recommendation for overall health and weight loss maintenance, whether a person is or isn’t on an anti-obesity medication.

“Regular exercise has a number of benefits, including increasing cardiovascular health, burning more calories, and building muscle,” says Ali. “It is important for a person to find some sort of activity that they enjoy and can do on a regular basis.”

Ali suggests doing at least 30 minutes of exercise per day, five times per week, though you may want to work up to that amount over time.

“Starting slow and building up to a regular regimen is perfectly fine,” he says.

Seek out another type of therapy

While anti-obesity medications can offer significant benefits, patients have other therapies available. 

“Much like any other disease state, if one type of therapy isn’t feasible due to cost, access, tolerance, or just ineffectiveness for a specific patient, then pursuing an alternate treatment strategy is a very reasonable course of action,” says Maselli.

Maselli says these treatments may include endoscopic bariatric therapies like endoscopic sleeve gastroplasty, which can be performed as a same-day outpatient procedure and does not require long-term medication use.

Treat other underlying conditions

Maselli reminds people that obesity and overweight can put individuals at risk for more than 200 conditions, including hypertension and type 2 diabetes. 

A patient on a weight loss drug like Wegovy may have one or more of them. That’s why it’s important to continue to treat these conditions after going off an anti-obesity medication.

“Left untreated, many of these conditions can reduce energy and tolerance of physical activity,” Maselli says. “It’s critical to see your physician to screen for these common conditions and treat them if found.”

Additionally, Maselli recommends asking your healthcare professional if other medications you take list weight gain as a possible side effect.

“It’s an incredibly common side effect, and many medications have a weight-neutral alternative that can be used instead,” Maselli said.

Set realistic expectations

Harbstreet says it’s important to manage expectations — you can do all of the above and still put weight back on.

“This likely isn’t what you want to hear, but the reality is that weight regain is very likely,” Harbstreet says. “Weight cycling can have a negative effect on metabolic health, as well as body image and self-esteem, so resist the urge to start another fad diet or start heavily restricting. This increases the risk of disordered eating or developing an eating disorder.”

Takeaway

Patients commonly regain weight after they stop taking GLP-1 medications, and a new, albeit small, survey indicates that patients who ceased anti-obesity medication reported consuming more calories.

GLP-1 drugs change a person’s biochemistry, making them feel fuller longer and slowing digestion. However, they do not cure obesity.

When a person stops taking the medication, its effects halt, too, and a person may return to their previous calorie consumption.

While there are steps you can take after ceasing these medications that may help reduce your risk of regaining weight, health experts say that a person’s best bet for maintaining weight loss while taking drugs like Ozempic is to take the medication long-term.

• As the demand for anti-obesity medications like Ozempic and Wegovy soars, American workers demand coverage.
• One survey found that employees would rather have coverage for anti-obesity medications than other benefits like child care.
• As the desire for these medications stays high, experts anticipate that more employers will find ways to cover them.

Nearly half of American adults are interested in taking a safe and effective prescription anti-obesity drug like Ozempic or Wegovy to lose weight. 

The desire for access to anti-obesity medication is so strong that people are more interested in coverage for these medications than other work perks, including child care.

Without coverage for these drugs, it can cost a person over $1,000 for a one-month supply.

To get a better understanding of consumer sentiment when it comes to GLP-1 medications, the cardiometabolic care solution, 9amHealth, surveyed over 1,300 Americans.

They discovered that workers are willing to leave their jobs (or stay at one they hate) and cut back on spending across the board to get their hands on these medications.

In fact, 67% of respondents stated they would be “likely” or “very likely” to stay at a job they didn’t like in order to sustain coverage for weight loss medication.

This doesn’t surprise Dr. Angela Fitch, co-founder of Knownwell and president of the Obesity Medicine Association.

“These medications are revolutionary in their efficacy in treating obesity. Patients finally find something helpful that many have been trying to treat with various lifestyle offerings by employers for years and have not found success,” Fitch told Healthline.

The medications help people achieve 20% weight loss or more compared to older medications that typically cause about 5% weight loss, said Dr. Sethu Reddy, past president of the American Association of Clinical Endocrinology.

The medications are so effective at blunting obesity-associated health problems that they were named the 2023 Breakthrough of the Year by Science, a peer-reviewed journal published by the American Association for the Advancement in Science.

While science and physicians back the medications, seeing people accomplish weight loss on the medications drives them to want to achieve the same, said Reddy.

“Everyone knows what their co-workers, friends, relatives, etc., are doing [because they’re] publicly sharing their experiences,” he told Healthline. “It has been known for decades that obesity is a state that plays a significant role in one’s self-image and worth and in one’s perception of success.”

Workers stress the need for access to anti-obesity medications

Other key findings from the survey included:

• Of respondents employed somewhere that does not offer coverage for semaglutide medications, 20% of respondents are “likely” or “very likely” to change jobs to gain coverage.
  • Many respondents reported spending a significant amount of their monthly income on GLP-1 medications, with 50% of respondents saying they are cutting back on entertainment, groceries, luxury purchases, and more to afford these medications.
• When it comes to job perks, respondents ranked coverage for weight loss medications as more important than child care assistance/reimbursement, unlimited PTO, work-from-home or hybrid work models, and team bonding activities.
• 38% of respondents have tried black market weight loss products in the past, but the majority have gone the more traditional route of trying dietary restrictions and exercise/personal training prior to considering GLP-1 medications.

Will employers start to prioritize coverage for anti-obesity medications?

In 2023, about 25% of employers covered anti-obesity medication. According to the healthcare firm Accolade, this could jump to 43% percent in 2024.

However, the cost to employers is so steep that in 2023, some companies like the non-profit healthcare system Ascension and the University of Texas system stopped coverage due to a 233% total cost increase for them.

And just this month, Ozempic and Mounjaro were among 800 medications that experienced a median list price increase of 4.5%, according to a Wall Street Journal report.

Despite the cost, Fitch said employees should continue to demand coverage for obesity care. She believes it should be a standard benefit on all insurance plans, just like coverage is offered for other diseases. 

“We don’t have to stay in a job we hate to have care for our cancer; why should we need to do this for our obesity?” she said. “Patients with obesity have been stigmatized and have not stood up for access to care given they feel as though the disease is their fault.”

Why access to anti-obesity medication should be a standard health benefit

Fitch said anti-obesity medications should be a standard benefit to all patients, including those on Medicare and Medicaid. 

“Currently, employers have to choose to add coverage and pay extra for coverage while large insurance companies continue to become more profitable [as] millions of Americans don’t have access to care,” said Fitch.

How employers respond to coverage may depend on how tight the job market is, noted Reddy.

“If the demand for workers is high, employers may be incentivized to update their health insurance policies. If there are lots of people looking for few jobs, then the job applicants will not use this drug access as a factor, and neither will employers upgrade their insurance coverage,” he said.

While he acknowledged that medications like Ozempic and Wegovy are revolutionary for obesity patients, he said that the ultra-fast communication driven by social media can cause trends to form quickly and end quickly.

“I’m sure the pharma companies are paying attention to this vast amount of free marketing. Publicity can rapidly change direction as well,” he said. “To give you an idea, 20 years ago, I had patients insist on a weight loss medication, even if there was a small chance of needing heart surgery. The popularity of bariatric surgery is another indicator.”

With more advances in medical therapy in the works, he notes that current branded anti-obesity medications will be off-patent.

“At that time, prices should fall, and access should get easier,” said Reddy.

• Sarah Ferguson, the Duchess of York, announced she has been diagnosed with malignant melanoma. 
• Ferguson’s melanoma diagnosis is the second time the former royal family member has been diagnosed with cancer in the past year. 
• Last summer, she underwent a mastectomy after receiving a breast cancer diagnosis.
• Breast cancer may also increase a person’s risk for melanoma.
• As with many forms of cancer, melanoma is often treatable when detected early.

Sarah Ferguson, the Duchess of York and ex-wife of Prince Andrew, shared on Monday that she has melanoma, a serious and aggressive form of skin cancer.

In an announcement on Instagram, the 64-year-old former royal family member said she’d been taking some time to herself since being diagnosed with malignant melanoma.

Ferguson, widely known as “Fergie,” said the diagnosis came as a “shock” since it is the second cancer diagnosis she’d received in the past year. 

Ferguson underwent a mastectomy and reconstructive surgery last summer after being diagnosed with breast cancer during a routine mammogram screening. A breast cancer diagnosis may also increase a person’s risk of melanoma.

A spokesperson for Ferguson told CNN the malignant melanoma was discovered during reconstructive surgery following a mastectomy. Several moles were removed, one of which was identified as cancerous. Ferguson promptly received treatment and is at home recovering and “in good spirits,” she shared in the post.

As with many forms of cancer, early detection of melanoma is key to increasing a person’s chance of survival.

“It was thanks to the great vigilance of my dermatologist that the melanoma was detected when it was,” Ferguson wrote.

“I believe my experience underlines the importance of checking the size, shape, colour and texture and emergence of new moles that can be a sign of melanoma and urge anyone who is reading this to be diligent,” Ferguson shared.

Ferguson’s melanoma announcement is the latest in a recent wave of royal family health news. Last week, Kate Middleton, the Princess of Wales, had a scheduled abdominal surgery, and King Charles III is being treated for an enlarged prostate. 

What causes melanoma

Melanoma is an aggressive form of skin cancer that can spread quickly to other parts of the body and can be deadly. Melanoma develops in the skin cells responsible for giving the skin its color or pigmentation, also known as melanin.

Melanoma may develop from an existing mole or manifest as a new growth resembling a mole.

In most cases, melanoma is caused by UV exposure from sunlight. Fair-skinned people are often more susceptible to melanoma, but melanoma can also affect people with darker skin tones. Sun protection, regardless of skin tone, is key to prevention.

Dr. Trevan Fischer, surgical oncologist and assistant professor of surgical oncology for Saint’s John’s Cancer Institute at Providence Saint John’s Health Center in Santa Monica, CA, told Healthline that in rare cases, genetic factors may increase a person’s melanoma risk. These include:

• P16 genetic mutation 
• dysplastic nevus syndrome (multiple atypical moles) 

“While most melanoma is due to sun damage, there are some congenital or genetic markers that can predispose you to having melanoma,” he explained. 

Who is most at risk for developing melanoma and why?

The biggest risk factor for developing melanoma is skin tone and UV damage from the sun.

Fischer explained that people who have lighter skin tones and tend to burn and have had chronic sun exposure are at the highest risk of developing melanoma. Hair and eye color may also factor into a person’s risk for developing melanoma.

Melanoma most frequently presents on the face, arms and other extremities, but Fischer explained the disease may appear anywhere on the body, including areas that do not get exposed to sunlight.

What’s the link between melanoma and breast cancer?

Breast cancer may increase a person’s risk of developing melanoma, which may have been possible in Ferguson’s case, though a direct link has not yet been established. 

Fischer explained that people who have a BRCA mutation, a known genetic mutation that increases breast and ovarian cancer risk, may have an increased risk for developing melanoma. 

He said other schools of thought believe that undergoing treatment for breast cancer may weaken the body’s immune system and make cells more susceptible to melanoma. 

Is melanoma treatable when detected early? 

Early detection, as with most cancers, is key to successful treatment. In most cases, early-stage melanoma may only require surgery at the site and follow-up appointments with your doctor.

When melanoma is detected early it is unlikely the cancer has spread to the lymph nodes. When melanoma spreads to the lymph nodes it may require treatment including immune therapy and other medications.

In severe cases of late-stage melanoma, radiation may be required. 

Early detection also reduces the risk of melanoma recurrence. Fischer said it’s more likely a person who’s had melanoma could have a new case of melanoma rather than a recurrence of the original melanoma that was treated.

People at high risk for melanoma, such as those with lighter skin tones, should be screened at least once yearly by a dermatologist, who will conduct a full body scan.

At this time, there are no official recommendations for skin cancer screening, Fischer explained, but experts say most adults should begin annual screenings in their 30s and 40s, though this recommendation may vary depending on an individual’s circumstances. 

“I always see my patients twice a year,” Fischer said. “And then I had them see the dermatologist twice a year for the first several years after [a skin cancer] diagnosis because we’re looking to catch something even at an earlier stage.”

Takeaway

Sarah Ferguson, the Duchess of York and former royal family member, shared on Instagram that she had been diagnosed with melanoma, an aggressive form of skin cancer. 

Ferguson’s melanoma diagnosis is the second time she’s been diagnosed with cancer in the past year. Ferguson’s doctors discovered a cancerous mole while she was undergoing reconstructive surgery following a mastectomy for breast cancer. 

A breast cancer diagnosis may increase a person’s risk for skin cancer. As with any form of cancer, early detection of melanoma is key to successful treatment.

• A new systematic review and meta-analysis found a link between drinking 100% fruit juice and weight gain among children and adults.
• One of the reasons fruit juice contributes to weight gain is that it does not make us feel full, which leads to consuming more calories.
• The healthiest beverage swap for both children and adults is water. And if you do drink fruit juice, cut it with water or seltzer.

High in sugar and calories, health experts are finding more evidence that 100% fruit juice may cause weight gain.

In a recent systematic review and meta-analysis, researchers looked at 42 studies, which included 17 that focused on children and 25 on adults.

They discovered a link between consumption of 100% fruit juice and weight gain in children. For adults, they also found a positive association.

“This comprehensive review is the first to evaluate 100% fruit juice consumption and body weight in children and adults using both prospective cohort studies (which follow large groups of people over time to assess relationships between exposures such as diet and lifestyle with health outcomes) and RCTs (which assign groups of people to an intervention or control and examine differences in outcomes between the group),” Michelle Nguyen, lead author of the study, PhD Candidate at the Department of Nutritional Sciences Faculty of Medicine at the University of Toronto, told Healthline. “The use of both these study designs are critical to evaluate the totality of evidence.”

Whether 100% fruit juice is a healthy beverage is a question of great interest from clinicians, the general public, parents and caregivers, and policy makers.

The evidence on 100% fruit juice and weight gain has yielded mixed findings from both observational studies (prospective cohort studies) and clinical trials, Nguyen explained. 

Study findings indicate that 100% fruit juice consumption was associated with weight gain in children, especially among younger children. Among prospective cohort studies in adults, they found that 100% fruit juice was associated with weight gain among studies that did not account for intake of calories in their statistical analyses (unadjusted for calories), suggesting that excess calories play a role in this association. 

“Ultimately, these findings support public health guidance to limit the consumption of 100% fruit juice, especially in young children – to consume whole fruit rather than fruit juices. Our findings are in support of the AAP guidelines on 100% fruit juice consumption in children.  We hope these findings will inform clinical practice guidelines and public health strategies to reduce overweight and obesity,” Nguyen stated.

How does 100% fruit juice contribute to weight gain?

The reason for weight gain is mainly due to the high sugar content.

“I find that most people have an easy time understanding how soda can lead to weight gain. But sometimes we forget how similar soda and fruit juice are,” Dr. Nate Wood, physician at the Yale School of Medicine and culinary school graduate, stated. “Although fruit juice originally comes from a whole fruit (and we know whole fruits are healthy), soda is made in a factory. Otherwise, the two drinks are largely the same: they are both very sugary water.”

Wood continued: “Although sugary water is high in calories, drinking it does not make us feel full. For this reason, the calories in sugary beverages like fruit juice are sometimes called ’empty calories.’ Drinking these calories frequently is one common way that we end up consuming more energy than our bodies need. This extra energy is then converted to body fat, which leads to weight gain.”

However, it is important to note there are other factors that need to be taken into consideration to know what’s causing the increase in BMI.

“The authors of this study looked at studies that compared fruit juice to a non-caloric beverage, so it makes sense that the drink that has calories will be linked with a higher BMI,” said Natalie Rizzo, MS, RD, author of Planted Performance. “And correlation doesn’t equal causation. This means that just because kids who drink fruit juice tend to gain BMI, it’s impossible to know if it’s from the fruit juice alone.”

In addition, the consumption of liquid calories has been shown to result in greater weight gain compared to the consumption of solid calories, Nguyen explained.

Furthermore, “the lack of dietary fiber in fruit juice compared to its whole fruit form can result in decreased satiety and overconsumption of these beverages. In children specifically, studies have indicated that early introduction of fruit juice may lead to increased risk of overweight and obesity due to increased preference for sweet food,” said Nguyen. “Thus, delaying the introduction of 100% fruit juice in young children, moderating serving sizes, and choosing whole fruit rather than fruit juice is recommended.”

This raises the question: “is it advisable to have the actual fruit and skip on the juice?” 

“The answer is nuanced because some kids refuse fruit, but they will accept 100% fruit juice. And 100% fruit juice is made from fruit and has no added sugar, so a kid who drinks it is still getting plenty of vitamins and minerals from drinking the juice,” Rizzo explained. “As a matter of fact, older research states that kids who drink 100% fruit juice have higher intake and adequacy of dietary fiber, vitamin C, magnesium, and potassium. But, if a kid is willing to eat fruit instead of drinking juice, then it’s a good idea to have them do so.”

Nutritional guidelines for children and adults regarding fruit juice 

Children under 12 months of age should not be given any fruit juice, Wood explained. For children and adults above 12 months of age, it’s reasonable to occasionally consume fruit juice as a sweet treat. 

“The key way to look at fruit juice is a sweet treat, not a health food,” said Wood. “It’s not the same as eating a serving of whole fruit. Fruit juice is not essential for children in the same way that it’s not essential for adults. We’re certainly better off opting for whole fruit.”

Limiting fruit juice consumption is advised.

“Kids tend to be more selective in what they will and will not eat,” said Rizzo. “Because of that, they will refuse other healthy options and over consume certain beverages, like juice. So for kids, I would recommend limiting juice intake if they are neglecting other things, like milk or water.” 

Adults have more knowledge of nutrition and are able to make more informed choices, so they can limit themselves to a serving of juice, rather than over consume. Both children and adults don’t need to fully avoid juice, but they should limit the serving size, Rizzo added.

Healthy beverage replacements

“Water is always the best choice for kids and adults,” Rizzo stated. “And milk is important for kids to get calcium and Vitamin D. If a kid wants fruit juice, makes sure it’s 100% juice and limit the serving to 4 ounces per day.”

Unsweetened, fortified soy milk is another option rich in calcium and vitamin D for children who can’t have dairy or whose families prefer plant-based options.

The most important thing when selecting juice is to opt for 100% juice, Wood stated. There are many products out there that look like juice but are actually a juice cocktail made with extra sugar. It’s also important to note that some fruit juices are higher in sugar than others.

 For instance, grape juice can have 36 grams of sugar in a single cup, whereas orange juice has about 21 grams of sugar per cup. 

“I often tell folks to cut their juice with a little still or sparkling water,” said Wood. “For instance, you could add 4 ounces of grape juice to a lime seltzer. It’s fizzy and fun, slightly sweet, has a zip from the lime, and contains much less sugar than a glass of pure grape juice would.”

He added: “Another option would be to take whole fruit, muddle it in the bottom of your glass, and then add some water or seltzer. This works particularly well with berries or slices of citrus — lemon, grapefruit, and lime.”

Takeaway

According to a new systematic review and meta-analysis, there is a positive association between drinking 100% fruit juice and weight gain among children and adults.

Fruit juice is a contributing factor to weight gain because it is high in sugar and calories. It also doesn’t make us feel full, which leads to drinking too much.

Health experts suggest switching to water for both children and adults.

• Cases of measles have been detected in multiple states in the U.S. as well as the U.K. in recent months.
• Measles is one of the most contagious diseases known to exist.
• Nine out of 10 people who have not been immunized against the measles virus will become infected after exposure.

Recent measles outbreaks in several northeastern states in the U.S., as well as across the U.K., have caused some alarm among health officials and renewed controversy over the level of vaccination rates.

Cases of measles have been reported in Delaware, Pennsylvania, and New Jersey, with other reports of infected individuals in Washington state; another person with measles reportedly traveled through Dulles International Airport and Ronald Reagan Washington National Airport on Jan. 3 and 4.

The Centers for Disease Control and Prevention has explained that more than 61 million doses of the measles vaccine (MMR) were postponed or missed between 2020 and 2022 as a result of supply delays during the first two years of the COVID-19 pandemic. “This increases the risk of bigger outbreaks around the world, including the United States,” a CDC statement says.

How contagious is measles?

Measles is an airborne virus that can stay in the air for two hours and can be acquired by touching contaminated surfaces or inhaling the virus in the air. According to the CDC, nine out of 10 people who have not been immunized against the measles virus will become infected after exposure. The symptoms of measles include:

• Cold or flu-like symptoms
• Red eyes
• Fever
• Red or reddish-brown rash across the entire body
• Spots inside the mouth

“Measles is extremely contagious and there has been an increase in measles cases around the world (with a million more measles cases reported in 2022 than 2021 by the WHO) due to setbacks in measles vaccination rates during the COVID-19 pandemic,” Dr. Monica Gandhi, MPH, a professor of medicine at the University of California San Francisco’s Division of HIV, Infectious Diseases, and Global Medicine, told Healthline. “Members of the public are at risk if they have not been vaccinated (which usually happens in childhood) so the larger population need not be concerned if vaccinations are kept up to date.”

In the last half of 2023, there were more than 20,000 cases of measles in Yemen, the country with the leading outbreak. This is an indicator that without widespread immunity or vaccination, the virus can spread widely, Dr. Tina Tan, an attending physician at Division of Infectious Diseases at the Ann & Robert H. Lurie Children’s Hospital of Chicago, told Healthline.

“There are multiple countries around the world where measles is endemic and circulates widely in the community,” Tan said. “With international travel on the increase, unimmunized individuals are getting exposed to measles in the foreign countries that they are visiting, they are getting sick and exposing unimmunized, under immunized and persons that are too young to be immunized or who are unable to be immunized for medical reasons to measles. This has been reported on a number of occasions where exposure is occurring on airplanes, in airports or in the unimmunized person’s community.”

What’s causing these new outbreaks?

The combination of reduced vaccine rates from the early pandemic years and a backlash against vaccines in general by some parents are likely contributors to this uptick in measles, which had been essentially eliminated from the general U.S. population for years. In Mississippi, for example, nearly 99% of kindergartners received both MMR in 2021-22 — the highest rate in the nation. But a U.S. District Court judge in 2023 allowed parents there to file for religious exemptions to state-mandated vaccines, and it appears that similar trends have occurred in other states.

“There are reduced rates of childhood vaccination in the US, with a record number of applications by parents for exemptions to mandatory vaccination at school (reported by the CDC in November 2023),” Gandhi said. “Therefore, young children who have not yet been vaccinated (vaccination starts at 12-15 months) or whose parents decline to get them vaccinated are most at risk of measles infections.”

Unlike the recent increases in respiratory infections around the U.S., these measles outbreaks are not a result of any type of seasonal patterns, Tan said.

“The surges that we are seeing are due to a decline in MMR immunization rates, so that there are more people that are unimmunized and do not protective immunity,” Tan said. “Measles is one of the most highly contagious infectious diseases with the attack rate in a susceptible individual exposed to measles being 90% in close contact setting. Population immunity needs to be 95% or greater in order to stop ongoing transmission in the community.”

What precautions can I take to avoid infection?

Vaccination against measles is extremely effective and safe. The World Health Organization estimates that between 2000 and 2021, 56 million deaths were prevented because of the vaccine. Children typically don’t receive the first dose of vaccine until they are a year old, with a second dose typically between the ages of 4 and 6. For adults who have not been vaccinated, getting the shot is ultimately the strongest defense.

“There is no evidence that face masks have any effectiveness against the small measles virus; ventilation is likely to minimize the risk of any pathogen spread by a respiratory route. The measles vaccine is a live, attenuated vaccine (developed in 1965) given in conjunction with live vaccines for mumps and rubella (e.g. MMR vaccine),” Gandhi said. “Natural infection confers lifelong immunity and the strength of protection from two vaccine doses (which confers 97% protection) is long, although adults should receive a booster MMR vaccine during an outbreak.”

“For those persons who are unimmunized who have been exposed to measles including those that for medical reasons are unable to be vaccinated, they should be quarantined at home and not attend school, daycare or be in a healthcare setting for at least 21 days after the onset of rash in the last case of measles reported in the setting where they were exposed,” Tan added.

Given that these surges are not seasonal, and how infectious the virus that causes measles can be, widespread vaccination is the most effective tool any population has to return to a status the U.S. had in 2000, when the WHO declared measles “eliminated” in the country.

“The level of immunity to measles in the general population in the U.S. is quite high given high vaccination rates (given in childhood since the 1960s) with high natural infection rates prior to the 1960s,” Gandhi said. “However, population immunity will decline if these childhood vaccination rates in the U.S. to measles do not improve. Young children should receive two doses and adults may require booster vaccination prior to international travel, prior to college, prior to pregnancy or during outbreaks.”

Takeaway

An increase in measles infections in several U.S. states is an indicator that immunity and vaccination rates have dropped.

The best defense against measles, doctors and health officials say, is getting vaccinated against the virus.

Children under the age of 1 cannot usually be vaccinated, but after that it’s recommended that they get both doses of the vaccine.

• A study of a half-million people found substantial increased risk of death in individuals who sit most of the day at work. The risk was even greater for cardiovascular disease.
• Individuals who were active at work or intermittently sitting did not have an increased risk.
• Experts say that more must be done to counteract prolonged occupational sitting to avoid these health risks.

People who sit for long periods of time at work are at higher risk of death, especially from cardiovascular disease, compared with those who are more active throughout the day, suggests a new study of nearly a half-million people.

But there’s good news too: moving intermittently even for as little as 15 minutes throughout the day appears to mitigate the risk, as does regular exercise.

Those findings come from a large retrospective study in Taiwan, published today in the journal JAMA Network Open.

Researchers used data from a biannual health checkup program between 1996-2017 that included both men and women who were twenty years old or older. The average age of participants was thirty-nine.

More sitting linked to 16% increased mortality risk

Participants were asked to respond to questions about their lifestyle, activity level, and how much sitting they did per day at work. Researchers then categorized the participants into three categories based on their “occupational sitting volume,” essentially, how much time at their job was spent sitting: “mostly sitting,” the highest volume of sitting per day, “alternating sitting and nonsitting,” intermittent sitting throughout the day, and “mostly nonsitting,” the most active category.

After controlling for things like BMI, smoking, drinking, sex, and age, the study found that individuals in the “mostly sitting” category had a 16% increased risk of death and a 34% increased risk of death from cardiovascular disease than those in the “mostly nonsitting” group.

“This increased risk was observed across various subgroups, including men, women, younger and older individuals, smokers, and non-smokers. These findings emphasize the need to reduce prolonged sitting in the workplace and increase daily physical activity to mitigate the elevated risks of mortality associated with sitting,” Dr. Wayne Gao, PhD, an Associate Professor at the School of Public Health, Taipei Medical University, Taiwan, and first author of the research, told Healthline.

Reduce risk by cutting sit time

The middle group, the intermittent sitters, on the other hand, did not demonstrate an increased risk of death when compared to the most active group.

Dr. Scott Lear, PhD, a Professor of Health Sciences and Chair in Cardiovascular Prevention Research at Simon Fraser University, is most interested in this middle group

“That middle group, that the intermittent sitting group, was really no different from those who did the least amount of sitting. So it was mainly the ‘mostly sitting’ group that  had increased risks for cardiovascular disease  and early death,” Lear said.

Researchers also found that exercise could offset the risks posed by extended periods of sitting during the day. While there’s no clear formula for how much exercise someone has to do to offset sedentary behavior, the study does offer some insight.

According to Gao, engaging in 15-30 minutes per day of exercise, what they refer to in the study as “leisure time physical activity” (LTPA), is enough to offset the health risks of the “mostly sitting” group. 

The researchers also used another physical activity metric known was Personal Activity Intelligence (PAI) to assess daily exercise. Individuals who scored greater than one-hundred per week using the PAI scale, also mitigated the risks associated with prolonged sitting.

Sitting too much linked to heart disease, type 2 diabetes and cancer

It’s no secret that Americans spend a lot of time sitting down, and that can lead to a host of health problems. According to the CDC, about one-in-four Americans sit for more than 8 hours per day, and the average US adult sits between 6.5-8 hours per day.

Sitting too much and other sedentary behavior has been linked to increased risk of early death, cardiovascular disease, type 2 diabetes, and cancer. Your mental health and brain can be affected too. Multiple studies have looked back on the increase in sedentary behavior during the Covid-19 pandemic and found a strong association between sitting time and mental health issues like depression and anxiety. 

This year, the National Institute on Aging published a study showing a strong association between sedentary behavior and dementia risk. They found the risk was particularly great for adults who were sedentary for 10 or more hours a day. 

“It has been reported that modern lifestyles have become increasingly sedentary, resulting in prolonged sitting as a regular part of daily life. Scientific literature also agrees on the harmful effects of prolonged sitting,” said Gao.

In 2020, the World Health Organization for the first time included recommendations on sedentary behavior in its physical activity guidelines. They don’t provide specific guidance about sedentary behavior, of which sitting is a major part, other than to recommend that “Adults should limit the amount of time spent being sedentary.” They also recommend including exercise and replacing sedentary activities with physical activity.

Sitting too much? Here’s what to do to improve your health

The study authors advocate for cultural and occupational changes to “denormalize” prolonged occupational sitting, similar to how public health initiatives have worked on smoking.

“Some recommendations include incorporating regular breaks, introducing standing desks, providing designated workplace areas for physical activity, and offering gym membership benefits. These changes can help shift the culture and perception surrounding prolonged occupational sitting,” said Gao

A few simple ways to be more active and sit less at work, Gao recommends:

• Taking regular breaks to get up and move around. Use an alarm if you need to.
• During set break periods, take a walk or engage in light physical activity.
• Find opportunities to be more active, like using stairs or riding a bike to work.
• Exercise or take part in physical activity during your free time.
• Join a company-sponsored sports team.

Lear also supports initiatives to get people more active, but admits: “We’re not going to get away from sitting.”

Although companies could use money to pay for things like standing desks or treadmills in the office, he believes those are probably inefficient ways to spend money and reduce sedentary behavior. Instead, he agrees that individuals should be more aware of how much time they spend sitting during the day and actively make time to stand up and move around, even if that means setting an alarm every thirty minutes.

“If we can encourage people to get up every 20 or 30 minutes, do something other than sitting, like moving around, that’s an easier message to get across and easier, more feasible for people than to say, ‘Oh, don’t sit anymore,’” he said.

The bottom line

Extended periods of sitting at work are linked to increased risk of death in a new study of a half-million people.

Prolonged sitting and sedentary behavior have become much more common and are associated with numerous serious health problems, like cardiovascular disease.

Exercise can help to offset the risks posed by prolonged sitting.

Finding ways to sit less while at work, like taking active breaks, are an important part of reducing the risks caused by sedentary behavior.

• A new study finds that taking a daily multivitamin may help your cognition and memory.
• Researchers found individuals who were given multivitamin had a modest benefit in their memory and cognitive function over two years.
• The vitamin may help with cognitive aging.

New research finds that a multivitamin may help you maintain both your cognition and memory.

The new study published online on January 18, 2024, in The American Journal of Clinical Nutrition, reports that daily multivitamin supplementation was beneficial for both global cognition and episodic memory.

Global cognition refers to the overall status of our cognition while episodic memory deals with our recollection of past events and experiences.

The study is the third in a series of studies that are part of the COcoa Supplement and Multivitamin Outcomes Study (COSMOS).

The purpose of COSMOS is to determine whether cocoa flavanols or multivitamins have the ability to reduce the risk for certain health conditions including cognitive decline, heart disease, stroke, and cancer.

Multivitamins linked to better memory and cognition

In the two previous COSMOS studies, the researchers assessed people’s cognition via telephone and the Internet. For the present study, COSMOS-Clinic, they gave a subset of 573 people in-clinic cognitive assessments.

After analyzing their data, the team saw a “modest” benefit from the multivitamin in these individuals over a period of two years. They also saw a significant improvement in the participants’ episodic memory.

When the data from all three studies was combined, it was found that there was strong evidence that both global cognition and episodic memory had improved.

The study authors estimated that daily supplementation had delayed cognitive aging by about two years in comparison to those who had received a placebo rather than a multivitamin.

Why these findings matter

These findings are important, according to Kelsey Costa, MS, RDN, a registered dietitian and nutrition consultant for the National Coalition on Healthcare because “[m]ild cognitive impairment (MCI) and Alzheimer’s disease (AD) pose significant health challenges in the US, especially in the aging population.”

Costa noted that those who have MCI are about three to five times more likely to develop some form of dementia.

Additionally, the prevalence of AD is expected to reach over 14 million by 2060. This especially affects Hispanics, African Americans, and people over the age of 85. It is also expected to be more prevalent among women.

“Given the increasing prevalence rates of MCI and AD, particularly in older adults and specific groups, finding safe and effective preventative measures is crucial,” said Costa. “The study suggests that daily multivitamin supplementation could serve as a key part of the solution.”

Why multivitamins might help with memory and cognition

Melanie Murphy Richter, MS, RDN, a Registered Dietitian Nutritionist and instructor of Nutrition Physiology at the University of California, Irvine, explained that the vitamins and minerals that are found in multivitamins play an important role as catalysts in a variety of brain functions.

“For instance, we need certain vitamins like B6 and B12 to produce the neurotransmitters serotonin and dopamine for the brain,” she stated.

Richter went on to say that neurotransmitters are involved in sending signals to other parts of the body.

“If they are underproduced, our signaling pathways will be slowed or even ineffective. Not to mention, serotonin dictates our sleep cycles. Underproduction of serotonin can lead to impaired sleep which is known to accelerate whole-body aging, including of the brain,” she explained.

Yet other micronutrients found in multivitamins — such as vitamins C and E and minerals like selenium and zinc — can protect against the oxidative damage that is associated with age-related cognitive decline, per Richter.

Richter added that micronutrients are also important in breaking down macronutrients like carbohydrates, fats, and proteins. Micronutrient deficiencies can leave us unable to break down our food for energy which can also deprive the brain of energy.

“This can lead to brain fog, poor memory recall and eventually more serious decline over time,” she explained.

Finally, Richter pointed to minerals like magnesium, zinc, and copper which play a big role in maintaining the brain’s electrical charge.

“Inadequate supply of these micronutrients … can lead to malfunctioning communications between brain cells and degradation of our overall brain functioning,” she remarked.

Should you be taking a multivitamin supplement?

Claire Sexton, DPhil, Alzheimer’s Association senior director of scientific programs and outreach said that although these results are encouraging, the organization is not ready to recommend widespread multivitamin use in order to prevent cognitive decline.

“Independent confirmatory studies are needed in larger, more diverse and representative study populations,” she stated.

“It is critical that future treatments and preventions are effective in all populations,” Sexton added. “COSMOS-Clinic, for example, had less than 2% non-White in the multivitamin group and 5% non-White in the placebo group.”

She noted, however, that multivitamins are easy to obtain and relatively affordable. “With confirmation, these promising findings have the potential to significantly impact public health — improving brain health, lowering health care costs, reducing caregiver burden — especially among older adults.”

Sexton further advised that people speak with their healthcare providers about the benefits and risks of any dietary supplements they are taking, including multivitamins, noting that, although it’s preferable to obtain nutrients through a balanced diet, this is not always possible for people.

Takeaway

Researchers have found that a daily multivitamin supplement was linked with slowed cognitive aging and improved memory.

This is important because of the growing prevalence of dementia.

The improvements in memory and cognition could be because vitamins and minerals play important roles in brain health.

It’s too soon, however, to say whether people should be taking a multivitamin as a strategy to prevent cognitive decline as they age. You should speak with your doctor if you have questions about whether a multivitamin supplement is right for you.

• People with cardiovascular disease who took an erectile dysfunction (ED) drug and a medication for angina, or chest pain, had a higher risk of early death.
• The ED drugs examined in the study are phosphodiesterase type 5 inhibitors (PDE5i), sold under the brand names Viagra, Levitra, Cialis and others.
• People taking both of these types of medications should talk to their doctor about stopping one or both of the medications, or possible alternative treatments.

A new study finds that Viagra, Cialis, and other similar types of medication are linked to a higher risk of cardiac issues for people who also take medication for chest pain.

Phosphodiesterase type 5 inhibitors (PDE5i) — sold under the brand names Viagra, Levitra, Cialis and others — are a common treatment for erectile dysfunction (ED) in people with cardiovascular disease.

However, people prescribed both a PDE5i for ED and a nitrate for angina (chest pain) had a higher risk of heart failure, early death, and other negative health outcomes, a new study shows.

“Physicians are seeing an increase of requests for erectile dysfunction drugs from men with cardiovascular diseases,” said senior study author Dr. Daniel P. Andersson, associate professor at Karolinska Institutet in Stockholm, Sweden, in a news release.

“While there is a positive association of ED medication for men with cardiovascular disease, patients taking nitrates may experience an increased risk of negative health outcomes,” he said.

The study was published Jan. 15 in the Journal of the American College of Cardiology.

Why using both Viagra and nitrates are not recommended

The use of PDE5i treatment in people with cardiovascular disease and ED has been controversial, the authors of the new paper write. These drugs can affect blood flow, disrupt the lining of the blood vessels, and cause oxidative stress.

In addition, use of a PDE5i and nitrate together is not recommended, because both types of drugs can cause drops in blood pressure, but through different mechanisms. In spite of this, some research has found that the number of people prescribed both types of drugs is growing.

In the new study, researchers examined whether men with cardiovascular disease who were prescribed both drugs had a higher risk of certain cardiovascular outcomes.

The study included 61,487 men who had a history of a myocardial infarction (heart attack) or percutaneous intervention (treatment to open a blocked artery, also known as revascularization) from 2005 to 2013. The data came from the Swedish Patient Registry.

In addition, participants filled at least two prescriptions for nitrates — sublingual nitroglycerin or oral nitrates — during that time. Some participants also filled at least two prescriptions for a PDE5i —sildenafil, vardenafil, tadalafil or a combination of those.

Among these men, 55,777 were treated with nitrates alone, and 5,710 were treated with nitrates and a PDE5i. Researchers followed nitrate-only users for an average of 5.7 years, and PDE5i and nitrate users for an average of 3.4 years.

The average age of the nitrate-only users was 70 years, and the average age of men treated with a PDE5i and nitrate was 61 years.

Researchers examined medical data to see how many men died early from any cause, or from a cardiovascular or other cause; or had a heart attack, heart failure, or any major cardiovascular event; or needed cardiac revascularization.

People taking both a PDE5i and nitrate had a higher risk of all of those health outcomes, compared to those taking a nitrate alone, the study showed.

However, few of these negative health events occurred 28 days after participants filled the prescription for a PDE5i, “indicating a low immediate risk for any event,” the researchers wrote.

Dr. Cheng-Han Chen, interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, Calif., wasn’t surprised by the study’s findings.

Chen was not involved in the study.

“We have known for a long time that using a PDE5i along with nitrates can result in an unsafe drop in blood pressure,” he told Healthline. “This study clearly confirms that this combination can result in increased risk of cardiovascular events and even mortality.”

What to know about heart health and erectile dysfunction

One of the limitations of the study is that researchers did not know if patients took the medications that they were prescribed, or how often — only that they filled the prescription.

The study also included people who had already had a heart attack or underwent revascularization, which makes them high-risk. As a result, the findings may not apply to other groups of people.

In addition, the study is observational, so it cannot show direct cause and effect. 

It could be that the increased risk of negative health outcomes is due to both types of medications causing dilation of the blood vessels, said Dr. Yu-Ming Ni, cardiologist and lipidologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, Calif. 

However, there could be other reasons for the increased rates of early death in people taking both drugs, he told Healthline. For example, the need for a PDE5i may be a sign of more severe cardiovascular disease overall.

“Having erectile dysfunction can be related to poor blood flow in the penis,” said Ni. However, “we know that having blood vessel disease in arteries in one part of the body suggests you’re going to have blood vessel disease in arteries in other parts of the body.”

More research is needed to understand the link between the use of these drugs and the negative health outcomes seen in this study.

In general, people should not be on both medications at the same time, Ni said, something backed up by the new study’s findings.

However, “many men [taking a nitrate] also happen to be on erectile dysfunction medications at the same time, and [your physician] may not be aware of it, for various reasons,” he said. “So it’s really important to bring this to the attention of your physician, if you’re taking both.”

Chen recommends that if you are taking both types of medications, you should talk to your primary care provider or cardiologist about stopping one or both drugs.

In addition, “patients with both ED and angina should know that there are alternatives to nitrates — such as calcium-channel blockers and ranolazine — that can be more safely used if they are taking a PDE5i,” he said.

Takeaway

Researchers examined medical data on men with cardiovascular disease who were prescribed a nitrate for angina, or chest pain. Some were also prescribed a phosphodiesterase type 5 inhibitors (PDE5i) for erectile dysfunction.

Men who were prescribed both types of drugs had a higher risk of dying early, heart attack, and other cardiovascular outcomes, compared to those who were prescribed only a nitrate.

Experts say that, in general, these two types of medications should not be used together. If you are taking both drugs, talk to your doctor about stopping one or both meds, or finding an alternative medication.