Geography helps shield Brazil from US-style bird flu epidemic, for now

FILE PHOTO: A person wearing a hazmat suit stands next to burning egg cartons and other items in a hole in the ground at a poultry farm after Brazil confirmed its first outbreak of bird flu in Montenegro, Brazil on May 16, 2025. REUTERS/Diego Vara/File Photo
FILE PHOTO: Chickens sit at a poultry farm as Brazil's egg exports soar amid stronger U.S. demand, in Taquari, Rio Grande do Sul, Brazil, March 12, 2025. REUTERS/Diego Vara/File Photo
FILE PHOTO: An excavator moves earth next to a hole in the ground at a poultry farm after Brazil confirmed its first outbreak of bird flu on Friday, triggering protocols for a country-wide trade ban from top buyer China and state-wide restrictions for other major consumers, in Montenegro, Brazil May 16, 2025. REUTERS/Diego Vara/File Photo
FILE PHOTO: An employee dilutes poultry serum samples for ELISA test for the detection of antibodies to the avian influenza virus at the Reference Laboratory of the World Organization for Animal Health in Campinas, Brazil April 25, 2023. REUTERS/Amanda Perobelli/File Photo
SAO PAULO - Brazil's vast and diverse geography, with the Amazon to the north, mountain ranges along the Atlantic coast and the Andes to its west, may have helped it avoid the U.S. fate of widespread bird flu among commercial poultry flocks by keeping migratory birds away from farms in the country's interior.
Wednesday marks more than a month without a new bird flu case on a commercial poultry farm in Brazil, ending an observation period after its first such outbreak. The success brings hope to farmers that there will be no repeat of the persistent infections in the U.S., where the virus devastated the domestic egg industry and triggered lasting trade bans.
There are doubts, however, whether the landscape can offer long-term protection.
Bird flu has spread around the world, even reaching Antarctica for the first time in 2024, in a threat to poultry flocks, wild birds and mammals, including U.S. dairy cows.
In Brazil, the Andes may delay the entrance of virulent new strains for two or three years, said Alex Jahn, researcher at Oregon State University's department of integrative biology.
But Brazil will remain at risk for outbreaks as wild bird populations now infected with the virus circulate more widely. South American birds can migrate in all directions depending on rainfall, Jahn said, unlike the north-south seasonal migration over the United States.
Those migratory flyways over the U.S. appear to be major vectors for contagion between wild birds and commercial poultry, said John Clifford, the U.S. Department of Agriculture's former chief veterinary officer.
"If you look at the wild waterfowl patterns, that's probably the key," said Clifford. "We have four flyways coming in through the U.S."
By contrast, the Amazon basin acts as a natural filter keeping wild birds away from Brazilian poultry, said Guillermo Zavala, a U.S.-based avian health consultant who has worked in the poultry industry for more than 30 years.
The wild birds spreading the virus tend to spend time in nesting areas north of the equator, he said.
Masaio Ishizuka, a senior epidemiologist at the Sao Paulo University, said evidence suggests migratory birds have now infected local Brazilian species, making the bird flu virus endemic in the world's largest chicken exporter, which accounts for 39% of global trade.
Last month, Brazil's first outbreak on a commercial farm led to the culling of about 17,000 breeding chickens, producing birds raised for meat. Since then, meatpackers BRF and JBS culled at least 141,000 healthy chickens preemptively.
Brazil has detected 174 cases of highly pathogenic avian influenza, or bird flu, since 2023, mostly in waterfowl along the coast, according to government data.
The United States has confirmed the virus in about 10 times as many commercial and backyard flocks since 2022, the USDA said. About 175 million U.S. chickens, turkeys and other birds have been culled.
China has blocked poultry products from Brazil and most U.S. states due to outbreaks, and other nations also restricted shipments.
Russia, Saudi Arabia and Mexico enforce statewide restrictions that only apply to poultry from Rio Grande do Sul, where the one commercial outbreak occurred. Japan and United Arab Emirates are among nations with even narrower import bans, restricting only poultry products from the town of Montenegro.
SECURITY MEASURES
Brazil's first commercial outbreak hit a chicken breeding farm, where biosecurity rules are supposed to be stricter than on facilities where chickens are raised for meat, said Felipe Sousa, assistant professor at Sao Paulo University's school of agriculture.
Security measures at breeding facilities require workers to shower before going in and use clean uniforms and shoes provided by employers.
Brazilian farmers are also required to put up fences 5 meters (16.4 feet) away from chicken houses and one-inch mesh screening, commonly known as chicken wire, both around the walls and the property to keep stray or wild animals away from flocks, Sousa said.
Many U.S. farms have similar precautions, except for the fencing and screening rules, said Ashley Peterson, a senior vice president at the U.S. National Chicken Council.
U.S. chicken flocks are tested for bird flu before being slaughtered as part of a monitoring program, she added.
Brazilian meat lobby ABPA and the government did not comment on pre-slaughter protocols.
Clifford, who works with a U.S. poultry export association, said he expects more commercial outbreaks in Brazil with the virus present in wild waterfowl.
"If they only have one, I would have a lot of curiosity about their surveillance program," he said. "They would be darn lucky."
Officials recently confirmed backyard and wild species outbreaks in the center of Brazil, showing the virus is traveling inland.
In response, Marcelo Mota, Brazil's chief veterinary officer, said the country will enforce new biosecurity guidance for zoos, parks and conservation sites.
"We will be busy," he said. REUTERS
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The Wegovy effect: A weight-loss drug reshapes the lives of US teens battling obesity

(Clockwise from left) Austin Smith and his mother, Katie Duncan and Stephanie Serrano are among young people using Wegovy for weight loss. PHOTOS: REUTERS High-school freshman Austin Smith sank into depression from the merciless teasing and bullying he endured from his classmates over his weight. By age 15, Katie Duncan felt unhealthy and self-conscious from the excessive weight she carried, but couldn't tame the incessant food cravings caused by a tumor that had damaged part of her brain. Ms Stephanie Serrano, diagnosed with type 2 diabetes and liver disease related to her obesity, stopped attending high school in person and became a virtual shut-in after years of failed dieting. For these teens, obesity had become a painful physical and emotional burden, the persistent social stigma of their condition isolating them from their peers, and they were frustrated by their inability to lose weight. That's why, with support from their parents, they joined a small but fast-growing cohort of American teens who have chosen to take Novo Nordisk's weight-loss drug Wegovy, placing them at the forefront of a monumental shift in the treatment of childhood obesity. As childhood obesity rates soared in recent decades to epidemic levels, pediatricians could offer children and their families little beyond the conventional – and often ineffective – counsel of healthier diets and more exercise. That changed in December 2022, when US regulators approved Wegovy, which has become a multibillion-dollar seller for treating obesity in adults, for children 12 and older. Since then, teenagers have been starting on Wegovy at quickly rising rates, as Reuters recently reported. Still, based on those rates, the overall numbers remain small – fewer than 100,000 – next to the roughly 8 million, or one in five, American teens living with obesity. Those who have embraced the treatment, including the American Academy of Pediatrics, say Wegovy gives adolescents a chance at a healthier future by reducing their risk of developing type 2 diabetes, liver disease and other debilitating, and costly, chronic illnesses. They say weight loss can also ease the harm of the teasing and social isolation teens with obesity often endure. Some doctors, though, are hesitant to prescribe the drug, citing the lack of long-term safety data, concerns that children won't get adequate nutrition while taking it, and the possibility that it could cause eating disorders. Their caution is echoed in statements by US Health Secretary Robert F. Kennedy Jr., who has criticised the 'overmedicalisation of our kids' and emphasises the role of healthier food in combating chronic disease. That split leaves families to consider for themselves the potential benefits and risks of Wegovy when deciding on a course of treatment for a child with obesity. For this article, Reuters reporters found children who had taken Wegovy or a similar weight-loss drug to speak with them about their experiences. The reporters spent more than a year closely following four teens and their families to examine in detail the impact of treatment. Here are their stories: 'I can't wait' GLADSTONE, Missouri – 'Why do you want to lose weight?' When Ms Elizabeth Smith asked her son Austin that question, he didn't hesitate. 'To be healthier and so people will stop bullying me,' he said. Elizabeth wrote his answer on the form she was filling out as they waited in the doctor's office. Austin was near the end of a miserable freshman year. At almost 300 pounds, he struggled each morning to squeeze down the aisle of the school bus. Other students teased him relentlessly. He looked pregnant, they said, and he was gross. At school, the insults continued. He found solace in woodworking class, where he could focus on his projects and tune out the taunts – until the day a classmate cornered him, jammed a power drill into his long, curly hair and turned it on, leaving the tool dangling from a messy tangle. Ms Elizabeth Smith tousles the hair of her son, Austin Smith, who uses Wegovy for weight loss. PHOTO: REUTERS Even before his parents learned about that incident, they knew something was wrong. Austin, who has a mild form of autism, had grown increasingly withdrawn and rarely left his bedroom, where his mother found him sobbing after school several times. 'I can't make any friends,' Austin told her. They feared he might contemplate suicide. They decided to seek medical help. A psychiatrist put Austin on an anti-depressant. Ms Elizabeth thought the obesity specialist who had been treating her could help, too. Five weeks earlier, Dr Matt Lindquist at University Health in Kansas City, Missouri, near their home in suburban Gladstone, had started her on Wegovy, and she had already dropped 20 pounds, to around 220. That's how Austin and Ms Elizabeth found themselves filling out forms in Dr Lindquist's office in April 2023. Four months earlier, US regulators had approved Wegovy for teens with obesity, defined as a body mass index at or above the 95th percentile for children of the same age and sex. The doctor judged Austin, then 15 years old, to be in good overall health and a good candidate for Wegovy. The drug would tame the constant hunger Austin described. Dr Lindquist told Austin that after starting on Wegovy, he should cut his meal portions in half and eat more healthy proteins and vegetables. Even then, the doctor said, Austin might experience the common side effects of nausea and vomiting. Out of pocket, the more than US$1,000 ($1,286)-a-month cost of Wegovy would have been unaffordable. The Smiths live paycheck to paycheck on Ms Elizabeth's pay as a hospital billing clerk at University Health and what her husband, Jeremy, earns building courtroom exhibits. But Ms Elizabeth's employer-sponsored health insurance covered Wegovy. About a month after the visit with Dr Lindquist, the first box of Austin's Wegovy injections arrived. Ms Elizabeth, fearing Austin would get sick in class, asked him to wait to start the drug until after the school year ended in a week. 'I can't wait,' Austin said. She gave him his first injection that night. The effect was almost immediate. He used to come home from school and devour dozens of chicken nuggets while playing video games. Now, he felt full far sooner. Many nights, he stayed in his room at dinnertime. 'I felt a little bad because I couldn't eat my parents' cooking,' Austin said. The only side effect he experienced was a little stomach upset. Elizabeth began keeping a log of Austin's weight. At the start of his sophomore year, two months after starting Wegovy, Austin had lost 23 pounds. That's when he first noticed the difference: On the school bus that morning, he didn't bump into the seats while walking down the aisle. 'I was so happy to go home and tell my parents about it,' he said. In early September 2023, Dr Lindquist increased Austin's weekly dose of Wegovy to the maximum, 2.4 milligrams, as recommended on the label. Austin started vomiting after eating. Dr Lindquist cut the dose back to the previous 1.7 milligrams. The vomiting subsided. Austin reveled in his altered appearance, and his mood lightened. He told Ms Elizabeth the bullying had stopped. He liked to stand in his now billowing marching band uniform and pull the waistband outward to reveal gaping spaces. He was back to tending his oregano, thyme and other herbs growing in pots outside the front door. He played in the backyard with his puggle, Lucy, or one of his family's other two dogs. He spent weekends hanging out with his best friend, an elderly man in the neighborhood, gardening, walking their dogs and watching movies. In October 2023, five months into treatment, Austin was down to 232 pounds. Ms Elizabeth wrote Dr Lindquist to ask about his target weight for Austin. The doctor responded that he didn't set weight goals, preferring to focus on a patient's overall health, and was encouraged by Austin's progress. 'I would say he likely needs meds lifelong to support a healthy weight,' the doctor wrote. Ms Elizabeth's heart sank. 'I wouldn't want him to be on this for a lifetime,' she said. Austin didn't share those qualms. 'Before, I would look in the mirror and hate myself and wish I could be an entirely different person,' he said. 'Now I feel like I can accept myself a bit more.' He had dropped to 222 pounds by early December 2023. One Saturday, he came into the kitchen and lifted his shirt to show his family his now-visible ribs. For Christmas, Ms Elizabeth bought him extra-large pants and shirts to replace his 2XL clothes. 'He's like a whole new person,' his pediatrician told Ms Elizabeth, echoing many family friends and relatives. Austin's father was cheered by his son's physical and emotional transformation. Jeremy had lost about 30 pounds while taking Ozempic, Novo's medication for type 2 diabetes that has the same active ingredient as Wegovy. At a January 2024 appointment, Dr Lindquist chided Austin when he admitted to skipping meals. 'You need to put gas in your tank to make it go,' the doctor told him. He referred the teen to a nutritionist. Ms Elizabeth scheduled an appointment, but had to cancel because of a work conflict and hasn't booked a new visit. The following April, Austin was at 200 pounds. He celebrated the end of his sophomore year by taking a trip in June to Belize with other students. He snorkeled and went on eight different zip-lines through the rainforest. The weight limit for riding the zip-lines was 280 pounds. Back home, Ms Elizabeth wept when she watched the video Austin shared of him gliding through the trees. 'He couldn't have done this before,' she said. Soon after his return, he was hit hard by the death of his elderly friend. His psychiatrist prescribed a more powerful anti-depressant. Austin then panicked when, after Dr Lindquist stretched out Austin's dosages, he started eating more and putting on pounds. That stopped when he went back to regular weekly injections. The family got another shock in January, when Ms Elizabeth's insurance through University Health quit covering Wegovy and other so-called GLP-1 drugs for weight loss. Wegovy had been free, after insurance and Novo-provided coupons. Now, the health system would be providing Wegovy at US$250 for a three-month supply through its own pharmacy. Insurance coverage for Wegovy has steadily expanded since the drug's 2021 launch, and Novo has offered ways to bring down out-of-pocket costs. But employers and government agencies often impose restrictions to hold down costs associated with the drug's high price and the large number of patients eligible to take it. In 2024, 64 per cent of US employers with 20,000 or more workers covered GLP-1 drugs for obesity, up from 56 per cent in 2023, according to Mercer, a benefits consulting firm. Medicare and most state Medicaid programs don't cover the drugs solely for weight loss. Ms Elizabeth has been able to scrape together enough to cover the cost. She also had to find Austin another doctor at University Health after Dr Lindquist left to set up his own practice and the hospital stopped covering Wegovy for doctors outside of its network. Austin is just relieved that his parents can afford to keep his prescription going. His weight has leveled off at about 200 pounds – a 30 per cent loss in two years. He doesn't want to contemplate life without Wegovy. 'I feel I would be bigger,' he said. 'I don't want to go back.' 'What I'm doing isn't working' WILMINGTON, Delaware – At 15, Katie Duncan, 6-foot-1 and 270 pounds, was growing increasingly anxious and depressed about her weight. Some of her clothes no longer fit, she was easily winded while walking, and her back ached. Classmates occasionally lobbed mean comments about her size. Blood tests showed she had high triglyceride levels, which can increase the risk of stroke and heart disease. But Katie's hunger never let up. She often ate four or five meals a day. She would devour an entire pizza and hide snacks in her bedroom to satisfy cravings. She had tried an older weight-loss drug that did nothing. 'We need to change something,' she told her father, Randy, in the summer of 2023. 'What I'm doing isn't working.' Ms Katie Duncan uses Wegovy for weight loss. PHOTO: REUTERS Randy scheduled an appointment at the Healthy Weight and Wellness Clinic at the nearby Nemours Children's Hospital. The Duncans knew the hospital well: Katie had been treated there after she was diagnosed at age seven with a brain tumor. Doctors had given her a 20 per cent chance of surviving the cancer. Katie took an experimental drug and underwent months of chemotherapy and radiation. She was tiny at the time, only 42 pounds. The cancer went into remission within a year. However, the tumor had damaged her hypothalamus, the portion of the brain that controls hunger, and the nearby pituitary gland, which releases hormones that regulate growth and metabolism, among other key functions. Her doctors put her on a lifelong regimen of synthetic hormones and a low-dose steroid to replace what she lost. The brush with death forged a fierce bond between father, divorced since Katie was 3, and daughter, the youngest of five siblings and the only one still living at home. Randy, a paramedic and volunteer firefighter, took off from work to go to every doctor's appointment and physical therapy session with her. Katie treasured a locket with her father's photo inside and refused to go to school without it. He accompanied her on every school field trip. Katie tried a sleepaway camp hosted by the hospital and called her dad to pick her up after the first night. 'I don't like being away from my family,' she said. But by the time Katie was 9, Randy, now remarried, noticed something was wrong. Katie was constantly hungry, and the two clashed repeatedly over it. During a trip to SeaWorld in Florida, they shouted at each other when Katie complained that she was starving, even after a big breakfast at their hotel. Katie steadily put on weight during her middle-school years. She avoided running and other sports due to painful neuropathy in her feet, likely caused by her cancer and chemotherapy. She couldn't keep pace with classmates in physical education. At her appointment in 2023, Katie saw Dr Thao-Ly Phan, medical director of the Nemours weight clinic. After examining Katie and reviewing her medical history, Dr Phan determined that Katie probably has 'hypothalamic obesity' from her brain injury, for which the replacement hormones don't fully compensate. 'Her body isn't helping her out,' Dr Phan said. While brain cancer isn't common, Dr Phan said, teens can have other, more common underlying conditions or treatments that lead to obesity and complicate their care. For example, polycystic ovary syndrome can cause hormonal imbalances and weight gain, especially around the belly, in young women. Antidepressants, mood stabilisers and other psychiatric medications can lead to weight gain, too. After prescribing Wegovy, Dr Phan had Katie see the clinic's psychologist and nutritionist, a routine step the doctor requires of her patients. 'We don't want kids to lose so much weight that they develop eating disorders,' she said. 'We want to make sure that they're still getting the nutrition they need to grow and to thrive.' Katie got her first dose of Wegovy in November 2023. She lost about 20 pounds in the first couple months, with only mild side effects. At times, Katie had no interest in eating and skipped meals, despite Dr Phan's warnings not to. Poor nutrition and eating habits during adolescence can have long-term consequences, from impairing cognitive development to increasing the risk of osteoporosis and bone fractures, research shows. About six months after Katie started treatment, the family's insurer cut off coverage of her Wegovy. Randy's appeal of that decision failed, and he switched Katie's prescription to her secondary insurance with the state Medicaid program, which had been in place since her cancer treatment. Delaware is one of 14 states with Medicaid coverage for the newer GLP-1 weight-loss drugs. Katie missed only one weekly dose. At an appointment with Dr Phan in March, Katie weighed 209 pounds, down 60, or 22 per cent of her body weight, in about 18 months. Her triglycerides were no longer elevated. The weight loss has brought welcome changes. Katie said she used to lack motivation to do much at all and would lounge for hours in bed. 'I used to always feel yucky before,' she said. 'The weight loss has actually helped a lot with my energy.' The 17-year-old now enjoys regular visits to the Planet Fitness gym with her father and stepmother, Denise, and spends more time on her painting and crafts. She has more stamina to cook two hours straight in her high-school culinary class. She also doesn't get winded chasing after her two-year-old niece at family gatherings. While she used to hide herself in baggy clothes, she now feels comfortable wearing sundresses. Randy is pleased with Katie's progress. He worries that Delaware may stop covering GLP-1 weight-loss drugs through Medicaid due to budget shortfalls or proposed cuts in federal funding. California and North Carolina are seeking to rescind Medicaid coverage of the drugs to save millions of dollars. 'I hope to God they keep Wegovy around for kids,' Randy said. Katie wants to stay on the drug and trusts that her dad and her doctor wouldn't let her take anything harmful. 'Wegovy doesn't scare me,' she said. 'I've had so many needles in my life.' 'I'll do whatever it takes' DODGE COUNTY, Wisconsin – Early in 2024, after eight months on Wegovy, Leo had a choice to make. He could stop taking the drug, end the side effects that were wreaking havoc on his life and risk regaining some of the more than 25 pounds he had lost. Or he could stay on it, keep losing weight and hope the severe stomach aches, nausea and diarrhea would abate. For this article, Leo and his mother, Jamie, asked Reuters to withhold details such as their precise location and Leo's surname, and Leo declined to be photographed. They said they feared the exposure would lead to more teasing from Leo's peers about his appearance and his decision to take a weight-loss drug. Leo had been a strong candidate for Wegovy when he first saw an obesity specialist, Dr Leslie Golden, in mid-2023. He was a compulsive eater from an early age, due in part to his attention-deficit/hyperactivity disorder, for which he takes medication. He was diagnosed with obesity at 11 years old. Three years later, he was carrying 181 pounds on his 5-foot-4 frame. Jamie tried to stock the kitchen with healthier foods. But Leo's older sister and two older stepbrothers wanted ultra-processed snacks and sugary drinks around. Leo would gulp down five cans of Coke in a day. He sneaked snacks and sodas into his bedroom at night, leaving empty wrappers and cans for his mother to find strewn about the next morning. One of his stepbrothers was severely underweight, complicating Jamie's food choices for the family. The teasing and bullying started in middle school. When he walked the halls between classes, other students hurled jeers and jokes at him. 'It was always directed at my weight,' he said. 'The comments just got to me.' Leo knew he had a problem but felt powerless to do anything about it. 'I was eating way too much,' he said. 'I was worried I was going to get way too overweight.' Jamie, a pharmacist, thought Wegovy might help. Frustrated with her own efforts to lose weight, she had started taking the drug in January 2022. She, like Leo after her, suffered severe gastrointestinal side effects, but they faded, and after a year, she had lost 50 pounds. Leo, having learned what Wegovy did for his mother, was open to trying it. In June 2023, Leo had his first appointment with Dr Golden, at her obesity clinic in a town near where he and his family live about an hour outside Milwaukee, Wisconsin. He already bore troubling signs of the effects of his obesity. His blood pressure was high. His elevated blood sugar level put him at increased risk for type 2 diabetes. The doctor worried that Leo could develop liver and heart disease if he didn't lose weight. She prescribed Wegovy. Dr Golden doesn't require families to undergo counseling on lifestyle changes as a prerequisite for prescribing the drug for children. She said most families have already tried other ways to lose weight before they reach her office, and imposing a months-long delay before drug therapy 'is really just another form of bias and stigma'. She does ask for monthly visits so she can monitor a child's progress. Her patients pick three goals for the coming month – for nutrition, movement and behavior. For Leo, at one point, that meant eating more carrots and cauliflower, playing basketball in the driveway and downing fewer sugary drinks. Soon, Leo was eating a lot less, though what he ate didn't change so much. At restaurants, he could stomach only three bites of the double cheeseburgers he usually ordered. He was happy with the weight he was losing. The bullying was easing up, and some classmates even complimented him on looking thinner. He grew comfortable raising his hand in class. 'It feels pretty good to get myself out there,' he said. But as his doses steadily increased – the standard of care for GLP-1 medicines is to up the dose every four weeks – the side effects started taking a toll. He took medicines to quell the nausea and diarrhea. He dropped off anti-diarrhea pills with the school nurse. Some days, his stomach upset was so bad that Jamie had to pick him up at lunchtime. Leo was experiencing by far the most common side effects of Wegovy. In the largest clinical trial of the medicine on teens, 62 per cent of patients experienced nausea, vomiting and diarrhea. Most reported mild to moderate side effects that lasted two to three days. Since their launch, Wegovy and other GLP-1 drugs have also been associated with much rarer incidents of gastric paralysis, pancreatitis, depression and blindness. As his absences piled up, Leo's grades suffered, and he grew moodier. At a parent-teacher conference in October 2023, teachers told Jamie that Leo had become more withdrawn in class. At a checkup with his regular pediatrician later that month, his answers on a questionnaire indicated depression. The doctor prescribed an antidepressant. That didn't lessen the side effects, though, and Leo's school absences persisted. In February 2024, the high school notified his mother that he had missed 10 days, the maximum allowed for the year. Soon after that is when Dr Golden presented Leo with the choice about continuing with Wegovy. Jamie favored sticking with the drug. The doctor wanted the choice to be Leo's. 'Jamie is a very involved parent who wants to protect and do what's best for him,' Dr Golden later told Reuters. 'I had to really zone in on Leo: Do you want to keep taking this?' Despite the physical pain and discomfort, the problems at school, the depression, Leo was adamant. 'I'll do whatever it takes,' Leo told Dr Golden. 'No matter how sick I get, I don't want to stop.' Several weeks later, the side effects began to ease. By last summer, Leo had dropped under 150 pounds. His waist had shrunk by five inches. Based on his body mass index, he no longer had obesity. 'I am happy that I don't get called names anymore,' Leo said. Then last autumn, he started to put on weight. Dr Golden had reminded Leo that some additional weight was expected as he grew three inches taller over the span of a year, eventually reaching 5 foot 7. But Leo's mother found food wrappers and soda cans in his bedroom. In November 2024, Leo wept when he stepped on the scale at home and saw that he had gained 14 pounds, up to 164. 'I'm getting fat again,' he told his mother. At an appointment with Dr Golden the following month, the doctor put Leo on the highest weekly dose of Wegovy to help counter his cravings. That worked, without the side effects he had experienced earlier. At a checkup in April, Leo weighed 154 pounds, down nearly 30 pounds in the past two years. Leo took a cooking class during his sophomore year and hopes to attend culinary school one day. He also took a part-time job stocking shelves at the local hardware store. Leo's pediatrician was pleased with his improved self-esteem and energy level. She asked Jamie: 'What is the end game? When is Dr Golden going to stop it?' That's an open question. Dr Golden has repeatedly advised Leo that he will probably have to take Wegovy for the rest of his life to maintain a healthy weight. Leo and his mother are OK with that. 'There is no end game,' Jamie told the pediatrician. Afraid of gaining it back FREDERICK, Maryland – Ms Stephanie Serrano didn't want to take a weight-loss drug. She didn't think it would work, and even if it did, she didn't like injections, especially if she had to get them for the rest of her life. But Ms Stephanie was desperate. At 320 pounds, she had already been diagnosed with type 2 diabetes and liver disease. She was tired of being the biggest kid in class and had become a virtual shut-in after years of failed dieting. 'Every doctor that I had ever seen would just tell me to eat healthier, like it was that simple,' Ms Stephanie said. In 2022, her family doctor referred the then-16-year-old to the obesity clinic at Children's National Hospital in Washington, DC. There, initial tests revealed that she had polycystic ovary syndrome, a common cause of weight gain in young women. 'That diagnosis changed everything,' she said. 'I wasn't lazy or not trying hard enough. My body was actually working against me.' In October that year, Ms Stephanie's doctor at Children's National, Dr Susma Vaidya, prescribed Ozempic, Novo's drug for type 2 diabetes with the same active ingredient as Wegovy, which hadn't yet been approved for teens. Ozempic has been widely used off-label for weight loss, both prior to Wegovy's launch and after due to shortages and spotty insurance coverage of the latter. By the time she saw Dr Vaidya, Ms Stephanie had her heart set on weight-loss surgery, swayed by TikTok videos of young adults showing their dramatic before-and-after transformations. 'Seeing how much they changed, it's incredible,' she said. 'So that's kind of what I wanted for my life. I wanted a permanent change.' Ms Stephanie Serrano lost weight by using Ozempic and undergoing bariatric surgery. PHOTO: REUTERS Dr Vaidya, medical director of the obesity clinic at Children's National, persuaded Ms Stephanie to accept a compromise: Ms Stephanie would give Ozempic a try while undergoing a six-month evaluation, including sessions with a dietician and a psychologist, to determine whether she was a good candidate for surgery, based on factors like adequate family support and eating regular, well-balanced meals. Ms Stephanie started taking the lowest recommended dose of Ozempic. The side effects were mild, though she occasionally experienced nausea and stomach pain after a big meal. She lost nine pounds in the first month. After four months, in February 2023, she was surprised – and pleased – that she had lost about 30 pounds. 'I had never seen the number on the scale go down,' she said. At that point, Dr Vaidya told Ms Stephanie she could continue taking the drug, or she could undergo surgery. Ms Stephanie's father, Jose, who was taking Ozempic for his type 2 diabetes, preferred that she stick with the drug. He worried about her risk of complications from a major operation. Ms Stephanie held firm. Despite her weight loss on Ozempic, she felt that surgery was the only way to end the isolation she had endured for years. Since the start of the Covid-19 pandemic, Ms Stephanie had retreated from school and friends. In 2021, during her sophomore year, her high school gave students the option to return or continue with online classes. She never went back to the classroom. Through the lens of social media, she watched classmates gloat about their beauty 'glow ups' and post photos of themselves with new makeup routines and outfits. MS Stephanie quit the school's Junior Reserve Officers' Training Corps, a leadership program sponsored by the US military, to avoid being around other people. 'I hid myself for those years,' she said. 'I no longer wanted to be a prisoner.' In April 2023, Ms Stephanie, at about 285 pounds, had gastric-sleeve surgery, which involved removing a large portion of her stomach to reduce food intake. She came through the surgery and recovery without complications. Today, the 19-year-old college freshman is down to about 175 pounds. She eats small meals and exercises regularly. Her diabetes is in remission, and her liver function is normal. She takes a full load of classes at a nearby community college and plans to transfer to a four-year university soon. She aspires to be a sports psychologist. As Ms Stephanie lost weight, she became more outgoing at school and in church and found she could make friends. She opened up to the possibility of a relationship and flirted with a young man at church. That didn't go anywhere, but she had surprised herself with her willingness to even try. 'Having a crush on anyone seemed so silly before. I could never imagine someone loving me,' she said. 'I was always ashamed of myself.' Amid all this progress, another problem emerged: Ms Stephanie was consumed with fear of gaining the weight back. She started skipping meals and guzzling energy drinks. After eating a small meal, she would run a mile to burn off the calories. Her legs and back began to ache, and she sometimes lost her balance – signs of possible muscle loss. Dr Vaidya told her, 'This is your body asking for protein.' Dr Vaidya diagnosed Ms Stephanie with an eating disorder in April 2024 and referred her to a hospital psychologist. Dr Vaidya also prescribed bupropion, an anti-depressant sometimes used to manage binge eating. The possibility that weight-loss drugs may put teens at risk of disordered eating is why some doctors urge rigorous screening of patients and continuous monitoring during treatment. Research on any association between weight-loss drugs or bariatric surgery and eating disorders is limited. Some small studies found that the use of GLP-1 drugs may decrease binge eating episodes among those who already had the disorder. But the studies only tracked patients for three to six months, leaving longer-term effects unknown. Ms Stephanie's psychologist urged her to stop counting calories and poring over the nutrition labels on packaged foods. She's making progress, but it's a 'constant battle,' she said. Stephanie still gives in sometimes to count calories, and when she exceeds her target, 'I completely shut down.' At home, Ms Stephanie does much of the cooking for her parents and older sister, Lily. She rarely eats what she cooks. At a recent dinner, her family enjoyed the carne asada, beans and pico de gallo she had prepared while she picked at a small bowl of rice and a homemade tortilla. She didn't finish either. Later, Ms Stephanie, her mother, Ms Vanessa Serrano, and Lily visited a local mall – a place she used to avoid because it was hard to find clothes her size there. At the American Eagle store, she tried on a pair of black jeans. She emerged hesitantly from the dressing room to have a look in a mirror. After Lily told her she looked incredible and snapped photos, Ms Stephanie checked herself out from several angles. She bought the jeans and wore them to church the next day. REUTERS Join ST's Telegram channel and get the latest breaking news delivered to you.

Straits Times

a day ago

• Straits Times

British Parliament votes in favour of assisted dying, paving way for historic law change

Protesters against the legislation held up placards that said 'let's care not kill' and 'kill the Bill not the ill' in London, on June 20. PHOTO: REUTERS British Parliament votes in favour of assisted dying, paving way for historic law change LONDON - Britain's Parliament voted on June 20 in favour of a Bill to legalise assisted dying, paving the way for the country's biggest social change in a generation. In the vote, 314 lawmakers were in favour, while 291 were against the Bill, clearing its biggest parliamentary hurdle. The Terminally Ill Adults (End of Life) law would give mentally competent, terminally ill adults in England and Wales with six months or less left to live the right to choose to end their lives with medical help. The vote puts Britain on course to follow Australia, Canada and other countries, as well as some US states, in permitting assisted dying. Supporters say it will provide dignity and compassion to people suffering, but opponents worry that vulnerable people could be coerced into ending their lives. The Bill now proceeds to Britain's upper chamber, the House of Lords, where it will undergo months of scrutiny. While there could be further amendments, the unelected Lords will be reluctant to block legislation that has been passed by elected members of the House of Commons. Prime Minister Keir Starmer's Labour government was neutral on the legislation, meaning politicians voted according to their conscience rather than along party lines. Mr Starmer had previously said he was in favour of allowing assisted dying. Opinion polls show that a majority of Britons back assisted dying. June 20's vote followed hours of emotional debate and references to personal stories in the chamber, and followed a vote in November that approved the legislation in principle. The vote took place 10 years after Parliament last voted against allowing assisted dying. Opponents of the Bill had argued that ill people may feel they should end their lives for fear of being a burden to their families and society, and some lawmakers withdrew their support after the initial vote in 2024, saying safeguards had been weakened. The 314 to 291 vote for the Bill compared to November 2024's result, which was 330 to 275 in favour. In the original plan, an assisted death would have required court approval. That has been replaced by a requirement for a judgement by a panel including a social worker, a senior legal figure and a psychiatrist, which is seen by some as a watering down. The Labour lawmaker who proposed the Bill, Mr Kim Leadbeater, said that the legislation still offered some of the most robust protections in the world against the coercion of vulnerable people. Hundreds of campaigners both in favour and against the legislation gathered outside Parliament on June 20 to watch the vote on their mobile phones. Those in favour chanted 'my decision, my choice', holding up posters that said 'my life, my death' and photos of relatives who they said had died in pain. Those against the legislation held up placards that said 'let's care not kill' and 'kill the Bill not the ill'. REUTERS Join ST's Telegram channel and get the latest breaking news delivered to you.

AsiaOne

2 days ago

• AsiaOne

Israeli hospital had taken patients underground hours before missile hit, World News

BEERSHEBA, Israel — Shattered glass and piles of rubble littered the floors of Soroka Medical Centre on Thursday (June 19), after an Iranian missile ripped through the hospital in Israel's south, injuring dozens. The major public hospital, which serves around one million people living in southern Israel, sustained extensive damage in the strike. Several wards were completely destroyed, with debris scattered across the parking lot and surrounding walkways. "We knew from the noise that it wasn't like anything we were used to, that it wasn't like anything we had seen before," said Nissim Huri, who was working in the kitchen and took refuge in a concrete shelter during the strike. "It was terrifying," Huri said, describing the scenes as she emerged from the shelter as "complete destruction". Israel launched an aerial war against Iran on Friday, calling it a preemptive strike designed to prevent Iran from developing nuclear weapons. Iran has denied plans to develop such weapons and retaliated by launching counterstrikes on Israel. Hospital staff said the blast was so powerful it threw them backward. On Thursday afternoon, they sat in the hospital courtyard rewatching videos of towering plumes of smoke. Israel's Health Ministry said 71 people were wounded in the attack, most of them suffering light injuries or panic attacks as they rushed for shelter. Hospital staff evacuated patients and cordoned off damaged areas. Iran's Revolutionary Guards said they had targeted Israeli military and intelligence headquarters near the hospital. An Israeli military official denied there were military targets nearby. The hospital began moving patients out of some buildings in recent days as part of emergency precautions in response to the Iranian strikes. It has since limited admissions to life-threatening cases only. Patients in the damaged building were taken to an underground facility just hours before the strike, a statement from the Israeli Health ministry said. Medical transporter Yogev Vizman, called to the scene just after the blast, said he witnessed "total destruction" when he arrived. "That whole building was on fire... everything collapsed, Vizman said. "I'm sad, this is like my home, they simply destroyed our home... I never thought there would be a direct hit on a hospital." Soldiers from the Israeli military's search and rescue unit searched the battered buildings to ensure nobody was trapped inside. An Israeli soldier told Reuters all he saw at first was "thick black smoke" and that they inspected every floor to look for casualties. "It's God's will that this place was evacuated from civilians last night," he said, speaking on the condition of anonymity. [[nid:719283]]