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Under Armour Is Now The Largest Digital Health And Fitness Company On Earth

Under Armour used to be known primarily for its moisture-wicking t-shirts. In the 21 years since the company was established in founder and CEO Kevin Plank’s grandmother’s basement, the company has expanded its product line extensively to include hats, pants, shoes, gloves, bags, and the like.

In recent years, the company has made three strategic acquisitions that will continue to reshape the company. With the acquisitions of MapMyFitness, EndoMondo, and MyFitnessPal, the company has become the largest digital health and fitness community in the world. I recently spoke with Under Armour’s Chief Technology Officer Paul Fipps, who leads this digital transformation of the company. He sees the future as a combination of the physical and the digital, where one’s clothing and accessories provide better information on heart rates and sleep quality. 

(To read future stories about people who are shaping the technology landscape, please follow me on Twitter @PeterAHigh.)

Peter High: Under Armour calls itself a digital health and fitness community. Please explain that concept and the role you play as Chief Technology Officer.

Credit: Under Armour

Under Armour CTO Paul Fipps

Paul Fipps: People move fast in the digital world. They get more information, have more choice, and find more deals. A downside to all of this information is people are bombarded with messages from companies that do not understand them. This happens everywhere in the digital world: on our mobile platforms, social platforms, and on the web. At Under Armour, we believe you need to approach consumers like a hotel concierge who deeply knows his or her guests. A concierge knows all of your preferences and the context. You have an incredible experience because it is highly personalized and memorable. At Under Armour, this experience means creating products that are relevant to our customers on both a personal and community level.

Another thing we recognize is that people spend a lot of time on their smartphones; they are on their smartphones as much as they watch TV. Smartphones are where consumers expect you to meet them. We recently acquired three companies that help us understand our athletes better and make it easier for us to connect with them. Our acquisitions of MapMyFitness, EndoMondo, and MyFitnessPal made us the largest digital health and fitness community in the world. These apps produce a vast amount of data; 215 million people have downloaded one of our apps. People tell us how much they sleep, how much they eat, how much they workout, and the types of workouts they do. We also get data from brand interactions, which are when someone comes into our retail stores, visits our e-commerce site, or interacts with us in some way that we can track. By combining the data from the apps with the brand interaction data, we can understand buying decisions. More importantly, we understand the behavior behind the buying decisions. That has been a huge success for us. We are creating a new digital experience for our athletes by combining connected fitness and our e-commerce engine and our global technology platform. It is game changing for us and our athletes. That is my primary role as Chief Technology Officer of Under Armour.

High: You provided a great overview of where things stand now and customers’ expectations for speed, customization, and transparency. Can you provide an example?

Fipps: We have done a lot of research on sleep over the past few years. In fact, we just finished a research study with Johns Hopkins on the science of sleep. For the past 18 months, we have worked closely with Tom Brady, who attributes a lot of his success to sleep. The information we gained from those two projects, and additional research with other premier athletes, provided us with insights we used to create our TB12 sleep product. This product lets people track their sleep so they can take steps to improve the quality of their sleep. This, in turn, will allow them to recover faster and perform better. The experience is about the physical and the digital, not just one or the other.

High: In recent years, Under Armour has made a big push internationally. What role did technology play in the global expansion?

Fipps: On the business side, as we grew quickly outside of North America, we had to create a technology organization that could support our growth. Over the past couple of years, we built a global operating model in the IT organization, while also building out capabilities we can grow and scale into. It is a different strategy for us. For instance, we recently implemented enterprise resource planning software from SAP, with the fashion management solution, that is designed to support one instance of SAP’s enterprise resource planning in the cloud, for the whole globe. This push and enabling foundational platforms and capabilities we can grow into, has allowed us to start catching up, from an infrastructure standpoint, in our new international regions and markets.

On the customer facing side, it is important that we localize experiences. We are redeveloping MapMyRun so that it couples with our new version of the connected shoe, which will launch in spring to summer of 2018. We want to mirror that combination well wherever we have athletes. We have to take the same app experience and make it great for the Chinese consumer, for example.

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Blue Cross official authors health IT article in New England Journal of Medicine

Advances in health care information technology and greater use of electronic health records and digital tools will drive better decision making and improve patients’ health, according to Blue Cross and Blue Shield of Louisiana’s chief medical officer.

Lead author Dr. Vindell Washington and co-authors Drs. David Blumenthal, Karen DeSalvo and Farzad Mostashari, all former national coordinators for health information technology for the U.S. Department of Health and Human Services, make this point and others in “The HITECH Era and the Path Forward.” The article was published in the Sept. 7 edition of the New England Journal of Medicine. 

The authors describe how the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed in 2009, led a majority of health care providers to implement electronic health records and digital data sharing. Washington and his co-authors also offer suggestions to continue advancing health care IT in the digital age.

“We are in position for a great leap forward in health information technology,” Washington said. “A digital health system holds the promise of empowered patients and better-informed providers. Caregivers can work together to track patients’ health outcomes and know if they are making progress. And better information lets health insurance companies and government programs that are spending health care dollars on behalf of members and citizens know they are purchasing services of high value. The bedrock of all of this is a robust health care IT infrastructure.”

Washington cites the results from the Blue Cross’s Quality Blue Primary Care program, where primary care providers can access claims data and work together, as an example of successful data sharing. The program has helped patients better manage conditions like diabetes, high blood pressure and heart disease, and it is holding down costs.

Blue Cross and Blue Shield of Louisiana’s Quality Blue program will be featured at a Capitol…

For the complete New England Journal of Medicine article, click here.

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Jessie J stepped away from the spotlight for two years due to secret health battle

JESSIE J has revealed she stepped away from the spotlight for two years due to a secret health battle.

The singer took a lengthy break from pop and she has now explained she was dealing with heartbreaking personal problems.

 Jessie J has revealed why she took time away from the spotlight
Jessie J has revealed why she took time away from the spotlight

Jessie’s last high-profile job was as a judge on the Australian version of The Voice, which ended in 2016, and a star turn in a live TV broadcast of musical  Grease in January that year.

She is now making a comeback with new music, and she has explained her lengthy absence from the world of showbiz.

Jessie, 29, has revealed she was diagnosed with a terrifying medical condition.

She has not given any further details about the health scare, but admitted it took time for her to process it.

The singer told the Daily Star Sunday: “In the two years that I did The Voice in Australia, I was diagnosed with some health issues that I’m not ready to talk about that I had to really face as a woman.”

Jessie was dealt a further blow as her grandparents passed away.

 The singer has been dealing with a secret health battle
The singer has been dealing with a secret health battle
 Jessie was also mourning the death of her beloved grandparents
Jessie was also mourning the death of her beloved grandparents

She added: “I also lost my grandparents and didn’t have time to grieve.

“The hardest part about being an artist is that you have to open your wounds to heal other people’s and you don’t often get the time to heal your own.”

Jessie, whose last single Flashlight hit the charts in 2015, has previously been open about her health issues as a child.

She spent her early years in and out of hospital as she battled a heart condition, and she suffered a stroke at the age of 18.

The star was diagnosed with an irregular heartbeat when she was seven, and she opened up about her tough childhood in her autobiography.

In the book, Nice To Meet You which was published in 2013, she wrote: “I remember collapsing a lot and having seizures.

“I was a sickly, skinny girl who had a slight green tinge to her skin because of the drugs and who was always in and out of hospital.

“There would be times when I’d be acting normal and then I’d just collapse.

“It was only then that people would realise I wasn’t well. I suppose I was good at covering it up and I know I’m very good at that now.”

 The new red hot music video sees the singer braless underneath a see-through bodysuit and fishnet tights as she seductively writhes on the ground
The new red hot music video sees the singer braless underneath a see-through bodysuit and fishnet tights as she seductively writhes on the ground

Jessie recently released her new red hot music video, in which she goes braless underneath a see-through bodysuit and fishnet tights as she seductively writhes on the ground.

The songstress, 29, shows off her pert bum in a thong as she places her arms outstretched against a wall, while she can also be seen crawling towards the camera wearing a bondage-inspired leather mask.

 Jesse gazes into the camera intensely, her hair slicked back behind her ears
Jesse gazes into the camera intensely, her hair slicked back behind her ears

The singer looks in fantastic shape, and a pair of teetering stilettos accentuate her toned legs.

Jessie seductively runs her hand over her crotch as she squats on the ground and she arches her back as she lies across the floor.

Think About That is the lead single from Jessie’s upcoming album R.O.S.E (Realizations, Obsessions, Sex, and Empowerment).

Speaking about the release, she told Clevver: “I feel like I did in 2011; it’s the feeling of a first date again. I’ve got butterflies and I’m wondering why I am feeling nervous. It’s exciting and nerve-racking, but it’s nice to finally let people hear my music.”

 The songstress shows off her pert bum in a thong as she places her arms outstretched  against a wall
The songstress shows off her pert bum in a thong as she places her arms outstretched  against a wall
 She be seen crawling towards the camera wearing a bondage-inspired leather mask
She be seen crawling towards the camera wearing a bondage-inspired leather mask
 The release follows Jessie's previous track Real Del, which was released last month
The release follows Jessie’s previous track Real Del, which was released last month

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How Big Business Got Brazil Hooked on Junk Food

FORTALEZA, Brazil — Children’s squeals rang through the muggy morning air as a woman pushed a gleaming white cart along pitted, trash-strewn streets. She was making deliveries to some of the poorest households in this seaside city, bringing pudding, cookies and other packaged foods to the customers on her sales route.

Celene da Silva, 29, is one of thousands of door-to-door vendors for Nestlé, helping the world’s largest packaged food conglomerate expand its reach into a quarter-million households in Brazil’s farthest-flung corners.

As she dropped off variety packs of Chandelle pudding, Kit-Kats and Mucilon infant cereal, there was something striking about her customers: Many were visibly overweight, even small children.

She gestured to a home along her route and shook her head, recalling how its patriarch, a morbidly obese man, died the previous week. “He ate a piece of cake and died in his sleep,” she said.

Mrs. da Silva, who herself weighs more than 200 pounds, recently discovered that she had high blood pressure, a condition she acknowledges is probably tied to her weakness for fried chicken and the Coca-Cola she drinks with every meal, breakfast included.

Nestlé’s direct-sales army in Brazil is part of a broader transformation of the food system that is delivering Western-style processed food and sugary drinks to the most isolated pockets of Latin America, Africa and Asia. As their growth slows in the wealthiest countries, multinational food companies like Nestlé, PepsiCo and General Mills have been aggressively expanding their presence in developing nations, unleashing a marketing juggernaut that is upending traditional diets from Brazil to Ghana to India.

    A New York Times examination of corporate records, epidemiological studies and government reports — as well as interviews with scores of nutritionists and health experts around the world — reveals a sea change in the way food is produced, distributed and advertised across much of the globe. The shift, many public health experts say, is contributing to a new epidemic of diabetes and heart disease, chronic illnesses that are fed by soaring rates of obesity in places that struggled with hunger and malnutrition just a generation ago.

    The new reality is captured by a single, stark fact: Across the world, more people are now obese than underweight. At the same time, scientists say, the growing availability of high-calorie, nutrient-poor foods is generating a new type of malnutrition, one in which a growing number of people are both overweight and undernourished.

    “The prevailing story is that this is the best of all possible worlds — cheap food, widely available. If you don’t think about it too hard, it makes sense,” said Anthony Winson, who studies the political economics of nutrition at the University of Guelph in Ontario. A closer look, however, reveals a much different story, he said. “To put it in stark terms: The diet is killing us.”

    Even critics of processed food acknowledge that there are multiple factors in the rise of obesity, including genetics, urbanization, growing incomes and more sedentary lives. Nestlé executives say their products have helped alleviate hunger, provided crucial nutrients, and that the company has squeezed salt, fat and sugar from thousands of items to make them healthier. But Sean Westcott, head of food research and development at Nestlé, conceded obesity has been an unexpected side effect of making inexpensive processed food more widely available.

    “We didn’t expect what the impact would be,” he said.

    Part of the problem, he added, is a natural tendency for people to overeat as they can afford more food. Nestlé, he said, strives to educate consumers about proper portion size and to make and market foods that balance “pleasure and nutrition.”

    There are now more than 700 million obese people worldwide, 108 million of them children, according to research published recently in The New England Journal of Medicine. The prevalence of obesity has doubled in 73 countries since 1980, contributing to four million premature deaths, the study found.

    Obesity’s Spread Across the World

    Obesity rates in the United States, the South Pacific and the Persian Gulf are among the highest in the world — more than one in four Americans is obese. But over the last 35 years, obesity, defined as having a body mass index over 30, has grown the fastest in countries throughout Latin America, Africa and Asia.

    By Audrey Carlsen | Source: Institute for Health Metrics and Evaluation. Data not available for French Guiana and Western Sahara.

    The story is as much about economics as it is nutrition. As multinational companies push deeper into the developing world, they are transforming local agriculture, spurring farmers to abandon subsistence crops in favor of cash commodities like sugar cane, corn and soybeans — the building blocks for many industrial food products. It is this economic ecosystem that pulls in mom-and-pop stores, big box retailers, food manufacturers and distributors, and small vendors like Mrs. da Silva.

    In places as distant as China, South Africa and Colombia, the rising clout of big food companies also translates into political influence, stymieing public health officials seeking soda taxes or legislation aimed at curbing the health impacts of processed food.

    For a growing number of nutritionists, the obesity epidemic is inextricably linked to the sales of packaged foods, which grew 25 percent worldwide from 2011 to 2016, compared with 10 percent in the United States, according to Euromonitor, a market research firm. An even starker shift took place with carbonated soft drinks; sales in Latin America have doubled since 2000, overtaking sales in North America in 2013, the World Health Organization reported.

    The same trends are mirrored with fast food, which grew 30 percent worldwide from 2011 to 2016, compared with 21 percent in the United States, according to Euromonitor. Take, for example, Domino’s Pizza, which in 2016 added 1,281 stores — one “every seven hours,” noted its annual report — all but 171 of them overseas.

    “At a time when some of the growth is more subdued in established economies, I think that strong emerging-market posture is going to be a winning position,” Mark Schneider, chief executive of Nestlé, recently told investors. Developing markets now provide the company with 42 percent of its sales.

    For some companies, that can mean specifically focusing on young people, as Ahmet Bozer, president of Coca-Cola International, described to investors in 2014. “Half the world’s population has not had a Coke in the last 30 days,” he said. “There’s 600 million teenagers who have not had a Coke in the last week. So the opportunity for that is huge.”

    Industry defenders say that processed foods are essential to feed a growing, urbanizing world of people, many of them with rising incomes, demanding convenience.

    “We’re not going to get rid of all factories and go back to growing all grain. It’s nonsense. It’s not going to work,” said Mike Gibney, a professor emeritus of food and health at University College Dublin and a consultant to Nestlé. “If I ask 100 Brazilian families to stop eating processed food, I have to ask myself: What will they eat? Who will feed them? How much will it cost?”

    In many ways, Brazil is a microcosm of how growing incomes and government policies have led to longer, better lives and largely eradicated hunger. But now the country faces a stark new nutrition challenge: over the last decade, the country’s obesity rate has nearly doubled to 20 percent, and the portion of people who are overweight has nearly tripled to 58 percent. Each year, 300,000 people are diagnosed with Type II diabetes, a condition with strong links to obesity.

    Brazil also highlights the food industry’s political prowess. In 2010, a coalition of Brazilian food and beverage companies torpedoed a raft of measures that sought to limit junk food ads aimed at children. The latest challenge has come from the country’s president, Michel Temer, a business-friendly centrist whose conservative allies in Congress are now seeking to chip away at the handful of regulations and laws intended to encourage healthy eating.

    “What we have is a war between two food systems, a traditional diet of real food once produced by the farmers around you and the producers of ultra-processed food designed to be over-consumed and which in some cases are addictive,” said Carlos A. Monteiro, a professor of nutrition and public health at the University of São Paulo.

    “It’s a war,” he said, “but one food system has disproportionately more power than the other.”

    Door-to-Door Delivery

    Mrs. da Silva reaches customers in Fortaleza’s slums, many of whom don’t have ready access to a supermarket. She champions the product she sells, exulting in the nutritional claims on the labels that boast of added vitamins and minerals.

    “Everyone here knows that Nestlé products are good for you,” she said, gesturing to cans of Mucilon, the infant cereal whose label says it is “packed with calcium and niacin,” but also Nescau 2.0, a sugar-laden chocolate powder.

    She became a Nestlé vendor two years ago, when her family of five was struggling to get by. Though her husband is still unemployed, things are looking up. With the $185 a month she earns selling Nestlé products, she was able to buy a new refrigerator, a television and a gas stove for the family’s three-room home at the edge of a fetid tidal marsh.

    The company’s door-to-door program fulfills a concept that Nestlé articulated in its 1976 annual shareholder report, which noted that “integration with the host country is a basic aim of our company.” Started a decade ago in Brazil, the program serves 700,000 “low-income consumers each month,” according to its website. Despite the country’s continuing economic crisis, the program has been growing 10 percent a year, according to Felipe Barbosa, a company supervisor.

    He said sagging incomes among poor and working-class Brazilians had actually been a boon for direct sales. That’s because unlike most food retailers, Nestlé gives customers a full month to pay for their purchases. It also helps that saleswomen — the program employs only women — know when their customers receive Bolsa Família, a monthly government subsidy for low-income households.

    “The essence of our program is to reach the poor,” Mr. Barbosa said. “What makes it work is the personal connection between the vendor and the customer.”

    Nestlé increasingly also portrays itself as a leader in its commitment to community and health. Two decades ago, it anointed itself a “nutrition health and wellness company.” Over the years, the company says it has reformulated nearly 9,000 products to reduce salt, sugar and fat, and it has delivered billions of servings fortified with vitamins and minerals. It emphasizes food safety and the reduction of food waste, and it works with nearly 400,000 farmers around the world to promote sustainable farming.

    In an interview at Nestlé’s new $50 million campus in suburban Cleveland, Mr. Westcott, head of food research and development, said the door-to-door sales program reflected another of the company’s slogans: “Creating shared values.”

    “We create shared value by creating micro-entrepreneurs — people that can build their own businesses,” he said. A company like Nestlé can bolster the well-being of entire communities “by actually sending positive messages around nutrition,” he said.

    Nestlé’s portfolio of foods is vast and different from that of some snack companies, which make little effort to focus on healthy offerings. They include Nesfit, a whole-grain cereal; low-fat yogurts like Molico that contain a relatively modest amount of sugar (six grams); and a range of infant cereals, served with milk or water, that are fortified with vitamins, iron and probiotics.

    Dr. Gibney, the nutritionist and Nestlé consultant, said the company deserved credit for reformulating healthier products.

    But of the 800 products that Nestlé says are available through its vendors, Mrs. da Silva says her customers are mostly interested in only about two dozen of them, virtually all sugar-sweetened items like Kit-Kats; Nestlé Greek Red Berry, a 3.5-ounce cup of yogurt with 17 grams of sugar; and Chandelle Pacoca, a peanut-flavored pudding in a container the same size as the yogurt that has 20 grams of sugar — nearly the entire World Health Organization’s recommended daily limit.

    Until recently, Nestlé sponsored a river barge that delivered tens of thousands of cartons of milk powder, yogurt, chocolate pudding, cookies and candy to isolated communities in the Amazon basin. Since the barge was taken out of service in July, private boat owners have stepped in to meet the demand.

    “On one hand, Nestlé is a global leader in water and infant formula and a lot of dairy products,” said Barry Popkin, professor of nutrition at the University of North Carolina. “On the other hand, they are going into the backwoods of Brazil and selling their candy.”

    Dr. Popkin finds the door-to-door marketing emblematic of an insidious new era in which companies seek to reach every doorstep in an effort to grow and become central to communities in the developing world. “They’re not leaving an inch of country left aside,” he said.

    Public health advocates have criticized the company before. In the 1970s, Nestlé was the target of a boycott in the United States for aggressively marketing infant formula in developing countries, which nutritionists said undermined healthful breast-feeding. In 1978, the president of Nestlé Brazil, Oswaldo Ballarin, was called to testify at highly publicized United States Senate hearings on the infant formula issue, and he declared that criticisms were the work of church activity aimed at “undermining the free enterprise system.”

    On the streets of Fortaleza, where Nestlé is admired for its Swiss pedigree and perceived high quality, negative sentiments about the company are rarely heard.

    The home of Joana D’arc de Vasconcellos, 53, another vendor, is filled with Nestlé-branded stuffed animals and embossed certificates she earned at nutrition classes sponsored by Nestlé. In her living room, pride of place is given to framed photographs of her children at age 2, each posed before a pyramid of empty Nestlé infant formula cans. As her son and daughter grew up, she switched to other Nestlé products for children: Nido Kinder, a toddler milk powder; Chocapic, a chocolate-flavored cereal; and the chocolate milk powder Nescau.

    “When he was a baby, my son didn’t like to eat — until I started giving him Nestlé foods,” she said proudly.

    Ms. de Vasconcellos has diabetes and high blood pressure. Her 17-year-old daughter, who weighs more than 250 pounds, has hypertension and polycystic ovary syndrome, a hormonal disorder strongly linked to obesity. Many other relatives have one or more ailments often associated with poor diets: her mother and two sisters (diabetes and hypertension), and her husband (hypertension.) Her father died three years ago after losing his feet to gangrene, a complication of diabetes.

    “Every time I go to the public health clinic, the line for diabetics is out the door,” she said. “You’d be hard pressed to find a family here that doesn’t have it.”

    Ms. de Vasconcellos previously tried selling Tupperware and Avon products door to door, but many customers failed to pay. Six years ago, after a friend told her about Nestlé’s direct sales program, Ms. Vasconcellos jumped at the chance.

    She says her customers have never failed to pay her.

    “People have to eat,” she said.

    Industry Muscles In

    In May 2000, Denise Coitinho, then director of nutrition for the Ministry of Health, was at a Mother’s Day party at her children’s school when her mobile phone rang. It was Nestlé’s chief of government relations. “He was really upset,” she recalled.

    The source of Nestlé’s concern was a new policy that Brazil had adopted and was pushing at the World Health Organization. If adopted, the policy would have recommended that children around the world breast-feed for six months, rather than the previous recommendation of four to six months, she said.

    “Two months may not seem like a lot, but it’s a lot of revenue. It’s a lot of selling,” said Ms. Coitinho, who left her position in 2004 and is now an independent nutrition consultant to, among others, the United Nations. In the end, infant food companies succeeded in stalling the policy for a year, she said. Asked about her story, Nestlé said that it “believes breast milk is the ideal nutrition for babies” and that it supports and promotes the W.H.O. guidelines.

    It is hard to overstate the economic power and political access enjoyed by food and beverage conglomerates in Brazil, which are responsible for 10 percent of the nation’s economic output and employ 1.6 million people.

    In 2014, food companies donated $158 million to members of Brazil’s National Congress, a threefold increase over 2010, according to Transparency International Brazil. A study the organization released last year found that more than half of Brazil’s current federal legislators had been elected with donations from the food industry – before the Supreme Court banned corporate contributions in 2015.

    The single largest donor to congressional candidates was the Brazilian meat giant JBS, which gave candidates $112 million in 2014; Coca-Cola gave $6.5 million in campaign contributions that year, and McDonald’s donated $561,000.

    So the stage was set for a mammoth political battle when, in 2006, the government sought to enact far-reaching food-industry regulations to curb obesity and disease. The measures, growing out of the earlier breast-feeding policy, included advertising alerts to warn consumers about foods high in sugar, salt and saturated fats, as well as marketing restrictions to dampen the lure of highly processed foods and sugary beverages, especially those aimed at children.

    Taking a page from the government’s successful efforts to limit tobacco marketing, the new rules would have barred brands like Pepsi and KFC from sponsoring sports and cultural events.

    “We thought that Brazil could be a model for the rest of the world, a country that puts the well-being of its citizens above all else,” said Dirceu Raposo de Mello, then director of the government’s health surveillance agency, widely known by the Portuguese acronym Anvisa. “Unfortunately, the food industry did not feel the same way.”

    The food companies took a low profile, mustering behind the Brazilian Association of Food Industries, a lobbying group whose board of vice presidents included executives from Nestlé; the American meat giant Cargill; and Unilever, the European food conglomerate that owns brands like Hellmann’s, Mazola oil and Ben Jerry’s. The association declined to comment for this article.

    During the early days of public hearings, the industry seemed to be negotiating the rules in good faith but behind the scenes, health advocates say corporate lawyers and lobbyists were quietly waging a multipronged campaign to derail the process.

    Industry-financed academics began appearing on TV to assail the rules as economically ruinous. Other experts wrote newspaper editorial pieces suggesting that exercise and stricter parenting might be more effective than regulations aimed at fighting childhood obesity.

    The industry’s most potent rallying cry, analysts say, was its strident denunciation of the proposed advertising restrictions as censorship. The accusation had particular resonance given the nearly two decades of military dictatorship that ended in 1985.

    At one meeting, a representative from the food industry accused Anvisa of trying to subvert parental authority, saying mothers had the right to decide what to feed their children, recalled Vanessa Schottz, a nutrition advocate. In another meeting, she said, a toy industry representative stood up and assailed the proposed marketing rules, saying they would deprive Brazilian children of the toys that sometimes accompany fast-food meals. “He said we were killing the dreams of children,” Ms. Schottz recalled. “We were dumbfounded.”

    Chastened by the industry criticism, Anvisa in late 2010 withdrew most of the proposed restrictions. What remained was a single proposal requiring that ads include a warning about unhealthy food and beverages.

    Then came the lawsuits.

    Over the course of several months, a disparate collection of industry groups filed 11 lawsuits against Anvisa. The plaintiffs included the national association of biscuit manufacturers, the corn growers lobby and an alliance of chocolate, cocoa and candy companies. Some of the lawsuits claimed that the regulations violated constitutional protections on free speech, while others said the agency did not have the standing to regulate the food and advertising industries.

    Although health advocates say the litigation was not entirely unexpected, they were blindsided by the response of the federal government’s top lawyer, Attorney General Luís Inácio Adams, a presidential appointee. Shortly after the proposed rules were officially published in June 2010, Mr. Adams sided with the industry. A few weeks later, a federal court suspended the regulations, citing his written opinion, which suggested that Anvisa did not have the authority to regulate the food and advertising industries. Mr. Adams declined to comment for this article.

    Mr. Raposo de Mello, the former Anvisa president, says he was stunned by Mr. Adam’s change of heart, given the attorney general office’s longstanding support for Anvisa. Seven years later, with most of the 11 lawsuits still unresolved, the regulations remain frozen.

    “The industry,” Mr. Raposo de Mello said, “did an end run around the system.”

    In the meantime, the food and beverage industry became more aggressive as it sought to neutralize Anvisa, which it viewed as its greatest adversary.

    In 2010, in the midst of the battle against the agency’s proposed regulations, a group of 156 business executives took its grievances to the campaign of Dilma Rousseff, who was running for president.

    Marcello Fragano Baird, a political scientist in São Paulo who has studied the food lobby’s campaign against the nutrition regulations, said Ms. Rousseff assured the executives she would shake up Anvisa. “She promised them she would ‘clean house’ once elected,” he said, adding that he learned about the encounter through interviews with participants.

    Ms. Rouseff won, and soon after her inauguration, she replaced Mr. Raposo de Mello with Jaime César de Moura Oliveira, a longtime political ally and a former lawyer for the Brazilian subsidiary of the food giant Unilever.

    A spokesman for Ms. Rouseff declined to make her available for an interview.

    In 2012, Anvisa hosted a traveling anti-obesity exhibit at its offices. Titled “Lose Weight Brazil,” the exhibit extolled exercise and moderation as the keys to tackling obesity, but largely ignored mainstream scientific evidence about the dangers of consuming too much sugar, soda and processed food.

    The exhibition’s sponsor? Coca-Cola.

    Irresistible Foods, Fatty Diets

    More than 1,000 miles south of Fortaleza, the effects of changing eating habits are evident at a brightly painted day care center in São Paulo, Brazil’s largest city. Each day, more than a hundred children pack classrooms, singing the alphabet, playing and taking group naps.

    When it was started in the early 1990s, the program, run by a Brazilian nonprofit group, had a straightforward mission: to alleviate undernutrition among children who were not getting enough to eat in the city’s most impoverished neighborhoods.

    These days many of those who attend are noticeably pudgy and, the staff nutritionists note, some are worryingly short for their age, the result of diets heavy in salt, fat and sugar but lacking in the nourishment needed for healthy development.

    The program, run by the Center for Nutritional Recovery and Education, includes prediabetic 10-year-olds with dangerously fatty livers, adolescents with hypertension and toddlers so poorly nourished they have trouble walking.

    “We are even getting babies, which is something we never saw before,” said Giuliano Giovanetti, who does outreach and communications for the center. “It’s a crisis for our society because we are producing a generation of children with impaired cognitive abilities who will not reach their full potential.”

    Nearly 9 percent of Brazilian children were obese in 2015, more than a 270 percent increase since 1980, according to a recent study by the Institute for Health Metrics and Evaluation at the University of Washington. That puts it in striking distance of the United States, where 12.7 percent of children were obese in 2015.

    The figures are even more alarming in the communities served by the center: In some neighborhoods, 30 percent of the children are obese and another 30 percent malnourished, according to the organization’s own data, which found that 6 percent of obese children were also malnourished.

    The rising obesity rates are largely associated with improved economics, as families with increasing incomes embrace the convenience, status and flavors offered by packaged foods.

    Busy parents ply their toddlers with instant noodles and frozen chicken nuggets, meals that are often accompanied by soda. Rice, beans, salad and grilled meats — building blocks of the traditional Brazilian diet — are falling by the wayside, studies have found.

    Compounding the problem is the rampant street violence that keeps young children cooped up indoors.

    “It’s just too dangerous to let my kids play outside, so they spend all their free time sitting on the couch playing video games and watching TV,” said Elaine Pereira dos Santos, 35, the mother of two children, 9 and 4 years old, both overweight.

    Isaac, the 9-year-old, weighs 138 pounds and can wear only clothing intended for adolescents. Ms. dos Santos, who works at a hospital pharmacy, shortens the pants legs for him.

    Like many Brazilian mothers, she was pleased when Isaac began to gain weight as a toddler, not long after he tasted his first McDonald’s French fry. “I always thought fatter is better when it comes to babies,” she said. She happily indulged his eating habits, which included frequent trips to fast-food outlets and almost no fruits and vegetables.

    But when he began having trouble running and complained about achy knees, Ms. dos Santos knew something was wrong. “The hardest part is the ridicule he gets from other children,” she said. “When we go out shopping, even adults point and stare” or call him gordinho, roughly translated to “little fatty.”

    At the São Paulo nursery, health care workers keep tabs on the children’s physical and cognitive development, while nutritionists teach parents how to prepare inexpensive, healthy meals. For some children, the center’s test kitchen provides their first introduction to cabbage, plums and mangos.

    One of the fundamental challenges is persuading parents that their children are sick. “Unlike cancer or other illnesses, this is a disability you can’t see,” said Juliana Dellare Calia, 42, a nutritionist with the organization.

    Although staff members say the program has made significant strides in changing the way families eat, many children will nonetheless face a lifelong battle with obesity. That’s because a growing body of research suggests that childhood malnutrition can lead to permanent metabolic changes, reprogramming the body so that it more readily turns excess calories into body fat.

    “It’s the body’s response to what’s perceived as starvation,” Ms. Dellare Calia said.

    Money Talks

    Even as nutrition experts bemoan the growing obesity crisis — and the potential long-term medical costs — one aspect of Brazil’s processed food revolution is undeniable: The industry’s expansion provides economic benefits to people up and down the ladder. Nestlé, which says it employs 21,000 people in Brazil, two years ago started an apprenticeship program that has trained 7,000 people under 30.

    Near the bottom of the food chain is Mrs. da Silva, the vendor in Fortaleza, who feels optimistic about the future despite her mounting health woes. Life has been a struggle since she dropped out of school at 14 when she became pregnant with her first child. Now she talks about fixing the missing teeth that mar her tentative smile and buying a proper home, one that does not leak during heavy rains.

    She has Nestlé to thank.

    “For the first time in my life, I feel a sense of hope and independence,” she said.

    She is aware of the connection between her diet and her persistent health problems, but insists that her children are well nourished, gesturing to the Nestlé products in her living room. Being a Nestlé vendor has another advantage: the cookies, chocolate and puddings that often sustain her family are bought wholesale.

    With an expanding roster of customers, Mrs. da Silva has set her sights on a new goal, one she says will increase business even more.

    “I want to buy a bigger refrigerator.”

    Article source:

As Global Obesity Rises, Teasing Apart Its Causes Grows Harder


Celene Gomes Da Silva and her daughter, Sabrina, are delivering Nestlé products door to door.

William Daniels for The New York Times

Asking overweight strangers about their health and eating habits is always going to be tricky for a reporter, but in some contexts it’s easier than others — say, at a program for overweight children, or an obesity clinic, two places that Andrew Jacobs, a reporter with The New York Times’s health desk, visited to report an article about Brazil’s growing obesity rates..

But broaching the subject with Celene Gomes da Silva, who sells Nestlé products door-to-door in poor neighborhoods of Fortaleza and is featured in the article, was a little different; with his translator and researcher, Paula Moura, Mr. Jacobs started by asking about her job. “It felt a little uncomfortable in the beginning,” he said. Then she broke the ice for him. “She kind of acknowledged, ‘Yeah, I’m fat.’ And she kind of laughed about it,” he recalled.

Today’s article is the first in a series being produced by the paper’s health and science desk. The project examines how the processed food, soda and fast food industries’ increasing focus on markets in the developing world — and the accompanying rise in obesity rates and weight-related illnesses — is playing out around the globe.

The idea had long been on the mind of Celia Dugger, The Times’s health and science editor. For several years, she had been filing away news stories and journal articles that touched on what seemed to be a growing trend. “It just seemed stunning to me,” Ms. Dugger said. “It was a huge problem and a fascinating one to try and understand.” Her hunch was confirmed in June, when a new study showed that 10 percent of the world’s population now has a body mass index, or B.M.I., of 30 or higher, the threshold many public health experts say qualifies as obesity.


Continue reading the main story

But it was clear that a story of this scale, driven largely by an economic and cultural transformation of the global food system, couldn’t be understood solely through a scientific lens. Last year, when Ms. Dugger approached The Times’s executive editor, Dean Baquet, with the idea of creating a health reporting “pod” that would bring in reporters with different areas of expertise, the global obesity story was part of her pitch. “This was just the kind of project we would be able to undertake if we had reporters with experience in business and international reporting, as well as in science and medicine,” Ms. Dugger said.

Continue reading the main story

Article source:

Why lupus sufferers may need kidney transplants: As Selena Gomez reveals going under the knife, we explain the …

  • The 25-year-old singer revealed on Instagram that her best friend donated her kidney for her this summer 
  • Selena admitted to her chronic illness in 2015 and how she has struggled with it 
  • Lupus is an illness where the body’s immune system attacks healthy tissues and organs such as the skin, joints, kidney and brain
  • People with lupus will seek a kidney transplant if their condition is attacking that organ and causing it to fail 

Danielle Zoellner For



Selena Gomez revealed that she underwent kidney transplant surgery as she continues to struggle with chronic lupus disease.

Lupus is a debilitating illness where the body’s immune system attacks healthy organs and tissue.

The 25-year-old was first diagnosed in 2015 and had to end her world tour early last year because of panic-related symptoms related to her chronic illness.

The disease affects five million people worldwide but is more prominent in females, according to the Lupus Foundation of America.

Selena’s best friend Francia Raisa gave her kidney to the singer whose diagnosis is known to attack areas of the organ and cause inflammation.

Selena Gomez posted a picture on Instagram showing her and her friend Francia Raisa (left) who donated her kidney to the singer. Selena first spoke about her illness in 2015

Selena Gomez posted a picture on Instagram showing her and her friend Francia Raisa (left) who donated her kidney to the singer. Selena first spoke about her illness in 2015


The singer also revealed her surgery scar from the transplant and how much weight she has lost because of the illness. Kidney transplants are necessary for people with lupus if the organ begins to fail because of the immune system attacking it

Lupus is a chronic illness where the immune system attacks healthy tissue and organs in the body

The singer also revealed her surgery scar from the transplant and how much weight she has lost because of the illness. Kidney transplants are necessary for people with lupus if the organ begins to fail because of the immune system attacking it


Lupus, or systemic lupus erythematosus (SLE), is a chronic illness where the body’s immune system attacks its own antibodies even if they are healthy. 

It is known as an ‘autoimmune’ disease because the immune system is attacking healthy tissue and organs instead of ones that are infected. 

Some areas that are commonly at risk are the skin, joints, kidneys and brain.

The direct cause for lupus is unknown, but it can span from a combination of genetics and the environment. 

About five million people worldwide have lupus and 90 percent of those people are women. 


Lupus develops differently in each person. 

Some might experience symptoms slowly such as tiredness or joint aches while others will have severe problems right away. 

People also experience a ‘butterfly’ skin rash that forms around the cheeks and nose. 

More severe symptoms include depression, lung disease, heart problems and kidney inflammation. 



Lupus nephritis is a specific form of the chronic disease that attacks and inflames the kidneys. 

The singer hasn't made as many public appearances this summer as she has recovered from her transplant. Doctors have to monitor transplant patients closely to make sure the organ isn't rejected. This is her during the Coach In-Store event during New York Fashion Week 

The singer hasn’t made as many public appearances this summer as she has recovered from her transplant. Doctors have to monitor transplant patients closely to make sure the organ isn’t rejected. This is her during the Coach In-Store event during New York Fashion Week 

Exercise could decrease the need for kidney transplants, a study claims 

Researchers from the Ohio State University found that exercise can help lower the person’s need for a kidney transplant. 

They studied mice who ran on treadmills and how it influenced their stress management. 

Stress is a link to increasing symptoms chronic illnesses such as lupus. 

And the researchers said that exercising helped lower the stress levels in the mice who ran on treadmills multiple days of the week. 

Moderate exercise was also found to help improve inflammation in the body, another key symptoms that normally happens to the kidneys of people who have lupus. 

The combination of lower-stress levels and inflammation could improve the need for lupus patients to need kidney transplants.

The researchers are now studying tai chi to see if it is a drug-free option to reduce inflammation in the body. 

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Wall Street Journal Mentions Paducah Health Care

NEW YORK, NY – The Wall Street Journal mentions Paducah in a recent story about health care in small-town communities.

In his How Communities Can Improve Health Care article, Dr. David Blumenthal discusses a recent study by the Commonwealth Fund that rated more than 300 local markets to see how the care and health of residents have changed in recent years. Paducah was among 14 communities that stood out as winners for improving on the majority of 33 indicators of population health and system performance.

The study cites Paducah’s emphasis on promoting physical activity as one of the main factors that got it such a high rating, noting efforts to keep the community active such as the recently completed Health Park, built by the Rotary Club and Foundation for a Healthy Kentucky. 

Other cities that scored highly in the study were Pueblo, CO and Stockton, CA

Article source:

UCLA Health Denies Using Expired Drugs

LOS ANGELES ( – UCLA health officials insisted Saturday that no patients were administered medications with outdated or adulterated ingredients, despite a report that the state Board of Pharmacy found more than 1,000 IV bags of sterile medications made with expired components at a university compounding facility.

Sterile medications are usually injected directly into the bloodstream.

The Los Angeles Times reported that UCLA quietly closed the Westside compounding facility last year after the state inspection. Inspectors found that at least 350 of the potentially tainted IV bags were delivered to patients throughout the UCLA Health system, according to records cited by The Times.

But UCLA officials said Friday there are “no allegations or findings that outdated ingredients were administered to patients.” According to the university, “the outdated compound identified by the Board of Pharmacy was never intended for use, because we were no longer compounding that product and had found other suppliers. No adulterated ingredients were identified.”

“In October 2016, UCLA Health voluntarily closed one off-campus compounding pharmacy following an annual site visit by the state Board of Pharmacy,” according to UCLA. “It was a business decision that does not affect UCLA Health’s other pharmacies or ability to provide exceptional patient care. UCLA Health is committed to compliance with pharmacy board regulations designed to ensure high-quality care.”

According to The Times, the state inspection prompted an investigation by the pharmacy board, which in July filed an accusation seeking disciplinary sanctions against former pharmacist-in-charge Richard C. Graul and the off-campus facility, UCLA Medical Center Pharmaceutical Technology. The board could impose sanctions such as license revocation, suspension or “further action as deemed necessary and proper,” The Times reported.

The accusation contends the pharmacy lacked proper licensing, used expired drugs in compounding sterile medications and failed to meet state standards for quality assurance and product testing, according to The Times.

Contacted by the paper, Graul declined to comment.

According to The Times, the expired drugs cited by regulators include monosodium glutamate monohydrate (MSG) and monosodium aspartate monohydrate (MSA), which are used in cardiac surgery and other surgical procedures; along with clopidogrel, which is used to prevent blood clotting; mexiletine, which is used to treat arrhythmia; and the hormone estradiol, which in intravenous solutions is sometimes used to treat heavy uterine bleeding.

UCLA officials said the Pharmaceutical Technology facility was used to compound nonsterile-to-sterile medications, but “like many medical centers, UCLA Health now no longer compounds such medications.”

“UCLA closed the pharmacy because it was providing services that were redundant to services available elsewhere,” according to the university. “UCLA had already begun to use other suppliers for the nonsterile-to-sterile compounding projects produced by the pharmacy, with the goal being to use other suppliers for all such compounds.

The decision to close the pharmacy was a business decision that does not affect UCLA Health’s other pharmacies or ability to provide exceptional patient care.”

(©2017 CBS Local Media, a division of CBS Radio Inc. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. Wire services contributed to this report.)


Article source:

Anthem to sell Obamacare health plans in Virginia’s bare counties

NEW YORK, Sept 15 (Reuters) – U.S. health insurer Anthem Inc said on Friday that it plans to sell Obamacare health plans in 68 cities and counties in Virginia next year, covering the only remaining U.S. counties that are currently without insurers offering the plans.

Anthem said last month that it was exiting the Obamacare market in the state, but reconsidered after no other insurer stepped up to cover most of Virginia’s counties.

The Centers for Medicare and Medicaid Services said earlier this week that 63 counties nationwide could be “bare counties” with no insurers selling the Obamacare plans. It said that 1,472 counties could have only one insurer in 2018. (Reporting by Michael Erman; Editing by Jonathan Oatis)

Article source:

Democrats Can Build on Their Health-Care Victory

The Republicans’ failure to repeal Obamacare has created a political opening. The American public, threatened with the withdrawal of health insurance from millions of people, has largely come to embrace the idea of universal coverage. At such a moment, Democrats are right to advance ideas for building on the gains accomplished by the Affordable Care Act.

Unfortunately, many of them are supporting Senator Bernie Sanders in his drive for a single-payer system. Universal coverage does not require single-payer — and pressing for that particular form of universal coverage is unwise both on the merits and as a matter of political strategy.

The legislation that Sanders introduced Wednesday — endorsed already by more than a dozen Democrats, several of whom might run for president — is needlessly radical. Supporters seem captivated by its apparent simplicity: Sweep away the current fragmented, wasteful system and have the federal government pay for all health care. In fact, implementing such an enormous, wrenching change might not save money and would be anything but simple.

A standard argument in favor of a single-payer system is that every country that has one spends less on health care. Actually, other countries’ systems vary widely, and few are truly single-payer. They succeed in controlling costs not because the government is paying for everything but because the prices of treatments and drugs are aggressively regulated.

The U.S. is still averse to this approach. It’s why Medicare isn’t allowed to negotiate drug prices, and it’s why Obamacare’s Independent Payment Advisory Board, which is meant to trim Medicare spending, has been widely (and wrongly) condemned as a “death panel.” Moving to a single-payer system would not, by itself, persuade Americans that rigorous cost-control is what they want.

A single-payer scheme could indeed simplify the system, but not without first putting it through tremendous upheaval. Keep in mind that half the population has employer-based health insurance, and many people like it. For these 156 million, a switch to single-payer would mean giving up that coverage and instead paying higher taxes to fund a program that would cost, by Senator Sanders’s own estimation, some $3 trillion a year.

A better way to extend health insurance to the 28.1 million Americans who still need it is to take incremental steps — starting with the bipartisan effort to shore up the ACA now under way in the Senate. Strategies beyond Obamacare are needed, too: automatic enrollment in basic subsidized plans, gradually lowering the age for Medicare, maybe offering Medicaid buy-in as a public option.