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The bariatric equation in morbid obesity

The bariatric equation in morbid obesity

THE word Bari or Baros in modern Greek means weight, burden, obese. Bariatric surgery is surgery for obesity. It is currently the only effective and sustainable weight loss method for those who have difficulty in losing significant weight despite food restriction and exercise.

An obese person tends to have multiple medical problems such as diabetes, hypertension, hypercholesterol and so on, hence bariatric surgery is not only for obesity, it also improves or helps alleviate such conditions. That is why it is sometimes referred to as metabolic surgery.

There are different types of bariatric surgeries which possess restrictive (reduce the amount of food intake) and hormonal effects (changes in body hormones to reduce absorption and digestion of food).

The standard types of procedures include:

• Sleeve gastrectomy – This procedure aims to reduce the size of the stomach. This will help to reduce the amount of food intake. The procedure involves removing most of the stomach, and this is irreversible.

• Roux-En-Y Gastric Bypass (RYGB) – This procedure involves creating a small stomach pouch (bag), leaving a small upper chamber and big lower chamber. The small intestine is then divided at a certain length (usually about 100cm from the duodenum). The first end is joined to the upper chamber.

The second is connected from the lower chamber (the disconnected stomach and duodenum) to the small intestine. This procedure will not remove any part of the stomach or intestine.

The amount of food intake will be reduced. Food entering the stomach will bypass the duodenum (first part of the small intestine) and jejunum (middle segment of the small intestine) into the later part of the small intestine. This will delay food digestion and absorption.

This is a restrictive and malabsorptive procedure.

• Adjustable gastric band – This procedure entails inserting an inflatable balloon into the upper part of the stomach. The balloon is attached to a port placed underneath the skin for adjustment. This band helps to create a small pouch of the stomach, limiting the amount of food intake and delaying food from entering into the remaining stomach. This will help to create a feeling of fullness.

We will have more options in the near future. These are currently under investigation/research.

What happens to the body after bariatric surgery?

The end goal of bariatric surgery is weight loss. While losing weight, the body goes through several other physiological changes due to restriction in diet.

For those with diabetes, sugar control will improve significantly. Total remission is observed in 80-90% of patient, with the rest having significant improvement in sugar control.

With excessive weight loss, the skin may become saggy; hair loss may happen, especially when dietary intake is not predominantly focused on protein; and vitamin deficiency might occur if the patient does not take proper vitamin supplements that are recommended.

In short, there is marked improvement or reversal in diabetes mellitus, hypertension, hyperlipidaemia and/or obstructive sleep apnoea. There will be significant improvement in the overall quality of life and social aspects.

How is bariatric surgery effective in combating obesity?

No operation, diet or medication by itself offers a permanent cure for obesity. Bariatric surgery, together with lifestyle modification, can offer wonderful long-term results for health and weight.

It helps to accelerate weight loss, especially for those who are morbidly obese with limited mobility and are unable to perform any exercise.

How did this surgery come about as an option in the first place?

Back in the early 1950s, a patient with diabetes mellitus had undergone hemigastrectomy (partial removal of stomach). The patient’s diabetes mellitus then went into remission.

Only after about 40 years later in the 1990s, a large number of studies were published regarding bariatric surgery. Since then, more studies and newer techniques have been introduced.

Who is eligible/suitable for bariatric surgery?

Those who are obese and meet certain criteria can opt for bariatric syrgery. General recommendations in Malaysia by expert committees include the following:

• Morbid obesity without co-morbidities (without any illnesses) with BMI of more than 37.5.

• Morbid obesity with co-morbidities (such as subfertility, obesity related spine or joint problems) with BMI of more than 32.5.

• Morbid obesity with metabolic syndrome (diabetes mellitus, hypertension, central obesity, raised cholesterol level) with BMI of more than 32.5.

• Acceptable age between 18 and 65.

Under what circumstances would someone have to undergo bariatric surgery?

It is not a must-do surgery. Bariatric surgery is recommended when diet, lifestyle modification and medications fail to help a patient reduce weight and improve their medical comorbidities.

It is proven to reduce weight in those who are obese, especially those with multiple medical problems.

For those who are morbidly obese and already suffer from multiple complications and medical conditions, it is a highly recommended procedure, such as someone who has a BMI of 50 with severe osteoarthritis of the knee and is unable to move about due to pain.

For those interested in undergoing bariatric surgery, what should they expect to undergo?

They should agree for long-term follow-up after surgery, making lifestyle changes, and attending regular check-ups.

Just like any other surgery, there are risks of complications and reoperation involved, though the chances are very small. They should seek advise from their bariatric surgeon on the suitability and type of surgery as the medical and physiological needs of every individual is different.

Advantages and disadvantages of each surgery need to be discussed before decisions are made.

Will bariatric surgery help lower obesity rates in the country?

Bariatric surgery will not lower obesity rates in the country. Awareness about obesity and a healthy lifestyle is the key to lower obesity rates in the country.

Bariatric surgery will help those in need of weight loss and improve their general wellbeing and overall quality of life.

This article is courtesy of Regency Specialist Hospital, Johor.
Eating from a can during disasters

Eating from a can during disasters

HAVING enough water and canned goods is an important part of any disaster preparation.

But creating a meal plan in advance also can be valuable, especially if refrigeration and electricity are unavailable.

“Whether it’s a hurricane, flood or another natural disaster, it’s important to know basic food and water safety in case of power outages or flooding,” says Sherry Mahoney, director of Nutrition and Food Services at Mayo Clinic’s Florida campus.

“But having a meal plan for your family can help ensure proper nutrition, energy and long-term wellness, since most people aren’t thinking about recipes during a disaster.

“Eating out of a can or box doesn’t have to be boring,” says Mahoney. “There are many things you can mix and match from your pantry to provide healthy and delicious meals for your family.”

Mahoney offers her top tips for prepping your pantry and planning an emergency menu:

• Know the safe temperature zones of perishable food.

• When the power goes out, keep the refrigerator and freezer doors closed as much as possible. The refrigerator, if unopened, will keep food cold for about four hours. A full freezer will maintain its temperature for around 48 hours (24 hours if half-full) if the door remains closed.

• Stock up on condiments, such as ketchup, mustard, soy sauce and barbecue sauce. Items that are vinegar-based have a long shelf life and are versatile. Consider travel-sized containers for convenience.

• Have various canned protein options on hand, such as chicken, salmon, beans and peanut butter.

• Get your calcium via boxes of powdered milk or shelf-stable cartons for cereal or desserts.

• Dried fruits, nuts and spices can add a boost of flavour to otherwise bland dishes.

• Don’t forget a manual can opener. — Mayo Clinic News Network/Tribune News Service

A Florida man died of flesh-eating bacteria after eating raw oysters — here’s how concerned you should be

A Florida man died of flesh-eating bacteria after eating raw oysters — here’s how concerned you should be

Raw oysters can carry Vibrio vulnificus, a bacteria that can cause flesh-eating disease.

Raw oysters can carry Vibrio vulnificus, a bacteria that can cause flesh-eating disease.
Melie Nasr / Shutterstock.com
  • A Florida man died on July 10 after eating a raw oyster at a Sarasota restaurant that was contaminated by the bacteria Vibrio vulnificus, which can cause flesh-eating disease, or necrotizing fasciitis.
  • These bacteria thrive in warm, salty water, which is why infections tend to happen more in the summer.
  • People can be infected by eating contaminated seafood or by wading in water with the bacteria if they have open cuts.

A 71-year-old man in Florida died on July 10 after being infected by bacteria that cause flesh-eating disease (necrotizing fasciitis) from eating a contaminated raw oyster, according to local news reports.

The man ate the bad oyster at a Sarasota restaurant two days before succumbing to gastrointestinal illness.

The Florida Department of Health told the Sun Sentinel that the oyster was contaminated with the bacteria Vibrio vulnificus, an organism that can cause severe and potentially fatal illness.

There are approximately a dozen different types of Vibrio bacteria that can trigger various forms of a gastrointestinal illness known as vibriosis. Most cases are unpleasant but resolve within a few days, but infections from the species Vibrio vulnificus cause a “flesh-eating” or necrotizing fasciitis condition that kills up to 30% of those infected.

This bacteria is known to thrive in warm, salty water, which is why it can be found in shellfish, especially in the summer.

The young, elderly, and those with underlying health conditions are particularly vulnerable to these infections.

It's especially important to be careful with raw oysters in the summer.

It’s especially important to be careful with raw oysters in the summer.

Vibriosis and flesh-eating bacteria

There are approximately 80,000 vibriosis infections in the US every year, according to the CDC. Estimates suggest 52,000 of those cases are likely the result of eating contaminated food, especially raw seafood. About 80% of those infections occur between May and October, when water is particularly warm – ideal for colonies of bacteria to grow and thrive.

The vast majority of vibriosis infections result in symptoms typical of a foodborne illness: cramping, diarrhea, vomiting, nausea, fever, and chills.

But the species the Florida man consumed, Vibrio vulnificus, is more dangerous. This infection can cause blistering skin lesions, bloodstream infections, and necrotizing fasciitis (flesh-eating disease, which causes soft tissue to die) if a wound gets infected. But it’s very rare; the CDC estimates are that there are about 205 cases in the US every year. There have been 16 confirmed cases in Florida so far this year, with three fatalities.

When treatment is possible, understanding that flesh-eating disease has been caused by Vibrio is important, since it’s treated differently from other bacteria. Other bacteria can cause flesh-eating disease as well – in fact, Vibrio bacteria are far less likely to cause these infections than group A Streptococcus bacteria and certain other types. But flesh-eating disease is one of the most common signs of Vibrio vulnificus, according to one study.

Skin lesions caused by Vibrio vulnificus bacteria after Hurricane Katrina.

Skin lesions caused by Vibrio vulnificus bacteria after Hurricane Katrina.

Risky oysters in brackish water

According to the CDC, there’s no way to know if an oyster carries bacteria like Vibrio. One study conducted by the Florida state health office found the infection was the leading cause of death from foodborne illness between 1981 and 1992. During that time there were at least 72 infections, mostly caused by eating raw oysters, and 36 deaths. Last year, Florida had 49 infections, and 11 deaths.

These bacteria thrive in brackish water – water that’s salty, but not quite at seawater levels, which is where oysters are often harvested from. People can also contract the bacteria if they wade in water and have any open wounds.

Hurricane floodwaters after Harvey resulted in at least one fatality from flesh-eating bacteria and there were several Vibrio deaths after Katrina.

For people with serious vibriosis, antibiotics can treat some cases. Other cases result in amputations or death. People with liver conditions are much more likely to get severely ill.

The CDC and other health departments have warned that the only way to kill bacteria is to properly cook oysters. Warmer waters (which are becoming more common) make raw oysters riskier to consume, Bill Marler, a lawyer who focuses on food poisoning cases, previously told Business Insider. That fact was enough to convince him never to eat raw shellfish.

Still, these cases are rare. Whether or not wading in partially salty water or eating raw seafood are worth the risk is an individual decision.

14 foods with wonderfully healthy fats that you should add to your plate

14 foods with wonderfully healthy fats that you should add to your plate

Eating fat won't make you fat, if you do it right.

Eating fat won’t make you fat, if you do it right.

Fat in food has gotten an unfair reputation as a belly-bulging demon that can wreck your diet and cause you to gain weight.

But the truth is, we need some fat in our diets to survive. The proper amount of the right kind of fat can fuel your body and help feed your brain. Many studies have shown that people who eat more fat don’t get more fat, nor do they have higher rates of other health problems like cancer or heart disease.

It’s true that fat packs a punch: it’s got more energy, calorie for calorie, than carbohydrates or proteins do, which means a little bit can go a long way. But you probably don’t need to track how much fat you’re eating every day.

Incorporating healthy fat into a diet can help people stay full, survive harsh conditions, and perhaps even live longer than their peers. One 2016 study followed more than 126,200 men and women for more than 30 years, and found that those who ate more healthy, unsaturated fat and less carbs were less likely to die from all causes.

One of the main reasons we need to eat fat is because it provides some essential fatty acids that our bodies can’t produce on their own.

That’s not an excuse to slather a layer of heavy lard onto everything you eat. The kinds of fats we consume make a big difference. Researchers have discovered that replacing just 5% of a person’s saturated fat intake with healthier polyunsaturated fats and monounsaturated fats is associated with a roughly 13% to 27% reduction in mortality. Eating the right kinds of fats, however, can help keep your body satiated, protect your cells, and keep your heart healthy.

Here are some prime examples of foods with the best fats that you could probably be eating more of:

Whole eggs

Shanti May / Shutterstock

Eggs are a great fatty addition to your diet because the dietary cholesterol (that’s the term for the kind of cholesterol you eat) in them doesn’t have much effect on your blood cholesterol (the kind your doctor measures).

In fact, eggs can help regulate how cholesterol is absorbed in the body because of their high concentrations of phospholipids: special kinds of fats that can also help control inflammation. Eggs also contain lutein and zeaxanthin, which may help keep our eyes healthy.

Plus, eggs are a great protein source, which means you’ll stay fuller for longer after an eggy meal. They also deliver omega-3 fatty acids, which are some of the essential fats the body can’t produce on its own. (But there is not nearly as much omega-3 in eggs as there is in fish.)

For people with Type 2 diabetes, it’s possible that eating eggs could increase the risk of developing heart disease, but more research on that is needed.

If you’re otherwise healthy, go ahead and get that omelette – and don’t bother with the egg-white substitution.


Flickr/Rachel Hathaway

Most people don’t think of oatmeal as a fat-rich food, but part of the reason the breakfast keeps people full is that it’s loaded with more fat than most other grains – mostly the good polyunsaturated and monounsaturated kinds.

Oats are also a great way to get more amino acids, as well as vitamins and minerals like B6 and iron. That’s all in addition to the protein and calcium oats are known to deliver.


Spirulina is a blue-green algae that people have been eating for centuries.

Spirulina is an ancient type of blue-green sea algae that has developed a cult following as a “superfood.” It’s often added to smoothies as a dark green powder.

The algae was a source of sustenance long before the age of blenders: The Aztecs dried and ate it in Mexico as early as the 1600s.

The cyanobacteria is rich in protein and iron, and also boasts a punch of amino acids and fat. Just two tablespoons of spirulina have a gram of fat. That’s not nearly as much fat as an egg or piece of meat contains, but it’s impressive for a piece of seaweed.

But be careful where you get your algae from – the National Institutes of Health warns that some contaminated spirulina can cause liver damage and harbor toxic metals and bacteria.

Seeds, especially chia, flax, and sesame.


Seeds aren’t just for the birds.

Options like ground flax, sesame, sunflower seeds, and chia seeds are all high in polyunsaturated fats and filled with omega-3s that can help lower your bad (LDL) cholesterol levels.

Just two tablespoons of chia seeds will give you 7 grams of unsaturated fat, and can also help lower cholesterol, decrease inflammation, and regulate blood pressure. Because chia seeds break apart easily when we digest them, you don’t need to grind them up like flax.

Of course, since seeds are small, it can be easy to overdo it; think of them more as replacements for less healthy saturated fats in your diet, and consume them in moderation.

Coconut oil

Coconut oil (that’s the fatty, meaty part, not the water) is an efficient source of energy.
Thomson Reuters

Coconut oil is high in saturated fat, but it’s not terrible for you.

About 50% of the fatty acid content in coconut oil is lauric acid, a kind that gets sent to the liver and used as energy by the brain and the body, instead of being stored as excess fat.

Coconut oil can can also help fill you up in a hurry, while the medium-chain triglycerides inside (MCTs) help you burn off more fat around your waistline, and lose weight all over. There’s even some evidence that the oil may help patients with breast and uterine cancers.

Still, nutrition experts like doctor Walter Willett at the Harvard School of Public Health caution that coconut oil should probably be used sparingly in your diet, since the health benefits of unsaturated fats and oils are more proven.

Nuts, especially walnuts

Flickr / Rebecca Siegel

Nuts are a great high-fat snack in general, but the health benefits of walnuts are unique.

They contain a kind of omega-3 fatty acid called alpha-linolenic acid (ALA), which is also in flax seeds, soybeans, hemp, and chia seeds. It’s one of two essential fatty acids that the body can’t produce on it’s own (the other is linoleic acid).


Brent Hofacker / Shutterstock

People don’t typically think of tofu as a high in fat, but it’s a nutritional wonder – a complete protein source bursting with good fat.

Just half a cup of the soybean curd can provide you with 20% of a day’s recommended protein intake and 6 grams of fat (and less than a single gram of that is saturated).



Like tofu, immature soybeans – or edamame – are a great source of fat. They’re also high in fiber and protein, and can be good for aging bones.

A single cup of cooked edamame will fill you up with eight grams of fat, but only a single gram is the saturated kind. The beans are also a good source of magnesium, potassium, and iron.



Olive oil gets promoted as a source of high-quality fat, and it’s a staple of many dietitians’ favorite Mediterranean Diet, but where do you think it comes from?

Olives have a special kind of healthy fat named after them: monounsaturated oleic fatty acid, which can reduce your risk of developing heart disease.

Consuming olive oil is a way to get more oleic acid and essential linoleic acid into your diet.

Full-fat dairy

Reuters/Dominic Ebenbichler

It may seem counterintuitive, but eating more heavy, full-fat dairy products can be a great way to stay healthy and trim.

A study of more than 3,700 healthy adults revealed those who ate more whole-fat dairy were more likely to have higher levels of the fatty acid trans-palmitoleate in their bodies. That, in turn, corresponded with slightly trimmer waistlines, less fat tissue, and more of the good kind of (HDL) cholesterol.

A much larger study of nearly 27,000 people from ages 45 to 74 found that participants who ate more high-fat dairy had the lowest diabetes rates.

“Those who ate the most high-fat dairy products had a 23% lower risk of developing Type 2 diabetes than those who ate the least,” study author Ulrika Ericson said in a statement.

That wasn’t true for people who ate more meat, which was linked to an increased risk of Type 2 diabetes, regardless of the fat content.

Fatty fish like tuna and salmon

This 400-pound bluefin tuna is brimming with healthy omega-3 polyunsaturated fats.
Reuters/Toru Hanai

Fatty fish are filled with essential omega-3 fatty acids that can reduce the amount of fat in your blood, lower blood pressure, and keep your heart healthy.

The American Heart Association recommends adding salmon, mackerel, herring, lake trout, sardines, or albacore tuna to your diet a couple times per week.

Wheat germ


Wheat germ is the meaty inner heart of a wheat kernel – the embryo that germinates to grow into a fully developed plant. Unfortunately, it is often stripped away in the creation of processed foods to help them last longer.

Wheat germ has tons of fiber and boasts some fat, too (about 1.4 grams per cup, most of it unsaturated). Some people sprinkle it on their cereal in the morning, or top fruit or yogurt with wheat germ for an extra nutrient-rich crunch.

Unsaturated cooking oils, especially olive oil


The kind of oil you consume can make a big difference to your heart.

Monounsaturated fats can actively lower your level of the bad (LDL) type of cholesterol. They’re called “mono” because the fat molecules have just one unsaturated carbon bond.

Oils like olive, peanut, and sesame are all high in monounsaturated fat, but there’s a lot of good research behind olive oil in particular.

People who use olive oil in their kitchen instead of going low-fat have been shown to have a lower risk of developing a heart attack, stroke or deadly heart disease. In one long-term study of 145,000 women, those who consumed at least a tablespoon of olive oil every day had a 10% reduced risk of developing adult diabetes.

And of course, avocados

You probably knew that avocado was going to make this list, but do you know why it’s so good for you?
Rob Ludacer

What would a list of healthy fats be without the darling fat of our times, the humble avocado?

A cup of the creamy green fruit has a whopping 14 grams of monounsaturated fat, along with smaller doses of polyunsaturated (2.7 g) and saturated fat (3.1 g).

In addition to fat, fiber, and protein, avocados are a great way to get potassium, which is a natural antidote to salt and can help maintain healthy blood pressure levels.

So go enjoy a little more fat today. Just make sure you’re eating rich, filling, healthy fats that will treat your body right.

Moderate drinking could increase male fertility, according to a new study

Moderate drinking could increase male fertility, according to a new study

Olena Yakobchuk / Shutterstock
  • A new study suggests drinking in moderation could boost male fertility.
  • Men who drank four to seven units a week had higher sperm counts and semen volume.
  • But the study comes with limitations, such as people self reporting their drinking habits.
  • More research is needed to really know what the impact is.

There’s no doubt that drinking too much alcohol is pretty bad for you, but it’s hard to keep up with whether or not drinking in moderation can have positive benefits.

For example, past research has appeared to show how having a few drinks a week may improve heart health. But some studies have since been revised, due to poor methodology or the fact that they were funded by the alcohol industry.

Scientists are trying to clear up the confusion, and one study earlier this year did find people who drink in moderation could actually live longer than teetotalers. And according to a new study, published in the journal Andrology, men who drink around four to seven units of alcohol a week may be more fertile than those who drink less.

The researchers recruited 323 men, about 10% of whom were teetotal, 30% drank one to three units a week, 30% drank four to seven units a week, and the remaining 30% drank more than eight units a week.

According to the results, drinking four to seven units a week was linked to higher sperm count and semen volume. In other words, the men who drank moderately were likely to be more fertile.

The study adds to a convoluted body of research. For instance, one study from 2014 found that sperm concentration and total sperm count were negatively associated with alcohol intake. Another study from 2005 suggested semen volume and sperm concentration were lower in alcoholics compared with abstainers.

“However, in other studies alcohol did not seem to play any role,” Elena Ricci et al wrote in the new paper. “The inconsistency between our findings and previous studies may be due to the different way of categorization of alcohol consumption and to the different drinking habits of the populations studied.”

There’s also the problem with self reporting, which can skew results. People tend to be dishonest – intentionally or not – when they talk about things like their sex lives, drugs, and alcohol consumption.

Ricci said in a statement that in Italy alcohol consumption is common, but usually limited to small quantities, and “since the dose makes the poison, they are counselled to limit but not avoid alcohol.”

Drinking excessively is notoriously bad for health, and has been shown to lower testosterone and sperm levels. But when it comes to drinking in moderation, more research is needed to conclude what the real benefits and costs are.

In terms of fertility, recent research has shown how diet can have an impact. Earlier this year, a study found that eating two handfuls of nuts a day could improve men’s sperm counts. Certain vitamins, such as zinc, have also been associated with women going into the menopause later.

Study finds frequent use of digital media linked to ADHD symptoms in teens

Study finds frequent use of digital media linked to ADHD symptoms in teens

July 19, 2018

Most teens today own a smartphone and go online every day, and about a quarter of them use the internet “almost constantly,” according to a 2015 report by the Pew Research Center.

Now a study published Tuesday in JAMA suggests that such frequent use of digital media by adolescents might increase their odds of developing symptoms of attention deficit hyperactivity disorder.

“It’s one of the first studies to look at modern digital media and ADHD risk,” says psychologist Adam Leventhal, an associate professor of preventive medicine at the University of Southern California and an author of the study.

When considered with previous research showing that greater social media use is associated with depression in teens, the new study suggests that “excessive digital media use doesn’t seem to be great for [their] mental health,” he adds.

Previous research has shown that watching television or playing video games on a console put teenagers at a slightly higher risk of developing ADHD behaviors. But less is known about the impact of computers, tablets and smartphones.

Because these tools have evolved very rapidly, there’s been little research into the impact of these new technologies on us, says Jenny Radesky, a pediatrician at the University of Michigan, who wrote an editorial about the new study for JAMA.

Each new platform reaches millions of people worldwide in a matter of days or weeks, she says. “Angry Birds reached 50 million users within 35 days. Pokémon Go reached the same number in 19 days.”

Research into their effects hasn’t been able to keep pace with the technological evolution, she adds.

“So it’s nice to finally to have some evidence on longer term impact that [these technologies are] having on children,” says Radesky.”I think it shows that something is going on, that there is an association, even if small, between these type[s] of media use habits throughout the day with emerging inattention, trouble with focusing, resisting distraction, controlling your impulses.”

The study followed 2,587 10th graders in schools in Los Angeles county over two years. The teens showed no symptoms of ADHD at the beginning of the study. By the end, teens with more frequent digital media use were more likely to have symptoms of ADHD.

The researchers assessed the students using a standardized questionnaire for ADHD symptoms, including nine symptoms each for inattention and hyperactivity. Students with six or more symptoms in either category were counted as having symptoms of the disorder, based on criteria in the Diagnostic and Statistical Manual Of Mental Disorders.

During the two years of the study, the researchers surveyed the teens every six months and asked them about the frequency of their participation in 14 different kinds of online activities such as texting, sharing on social media and streaming videos or music.

The students reported how many of the 14 activities they did and how often (0, 1-2 times a week, 1-2 times a day, or many times a day). If they did any activity many times, it counted as “high frequency use.”

About half of the students said they check social media sites and text many times every day.

“These results show that teens are really attached to their [digital] technologies, throughout the day,” says Radesky, who wasn’t involved in the new study. “It really captured the pervasive design that so many of these mobile technologies have taken on.”

By and large, students who frequently used six or more activities had a higher likelihood of developing ADHD symptoms.

For instance, among the 51 students who frequently did all 14 online activities, 10.5 percent showed ADHD symptoms over the course of the study. And of the 114 teens who frequently did seven digital activities, 9.5 showed symptoms. In contrast, only 4.6 percent of the 495 kids who didn’t do any of the activities frequently had new ADHD symptoms over the two-year period.

In other words, teens who were high frequency users of seven or 14 digital media platforms were more than twice as likely to develop ADHD symptoms than teens who did not use any media platform at a high frequency rate, notes Leventhal.

He and his colleagues statistically controlled for other potential confounding factors like family income level, race/ethnicity and pre-existing mental health conditions.

Leventhal is quick to caution that his study does not prove that being plugged into their devices caused ADHD among teens. “We don’t know that,” he says.

Showing ADHD symptoms is not the same as ADHD diagnosis,which is a multi-step process that involves a clinician in addition to the questionnaire. The study did not diagnose any of the kids with ADHD.

The study doesn’t prove causation — it finds an association. Still, because the study involved students who did not show symptoms in the beginning, the results give some cause for concern, Leventhal says. “To have 10-ish percent [of the high frequency media users] have the occurrence of new symptoms is fairly high,” he says.

Starting the study with kids who did not have ADHD at baseline was “a smart choice.” notes Radesky. “It helps reduce the chicken and egg situation.”

One of the strengths of the study is that it included a large number of teens from a diverse backgrounds, because “sociodemographic diversity has been a limitation of prior studies on digital media,” she writes in the JAMA editorial.

While the study doesn’t show that all children are at risk of developing problems with attention and hyperactivity, “there is probably a sub-sample of kids who are more vulnerable,” notes Radesky.

For example, the study found that children with mental health problems were more likely to develop these symptoms.

“That’s important because those are the kids who are doing their emotional expression online,” says Radesky. “They might be getting into more drama online, getting into more cyber bullying. And that can definitely be dysregulating and affect your ability to focus on things.”

However, the study did have some limitations, she notes.

“There are other things changing over time that might explain the results you’re seeing,” she says. “In this case, they did not collect data on teenagers’ sleep. They didn’t have information on what the family dynamics were like at home, you know how involved were the parents? … How much media is being used at home by the parents?”

Previous studies have shown that social media use is associated with disturbed sleep, which could itself affect children’s ability to focus in school and that might manifest in ADHD-like symptoms.

Similarly, “the more parents are on their phone, the more teens are likely to be as well,” adds Radesky.

Radesky, who co-wrote the American Academy of Pediatrics’ media use guidelines, says that she recommends parents and their children pause and reflect on how they use media, so children can understand the benefits and pitfalls of their online habits.

“I’d really like teenagers to develop a sense of tech savviness … so they don’t all feel this pressure to be online constantly in order to feel social relevance or acceptance,” she says.

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Category: Features, Health alert

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