As world's hunger worsens, vast supplies of U.S. aid remain stranded
And Mana Nutrition's warehouse holds plenty more of the peanut paste, a crucial element in treating malnutrition. A $50 million supply has been stacked for months in the nonprofit's facility in Pooler, a short drive from Savannah, caught in the chaos as the Trump administration upended foreign aid and never shipped.
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Skift
12 minutes ago
- Skift
'Never Seen a Drop Like This:' U.S. Politics Drive Meeting Attendees Away
The sharp decline in global attendance at a recent international medical congress is more than a one-off, it's a red flag. As political rhetoric escalates, the U.S. is becoming a less viable destination for truly international meetings. Attendance at the International Society on Thrombosis and Haemostasis Congress in Washington, D.C. this June fell well below expectations, a warning to organizers who rely on the U.S. as a global meetings hub. The group expected 6,000 attendees, but just 4,500 showed up. Canadian participation alone plummeted 55% from the 2023 meeting in Montreal, while attendance from the UK, France, and the Netherlands was down nearly 30%. An additional 500 U.S.-based registrants was not enough to compensate for the decline in international participation. 'We have never seen a drop like this,' said Thomas Reiser, executive director of ISTH. 'Our numbers are very low for a truly international congress.' In total, 55% of attendees came from outside the U.S., a drop from the typical 75%. U.S. Political Climate a Deterrent A mix of factors drove the decline, said Reiser. The biggest was a growing discomfort with the U.S. political environment. In addition, some European countries as well as Canada have issued advisories for travelers to the U.S., and some international scientific organizations have recommended against sending researchers to the U.S., said Resier. 'U.S. politics, more so than geopolitics, although the Middle East conflict also played a role, particularly with the U.S.'s greater involvement in the weeks before the congress had an impact. We received information from quite a few members in particular, Canada, the UK, and Western Europe, typically some of the strongest membership and registration countries, that either they themselves did not feel comfortable attending or their institutions had travel advisories, including recommendations not to go to the U.S.,' said Reiser. Although actual travel and border entry went smoothly for those who attended, perception damage had already been done. 'Media reports about possible questioning, detentions, and refusal of entry into the U.S. did not help,' he said. Revenue Takes a Hit The consequences are not just a decline in attendees. 'We heard from several participants, exhibitors, and sponsors that they would have expected higher numbers overall,' said Reiser. 'With an overall reduction in numbers of an estimated 20 to 25%, this of course has a significant financial impact on the meeting and the society. This may also have a bit of an impact on future congresses, if sponsors and exhibitors believe our registration numbers are closer to 4,500 than 6,000.' Next year's meeting will be in Paris. The 2027 meeting, which should be in North America due to event rotation, is under review. 'We're in the midst of considering whether the U.S. is the right destination for an international meeting like ours,' Reiser said. 'It's an unfortunate situation. The way the U.S. is perceived is having a real impact in the scientific space.'
Medscape
12 minutes ago
- Medscape
I Prescribed a GLP-1. Now What?
This transcript has been edited for clarity. We've got another really important one today. We're going to discuss the new joint recommendations from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and the Obesity Society around nutrition and exercise for people prescribed GLP-1 therapy for obesity. This is a critically important area, as GLP-1 receptor agonists and the GLP-1/GIP dual agonist have become one of the most common medicines that we prescribe. These medicines are powerful and can lead to 15% to 22% weight loss with semaglutide and tirzepatide, respectively. A level of weight loss that I'll venture to say we did not imagine could have been possible just a few years ago. But as Spider-Man once famously said, 'With great power comes great responsibility.' We need to make sure we're spending the time that it takes to give proper advice to patients about nutrition and exercise if we want our patients to achieve the optimal health outcomes that they can get from this class of medicines. GLP-1 receptor agonists and the GLP-1/GIP dual agonist have absolutely changed the landscape for treating overweight and obesity but also come with powerful side effects, both short- and long-term. On the good side, these medicines are clearly metabolically healthy. They lead to a decrease in LDL cholesterol and triglycerides, improvement in HDL cholesterol, decreased blood pressure and blood sugar, as well as decreased vascular events in those with existent ASCVD and even improvement in arthritis pain, resolution of obstructive sleep apnea (in half of the people with OSA and obesity that were studied in an important study), and improvement in fibrosis in MASH. Nonetheless, the GLP-1s need to be used carefully and our advice is critically important if the promise of these medicines is to be fulfilled. Prior to starting weight-loss medicines, a comprehensive weight history should be taken, including asking about identifiable influences to gaining weight. We also need to look for evidence of eating disorders, which would affect the decision of whether to start an appetite-suppressing medicine, as well as influence the way that we're going to monitor people once they're on it. In addition, we should ask about mood disorders because weight loss can either exacerbate or improve depression. Finally, ask about risk of sarcopenia and assess for risk of sarcopenia, which is more common with increasing age, chronic illness, and sedentary lifestyles. Let me now discuss symptomatic side effects. First, after starting a GLP-1 receptor agonist, about a third of people during the first 1-3 months will have some degree of nausea, vomiting, diarrhea, or constipation, which are usually described as mild to moderate in degree. In order to mitigate those GI side effects, we can remind people of a few tricks. Eat small meals frequently rather than just one or two large meals a day. Avoid greasy or fatty foods. Practice mindful eating — always has been important, still is. Things like eating slowly and making sure to stop eating when you begin to feel full. In addition, it's important to remind people to consciously stay hydrated because along with suppression of appetite, there can be alterations in thirst mechanism, which is particularly important this time of year. For people who are experiencing a lot of GI side effects, a slower dose titration can be helpful. If nausea is a challenging issue, antinausea medicines, such as prochlorperazine or ondansetron, can be prescribed to help people get through the first few months. If constipation is an issue, increasing fluids and fiber can be encouraged and medications such as polyethylene glycol can be used. Let's move on, now, to potential for nutritional deficiencies. When you decrease the amount you eat substantially, you can decrease the amount of vitamins and minerals that you get. Advise patients to eat nutrient-dense, minimally processed foods, including fruits, vegetables, whole grains, legumes, lean proteins, nuts, and seeds. Supplementation can be considered for at-risk nutrients, such as vitamin D, calcium, and B 12 — or just recommend a multivitamin with minerals. Preservation of muscle and bone is critical. Rapid weight loss can lead to loss of both fat and lean body mass (that is, muscle mass). About a quarter of all the weight that is lost on GLP-1s comes from muscle. It is not the medicines, though, that caused the loss of muscle. It's the rapid weight loss. That same thing happens with a very low-calorie diet, bariatric surgery, or medications. To mitigate the loss of lean body mass, two things are important. The first thing is nutrition. The second thing is exercise. When you're in a calorie deficit, your body needs to get sufficient amino acids to preserve and build muscle mass. While the recommended daily allowance for protein in adults is 0.8 g/kg/d, when someone is at a significant calorie deficit, a higher intake of protein is recommended. There's not clarity in the literature as to the correct amount of protein. Some recommendations actually go up to 1.2-1.6 g/kg/d during active weight reduction. Some experts recommend protein needs to be calculated based on total weight; others recommend based on lean body weight. There's a lack of clarity here. As a reasonable compromise to these varied recommendations, I usually recommend that patients take in about 0.4-0.5 grams of protein per pound of body weight during weight loss. This means that a roughly 200-pound individual should aim to get about 70 or 80 grams of protein daily. Don't fret over the exact amount, but just make sure that you're not way undershooting the right amount. The reality here is that this often requires planning in order to achieve adequate protein intake. I usually recommend to patients that they can try a protein shake in the morning to help them achieve their protein goals. The advisory emphasizes that lower-volume nutrient-dense protein foods can be encouraged. Things like fish, eggs, Greek yogurt, cottage cheese, nuts and seeds, chicken. I want to emphasize that protein alone, though, is not going to be enough to help preserve muscle mass. You need to do resistance exercises, as well. As for bone health, the relationship between GLP-1 use and bone density is complex and unclear. There's some evidence that GLP-1s may actually protect bone density, while it is clear, though, that rapid weight loss leads to a loss of bone density. What is clear is that exercise is critical for the preservation of both lean body mass — meaning muscle — and bone density. So, putting it all together: When GLP-1s or dual agonists are prescribed, in order to have optimal outcomes, they should be prescribed with an exercise program, aiming for strength training at least three times weekly, plus at least 150 minutes of moderate-intensity aerobic exercise weekly, as well, to preserve muscle and bone mass. This is not easy. I'm not saying it is. I am saying it's important. A dietitian can help with nutrition, and a personal trainer or YouTube videos are also resources for learning how to do strength training — that is, resistance exercises. Finally, for a variety of reasons, people often stop taking GLP-1s. It's clear that most people will put weight back on. Maybe not everyone and maybe not all of the weight — that's going to depend on how you approach these lifestyle issues. When you gain weight back, unless you're exercising you will not gain back muscle that has been lost. And muscle is important for health. It's important to utilize the time on the medications to reinforce healthy habits, healthy food choices, and regular exercise, because doing so increases the likelihood of success in keeping at least some of the weight off and diminishes the loss of bone and muscle over time. These are powerful medicines. And to make the best use of them, and for patients to achieve the best outcomes, requires input from us, as clinicians, for a significant commitment on the part of patients to do the work, as long as we provide the knowledge in order to achieve those outcomes. I'm interested in your thoughts. For Medscape, I'm Dr Neil Skolnik.
Forbes
13 minutes ago
- Forbes
Let's Preview 2026 Medicare Part D Premiums, Costs; Prepare To Pay More
The Centers for Medicare and Medicaid Services has started releasing information about the 2026 costs and changes to Medicare. One of the first notices addresses Part D prescription drug plans. Five facts apply to most Medicare beneficiaries who have this Inflation Reduction Act limits the increase in the base premium to 6% and that is exactly how much it will increase next year. This premium factors into what enrollees pay but plans determine their specific premiums. It's unlikely anyone will be paying $ who go more than 63 days without creditable prescription drug coverage pay a penalty for the life of Part D coverage. It is 1% of the base premium, $0.3899 in 2026, for every month Part D enrollment was delayed. An example: A person who did not enroll for three years will pay an additional $14.40 (rounded to the nearest dime) every month. That's $1.15 more per month than in $25 increase is less than the $45 that happened this year. Plans can charge any amount up to the standard deductible.A quick review will help explain this change. With the introduction of the $2,000 cap on Part D drug costs in 2025, CMS feared there would be significant increases in Part D premiums. In response, CMS conducted a voluntary premium stabilization demonstration. This demonstration applied a $15 reduction to the base beneficiary premium and limited premium increases to $35. In 2026, the subsidy will continue; however, it will be $5 less than this year. Premium increases will be limited to $50, up from $35 in 2025. Those with Part D plans will likely face sticker shock. This likely won't happen to those with Medicare Advantage plans. The government provides subsidies in the form of rebates. In 2025, plans received more than $500 per enrollee to lower or reduce Part D premiums and offer supplemental Part D benefits. Over 75% of enrollees pay no monthly premium for their Medicare Advantage plans with no or lower drug plan is a bit of good news amidst all the cost increases. The most anyone will pay for covered Part D drugs from an in-network pharmacy will increase $100 from year, I repeatedly said the Open Enrollment Period would be the most important ever. And once again, in January, I heard from those who did not pay attention. They were stuck with higher costs that could have been avoided had they followed my advice. In about seven weeks, plans will send out the Annual Notice of Changes. Please open and review that closely. Then, take the time to check out what other plans have to offer. And, if Medicare Advantage looks attractive, go beyond the drug plan premium to determine how that coverage will work for you.
