Latest news with #HarvardT.H.ChanSchoolofPublicHealth
Yahoo
2 days ago
- Business
- Yahoo
Heat waves may accelerate the aging process
When you buy through links on our articles, Future and its syndication partners may earn a commission. Every day, Kalpana Suryawanshi, 48, looks into the mirror and whispers, "I look older than my age." Eight years ago, she was diagnosed with Type 2 diabetes. Since then, her health has deteriorated, which she attributes to increased exposure to heat while working in the fields, planting crops, harvesting produce, and carrying heavy loads of cattle fodder. During this time, she frequently experienced dizziness and weakness as temperatures exceeded 40 degrees Celsius (104 F) in her village of Nandani in Maharashtra state, India. Heat is known to affect cognitive function, cardiovascular health, and kidney function, and a growing body of research suggests that exposure to rising temperatures also accelerates the body's aging process. A 2023 German study published in Environment International was the first to find that higher air temperatures are associated with faster aging at the cellular level. It found that prolonged exposure to elevated temperatures can make the body age faster than its chronological age, a phenomenon known as epigenetic age acceleration. Scientists measure this process using epigenetic clocks, which analyze chemical markers called DNA methylation that turn genes on and off. The study found that in areas where the average annual temperature is 1°C higher, people tend to show signs of accelerated aging at the cellular level. When scientists talk about epigenetic age, they measure how old a body is at the cellular level, which can differ from the actual age in years. This is based on changes to DNA called epigenetic markers, the chemical tags that turn genes on or off. Environment, lifestyle, and stress influence these markers. As one ages, the pattern of these chemical tags changes, and scientists use this information to create an epigenetic clock, a tool that estimates biological age. The genes affected by these changes control many vital functions, like repairing cells and tissues and protecting against toxins. When the wrong genes are switched on or off, it can make it harder for the body to repair itself, fight disease, or recover from stress. Over time, these hidden changes can lead to outward signs of aging, such as weaker bones or slower healing. Epigenetic age gives a glimpse into how well the body is holding up on the inside. 2024 was the hottest year on record, with 6.8 billion people worldwide experiencing extreme heat for at least 31 days. One unusual effect of this rising heat is observed firsthand by India's community health care workers, who report that more people appear older than their actual age. Scientists are now also finding the biological mechanisms that contribute to premature aging. Wenli Ni, a postdoctoral research fellow at Harvard T.H. Chan School of Public Health and the lead author of the German study, said heat exposure can induce alterations in DNA methylation, which is a biological process that can influence gene expression and cellular function. She explained that this mechanism can trigger harmful biological processes and accelerate aging. "Heat exposure may also lead to oxidative stress, resulting in DNA damage that could alter DNA methylation patterns and impact aging," she added. Oxidative damage occurs when unstable molecules called free radicals attack cells. They can harm DNA, cell membranes, and proteins, contributing to aging, cancer, and cardiovascular health issues. These results were repeated in Taiwan, where scientists examined over 2,000 people and found high ambient temperature and heat index exposure were linked to increased aging, with stronger associations in prolonged exposure. The study revealed that a 1°C increase in the 180-day average temperature was linked to a rise of 0.04 to 0.08 years in biological age acceleration, as measured by three different epigenetic aging clocks that estimate biological age. Related: Human aging accelerates dramatically at age 44 and 60 While this increase in age acceleration might seem small at first, it's important to consider how these effects can build up over time. Even slight increases in biological aging, when sustained year after year, can add up to several years of accelerated aging. This can mean an earlier occurrence of age-related illnesses. Moreover, when these small shifts affect large populations, they can contribute to a tremendous rise in disease burden and health care costs. A recent study published in Science Advances examined the relationship between heat and aging in more than 3,500 adults aged 56 and above in the U.S. The study found that long-term heat exposure, lasting from one to six years, was associated with epigenetic aging. Persistent exposure to high temperatures can result in frequent sleep disturbances, raising stress and anxiety levels. Over time, this physiological degradation accumulates and may accelerate health decline with age. The German study found that women and individuals with obesity or Type 2 diabetes exhibited stronger associations between air temperature and aging. Women generally sweat less and have different body responses to heat, which can make it harder for them to cool down and sometimes cause their body temperature to rise faster, Ni explained. She also said that studies suggest women have a higher threshold for activating the sweating mechanism at high temperatures, indicating their bodies take longer to start sweating. Diabetes also makes people more susceptible to high temperatures. People with diabetes often have reduced blood flow to their skin, which can interfere with the body's ability to release heat and stay cool in hot weather. Additionally, body fat can act as insulation, making it harder for heat to move from the body's core to the skin, reducing its ability to release heat and stay cool. Epigenetic age acceleration can contribute to cardiovascular diseases, cancer, diabetes, and mortality, putting more pressure on public health care systems. In 2016, Rajma Jamadar, now 47 years old, from Maharashtra's Haroli village, woke up in the middle of the night with irregular heartbeats. The next day, the doctor said that her blood pressure spiked and prescribed lifelong medication. Within months, her symptoms worsened as her cardiovascular health declined. "Upon further diagnosis, the doctor then told me my heart isn't pumping blood efficiently," she said. She prepares meals for 175 children at a public school in her village, but rising temperatures make her job increasingly difficult as the heat from cooking takes a toll on her. "Every day, I feel sick," she said. Remarkably, climate change may sometimes accelerate epigenetic aging in children even before birth. A study published last year in Nature examined 104 drought-exposed children and 109 same-sex sibling controls in northern Kenya. It found a positive association between in-utero drought exposure and aging, emphasizing that the stressors from drought may decrease overall life expectancy. According to study author Bilinda Straight, changes can happen through three key pathways in the body. The first is the immune system, the body's first line of defense that protects one from infections and diseases. The second involves metabolic processes that provide the body with energy. The third is responsible for maintaining and repairing cells in response to stress. "Whether the threat we face is physical or emotional, we still perceive it as a danger to our homeostasis, a health-preserving balance between all our physiological systems," she explained. This suggests that the emotional stress experienced by the women in the study, along with caloric restriction and dehydration, activated systems that help the body manage stress but can harm health if overactivated for extended periods. Women in the study were seen to be engaged in outdoor labor while they were also experiencing hunger and dehydration. "Those physiological stressors were accompanied by worry about the next meal, for themselves, their children, and loved ones," she added. Moreover, social factors like gender inequality exposed women to coercion, overwork, and violence. While farmers risk loss from drought, those in livestock agriculture suffer the emotional and financial toll of watching their animals die. Combined with heat stress, dehydration, and hunger, this creates immense hardship. Eventually, this maternal stress during pregnancy contributes to changes in DNA methylation in their children, Straight said. RELATED STORIES —Biological aging may not be driven by what we thought —Climate change is spoiling food faster, making hundreds of millions of people sick around the world —Climate wars are approaching — and they will redefine global conflict She suggests adequate nutrition and close monitoring of children's cardiovascular and metabolic health. Researchers advocate for long-term studies to better understand the impacts of the environment on epigenetic age acceleration. "Slowing down epigenetic age acceleration is going to be tied to increasing food security and identifying alternatives to women engaging in high-risk occupational labor," she added. Effective policies are needed to achieve food and livelihood security while reducing social and economic inequalities. However, for many women, economic insecurity and the lack of social safety nets make it nearly impossible to prioritize health. Suryawanshi's struggle highlights this problem. So far, she has spent over 600,000 Indian rupees ($7,046) on medical treatment. "I can't afford any more expenses, so I've stopped taking some medicines," she said. She visited eight hospitals in two years to search for an effective treatment. "It's a miracle that I survived. Despite being only 48, I have no strength left, but I still have to work." This article was originally published by Yale Climate Connections.
San Francisco Chronicle
3 days ago
- Health
- San Francisco Chronicle
Too much salt? How sodium consumption varies by culture
It's no secret that adults in the U.S. consume more sodium on a daily basis than what's recommended – often through prepared foods, such as pizza, cold cuts, canned soup and bread. But sodium intake patterns can vary by race and ethnicity, suggesting a need for culturally tailored advice, according to new research. On average, an adult in the U.S. consumes about 3,400 milligrams of sodium each day. That's significantly more than the maximum 2,300 mg – about a teaspoon of table salt – recommended by federal dietary guidelines and the American Heart Association. Excess sodium consumption can increase the risk of high blood pressure, a major risk factor for heart disease and stroke. For adults with high blood pressure, the American Heart Association says the ideal daily limit of sodium is 1,500 mg. "High sodium intake can even affect non-heart-related diseases like kidney disease," lead study author Dr. Jessica Cheng said in a news release. Cheng is a postdoctoral research fellow in epidemiology at the Harvard T.H. Chan School of Public Health in Boston. Cheng and her team used National Health and Nutrition Examination Survey data collected from 2017 to March 2020 to analyze differences in sodium intake by race and ethnicity. Their findings were published May 28 in the Journal of the American Heart Association. The roughly 8,000 survey participants self-reported what they ate in the previous 24-hour period, as well as the type and frequency of salt used in cooking and at the table. Pizza, soup and whole pieces of chicken ranked among the main sources of sodium regardless of the participant's race and ethnicity, researchers found. Tacos, burritos and Mexican mixed dishes – which Cheng said included enchiladas, tamales and chiles rellenos (stuffed peppers) – were among top sources of sodium for Mexican American adults. For Black adults, chicken patties, nuggets and tenders were a unique source of sodium. For white participants, the main sources were cold cuts and cured meats, cheese and mixed meat dishes. Among Asian American adults, four culturally unique foods made up more than 14% of their daily sodium consumption: soy-based condiments; fish; fried rice and lo/chow mein; and stir-fry/soy-based sauce mixtures. About two-thirds of Black participants reported making an attempt to reduce their sodium intake, more than any of the other groups. They also had the highest rate of being advised by a doctor to lower their sodium consumption. The study also found that Asian American adults were most likely to use salt while cooking, but they were least likely to use it at the table. Cheng and her team also examined an assumption within the NHANES database that rice is salted. Changing that assumption to unsalted had little effect for most groups in the study. However, it reduced the daily sodium intake of Asian American adults by nearly 325 mg. Cheng said sodium intake among Asian Americans may have been overestimated because it was assumed salt was added to rice. That assumption led to research that showed Asian Americans have the highest sodium intake of all racial and ethnic groups. However, "culturally, not all Asians salt plain rice. If they don't add salt to rice when cooking, then their sodium intake is among the lowest across all racial and ethnic groups." Dr. Stephen P. Juraschek said the new study raises awareness of how sodium is introduced across cultural groups in the U.S. "Such knowledge is critical for health professionals counseling patients on how they can reduce sodium in their lives and within their families," said Juraschek, an associate professor of medicine at Harvard Medical School and an associate professor of nutrition at Harvard T.H. Chan School of Public Health. He was not involved in the research. Efforts to target sodium reduction "should account for differences among groups and tailor to patients' unique needs," he said in the news release. Cheng agreed. "Researchers, health care professionals and policymakers should help people understand the sodium content in packaged foods, restaurant meals, home cooking and table salt while suggesting methods to cut their salt intake," Cheng said. And lowering sodium intake doesn't have to be difficult, Cheng said. Either use a salt substitute or just vary your diet and add more potassium-rich foods such as vegetables, which can also help reduce blood pressure, she said. "You don't have to avoid pizza completely; eat it less often or try making it at home with low-sodium cheese, dough and tomato sauce you make from scratch."
Boston Globe
4 days ago
- Health
- Boston Globe
The CDC now says healthy kids don't need COVID shots. Is that true?
Get Starting Point A guide through the most important stories of the morning, delivered Monday through Friday. Enter Email Sign Up That discrepancy is at the root of a continuing debate among medical researchers about just how much of a risk COVID poses to children, and whether they should receive annual vaccines against it. Advertisement Many agree that the original course of vaccination offered significant protection against serious illness in children. Data from the CDC shows that two or more doses of COVID vaccines were 40% effective at preventing emergency room visits and hospitalizations among children under the age of 5. But the question of whether children need annual vaccines to protect against the latest circulating variants is more contentious. Advertisement Children might not benefit as much as adults would from a yearly shot because their immune systems can remember vaccinations for much longer, said Dr. Michael Mina, a former professor of epidemiology at the Harvard T.H. Chan School of Public Health who has extensively studied COVID. Another argument against annual shots is that most children in the United States now have some degree of protection from previous infections or vaccinations. Those in favor of annual vaccines for children stress that protection from vaccines or infections wanes over time, especially as new variants emerge, so they can benefit from another dose. And emerging evidence shows that vaccination may protect against long COVID — although that is far from settled science. 'We know that COVID's still out there. We can prevent it, and the vaccine has got no appreciable side effects,' said Dr. Chris Forrest, a professor of pediatrics at Children's Hospital of Philadelphia. 'So I think it's a totally positive value proposition.' This added protection may be especially important for children with underlying conditions, and for those who live with relatives who are older or at high risk of severe illness. 'The more comorbid illnesses the child has, the quicker I would be in general to consider COVID vaccination,' said Dr. Aaron Glatt, chair of the department of medicine at Mount Sinai South Nassau in Oceanside, New York. 'And the reverse would be true. A perfectly healthy 3-year-old, he doesn't have any medical problems, he's had COVID once or twice — I'm not sure that there's any scientific data to support vaccination.' But, he added, 'it doesn't mean that it would be wrong or dangerous to give it.' Advertisement In a still image from video posted to X, Robert F. Kennedy Jr., the health secretary, flanked by Dr. Marty Makary, (left) and Dr. Jay Bhattacharya, who lead the Food and Drug Administration and the National Institutes of Health, announce that the Covid vaccine will no longer be recommended for healthy children or healthy pregnant women. X/NYT Ultimately, doctors said, the question comes down to how families make sense of the risk to their children. Here's what the data shows. How mild is COVID usually for children? It is difficult to get good data on what share of pediatric cases are mild, but doctors say that most children develop few symptoms. Some of the best information on children we have is from 2020, before children had built up widespread immunity from vaccination or infections. A review of studies from that year found that around 4% of children with COVID worldwide developed severe symptoms, which can include difficulty breathing, high fever and chest pain. How likely is it that children will be hospitalized with or die from COVID? Children who have COVID are generally at a low risk for hospitalization. About 234,000 children in the United States were hospitalized with infections between September 2020 and April 2024. Though the virus has led to milder disease over time, children and teenagers still accounted for about 4% of hospitalizations related to COVID between October 2024 and March 2025. The risk is higher for babies younger than 6 months. From October 2022 to April 2024, young infants were more likely to be hospitalized than any other age group apart from adults 75 and older. Pediatric COVID deaths are very rare. Provisional data from the CDC shows that more than 1,800 children in the United States have died from has said that more than 17,400 children and adolescents under 20 years old around the globe have died from COVID. Are only children with underlying health conditions falling seriously ill? In an April appearance on Fox News, Kennedy said that some children with 'very profound morbidities may have a slight risk' from COVID but that 'most kids don't.' But CDC data from July 2023 to March 2024 found that half of children who were hospitalized because of COVID had no underlying medical conditions. Advertisement It is true that underlying health conditions like obesity, diabetes, heart disease and chronic lung diseases raise the risk of hospitalization. Children with these and other conditions will still be able to be vaccinated. But the increase in risk isn't small. Research has shown that young people with at least one underlying condition are 28% more likely than those with no underlying conditions to end up in critical care with COVID, and are 125% more likely to die from it. The more underlying conditions a child has, the greater the risk. Related : A review of data on 183 pediatric COVID deaths from 2020 to 2022 found that 32% of children who died did not have another medical condition. Does vaccinating pregnant women protect infants? Kennedy also announced Tuesday that the CDC will no longer recommend that healthy pregnant women be vaccinated against COVID. Pregnant women are at a far higher risk of severe disease from COVID. Vaccinating pregnant women also reduces the risk that their infants will be hospitalized from COVID. Babies under 6 months are at higher risk of hospitalization from the disease, in part because their immune systems are so fragile, and they are not able to be vaccinated. What about the risk of myocarditis? Kennedy has claimed that COVID vaccines have 'huge associations' with types of heart inflammation, called myocarditis or pericarditis. The shots have been linked to this issue in rare cases, particularly among adolescent boys. Most instances of myocarditis associated with vaccines have been mild. One analysis of nearly 4 million people who received booster shots found 28 instances of probable or confirmed myocarditis, all of which resolved quickly. Advertisement COVID-19 vaccines note the minor risk of heart inflammation to young men on their warning labels. Last month, the FDA told Pfizer and Moderna to broaden that warning to include boys and men between the ages 16 and 25, citing data that showed about 38 cases of heart inflammation per million doses among this age group. Research has consistently shown that the virus itself is far more likely to cause this inflammation. One review found that the risk of myocarditis after infection was more than seven times greater than the risk after vaccination. What's the risk of long COVID? Estimates of long COVID among children vary widely. But even at the lower end, studies show that around 1% of children in the United States, or roughly 1 million children, have ever had long COVID, broadly defined as symptoms that persist or emerge at least three months after an infection. These include many children who had mild or asymptomatic infections. The condition commonly causes children to experience fatigue, dizziness, shortness of breath, and trouble concentrating and sleeping. 'We see kids that are having huge impacts on their everyday activities. They can no longer go to school because they're having such profound fatigue or other symptoms,' said Dr. Laura Malone, director of the Pediatric Post-COVID-19 Rehabilitation Clinic at the Kennedy Krieger Institute. 'These kids are not able to play sports or go to their school dances,' she added. This article originally appeared in .
Yahoo
6 days ago
- Health
- Yahoo
Health officials investigating reasons for chemical spill that is impacting community: 'These ... just don't disappear'
Most people in Harpswell, Maine, had no idea anything was wrong until they were told not to eat the fish. A firefighting foam spill months earlier had quietly made its way into the water, and the chemicals were persistent. Locals are asking why it took so long to find out, and what it means for their health moving forward. Environmental officials in Maine are still assessing the fallout from the state's largest recorded spill of PFAS (per- and polyfluoroalkyl substances) months after it happened. As News Center Maine reported, a malfunction at the former Brunswick Naval Air Station caused more than 50,000 gallons of water mixed with PFAS-laden firefighting foam to spill. The contaminated runoff traveled through storm drains and ponds before reaching Harpswell Cove. "These chemicals just don't disappear; they stay around, but the ocean is a big body of water, so it dilutes them," said senior research scientist Christoph Aeppli. According to the Harpswell Anchor, tests later revealed PFAS levels in the cove had jumped to 70 times higher than what was recorded just two years earlier. State agencies issued a warning against eating fish from the area, and community members are now worried about the safety of the water and wildlife they rely on. PFAS are often called "forever chemicals" because they don't break down naturally. Do you worry about having toxic forever chemicals in your home? Majorly Sometimes Not really I don't know enough about them Click your choice to see results and speak your mind. They are used in a diverse range of products and substances, from cookware to firefighting foam. These synthetic compounds have been linked to serious health problems, including cancer, liver damage, immune system harm, and reproductive issues, as Harvard T.H. Chan School of Public Health observed. These chemicals can build up in fish, soil, and drinking water. In the case of Harpswell Cove, nearby residents are concerned about what long-term exposure could mean for their health. According to the Environmental Working Group, 2,719 U.S. communities have documented PFAS contamination, and many of them are still waiting for cleanup plans or drinking water protections. In response to the Brunswick spill, Maine's Department of Environmental Protection has launched an investigation and stepped up water testing in the area. The U.S. Navy, which operated the former airbase, is also under pressure to expand cleanup and monitoring plans. Meanwhile, local environmental groups are conducting independent sampling to hold agencies accountable and track the spread of contamination. On the policy front, Maine has passed some of the nation's toughest PFAS laws, including a ban on most PFAS-containing products by 2030. More states are following suit, and the EPA finalized federal drinking water standards for six PFAS compounds, which will require utilities to start testing and filtering for them in the coming years. At home, you can help protect yourself by using water filters certified to remove PFAS and checking for contamination in your area through your state's health department or the EWG's tap water database. Taking action to educate yourself on toxic chemicals like PFAS and the health risks that come with them is one small but powerful step toward building a healthier, more resilient future. Join our free newsletter for good news and useful tips, and don't miss this cool list of easy ways to help yourself while helping the planet.
Daily Mirror
21-05-2025
- Health
- Daily Mirror
Weight loss method backed by Dr Michael Mosley and loved by Davina McCall
Intermittent fasting is popular with celebrities from Davina McCall to Jennifer Aniston and current research suggests it's more effective for weight loss than regular dieting Celebrity fad diets come and go, from Atkins to Keto, but one weight loss method seems to be sticking around for the long haul: intermittent fasting. There are several ways to utilise this technique, whether it's on a day-to-day basis - the 16:8 method - or structured around your week - the 5:2 method. Proponents of intermittent fasting are varied, with the likes of Davina McCall, Chris Moyles, Jennifer Aniston, Kourtney Kardashian, Scarlett Johansson and Wolverine himself Hugh Jackman all using this method at one point in their careers. But does it work? And what should you look out for? While fasting can seem scary, research on the topic seems to indicate it's more useful than regular dieting for weight loss. There are also a multitude of different ways to help people on their weight loss journey, including intermittent fasting tracking app Simple. Utilising the 16:8 method, it allows people to track their food intake, build meal and exercise plans, and also get help from their AI assistant, Avo. Here's everything you need to know about intermittent fasting. What is Intermittent Fasting? There are two major ways to use intermittent fasting to help with weight loss. One of the most popular ways is the 5:2 diet, which was popularised by the late Dr Michael Mosley in his book The Fast Diet. This includes picking two non-consecutive days to eat 500 calories (for women) or 600 calories (for men), while hitting your regular calorie count on the other days (2,000 recommended for women; 2,500 recommended for men). Otherwise there's the 16:8 method, where you fast for 16 hours - which means only having water, black coffee or plain tea - then eating in the other eight hours of your day. This is the technique promoted by Simple, but can be tracked using other apps like MyFitnessPal and Hevy. Does the 16:8 method work? There are multiple studies indicating 16:8 works better than regular dieting, as well as linking it to other health benefits like reducing obesity and promoting a healthier gut microbiome. One advantage of 16:8 is the ease of which people can do it. Speaking to Harvard Health Publishing, Dr Frank Hu - professor of nutrition and epidemiology at Harvard T.H. Chan School of Public Health - said: "The 16:8 schedule is often easier to follow, since you sleep for about half of the fasting period. You just don't eat after dinner — no nighttime snacking — and either skip or postpone breakfast." Dr Hu also mentions the fasting schedule can help kickstart ketosis - the process where the body burns stored fat after running out of glucose. He adds: "Sixteen hours of not eating is sufficient for some people to start producing ketones or go into ketosis." Meanwhile, a study published on the USA's National Library of Medicine showed intermittent fasting is equally as effective for weight loss in those who are overweight and obese. Combined with the ease of which 16:8 can fit into your schedule, this makes a strong case for the method. However, long-term effects still need to be studied. One study did suggest your weight loss can plateau after six months, with the researchers suggesting this can be down to how well your body adapts to eating patterns. Also, intermittent fasting is not suitable for the elderly, those under the age of 18, people on certain medications and those with disordered or unhealthy eating patterns. Success stories One proponent of intermittent fasting is Davina McCall, who told Women's Health UK: "I used to snack all evening and didn't see anything wrong with it as I was reaching for healthy foods, such as carrots and hummus… Since putting a cut-off point on my eating, I crave (snacks) so much less and wake up feeling better." Simple has a multitude of success stories on their site. One woman named Debi dropped from a size 20 to a size 12 and lost 76lbs (or 5.4 stone) using the app. She said: "I went from a size 20 to a size 12, which is amazing. I still have 24lbs to go until I get to my goal of 140. But more importantly, I feel fabulous." Meanwhile, mum-of-two Laci Gilbert dropped 115lbs with the app by tracking her food and using wall Pilates via Simple. Available on Apple and Android, the app requests an extensive survey of users' lifestyle in order to create a tailored regime for them. She said: "It has changed my life and I'm so grateful for it. As working mums, wives, mothers, life takes over and sometimes we don't have time in the evenings to get to the gym or just don't feel like moving. The Simple App gives you a no-excuse reason to get up and move, especially when you can do it at home with no equipment." Real Simple users are featured who have been compensated for their honest testimonials. Results may vary. Shoppers can read The Mirror's review of the Simple app here with writer Tom Capon losing 43lbs in eight months using intermittent fasting. Simple app reviews The app boasts a 4.3 out of five stars on Trustpilot from over 29,000 reviews. One person shared: "This is the only plan that has worked for me. Tried several in the past and nothing has worked for me. Easy meal plans based on the foods I like. Workouts are designed for me based on my limitations. If I have a question about serving size or help with my workouts it gets answered immediately." A second wrote: "Love the app, easy to use. Positive helpful AI support. Doesn't over complicate things, eg counting calories or worrying about portion size. If you are dishonest it is only with yourself." Not everyone found it useful, as one user found the Simple App to be a bit tricky: "Not the easiest to navigate to log food or activity from the day before." Another agreed, simply stating: "It's too complicated." However, someone else said: " This app is amazing. It has kept me way more engaged than any other dieting app I've tried. It is super helpful and I love the feature of chatting with coach Avo, who always has the answers and suggestions I need to keep going."
