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‘I got a whole different face going on’

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The Conversation

A doctor’s open apology to those fighting overweight and obesity

Doctors have told people who are overweight to exercise more and eat less, when in fact their overweight may be due to genetic or other factors that exercise won’t change. UConn Rudd Center for Food Policy & Obesity, CC BY-SAObesity has emerged as a significant risk factor for poor outcomes in patients infected with COVID-19. Based on how doctors and others in health care have previously treated patients with obesity or overweight conditions, my guess is that many will respond by declaring: “Well, it’s their own fault for being overweight!” In the spirit of recognizing that people who struggle with weight loss include our family and friends, let me propose a different sentiment. To those who we have shamed for having excess body weight and/or failing diets: “You were right, and we are sorry. After giving you undoable tasks, we ridiculed you. When you tried to tell us, we labeled you as weak and crazy. Because we didn’t understand what you were experiencing, we looked down on you. We had never felt it ourselves. We did not know. And for that, we apologize.” A nutritionist talks with a patient at an obesity clinic in Mulhouse, France. BSIP/Universal Images Group via Getty Images ‘Fat shaming’ doesn’t work This is just one version of the apology we owe our fellow human beings whom we told to lose weight using diet and exercise. Then, when it didn’t work, we blamed them for our treatment plan failures and smothered their feedback with prejudice and persecution. As a physician and researcher, I have worked in this space for many years. I have witnessed firsthand the life-altering power of preexisting ideas, judgments and stereotypes. I have seen how unfounded, negative ideas are woven through virtually every interaction that those struggling with weight loss endure when seeking help. And there are tens of millions of them. The Centers for Disease Control and Prevention classifies more than 70% of U.S. adults as overweight, and more than 40% as obese. Those numbers continue to climb, and even when some manage to lose weight, they almost always gain it back over time. Rash judgments To illustrate, imagine that I am your doctor. You have a body rash (which represents the condition of being overweight or obese), and you make an appointment with me to discuss a treatment plan. During your visit, my office staff uses stigmatizing language and nonverbal signals that make it clear we are annoyed at the idea of dealing with another rash person. We invoke a set of assumptions that dictate the tone of our relationship, including the notions that you are lazy or ignorant or both. You will sense my disgust, which will make you uncomfortable. Unfortunately, health care providers commonly treat patients who struggle with weight loss by assigning stereotypes, snap judgments and ingrained negative attributes – including laziness, noncompliance, weakness and dishonesty. After this uncomfortable exchange, I will prescribe a treatment program for your rash and explain that it’s quite straightforward and easy to use. I will point you to several resources with pictures of smiling people with beautiful skin who never had a rash to emphasize how wonderful your outcome will be. “It’s just a matter of sticking to it,” I will say. Back at home, you are excited to start treatment. However, you quickly realize that putting on the cream is unbearable. It burns; your arms and legs feel like they’re on fire shortly after you apply the treatment. You shower and wash off the cream. A dismal conversation After a few days, you try again. Same result. Your body will not accept the cream without intolerable burning and itching. You return to my office, and we have the following conversation: You: Doctor, I cannot stick to this plan. My body cannot tolerate the cream. Me: This is exactly why doctors do not want to deal with rash people. I’m giving you the treatment and you won’t stick to it. I put the cream on myself every morning without an issue. You: But you don’t have a rash! Putting this cream on when you have a rash is different than putting it on clear skin. I do want to get rid of my rash, but I cannot tolerate this cream. Me: If you don’t want to follow the treatment, that’s up to you. But it’s not the cream that needs changing. It is your attitude toward sticking with it. This exchange illustrates prejudical behavior, bias and a disconnect between a provider’s perceptions and a patient’s experience. New approaches are needed for those trying to lose weight. Jamie Grill/JGI via Getty Images Prejudice and bias For someone who wants to lose weight, the experience of a diet and exercise prescription is not the same as for a lean person on the same program. Perceiving another person’s experience as the same as one’s own when circumstances are different fuels prejudice and bias. That night, though, you can’t help but wonder: “Is something wrong with me? Maybe my genes or thyroid or something? The cream seems so fun and easy for everyone else.” At this point, the blame unconscionably lands on the patient. Despite an undeniable explosion of this rash, and abysmal treatment adherence rates while we have been touting the cream, we stubbornly maintain it works. If the rash is expanding, and hundreds of millions of people are failing treatment or relapsing every day, well – it’s their own fault! As time goes on, you feel increasingly discouraged and depressed because of this untenable situation. Frustration wears on your sense of optimism and chips away at your happy moments. You have this rash and you can’t tolerate the treatment plan, but no one believes you. They judge you, and say you choose not to use the cream because you lack willpower and resolve. You overhear their conversations: “It’s her own fault,” they say. “If that were me, I would just use the d#$% cream.” This is the very definition of prejudice: an opinion, often negative, directed toward someone and related to something that the individual does not control. Although it has been extensively demonstrated that the causes for overweight and obesity are multifactorial, the myth that it’s the patient’s fault is still widely accepted. This perception of controllability leads to the assignment of derogatory stigma. A setup for failure That evening you sit alone. You think there’s not a single person on the planet who believes your body won’t tolerate this treatment. Society believes you brought this on yourself to begin with; there doesn’t seem to be a way out. We have driven those with overweight and obesity conditions to this place far too many times. We have set them up to take the fall for our failed treatment approaches. When they came to us with the truth about tolerability, we loudly discredited them and said they were mentally weak, noncompliant or lazy. [Deep knowledge, daily. Sign up for The Conversation’s newsletter.] So where do we go from here? If we agree to stop stigmatizing, stereotyping and blaming patients for our treatment failures, and we accept that our current nonsurgical paradigm is ineffective – what takes its place? For starters, we need a new approach, founded on respect and dignity for patients. A fresh lens of acceptance and suspended judgment will allow us to shift our focus toward treatments for the body, rather than “mind over matter,” which is a concept we use for no other medical condition. A perspective based in objectivity and equality will allow caregivers to escape the antiquated blaming approach and perceive those with overweight or obese conditions in the same light as those with other diseases. Only then will we finally shift the paradigm.This article is republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts. It was written by: J. David Prologo, Emory University. Read more:Here’s why we crave food even when we’re not hungryVegetarian and vegan diet: five things for over-65s to consider when switching to a plant-based diet8 simple strategies to fuel your body during a pandemic J. David Prologo does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Would Pence Challenge Trump in 2024?

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Mike Pence spent much of his vice presidency quietly catering to the whims of President Donald Trump. But on January 6, he broke with Trump by refusing to overturn the 2020 election results. And now, Pence is eyeing a presidential run of his own, even though his old boss hasn’t ruled out a 2024 campaign. Pence wouldn’t necessarily stay out of the race even if Trump jumps in.

“If you know the Pences, you know they’ll always try to discern where they’re being called to serve,” Marc Short, Pence’s former chief of staff, told me. “And I don’t think that is dependent on who else is in or not in the race.”

A 2024 Pence campaign looks futile no matter the scenario. If Trump runs, he’ll rally the same MAGA zealots who refuse to believe he lost the last election. And if Trump opts out, Pence isn’t his natural successor; he may have spoiled any hope of inheriting the Republican base when he defied Trump on January 6. Scanning the Republican universe, it’s hard to detect a glimmer of a Pence-for-president movement of any sort. Which leaves GOP operatives asking a version of the same question: What in the world is Mike Pence thinking?

Sarah Longwell is an anti-Trump Republican strategist who has led dozens of focus groups since the 2020 election with hard-core Trump voters, reluctant Trump voters, and 2016 Trump voters who switched to Joe Biden last year. “Pence doesn’t do well with anybody,” she told me. People make faces when she mentions Pence’s name, faces that convey a collective nah. Or maybe meh, she said, thinking it over. But the impression they leave is obvious enough, she added: “Not interested.”

As of this point, Pence hasn’t decided whether to run, his advisers say. For now, he’s focused on helping Republicans win back congressional majorities in the 2022 midterm elections. But he’s also making the sorts of moves that typically precede a presidential bid. Since leaving office on January 20, he’s been showing up in states that hold early presidential contests: New Hampshire, South Carolina, and Iowa. Next month he’s set to return to New Hampshire for a Republican fundraising event. He’s writing a book and has started a podcast, American Freedom, that is a platform to reintroduce himself to voters after four years as Trump’s mostly subservient No. 2. Speaking in a flat baritone, the erstwhile talk-radio host mixes treacly odes to public service with sharp critiques of Biden’s record. One episode devoted to the 20th anniversary of the September 11 terrorist attacks opens with Pence denouncing “the failed leadership of the Biden administration” and closes with a vignette of him and other lawmakers singing “God Bless America” on the steps of the U.S. Capitol after the attacks.

“I will tell you, on that day and in the weeks and months that followed, there were no Republicans in Washington, D.C.,” Pence tells his listeners. “There were no Democrats in Washington, D.C. It was just Americans. Everybody rolled up their sleeves and did what needed to be done.” (Left unsaid is that he later abetted a president who politicized virtually every random bit of human experience, including wearing a mask and watching a football game, and who stirred up the insurrectionists before what was perhaps the most unsettling day on U.S. soil since 9/11.)

Former Vice President Dan Quayle has told me that he advised Pence back in 2012 that if he wanted to run for president, the Indiana governor’s office would be a better springboard than Congress. (Pence campaigned for the statehouse office that year and won.) A cold-eyed political calculus suggests that 2024 would be Pence’s best and maybe last real shot. He’ll be 65 by the next inauguration, and fresher faces are emerging in Republican politics, notably Glenn Youngkin, the incoming Virginia governor who won a state that Biden had captured a year ago by 10 points. “Someone like Glenn Youngkin is the future,” Sarah Chamberlain, the president of the Republican Main Street Partnership, a group that promotes centrist policies, told me. “He would be a wonderful presidential candidate.”

Still, Pence has been mulling a presidential run for years, and such ambitions aren’t easily quashed. He remains in demand for GOP fundraising and campaign events, a means to cement alliances. Some Republicans see a rationale for Pence’s potential candidacy built on his conservative credentials.

Pence’s chances in the ’24 race brighten if Trump stays out. Right now, Trump is sounding like a candidate, though some people who have worked with him suspect he’ll ultimately stand down. “Trump won’t run,” John Kelly, who was Trump’s longest-serving chief of staff, told me. “He’ll continue talking about it; he may even declare, but he will not run. And the reason is he simply cannot be seen as a loser.” John Bolton, who was Trump’s former national security adviser, predicted much the same thing.

Whatever Trump’s future, for Pence to be competitive in a Republican presidential primary race, he’d need to assemble a coalition of fellow evangelical Christians, cultural conservatives, and a chunk of mainstream Republicans who appreciate that he upheld Biden’s victory. Pence’s apostasy on January 6 drew Trump’s ire, but his actions that day helped preserve the notion that voters pick the winners. Is anyone willing to give him credit? Perhaps, but it’s also a fair bet those who might do so still resent Pence for obliging Trump through years of chaos.

It’s hard not to see Pence as the author of his own misfortune. Listening to his podcast, one hears a politician who sounds like a throwback to a pre-Trump era. He criticizes the Biden administration for “one crisis after another” though the twice-impeached Trump presided over the lengthiest government shutdown in history and a pandemic. Pence tsktsks about graffiti scrawled on a federal building in Portland, Oregon, without mentioning that the insurrectionists spread feces through the halls of the U.S. Capitol.

Trump dismantled the Republican Party and remade it into a vehicle for his own promotion. Pence enabled that makeover. Yet he is now acting as if the old establishment party that gave rise to Bob Dole and Howard Baker is still intact and his to reclaim.

“He stood by while the party was actively changed by Trump, and now it’s not interested in politicians like him anymore,” Longwell said.

What, then, is Pence thinking? Maybe that if a former reality-TV star can upend the laws of politics and become president, so can he.

Pence is “one of the most likable people in either party,” Mick Mulvaney, another former Trump White House chief of staff, told me. And yet: “What is Mike Pence offering that 15 other people aren’t offering—other than having been vice president, which I’m not sure is very compelling these days.”

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[18+] Love Lesson (2013) English [Subtitles Added] Web-DL Download | 480p [300MB]

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✅ Download Love Lesson (2013) English [Subtitles Added] available to download in 480p, 720p qualities. 480p in 300MB, 720p in 900MB in MKV Format. This Hollywood movie based on Drama, Adult, Romance . The main stars of the movie are Sun Yeong Kim, Joon-Suk Byun, Ji-hyeok Min.

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Movie Information

Name: Love Lesson

Release Year: 2013

Language: English [Subtitles Added]

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Quick Story Line

Hee-Soo is a lonely composer who is not doing very well with her work. New ideas flow when she meets a high school boy who wants to learn how to play the piano.

Love Lesson (2013) Fancy Walk – An adult rated love lesson between a woman and a boy she runs into. The Korean version of “Private Lessons”. Korea’s most popular song writer Hee-soo (Kim Seon-yeong) runs into a nineteen-year-old boy in the elevator. Hee-soo is inspired by a new song watching him shake at her figure. She starts to tell him about women under the excuse that she’s teaching him music. They fall for each other but things get complicated when her life teacher, Joon-ho who taught her about life and music comes back.

within a prestigious female high school. Right after Yuzuki Muto entered school, she becomes a member of the Torture Club. The club trains students secretly to enter military and police fields as interrogation experts. Senior student Aoi Funaki, who is a member of the club, tortures members including Yuzuki Muto.

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What to know about transmission, vaccine

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Researchers are still learning about Covid’s new omicron variant, but one expert has a stark prediction.

“All the scientists I’ve talked to… are like, ‘This is not going to be good,'” Moderna CEO Stéphane Bancel told the Financial Times on Tuesday.

On Sunday, at least two omicron cases were detected in Canada, marking its arrival in North America — roughly two weeks after the variant was first detected in South Africa, on November 9. White House chief medical advisor Dr. Anthony Fauci said he “would not be surprised” if omicron is already in the United States, in an interview with NBC’s “Weekend TODAY” on Saturday.

The next few weeks will be telling, as scientists analyze how effective the Covid vaccines are against omicron and countries crack down on testing and tracing to identify where the variant is. The World Health Organization said Monday that omicron poses a “very high” global risk.

In the meantime, multiple states have warned people to stay vigilant. New York City is back to “strongly recommending” masks in all indoor public settings, regardless of vaccination status, Dr. David Chokshi, commissioner of the New York City Department of Health and Mental Hygiene, told reporters Monday.

You may have questions about what this means for you. Here’s what you need to know:

WHO.

Most notably, the variant contains “a disturbingly large number of mutations in the spike protein,” Fauci told ABC’s “This Week” on Sunday. The spike protein is the part of the virus that latches onto and penetrates cells in your body, leading to a Covid infection.

Omicron has more than 30 spike protein mutations, compared with the original virus — significantly more than the delta variant. The function of those mutations isn’t fully known yet, but some of them could make it easier for the virus to infiltrate human cells.

The WHO noted on Friday that “infections have increased steeply” in South Africa, in tandem with the discovery of omicron. Only 24% of the population in South Africa is vaccinated, compared to 59% of the U.S. population. Still, other countries can expect a similar pattern to unfold as the variant spreads, Fauci said.

Here’s some potentially good news: So far, omicron hasn’t caused any known deaths, and its symptoms appear to be “extremely mild,” Dr. Angelique Coetzee, chair of the South African Medical Association that discovered the variant, told the BBC on Sunday.

If true, that could mean omicron’s mutations make it more easily transmissible, but less severe. (According to the WHO, there’s no consensus yet that omicron symptoms differ from other variants.)

vaccine-induced protection. Bancel even said he anticipates a drop in vaccine effectiveness.

Researchers will likely have answers within the next two weeks by testing antibodies from people who are vaccinated, and seeing if they are capable of neutralizing the virus. The next steps hinge on these results.

“If those antibodies can neutralize this particular virus… we’re in pretty good shape,” Fauci told NBC’s “Meet the Press” on Sunday. Otherwise, “you’ve got to change and modify what the vaccine is going to be, which you can do pretty easily.”

President Joe Biden instructed the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention to use the “fastest process available without cutting any corners,” to make omicron-specific vaccines available if necessary, in a briefing Monday.

It’s not yet clear who would be eligible for those vaccines, if they eventually get approved.

Moderna says it’s already working on one, which could be ready to ship by early 2022, if necessary. On Monday, Pfizer CEO Albert Bourla told CNBC’s “Squawk Box” that his company is waiting for more data before acting — but could have its version ready in 100 days.

Non-vaccine treatments could also be a mixed bag. Pfizer’s Covid antiviral pill, Paxlovid — which has yet to be approved by the FDA — might work against variants like omicron, because it’s designed to address spike mutations, Bourla said.

But fellow drugmaker Regeneron said Tuesday that its monoclonal antibody cocktail, along with any other similar drugs, could be less effective against omicron than other variants. The company said it’s exploring other alternatives.

Should you wait on getting a booster until there’s an omicron-specific shot?

No. Get your booster as soon as you’re eligible, regardless of any omicron developments. In a statement on Monday, CDC director Dr. Rochelle Walensky specifically cited omicron as a reason why eligible people should get their boosters.

Plus, if the current Covid vaccines prove effective against the new variant, omicron-specific shots may never be deemed necessary. Waiting for that answer is a gamble akin to playing “mind games,” Fauci told “Meet the Press.”

And the longer you wait, the more you risk getting infected by any of the Covid variants currently circulating — including delta, which remains dangerous.

Since the booster shot lifts your body’s level of antibodies high enough to protect against every other known variant, it should give you “at least some degree, and maybe a lot of protection” against omicron, Fauci said.

Weekend TODAY.”

On Monday, the Biden administration restricted most air travel from South Africa and seven other countries: Botswana, Eswatini, Lesotho, Malawi, Mozambique, Namibia and Zimbabwe.

Travel bans cannot completely prevent the virus from entering the country, but they “delay it enough to get us better prepared,” Fauci said. Lockdowns aren’t currently being discussed, Biden said Monday.

Even if omicron gets bad, it probably won’t undo the world’s Covid-fighting progress.

Tests can easily detect omicron, promising therapeutics like the antiviral pills are on the horizon and scientists know much more about the disease than they did in March 2020, Dr. Ashish Jha, dean of the Brown University School of Public Health, tweeted on Sunday.

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