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Validity of claims made in weight management research: a narrative review of dietetic articles
Nutrition Journal volume 9, Article number: 30 (2010)
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The best available evidence demonstrates that conventional weight management has a high long-term failure rate. The ethical implications of continued reliance on an energy deficit approach to weight management are under-explored.
A narrative literature review of journal articles in The Journal of Human Nutrition and Dietetics from 2004 to 2008.
Although the energy deficit approach to weight management has a high long-term failure rate it continues to dominate research in the field. In the current research agenda, controversies and complexities in the evidence base are inadequately discussed, and claims about the likely success of weight management misrepresent available evidence.
Dietetic literature on weight management fails to meet the standards of evidence based medicine. Research in the field is characterised by speculative claims that fail to accurately represent the available data. There is a corresponding lack of debate on the ethical implications of continuing to promote ineffective treatment regimes and little research into alternative non-weight centred approaches. An alternative health at every size approach is recommended.
The assessment and management of body weight is a major preoccupation of contemporary UK health policy. Clinical interventions focus on achieving energy balance deficit and are premised on claims that excess weight/fatness (body mass index (BMI) > 25) is a significant direct cause of morbidity and mortality and, correspondingly, that weight loss in fat ('overweight' or 'obese') people will reduce risk and/or improve health outcomes. Yet at the same time, reputable organisations continue to urge caution with regard to the evidence base presumed to underpin these tenets. Thus, epidemiological data from the Center for Disease Control highlights that "even severe obesity failed to show up as a statistically significant mortality risk" and confirmed previous findings that 'overweight' people live slightly longer than people of 'healthy' weight [1]. In addition, there is a growing inter-disciplinary literature [2] that contests the effectiveness of a weight-centred approach to health and draws attention to the ethical implications of unintentional outcomes. The vigorous scientific debate on approaches to healthy weight is inadequately represented in research. It could be said that weight loss enjoys special immunity from accepted standards in clinical practice and publishing ethics. This paper analyses a selection of dietetic research articles to assess practice in the area.
The purpose of this review is to evaluate the validity of claims made by weight loss researchers. A purposive sample was chosen: all articles published in The Journal of Human Nutrition and Dietetics between January 2004 and December 2008 in which the main focus was weight loss are included in the analysis. The Journal of Human Nutrition and Dietetics is the official journal of British Dietetic Association and as such is internationally regarded in the field of nutrition and dietetics. All articles are peer reviewed by two or more reviewers at least one of whom is a dietitian with a track record in publishing. Articles appearing in the journal can therefore be said to be representative of the best contemporary scientific research into weight management. The journal was hand searched and a total of 15 articles obtained. For ease of reference, these are indicated by the prefix 'J' where they are referred to throughout this article, eg. J[1]. The sample included an anniversary issue of the journal in which past influential papers were republished.
A narrative review was undertaken in which references to benefits or effectiveness of weight loss behaviour, or other justifications for intervention, in the selected articles were scrutinised for fitness for purpose. Effectiveness and other justification for intervention was chosen because a credible rationale for treatment is a prerequisite of ethical practice. Secondly, articles were reviewed for the rigour of reporting of adverse events and discussion of risk benefit. This is because it is an ethical requirement for recommendations for treatment to take account of any adverse effect and risk benefit. Thirdly, the appropriateness of any links made between recommendations and evidence were assessed. This was to ascertain to what extent recommendations accurately reflected research findings and to identify any role played by the dominant obesity discourse in influencing researchers' conclusions.
Justification for treatment: implicit beliefs about weight loss and health
In the UK, a plethora of national anti-obesity documents recommend individual and population-level strategies to help people maintain a weight deemed healthy, usually categorised as having a body mass index (BMI) of 20-25. Weight management advice is typically justified by claims that weight loss will yield a range of benefits from improved metabolic fitness through to relief from musculoskeletal conditions and less discrimination. The belief in the value of weight loss is so firmly held that the rationale for intervention may not always be explicitly articulated. There is also concern that if no action is taken the population will become inexorably fatter.
This section investigates some of the common implicit justifications relied on when promoting weight loss. In several instances, a secular rise in population BMI is the sole justification for intervention J[3], J[4]. In other cases, the supporting rationale is high numbers of referrals for dietary weight loss and acknowledgment of treatment ineffectiveness J[5], J[6]. In the absence of further explanation or information on BMI and health, and likely outcomes of weight loss, these justifications rely on readers unequivocally accepting the dominant position on body weight, health and dieting, namely, that high BMI is a reliable indicator of poor health and weight loss a reliable remedy. This contrasts with the usual requirements of the scientific convention that assumes clear justifications for treatment are required.
Justification for treatment: overall benefit
Obesity discourse, as reflected in the papers reviewed previously, provides examples of implicit justifications for treatment which are presented without an explicit, scientific rationale. In addition, it is not unusual to find claims of non-specific 'health benefits' which are not substantiated. In particular, the advice that clinically significant health improvement can result from a 5-10% loss of body weight is well rehearsed by researchers in the field and maintains a pervasive presence in anti-obesity campaigns and policy [7, 8] and it is therefore not surprising to see it reiterated by studies included in this review.
The 5-10% weight loss target appears in a paper included in the review J[9] that reports a preliminary evaluation of men-only dieting groups. Authors claim that 'there are clear benefits to treating obesity' continuing that even modest weight reduction has beneficial effect. This latter claim is corroborated by citing Goldstein, 1992 [10], which as discussed in the following section, does not provide substantive justification for instituting weight loss interventions. The '5-10% weight loss' theme (in J9) is referenced to a document by the United Kingdom (UK) National Obesity Forum that claims health benefits but does not in turn supply any original source. Here, as illustrated elsewhere in the review, it appears that beliefs about weight and health acquire a truth status so that they circulate as intuitively appealing 'facts', immune from scrutiny and become used, and accepted by editors, without supporting references.
Justification for treatment: regulation of blood lipids and blood pressure
More specific health benefits of losing 5-10% of body weight are given in anti-obesity documents and are repeated in some of the papers reviewed. Thus, a team of researchers from a UK anti-obesity research programme known as the Counterweight project J[11] recommend 5-10% weight loss for improvements in blood lipids, blood pressure, diabetes prevention and overall reduction in mortality.
In this section I will appraise three articles used by the Counterweight team to support claims that modest weight reduction improves blood lipid profiles and helps manage blood pressure. The authors of paper one [12] state that their meta-analysis indicates that weight reduction through dieting can normalise blood lipids. However, this conclusion contradicts their own observation that "it was impossible to identify the independent influence of dietary fat on changes in lipids and lipoproteins" (p 325). Moreover, further qualification is warranted due to the scope of the 70 studies included in their meta-analysis of which 67% had 20 participants or less, 35% lasted for 10 weeks or less and 82% had no control group.
A second paper [10] discussing the beneficial effects of weight loss on, among other indictors, blood pressure and blood lipids, is also inaccurately appropriated by the Counterweight project team. Studies on the effect of weight loss on blood pressure and blood lipids include those involving medication, exercise, salt restriction and other dietary modification. This means that the results do not in fact demonstrate the independent effects of weight loss on measured outcomes. As participant numbers in individual studies were typically small and studies were of short duration, a more circumspect interpretation of the results would seem justified.
The scientific merit of a third paper relied upon [13] can be discounted as authors neglected to include any methodology.
Justification for treatment: Prevention of diabetes
Another common justification for weight management is its role in the prevention of diabetes [7], a claim I explore in this section.
Where the Counterweight project team J[11] makes claims for the role of weight loss per se in preventing diabetes, the cited articles are found wanting. The authors of one paper[14] note that their study does not demonstrate the effect of weight loss, as represented by the Counterweight project team, but demonstrates the effect of lifestyle intervention which included a significant increase in participants' exercise levels, a variable strongly associated with improvements in insulin resistance. Likewise, the second paper used by the Counterweight team [15] reports that ' The reduction in the incidence of diabetes was directly associated with changes in lifestyle' again including significantly increased exercise levels. A more detailed reading of the results indicates that, on the one hand, weight loss in the absence of change in exercise levels (change in other variables cannot be determined from the data presented so results cannot be confidently attributed to weight loss alone) did occur, with impact on incidence of diabetes. ('The odds ratio for diabetes in subjects in the intervention group who had lost more than 5 percent of their initial weight by the one-year follow-up visit was 0.3 (95 percent confidence interval, 0.1 to 0.7)'), However, changes in exercise levels led to more favourable outcomes:
Among the subjects in the intervention group who did not reach the goal of losing 5 percent of their initial weight, the odds ratio for diabetes in those who had achieved the goal with respect to exercise (more than four hours per week) during the first year was 0.2 (95 percent confidence interval, 0.1 to 0.6).
This finding is not further discussed by the Counterweight project team and so the benefits of health behaviour change are submerged in favour of weight-centred outcomes, a theme which I will develop later. In addition, there is no comment on the high quality evidence that weight loss at one year is almost invariably followed by weight regain [16].
Effectiveness: success and failure in weight loss and health improvement
As I have discussed earlier, the dominant view in current obesity discourse asserts that weight loss per se is synonymous with improved health. This position is necessarily underpinned by the belief that weight loss is possible. The linked ideas, that weight loss is a reliable, effective method for improving health are the topic explored in this section.
Some studies included in the review used weight loss as an end in itself J[9] with no attempt to measure other specific clinical outcomes, change in diet and exercise behaviours, or to collect qualitative data on participants' views and experiences (or adverse effect). In this way, the discourse valorises the pursuit of thinness as a health goal in itself, paying little attention to the processes by which this may be achieved. This is problematic for three reasons.
First, the focus on weight loss as a primary goal overlooks the clinically significant benefits that can be expected through change to diet and exercise patterns independent of weight loss [17, 18], for example, how a focus on weight obscures health benefits of improved fitness on diabetes prevention. Second, it detracts attention from the reality that weight loss may be achieved at the expense of health: Green and Buckroyd J[19] explain the role of disordered eating behaviours among 'successful' dieters. Third, the focus on attaining one specific body size over another raises ethical issues [20]. Researchers included in this analysis work within a particular framing of fatness as always pathological ie. 'obesity' and some articulation of the value judgements inherent in this position would help the reader assess scientific merit.
Some studies in the review that rely on weight change as the primary variable do not include details of any co-morbidity or explicitly refer to weight loss attempts by people who have no co-morbidities J[9],J[21]. In such cases the authors appear incognisant of the literature relating intentional weight loss in healthy people with increased mortality [22] as there is no discussion of the ethical tensions raised by the complexity of positions on weight management.
What about claims for effectiveness? The sample of papers included in this review had all the hallmarks of contemporary mainstream approaches to obesity in their approach to effectiveness. Hand in hand with a belief in the indisputable benefits of weight loss is the associated belief that clinically meaningful weight loss is a realistic goal for most people. This ignores the evidence of the overwhelming failure of weight reduction interventions: two high quality reviews find evidence that weight loss behaviour does not lead to long-term weight reduction and moreover that it can be counterproductive and harmful [16, 23].
Despite this, the goal of sustained weight-loss was ubiquitously promoted as reasonable and desirable in all papers included in the review even though most papers also confirmed the high failure rate of weight loss in the long-term, a finding summed up as " there is increased awareness that short-term interventions are rarely successful' (p 504) J[24] and "long-term success in weight loss treatments for obesity is elusive" (p31) J[19]. Nevertheless, the collective supposition was that failure was due to lack of research/poor evidence base and there was no suggestion that it signalled the need to ultimately dispense with the belief in the success of weight loss.
A qualitative study of patients' views of dietary treatment for weight loss is a case in point. The study reports participants' views that, as compared to other people, they followed a healthy diet and were therefore at a loss to explain their current heavy weight and felt 'a lack of trust in their ability to succeed' (p491). One interpretation of this is suggested which speculates on a tension between patients assuming 'personal responsibility' for their health and the tendency for the patient to avoid responsibility through blaming their 'unfair' situation' (p 493) J[3]. Inherent in this analysis is the assumption that high BMI necessarily arises from 'excess' energy intake and can be 'corrected' by weight loss through energy deficit. This assumption ignores evidence that adult body weight is not primarily determined by current diet and exercise behaviours and is in fact highly resistant to alteration [25]. The framing also conflates weight outcomes with health and dietary quality. The erroneous belief that anyone can lose weight and keep it off if they try hard enough is later reiterated by the authors in a statement that dietitians 'still have far to go in enabling patients to achieve permanent weight loss' (p 493). The logic of this argument is faulty: the point is that permanent weight loss has been shown time and again to be an unattainable objective for the vast majority of dieters. It would seem, rather, that researchers still have far to go in recognising the significance of the evidence and responding accordingly.
Similarly, reporting on dietitians' views on weight management, Barr et al. J[24] wrote that the majority of respondents believed that 'loss of even a small amount of weight can be beneficial' ( p 509). In light of the rigorous debate about the evidence supporting this statement and the associated implicit belief that sustained weight loss is possible, and the statistically significant fact of weight regain, further discussion is merited.
Effectiveness: use of energy deficit
It becomes apparent that mainstream obesity discourse is underpinned by the rationale that modifying energy balance will lead to weight loss, a view that is mirrored in papers in the review J[5], J[11] and discussed in this section.
Researchers variously calculated energy deficit from formulae derived from basal metabolic rate or from a diet history assessment. In one paper, where inconsistencies arose in actual vs expected weight loss, this was assumed to indicate 'non-compliance' as it was held that a 'linear relationship [exists] between weight loss and energy restriction' ( p 156) J[5]. As authors in the wider scientific community have noted 'Despite its scientific pedigree, the 'body as machine' model remains largely a theoretical proposition only. In fact, it is hard to find human beings in their 'natural settings' whose bodies conform to it.' (p.41) [26]. By continuing to advocate an energy deficit intervention without comment that it has never been proven to be effective long-term, and by automatically ascribing unexpected results to patient behaviour rather than exploring the model for potential flaws [25], there is a danger that the approach may be interpreted as being rather more successful than the evidence shows. This could compromise patient welfare and divert research capacity from more productive avenues.
A second paper by the Counterweight team also incorporated a tailored energy deficit diet J[11]. Authors state that, as compared to generalised low calorie diets, an energy deficit approach is a more effective method of assisting compliance and weight loss. The first paper cited to substantiate this claim is the paper mentioned above J[5]. This study followed patients for 3 months and involved small numbers. Regardless of any findings in relation to energy deficit diets/compliance/effectiveness therefore, it could be considered inappropriate to cite this paper as good evidential support for the intervention without qualifying its limitations. After all, as I have shown, many studies demonstrate that there is nothing unusual in participants losing weight over three months, the real test lies in maintaining weight loss - diet trials to date have consistently proven what is clinically ineffective. In fact, Frost et al. J[5] found there was no significant difference in actual mean weight loss with the energy deficit method except when a subgroup (n = 11) calculation was made.
The second paper cited by the Counterweight project team concludes that ' the [energy deficit] approach was no more effective in terms of weight loss than the 6279 kJ (1500 kcal) [generalised low calorie] approach (p1469) [27] and while compliance was indeed deemed better, weight regain was still significant. An odd, not say misleading, choice, to argue for the proven benefits of an energy deficit programme.
The Counterweight project team justify their treatment decision by underscoring the fact that the 600 kcal deficit diet is endorsed in a report from an expert obesity organisation, the Scottish Intercollegiate Guidelines (SIGN) [28]. Coming full circle, SIGN [29] cites Frost et al. J[5] to support their claims for the effectiveness of energy deficit. SIGN is a highly regarded document but the decision to extrapolate transferable claims for effectiveness from the short-term results of a subgroup of eleven people in a quasi-experimental trial and subsequently to use this as the basis for national recommendations is of dubious scientific merit. SIGN [28] further states that the energy deficit method 'produces an average weight loss of > 5 kg in patients with a BMI of 30-43' (p24). Given the substantial amount of evidence available at the time that showed the overall ineffectiveness of non-surgical weight loss, this seems an extraordinary claim to make and it is notable that no reference is supplied. In the same vein, the suggestion that the status of evidence underpinning the energy deficit approach ''will probably be upgraded once the results of multiple international trials are published' (p 24) also appears rather fanciful. In short, the review illustrated a number of instances in the primary and secondary literature where citations justifying treatment and verifying effectiveness are unfit for purpose.
Effectiveness: scientific credibility of claims for dieting success
Another common discursive device emerged in which authors made inflated proof claims that dieting in general was an effective strategy. A selection of examples follows. Herriot et al. J[21] state that a study [30] 'demonstrated the benefit of the inclusion of commercial weight programmes within the matrix of effective weight control behaviour' (p 79). While there is arguably room for ambivalent interpretation of the precise intended meaning of this phrase, it clearly points to a favourable outcome. The claim refers to the finding that a combination of decreased food quantity, cutting down on fats/sugars, use of a commercial weight loss programme and exercise led to a weight loss over two years of 0.03 kg compared to a group with no intervention (who gained weight) [30]. It is inconsistent with the data to subsequently propose that on this basis it 'seems likely that reputable commercial programmes could play an important role in any future national obesity strategy', notwithstanding the tentative qualifier 'could'.
Likewise, to say that 'all diets in 'Diet Trials' were ultimately successful in achieving weight loss in those who complied' ( p 78) J[21] is semantically true but does not accurately communicate the facts that 64% of people had withdrawn by week 8; that some people gained weight; that weight rebound was common. Further, it elides the authors' own informative discussion of the clinical (in)significance of weight loss in the short term. It would have been useful if the implications of a finding of short term weight loss were developed in relation to study outcomes, rather than, as was in fact the case, the earlier discussion being effectively overlooked in favour of a recommendation for more studies.
This overly optimistic tone, where a more qualified report of findings would increase scientific credibility, occurs in other papers. For example, one paper J[29] conveys an impression of reliable, positive outcomes in terms of long-term weight loss in concluding that 'adding orlistat, sibutramine, exercise or behaviour modification to dietary advice can improve long-term weight loss' (p 293). But a more judicious reading of the results does not support this conclusion. First, in relation to sustained weight loss and medication the authors note that only one randomised controlled trial reported weight change post-medication and this found that weight regain was almost double that of the control (placebo) group. Second, in relation to behaviour therapy, the authors report that adding behaviour therapy to dieting led to weight loss at 12 months but weight increase at 60 months, indicating the need for clarification of the use of the phrase 'long-term'. Third, implicit in the claims for effective weight loss is the assumption of attendant health gains. However, authors note that 'few risk factors were examined in the non-drug trials, and trials which examined risk factors were usually small and therefore had insufficient power to detect clinically important differences' (p 312). Such differences could of course be positive or negative: orlistat, for example, was linked with an unfavourable change in blood HDL.
Some authors make explicit claims for the impact of dieting on clinical outcomes, other than weight change, which are similarly amplified. A systematic review of randomized controlled trials to determine the long-term benefits of weight reducing diets in adults by Avenell et al. J[31] that was included in the sample, is frequently cited in anti-obesity research. The title conveys the tacit assumption that diets do have long-term benefits. Authors note that adverse effects are frequently not reported but do not further discuss any practice implications or ethical dimensions of this omission which thus detracts from the applicability of their findings. The authors conclude that what they categorise as low fat diets are effective in achieving significant weight loss at 12, 24 and 36 months. It is further concluded that these diets have benefits in managing blood pressure, fasting glucose and lipids at 12 months and noted that there is limited data on risk factors after 12 months with 'a trend for blood pressure to be decreased by these diets at 36 months' (p 330). This statement appears to contradict an earlier statement in the results section that the limited data [from low fat diets] after 12 months no longer showed statistically significant risk factor changes [diastolic and systolic blood pressure, lipids and fasting glucose].
In the authors' discussion, the most recent paper cited in support of the claim that low fat diets can 'help prevent the development of diabetes, improve blood pressure control and reduce the use of anti-hypertensive medication for up to 3 years' is by Swinburn et al. [32] and this was therefore selected for appraisal. Swinburn et al. [32] report initial weight loss of a low magnitude (3.3 kg at 12 months) and note that 'like most interventions for weight loss, weight was regained in the long term' (p 622). Readers may consider this a salient fact, especially as data on long-term follow up is so sparse, but it is not reported in the paper under review. Swinburn et al. [32] note that compliant dieters showed reduced fasting glucose levels at 5 years. They explain that the low fat diet had significant effects on glucose tolerance at one year and that 'a smaller proportion of participants had type 2 diabetes or IGT [impaired glucose tolerance] in the [low fat] group (47 compared with 67%) [but] No intervention effect was present at 2, 3, or 5 years' (p 621). In this case, the paper shows a sub-group effect on fasting glucose levels but does not show diabetes prevention for up to 3 years, a claim it is used to corroborate.
Avenell et al. J[31] report the 20% difference in development of diabetes or impaired glucose tolerance found in Swinburn et al. [32] but do not provide details of when this finding was measured (ie. at 12 months) or subsequent lack of intervention effect which makes it impossible for readers to assess the relevance of the data. Swinburn et al. [32] discuss changes in exercise habits among study participants which is a variable relevant to fasting glucose levels and as such deserves mention, even if only to explain why it may not, in fact, have a bearing, in drawing conclusions of diet outcomes.
In a second paper included in the sample reviewed Dyson J[33] states that 'the health benefits of weight loss for overweight and obese people with type 2 diabetes are now well established', relying on a paper by Aucott et al. [34]. However, the paper by Aucott et al. does not substantiate the certainty of this claim - the authors caution that their conclusions are based on studies of moderate quality and find only two studies relevant to change in mortality following weight loss in overweight/obese people with diabetes. The results from one of the studies is non-significant. The other study was an observational study employing retrospective calculation of self-reported weight change which has inherent methodological limitations. The studies reporting changes in diabetic status after weight loss refer only to very fat, not 'overweight', people who underwent weight loss surgery. In one study the follow-up period of the post-operative changes in glucose handling was not specified and no data was provided from those patients who were available for follow-up. There is a similar lack of useful data in the second paper. In short, the paper by Aucott et al. [34] reports that one large observational study found reduced mortality with intentional weight loss in overweight/obese people with type 2 diabetes and poorly specified post-operative improvements in glucose handling in ' morbidly obese' people with diabetes. It is doubtful whether this qualifies as firmly establishing the health gains of weight loss in diabetes.
Overall, throughout the reviewed papers, authors typically comment on the lack of information on changes in risk factors and quality of life from the currently available evidence of weight loss trials. In addition, one team discusses the underreporting of obesity and low treatment rates in primary care. These authors speculate that 'lack of evidence of the effectiveness of weight management interventions in primary care' may be a contributing factor J[35]. There is, however, ample evidence that points to treatment ineffectiveness [16]. It is a logically flawed argument to presuppose that it is only a matter of time until effectiveness is demonstrated.
Adverse Effect
In the third section of this paper I will consider reporting on adverse effects in more depth. Generally, authors included in the review represent the effects of weight fluctuation on health more neutrally than in the wider literature. Thus, it is suggested J[24] that although there is evidence that weight fluctuation may increase risk factors for heart disease, 'it is premature to make strong conclusions about effects on physical health'. A reference is given which investigates links between weight cycling, blood lipids and blood pressure. This position contrasts sharply with the British Nutrition Foundation's statement [36]:
"a positive association has consistently been observed between body weight fluctuation and all-cause mortality and usually... with coronary mortality in particular. This finding is very robust, further confirmation is found in the British Regional Heart Study (Wannamethee & Shaper, 1990), in the Seven Nations Study (Peters et al., 1995) and in the Iowa Women's Health Study (French et al., 1997) (p 137)."
Some discussion of the controversy would have enhanced the credibility of the authors' argument. Further, the impact of weight fluctuation on physical health is considered in relation to cardiovascular parameters only. Omitting discussion of the detrimental effects of weight fluctuation on bone health [37] weakens the scientific legitimacy of the argument. A more detailed and balanced discussion of the general literature on weight fluctuation and health may be necessary to improve the validity of their argument.
Authors of a second paper in the sample report findings that study participants intended to diet in future on an ad hoc basis J[21] which raises the issue of weight fluctuation. There is no discussion of how the ethical issues this presented to the researchers were dealt with and authors do not flag up the consequences of weight cycling to participant health.
Similarly, in a third paper J[19], the controversy over weight fluctuation is elided in a statement that 'the health impact of weight loss has been found to be more strongly associated with net amount of weight loss as opposed to the pattern of weight change over time' (p 33 ). The article displays a positive attitude towards weight loss and it may be reasoned that the reader is expected to share the assumption that the 'health impact' referred to is a beneficial impact rather than a detrimental one. There is no discussion of the adverse effects of dieting on physical health which limits confidence in the authors' familiarity with the literature in their area and consequently in the clinical validity of their recommendations. It would be helpful if the authors highlighted that this was an area of considerable debate in the same way that they draw attention to conflicting views and findings concerning weight management and eating cognitions and behaviours. The same authors state both that 'long-term success in weight management treatments for obesity is elusive' (p 31) and also imply that dieting typically leads to overall weight loss by describing a pattern of weight loss followed by regain of some, but not all, of the initial weight loss. This contradiction warrants further expansion as it is in stark contrast to high quality findings on the long-term outcomes of dieting [16] which have greater validity than the study [38] later relied on to support claims for weight loss maintenance. Clearer demarcation between opinion and evidence to increase transparency in the development of recommendations may improve the transferability of results to practice and improve patient welfare.
There are other instances, aside from consideration of adverse effect, where authors omit relevant debate. Jehn et al. J[4], for example, refer to the findings of the United States National Weight Control Registry on variables associated with long-term weight loss. It would have been useful if they had alerted the reader to some of the challenges raised to these claims [39].
Health at Every Size
I have argued that weight management cannot be considered to be an evidence based intervention. Moreover, a focus on individual behaviour change in the pursuit of health detracts attention from the wider social and material determinants of morbidity and mortality. Further, the weight-centred paradigm stymies research and practice developments into a more effective, alternative approach to improving nutritional wellbeing. This non weight-centred approach is known as 'health at every size', or HAES. (HAES is also known as a no-diet or size acceptance approach).
HAES advocates adopt a weight-neutral approach to lifestyle change where the primary goal is moved from achieving weight change to modifying health behaviours. Outcome measures relate to metabolic fitness - such as blood pressure and cholesterol - eating disorder symptomology, exercise levels, and psychological parameters. HAES research demonstrates that clinically and statistically significant improvements in a range of health measures can be achieved independently of weight reduction [17, 18]. That is, improving someone's health behaviours has health benefits even when weight stays the same and moving the focus off weight reduction helps people sustain improved health behaviours. For example, in a small randomised controlled trial [18] (n = 78) comparing HAES with conventional weight management, HAES is associated with sustained improvements in health outcomes at 2 years follow-up, with weight stability, and with no adverse effect, whereas early improvements were not maintained in the diet arm of the trial, and there was a decrease in self-esteem. This paper is a classic in HAES scholarship and the research results are typical of findings in other HAES research [17].
There are four key tenets of HAES that mark it as different from conventional healthy weight interventions. First, it is weight neutral; second, it teaches people to rely on internal signals and to eat intuitively, rather than relying on external regulation to eat; third, it encourages positive body esteem in people of all shapes and sizes (size acceptance). Importantly, HAES challenges implicit and overt size discrimination in and beyond the clinic.
Implications for research and practice
It has been suggested that 'a temptation in clinical research is to sacrifice the interests, [and] the health' of research participants (p 69) [40]. This review indicates that anti-obesity researchers publishing in contemporary UK dietetics adopt a particular stance towards body weight management practices that may inadvertently compromise the health of participants. Weight management research appears to occupy a hallowed place where deviations from regular scientific conduct are readily tolerated, for example, continued support of research programmes that do not adequately report adverse effect, or rely on acceptance of common assumptions that are inadequately supported by data, which in turn may point to a lack of stringency in research ethics decisions regarding weight management. It also demonstrates the influence of ideology in selecting and reporting data, whether intentional or not, which has material implications for research participant/patient welfare and research directions in that it eclipses other positions and ensuing discussions are poorer for this bias.
The papers analysed in this review unfailingly frame fatness as a pathological condition that is primarily under personal control through volitional modification of eating and exercise habits. A broader reading of the literature shows that there is in fact a vigorous scientific controversy about many of the treatment premises that are taken for granted within this dominant anti-obesity agenda. This wider debate interrogates the theory and science behind assumptions about the links between body mass index/body weight (specifically fatness) per se and health outcomes [1, 17, 26, 41–44].It also questions the appropriateness of using anthropometric measurement in diagnosing disease/risk and the value of BMI as a meaningful variable for assessing research outcomes. These critical perspectives on claims made about an obesity crisis further explore the broader ethical consequences of the thinness imperative. As seen in this review, dietetic papers on weight management conventionally conclude with recommendations for more robust and informative trials. I would instead suggest that there is more progress to be made from reframing the scope of enquiry. Within this reframing further research is needed to determine: the appropriateness of criteria relied on to determine the scientific justification for weight reduction research; the completeness of Patient Participant Information Sheets submitted to research ethics committees; the impact of size bias on clinical decision making (see also [42]); the safety and effectiveness of treatments that seek to improve cardiovascular risk factors independent of weight change; reasons for intransigence in practitioner and researcher commitment to prescribing weight reduction; the effectiveness of interventions designed to improve health professional's practice with regard to evidence based intervention in nutritional lifestyle intervention; dietetic resistance to adopting the evidence-based health at every size paradigm [2]. This review also has ethical implications regarding researcher and peer reviewer responsibility and accountability in the use of citations to support claims.
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Dattilo AM, Kris-Etherton PM: Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr. 1992, 56: 320-8.
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Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M, Finnish: Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001, 344: 1343-50. 10.1056/NEJM200105033441801.
Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J: Medicare's search for effective obesity treatments: diets are not the answer. Am Psychol. 2007, 62: 220-33. 10.1037/0003-066X.62.3.220.
Bacon L: Health at Every Size: The Surprising Truth About Your Weight. 2009, Ben Bella
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Green GC, Buckroyd : Disordered eating cognitions and behaviours among slimming organization competition winners. J.Hum Nutr Diet. 2008, 21: 31-8. 10.1111/j.1365-277X.2007.00838.x.
Holm S: Obesity interventions and ethics. Obes Rev. 2007, 207-10. 10.1111/j.1467-789X.2007.00343.x. Suppl 1
Herriot AM, Thomas DE, Hart KH, Warren J, Truby H: A qualitative investigation of individuals' experiences and expectations before and after completing a trial of commercial weight loss programmes. J Hum Nutr Diet. 2008, 21: 72-80. 10.1111/j.1365-277X.2008.00890.x.
Sørensen TI, Rissanen A, Korkeila M, Kaprio J: Intention to lose weight, weight changes, and 18-y mortality in overweight individuals without co-morbidities. PLoS Med. 2005, 2: e171-10.1371/journal.pmed.0020171.
Jain A: Treating obesity in individuals and populations. BMJ. 2005, 331: 1387-90. 10.1136/bmj.331.7529.1387.
Barr SI, Yarker KV, Levy-Milne R, Chapman GE: Canadian dietitians' views and practices regarding obesity and weight management. J Hum Nutr Diet. 2004, 17: 503-12. 10.1111/j.1365-277X.2004.00562.x.
Sørensen TI: Challenges in the study of causation of obesity. Proc Nutr Soc. 2009, 68: 43-54. 10.1017/S0029665108008847.
Gard M, Wright J: The Obesity Epidemic: Science, Morality, Ideology. 2005, New York: Routledge
Leslie WS, Lean ME, Baillie HM, Hankey CR: Weight management: a comparison of existing dietary approaches in a work-site setting. Int J Obes Relat Metab Disord. 2002, 26: 1469-75. 10.1038/sj.ijo.0802153.
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Avenell A, Brown TJ, McGee MA, Campbell MK, Grant AM, Broom J, Jung RT, Smith WC: What interventions should we add to weight reducing diets in adults with obesity? A systematic review of randomized controlled trials of adding drug therapy, exercise, behaviour therapy or combinations of these interventions. J Hum Nutr Diet. 2004, 17: 293-316. 10.1111/j.1365-277X.2004.00530.x.
Williams L, Germov J, Young A: Preventing weight gain: a population cohort study of the nature and effectiveness of mid-age women's weight control practices. Int J Obes. 2007, 31: 978-86. 10.1038/sj.ijo.0803550.
Avenell A, Brown TJ, McGee MA, Campbell MK, Grant AM, Broom J, Jung RT, Smith WC: What are the long-term benefits of weight reducing diets in adults? A systematic review of randomized controlled trials. J Hum Nutr Diet. 2004b, 17: 317-35. 10.1111/j.1365-277X.2004.00531.x.
Swinburn AB, Metcalf PA, Ley SJ, Long-Term (5-Year): Effects of a Reduced-Fat Diet Intervention in Individuals With Glucose Intolerance. Diabetes Care. 200, 24: 619-624. 10.2337/diacare.24.4.619.
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Aucott L, Poobalan A, Smith WC, Avenell A, Jung R, Broom J, Grant AM: Weight loss in obese diabetic and non-diabetic individuals and long-term diabetes outcomes--a systematic review. Diabetes Obes Metabolism. 2004, 6: 85-94. 10.1111/j.1462-8902.2004.00315.x.
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Riedt CS, Cifuentes M, Stahl T, Chowdhury HA, Schlussel Y, Shapses SA: Overweight postmenopausal women lose bone with moderate weight reduction and 1 g/day calcium intake. J Bone Miner Res. 2005, 20: 455-63. 10.1359/JBMR.041132.
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Laurence D: Guide, guide thyself: law and order in clinical research. Research Ethics Review. 2008, 4: 69-72.
Campos P: The Obesity Myth: Why America's Obsession with Weight Is Damaging to Your Health. 2004, Gotham Books, USA
Aphramor L: Is a weight-centred health framework salutogenic? Some thoughts on unhinging certain dietary ideologies. Social Theory and Health. 2005, 3: 315-340. 10.1057/palgrave.sth.8700059.
Mulvihill C, Quigley R: The Management of Obesity and Overweight: An Analysis of Reviews Of Diet, Physical Activity And Behavioural Approaches. 2003, London: Health Development Agency, 1
Debating Obesity: Critical Perspectives. Edited by: Rich E, Monaghan L, Aphramor L. U.K: Palgrave Macmillan, (forthcoming)
The author acknowledges the role of friends and colleagues involved in HAES and Fat Studies in supporting the development of her research ideas. Thanks also to the reviewers whose input considerably strengthened the paper.
Additional information
Competing interests
LA promotes a health at every size approach to nutritional intervention. She has no competing financial interests.
Authors' contributions
LA researched and wrote the paper.
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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Aphramor, L. Validity of claims made in weight management research: a narrative review of dietetic articles. Nutr J 9, 30 (2010). https://doi.org/10.1186/1475-2891-9-30
DOI: https://doi.org/10.1186/1475-2891-9-30
- Weight Management
- Orlistat
- Sibutramine
- Energy Deficit
- Weight Cycling


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I thought it might be nice if we all got to share some traditions and ideas at the same time so each day I will also include a link up gadget so you can share posts on the same theme. On the 12th Day, December 12, I am hosting a linky party where we can share our posts on all things Christmas.
I sure do hope you will be able to join me each day and that you can link up each day and help me Keep the Christmas Spirit Alive!
See you December 1st!
Blessings and best wishes,
Natasha In Oz

subset: commoncrawl


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Aug.18 (GMM) Former Force India driver Paul di Resta is not ready to give up on his formula one career.
The 28-year-old Scot lost his seat with the Silverstone based team at the end of last year and returned to the German touring car series DTM with Mercedes.
He was linked with a potential F1 reserve role with the German marque's Brackley based team this year, but for now he is committed to improving in DTM.
"When I came back (to DTM), I thought I might be able to get to the front straight away, but that clearly hasn't happened and we are not where we want to be just now," said the former series champion.
"It's too early to say what my plans are for 2015 and my thoughts are completely devoted to chasing better results in DTM and helping Mercedes in any way I can," he told Scotland's Herald newspaper.
"But I am positive I can gain another drive in F1 and, if anything, I am even more determined than I was.
"The decision isn't up to me, but I delivered good, steady performances and I have no doubt I can build on that," di Resta added.


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After studying hundreds of speeches, I've found that the most effective presenters use the same techniques as great storytellers: By reminding people of the status quo and then revealing the path to a better way, they set up a conflict that needs to be resolved.
That tension helps them persuade the audience to adopt a new mindset or behave differently — to move from what is to what could be. And by following Aristotle's three-part story structure (beginning, middle, end), they create a message that's easy to digest, remember, and retell.
Here's how it looks when you chart it out:
And here's how to do it in your own presentations.
Craft the Beginning
Start by describing life as the audience knows it. People should be nodding their heads in recognition because you're articulating what they already understand. This creates a bond between you and them, and opens them up to hear your ideas for change.
After you set that baseline of what is, introduce your vision of what could be. The gap between the two will throw the audience a bit off balance, and that's a good thing — it jars them out of complacency. For instance:
What is: We fell short of our Q3 financial goals partly because we're understaffed and everyone's spread too thin.
What could be: But what if we could solve the worst of our problems by bringing in a couple of powerhouse clients? Well, we can.
Once you establish that gap, use the rest of the presentation to bridge it
Develop the Middle
Now that people in your audience realize their world is off-kilter, keep playing up the contrast between what is and what could be.
Let's go back to that Q3 update. Revenues are down, but you want to motivate employees to make up for it. Here's one way you could structure the middle of your presentation:
What is: We missed our Q3 forecast by 15%.
What could be: Q4 numbers must be strong for us to pay out bonuses.
What is: We have six new clients on our roster.
What could be: Two of them have the potential to bring in more revenue than our best clients do now.
What is: The new clients will require extensive retooling in manufacturing.
What could be: We'll be bringing in experts from Germany to help.
As you move back and forth between what is and what could be, the audience will find the latter more and more alluring.
Make the Ending Powerful
You don't want to end with a burdensome list of to-dos. Definitely include a call to action — but make it inspiring so people will want to act. Describe what I call the new bliss: how much better their world will be when they adopt your ideas.
So if you're wrapping up that Q3 update from above, you might approach it this way:
Call to action: It will take extra work from all departments to make Q4 numbers, but we can deliver products to our important new clients on time and with no errors.
New bliss: I know everyone's running on fumes — but hang in there. This is our chance to pull together like a championship team, and things will get easier if we make this work. The reward if we meet our Q4 targets? Bonuses, plus days off at the end of the year.
By defining future rewards, you show people that getting on board will be worth their effort. It'll meet their needs, not just yours.
This is the fourth post in Nancy Duarte's blog series on creating and delivering presentations, based on tips from her new book, the HBR Guide to Persuasive Presentations.
Read the other posts here:
Post #1: How to Present to Senior Executives
Post #2: Create a Presentation Your Audience Will Care About
Post #3: Do Your Slides Pass the Glance Test


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COLORS PARICHAY-REUNITE KUNAL - SIDDHI and EXIT ABHAY-RICHAS
The Petition
To the Secretary,
Dear Sir/maam,
We fans of Daily soap Parichay Nayee Zindagi Kay sapno ka aired on COlors channel Daily at 10:30 PM IST are strangely amused and baffled at something. The show is produced by Balaji Telifilms and EKta kapoor is the producer. The BCCC feels that kissing (which is a sign of love and affection) needs to be censored but not Mockering of Indian Traditional Marriage system? A female is shown first getting in to a deal and providing wrong statements in front of law and Another female is shown to be killing, blackmailing and insanely behaving. They show rapes, molesstations, multiple marriages under the name of drama. One hand Mother of two kids is seperated from them by sitting in jail and her kids praying for their family to reunite and shown desperate. On the other hand they are showing mother getting married to some other guy who blackmails her or raises her kid while the actual husband and biological father Mr. Kunal Chopda is shown to be accepting his wife and second son.
They are showing female obsession so worstly and insanely that its affecting most of the viewers in a pathetic manner. Is the meaning of a daily soap is to show all illegal stuff insulting Indian legal system, Indain Marriage acts and systems, and Child freedom?
We were very liberal about most things and just not squeamish about violence lines but since 5 months till date the violence and torture in the show has become entertainment to the Production HOuse and Creative heads of Balaji Telefilsm and hence hereby we request BCCC and IBF to take an action on this sensitive matter of insulting feminity by allowing such marriages in the show. There are n no of under 18 tooo who are die hard fans of the show. Media is a platform to bring enlightenment and Positivity among the viewers by innovatively showing creative tracks and bringing out morals But what are they showing? How to rape? How to spike drinks and throw false cases against innocent ppl? How to make deals to acquire others husbands out of our obsessive insane love? or How to stoop low by kidnapping, attempting to murders, by making deals to ruin others lives? Out of obsessive love how to seperate a loving couple? How to seperate a newly born baby from her mother?
Is this what they are showing under the name of drama? Ok we are ready to consider all the above said as drama. But forcible seperation of loving couple and seperation mother from her kids and thrashing out a beautiful family by showing female loosing her self respect and feminity is not at all accepted and tolerated.
For years to gether we have seen Soap Queen Ekta Kapoors so called creativity in a Kasamh se, Kasauti Zindagi ki, Tere Liye etc. But not anymore. They dont have right to say with attitude that if viewers want to see let them else let them switch the channel.
THey promissed the viewers that Parichay will be a male centric show. But unfortunately to say that Male is present but show is of Insane people and vamps and innocent lady there SIddhi the female lead is shown to be sacrificing lamb.
Something that maybe quintessentially acceptable to some cultures is completely repulsive to another and I must say that our sensitivity towards Multiple marriages and a female shown ditching her husband or husband ditching his wife under the name of lame sacrifices and two new borns been shown taken away or seperated from their mother is something that entire viewership of Parichay can never accept such uncalled for, and is very strange to say the least.
Taking the Epics of our Indian culture Ramayan, they are showing the play and insulting the traditional values of indian Marriage system and also under Human rights act and child rights act coz ... two kids were shown desperately wanting to reunite their parents and live with them and They are showing evil winning on good during auspicious days by secribing Ramayan and Killing ravan
There kids are crying here these two couple are crying and still insane drama and lame sacrifices and they even show the public how to manipulate and camoflage truth and witnesses in front of law. Insult to the Indian Law system and Indian Traditional Marriage system
Referrring to the episode aired on 13 Nov 2012 Where they showed, RICHA who plays VAMP CHARACTER ASKS ABHAY WHO IS OBSESSIVE ABOUT SIDDHIS SON ANAND DEEWAN , TO FILL VERMILLON AS SHE MISSED TO SEE HOW DID SIDDHI REACT AS TO SEE " DID SHE CRY DID SHE LOOKED AT HIM WITH HEATEERDNESS OR DID SHE TRY TO DIE OR WHATEVER" AND MAKES ABHAY TO FILL VERMILON ON SIDDHIS HAIR PARTITION WHICH IS TOTALLY COMPLETELY INSANE WHY IS EKTA KAPOOR PLAYING WITH INDIAN TRADITION UNDER THE NAME OF DRAMA AND HER CVS WHO DOESNT HAVE VALUES FOR RELATIONS AND THEIR SERENITY.
Its heights of insanity and saddism thats being shown. A woman who sacrifices everything for her husband is made to cry like hell on the earth and making viewers too to cry is not the right way a show has to be show. Viewers are feeling insulted of their intelligence and women are really feeling insulted on this nasty track. Viewers request the Production House Balaji Tele films to mend their ways and show logical stuff in the story. Other shows are getting good amount of promotions But our favorite show is neither getting promotion nor proper tracks.
Anyways, we as fans are trying to the our part and complaining about something we found very distressing and not just to us. but entie viewership of Parichay and fans of Kunal and Siddhi were equally flinching. Just because they like to show the insane tracks as drama to gain TRP's doesn't mean they can show nonsense to the viewers by insulting our intelligence and when we try to contact them over Social networking sites none of them responds and in turn blocks our IDs so that our voice doesnt reach them and arrogantly does whatever they think is creative is utterly disgustive for all of us to accept. During festival days they are showing evil winning on good and couple seperations y and no Indian in their right mind would want such crap of seperations , murders, violence, Plots.
Hence we the viewers of Parichay on colors humbly request and loyally demand that we want Kunal and SIddhi to reunion ASAP and the evil Richas exit from the serial. If the Production House decides to wind up the show We DONT ACCEPT IT WE WANT THE SHOW TO BE CONTINUED AS PROMISED. KUNAL TO MAN UP AND KICK RICHA AND ABHAY OUT . SAVE HIS WIFE AND KIDS.
Viewership and Fans of Parichay


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I've never really come across 9iAS so apologies if this is a simple question. We've got a load of f60webm processes on our UNIX box, some are spinning and consuming lots of CPU's. Are the processes caused by people requesting Forms from the form server process (f60svrm)?
Could anyone give a simple explanantion on how these processes are spawned?


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• Ramadan •
rah-mah-dahn • Hear it!
Part of Speech: Noun, proper
Meaning: The ninth month of the Muslim calendar is devoted to the Fast of Ramadan. One night around 610 AD, according to the Muslim faith, the archangel Gabriel appeared to Mohammed, a caravan trader, in the vicinity of Mecca, and told him that he had been chosen to hear the word of God (Allah). Over the following days, Mohammed began reciting the verses that ultimately became the Qur'an (Koran).
Notes: Ramadan begins the day after the lunar crescent and ends with the next new crescent. During the Fast of Ramadan observant Muslims do not eat or drink during the daylight hours. Neither smoking nor sexual relations are allowed. The fast may be broken at the end of the day with prayer and a meal called the iftar that usually begins with dates. The fast is resumed the next morning after a predawn meal, the suhoor, which usually is prepared from the leftovers of the iftar the night before.
In Play: The end of the fast is celebrated as Eid ul-Fitr, the Festival of Fast-Breaking. On Eid ul-Fitr Muslims universally greet each other by saying, "Eid mubarak" (a blessed Eid). In 2022 Ramadan began at sunset yesterday and continues until sundown May 1. We hope all our Muslim readers around the world will have a blessed and happy Ramadan.
Word History: Ramadan comes from the Semitic root rmd, which appears in Arabic as ramida and ar-ramad, meaning "intense scorching, heat, and dryness". Semitic roots usually contain only consonants. Different sets of vowels are inserted between them to convey the same meanings that suffixes convey in Indo-European languages. The same root produced ramdaa "sunbaked sand" and the famous idiom: kal mustajeer minar ramadaa binnar "to jump out of the frying pan into the fire." Hebrew remetz "embers" is another member of this Semitic root family.
P.S. - Register for the Daily Good Word E-Mail! - You can get our daily Good Word sent directly to you via e-mail in either HTML or Text format. Go to our Registration Page to sign up today!
Come visit our website at <http://www.alphadictionary.com> for more Good Words and other language resources!


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SURPRISE!!! Rovio has released Angry Birds Star Wars II a day early! Speculation suggests that it is related to the release of iOS 7, but who knows for sure — and frankly, who cares?! We'll talk more about system requirements further below, but for now, Angry Birds Star Wars II is available for iOS, Android via Google Play and the Amazon Appstore, and Windows 8 Phone.
Update 24 October: ABSW2 released for PC.
Let's jump straight into the details. We'll have a "first look" video soon, but we were caught off guard by the early release.
Check the Cargo Hold! (What's Included)
Gotta start with the best stuff. There's an insane amount of content.
- Two episodes = 80 normal levels are available at launch. We begin at the beginning: Naboo Invasion and Escape to Tatooine. Each episode has two sides: Bird (light) and Pork/Pig (dark). Each side has 20 normal levels! Quick math: 20 × 2 × 2 = 80! Walkthroughs for all levels.
- You must start your journey on the Bird side of Naboo Invasion. (Levels numbered B1-# for "Bird, Episode 1")
- The Pork side of Naboo Invasion unlocks after accumulating 20 stars. (Levels numbered P1-# for "Pork, Episode 1")
- When you complete Naboo Invasion, you can pick which side of Escape to Tatooine to join. The other side unlocks after accumulating 20 stars there. (Levels numbered B2-# and P2-#)
- 8 "Side" levels! Hidden in each side of each episode is a treasure map. Obtaining this map opens a 2-level side quest, which is some cases is a shortcut! The levels are not required to earn "Complete an Episode" achievements, but 3-starring IS required to earn "3-star an Episode" achievements. (Levels numbered B1-S#, P1-S#, …)
- Reward Chapter! This is pretty interesting. Each character has a points-accumulated achievement associate with it. When you reach that threshold, that character's level is unlocked in the Reward Chapter.
Important Note: Bird Bonus Points are not credited to this counter. It must be in-game points done by that character's fling, and points do not accrue unless you complete the level.
Secondary Note: Not all levels of the Reward Chapter can be unlocked by normal gameplay at time-of-launch. In fact, not all levels will be unlockable via normal gameplay ever (Luke Skywalker, for example) since they are only available by TELEPOD or Character Swap usage. See more below.
- Bird Credits, TELEPODs and Character Swap! We'll talk more about this below, since it's very extensive.
- Achievements! These are now listed both in GameCenter (iOS only) and in-game! This way, all users can compete! There's a massive 67 to begin the saga!
- Ability Label: Since there are so many birds and so many abilities, each character in the lineup has a little label next to it. This identifies what that character's ability is: A small lightsaber handle, a shockwave, a laser blaster, etc.
Choose Your Destiny! Who Will You Join?
Bird Side
Playable characters on the Bird side at initial launch include:
- Qui-Gon Jinn and his single-lightsaber attack.
- Obi-Wan Kenobi and the Force
- Yoda and his incredible bouncing spinning attack of doom!
- Jar Jar Binks and his grappling-hook tongue.
- Anakin Episode I and his missile-riding daredevil-ness.
- R2-D2 and his electronic blasts.
- C-3PO and his self-destructive explosion.
Pork Side
Playable characters on the Pork side at initial launch include:
- Darth Sidious and his magic lightning fingers.
- Jango Fett and his single-rocket attack!
- Battle Droid and its triple-shot laser blaster.
- Darth Maul and his double-ended lightsaber attack.
- Count Dooku and his boomerang lightsaber throw.
- Droideka and its incredible bouncing spinning attack of doom.
Characters Not Yet Featured
More characters will be made available in later updates to the app, and some are only available by using TELEPODs or Character Swaps (more below). While we won't list them all here, they include Darth Vader, General Grievous, Padme, Mace Windu, and many many more.
Be sure to check out our Star Wars 2 Character Reveal videos to see all their abilities in action!
The Shop: TELEPODs, Character Swaps, and More
If you don't like the character lineup you've been given for a particular level, don't worry! With the technology of TELEPODs and "Character Swaps", you can now set your own attack lineup! This feature has actually been requested for years in the Angry Birds community, and it's interesting to see how Rovio has included it.
So let's talk about how exactly this works:
- TELEPODs are physical figurines that you can place on a stand over your device's front-facing camera (if applicable). The stand has a small magnifying glass and the figurine has a QR-code. Clicking the "TELEPOD" button in-game (looks like a T roughly) will use the camera to read the code, then BAM that character appears in the slingshot! Note that you can only import a like-side character: Pork-for-pork or bird-for-bird.
- Bird Credits are earned periodically through normal gameplay, or can be purchased from the shop. Prices are 150 credits for $1.99, 400 for $4.99, 1000 for $9.99, 2250 for $19.99, 6000 for $49.99, and 15000 for $99.99. (Worried? Be sure to see our post about restricting In-App Purchases.)
- Character Swaps are used to switch the active character in the slingshot for any character that you have "swaps" available for (on the same side)! These uses come in many shapes and sizes. They are earned in-game by completing certain achievements, can be purchased from the shop, or activated using TELEPODs. When purchasing from the shop, you can choose to purchase 10, 30, 100, or unlimited for any specific character. Note that the credit cost varies by character, with Darth Vader costing 3500 credits for unlimited.
There are also some restrictions on how these items can be used:
- You may only TELEPOD-in a certain character once per level, but you can use multiple TELEPODs per level. As an example, if you start with a level of all Jango Fett, you can one-by-one change the lineup to go Darth Vader, Darth Maul, Droideka. You cannot use TELEPODs to make the lineup 3 Darth Vaders in a row, however.
- You may use in-game Character Swaps without such a restriction. That is, you can use in-game Character Swaps to make a level of all Jango Fett into all Darth Vaders. Mwahahaha!!!
- Using a TELEPOD temporarily changes the in-game counter for that character. This seems to disappear after some time, however, and these character swaps appear to be stored in the Cloud. We tried turning on Airplane Mode and we lost them, but we will try playing around a bit more to get some more info.
Which Systems Are Go? Compatibility and Pricing
* Please be aware that this info may change at anytime. Beware of fakes! Only download apps published by Rovio Entertainment Ltd.
- iOS: Angry Birds Star Wars II is a universal app for iOS and costs $0.99 USD. It is compatible with iPhone 3GS+, iPod Touch 3rd+ generations, and all iPads. You must have iOS 4.3 or higher, and yes, it does include iPhone 5 support!
- Android (Google Play & Amazon Appstore): The Android app costs $0.99 USD and requires Android 2.3 or higher. Specific device requirements may vary and users should contact Rovio with questions pertaining to their particular device. There is also an ad-supported free version of the app.
- Windows 8 Phone: The Windows 8 Phone app costs $0.99 USD and has a plethora of device requirements. See the Windows Phone Store for all the details.
Notice for PC/Mac users: PC and Mac are not included with initial launch. Until recently, Rovio has made no statements about the future of these platforms. On the 19th, Rovio tweeted: "#AngryBirdsStarWarsII is now the #1 app on the @AppStore. We're also working on a PC/Mac version!"
No word yet on ETA, but it will likely be some time. Released for PC on 24 October; no ETA yet for Mac. We also suspect that TELEPODs will not be compatible with desktop platforms.
Helpful Links and ABN Information
- All Angry Birds Star Wars II 3-star walkthrough videos are live. This will also include Hidden Bonus Boxes, Treasure Maps, and much more.
- Compete with the best players in the world by entering your scores on our Angry Birds Star Wars II leaderboard. For the first time ever in a mobile app, ALL SCORES ARE VALID. This includes scores obtained with TELEPODs and Character Swaps. However, please explain what characters you used on the walkthrough pages.
- Hunting for hidden bonus boxes? Check out our complete boxes guide that shows their locations and how to obtain them.


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Your dog knows some pretty good tricks. Like most pooches, he'll do anything for treats, including "sit" and "stay." He can shake, roll …
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Your dog knows some pretty good tricks.
Like most pooches, he'll do anything for treats, including "sit" and "stay." He can shake, roll over, and fetch; he gives kisses, picks things up, plays hide-n-seek, and he might even know how to keep you healthy and mobile.
Yes, your dog is talented in ways that surprise you every day. And in the new book "A Dog Named Boo" written by Lisa J. Edwards and published by Harlequin, you'll read about a pup whose talent is to change lives in very different ways.
Unable to hold his own against his brothers and sisters, the little puppy seemed weak. Lisa Edwards watched as its siblings stepped on and around the black-and-white "baby dog," and she couldn't stop herself from falling in love.
Her two older dogs, Atticus and Dante, indicated toleration for the pup but Edwards' husband, Lawrence, was against another pet. He'd just had major surgery, Edwards wasn't in the best of health, and neither of them had time for a new puppy.
Edwards brought the little guy home anyhow, thinking that Lawrence would come to love the boy she named Boo. She knew it would be an uphill battle – she and Lawrence were both also dealing with abusive childhoods – but this dog seemed to need what Edwards had to offer: a loving home, understanding, and guidance.
Boo grew to be a people-dog, so when Edwards' brother fell ill and needed a service animal, Edwards thought Boo would be perfect. She tried to train him but even after repeated classes and training sessions, Boo seemed to be locked. He didn't listen, couldn't retain more than the most basic commands, and class-time was pandemonium.
Boo would never be a service dog, but Edwards sensed that he had empathy. He wasn't ill-behaved, but he wasn't an obedience star, either. He definitely wasn't aggressive. It wasn't until two veterinarian-friends noticed his "silly puppy-walking" and diagnosed a congenital brain condition that everything finally made sense.
Because she was interested in training, Edwards tried another tactic by listening and observing. She watched for Boo's strengths and worked around his weaknesses until she found a way for him to make a difference.
She never thought about the difference he'd make in her life…
With a good sense of humor, obvious love for dogs, and an amazingly open demeanor, author Lisa J. Edwards tells the story of a hurting family, a handicapped dog, and the healing they did, separately and together.
The best thing about this book is that it contains a great story but, if you can read between the lines, there's even more to gain. Because Edwards is a dog trainer, there's plenty to learn in here; mainly, she subtly teaches her readers to pay close attention to their dogs' behavior and body language to get the best results in training.
Overall, I think you should find this book for its lessons and savor it for its story. If you're a dog lover looking for something to curl up with, "A Dog Named Boo" should do the trick.
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Hazañas del Oeste #1
The Spanish artist Jordi Buxade Tonijuan was a master in making western comics the American way. A personal friend of 'Red Ryder' artist Fred Harman, Buxade is the creator of such series as 'Buck Tyler' and 'Jim Huracan'. Buxada created his first comic pages for El Botones in 1952, followed by Gorrion and Nicolás. 'Jim Huracán' was born in 1959, followed by several western series throughout the 1960s, such as 'Ringo Ley' and 'Daniel Boom y Cow-boy Tim'. Buxade got his biggest success with 'Buck Tyler', which started in Ilustración Comix Internacional in 1981. Two years later, he had a try on a humorous comic in Tio Vivo, 'Hawitta', which lasted for only one year because of Tio Vivo's disparation. Starting in 1984, Buxade has focused on commercial and advertising art.


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Last month, someone emailed me to ask how I'd suggest she adapt the Icebox Cake to feed 30 to 40 people. Anyone who has ever emailed me to ask me a question before probably knows what happened next: I answered at least 10 (cough 20) days after the fact. Nevertheless, she assured me that she'd scaled it just fine and her husband and hers joint birthday part was wonderful, or at least I think this is what she said because I do not remember a single word that passed between us after she uttered what have to be the four most beautiful words in the dessert lexicon: Hazelnut. Brown. Butter. Cake.
[Insert sound of tires screeching to a halt.]
"Did you say someone made a Hazelnut Brown Butter Cake?"
"It's from Sunday Suppers at Lucques and not to torment you or anything, but I am eating a piece right now."
[Insert sound of Deb fainting to the floor. Or something equally melodramatic. Because nobody feeds me, ever.]
And this, my friends, is an excellent time for me to introduce my new favorite cookbook: Suzanne Goin's Sunday Suppers at Lucques. I know I'm always two-plus years late to the party but what is important is that I got there at all. Falling head over heels in love with a cookbook is dangerous, however; on one hand, I get to share something with you that I am gaspingly excited about. But on the other hand, if I were to, say, only post recipes from Sunday Suppers for the next two weeks, it wouldn't be very cool at all. We must strive for moderation! But this doesn't make it easy. In fact, I'm already on my second recipe, I created a third one this weekend and I've got my eye on, oh, sixteen or seventeen more.
But if this cake doesn't get you running to the store to buy Suzanne Goin's masterpiece, I just don't know about you. Did you hear the part where I mentioned hazelnuts, and the brown butter? There's a vanilla bean in there too. Oh, and because I was bringing it to my in-laws who–how shall I state this mildly?–have a slight thing for chocolate, I draped it with ganache, though the original recipe just suggested powdered sugar and caramelized pears.
Anyway, the two weeks between the time I learned of this cake, ordered the book and finally found a chance to make it were probably a little difficult for Alex. "What would you like for dinner?" "Hazelnut Brown Butter Cake." "What should we do today?" "Hazelnut Brown Butter Cake." "Do you like this shirt and jeans together?" "Hazelnut Brown Butter Cake."
I think you can see where I am going with this. Had his Aunt's 65th birthday not given me an excuse to finally bake the cake, Alex might have taken to wearing earplugs around the apartment. Uh, again. Thank goodness things never got that ugly, I mean, until he suggested that we share the piece left in the fridge. It's like he doesn't know me AT ALL.
Hazelnut Brown Butter Cake
Adapted from Sunday Suppers at Lucques
Chef Goin served this as her wedding cake. Need I say more? Okay fine, I will: I liked it even better out of the fridge the next day.
5 ounces (about one heaping cup) hazelnuts, blanched to remove dark skins*
1/2 pound unsalted butter (plus 1 tablespoon melted extra for greasing the pan)
1/2 vanilla bean
1 1/3 cups powdered sugar, plus extra for dusting the cake
1/3 cup all-purpose flour
5 extra-large egg whites (I used 6 since I was using
large eggs)
3 tablespoons granulated sugar
Preheat oven to 350 °F.
Spread the hazelnuts on a baking sheet, and toast 12 to 15 minutes, until they're golden brown and smell nutty. Let them cool.
Cut out a circle of parchment paper to fit in the bottom of a 10-inch round cake pan. Brush the pan with a little melted butter and line the bottom with the paper.
Place the rest of the butter in a medium saucepan. Slice the vanilla bean lengthwise down the center, and using a paring knife to scrape the seeds and pulp onto the butter. To make sure not to lose any of the seeds, run your vanilla-coated knife through the butter. Add the vanilla pod to the pan, and cook the butter until the butter browns and smells nutty (about 6 to 8 minutes). It helps to frequently scrape the solids off the bottom of the pan in the last couple minutes to ensure even browning. Set aside to cool. Remove the vanilla pod and discard.
Grind the hazelnuts with the confectioners' sugar in a food processor until they're finely ground. Add the flour and pulse to combine. Transfer to a large bowl.
Place the egg whites in the bowl of a stand mixer fitted with the whisk attachment. Add the granulated sugar and mix on high speed 4 to 5 minutes, until the mixture forms very stiff peaks. When you turn the whisk upside down, the peaks should hold. Transfer the whites to a large mixing bowl.
Alternate folding the dry ingredients and the brown butter into the egg whites, a third of a time. Remember to scrap the bottom of the brown butter pan with a rubber spatula to get all the little brown bits.
Pour the batter into the prepared cake pan, and bake for 50 minutes to 1 hour**. Cool on a rack 30 minutes. Run a knife around the inside edge of the pan, and invert the cake onto a plate. Peel off the paper, and turn the cake back over onto a serving platter. Sprinkle it with powdered sugar or cover with ganache (below).
* I removed the skins (which are especially tough on the delicious Oregon hazelnuts I found) by toasted them on a baking sheet at 350°F for about 15 minutes then either (I tried both methods) wrapping the warm nuts in a dish towel, letting it steam for five minutes and then vigorously rubbing them together to remove the skins or by plunking them in a colander and using a hard, dry, clean scrub brush to brush their skins off.
** Mine was done at 40 minutes so check yours even earlier, okay?
Draping Ganache for 10-inch Cake
4 ounces semisweet chocolate chips or finely-chopped chocolate
1/4 cup heavy cream
1/2 teaspoon instant coffee granules
Melt the chocolate, heavy cream, and coffee in the top of a double boiler over simmering water until smooth and warm, stirring occasionally. Drizzle over the top of the cake. (I usually use the boil cream and then stir in chips until they melt method, but found that this time it ended up too thick and hard to drizzle. Feel free to try either, though!)
Updated to add: Eggbeater's Shuna has made this cake before, and has terrifically detailed instructions and step-by-step pictures for those of you who need more than gushing to guide you through a recipe! Check it out.


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Diep has to be one of my personal favourites that I've looked at, its provided me with hours of entertainment and I'm still not bored of it! Diep is a free for all, 2d shooter game where the only rules are kill or be killed. Shoot shapes that passively sit around the map to gain xp or kill other players, once you have enough xp to level you will be offered the option to level up several stats such as maximum hp, bullet speed, bullet damage and several others!
Game directions: n the world of Diep you control a tank and shoot projectiles who's behaviour can be modified through the levelling system to defend yourself and attack opponents. Every 10 levels you will get the choice to modify your overall vehicle and change the way you shoot/play. Like several other io games there is an in game leader board which displays the players score and an icon of the type of tank they are currently using, I'd recommend that new players pay attention to this to begin with so you can get a better feel for strong tank builds. It is highly recommended that you try to move as much as possible as the higher level tanks deal a lot of damage to new players! Diep.io Strategy Your tank sits in the middle of the screen and can be moved to navigate the map using the WASD keys or the arrow keys, your gun barrel will follow your mouse cursor however. You can fire your cannon using left click or the space bar.
Game Tags


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Obama's Change ñ A Brand of Evil
July 8, 2013
Every period of time in this world has had its despots, and tyrants who forced their particular brand of evil on those they ruled.
To insult the Jews, Antiochus Epiphanes (Antiochus IV) slew a pig in the most sacred spot in the world for Jewish people, the Holy of Holies.
Herod wanting to please the Romans hoisted up the Roman Eagle over the door of the Temple; which was a clear defilement in the eyes of every Jew.
Later Roman Emperor Nero began killing Christians for sport and to entertain his willing blood thirsty citizens.
Fast forward to modern despots. There are so many we will hone in on the best known. Hitler killed Jews and anyone else who resisted his diabolical Third Reich. Millions died before his twisted schemes could be reined in and Germany brought down to a heap of smoldering rubble.
All successful despots throughout all time have shared one thing in common; they knew that crowd control was not something that you do when everything has gone out of control; it is something you do so it won't ever go out of control. Julius Caesar was known for saying that if you gave people a piece of bread and a spectacle you could do anything you wanted with them.
Enter Barack Obama, unlike any President before him, he tosses those with a nanny state mentality a pile of freebies, cuddles up with Hollywood moguls and celebs who keep us titillated and laughing and sits down to dinner with the kings of earth on the taxpayer's dime. His wife flourishes in her role as the queen of America, with TV appearances, worldwide trips and $3,000 per night stays in world-class hotels.
Scandals are too many to keep track of and confusion and pandemonium reigns in the other branches of government to the point of paralysis and confusion of face. Because Obama's Vice President, appointees, cabinet members, agencies, sycophantic drooling main stream media and unquestioning minions and followers are all flesh of his flesh; the Congress is fighting brush fires and rumors of fires while the entire forest is burning down.
Seventeen trillion in debt will soon be accompanied by the biggest train wreck in American history known as –"ObamaCare."
The president's way of handling all of this is to shoot off to Africa for a multi-million dollar PR junket for some political purpose known only to him.
At home DOMA has been dumped due to the dilettante 'evolved' morality of the president and every major guide and tradition has been abandoned for the whims of man with no known accomplishments to his credit and over twenty hidden and never seen documents about his past.
The Bible, the constitution and 6,000 years of human adherence to the laws of nature and common sense regarding marriage have been dumped under the auspices of a single man who has promised a change that is now becoming the most defiant, divisive and destructive policy ever presented to any nation in history.
What contribution has Barack Obama made to American greatness and her way of life on any level? Honesty would convulse if we named any area at all - but one. The prurient, perverted lifestyle and practices of the lesbian, gay, bisexual and transgender population is the only thing noticeably promoted in the first and second term of Barack Obama.
It is Barack Obama's unique and particular brand of evil, and yet it is being presented as a great win for civil rights. It is dragged up and paraded as something akin to the great civil rights struggle of the blacks. At the very least, it is touted as the means by which Obama has streamlined America and brought her into the twenty first century.
The path to a nation's demise and doom has been well catered or pimped depending on your view, but a confetti strewn floor and a few straggling balloons, once the party is over, will hardly be an answer for a nation whose greatness was the most remarkable accomplishment of civil government in the history of the world.
When Obama announced he would not defend DOMA, the courts were weakened and on the fortieth year of the inception of Roe v. Wade, the Supreme Court made its second worst decision in the nation's history.
Those who know their Bibles will tell you in a heartbeat that America had only three aces in her hand and one of them is not the incessant declaration that our president is the leader of the free world.
Our morality and conscience were all that ever mattered. It is what kept families sacred and children safe, but now, under the administration of one man, those things have plunged to the place of no return. The other ace was our connection to, and our protection for Israel, now, even that is fully in question.
Obama's involvement in the advancement of the Muslim Brotherhood, a complete failure, and his spineless commitments to everyone from our Libyan ambassador to Syrian peace gives little hope that he will stand up for Israel if she is attacked in force by Muslims, who are committed to the hatred of this tiniest of countries.
The world mocks those who proclaim that antichrist will soon emerge and reign for the last few years of time before the Lord Jesus Christ returns and takes the reins of power away from men. Yet, we have a man said to be the leader of the free world doing everything to prepare the way for such a man.
Yes, the rest of the world is also chomping at the bit to enter the changes that Barack Obama is proposing here in the U.S. To those who understand prophecy that is only proof that the stage is being set for the coming the 'Man of Sin.' (2Th 2: 3)
Will it be the free for all of the LGBT with parades and open shows in media and public, or the dark portent of Sharia law where women are entombed in black potato sacks and reduced to the social level of cattle? Will America be a nation ruled by a political party led by Jihadists or a big party put on by the LGBT? Will the Muslims bring Sharia to Hollywood first to cover up the nudies and thus end the excesses virtually overnight? Which confusion will emerge to take us into the twenty first?
Will we thank Mr. Obama during his lame duck year, if the world lasts that long? Will we see him on his way to other great pursuits and welcome in the next modern avatar of avant garde modernity? Will we rest under the shade of the spreading social changes we have planted like so many trees in the garden and watch posterity reap the rewards of the "change we can believe in?"
We will do nothing of the kind, but rather we will not have time to lick our wounds or recover and start again. The order may change now, but it will be short lived and the real change will become permanent, as in eternal.
"For yourselves know perfectly that the day of the Lord so cometh as a thief in the night. For when they shall say, Peace and safety; then sudden destruction cometh upon them, as travail upon a woman with child; and they shall not escape." (1Th 5: 2, 3)
Not even Barack Obama could circumvent or abort this baby, (sudden destruction) it will be born to the nations as has been foretold by prophets from the foundation of the world.
American Prophet.org has since 2005 featured the articles and reports of journalist Rev Michael Bresciani along with news and reviews that have earned this site the title of The Website for Insight. Millions have read his timely reports and articles in online journals and print publications across the nation and the globe. Follow us on Twitter and Facebook
Michael Bresciani is the publisher of American Prophet.org since 2005. The website features the articles and reports of Rev Bresciani along with some of America's best writers and journalists, news and reviews that have earned the site the title of "The Website for Insight." Millions have read his timely reports and articles in online journals and print publications across the nation and the globe. Follow us on Twitter and Facebook!
Visit Rev. Michael Bresciani's website at www.americanprophet.org
See more from Rev. Michael Bresciani at email@example.com


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Featured Video Tutorial
Check out the tutorials page for complete instructions on how to make a rag rug!
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This exceptional book, a compilation of five essays, is glorified by all those in the Gauḍīya Vaiṣṇava sampradāya for fearlessly glorifying and protecting its philosophical principles. The five topics are (1) The Śrī Gauḍīya Vaiṣṇava Sampradāya and Sannyāsa, (2) Pāñcarātrika and Bhāgavata Guru-paramparā, (3) The Gauḍīya Sampradāya is in the Line of Madhvācārya, (4) Babājī- veṣa and Siddha-praṇālī and (5) Eligibility to Hear Rāsa-līlā Kathā. Each refutation is elaborately and conclusively proven with evidence from śāstra.
"With folded hands, it is our earnest prayer that, after deeply and seriously studying this Prabandha-pañcakam, the camaraderie within the pure sampradāya may be protected and preserved." [Śrī Śrīmad Bhaktivedānta Nārāyaṇa Gosvāmī Mahārāja]


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natrium salicylicum
Materia Medica
Has an extensive range of action affecting the head, ear, throat, kidneys and liver and on metabolism. Haemorrhages, especially epistaxis. Produces marked effects upon the internal ear, with vertigo, deafness, noises in ears and loss of bone conduction, hence, its use in Meniere's disease. One of the best remedies for the prostrating after-effects of influenza. Lassitude, drowsiness, listlessness, tremor. Incipient dementia. Increases the quantity of bile. Follicular tonsillitis.
Head: Perfectly rational periods, alternate with manifestations of insanity of a somber character. Vertigo; worse, raising head. All objects seem to move to the right. Dull headache and confusion. Fibrositis of the scalp.
Eyes: Retinal haemorrhage, albuminuric retinitis with haemorrhage. Iridocychitis due to traumatism with infection, and in sympathetic disease secondary to it (Dr. Gradel).
Ears: Tinnitus of a low tone. Deafness. Auditory vertigo.
Chest: Dyspnoea; breathing noisy, shallow, panting; pulse irregular. Complete loss of voice.
Skin: Å'dema, urticaria, red in circumscribed patches. Tingling and itching. Pemphigoid eruption.
Lobelia purpurascens (drowsiness; dizzy headache between eyebrows; cannot keep eyes open; tongue-white-feels paralyzed as also do the heart and lungs intense prostration of all vital forces; deadly chill, without shivering; useful for the low, nervous prostration of grippe
Gaulth; China.
Pyrus malus-Crab apple tree--(Labyrinthine vertigo. Dr. Cooper


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Skin Pigment Disorders
What are skin pigment disorders?
Skin color is determined by a pigment (melanin) made by specialized cells in the skin (melanocytes). The amount and type of melanin determines a person's skin color.
What is the function of melanin?
Melanin gives color to the skin, hair, and iris of the eyes. Levels of melanin depend on race and amount of sunlight exposure. Sun exposure increases melanin production to protect the skin against harmful UV (ultraviolet) rays. In addition, hormonal changes can affect melanin production.
What are the different types of skin pigment disorders?
|Pigment disorder
CharacteristicsThis is a rare, inherited disorder. It reduces the amount of melanin pigment in the skin, hair, and eyes. People with albinism (albinos) have white hair, pale skin, and blue eyes. Their eyes may seem red in different lighting conditions. Many also have vision problems.
TreatmentThere is no cure for albinism. People with this condition should avoid sun damage to the skin and eyes by wearing sunscreen, hats, and sunglasses.
CharacteristicsDark brown to gray-brown, symmetric patches of pigment on the face. During pregnancy, this is called the mask of pregnancy. Sun exposure, hormones, and birth control pills are thought to cause melasma.
TreatmentSunscreens and avoiding sun exposure can prevent melasma from becoming worse. Other treatment may include prescription creams containing hydroquinone and tretinoin to lighten the patches. Chemical peels and laser treatment can also be used.
|Pigment loss after skin damage
CharacteristicsSometimes, after an ulcer, blister, burn, or infection, the skin does not replace some of the pigment in that area.
TreatmentNo treatment is needed. Makeup can usually cover the blemish.
CharacteristicsThis causes smooth, white patches on the skin. It is caused by the loss of pigment-producing cells in the skin (melanocytes). It is thought to be an autoimmune disease. The white patches are very sensitive to the sun.
TreatmentThere is no cure. Treatment may include covering smaller patches with long-lasting dyes, light-sensitive medicines, UV light therapy, corticosteroid creams, surgery, and removing the remaining pigment from the skin (depigmentation).


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Baghdad Rocked Again By Deadly Bomb Blasts
The death toll is rising in Baghdad from another series of deadly bombings apparently aimed at Shiite Muslims.
About 30 people were killed today and more than 60 wounded, according to authorities, by explosions near two sites where day laborers were gathering to look for construction work.
Iraq's Interior Ministry tells the BBC that the attacks happened in Baghdad's Sadr City and Kadhimiya neighborhoods, both predominantly Shiite.
It's the worst day of violence since Dec. 22, when multiple explosions in about 13 different locations in Baghdad killed dozens and wounded more than 200. Those attacks also were predominantly in Shiite Muslim neighborhoods.
As al-Jazeera correspondent Dahr Jamail reported from Baghdad, the attacks add to already high tension in Iraq, where Iraq's Shiite-dominated cabinet has issued an arrest warrant for Vice President Tariq al-Hashemi, Iraq's highest-ranking Sunni Muslim politician.
"Many Sunnis," The Guardian notes, "have complained of being sidelined in the political process since Saddam Hussein was ousted and the majority Shia dominated the government."
The U.S. withdrew the last of its combat forces from Iraq last month, nearly nine years after the start of the Iraq War.
Copyright 2020 NPR. To see more, visit https://www.npr.org.


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The instruction manual is reserved for HP printers that are web enabled and supports remote printing via HP ePrint .
HP provides an exclusive service for its customers who do not always be in geographical proximity with their printers. They would like to print from remote locations and send print commands to their printers both from far and near. This exclusive service called HP ePrint is a cloud supported remote printing app allowing the users to print remote provided an active internet connection is present.For regular updates 123.hp.com/envy7864 All In One Printer.The user has to simply shoot an e mail with photos and documents straight to the printer's e mail address and print them.