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fewer Millennials are taking part in traditional family building, and the ones doing it are waiting longer than their parents did. Now the structure of social life isn’t that different for many people in their mid-30s than it was in their early 20s, which provides plenty of time for drinking on dates and with friends for them to start to get a little tired of it.

“Folks in the Millennial generation have maybe a better sense of balance. Some do yoga or meditation or are physically active, so they don’t need to find stimulation and stress reduction in substances.” That mirrors the generation’s general interest in maintaining its health,

Millennials who haven’t developed their generation’s signature coping skills often use alcohol heavily. Starke sees an alarming number of people under 35 with advanced liver disease or alcohol hepatitis. As attitudes may be moderating for many young adults, plenty of others are struggling: Nearly 90,000 people still die from alcohol-related causes in America every year, and that number hasn’t started to meaningfully improve.

“It still seems like this is a generation of self-medicating, but they’re using things differently,” says Starke, and the normalization and ever more common legalization of cannabis have a big part in that.

A 2017 study found that in counties with legalized medicinal cannabis, alcohol sales dropped more than 12 percent when compared with similar counties without weed. Recreational legalization has the potential to bolster that effect by making cannabis products even more broadly accessible

She sees many patients looking for help with opioids, as well as benzodiazepines such as Xanax.

uicide rates are up among young adults, and prescription-drug abuse is a problem the country is only beginning to address

Gen Z is drinking at lower rates than adolescents have in generations, and so much about a person’s lifetime relationship with substance abuse and consumption is set by use in early life.

“For many people, when they’re honest with their friends [about wanting to skip out on drinks], their friends are like, ‘Oh my God, I was thinking about that too,’” says UNC’s Starke. “I don’t know too many people who have gotten a negative response.”

They will expand the presence of low- and no-calorie drinks, as well as drinks sold in smaller portions, and use their promotional skills to educate consumers and encourage them to reduce the calories they are drinking.

The program will cover company-owned vending machines and coolers in convenience stores, as well as fountain soda dispensers like those found in fast-food restaurants and movie theaters. The companies control almost all of those machines, in addition to about one-third of vending machines and 80 percent of coolers.

It also will spill into grocery stores in end-of-aisle promotions and other marketing. “We’ll use the most critical levers we have at our disposal, and the focus really will be on transforming the beverage landscape in the U.S. over the next 10 years,”

“While they’re making this pledge, they are totally dug in, fighting soda tax initiatives in places like Berkeley and San Francisco that have exactly the same goal,” said Professor Nestle, who has just finished a book about the industry.

From 2000 to 2013, calories consumed through sugary drinks fell 12 percent, according to Beverage Digest, attributed to declining soda sales and increased consumption of water and low-calorie drinks.

“I suspect they’re promising what’s going to happen anyway,” said Kelly Brownell, an expert on obesity and dean of the Sanford School of Public Policy at Duke University. “All the trends are showing decreased consumption of high-calorie beverages, and so what better way to get a public relations boost than to promise to do what’s happening anyway?”

People who drank 45 grams of alcohol or more a day—about as much as in three glasses of wine—increased their risk of dying sooner by up to a third. Among women, anything more than 25 grams of alcohol increased their risk of dying sooner. 

The findings suggest that the average man can drink up to about three drinks a day and expect to live as long as nondrinkers. Women might want to stop at about two drinks, the research suggested.

Health officials in Canada this year recommended that people have two drinks or fewer a week to lower health risks. That replaced guidance that 10 drinks a week was a low health risk. 

A recent series of articles on fraternities by Bloomberg News’s David Glovin and John Hechinger notes that since 2005, more than 60 people—the majority of them students—have died in incidents linked to fraternities, a sobering number in itself, but one that is dwarfed by the numbers of serious injuries, assaults, and sexual crimes that regularly take place in these houses.

I have spent most of the past year looking deeply into the questions posed by these lawsuits, and more generally into the particular nature of fraternity life on the modern American campus

to answer the vexing question “why don’t colleges just get rid of their bad fraternities?”—the system, and its individual frats, have only grown in power and influence. Indeed, in many substantive ways, fraternities are now mightier than the colleges and universities that host them.

The entire multibillion-dollar, 2,000-campus American college system

the Kappa Alpha Society. Word of the group spread, and a new kind of college institution was founded, and with it a brand-new notion: that going to college could include some pleasure. It was the American age of societies, and this new type fit right in.

every moment of the experience is sweetened by the general understanding that with each kegger and rager, each lazy afternoon spent snoozing on the quad (a forgotten highlighter slowly drying out on the open pages of Introduction to Economics, a Coke Zero sweating beside it), they are actively engaged in the most significant act of self-improvement available to an American young person: college!

There are many thousands of American undergraduates whose economic futures (and those of their parents) would be far brighter if they knocked off some of their general-education requirements online, or at the local community college—for pennies on the dollar—before entering the Weimar Republic of traditional-college pricing. But college education, like weddings and funerals, tends to prompt irrational financial decision making,

depends overwhelmingly for its very existence on one resource: an ever-renewing supply of fee-paying undergraduates. It could never attract hundreds of thousands of them each year—many of them woefully unprepared for the experience, a staggering number (some 40 percent) destined never to get a degree, more than 60 percent of them saddled with student loans that they very well may carry with them to their deathbeds—if the experience were not accurately marketed as a blast.

When colleges tried to shut them down, fraternities asserted that any threat to men’s membership in the clubs constituted an infringement of their right to freedom of association. It was, at best, a legally delicate argument, but it was a symbolically potent one, and it has withstood through the years. The powerful and well-funded political-action committee that represents fraternities in Washington has fought successfully to ensure that freedom-of-association language is included in all higher-education reauthorization legislation, thus “disallowing public Universities the ability to ban fraternities.”

While the fraternities continued to exert their independence from the colleges with which they were affiliated, these same colleges started to develop an increasingly bedeviling kind of interdependence with the accursed societies

the fraternities involved themselves very deeply in the business of student housing, which provided tremendous financial savings to their host institutions, and allowed them to expand the number of students they could admit. Today, one in eight American students at four-year colleges lives in a Greek house

fraternities tie alumni to their colleges in a powerful and lucrative way. At least one study has affirmed what had long been assumed: that fraternity men tend to be generous to their alma maters. Furthermore, fraternities provide colleges with unlimited social programming of a kind that is highly attractive to legions of potential students

It is true that fraternity lawsuits tend to involve at least one, and often more, of the four horsemen of the student-life apocalypse, a set of factors that exist far beyond frat row

the binge-drinking epidemic, which anyone outside the problem has a hard time grasping as serious (everyone drinks in college!) and which anyone with knowledge of the current situation understands as a lurid and complicated disaster

The second is the issue of sexual assault of female undergraduates by their male peers, a subject of urgent importance but one that remains stubbornly difficult even to quantify

The third is the growing pervasiveness of violent hazing on campus

But it’s impossible to examine particular types of campus calamity and not find that a large number of them cluster at fraternity houses

the fourth is the fact that Boomers, who in their own days destroyed the doctrine of in loco parentis so that they could party in blissful, unsupervised freedom, have grown up into the helicopter parents of today

during the period of time under consideration, serious falls from fraternity houses on the two Palouse campuses far outnumbered those from other types of student residences, including privately owned apartments occupied by students. I began to view Amanda Andaverde’s situation in a new light.

Why are so many colleges allowing students to live and party in such unsafe locations? And why do the lawsuits against fraternities for this kind of serious injury and death—so predictable and so preventable—have such a hard time getting traction? The answers lie in the recent history of fraternities and the colleges and universities that host them.

This question is perhaps most elegantly expressed in the subtitle of Robert D. Bickel and Peter F. Lake’s authoritative 1999 book on the subject, The Rights and Responsibilities of the Modern University: Who Assumes the Risks of College Life?

The answer to this question has been steadily evolving ever since the 1960s, when dramatic changes took place on American campuses, changes that affected both a university’s ability to control student behavior and the status of fraternities in the undergraduate firmament. During this period of student unrest, the fraternities—long the unquestioned leaders in the area of sabotaging or ignoring the patriarchal control of school administrators—became the exact opposite: representatives of the very status quo the new activists sought to overthrow. Suddenly their beer bashes and sorority mixers, their panty raids and obsession with the big game, seemed impossibly reactionary when compared with the mind-altering drugs being sampled in off-campus apartments where sexual liberation was being born and the Little Red Book proved, if nothing else, a fantastic coaster for a leaky bong.

American colleges began to regard their students not as dependents whose private lives they must shape and monitor, but as adult consumers whose contract was solely for an education, not an upbringing. The doctrine of in loco parentis was abolished at school after school.

Through it all, fraternities—for so long the repositories of the most outrageous behavior—moldered, all but forgotten.

Animal House, released in 1978, at once predicted and to no small extent occasioned the roaring return of fraternity life that began in the early ’80s and that gave birth to today’s vital Greek scene

In this newly forming culture, the drugs and personal liberation of the ’60s would be paired with the self-serving materialism of the ’80s, all of which made partying for its own sake—and not as a philosophical adjunct to solving some complicated problem in Southeast Asia—a righteous activity for the pampered young collegian. Fraternity life was reborn with a vengeance.

These new members and their countless guests brought with them hard drugs, new and ever-developing sexual attitudes, and a stunningly high tolerance for squalor

Adult supervision was nowhere to be found. Colleges had little authority to intervene in what took place in the personal lives of its students visiting private property. Fraternities, eager to provide their members with the independence that is at the heart of the system—and responsive to members’ wish for the same level of freedom that non-Greek students enjoyed—had largely gotten rid of the live-in resident advisers who had once provided some sort of check on the brothers

, in 1984 Congress passed the National Minimum Drinking Age Act, with the ultimate result of raising the legal drinking age to 21 in all 50 states. This change moved college partying away from bars and college-sponsored events and toward private houses—an ideal situation for fraternities

lawsuits began to pour in.

Liability insurance became both ruinously expensive and increasingly difficult to obtain. The insurance industry ranked American fraternities as the sixth-worst insurance risk in the country—just ahead of toxic-waste-removal companies.

For fraternities to survive, they needed to do four separate but related things: take the task of acquiring insurance out of the hands of the local chapters and place it in the hands of the vast national organizations; develop procedures and policies that would transfer as much of their liability as possible to outside parties; find new and creative means of protecting their massive assets from juries; and—perhaps most important of all—find a way of indemnifying the national and local organizations from the dangerous and illegal behavior of some of their undergraduate members.

comprising a set of realities you should absolutely understand in detail if your son ever decides to join a fraternity.

you may think you belong to Tau Kappa Epsilon or Sigma Nu or Delta Tau Delta—but if you find yourself a part of life-changing litigation involving one of those outfits, what you really belong to is FIPG, because its risk-management policy (and your adherence to or violation of it) will determine your fate far more than the vows you made during your initiation ritual

the need to manage or transfer risk presented by alcohol is perhaps the most important factor in protecting the system’s longevity. Any plaintiff’s attorney worth his salt knows how to use relevant social-host and dramshop laws against a fraternity; to avoid this kind of liability, the fraternity needs to establish that the young men being charged were not acting within the scope of their status as fraternity members. Once they violated their frat’s alcohol policy, they parted company with the frat.

there are actually only two FIPG-approved means of serving drinks at a frat party. The first is to hire a third-party vendor who will sell drinks and to whom some liability—most significant, that of checking whether drinkers are of legal age—will be transferred. The second and far more common is to have a BYO event, in which the liability for each bottle of alcohol resides solely in the person who brought it.

these policies make it possible for fraternities to be the one industry in the country in which every aspect of serving alcohol can be monitored and managed by people who are legally too young to drink it.

But when the inevitable catastrophes do happen, that policy can come to seem more like a cynical hoax than a real-world solution to a serious problem.

Thanks in part to the guest/witness list, Larry can be cut loose, both from the expensive insurance he was required to help pay for (by dint of his dues) as a precondition of membership, and from any legal defense paid for by the organization. What will happen to Larry now?

“I’ve recovered millions and millions of dollars from homeowners’ policies,” a top fraternal plaintiff’s attorney told me. For that is how many of the claims against boys who violate the strict policies are paid: from their parents’ homeowners’ insurance

, the Fraternal Information and Programming Group’s chillingly comprehensive crisis-management plan was included in its manual for many years

the plan serves a dual purpose, at once benevolent and mercenary. The benevolent part is accomplished by the clear directive that injured parties are to receive immediate medical attention, and that all fraternity brothers who come into contact with the relevant emergency workers are to be completely forthright

“Until proven otherwise,” Fierberg told me in April of fraternities, “they all are very risky organizations for young people to be involved in.” He maintains that fraternities “are part of an industry that has tremendous risk and a tremendous history of rape, serious injury, and death, and the vast majority share common risk-management policies that are fundamentally flawed. Most of them are awash in alcohol. And most if not all of them are bereft of any meaningful adult supervision.”

the interests of the national organization and the individual members cleave sharply as this crisis-management plan is followed. Those questionnaires and honest accounts—submitted gratefully to the grown-ups who have arrived, the brothers believe, to help them—may return to haunt many of the brothers, providing possible cause for separating them from the fraternity, dropping them from the fraternity’s insurance, laying the blame on them as individuals and not on the fraternity as the sponsoring organization.

So here is the essential question: In the matter of these disasters, are fraternities acting in an ethical manner, requiring good behavior from their members and punishing them soundly for bad or even horrific decisions? Or are they keeping a cool distance from the mayhem, knowing full well that misbehavior occurs with regularity (“most events take place at night”) and doing nothing about it until the inevitable tragedy occurs, at which point they cajole members into incriminating themselves via a crisis-management plan presented as being in their favor?

I have had long and wide-ranging conversations with both men, in which each put forth his perspective on the situation.

the young men who typically rush so gratefully into the open arms of the representatives from their beloved national—an outfit to which they have pledged eternal allegiance—would be far better served by not talking to them at all, by walking away from the chapter house as quickly as possible and calling a lawyer.

The fraternity system, he argues, is “the largest industry in this country directly involved in the provision of alcohol to underage people.” The crisis-management plans reveal that in “the foreseeable future” there may be “the death or serious injury” of a healthy young person at a fraternity function.

His belief is that what’s tarnishing the reputation of the fraternities is the bad behavior of a very few members, who ignore all the risk-management training that is requisite for membership, who flout policies that could not be any more clear, and who are shocked when the response from the home office is not to help them cover their asses but to ensure that—perhaps for the first time in their lives—they are held 100 percent accountable for their actions.

The fraternity system, he argues, is “the largest industry in this country directly involved in the provision of alcohol to underage people.” The crisis-management plans reveal that in “the foreseeable future” there may be “the death or serious injury” of a healthy young person at a fraternity function.

His belief is that what’s tarnishing the reputation of the fraternities is the bad behavior of a very few members, who ignore all the risk-management training that is requisite for membership, who flout policies that could not be any more clear, and who are shocked when the response from the home office is not to help them cover their asses but to ensure that—perhaps for the first time in their lives—they are held 100 percent accountable for their actions.

Unspoken but inherent in this larger philosophy is the idea that it is in a young man’s nature to court danger and to behave in a foolhardy manner; the fraternity experience is intended to help tame the baser passions, to channel protean energies into productive endeavors such as service, sport, and career preparation.

In a sense, Fierberg, Smithhisler, and the powerful forces they each represent operate as a check and balance on the system. Personal-injury lawsuits bring the hated media attention and potential financial losses that motivate fraternities to improve. It would be a neat, almost a perfect, system, if the people wandering into it were not young, healthy college students with everything to lose.

In a sense, Fierberg, Smithhisler, and the powerful forces they each represent operate as a check and balance on the system. Personal-injury lawsuits bring the hated media attention and potential financial losses that motivate fraternities to improve. It would be a neat, almost a perfect, system, if the people wandering into it were not young, healthy college students with everything to lose.

Wesleyan is one of those places that has by now become so hard to get into that the mere fact of attendance is testament, in most cases, to a level of high-school preparation—combined with sheer academic ability—that exists among students at only a handful of top colleges in this country and that is almost without historical precedent.

Wesleyan is one of those places that has by now become so hard to get into that the mere fact of attendance is testament, in most cases, to a level of high-school preparation—combined with sheer academic ability—that exists among students at only a handful of top colleges in this country and that is almost without historical precedent.

This January, after publishing a withering series of reports on fraternity malfeasance, the editors of Bloomberg.com published an editorial with a surprising headline: “Abolish Fraternities.” It compared colleges and universities to companies, and fraternities to units that “don’t fit into their business model, fail to yield an adequate return or cause reputational harm.”

A college or university can choose, as Wesleyan did, to end its formal relationship with a troublesome fraternity, but—if that fiasco proves anything—keeping a fraternity at arm’s length can be more devastating to a university and its students than keeping it in the fold.

A college or university can choose, as Wesleyan did, to end its formal relationship with a troublesome fraternity, but—if that fiasco proves anything—keeping a fraternity at arm’s length can be more devastating to a university and its students than keeping it in the fold.

there is a Grand Canyon–size chasm between the official risk-management policies of the fraternities and the way life is actually lived in countless dangerous chapters.

When there is a common denominator among hundreds of such injuries and deaths, one that exists across all kinds of campuses, from private to public, prestigious to obscure, then it is more than newsworthy: it begins to approach a national scandal.

When there is a common denominator among hundreds of such injuries and deaths, one that exists across all kinds of campuses, from private to public, prestigious to obscure, then it is more than newsworthy: it begins to approach a national scandal.

“Bro culture is a dynamic that’s been creating men-only environments in their most toxic form by encouraging bad behaviors, from excessive drinking to heavy sexualized talk, that excludes women and any person who doesn’t support those behaviors,” Ms. Cooper says.

She adds that it isn’t just women whom bro culture excludes. It’s anyone who doesn’t want to participate in these kinds of behaviors. “Very few people enjoy those things, but they don’t want to stand up to the popular crowd making the rules,” she says. “I like beer pong as much as the next person, but I don’t want to do it at work. “

Perhaps the biggest efforts involve separating work from alcohol. Stories abound in Silicon Valley about networking events that happen late into the night at alcohol- and drug-fueled parties

“We make sure the activities we do within the company and with the founders are gender-neutral,” Ms. Hebb says. “We aren’t doing whiskey drinking and shooting. We’ll do a scavenger hunt, or a hike, which is actually a better way to get to know people than over drinks. Is a scavenger hunt less bro-ey than drinks? It’s different, and we think that relates to a broader group of people who have felt excluded from a singular way of networking

In 2017, Pipeline Angels announced an alcohol-free policy. It came about when Pipeline Angels’ founder, Natalia Oberti Noguera, attended a tech conference where the host announced an impromptu “drunk talk” on stage. It’s a fairly common tactic in Silicon Valley, with the idea being that a volunteer from the audience will drink a lot and then give a talk in the hopes that alcohol will make that person more vulnerable and more forthcoming.

“Do you know who volunteered to give the drunk talk? A white guy,” Ms. Oberti Noguera says. She didn’t see that as surprising given the potential reputational risks of getting drunk for someone other than a white man.

“We’re already vulnerable,” she says. “It’s not safe in terms of our reputation for a woman, a man of color or a nonbinary person to get drunk and give a drunk talk at a professional event. And so I thought I can take someone else’s mistake and make it a best practice. Now all our events, including meals and evening receptions, are alcohol-free.”

“Something like 90% of VC investors are men,” Ms. Nelson says. “Only 2% of VC dollars go to women. That’s the definition of bro culture—men supporting men, opening doors for one another and making those connections.”

“We’re opening doors for people that weren’t open before,” she says. “You can really have whatever kind of culture you want. It’s up to us to determine what that is.”

A new report from the body found that raising prices by 20% or more results in lower consumption and "improved nutrition".

"Free sugars" are all the different types of sugar in the diet, except for the sugars that are found naturally in fruit and milk.

The WHO's nutrition director, Dr Francesco Branca, said "nutritionally, people don't need any sugar in their diet".

He recommended sugar intake be kept below 10% of a person's total calorie intake - and preferably below 5%.

It also said that the same tax measures levied against sugary drinks appear to work with other sugary foods, as well as those high in saturated fats, trans fats, and salt.

Moses and the Israelites found that the water in Marah was bitter.

In the 8th century A.D., an Arabian chemist called Gerber suggested the use of wick siphons as a way to purify water.

This method employed the use of three pairs of sand filters, each of which had an upward-flow filter and a downward-flow filter.

His system included a covered and elevated cistern, which could prevent the growth of moss and freezing.

Nonetheless, slow sand filtration used up a lot of land, and it could not keep up with rapid population growths. In the 1880s, the rapid sand filtration method was introduced in the United States.

After the Industrial Revolution in the 19th century, water around the world became more and more polluted, and new and more sophisticated water treatment systems are being developed to ensure that everybody will have safe and clean water to drink.

The survey also looked at behavior among adults 19 to 30 years old. For this group, use of marijuana in 2022 was significantly greater, at 44 percent, up from 28 percent in 2012.

But their self-reported binge drinking had fallen to 30.5 percent, down from 35.2 percent a decade earlier.

“Drug use trends evolve over decades and across development, from adolescent to adulthood,”

, a recent study found that alcohol-related deaths continued to increase among people 65 and older, with deaths among women in this age group rising at a faster rate than among men

The ordinary fixes—the kind that draw on people’s will, and require eating less and moving more—rarely have a large or lasting effect. Indeed, America itself has suffered through a long, maddening history of failed attempts to change its habits on a national scale: a yo-yo diet of well-intentioned treatments, policies, and other social interventions that only ever lead us back to where we started

Through it all, obesity rates keep going up; the diabetes epidemic keeps worsening.

The most recent miracle, for Barb as well as for the nation, has come in the form of injectable drugs. In early 2021, the Danish pharmaceutical company Novo Nordisk published a clinical trial showing remarkable results for semaglutide, now sold under the trade names Wegovy and Ozempic.

Patients in the study who’d had injections of the drug lost, on average, close to 15 percent of their body weight—more than had ever been achieved with any other drug in a study of that size. Wadden knew immediately that this would be “an incredible revolution in the treatment of obesity.”

Many more drugs are now racing through development: survodutide, pemvidutide, retatrutide. (Among specialists, that last one has produced the most excitement: An early trial found an average weight loss of 24 percent in one group of participants.

In the United States, an estimated 189 million adults are classified as having obesity or being overweight

The drugs don’t work for everyone. Their major side effects—nausea, vomiting, and diarrhea—can be too intense for many patients. Others don’t end up losing any weight

For the time being, just 25 percent of private insurers offer the relevant coverage, and the cost of treatment—about $1,000 a month—has been prohibitive for many Americans.

The drugs have already been approved not just for people with diabetes or obesity, but for anyone who has a BMI of more than 27 and an associated health condition, such as high blood pressure or cholesterol. By those criteria, more than 140 million American adults already qualify

if this story goes the way it’s gone for other “risk factor” drugs such as statins and antihypertensives, then the threshold for prescriptions will be lowered over time, inching further toward the weight range we now describe as “normal.”

How you view that prospect will depend on your attitudes about obesity, and your tolerance for risk

The first GLP-1 drug to receive FDA approval, exenatide, has been used as a diabetes treatment for more than 20 years. No long-term harms have been identified—but then again, that drug’s long-term effects have been studied carefully only across a span of seven years

the data so far look very good. “These are now being used, literally, in hundreds of thousands of people across the world,” she told me, and although some studies have suggested that GLP-1 drugs may cause inflammation of the pancreas, or even tumor growth, these concerns have not borne out.

adolescents are injecting newer versions of these drugs, and may continue to do so every week for 50 years or more. What might happen over all that time?

“All of us, in the back of our minds, always wonder, Will something show up?  ” Although no serious problems have yet emerged, she said, “you wonder, and you worry.”

in light of what we’ve been through, it’s hard to see what other choices still remain. For 40 years, we’ve tried to curb the spread of obesity and its related ailments, and for 40 years, we’ve failed. We don’t know how to fix the problem. We don’t even understand what’s really causing it. Now, again, we have a new approach. This time around, the fix had better work.

The fen-phen revolution arrived at a crucial turning point for Wadden’s field, and indeed for his career. By then he’d spent almost 15 years at the leading edge of research into dietary interventions, seeing how much weight a person might lose through careful cutting of their calories.

But that sort of diet science—and the diet culture that it helped support—had lately come into a state of ruin. Americans were fatter than they’d ever been, and they were giving up on losing weight. According to one industry group, the total number of dieters in the country declined by more than 25 percent from 1986 to 1991.

Rejecting diet culture became something of a feminist cause. “A growing number of women are joining in an anti-diet movement,” The New York Times reported in 1992. “They are forming support groups and ceasing to diet with a resolve similar to that of secretaries who 20 years ago stopped getting coffee for their bosses.

Now Wadden and other obesity researchers were reaching a consensus that behavioral interventions might produce in the very best scenario an average lasting weight loss of just 5 to 10 percent

National surveys completed in 1994 showed that the adult obesity rate had surged by more than half since 1980, while the proportion of children classified as overweight had doubled. The need for weight control in America had never seemed so great, even as the chances of achieving it were never perceived to be so small.

Wadden wasn’t terribly concerned, because no one in his study had reported any heart symptoms. But ultrasounds revealed that nearly one-third of them had some degree of leakage in their heart valves. His “cure for obesity” was in fact a source of harm.

In December 1994, the Times ran an editorial on what was understood to be a pivotal discovery: A genetic basis for obesity had finally been found. Researchers at Rockefeller University were investigating a molecule, later named leptin, that gets secreted from fat cells and travels to the brain, and that causes feelings of satiety. Lab mice with mutations in the leptin gene—importantly, a gene also found in humans—overeat until they’re three times the size of other mice. “The finding holds out the dazzling hope,”

In April 1996, the doctors recommended yes: Dexfenfluramine was approved—and became an instant blockbuster. Patients received prescriptions by the hundreds of thousands every month. Sketchy wellness clinics—call toll-free, 1-888-4FEN-FEN—helped meet demand. Then, as now, experts voiced concerns about access. Then, as now, they worried that people who didn’t really need the drugs were lining up to take them. By the end of the year, sales of “fen” alone had surpassed $300 million.

It was nothing less than an awakening, for doctors and their patients alike. Now a patient could be treated for excess weight in the same way they might be treated for diabetes or hypertension—with a drug they’d have to take for the rest of their life.

the article heralded a “new understanding of obesity as a chronic disease rather than a failure of willpower.”

News had just come out that, at the Mayo Clinic in Minnesota, two dozen women taking fen-phen—including six who were, like Barb, in their 30s—had developed cardiac conditions. A few had needed surgery, and on the operating table, doctors discovered that their heart valves were covered with a waxy plaque.

Americans had been prescribed regular fenfluramine since 1973, and the newer drug, dexfenfluramine, had been available in France since 1985. Experts took comfort in this history. Using language that is familiar from today’s assurances regarding semaglutide and other GLP-1 drugs, they pointed out that millions were already on the medication. “It is highly unlikely that there is anything significant in toxicity to the drug that hasn’t been picked up with this kind of experience,” an FDA official named James Bilstad would later say in a Time cover story headlined “The Hot New Diet Pill.

“I know I can’t get any more,” she told Williams. “I have to use up what I have. And then I don’t know what I’m going to do after that. That’s the problem—and that is what scares me to death.” Telling people to lose weight the “natural way,” she told another guest, who was suggesting that people with obesity need only go on low-carb diets, is like “asking a person with a thyroid condition to just stop their medication.”

She’d gone off the fen-phen and had rapidly regained weight. “The voices returned and came back in a furor I’d never heard before,” Barb later wrote on her blog. “It was as if they were so angry at being silenced for so long, they were going to tell me 19 months’ worth of what they wanted me to hear. I was forced to listen. And I ate. And I ate. And ate.”

For Barb, rapid weight loss has brought on a different metaphysical confusion. When she looks in the mirror, she sometimes sees her shape as it was two years ago. In certain corners of the internet, this is known as “phantom fat syndrome,” but Barb dislikes that term. She thinks it should be called “body integration syndrome,” stemming from a disconnect between your “larger-body memory” and “smaller-body reality.

In 2003, the U.S. surgeon general declared obesity “the terror within, a threat that is every bit as real to America as the weapons of mass destruction”; a few months later, Eric Finkelstein, an economist who studies the social costs of obesity, put out an influential paper finding that excess weight was associated with up to $79 billion in health-care spending in 1998, of which roughly half was paid by Medicare and Medicaid. (Later he’d conclude that the number had nearly doubled in a decade.

In 2004, Finkelstein attended an Action on Obesity summit hosted by the Mayo Clinic, at which numerous social interventions were proposed, including calorie labeling in workplace cafeterias and mandatory gym class for children of all grades.

he message at their core, that soda was a form of poison like tobacco, spread. In San Francisco and New York, public-service campaigns showed images of soda bottles pouring out a stream of glistening, blood-streaked fat. Michelle Obama led an effort to depict water—plain old water—as something “cool” to drink.

Soon, the federal government took up many of the ideas that Brownell had helped popularize. Barack Obama had promised while campaigning for president that if America’s obesity trends could be reversed, the Medicare system alone would save “a trillion dollars.” By fighting fat, he implied, his ambitious plan for health-care reform would pay for itself. Once he was in office, his administration pulled every policy lever it could.

Michelle Obama helped guide these efforts, working with marketing experts to develop ways of nudging kids toward better diets and pledging to eliminate “food deserts,” or neighborhoods that lacked convenient access to healthy, affordable food. She was relentless in her public messaging; she planted an organic garden at the White House and promoted her signature “Let’s Move!” campaign around the country.

An all-out war on soda would come to stand in for these broad efforts. Nutrition studies found that half of all Americans were drinking sugar-sweetened beverages every day, and that consumption of these accounted for one-third of the added sugar in adults’ diets. Studies turned up links between people’s soft-drink consumption and their risks for type 2 diabetes and obesity. A new strand of research hinted that “liquid calories” in particular were dangerous to health.

when their field lost faith in low-calorie diets as a source of lasting weight loss, the two friends went in opposite directions. Wadden looked for ways to fix a person’s chemistry, so he turned to pharmaceuticals. Brownell had come to see obesity as a product of our toxic food environment: He meant to fix the world to which a person’s chemistry responded, so he started getting into policy.

The social engineering worked. Slowly but surely, Americans’ lamented lifestyle began to shift. From 2001 to 2018, added-sugar intake dropped by about one-fifth among children, teens, and young adults. From the late 1970s through the early 2000s, the obesity rate among American children had roughly tripled; then, suddenly, it flattened out.

although the obesity rate among adults was still increasing, its climb seemed slower than before. Americans’ long-standing tendency to eat ever-bigger portions also seemed to be abating.

sugary drinks—liquid candy, pretty much—were always going to be a soft target for the nanny state. Fixing the food environment in deeper ways proved much harder. “The tobacco playbook pretty much only works for soda, because that’s the closest analogy we have as a food item,

that tobacco playbook doesn’t work to increase consumption of fruits and vegetables, he said. It doesn’t work to increase consumption of beans. It doesn’t work to make people eat more nuts or seeds or extra-virgin olive oil.

Careful research in the past decade has shown that many of the Obama-era social fixes did little to alter behavior or improve our health. Putting calorie labels on menus seemed to prompt at most a small decline in the amount of food people ate. Employer-based wellness programs (which are still offered by 80 percent of large companies) were shown to have zero tangible effects. Health-care spending, in general, kept going up.

From the mid-1990s to the mid-2000s, the proportion of adults who said they’d experienced discrimination on account of their height or weight increased by two-thirds, going up to 12 percent. Puhl and others started citing evidence that this form of discrimination wasn’t merely a source of psychic harm, but also of obesity itself. Studies found that the experience of weight discrimination is associated with overeating, and with the risk of weight gain over time.

obesity rates resumed their ascent. Today, 20 percent of American children have obesity. For all the policy nudges and the sensible revisions to nutrition standards, food companies remain as unfettered as they were in the 1990s, Kelly Brownell told me. “Is there anything the industry can’t do now that it was doing then?” he asked. “The answer really is no. And so we have a very predictable set of outcomes.”

she started to rebound. The openings into her gastric pouch—the section of her stomach that wasn’t bypassed—stretched back to something like their former size. And Barb found ways to “eat around” the surgery, as doctors say, by taking food throughout the day in smaller portions

Bariatric surgeries can be highly effective for some people and nearly useless for others. Long-term studies have found that 30 percent of those who receive the same procedure Barb did regain at least one-quarter of what they lost within two years of reaching their weight nadir; more than half regain that much within five years.

if the effects of Barb’s surgery were quickly wearing off, its side effects were not: She now had iron, calcium, and B12 deficiencies resulting from the changes to her gut. She looked into getting a revision of the surgery—a redo, more or less—but insurance wouldn’t cover it

She found that every health concern she brought to doctors might be taken as a referendum, in some way, on her body size. “If I stubbed my toe or whatever, they’d just say ‘Lose weight.’ ” She began to notice all the times she’d be in a waiting room and find that every chair had arms. She realized that if she was having a surgical procedure, she’d need to buy herself a plus-size gown—or else submit to being covered with a bedsheet when the nurses realized that nothing else would fit.

Barb grew angrier and more direct about her needs—You’ll have to find me a different chair, she started saying to receptionists. Many others shared her rage. Activists had long decried the cruel treatment of people with obesity: The National Association to Advance Fat Acceptance had existed, for example, in one form or another, since 1969; the Council on Size & Weight Discrimination had been incorporated in 1991. But in the early 2000s, the ideas behind this movement began to wend their way deeper into academia, and they soon gained some purchase with the public.

“Our public-health efforts to address obesity have failed,” Eric Finkelstein, the economist, told me.

Others attacked the very premise of a “healthy weight”: People do not have any fundamental need, they argued, morally or medically, to strive for smaller bodies as an end in itself. They called for resistance to the ideology of anti-fatness, with its profit-making arms in health care and consumer goods. The Association for Size Diversity and Health formed in 2003; a year later, dozens of scholars working on weight-related topics joined together to create the academic field of fat studies.

As the size-diversity movement grew, its values were taken up—or co-opted—by Big Business. Dove had recently launched its “Campaign for Real Beauty,” which included plus-size women. (Ad Age later named it the best ad campaign of the 21st century.) People started talking about “fat shaming” as something to avoid

By 2001, Bacon, who uses they/them pronouns, had received their Ph.D. and finished a rough draft of a book, Health at Every Size, which drew inspiration from a broader movement by that name among health-care practitioners

But something shifted in the ensuing years. In 2007, Bacon got a different response, and the book was published. Health at Every Size became a point of entry for a generation of young activists and, for a time, helped shape Americans’ understanding of obesity.

Some experts were rethinking their advice on food and diet. At UC Davis, a physiologist named Lindo Bacon who had struggled to overcome an eating disorder had been studying the effects of “intuitive eating,” which aims to promote healthy, sustainable behavior without fixating on what you weigh or how you look

The heightened sensitivity started showing up in survey data, too. In 2010, fewer than half of U.S. adults expressed support for giving people with obesity the same legal protections from discrimination offered to people with disabilities. In 2015, that rate had risen to three-quarters.

In Bacon’s view, the 2000s and 2010s were glory years. “People came together and they realized that they’re not alone, and they can start to be critical of the ideas that they’ve been taught,” Bacon told me. “We were on this marvelous path of gaining more credibility for the whole Health at Every Size movement, and more awareness.”

that sense of unity proved short-lived; the movement soon began to splinter. Black women have the highest rates of obesity, and disproportionately high rates of associated health conditions. Yet according to Fatima Cody Stanford, an obesity-medicine physician at Harvard Medical School, Black patients with obesity get lower-quality care than white patients with obesity.

That system was exactly what Bacon and the Health at Every Size movement had set out to reform. The problem, as they saw it, was not so much that Black people lacked access to obesity medicine, but that, as Bacon and the Black sociologist Sabrina Strings argued in a 2020 article, Black women have been “specifically targeted” for weight loss, which Bacon and Strings saw as a form of racism

But members of the fat-acceptance movement pointed out that their own most visible leaders, including Bacon, were overwhelmingly white. “White female dietitians have helped steal and monetize the body positive movement,” Marquisele Mercedes, a Black activist and public-health Ph.D. student, wrote in September 2020. “And I’m sick of it.”

Tensions over who had the standing to speak, and on which topics, boiled over. In 2022, following allegations that Bacon had been exploitative and condescending toward Black colleagues, the Association for Size Diversity and Health expelled them from its ranks and barred them from attending its events.

As the movement succumbed to in-fighting, its momentum with the public stalled. If attitudes about fatness among the general public had changed during the 2000s and 2010s, it was only to a point. The idea that some people can indeed be “fit but fat,” though backed up by research, has always been a tough sell.

Although Americans had become less inclined to say they valued thinness, measures of their implicit attitudes seemed fairly stable. Outside of a few cities such as San Francisco and Madison, Wisconsin, new body-size-discrimination laws were never passed.

In the meantime, thinness was coming back into fashion

In the spring of 2022, Kim Kardashian—whose “curvy” physique has been a media and popular obsession—boasted about crash-dieting in advance of the Met Gala. A year later, the model and influencer Felicity Hayward warned Vogue Business that “plus-size representation has gone backwards.” In March of this year, the singer Lizzo, whose body pride has long been central to her public persona, told The New York Times that she’s been trying to lose weight. “I’m not going to lie and say I love my body every day,” she said.

Among the many other dramatic effects of the GLP-1 drugs, they may well have released a store of pent-up social pressure to lose weight.

If ever there was a time to debate that impulse, and to question its origins and effects, it would be now. But Puhl told me that no one can even agree on which words are inoffensive. The medical field still uses obesity, as a description of a diagnosable disease. But many activists despise that phrase—some spell it with an asterisk in place of the e—and propose instead to reclaim fat.

Everyone seems to agree on the most important, central fact: that we should be doing everything we can to limit weight stigma. But that hasn’t been enough to stop the arguing.

Things feel surreal these days to just about anyone who has spent years thinking about obesity. At 71, after more than four decades in the field, Thomas Wadden now works part-time, seeing patients just a few days a week. But the arrival of the GLP-1 drugs has kept him hanging on for a few more years, he said. “It’s too much of an exciting period to leave obesity research right now.”

When everyone is on semaglutide or tirzepatide, will the soft-drink companies—Brownell’s nemeses for so many years—feel as if a burden has been lifted? “My guess is the food industry is probably really happy to see these drugs come along,” he said. They’ll find a way to reach the people who are taking GLP‑1s, with foods and beverages in smaller portions, maybe. At the same time, the pressures to cut back on where and how they sell their products will abate.

the triumph in obesity treatment only highlights the abiding mystery of why Americans are still getting fatter, even now

Perhaps one can lay the blame on “ultraprocessed” foods, he said. Maybe it’s a related problem with our microbiomes. Or it could be that obesity, once it takes hold within a population, tends to reproduce itself through interactions between a mother and a fetus. Others have pointed to increasing screen time, how much sleep we get, which chemicals are in the products that we use, and which pills we happen to take for our many other maladies.

“The GLP-1s are just a perfect example of how poorly we understand obesity,” Mozaffarian told me. “Any explanation of why they cause weight loss is all post-hoc hand-waving now, because we have no idea. We have no idea why they really work and people are losing weight.”

The new drugs—and the “new understanding of obesity” that they have supposedly occasioned—could end up changing people’s attitudes toward body size. But in what ways

When the American Medical Association declared obesity a disease in 2013, Rebecca Puhl told me, some thought “it might reduce stigma, because it was putting more emphasis on the uncontrollable factors that contribute to obesity.” Others guessed that it would do the opposite, because no one likes to be “diseased.”

why wasn’t there another kind of nagging voice that wouldn’t stop—a sense of worry over what the future holds? And if she wasn’t worried for herself, then what about for Meghann or for Tristan, who are barely in their 40s? Wouldn’t they be on these drugs for another 40 years, or even longer? But Barb said she wasn’t worried—not at all. “The technology is so much better now.” If any problems come up, the scientists will find solutions.

Drunkorexia addresses the need to be the life of the party while staying extremely thin, pointing to a flawed mind-set about body image and alcoholism among college students, mostly women.

why would a promising college freshman choose this unhealthy pattern? It’s probably not a choice, but mental health and addiction issues mixed together. Studies show that having a preexisting eating disorder or alcoholism are predictors of drunkorexia

surveys from colleges range widely: One report concluded that 34 percent of all students surveyed had engaged in this behavior; another said 81 percent of students who drink heavily had

In 2001, it found, only 12 percent of English 16- and 17-year-olds considered themselves non-drinkers; in 2016, that was up to 35 percent.

“Alcohol doesn’t play as important a role in socializing as it did in the past,” Mr. Nicholls said. “Young people can now have an active social life without leaving their house.”

Alcohol has become more expensive in Britain over the last decade, driven in part by higher taxes, which may help dissuade young drinkers. Some young people guessed a reason for the decline is that their peers have become more likely to resort to drugs like marijuana and ecstasy, which are often more accessible to minors than alcohol.

“I suppose it was a combination of it being more cool and more enjoyable,” said James Samouel, a 19-year-old history student who grew up in south London, referring to marijuana use by peers. “A health thing as well — alcohol is so much worse for you.

But in fact, surveys show that drug use, while still common, has also become less prevalent among young people.

“It doesn’t seem that people are switching from drinking to drugs,” said Dr. Melissa Oldham, the lead author of the Sheffield University report. “It’s a move away from alcohol and drugs to other hobbies.”

scientists and administrators in the E.P.A.’s Office of Water were alarmed in late May when a top Trump administration appointee insisted upon the rewriting of a rule to make it harder to track the health consequences of the chemical, and therefore regulate it.

The chemical, perfluorooctanoic acid, or PFOA, has been linked to kidney cancer, birth defects, immune system disorders and other serious health problems.

The revision was among more than a dozen demanded by the appointee, Nancy B. Beck, after she joined the E.P.A.’s toxic chemical unit in May as a top deputy. For the previous five years, she had been an executive at the American Chemistry Council, the chemical industry’s main trade association.

The E.P.A.’s abrupt new direction on legacy chemicals is part of a broad initiative by the Trump administration to change the way the federal government evaluates health and environmental risks associated with hazardous chemicals, making it more aligned with the industry’s wishes.

He had expected his eating habits to change once he began taking the medication — he became less interested in fatty, sugary foods and found himself eating smaller meals — but he didn’t anticipate the aversion to alcohol.“That’s what surprised me,” he said. “It makes you want to do all the things doctors have told you your whole life.”

The Fast Start plan will require extensive coordination between city, state and federal officials,  Weaver said. She was joined Tuesday by retired National Guard Brig. Gen. Michael McDaniel, who said he thinks the project can be done within a year by 32 crews.

McDaniel — who is assisting in coordinating activities between the city, the Lansing Board of Water and Light, state and federal agencies, and other stakeholders -- said the project could begin within the next month. But McDaniel reiterated the plan is still in its early phases and much of it is based on "assumptions."

The preliminary project scope developed by the BWL shows that up to 15,000 lead pipes could be removed in one year "under optimal conditions," Weaver said.McDaniel noted that while it took the BWL 10 years to remove 13,500 pipes, he thinks they can move quicker in Flint because they've perfected the process. McDaniel and Weaver said Flint crews would also be involved in the project.

The project would be done in two phases, with the first targeting high-risk households of children under the age of 6, children with elevated blood-lead levels, pregnant women, senior citizens, residential day care facilities, people with compromised immune systems and households where water tests indicate high levels of lead at the tap.

The project will not immediately address schools, businesses and other locations in Flint, according to a document released by the city detailing the plan. The city said most large facilities are served by "high-capacity cast iron water services," and not the typical lines found in residential water services.

the document states. "For institutional entities like schools and businesses, bottled water can continue to provide for their short-term needs."

Phase two of the program would ramp up to a "full-scale operation" that would bring in 32 crews and a "robust administration and logistics support team to meet the one-year goal," Weaver said.

McDaniel said the costs in the projected $55-million effort could fluctuate because of  the architecture and condition of the water distribution system. The estimated cost per line is $3,670, according to a city document. Of the $55 million, about $1.5 million will go toward administration and logistics, according to the city, which said personnel costs are estimated at $900,000 and operations costs are projected to be $600,000. According to the city, the bulk of the cost — $36 million — will go toward the labor and about $9.7 million will go toward the materials.

According to the city, the Fast Start program will remove and replace the lines at no cost to the homeowner. However, homeowners will be required to sign an agreement that authorizes Flint to remove and replace the portions of the lines on their private property and allow access to the meter inside the home.Lead lines will be replaced with new copper lines and a water filter will be installed at the kitchen tap for three months as a precaution, city officials said.

Flint's drinking water became contaminated with lead in April 2014 after the city, while under the control of a state-appointed emergency manager, switched its source to the Flint River as a temporary cost-cutting move and the state Department of Environmental Quality failed to require the addition of needed corrosion-control chemicals. As a result, corrosive water caused lead to leach from pipes, joints and fixtures, causing many citizens to receive water with unsafe lead levels. The state has told residents not to drink the water without filtering and says it is treating all Flint children as having been exposed to unsafe levels of lead

The FBI is now investigating the contamination of Flint’s drinking water amid a growing public outcry. U.S. Rep. Candice Miller, R-Harrison Township, proposed an emergency $1-billion grant to be authorized through the Environmental Protection Agency, and two Democratic U.S. senators and U.S. Rep. Dan Kildee, D-Flint Township, proposed up to $400 million in dollar-for-dollar matching funds from the state to do much the same thing.

The U.S. Attorney's Office announced Jan. 5 that it was assisting the EPA in the investigation

Several lawsuits have been filed in connection with the crisis.

When asked at the news conference whether she thinks Snyder will support the plan, Weaver said the city can no longer afford to wait."We’re putting forward our plan and we cannot wait for that," Weaver said. "We don’t trust that and we deserve new pipes. That’s the only way this community is going to be confident and people will stay here and people will come. I cannot imagine that he would not support this plan. If he doesn’t, shame on him."

Stabenow and Peters say federal funding is needed to replace aging pipes in Flint and other parts of the infrastructure to ensure public safety and restore confidence in the water system in the Michigan city.

It would authorize the federal Drinking Water State Revolving Fund to make up to $100 million in grants between now and October 2017 "to any state that receives an emergency declaration ... to a public health threat from lead or other contaminants in a public drinking water system."

The bill also authorizes $50 million for public health — though that funding is not specific to Flint — including $17.5 million to monitor the health effects of lead contamination in municipal water, along with allowing Michigan to use other funding to repay earlier federal loans taken out by Flint for work on its water system.

While Lee said, however, that Gov. Rick Snyder hadn’t asked Congress to authorize emergency funds, that misses some of the nuances of the situation in Flint, where a lack of corrosion-control treatment when the city switched to the Flint River in April 2014 allowed lead to leach from aging water pipes.

Snyder initially requested that President Barack Obama declare a major disaster in Flint and provide more than $700 million for infrastructure repairs to pipes and the water system. But Obama turned down that request because federal law only allows for such declarations in the cases of natural disasters, fires or explosions.

“What is happening to the people of Flint, Michigan is a man-made disaster,” Lee said. “Congress has special mechanisms for emergency spending when it is needed. But to date Michigan’s governor has not asked us for any, nor have Michigan’s senators proposed any. Contrary to media reports, there is no federal ‘aid package’ for Flint even being considered.”

Explosives experts said it was feasible the device shown in the photo could bring down a plane, depending on where it was located and the density of explosives in the soft drink can. The most vulnerable locations include the fuel line, the cockpit or anywhere close to the fuselage skin.

Experts added that the photo could also provide a key clue in tracking Islamic State as the detonator pictured was a commercial one, which could be traced back to its manufacturer.

State Department spokesman John Kirby said on Wednesday the U.S. government was not in a position to confirm "the veracity" of the magazine's claim.

activity is likely the reason," he said, referring to the crash.

"We do believe that terrorist

also published a photo of what it said were passports belonging to dead Russians "obtained by the mujahideen". It was not immediately possible to verify the authenticity of the published photos.The group, which has seized large swathes of Syria and Iraq, said it had exploited a loophole at Sharm al-Sheikh airport, where the plane originated, in order to smuggle a bomb on board.

The airport is widely used by budget and charter airlines to fly tourists to the nearby resorts on the Sinai coast.

said it had initially planned to bring down a plane belonging to a country participating in the U.S.-led coalition bombing it in Syria and Iraq, but it changed course after Moscow started its own air strikes campaign in Syria.

Islamic State's Egyptian branch, Sinai Province, claimed responsibility for the attack the day it happened but Egyptian officials were quick to dismiss talk of a bomb as premature.

Xinhua, China’s official news agency, said environmental authorities were engaged in a “tough” crackdown on firms that continued to ignore the compulsory three-day shutdown, which began at 7am on Monday.

In a tweet entitled Tips to survive the smog, the state-run network CCTV wrote: “Smile and try to be positive (hopefully there will be less smog tomorrow)

“I think we should comply with the government’s policy,” Qian added. “After all, the pollution is really bad.”

Still, the government’s unprecedented step was a sign that “the country now faces its problems head-on and respects the public’s appeals and demands”, it said.

But many reacted to the latest “airpocalypse” with resignation. “This is modern life for Beijing people,” office worker Cao Yong told Associated Press. “We wanted to develop and now we pay the price.”