Children's Health Care in Madeira, California. He is also board certified in obesity medicine and has done original research on genetics and epigenetics of obesity and insulin resistance. Without further ado, I'd like to pass it on to Dr. Ali. Dr. Ali, you may begin. Good afternoon, everyone. And thank you for inviting me. I hope this will be a useful program for people. I'm going to start my presentation so you can see it on the screen. So I think everyone can see the presentation on the screen. Yes. So we will begin. This is going to be sort of a quick overview of basic facts and treatment options about obesity. Obviously, obesity is a very large topic and we won't be able to cover every aspect. So we will fly over some things, but there will be questions at the end and you can ask me questions and sort of look up other things in your own time. But we will start by trying to define what is obesity? So obesity basically just means an excess of fatness, right?  So it's not the same as weight. It is possible to be overweight without having excess fat, right? Like bodybuilders who have 5% fat can be very overweight in terms of weight or underweight with excessive fat. Like there is a condition called Prader-Willi syndrome in which babies are born with very low lean muscle mass. So they have relatively more fat, but they are still underweight at that stage. But for most otherwise normal adults, increasing weight will mean increasing fat, right? That's normally the case when someone gains weight. But increasing weight is less reliable as a tool in children because in children, obviously, they normally gain weight as they get older because they gain height. So we have to plot their height and weight and then see if this is excessive for that age and that size. So what would be a good measure that would assess fatness and not just weight? I'm sorry, Mr. Dr. Ali. You're supposed to go to the next slide. We're still on the first... Oh, okay, sorry about that. You can see the slide that says, what is obesity? No, we're still on the first, the cover slide. Oh, really? I moved the slides here. Sorry, I don't know why it's doing that. And also the full slide. Screen is not working. Sorry, let me just go back and fix that. So I was saying obesity is not the same as weight. So we are looking for a good measure to assess fatness and not just weight, right? And we have to find a quick and easy way to measure it. There are tools for measuring fatness.  But you need some tool or something and it needs to be a process. So we are looking for something simpler. And what they came up with is body mass index. So what is a body mass index or BMI? BMI is basically a ratio of weight per unit height. So we take weight and divide it by height squared. Why height squared? There's a long discussion of why height squared. It turns out that height and weight don't sort of increase linearly with each other. The height, the weight increases in relatively more. Or relatively less, sorry, as you get taller. So the correct proportion to which would capture excess fatness best is not the weight divided by height, but the weight divided by height raised to some power. That power is actually closer to 1.6, 1.7 is ideal, but that would be harder to do. So eventually the bottom line is we came up with this figure of weight divided by height squared. And what that means is that if someone weighs 120 kilograms and they are 150 centimeters or 1.5 meters tall, then what is their BMI? We divide the 120, their weight by 1.5, their height in meters, and then divide it again by 1.5, right? That's the same as dividing by 1.5 squared. And you get a number which is in this case, 53, which is a very high BMI. So there's someone who is very overweight. In adults, we can just use cutoffs of BMI to define what is normal and abnormal. A BMI of 18 to 25 would be considered normal. Anything from 25 to 30 is overweight and anything greater than 30 is considered obese. In children though, normal fatness does vary with age. So we have to rely on plotting according to age. Because as you can see on this chart, a child who is four years old, his sort of maximum fatness should be around here, but that amount would be normal in a 14-year-old, right? So whether you consider it excessive or not depends on their age also. So we have to plot it on a graph to see if it is excessive or not. So what are the guidelines? As I mentioned, adults, BMI of 25 to 29.9 is overweight, more than 30 is obese. In children, you plot them on the chart if they're below the fifth percentile, they're underweight. From fifth to 85th, they're considered normal. If a child is at the greater than the 85th percentile, we call them overweight. And if they are over the 95th percentile, we call them obese. So on these criteria, how common is it to be overweight or obese? It is, of course, very, very common, right? And all over the world, the prevalence of obesity is increasing in both adults and children. Overall, the obesity rates in the US did seem to plateau in children for a while. There was hope that after about 2000 to 2015, there wasn't a big change. So while there was a lot of weight gain in the 80s and 90s, it seems to have slowed down in the early 2000s. But unfortunately, with the COVID epidemic and the school closures, that whole thing took off again. And the obesity rate in children is going up as well as the obesity rate in adults, which never stopped rising. And the rate of extreme obesity never stopped rising either. The people who are extremely overweight, their numbers have continued to go up. So how common is it in children in the United States? About one-third are either overweight or obese. About 20% are obese and another 15% are overweight. So about a third of them, half of them in the overweight category, about half of them in the obese category. In adults, it's much worse, right? Just double what it is in children. In adults, two-thirds are overweight or obese. So if you were going by just normative data, you would have to say that it's normal to be overweight or obese in adults because most of them are overweight or obese. There's about half in each category. So half of them, half of the adults in the US are between 25 and 30 BMI. And the other half of that, or one-third are going to be above that 30 BMI and are going to be obese. So what causes this obesity? Why? This is a doctor saying, patient eating many sweet delicacies and fatty foods. And this is from the Yellow Emperor's Medicine Classic in 700 BC. So it's not something new, right? We know people get overweight because they eat too many sweets and fat.  But why is that happening though? It turns, there is a system for regulating weight in our body, right? You don't have to go into these details. This is really a medical school slide. But the thing I want you to take away from this is that there is a system in the body to regulate weight, right? The body doesn't, you don't just eat out of habit or eat whatever you want.   And this message is passed to the brain. There are neurons in the brain, mostly in the hypothalamus that sort of integrate all this information and decide whether the person needs to gain weight or lose weight. Unfortunate part though, is that this system was designed to avoid being underweight, right? It's not really designed to be, to treat overweight or to avoid overweight. For millions of years, we have been evolving in a setting of scarcity where our ancestors or our ape ancestors as well as our hominid ancestors were always short of food. So the brain has very extensive systems for figuring out that we don't have enough fat, we need to go out and eat more.  Human beings really did not have a great need to try and lower their weight in the so-called good old days, right? But now that we live in an environment of plenty, this has become a problem. Now we live in an obesogenic environment, so people are gaining weight. But even now, it's not like people gain weight completely uncontrollably, there is still a system in place. And to give you an idea, I just put this fact in here, in the United States, the average adult gains two pounds a year on average, right? As you get older, you gain more weight. This weight, two pounds is really just 4,000 calories of stored energy. It's not like it doesn't take a lot of calories to put on two pounds. You eat 900,000 calories a year. If you ate just 1% more, you would gain dozens of pounds, not just like one pound. So the body is regulating it. Even today, the body is regulating your weight, but it's not succeeding in overcoming the obesogenic environment because it wasn't designed for this environment. So most cases of obesity are not due to an abnormality of the regulation of the system that we can detect in a kind of mutation that we can find, right? Most people, there are such mutations, but they are not a major cause of obesity. It's not per se a genetic disorder. If it was a genetic disorder, we would expect it to have been present 100 years ago the same way it's present today because genes don't change that fast, right? But obviously the prevalence of obesity has dramatically increased. So the genes are the same, but the same genes are being expressed or the same tendency to gain weight is being expressed now that we are in an obesogenic environment, right? And there are other, they're just looking at other causes of obesity. There's thyroid problems, cortisol problems, growth problems. None of these are really common causes of obesity. Common obesity is not due to a medical condition. It's due to an environment that we are not designed for. Our overall genetic makeup does influence how easily we gain weight, though, right? There are some people who are clearly more prone to gaining weight than others. And these people, they don't have a single gene defect. It's not like there's one mutation that caused that. It's a large number of genes working together.  And a little bit is enough. As you saw in that example, you eat 900,000 calories a year. If you eat 910,000, you will gain three pounds. So there is a small excess will add up. If you put people in an obesogenic environment, there are still some people who don't gain weight. So really some people's internal regulation is so good that even in this environment, they don't gain weight. But most people in this environment, unfortunately, tend to gain weight. One way you can get an idea of what the genetic component of obesity is, is that you look at what happens if you have an obese parent. Your risk of obesity goes three or four times higher. If you have two obese parents, your risk of obesity is 10 times higher than the general population, right? So there is an inherited tendency. There's no question about that. When people tell you that I have a tendency to gain weight or I am sort of prone to gaining weight, they're not lying. It's not just like willpower or you can say even willpower is genetic, right? There is some people will genetically have more willpower than someone else, but it's not a choice in that sense. Some people really are more prone to gaining weight than others, but they won't gain weight in a non-obesogenic environment. There are some genetic syndromes that cause obesity, and I don't want to get into any details, but just to give you an idea, the most common syndrome causing obesity is a condition called Prader-Willi syndrome, and it's only one in 10,000 to one in 15,000 people. So even this most common disorder is very rare act. The others are even rarer. Lawrence Moon, Beatles syndrome, Alstom syndrome, you'll hear these names sometimes, they cause obesity, but they're all extremely rare. There are some defects in a gene called MC4 receptor, which are a little bit more common, but even those are not a common cause of obesity. They are just one of the rarer causes of obesity. Most obesity is not due to inherited genetic defects, but an inherited genetic makeup does make you more or less prone to gain weight in an obesogenic environment, right? In a lean environment, everyone would be lean. There are no obese people in concentration camps, right? But in an obesogenic environment, only about a third of the people can seem to resist it. So why is everyone becoming obese? It's probably an imbalance of evolution, physiology, and civilization, right? We evolved because in a situation where you couldn't find food. For 2 million years, we had scarcity. Lifespan was short, survival was difficult. In this condition, our evolution favors energy storage, right? We like dessert because dessert is sugar and fat. We are designed to like sugar and fat, right? And why not? That's exactly the best ways to get energy. And for 2 million years, we were short of energy. We were never in a situation of excessive energy. So in that kind of environment, in what you might call a natural environment, human evolution naturally favored looking for food, not protecting against food. This protests against malnutrition. It doesn't protect against weight gain as much, right? On the other hand, civilization has evolved to give us more food. It has made food more easily available. It has made food more calorie dense. When you were hunters, gatherers, you were picking up foods that were not really designed as high sugar, high fat items. But over time, we have modified them. We have evolved them to become higher in sugar, higher in fat. And the way we cook them, the way we prepare them makes that aspect even more sort of sharp. So I'll just skip over this because I don't want to take it, but you can see these are the times when these things started, because the cream started, the tunnel started. We are now at the last stage, right? And everyone is prone to gain weight. So why are we growing, becoming obese? Because we are designed to look for food. If food is half as costly, we will buy two times more. So the successful but excessive evolution of civilization to serve our evolved physiologic needs is probably the underlying reason for the obesity epidemic. Other consequences of progress may be playing a role as well though, right? It's not just that food is available outside, but some other things have also changed with what you may call progress. One big change is sleep schedules, right? Abnormal circadian rhythms. We are designed to sleep at night, work by day. We are not necessarily doing that. We have artificial light keeping us going until late at night. We have TVs, screens, phones. Those changes in sleep and circadian rhythm are definitely playing a part in the obesity epidemic, and especially in the insulin resistance epidemic, in why people are becoming more diabetic, more fatty liver, so on. So these things are connected. There's no doubt about it. I don't want to go into the details right now, but they are connected. The other thing that has recently been found to play a role is the gut microbiome, right? The bacteria you carry in your gut, they also shift with how our diet changes. And as they shift, they seem to change how likely we are to become obese. So if you take the bacteria from an obese person and put them into a lean person, that lean person tends to gain weight. If you do the opposite, the obese person tends to lose weight. So the gut microbiome does have a role in this. Some commonly used medications are obesogenic, right? Especially there is an epidemic of psychiatric medication, right? In the United States, there are some subpopulations where more than half the people are on psychiatric medication, right? Like young upper class females, more than half are on some kind of medication. So in that kind of group, those side effects play a role because those medications, not all of them, but many of them make you gain weight. Other factors also play a role, stress plays a role. Endocrine disruptors may play a role, right? You'll hear about bisphenol A in plastic bottles and things like that. Even viruses may play a role. Some cases of obesity may be due to infection with a virus that causes obesity. There is a virus that causes obesity in chickens. So we think there may be viruses that cause obesity in humans as well. Central heating may play a small role also because we don't shiver as much, right? When we burn energy, when we shiver, we burn calories. Now of course we are warm all year round. So what does it matter? People are becoming more obese, evolution has made us prone to obesity. So why does that matter? It matters because obesity causes a lot of problems. First of all, obesity causes insulin resistance. The mechanism is not completely clear, but people who become, as they become more obese, their insulin doesn't work as well. One of the consequences of that is that at some point they will develop type two diabetes. That's classic insulin resistance. But even short of that, they will have issues that arise because of insulin resistance. People have dyslipidemia, their triglyceride levels go up, their good cholesterol goes down. One very common condition in women is polycystic ovary syndrome, where their testosterone levels go up because they gain weight. Coronary artery disease obviously is another common issue that is happening more because of obesity. Obstructive sleep apnea, starting with snoring and going on to completely stop breathing at night, is a common problem with extreme obesity. Low self-esteem is a huge big deal. It's not just all, if you don't have diabetes or PCOS or anything and you're overweight, you still suffer social consequences of obesity. You feel like you're not, people are constantly stressed by the fact that they are obese. Unfortunately, that stress we know makes you eat more and stress is bad for you. It causes insulin resistance. It causes your circadian rhythms to be upset. So it's a vicious cycle. You are worried about your obesity and that worrying probably contributes to more obesity. Bullying and fat shaming is a real thing, right? People, children get bullied in school when they're overweight.  Osteoarthritis, as you can imagine, you're carrying 300 pounds on your knees. You're more likely to damage those knees than if somebody's carrying 150 pounds. Increased risk of cancers. There's all kinds of problems that can come from being overweight. So it's not a benign condition, right? It's not just that we have gained weight and become heavier. It does cause us medical issues. So at what level do these issues become a problem? On that, there is some controversy actually. The BMI cutoffs were designed to detect the level at which something starts to go wrong. And the cutoff for overweight in adults was set at 25.  The people who are around and BMI of 27 have actually the best outcome. They are sort of the healthiest in that sense. Is there are some arguments back and forth around this? Is this cutoff still good or not? But what it brings home is that mild degrees of obesity are not necessarily unhealthy for you. Or at least not so unhealthy that they are your biggest problem.  So if that obesity obsession is then causing stress and more eating and more worrying and low self-esteem, you're probably better off not thinking of yourself as obese. So, and the other thing to keep in mind is that fitness trumps fatness, right? There is a lot of data about this. If you have a BMI of 30 and the other person has a BMI of 25, but you exercise every day for an hour and he has never been on an exercise bike at all, the outcome is better for the person with the BMI of 30 than the BMI of 25, right? BMI alone is not the only thing that matters. Fitness trumps fatness until you get to be very overweight. Once you get to a BMI of 45, then yes, that obesity is going to cause far more problems even if you do exercise every day. But at a BMI of 25, 30, 28, 30, 32, if you are fit, you have much less to worry about, not zero, but much less. We don't want to encourage obesity, but we do want to say that it does size matters. Lower degrees are not as big a deal as the bigger degrees. So how can we treat obesity? We can decrease your caloric intake by modifying taste preferences. Like we are designed to look for sugar and fat. Could we eat a pill that doesn't make us look for sugar and fat anymore? In theory, we could, but it's not happened yet. It's not practically happened yet. We can use medications to suppress the drive to eat, right? Anti-obesity medications. And we'll come to those until a couple of years ago, this was something we could touch in one slide and say there's like 10 medications, but none of them are completely safe or completely effective. And really the outcomes were not great. But in the last two years, we do have some new medications that do seem to help and we touch on those. Then you could modify the ability to eat, right? You could fire the jaw. You could put a band on the stomach so you don't have enough space in there. You could do bypass the stomach. You could modify the ability to absorb nutrients with anti-absorptive agents or with surgeries. We'll touch on all these a little bit. Or you could increase the energy output, right? There are some medications that can make you burn more calories. Unfortunately, at the level at which you'll burn enough calories to make a difference to the obesity, you will have too many side effects from these medicines because the same medicines will make your heart race fast. It will cause arrhythmias, would make you pass out. There are blood pressure could go up. There's many things that can go wrong. So they're not ideal. These are not the medicines we want to use to treat obesity. The other way to increase energy output is just to exercise, right? And that is a big deal. We should definitely all try to do some exercise, but I'll show you the figures around that as well. Finally, modifying the overall obesogenic environment will work best, right? Out of all these things, that's the one thing where individual willpower doesn't matter. If the environment is not obesogenic anymore, the lifestyle that we live in involves walking to work, going up and down or doing something physical at work, going, walking, biking to get groceries, things like that.  And if your environment doesn't have a lot of fast food, a lot of fat, a lot of sugar, a lot of cheap calories, you will definitely gain less weight. But how to get into that environment and is that an environment people are happy with? Those are actually big questions as you may imagine. So first-line treatment for obesity is then diet and exercise, right? Everyone will tell you that this is the first-line treatment. We'll touch on both of those in a little bit of detail. Then if diet and exercise is not working, we could go to medical intervention, drugs, surgeries, things like that, and we'll touch on those a little bit. And finally, we can change the obesogenic environment. We can make walking paths, bike paths, work settings, standing desks. It's amazing how much difference these small things will make. People switching from sitting at a desk to standing at a desk reliably lose some weight. And all sorts of things improve. Their insulin resistance improves just from standing around at work instead of sitting at work. It's a wonderful intervention. If any of you has that option, I would advise you to do that. It does make a difference. Having different treats and snacks, right? We have a clinic in which every day somebody brings cakes and donuts and whatever, and we love it. But maybe we should switch to something less calorie dense. Have fewer vending machines in schools. Have increased taxes on some foods. Laws to change how foods are advertised and so on. All these things are proposed. Some of them are good ideas. Some of them are not so good. And some of them have hidden risks involved, which will come out once you start to try it. So it's not straightforward. But let's start with dieting. What diet is best? The short answer is that all diets work for some people, but no diet works for everyone. And 85 to 90% of all diets fail in the sense that weight regain occurs over time. It may occur six months a year later, but people tend to regain that weight. When they go on a diet, they lose weight. In six months, they gain it back. So in that sense, dieting is not proven intervention for obesity because we have not shown it to work. It can work. In principle, it should work, but people have a very hard time sticking to any diet. In general, carb-limited diets where you lower the carbs tend to show better initial results in most people. Whether those results are sustained or not still depends on how much people can change their lifestyle long-term. And that seems very hard to do. But still when you compare diets, it's not any diet will, almost any diet will work if you stick to it. But lower carb diets tend to work more quickly. Mediterranean diet and its variants are all good because they have other advantages. They seem to be healthier for you in other ways. Even when you don't lose weight, they seem to be healthier for you. Maybe they have more antioxidants. Maybe they have different fats.  Butter is actually a better fat than the fruit. Intermittent fasting became popular, reached a peak. It's probably now it's sort of all these things have a hype cycle now sort of falling out of fashion a little bit, but it does work. It does help. In many people, it does seem to be better than the alternatives. Compared to many other diets, intermittent fasting seems to help people. Skipping breakfast is a dietitians for some reason that made it a big deal that you must eat breakfast because there were studies showing that people who don't eat breakfast gain more weight. But this on closer sort of examination doesn't turn out to be a big deal. Whether you skip it or eat it, more depends on the rest of the, how about your total intake? Extreme low calorie diets also work. So if somebody tells you they're like on a one week fast and going to lose 20 pounds, it's doable. It's not that these things don't work. It's just that they're very hard to do and very hard to stick to. Junk food and processed foods are not good for you in general, right? So whatever diet you're trying to do, it's very good if you can cut down on quote unquote junk food. What is junk food is an open question also, but really most fast foods outside when you go to McDonald's, Chick-fil-A, whatever, the secret of success in the food business is fat and sugar. And this makes complete sense, right? Because that's what our evolution has designed us to look for. So there's no way a restaurant is deliberately going to cut down on fat or butter or something because that's what makes their food more delicious. So you're always better off eating at home and processed foods will frequently have trans fats. Those are really bad fats for you. So the bottom line is if you can cut down on those, it's generally going to be good for you. But any diet that the patient can follow and lose weight on is a good diet. If there is this thought in the background also, low-fat diets may actually have made things worse. This isn't controversial. I don't want to give you the impression that this is something we know for sure. We don't. There's constant argument about this. But it's interesting to see that the American population was actually not very obese when the American government decided to give them dietary guidelines. Before dietary guidelines, they were doing fine. They were eating steaks and potatoes and butter and they were really not that obese. But after the dietary guidelines came in and the dietary guidelines said eat less fat, they started gaining weight. And they have continued to gain weight ever since. Now there's many other things that changed at the same time, right? So maybe it's just progress in other areas that made the environment so obesogenic. But there is a thought out there that the low-fat diets made things worse because people started to substitute carbs for fat. And carbs have a little less calories, less than half the calories of fat, weight for weight. But if you eat more of them, you are going to gain weight. And they turned out to be bad for you in other ways. In many ways, fats are healthier than carbs. The sugar rush is involved in producing the insulin resistance and problems that we talked about. So what practical advice can we give in like a short, some presentation like this is try to read more labels, right? Try to see how many calories are in various things. You will be surprised at some of the things that you eat on a very regular basis, how many calories are in there. How many calories are in Cheetos, for example, is a shock to most people. So reading labels definitely helps. Knowing how many calories are in there gives you a better sense of what we eat and what not to eat. Try to be more active, try to avoid mindless snacking. No regular soda and no juice, right? These liquid calories really bring nothing but bad things to the table. So try to stay away from all of that. Now people switch to diet soda and it turns out that doesn't always work either, right? People still gain weight. In fact, in some cases gain more weight. Maybe there's something bad about the diet soda itself, but it may also just be that that wasn't there. With the diet soda, they're still having their french fries and their burgers and whatever. It hasn't really made the difference they thought it was. Fast food and processed food we already mentioned. So a practical carb limited diet would be to avoid all simple sugars, right? This is easy to say, but you'll see how much it cuts out. No sugar in tea, no sugar in coffee, no sugary desserts, no cakes, no donuts.  No regular soda, right? No sweetened juices. No foods with more than five grams of sugar. Make that a rule and just stick to that. Try to limit other carbs to smaller helpings, right? Everybody eats bread, potatoes, rice, but try to eat smaller helpings of those and don't worry about the fat and the protein part. If you can do this, you will actually lose weight. More lean protein is better, more fish and selfish is better. Low carb or non-carb snacks are best, right? It's the carbs and sugar are an enemy. And exercise at least 30 minutes, five times a week. It's a very, very minimal exercise goal here. The idea is that this is something most people can follow, right? They can stop eating sugar and drinking soda and they can start doing 30 minutes every day to a lot of people, even this will make a difference. And the problem is that even sticking to this is hard. It's not easy. On the exercise size, what can you do? How much would it take to lose weight? Well, the short answer is it would take a lot more than an average adult or child will voluntarily do. It's actually not easy to lose weight on just exercise. You have to cut down the calories because exercise is not sort of magic. It is good. As I said, fitness trumps fatness. There are huge advantages to being fit beyond even the obesity issue. But still people overestimate how much difference it makes to weight gain. If you are doing heavy exercise, and this is not walking, this is like doing swimming, proper biking, something like that, you're burning about 500 calories an hour. One burger fries and coke can be a thousand calories, right? You would have to swim for two hours just to work off that one McDonald's meal. And nobody except like competitive swimmers is going to swim two hours every day. So what I'm trying to say is that the exercise is great, but it doesn't actually burn the number of calories you are eating. Those will still exceed the exercise unless you cut down on the intake side also. You have to cut down on that, otherwise it doesn't work. And just to give you an idea of what the energy expenditure is going to, 60% of our daily calories are just going to resting energy expenditure. That's the basic functions of the body, the cells all sort of humming along inside your body. That takes up 60% of your, so that doesn't change day to day anyway, right? The big change is the non-resting energy expenditure. That's where you are walking, running, sports, activities, fidgeting, all of that. Sometimes there is a subset or I put NEAT, it should be NEAT of that, which is the kind of activity you do, which is not formal exercise.  This is also burning calories. It is non-resting energy expenditure, but it's not active exercise that I'm doing. That also makes a difference. Some people who are thin, maybe thin, because they are very fidgety. They never sit still. Over time, that makes a difference. There's a thermic effect of feeding, you don't have to worry about that. So the bottom line with this is that you, just going on a diet is not a very successful study. Most diets fail, but if you do want to lose weight, you do have to diet, but you also have to start exercising more and you have to make both the diet and the exercise a part of your lifestyle. Not something you took up for a month or a week or something. It has to be that this is going to be your life. So pick something that you can do lifelong doing or pick something very drastic to lose weight initially, but then pick something that will go lifelong. You can't sort of go back to your old ways because that will mean you just gain that weight back. Now, coming to medications. All these appetite suppressants and things, you don't have to sort of even look at, all of them had side effects, they didn't work very well or they were not even approved for prolonged use. The big change that has happened in medication side is that there's a class of medications called GLP-1 agonists. These are medications used initially to treat diabetes. They are hormones, they are sort of, they're analogs of hormones that our gut makes when it's exposed to food. And these hormones basically tell the brain to slow down eating because there's already enough food in the system. And they slow down the emptying of the stomach. They have other effects, then more insulin is produced, better beta cell function improves, but the effects on weight loss come mostly from the fact that these medicines suppress appetite and reduce gastric emptying. The stomach doesn't empty as quickly. So you feel full more quickly. These medications initially used for diabetes seem to be causing a fair amount of weight loss in those diabetic patients. So in 2021, they were also approved for weight loss. And now more of them have been approved and we'll look at them in detail. There's another new medication called Set Melanotide. This you may not have heard of because it's a very fringe niche medicine right now, but it's a medication that blocks that you saw that circuit that makes you hungry. It blocks that circuit in a crucial place. So it blocks your drive to eat. In theory, it should make everyone lose weight. Till now, it's only been approved for some genetic forms of rare genetic forms of obesity. There are side effects. We will see how it goes with those rare forms, but in time, it may be that this medication will become more widely available and will also be a big sort of boost to our medical and momentary illness. Then if the medications don't work, you can go to bariatric surgery. Surgery is not much of an option in children. They generally don't recommend bariatric surgery until you've finished your growth. But in adults and older adolescents, it's definitely an option. It does work, right? People lose weight after bariatric surgery. Almost everyone loses weight after bariatric surgery. But it can have complications including fatal complications. It is major surgery. It's not like a joke. So it's our last choice after everything else is failed. So coming back to GLP-1 agonists, these are incretin hormones that tell your body that we already have food in the system. You don't have to eat any, right? Initially found to treat type 2 diabetes, then approved in 2021 as a once a week injection for weight loss. It's an injection. There is a pill now. The pill doesn't seem to have the same drastic effect as the dramatic benefit as the injection does. So till now it's really mostly the injection that's working. But we will see if the higher doses of the pill work that will make life much easier for people who don't like shots. So the results of these drugs have been much better than any previous drug. And so these drugs are now being produced in higher concentrations for weight loss specifically. Previously they were produced really for diabetes. They're not for everyone, right? They are contraindicated in pregnancy or in someone who has had pancreatitis because in some rare cases they will cause pancreatitis. And there's a rare form of thyroid cancer that these drugs when they were tested in mice seem to increase the risk in mice at least. We don't know for sure if they actually increase the risk in humans, but obviously we don't want to test that or risk that. So people who have a family history of that particular cancer are also not candidates. But otherwise most people can try these medications. And this is the result. You don't have to worry about the detail, but look at this. This is the group that got placebo injection and this is the group that got the semaglutide injection. And there is a huge difference, right? These are the first medications that could cause 15, 20% weight loss. That's very impressive weight loss for a medication, especially since all the medications we had in the past, none of them could do this. So this is very dramatic. This is another one of the same group of medicines. You can see again, the higher the dose, the more the weight loss. This is the mechanism of action. I left it in there just because this will be saved in the presentation. People can look at it later. You don't have to worry about it. This is really medical school stuff. There is a new version of these medications coming or already on the market called Zepetide. Not yet approved for kids. Approved right now just for diabetes, but it's going to be approved for weight loss very soon. This medication seems to work even more than the first one's approved. So you may see a dramatic improvement in weight loss with this kind of medicine. The other drug I mentioned is set melanotide. This is a MC4 receptor. It's the drug that works in the brain basically blocks your drive to eat, right? It's been approved for some rare genetic forms of obesity because that's the particular gene the area it's targeting. There may be more approvals in the future. If it really works and if the side effects don't turn out to be too dangerous, this may also be a good drug for weight loss. There are other things coming. There's this medicine. This is not a medicine. It's a capsule that you swallow and it grows into this giant ball of cellulose or not ball triangle of cellulose in your gut, in your stomach. So it's sort of, it acts like a gastric balloon. You can't eat anymore. And eventually it just sort of dissolves and passes out in the stool. It's not yet approved in the US but it's already approved in Europe. We'll see how well it does. But this is also coming. Bariatric surgery, as I said, I won't go into details because we'll run out of time. But there are many different procedures that are out there for older adolescents and adults, not approved for younger children. Not our first choice, but if nothing is working, it does work. These are some of the ways you can, some of the ways you can do bariatric surgery. You can make a smaller stomach. You can put a balloon in the stomach. You can bypass some of the gut. So these are, and there's many more variations on these, but really the idea in all of these is that you make it harder to eat more and you make it harder to absorb that food. Redirecting civilization, as we mentioned, you can alter the composition of prepared foods, right? Somebody in a dictatorship, maybe you can change how much sugar they put in Twinkies. But in a democracy, I think this is harder to do. You can also limit portion sizes, things like that. You can do this in schools, but I doubt you can do this in restaurants because people don't go to restaurants to eat limited portions. Public health programs make a difference. Legal penalties can make a difference, but then how do you sort of fairly target people, right? There may be some people who need those higher calorie stuff or who are not being harmed by them. But taxes hurt everyone, not just the people who are overweight. So that's why these things all help, but redirecting civilization not always easy. And finally, just sort of to go back to, this is just mortality in older adults. And you can see on this that the lowest mortality is in a region which is considered overweight right now, right? Your chances of dying then start to go up as you get heavier, but you can see they're also very heavy if you're super thin. That's not because you're thin necessarily. It's because this is just adults captured in one snapshot. These are people who probably already had some illness that's made them lose weight, right? So that's why they're dying and they're thin. But it may be that there is a healthy level below which your illness or morbidity or risk of dying does go up even with being overweight. I just wanted to show this picture because you'll see this a lot, right? People used to be unfamiliar with this thing. And if you saw this on somebody's neck, you would assume that they're dirty, they haven't bathed. But now with the obesity epidemic, you'll see this in a lot of people and it's not because they are not washing. It's because the excess, you know, the insulin resistance has chicken in their skin and it causes this kind of appearance called acanthosis, migra cans. So if you see this on somebody's neck, they are at risk for getting diabetes. So I will stop here. There's more information that we can get to, that I left in the presentation for people to sort of look at if they wanted to just details about the genetic causes of obesity and things like that. But I decided not to include them and thought we'll just leave a few minutes for questions. Thank you so much, Dr. Ali. We received a couple of questions. The first question we have is, it's obesity a result of PCOS or is PCOS a cause of obesity? And for those of us who are not familiar with the term, PCOS stands for Polycystic Overy Syndrome. So primarily PCOS is a result of obesity, right? We think that people who are overweight tend to develop higher testosterone levels because of the insulin resistance and the higher testosterone levels cause hair growth on the face, they cause acne, they cause irregular periods. So all those features of PCOS will then show up. And if they lose weight, PCOS will improve. So it means with weight loss it can be reversed. But there is a little bit of chicken and egg there too because it turns out that if you are insulin resistant you seem to have more of a tendency to gain weight. So there is a vicious cycle of sorts. If you gain weight you become more insulin resistant, but if you are insulin resistant you tend to gain weight also. And in mice and in animal studies they have shown that if you make them insulin resistant they start to gain weight. You made them artificially insulin resistant but they can start to gain weight from that. So there is some chicken and egg thing also going on but primarily we would say PCOS is the result of being overweight, not a cause of obesity. Thank you. Another question sent directly to me, it's about with overweight, do insulin resistance and testosterone levels lessen? Also does estrogen increase? Right. So insulin resistance actually goes up with weight, right? So when you gain weight you become more insulin resistant. So your insulin levels tend to go up because your body is trying to overcome that resistance. So people have higher insulin levels when they are overweight. The other part was that does it... What was the second? Does estrogen increase with weight loss? Yes. No, again it actually increases with weight gain. Estrogen levels, fat is one of the sites where the body makes estrogen. So if you have more fat you tend to make a little bit more. In women it matters less because women make a lot of estrogen obviously in their ovaries. In men most of the estrogen they have is coming from their fat. So there is... If you gain weight your estrogen levels tend to go up just a little bit. It's not a big deal either way. But if anything increase your estrogen, not decrease. Okay. The last question that sent directly to me is for adolescents with obesity caused by PCOS and other physical issues who exercise and restrict calories with little positive results. Do you have any suggestion for them? They're considering biiatric surgery as well as OSAMPIC if they can get insurance to help them. Right. So we would say diet and exercise is not working for someone and they're finished with growth. We would... First we would try these new medications since the medications are working for a lot of people. So if they can get the medication I would try the ones who make shots first. And if the ones who make shots are not working or they're not able to get it. This... Our healthcare system is like so insane that $1,000 drug may not be available and that $20,000 surgery may be available. So weird things will happen. But rationally you will try the medicines first and the surgery later. Thank you, Dr. Adley. We have a question from Kevin and Kevin also raised his hand. I'll read his question then maybe he can unmute himself to explain. He said, it's plant-based organic only effective. Isn't heavier when older just giving up? I'm sorry, what was the second part? Is it what? Well, if you say your BMI is greater if you're heavier when you're older saying that that's okay, isn't that just giving up? It's not necessarily just giving up because there seems to be some normal weight gain with age in human beings in general. If you go to any country and even historically if you look back at people, whatever records they have for people in the armies and things like that, as they got older, they gained some weight. Some weight gain as you get older seems to be normal. They shouldn't become obese though. They should not become abnormally obese. They shouldn't become overweight, but they do gain some weight. So if somebody saying normal weight in a 50-year-old can be like 10, 15 pounds more than normal weight in a 20-year-old, they're probably right at least in the statistical sense that this is what human beings tend to do. They gain a little bit of weight as they get older. My other question was about plant-based. And plant-based organic and no standard American diet. Right. It will almost certainly help, right? And it doesn't have to be most of these restrictive diets even if you don't believe in their other benefits. You don't believe that vegetarians are better than meat or something. The fact is that when you go on one of these diets, you are restricting yourself in some ways, right?  So it automatically makes your intake a little less. But beyond that, I think there is some benefit too. I think that we do think, we do see foods are more pro-inflammatory than others. They seem to cause inflammation in your body and generally plant-based foods, vegetarians, vegans, they do better on this than people who are eating meats and processed foods. Okay, thank you. Thank you. Question from Denise. Why do children of same parents and environment very greatly in tendency to gain weight? She also wanna say she enjoyed your presentation very much and you're putting our culture in historical context. Thank you. So this, people tend to gain weight, I'm sorry, you said that because of what? Why do children of same parents and environment very greatly in tendency to gain weight? Why do they vary greatly? I think first of all, they don't vary greatly. They do have a higher risk of being obese, right? If you have two obese parents, the chances are very high that all the children are likely to be obese. Now, they may not all be the same degree of obese, but that's because the same thing with height, right? If you have two parents who are six foot and five foot four, all their children will not be at these heights, male and female. Some will be taller, some will be shorter because you don't get the exact same genes. It's a sort of a reshuffling of genes that happens when that fertilization happens. Half the genes come from one parent, half from the other. Which half you get from which parent is a random chance thing, right? And so nobody, no two siblings are going to be exactly alike. They share 50% of their genes, but there's another 50% they don't share. So this is not surprising that there's some difference. But in fact, in actual practice, it tends to go the other way more. They do resemble each other more than their children. Most of them do tend to be obese. Thank you, Dr. Ali. Another question from Denise. Would you discuss metabolism of aging? I'm an active elder with osteoporosis and finding it very frustrating to be eating better and less and it is so difficult to shed excess pounds. Right, it is difficult as you get older, metabolism slows down. So normally people would need to eat less as they get older, right? Then that's a known fact. Because their overall metabolism slows down a little bit as they get older. And their activity level slows down, right? You're not as active as you get older. So you would expect to find it harder to lose weight as you get older because you have to cut down even more to lose that weight. There may be more things going on than we know also. I mean, there are changes in hormones, obviously. Women go through menopause, men go through a sort of andropause also. What difference these things make? Are they contributing to difficulties with weight loss in older? But the bottom line is that it's difficult in every age. Yeah, it's hard to hold on to weight and our body will fight back and make it very hard to lose weight. Thank you, Dr. Ali. That's the last question I see in the chat. Anna, did you get any direct message questions? No, I did not. So with that, I'd like to thank Dr. Ali. We really appreciate you taking the time to share with us the basic facts and treatment options for obesity. And I also want to thank everyone for joining the program. I hope you all find the presentation informative and helpful to you. We will send out an evaluation survey together with the recording link and Dr. Ali's slides later today. Please give us your feedback so we can continue to improve. Again, thank you, everyone. Stay healthy and have a wonderful rest of your day. Bye-bye now.


You boys haven't been paying attention. Do you genuinely think I wasn't worried about false steroid Accusations nine months ago. Seriously. What were the possible scenarios one?  We can address the form later But the bigger concern is the steroid accusation now I think everyone understands that bodybuilding is a huge time and money investment Two hours in the gym every day all this food. It's exhausting and if one was to do it naturally You know spending a few hundred dollars on a drug test a few times per year seems like a no-brainer I think anyone that uses money as an excuse to not get drug tested as a natural bodybuilder is Lying come to think of it. I've never seen one of these Natural bodybuilders post a drug test What usually happens is they get bunched into one of two categories the fake Naturals and the real naturals basically if the general population thinks they're too muscular They're a fake natural either way it pans out in a similar fashion Someone with a large social media platform. That's jealous or has some type of vendetta makes a steroid accusation Then the person gets put in a tough position whenever someone calls you out Whenever someone makes the first move when you're on the defense It seems like you've already lost because there's a large percentage of people that will take whatever was said first at face value And never change their mind So, you know, I'm stuck in a position where I'm defending myself And there usually ends up being a bunch of drama back and forth between the accuser and the natural the recent Athlean X stuff with Jeff Cavalier is a good example People accused Jeff of using steroids But then when Jeff stepped up to the plate told them he would get drug tested if they paid for it Everyone kind of backed down and apologized I think this was all planned and orchestrated Acting on both sides to get publicity for everyone involved But this is all that ever happens the person will either Agree or disagree to the drug test if they agree to the drug test Everyone backs down as what happened and the person is lumped into the real natural category If the person ignores the drug test request or denies getting drug tested They get lumped into the fake Natty category. Either way, it's just a bunch of chest puffing and bullshit If you're a fitness influencer and you claim natural if you don't have drug tests from when you started your YouTuber social media, I would call you a fake Natty It's one thing if you lifted weights for a couple years before starting social media But the first thing that would come to mind of a true natural that is marketing themselves towards a mass public is To get drug tested because it doesn't make sense not to you spend a few hundred bucks And that will pay itself back in thousands for your reputation for your honesty for your integrity It's so easy.  There is no excuse no excuse at all to not have your own drug test Listen listen listen. I get it. I get it.   You really are now Frank. How have you done this? Unbelievable transformation over nine months.  While training like a sissy la la fairy boy and not knowing anything about weightlifting Hey to break it to you guys But I body-build it for about eight years and that muscle memory is irreplaceable I'm sure some of you know Kevin Lerone's Transformation how much muscle he put out in just a year. That's a good testament to muscle memory People don't understand that once you build a certain amount of mass it comes back Incredibly quickly and even with muscle memory most people would take a little bit longer due to modern training methods and beliefs I would say, you know, three to four years to build my physique with that BS five by five Browsplit routine I do four to five times as much volume in my training routine as the average person and my diet is as clean and Nutritious as possible for bodybuilding pure muscle synthesis from two pounds of red meat every day with a readily available Glucose source in the form of some mysterious honey like carbohydrate that I'll share with you guys eventually That combined with a specific mineral and vitamin protocol. I am giving my body every raw material needed No creatine no steroids. I don't even know what psalms are some of you guys saying I use psalms I haven't even I don't even know what they are 100% clean and natural I won't even touch creatine. That's how legitimate I want to do this I will say my sleep hasn't been that great I mean, it's been horrible on a good night four hours most nights no sleep I would imagine my progress would be so much better if I had slept well And that's why I'm continuing this bodybuilding bullshit probably for another year and a half two years because I want to feel good For a decent period of time while doing this to see where I can get and I really believe That the majority of a person's natural potential can be reached in just a couple years on the proper training routine And I'm here to prove that Overall, I'm disappointed.  That's how these people operate They steal other people's ideas. They use their connections to push those people onto the rug and promote themselves It's unfortunate that the world is such a negative place and that People can't run a genuine business, but I'm dealing with it the best I can and I really just You know want to help you guys, you know, put you guys in a similar position where you're happy and healthy You're working out you're achieving your goals It's just seems like everyone's against me because they want to make money for themselves and that's the truth about it so You know, definitely a weird spot to be in but I always laugh when everyone needs to copy Frank Tafano to stay relevant They know who's in charge. So thank you boys for joining me today If you could please like the video leave a comment down below Share the video on social media if you can if you do want to support me further, you know how to do so down in the description Thanks again for joining me today guys. I'll see you for tomorrow's video If I don't die of steroid overdose


This study compared two types of satellite images, WorldView2, WV2, and QuickBird2 simulated QB2 to determine how they could best be used for object-based urban land cover classification. The authors first identified optimal segmentation parameters for both datasets, then compared the resulting segmentations and assessed the accuracy of the resulting classifications. They found that the WV2 dataset produced more accurate results due to its additional spectral bands, while the QB2 dataset was more suitable for simpler classifications. Additionally, the authors found that certain features from the WV2 dataset were not present in the QB2 dataset, suggesting that the former may provide more detailed information for urban land cover classification. This article was authored by Tessio Novak, Hermann Krux, Uwe Stille, and others.


Hello everyone and welcome to The Christmas Everton's Show, and for this special festive episode I'm delighted to be joined by Duncan Ferguson. Great times I have you on The Everton's Show, Duncan, not just because it's Christmas but because there's a great deal of positivity about Evan at the moment. It's been brilliant, hasn't it? With the results I've written very well for us so we're on a good feel factor. You can tell around the training ground there's a buzzback isn't there? I think you get the confidence back and you get the results, you know what I mean? Rwy'n ystod gan y rhan, yn y cyffredin ac mae'n edrych i'w ymgyrch yn gyflwydoedd o'r cyflwydoedd. Rai'n amsiau'n gweithio'n digwydd, amser Osam i'n Greig Shakespeare? Rwy'n gweithio'n gwahanol i'r gyflwydoedd. Mae'n gweithio'n gwahanol yn gyfathor ac rwy'n ei ffobl i'w ffór. Rwy'n gweithio'n gwahanol i'r gwahanol i'w ffobl i'w gwaith. ..y'r bod yn cael periwn cyffred Tools rum. Yn mor tyfu lynyddiad yma felly mae'n gwneud amser. Mae'n llwy reddiwch yn ymlaen i'r ysgol. Yn ei rhaid i'r hyffredig a'r cael i'r llwy ffoclwyr yw... ..a phrygau arhennyrch gan o'r cwrs ar gyfer y tŷ... ..y'r llw ar y Cymru, yw cael ei ffoblol yn ladodd. Ie, tynnu'n un lle ddwy'r gweithio. Mae'n rhaid i'r lle ar y cyffredig. Rwy'n cael eu gair o'r cyffredig. Mae am TikTok i essaysidio i gweithio. Yma yng Nghymru? Maenai, mae 싶wydio ar y mewn gyflawn i'r ysgawdd. Mae'r gwaith fynd o gwych gyflawn a oedd hefyd. Mae nid ond pan oedd eich newid o'r gwaith yn mae'r haneselu. Fyn am ddaeth o'r pob gyllennieddaeth hefyd ifaeth yma? Yn cael, mae'n gyllanau ond erいます. Mae'r rhe – mae'r cyllident ychwanegoedd. Fe gweld yn allu y wyd écfnog, It's two different things. I think that the manger coming in and he's really got us organised, the defensive side. I think that's shown in the pitch so far. Do you enjoy watching Big Sam Sessions? I love the bossy sessions. I mean, I enjoy... I'm a manager sessions to be honest. As I said I enjoy learning and watching if I have a lot of experience myself in a game now. So you're always learning something new. Let's speak about Wayne Rooney who's been in tremendous form recently. And you won't be surprised at all at that will you? Classes permanent isn't it? Fe wrth gwrs, ym mhug gan fi i wedi'i wneud arno, dyma, llawditteb. Felly efallai, mae'n gwrs fluidr הדdfodraeth wedi'i feddwl i'r glas ffliad ar y gwneud erbyn. Mae'n ganddo sydd wedi'i bach iawn pwysig yma. A'r ddisgwyd am hynny wedi'i'r pryd yn ffliad i'r clwb yn ein glas bwyd. Mae'r gwerth gweithio'n teimlo ddeud i'r gwrs wedi'u gwneud hwnnw. Fflaen i'r gwr yw ar y bod wedi rhoi'u ar y chwrdd. ac os i'n wneud i oswb wrth y gymryd. Oedd eich cyreol, mae'n gwneud i oswb, a yna'n gwneud i oswb i oswb eich pob gynhalu, mae eich hyn ymddindig yn fath o'r bod yn fath i fath. Os ewch yn ymddindig, lle mae'r club ei r�sio'r lle. Yn daEN mae'r club eich lle a'r gwasanaethu'r hoff. Ac oedd eich bod ni'n siwr, ond dechrau'n chi ddim. Os eich ei bod yn ddweud hwng yn fath o'r hoff, ond mae'n siwr yn ymddindig, Maen nhw'n dychydig wrth Felly mae'n gwestiwr, mae'n gwestiwr yn cael rhaid o bros llwyddofyn yn gallu'r clob. Byddai'n debyg ac mae yna'n dif recru o'r blygu i'r parrindig. Felly mae'n gofio ar gyfer hyn mae'n gwestiwr yn raddol byddai. Felly mae'n gwestiwr yn debyg ac mae'n gwestiwr yn roi ffilm yn eu parryd. Mae'n gwestiwr yn teidio chi'n gwasanaeth sy'n farson yng Ngysgriff Cymru ar y gall i'r llwyddofyn. A nodd dob i'r glwhenu sydd yn gweithio ei erbyn jyfin iawn.  Rwy'n meddwl ein addresses o'r wiad yma a dyna i'r mynd o wneud sydd yn falch ar un dyn ni peirio'n meddwl sy'n meddwl... ... yn meddwl i'r meddwl ag y gallwn meddwl ar gyfer y lodiad yr un dil yn meddwl i ardal. Yn meddwl guardingio ernyn i'r meddwl a blwyddsod y tîm. Mae'n gwneud i'n ddigonio ar gyfer y gweithio, ond mae'n llin o'n gweithio. Ond John Jo'r gwneud a'n gweithio'n ddwylo, mae'n ffyrwm yn llunio'n gweithio'n gweithio'n gweithio'n gweithio. Mae'n gofyn oedd y cwbl i'n gweithio, yn fawr. Mae'n gofynu i John Jo o ysgolion. Mae'n gofynu i'r Gweithio Tom Davis, Benny Benninghamu. Has that been a help to those young players to come in and look around the dressing room and it must be big for young players to come into a Premier League dressing room, but to see somebody that they've worked with before like yourself, a familiar face who knows all about them? I'm sure it does help them, but coming into the first team is a massive step, and you can sink or you can swim. They'll add in the moment, they're doing well, they've got the potential to continue to be an everton player, but it's just to start for them. I mean they step up from youth football to the first team is massive, and it's going to take them time to establish themselves as Premier League players, but a lot of hard work and dedication which they've been showing, they've got a chance to continue their career at Everton, but they've done very well so far. Of course there's big expectation at this football club, and we expect to be fighting towards the top of the league, and it's a big ask for a lot of these players, but at the moment they're certainly stepping up to the mark. Is it mentally tough for a young boy to come into a team as well as physically tough? I think every lad is different, I mean obviously, when you're young you maybe know the same pressure on you as an older player's got, but no, they've worked hard, and they've dealt with it well, what I've saw. You still keep an eye on all the young kids and all the age groups coming through, don't you do the Cadwent? You've still seen you out there here at USM Finch Farm watching all the different age groups? Yeah, you've got to keep your eye on, haven't you? Because when you're asked you're a pin you've got to give it, so I try to make sure I keep an eye on all the players through all the age groups, and if my opinion is asked I give it, so obviously by watching as many football games as I can and watching as many kids as I can, it gives you a good perspective on who's coming through. As a coach now, do you find yourself watching matches on the television as a coach or still as a football fan? If Manchester City are playing Manchester United for example, are you looking at it as a coach and analysing it? Yeah, I mean you look at it as a coach now, I mean it's a long time since I've played, so no, you look at it as a coach and you look at potential signings, you're looking at information, you're looking at tactics, so it's always been a coaching point of view. You're still very much involved and you've still got that passion on the sidelines, we don't see that, but three o'clock when Z-cars is playing, is that when you really miss actual playing?  My focus now is on my coaching and it's just been focused for that game as a coach really, I look at football now as a coach now. Is the Duncan Ferguson style centre forward a dying breed? There don't seem to be many big barnstorming centre forwards like yourself in the game at the moment. There's just trends in there, different trends, I think a few years ago it was all the smaller players like Barcelona had and they were really the team everybody was trying to chase and they didn't hear any big players, so I think that's kind of starting to come back to the big target man there, I think it's just a trend isn't it? But yeah, there's not many good big strikers there, but if there is one, I'm sure every team would like to have one. There's always room for a big barnstorming centre forward in football, that's for sure. Right, we're going to show you a lovely piece of film now, it's one of our blue crimbo edits, Helen Fosborough, who visited Alderhay recently with three of our young players. We're here at Alderhay Hospital waiting for some of the first team players to arrive to meet some very special children. They're undergoing treatment here for cancer and today we're going to try and bring Christmas to them just that little bit early. What was it like when you were here? Can you tell the lads a bit about what you went through and what you were... Some days are better with those, sometimes you're a bit depressed, obviously other days you feel bad in yourself but you get through it, you'll be able to family and what else. How much has this place meant to you then? Quite a lot, because they've saved me life really, haven't they? If it wasn't for the nurses here, what they do for people like me, I wouldn't be here today. I think it's been great for the lads to come down and see the kids and just put a smile on their face. I think half an hour, an hour out of your day to come and break up a long day for them and a long week I think it's brilliant to come and see them. Is it quite humbling seeing kids like this when you realise what a struggle some people are going through?  I think the kids here are brilliant, I think the staff are brilliant, helping the kids get well so I think it's great. It's hard to understand what these youngsters are going through and have been through. All they want for Christmas is their health. But seeing the joy and the smiles on their faces when the players arrived and listening to their stories really has been very moving. Hopefully the lads have managed to deliver some festive cheer.  Yeah, it was a great time. It was great to go into the hospitals and see the families and the young kids and obviously they were going through a tremendous hardship.  So it's something that's really rewarding and something I really look forward to, to enjoy that. It's good for the staff as well I always think that the porters, the doctors, the nurses, everybody that works at these places, they enjoy seeing the players as well don't they? Yeah, absolutely. I mean they're all heroes aren't they? I mean they're doing an unbelievable job, fantastic people, real heroes and it's great to be a wee bit of part of that on that day. We do the community sad really well don't we Evan? Yeah we do, brilliant yeah, do a fantastic doing a great job. That's just about it from Duncan and myself for part one, but don't go too far away because coming up in part two we'll hear from Andy Johnson, we'll hear from Aaron Lennon and of course we look ahead to the weekend Premier League visit of Chelsea. Welcome back to part two, time to hear now from another former Everton centre forward, Andy Johnson was back at Goodison last week for the Swansea City game and he took time out to speak to me for the Everton show. You enjoyed yourself for Evan didn't you? Yeah I loved it, it's an amazing club, I didn't realise how big it was until I left really. It's an amazing club, it's top class, the fans are great, I had a great set of lads around me, great management staff and I scored some goals here and had some really good memories. And you're off to a flying start of course, it's always nice for the strikers to score a goal on this Premier League debut for a new team isn't it? Yeah it took a bit of a deflection but I'll take it so yeah it's just one of them ones where you need to get up and running and it's nice to get up and running on your debut. Then it continued into the season, obviously played Tottenham away and then obviously the big light game here which was like the Derby at home so yeah it was a good season for me. Do you wish you had a pound for every time an Evertonian stopped you and asked you about that 3-0 win? Yeah I'd be a rich man. Do you miss playing? Everybody does don't they? Yeah of course yeah you know out there now just watching it from up in the stands like you wish it was out there trying to affect the game, it's a fantastic atmosphere. I love the night games as well, they're great, bit like during the grass, definitely like the banter as well. The boys I think that's the hardest thing to adapt when obviously you finish coming out of that dressing room with 30 lads for 20 years, it's tough but yeah I miss it. What about the current Everton centre for Dominic Calvert-Lewan, you like the look of him don't you? Yeah I really like him, I think he's fantastic. You know for such a young lad to take on that responsibility we've obviously the team being in such a difficult position you know I think he's done fantastic. You know he gets up, he's horrible, he's nasty, he wins the ball, I just wish there was a couple more running beyond him to obviously have him out once like then balls are flicked on but you know he's obviously living in the shadow of Lukaku but you know for his age and the way he affects the game you know I think he's fantastic. It's a lonely role isn't it the lone striker? It's tough, it's tough yeah unless you've got a little Australian lad called Timmy Cahill flying in behind you yeah it's tough you know it's really tough but you know he's taking it well, he's doing well, you know he's causing all kinds of problems, he's quick, he's strong, you know he's hungry which is what I like. Dominic Calvert-Lewan for a young boy has done really really well hasn't he? He's done well, he's done well, he's got himself a position there and he's been working hard, he's done well we always want more for him and yeah he's got to lead the line and he's quite young so it's a tough position to be on your own up front but he's done really well. The lone striker is a tough position in the Premier League for an experienced striker isn't it let alone a youngster who's let's get it right is still learning his trade. Yeah it's tough I mean the Premier League is tough and to be on your own up front it's not easy you know playing that target man I mean he can run in behind as well is that there's a lot to his game that he needs to improve on but of course we're doing that on the training field as best we can and he's doing fine. Do you do a lot of work with the young strikers yourself Donk? Yeah well all the work I do is when the manager instructs me to do it so yeah we do work with them if it's a striker, if it's a midfielder, if it's a defence or it depends what we're working on and I'll get asked to whatever the manager asks me to do I'll do. Talking about the Premier League being a tough playground, the top division in Scotland in your day was a tough playground for a teenage centre forward under United was it? Was it tough for you in the early days? Yeah it was very tough there, that's a different world isn't it, when you look back at how we come through, you know the upbringing was completely different for the kids now, it was a tough environment and one that wouldn't have changed for the world. You must have learnt an awful lot coming up against some really experienced, battle hardened Scottish centre haws. Definitely, you know we've got a few knocks and a few bruises to prove that but now the game's changed and back then it was much tougher, it was a great education as I said but I mean the game's obviously now it's a wee bit more quicker, it might be a lot fitter now but no back in the early days it was tough to survive up there. We're talking here at USM Finch Farm, the facilities are fantastic, the young players want for nothing, probably wasn't like this at under United was it, did you have to do all the usual apprentice jobs? Yeah well everybody did didn't they back then, you know you did all the jobs, everything, cleaning the toilets, marking the floors, doing the kit, washing the kit, cleaning the boots, cleaning the manager's car. Cleaning the manager's car? Yeah we used to wash his car until some sprites back decided to take this car to the car wash so we scraped a pound together and took the manager's car to the car wash, about six of us hanging it, it was big, quite ouday. So we used to start doing things like that but it was great, great and the best job was sweetening the terraces, that was the best job because you always got a few quidders, because obviously the lads are on the terraces and they're towing their money at their pockets and they're dropping their money. So when you're going up to the terraces you've always got a few quidders. It's a great upbringing in that though isn't it, you must teach it a little bit of discipline and give you more desire to leave that behind and get involved with the first team. It's just the way it was when I've never had a lot, wasn't it any big wages back then, my wage was 38 quidders something I was getting and I got a wee bit of dig money when the manager decided to give me the dig money, so no, it was just the way it was. It's interesting when you say you wouldn't have changed it for the world, it shapes you to become what you are. Absolutely, I think everything does, as you get older you get wiser don't you, you draw in these past experiences and certainly in my education we're under the guys like Jim McLean, Walter Smith, no proper old school, proper managers, guys that are respected, it was a fantastic upbringing for me. That's some tough managers haven't you really? Yeah, quite a few tough ones, they've all been good to be fair and you're learning for everyone in a month and you try to remember the things they say to you and you know you're coming through and you try to pass that information on to the kids now. It's an interesting story really is but we're going to take some time now to look ahead to the Premier League game against Chelsea at Godderson Park at the weekend. One player who's been delighted to be back in the first team frame is Aaron Lennon and as he tells us now he's also pleased with his own form. We've picked up some great wins, a great draw against Liverpool as well and confidence is coming back and you can see that in the performances but definitely we're getting better and better each week now. And do you feel that's the case personally as well? Yeah, I think my thickness is getting up there now, I feel sharper, stronger in the games and yeah personally I feel a lot better in the games. Is the manager here having a good influence on you personally as well? Yeah he's been great and some of all the staff that have come in have been great with me, showing me clips on how to improve and the spaces to get in and where to run and stuff. Now they've really helped me since they've got in and not just the gaffer and they've all been great for me and the staff as well. The next game is Chelsea and what a great challenge to come off the back of this game now? Yeah of course, Chelsea are a great side but we're in a good form and at Goodison we fancy our chances against anyone so we'll look forward to that. We'll get ready in the training pitch this week and we'll get ready for Saturday. Are you starting to get that mindset here at Goodison Park now where it almost doesn't matter who the opposition are, you feel like you can win the match? Yeah I think we've always had that here. Like I said we know at home the fans get behind us and we're a match for any team if we're at it so like I said we know that no team really wants to come to Goodison and if we're at it we know we can get a good result. These big games at Goodison, the big big games against the likes of the Chelsea's and what have you, do you still get pre-match nerves, in fact you get different pre-match nerves as a coach than you did as a player? Yeah definitely, probably more nervous to be honest. Really? Of course you're really controlled by Lily but isn't it? It's down to the players then when they cross that white line to carry your instructions and they've obviously got to perform. As a player you were just in that mode and you got nervous but I wouldn't say I was too nervous player you know what I mean but as a coach you get very uptight in the touchlines. Even though you've done all that preparation you've passed on the information as best you can once the whistle blows and you can't influence the game. That's when it's frustrating for you is it? It can be but you can influence it but not as much as obviously when you played but it's certainly I find it more nerve wracking anyway. Momentum is such an important part of football isn't it? Particularly at this busy time where we can keep the momentum going and pick up a few points, you're right up there aren't you? Yeah I mean considering we were confident in the last few weeks we were fighting relegation a month ago so now we're in the top half of the table. It's been a tremendous steps of me and we've just got to continue that and as you said we've got to continue that momentum and that confidence we've got to keep that going and that obviously just comes with the results. It's going to be a massive game for us on Saturday so fingers crossed. Need the fans don't we? We need the fans but the fans are always important to us aren't they especially at home. We need to get behind us and I'm sure they'll always do it anyway and we've just got to try and make sure we perform on the pitch. That's the main thing isn't it and picking up their wins. Just to finish off then Doug just like to revert back to the academy. There's a lot of young players who have come through the academy and made it to the first team and you as a coach have taken the same path as well haven't you? I have done. I mean I've learned tremendous amount for the academy for that pathway that I took. I mean the academy coaches will end off like the Sean London's and the Paul Tates and at the moment they've got Joe Waldrum and Matt Molden doing a fantastic job there and of course they're the lifeline of the club. We need these players coming through and they've done a tremendous job doing that and really are the unsung heroes in that development of these players. I mean there's no young player nailed on who's ever going to play in the first team. I mean very few young players you could say 12-year-old or 13-year-old or 14-15 are going to play in the first team. There's very few of them so it needs hard work and dedication for other players and the staff. I mean there really is a lot of unsung heroes in our academy who deserve a pat in the back in recognition for the hard work that they're doing for their club. You still love this football club don't you? Absolutely. That will never change. It's our club isn't it? It's the best club in the world and I'm the best job in the world and I've got a ring side seat. Can't beat that. That's just about it for this Christmas edition of The Everton Show. Thanks enormously to Duncan Ferguson for joining us. Thank you for watching as well and please make sure you watch next week as well because we've got an exclusive interview with Mike Walker and that's not one to be missed. A very merry Christmas from everybody at The Everton Show.


Our final presenter is Navid Kazem from Sivland Environmental Engineering whose title is Soft Multifunctional Composite Using Liquid Metal. Conventional robotics and electronics rely on rigid materials like metals, carbons and ceramic. However, in order to design a device that can have physical human interaction or be safe around us, we really need to stay away from those rigid materials and start adapting some softer materials. So elastomers and rubbers are very popular for this adaptation in order, because of their extraordinary mechanical properties. They are hardly stretchable, they are resistant to tear and also they are elastic. If you deform a rubber, it always spring back into its original shape. However, the downside of these rubbers is that they are insulators. They do a horrible job of conducting heat or electricity. The current way of improving conductivity of these rubbers is by embedding metal powders, carbon or ceramic particles. However, the problem is that these rigid inclusions will degrade the mechanical properties of these rubbers, the exact same thing that made them popular in the first place. It makes them hard and it makes them brittle. In my thesis, I've taken a different approach. I'm using micro droplets of a special type of metal alloy, which is liquid at room temperature. These liquid metals are non-toxic and are safe for contact with the skin. Moreover, the viscosity is similar to water, so embedding them inside rubber doesn't change the elasticity of this rubber. Because they are conductive, they can be used to thaylour the electrical and thermal properties of this rubber. Here I introduced you to Thubber, our thermally conductive rubber. We have not yet made the flubber, but we are very close. This material is highly stretchable and elastic. Thubber has very unusual combination of electrical, thermal and mechanical properties. On one hand, it has mechanical properties similar to soft rubbers. On the other hand, it has metal-like thermal properties while being electrically insulated. These combination of materials make Thubber a great choice for conducting heat and dissipating heat in soft robotics and electronics. So my thesis can be an important step into designing soft robots and soft electronics, composed of entirely soft parts, and be the future for the next future of robotics and personal electronics, and make robots be safe around all of us instead of just being used in very houses. Thank you so much for your attention.


The human mind is a curious thing, and it might be much more powerful than anyone fully realizes. We've all heard urban legends of people displaying stunning examples of mind over matter. But what does mainstream psychology have to say about this? Are any of these bizarre, seemingly magical occurrences proven by science? There are countless situations where psychological changes in the brain have caused baffling effects in the physical real world. While psychologists have studied and observed this phenomenon, they're often at a complete loss for words. One thing's for sure. There's an incredible connection between the mind and the body. Helen Ross was just one patient who suffered from a rare condition called cardiomyopathy, otherwise known as broken heart syndrome. Simply put, she almost lost her life due to a broken heart caused by a failed romance. In this case, her broken heart wasn't just a metaphor. Her stress created a real physical effect. In fact, her heart completely stopped beating, and she even needed a pacemaker for years after this literally heartbreaking moment. The placebo effect is one of the most famous examples of mind over matter. Sometimes we're given a medication or a treatment that we believe to be effective in some way. But in reality, it's just a sugar pill or an injection filled with salt water. Even though the seemingly useless medicine shouldn't benefit our bodies in any way, our minds seem to make it real. One famous study involves a doctor who started administering a placebo injection instead of morphine because he was afraid his patient would develop a dependency. Stunningly, the patient experienced no difference in pain relief. So why does this happen? Researchers believe that in this specific case, the brain releases pain relieving endorphins because of an expected reaction after a placebo injection. This might also explain other examples of the placebo effect throughout mainstream science, like the fact that big red pills are almost always more effective than other sizes and colors. Men won't ever experience what it's like to get pregnant, but sometimes their minds seem to create some of the symptoms. Also known as Kuwait syndrome, this strange phenomenon causes men to experience cramps, morning sickness, and even swollen stomachs. Studies have revealed that there are no possible physical causes for these symptoms. The only explanation is that it's caused by the brain, and it's possibly related to anxiety over their partner's pregnancy. After the amputation of limbs, many patients experience pain in parts of their bodies which do not physically exist anymore. Known as phantom limb pain, it's one of the hardest things to deal with as an amputee. It's also one of the most stunning examples of a physical symptom caused by the brain alone. Researchers aren't exactly sure what causes phantom limb pain, but they think it might have something to do with nerve signals being sent by the brain, when these nerves can't connect with their matching limbs, they seem to automatically create a pain response in the brain. History is littered with examples of people exhibiting superhuman strength, seemingly doing things that should not be possible. One example was when 22-year-old Lauren Karnaki lifted a BMW in order to save her father, or Tom Boyle, who lifted a 3,000-pound Camaro in order to save a trap cyclist. There are tons of other real, documented examples of this so-called superhuman strength, so how is it even possible? Researchers state that things like adrenaline and endorphins are important, and that these factors prevent our muscles from ripping and being completely destroyed. But the truth is that most of the time, we're not using 100% of our power until fear and shock unleashes our potential. By now, most of us have heard stories about the power of meditation. Skilled Buddhist monks have displayed incredible control over their bodies, even controlling their blood pressure and heartbeats. But one of the most impressive effects of meditation is the ability to survive extreme temperatures. Wim Hof, otherwise known as the Ice Man, is famous for his ability to withstand insane temperatures, bathing in freezing waters for hours, and climbing Mount Everest in just a pair of shorts. Until recently, researchers believe that it was impossible to control the autonomic nervous system at will. But Wim Hof and others seem to have unlocked the ability to control their adrenaline and hormones through the practice of meditation. Multiple personality disorder is when an individual has two or more personas within their psyche, and these different personas behave and think very differently. One of the most stunning things about multiple personality disorder is the fact that different personalities within a patient might have different physical conditions. For example, one personality might need glasses while the other has normal vision.  These differences have been measured and proven with multiple studies. The nocebo effect is basically the opposite of the placebo effect. Instead of believing that a substance is beneficial, patients believe that it's negative or even poisonous and they experience the expected effects as a result. One example would be if a person touches what they think is poison ivy and they develop a nasty rash. Only later did they find out that it was just a normal plant. Researchers are still trying to figure out the nocebo effect, but they believe that once again, it's probably caused by the brain creating expected results. The effect of our minds on the physical world is a very interesting and bizarre subject, but above all else, it should reveal the powers of positive thinking. Maybe the fairytale lesson was true after all. If you believe in your dreams, they might just come true. Have you experienced any of these effects? Let us know in the comments below.


Today, we're going to be taking a look at the Justice League action Green Lantern from DC Comics. So stay tuned. Hey guys, welcome back to come again TV We're all geek culture collides if you're new to the channel don't forget to hit that subscribe button So you don't miss out on a single video Today, we're taking a look at Justice League Green Lantern from Justice League action. I believe no It's kind of confused because it has the Justice League action sticker there, but this is just from Justice League Is I believe it is a loot crate loot crate exclusive. I Got it for Christmas. I'm just now doing a review on it So here we go Here's the package as you can see a loot Justice League action sticker there Nice little image of how Jordan Green Lantern there with the Justice League logo nice little display side there and other figures in the line are Batman Superman and Cyborg, I do believe that's the Jim Gordon Batman From the new 52 New 52 Superman. I've got some warnings there not for children under three years of age Let's go ahead and take a look inside As you can see he is held in there By some little plastic ties easy break easy to break through So let's go ahead Pop those off All right He's not bad He does kind of look like the Justice League action Green Lantern though, which really made me think that this Was a Justice League action figure it is by Mattel Love the paint work Love that shade of green that's that's what Green Lantern should look like not the forest green that a lot of the figures have Not much for articulation. He's got three points of articulation. He's got his head Can go side-to-side and all the way around and his arms Go all the way around at the shoulder That's it for articulation however There is slight movement at the boot I guess because the glue didn't dry all the way When they put the boots on the boot Boots are kind of a separate piece. I guess they just kind of pegged it in there But overall not a bad figure not a bad figure at all Can't do much with him So he's mainly just a collectible he's going to go up on my shelf with the rest of my Green Lantern figures as Most of you know if you watched my videos before you guys know I'm a big Green Lantern fan So there you go guys Mattel's Justice League Green Lantern from DC Comics I'm Shannon for come again TV. Take care