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This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing!The American Academy of Pediatrics has put out a new Clinical Guideline for the care of higher-weight children. This document is 100 pages long including references and there are so many things that are concerning and dangerous in it that I had trouble deciding how to divide it up to write about it. I began on Thursday with a piece about the undisclosed conflicts of interest. Ultimately for today, I decided to focus on what I think will do the most harm in the guidelines, which is the recommendations for body size manipulation of toddlers, children, and adolescents through intensive behavioral interventions, drugs, and surgeries.A few things before we dive in. First, this piece is long. Really long. I thought about breaking it up to make it easier to parse, but I also know that people are (rightly) very concerned about these guidelines and I didn't want to trickle information/commentary out over days and weeks in case it might be helpful to someone now. Also, know that this may be emotionally difficult to read, in particular for those who have been harmed by weight loss interventions foisted on them as children. That will likely be exacerbated by the gaslighting these guidelines do to erase the lived experience of harm and trauma from the “interventions” they are recommending, and from their co-option of anti-weight-stigma language to promote weight loss. So please take care of yourself, you can always take a break and come back. Per my usual policy I will not link to studies that are based in weight bias and the weight loss paradigm, but will provide enough information for you to Google if you want to read them. I'll also use an asterisk in “ob*sity” for the reasons I explain in the post footer. Ok, big breath and let's get into this.In later newsletters, I'll address other issues in depth, but for now here are some quick thoughts and links about overarching issues before I dig into the actual recommendation:The claim that “ob*sity is a chronic disease—similar to asthma and diabetes”No, it's really not. And it's this faulty premise (that having a body of a certain size is the same thing as having a health condition with actual identifiable symptomology) that underlies everything in these guidelines. The diagnosis of asthma requires documentation of signs or symptoms of airflow obstruction, reversibility of obstruction (improvement in these signs or symptoms with asthma therapy) and no clinical suspicion of an alternative diagnosis. The diagnosis of diabetes requires a glycated hemoglobin (A1C) level of 6.5% or higher. But to diagnose “ob*sity” you just need a scale and a measuring tape. A group of people with this “diagnosis” don't have to share any symptoms at all, they simply have to exist in their bodies. That is not the same as asthma or diabetes, though the weight loss industry (in particular pharmaceutical companies and weight loss surgery interests) have absolutely poured money into campaigns to try to convince us that it is. (Note that the argument that ob*sity is correlated with other health conditions and thus is a disease actually proves the fallacy since some kids/people who are “diagnosed” with “ob*sity” don't have any of those health conditions and some kids/people who are thin do have them. It's especially disingenuous as it ignores the confounding variables of weight stigma and, in particular, weight cycling both of which these guidelines, if adopted, are very likely to increase.)The myth of “non-stigmatizing ob*sity care” Like so much of these guidelines, this idea and much of the verbiage around it mirrors that of the weight loss industry. In this case, it's attempt to co-opt the language of anti-weight-stigma in order to promote (and profit from) weight loss (there's a guide to telling the difference between true anti-stigma work and diet industry propaganda here!) In truth, there is no such thing as non-stigmatizing care for ob*sity, because the concept of ob*sity is rooted in size and the treatment is changing size (the word was made up to pathologize larger bodies, based on a latin root that literally means to eat until fat so…less science than stereotype there.) There is no shame in having a disease, it's just that existing while fat isn't one. The concept of “ob*sity” as a “disease” pathologizes someone's body size. The concept of ob*sity says that your body itself is wrong, and requires intensive therapy and/or risky drugs and surgeries so that it can be/look right. There is no way to say that without engaging in weight stigma.If someone claims that the treatment is actually about health and not size, then it's not “ob*sity” treatment since both the criteria for the “disease” and the measure of successful “treatment” of ob*sity are based on body size. If the treatment is about health and not size, then the treatment and measures of success should be about actual metabolic health, not body size (which would be ethical, evidence-based, weight-neutral care.)The idea that “It is important to recognize that treatment of ob*sity is integral to the treatment of its comorbidities and overw*ight or ob*sity and comorbidities should be treated concurrently”Again, I think this is demonstrably untrue. Any health issues that are considered “comorbidities” of being higher-weight are also health issues that thin people get, which means that they have independent treatments. We could skip body size manipulation attempts entirely and still treat any health issues that a higher-weight child/adolescent has.The dubious claim that “ob*sity treatment” is compatible with eating disorders preventionI wrote a specific piece about this here. Weight loss as a “solution” to weight stigmaThis is unconscionable. Regardless of what someone believes about weight and health, the message that children (as young as 2!) should solve stigma by undertaking intensive and dangerous interventions that risk quality of life moves beyond inappropriate to disgusting, especially when one is perpetuating weight stigma, as these guidelines (and the weight loss industry talking points that are repeated herein) do.There is so much more to unpack here, but I want to move into a discussion of the recommendations themselves.For this, I will start where I left off on the conflict of interest piece. Which is to say, almost all of the authors of these guidelines are firmly entrenched in the body-size-as-disease paradigm. They have pinned their careers to it. None of the authors are coming from a weight-neutral paradigm.  In fact, in the research evaluation methodology section, they explain that they excluded studies that looked at impacting health, rather than weight. In their own words:The primary aim of the intervention studies had to be examination of an ob*sity prevention (intended for children of any weight status) or treatment (intended for children with overw*ight or ob*sity) intervention. The primary intended outcome had to be ob*sity, broadly defined, and not an ob*sity comorbidity.Note that by “ob*sity comorbidity” they mean a health condition that happens to children of all sizes.I don't know if it was intentional, or just a myopic focus on body size manipulation as a supposed healthcare intervention, but the option to focus on health rather than size was specifically excluded by a group of authors whose careers on based on focusing on size.There are three main areas of their recommendation that I'll talk about today - Intensive Health Behavior and Lifestyle Treatment, Weight Loss Drugs, and Weight Loss Surgeries.RECOMMENDATION:  Intensive Health Behavior and Lifestyle Treatment (IHBLT)This is recommended starting as young as age two. That's right, they are recommending intensive interventions to kids in diapers (and they think that they should look into how to “diagnose” kids who are even younger, yikes!) What these guidelines subtly admit is that these interventions don't actually work. They include this (long-time weight loss industry) talking point “a life course approach to identification and treatment should begin as early as possible and continue longitudinally through childhood, adolescence, and young adulthood, with transition into adult care.”The translation to this is that they have absolutely no idea how to make higher-weight people of any age thin long-term. They are aware (and if not they are negligent) that a century of data shows that the vast majority of people will lose weight short-term and gain it back long-term. What they seem to be trying to do here is rebrand yo-yo dieting (aka weight-cycling) as a successful intervention. If there is a prize for moving the goalpost and declaring victory, they are in the running.Don't just take my word for it, they created a graphic as part of Figure 1 to show it:Pro tip: When they say “relapsing remitting” they mean “yo-yo dieting". I know why the weight loss industry loves this idea - it's how they've built a business that creates exponential growth with a product that doesn't work. What I don't understand is how this group of authors can possibly justify this ethically. The health risks of weight cycling are documented (and very consistent with the health risks that get blamed on higher-weight bodies) so setting people up for weight cycling starting as toddlers does not, to me, have the ring of sound science or ethical, evidence-based medicine.Let's dig into the evidence they are using to support this:The guidelines claim that “IHBLT is the foundational approach to achieve body mass reduction or the attenuation of excessive weight gain in children. It involves visits of sufficient frequency and intensity to facilitate sustained healthier eating and physical activity habits.” The study they cite to back this up (Grossman et al; 2017, Screening for ob*sity in children and adolescents: US Preventive Services Task Force recommendation statement) says “Comprehensive, intensive behavioral interventions (≥26 contact hours) in children and adolescents 6 years and older who have ob*sity can result in improvements in weight status for up to 12 months.”They also include a chart of seven randomized controlled trials (RCTs) from 2005-2017. The combined study population of all seven studies was just 1,153 kids. The largest study (with 549 participants) and the only study to include children from ages 2 to 5 had a duration of 12 months and showed a BMI change of 0.42 that year, and was only “effective” (if you consider a .42 change in a year “effective”) in kids ages 4-8 years old. There was only one study that followed up for more than 12 months, and from 12 months to 24 months, the BMI change decreased (from 3.3 to 2.8,) consistent with the weight regain pattern that we would expect.This will be a running theme in these guidelines - short-term studies will be used to justify life-long recommendations, and weight regain is ignored. In general, sometimes this is based on the idea that if a weight loss intervention works short-term, then it will continue to work forever, other times it's based on the idea that weight cycling is an ethical, evidence-based healthcare intervention. Again, the data on both the long-term failure of weight loss and the danger of weight cycling does not support this.They make a point to mention that IHBLT “involves interaction with pediatricians and other PHCPs who are trained in lifestyle-related fields and requires significantly more time and resources than are typically allocated to routine well-child care.” At this point I'll note that many of the authors of the guidelines run clinics or have practices that provide exactly this type of care.Their criteria for the studies was, I'll just call it lax: “Over a 3-12 month period: The criteria for the evidence review required a weight-specific outcome at least 3 months after the intervention started.” Obviously, this is a very short-term requirement and, again, excludes studies that looked at actual health instead of just body size.Here again they tell on themselvesTreatments with duration longer than 12 months are likely to have additional and sustained treatment benefit. There is limited evidence, however, to evaluate the durability of effectiveness and the ability of long-term treatments to retain family engagement.Note that the idea that longer duration treatment is “likely” to have additional and sustained treatment benefit is not remotely an evidence-based statement, and I would argue that it is biased and should not be included here. Also, they seem to be setting the stage for blaming families for the entirely predictable and almost always inevitable weight regain.Under “referral strategies” they get real about how little weight loss we're actually talking about:Pediatricians and other Primary Healthcare Providers (PHCP's) are encouraged to help to set reasonable expectations for these [BMI-based] outcomes among families, as there is a significant heterogeneity to treatment response and there is currently no evidence to predict how individual children will respond. Many children will not experience BMI improvement, particularly if their participation falls below the treatment threshold.”As described in the Health Behavior and Lifestyle Treatment section, those who do experience BMI improvement will likely note a modest improvement of 1% to 3% BMI percentile decline.So they are recommending an “intensive,” time-consuming, expensive intervention to kids starting as young as age 2 with no prognostics as to which kids might be “successful,” the stated result of which is that “many” (their word) of them won't experience any change in the primary outcome, those who do will see a very small change.They do mention the supposed actual health benefits of these interventions, but fail to mention that the health benefits may have nothing to do with the very small change in size. That's because often when health changes and weight changes (at least temporarily) follow behavior change, those who are invested in the weight loss paradigm (financially, clinically, or both) are quick to credit the weight change, rather than the behavior change, for the health change. Here again, the evidence does not support this. It's very possible that these same health improvements could be achieved with absolutely no focus or attention paid to weight, which would provide more benefits and less risks (including the risks associated with both weight stigma and weight cycling.) It could also allow the children (some, remember, still in diapers) to create healthy relationships with food and movement, rather than seeing choices around food and movement as punishment for their size or a way to manipulate it.As they move into specific recommendations, they start with:Despite the lack of evidence for specific strategies on weight outcomes many of these strategies have clear health benefits and were components in RCTs of intensive behavioral intervention. Many strategies are endorsed by major professional or public health organizations. Therefore, pediatricians and other PHCPs can appropriately encourage families to adopt these strategies. To me this sounds a lot like throwing the concept of “evidence-based” right out the window. None of this means “these strategies are likely to lead to long-term weight loss,” but I'll bet that won't be what is conveyed to the patients and families upon whom these “strategies” are foisted. Before we move on to their recommendations around diet drugs, here is some research to contextualize these recommendations:Neumark-Sztainer et. al, 2012, Dieting and unhealthy weight control behaviors during adolescence: Associations with 10-year changes in body mass indexNone of the behaviors being used by adolescents for weight-control purposes predicted weight lossOf greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors…including eating disorders and weight gain [Note: This is not to say that there is anything wrong with higher-weight, but that there is something wrong with a supposed healthcare intervention that has significant risks, almost never works, and has the opposite of the intended effect up to 66% of the time.] Raffoul and Williams, 2021, Integrating Health at Every Size principles into adolescent careCurrent weight-focused interventions have not demonstrated any lasting impact on overall adolescent healthBEAT UK, 2020 Eating Disorders Association, Changes Needed to Government Anti-ob*sity StrategiesGovernment-sanctioned anti-ob*sity campaigns* increase the vulnerability of those at risk of developing an eating disorder* exacerbate eating disorder symptoms in those already diagnosed with an eating disorder* show little success at reducing ob*sityStrategies including changes to menus and food labels, information around ‘healthy/unhealthy' foods, and school-based weight management programs all pose a risk.Pinhas et. al. 2013, Trading health for a healthy weight: the uncharted side of healthy weights initiativesOb*sity-prevention programs that push “healthy eating” are triggering disordered eating in some children, creating sudden neuroses around food in children who never before worried about their weightThey were all affected by the idea of trying to adopt a more healthy lifestyle, in the absence of significant pre-existing notions, beliefs or concerns regarding their own weight, shape or eating habits prior to the interventionFiona Willer, Phd, AdvAPD, FHEA, MAICD, Non-Executive Board Director at Dietitians AustraliaQuoted from: health.usnews.com/health-news/blogs/eat-run/articles/for-healthy-kids-skip-the-kurbo-app“Dieting to a weight goal was found to be related to poorer dietary quality, poorer mental health and poorer quality of life when compared with people who were health conscious but not weight conscious”Ok. Moving on.RECOMMENDATION: Use of Pharmacotherapy (aka Weight Loss Drugs)Their consensus recommendation is that pediatricians and other PCHPs “may offer children ages 8 through 11 years of age with ob*sity weight loss pharmacotherapy, according to medication indications, risks, and benefits as an adjunct to health behavior and lifestyle treatment.”They admit that “For children younger than 12 years, there is insufficient evidence to provide a Key Action Statement (KAS) for use of pharmacotherapy for the sole indication of ob*sity,” but then go on to suggest that if kids 8-11 also have other health conditions, somehow weight loss drugs (which are not indicated for the treatment of the actual health conditions they have) “may be indicated.”Their KAS is that “pediatricians and other PHCPs should offer adolescents 12 y and older with ob*sity weight loss pharmacotherapy, according to medication indications, risks and benefits as and adjunct  to health behavior and lifestyle treatment.”The studies that were actually included in the evidence review predominantly studied metformin (alone and in combination with other drugs,) which is not approved for weight loss, orlistat, exenatide, and one study that looked at phentermine, mixed carotenoids, topiramate, ephedrine, and recombinant human growth hormone.Even though the studies for other drugs did not exist at the time of the evidence review, they made the choice to include them anyway. (This includes Wegovy, the drug that Novo Nordisk, a donor to the AAP, has promised their shareholders will be a blockbuster and that announced its approval in children as young as 12 just days prior to the publication of the guidelines.) Let's look at the efficacy of the drugs they are recommending:MetforminAdverse effects include bloating, nausea, flatulence, and diarrhea and lactic acidosis which they characterize as “serious but very rare.” The guidelines describe the evidence of metformin for weight loss in pediatric populations as “conflicting” They evaluated 16 studies, about two-thirds of which showed a “modest BMI reduction” and one-third showed “no benefit.” Also, this drug is not approved for weight loss. They recommend that due to the “modest and inconsistent effectiveness, metformin may be considered as an adjunct to intensive health behavior and lifestyle treatment (IHBLT) and when other indications for use of metformin are present.”Orlistat:This drug is currently approved for ages 12 and up. Orlistat is sold under the name alli by GlaxoSmithKline and as Xenical by Genentech (both GlaxoSmithKline and Genentech are donors to the AAP.) The guidelines point out that the side effects (including fecal urgency, flatulence and oily stool) “greatly limit tolerability” but do say that “Orlistat is FDA approved for long-term treatment of ob*sity in children 12 years and older.” They cite two studies from 2005. One (Behzat et al., Addition of orlistat to conventional treatment in adolescents with severe ob*sity) started with 22 adolescents, 7 of whom dropped out within the first month due to drug side effects. The remaining 15 subjects were followed for 5-15 months with an average of 11.7 months of follow up. Those 15 patients lost 6.27 +/- 5.4 kg within the study time.The other (Chanoine JP et al, 2005, Effect of orlistat on weight and body composition in ob*se adolescents) was a one-year study with 357 adolescents (age 12-15) in the Orlistat group. They lost weight initially but the weight loss stopped at week 12 and by the end of the study the weight of those in the Orlistat group had increased by .53kg.Glucagon-like peptide-1 receptor agonistsThese are drugs that are type 2 diabetes medications that were found to have a side effect of weight loss. In some cases they have been rebranded specifically for weight loss and, in others, are prescribed off-label.ExenatideThis drug is currently approved in kids ages 10 to 17 years of age. The guidelines point out that a small weight loss was shown in two small studies but with “significant adverse effects.”LiraglutideThe study they cite for liraglutide (Kelly et al, Trial Investigators. A randomized, controlled trial of liraglutide for adolescents with ob*sity.) was a 56 week study with a 26-week follow-up period. Participants lost weight initially, but after 42 weeks began to regain weight (though they were still on the drug) at 56 weeks weight gain became more rapid and at the end of the 26-week follow up they were nearing baseline. The guidelines characterize this as “A recent randomized controlled trial found liraglutide (daily injection) more effective than placebo in weight loss at 1 year among patients 12 years and older with ob*sity who did not respond to lifestyle treatment.” They do not make it clear that participants experienced near total weight regain (see graphic below.) In addition to the near total lack of weight loss (and remember that it's pretty likely that subjects continued to regain weight after the tracking stopped at 82 weeks,) side effects included nausea and vomiting, and among patients with a family history of multiple endocrine neoplasia, a slightly increased risk of medullary thyroid cancer. Liraglutide is sold as Victoza and Saxenda by Novo Nordisk. This study was a clinical trial funded by Novo Nordisk, multiple study authors work for, are employees of, take payments from and/or own stock in Novo Nordisk (see disclosures below) and Novo Nordisk provides funding directly to the American Academy of Pediatrics, and has paid thousands of dollars to authors of these guidelines.Just for funsies I checked the disclosures: Dr. Kelly reports receiving donated drugs from AstraZeneca and travel support from Novo Nordisk and serving as an unpaid consultant for Novo Nordisk, Orexigen Therapeutics, VIVUS, and WW (formerly Weight Watchers); Dr. Auerbach, being employed by and owning stock in Novo Nordisk; Dr. Barrientos-Perez, receiving advisory-board fees from Novo Nordisk; Dr. Gies, receiving advisory-board fees from Novo Nordisk; Dr. Hale, being employed by and owning stock in Novo Nordisk; Dr. Marcus, receiving consulting fees from Itrim and owning stock in Health Support Sweden; Dr. Mastrandrea, receiving grant support from AstraZeneca and Sanofi US and grant support and fees for serving on a writing group from Novo Nordisk; Ms. Prabhu, being employed by and owning stock in Novo Nordisk; and Dr. Arslanian, receiving fees for serving on a data monitoring committee from AstraZeneca, fees for serving on a data and safety monitoring board from Boehringer Ingelheim, grant support, paid to University of Pittsburgh, and advisory-board fees from Eli Lilly and Novo Nordisk, and consulting fees from Rhythm Pharmaceuticals. Melanocortin 4 receptor (MC4R) agonistsThese are specialty drugs that are only FDA approved for patients 6 years and older with proopiomelanocortin deficiency, proprotein subtilisin or kexin type 1 deficiency and leptin receptor deficiency confirmed by genetic testing. They site a small, uncontrolled study in which patients experience weight loss of 12-25% over 1 year. PhenterminePhentermine is a controlled substance chemically similar to amphetamine which carries a risk of dependence as well as side effects including elevated blood pressure, dizziness, and tremor. These are FDA approved for a 3-month course of therapy for adolescents 16 or older. I'm not clear what good could come out of giving a teenager a drug with these kinds of risk for 3 months?TopiramateThis is a drug that is used to treat seizures and migraines that happens to have a side effect of making people not want to eat through what the guidelines admit are “largely unknown mechanisms.” These drugs cause cognitive slowing and can cause embryo malformation. It's approved for children 2 years and older with epilepsy and 6 and older for headaches and I cannot for the life of me imagine how it could possibly be ethical to cause cognitive slowing in a child (who is going to school!) in order to disrupt their bodies hunger signals.Phentermine/TopiramateYou read that right, those last two drugs with the dangerous, quality-of-life impacting side effects? The guidelines discuss the option of prescribing them together. To children. This is based on a 56-week study (Kelly et al, 2022, Phentermine/topiramate for the treatment of adolescent ob*sity.) In the study, 54 subjects were given a mild dose, 15 of them dropped out. 113 were given the “top dose” 44 of them dropped out. As we've seen in other studies, weight loss had leveled off and begun to rise slightly by week 56 and there is no reason to believe it wouldn't go back up, but we'll never know because they didn't do any more follow-up. By the way, like most of the other studies, these subjects were also undergoing a “lifestyle modification program.” Also, like the other drugs, I think it's important to note that this was FDA-approved for “chronic treatment” based on the results of a study that only lasted 56 weeks. That is a common situation with weight loss drugs.Finally, the guidelines don't mention that side effects of this drug include increased heart rate, suicidal behavior and ideation, slowing of linear growth, acute myopia, secondary angle closure glaucoma, visual problems; mood and sleep disorders; cognitive impairment; metabolic acidosis; and decrease in renal function.  As I was looking this up, I noticed that the lead author of this study is the same lead author of the liraglutide study. Phentermine/Topiramate is sold under the brand name Qysmia by Vivus. I had to do some digging to get to the disclosures on this one and what do you know, Dr. Kelly has received grant consideration and consults for Vivus. In fact, with the exception of Megan Oberle, every author of this study either receives funding from/consults for Vivus, or is an employee of Vivus. Megan Oberle lists no conflicts of interest in this 2022 study but, interestingly, in a 2019 study (It is Time to Consider Glucagon-Like Peptide-1 Receptor Agonists for the Treatment of Type 2 Diabetes in Youth) the disclosure states “MO serves as site PI [principal investigator] for study through Vivus Pharmaceuticals” so we know they're not strangers. LisdexamfetamineThis is a stimulant that is approved for kids 6 and older who have ADHD, in those 18 and up for Binge Eating Disorder, and while it is sometimes prescribed off-label for higher-weight kids, the guidelines note that “no evidence available at the time of this review to demonstrate safety or efficacy for the indication of ob*sity in children.”Summing up, there are significant risks of side effects (some life threatending) and not a drug among them has shown anything approaching long-term efficacy. Let's look at the last of the recommendations.RECOMMENDATION: Weight Loss SurgeryThis is the last bit I'll write about today. This section beginsIt is widely accepted that the most severe forms of pediatric ob*sity (ie, class 2 ob*sity; BMI ≥ 35 kg/m2, or 120% of the 95th percentile for age and sex, whichever is lower) represent an “epidemic within an epidemic.”Remember, for a moment, that this phrasing is from authors who swear up and down that they are working to end weight stigma. One wonders what they would have written if they were trying to stigmatize higher-weight children. (Just fyi, if anyone is confused, you can't usefear-mongering language, describing a group of people simply existing in the world at a higher-weight as an “epidemic” without stigmatizing them.)The KAS here (for me the most horrifying of those offered,) isPediatricians and other PHCPs should offer referral for adolescents 13y and older with severe ob*sity (BMI ≥ 120% of the 95th percentile for age and sex) for evaluation for metabolic and bariatric surgery to local or regional comprehensive multidisciplinary pediatric metabolic and bariatric surgery centers. [I'll note here that at least one of the authors of these guidelines runs just such a facility.]Before we get too far into this, let's be clear about what these surgeries do. They take a child's perfectly functioning digestive system, and put it into a (typically irreversible) disease state forcing, restriction and/or malabsorption (for an explanation of the various surgeries, check out this post.) If this state happens to a child because of disease or accident, it is considered a tragedy. If the child is higher-weight, it is considered, at least by the authors of these guidelines, healthcare.They make the claim “Large contemporary and well-designed prospective observational studies have compared adolescent cohorts undergoing bariatric surgical treatment versus intensive ob*sity treatment or nonsurgical controls. These studies suggest that weight loss surgery is safe and effective for pediatric patients in comprehensive metabolic and bariatric surgery settings that have experience working with youth and their families”To support this, they cite a single study. The study (Laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity (AMOS): a prospective, 5-year, Swedish nationwide study) included 81 subjects who underwent Roux-en-Y gastric bypass.The average weight loss was 36·8 kg over five years, but 11% of those who had the surgery lost less than 10% of their body weight.A full 25%  had to have additional abdominal surgery for complications from the original surgery or rapid weight loss and 72% showed some type of nutritional deficiency. And that's just in five years. Remember that the damage done to the digestive system is permanent. They are recommending this as young as 13, so a five year follow-up only gets these kids to 18. Then what?By the look of their own graph, what comes next may well be more weight gain, since the surgery survivors' weight loss leveled off after year one and started to steadily climb after year two. There's also the impact of those nutrient deficiencies. They also claim that these surgeries lead to a “durable reduction of BMI.” Let's take a look at the studies they cite to prove that.Inge et al., 2018 Comparison of Surgical and Medical Therapy for Type 2 Diabetes in Severely Ob*se AdolescentsThis study lasted two years. It looked at data from 30 adolescents who had weight loss surgery. They averaged 29% weight loss over 2 years and 23% of the subjects had to have a second surgery during those two years.Göthberg et al., 2014, Laparoscopic Roux-en-Y gastric bypass in adolescents with morbid ob*sity--surgical aspects and clinical outcomeThis study just rehashes information from the Olbers study above.O'Brien et al. Laparoscopic adjustable gastric banding in severely ob*se adolescents: a randomized trialThis study is about gastric banding and I'm not sure why they included it because in the paragraph above it they point out that these surgeries are “approved by the FDA only for patients 18 years and older, have declined in use in both adults and youth because of worse long-term effects as well as higher-than expected complication rates” (they cite 18 studies to back up this particular claim.)Olbers et al., 2012 Two-year outcome of laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity: results from a Swedish Nationwide Study (AMOS)These are just the two-year outcomes from the five-year Olbers study aboveOlbers et al. Laparoscopic Roux-en-Y gastric bypass in adolescents with severe ob*sity (AMOS): a prospective, 5-year, Swedish nationwide study.This is the exact same 5-year Olbers study from above, just given a different citation number.Ryder et al., 2018 Factors associated with long-term weight-loss maintenance following bariatric surgery in adolescents with severe ob*sityThis study included 50 subjects who had Roux-en-Y gastric bypass and had a follow-up at year one and another follow-up sometime between years 5 and 12. They were then divided into “regainers” and “maintainers” though by their criteria, “maintainer” subjects could regain, they just couldn't regain more than 20% of the weight they lost prior to their follow-up. Though the study is called “Factors associated with long-term weight-loss maintenance” they were not able to identify any factors that were predictors of “regaining” or “maintaining.” You'll note in the graph below that weight was still trending upward when they stopped following up.So let's recap: They cite 7 studies to back up their recommendation of referrals for these surgeries for kids ages 13 and up. Four of the seven are the same study. One is a study for a surgery that they themselves have said is declining in use, so I'm excluding it. Combined, the rest of the studies followed a grand total of 161 people. The longest follow-up is “5+ years” and the studies consistently showed weight regain that was trending up when follow-up ended, as well as high rates of additional surgery and nutrient deficiencies. This, to me, doesn't come close to justifying a blanket recommendation that every kid 13 and older whose BMI ≥ 120% of the 95th percentile for age and sex be referred for evaluation for weight loss surgery.And when it comes to their criteria for these surgeries, they predicate risk on size. Those with “class 2 ob*sity” are required to have “clinically significant disease” which doesn't make the surgery ethical but, in comparison; children with “class 3 ob*sity” simply have to exist in the world to meet the criteria to have their digestive system put into a permanent disease state. One thing they do point out is that recent data showing multiple micronutrient deficiencies following metabolic and bariatric surgery serve to highlight the need for routine and long-term monitoring. Here we see a serious issue with giving this surgery to adolescents. First of all, they are rarely in control of their access to food. If their parents don't buy them what they need, if a parent loses their job and can no longer afford the supplements they require, if they experience hunger and/or homelessness… there are so many things that could impact a 13-year-old's ability to eat in the very specific ways they need to after the surgery for the rest of their life. Also, these surgeries are going to change the ways that these kids eat - at every school lunch, birthday party, family holiday. Anytime food is served, it is going to become clear that they are different, and if they aren't in charge of preparing the food, there is no guarantee that they will be able to get what they need. And that's if they want to do that. Let's not forget, these are humans who are/will be exploring their independence, including through rebellion, they are humans whose prefrontal cortex is not fully developed, meaning that they can literally lack the ability to fully recognize the consequences of their choices. (Of course, given that we only have five years of follow-up data, I would argue that their doctors and surgical teams also lack the ability to fully recognize the consequences of their choices.)The authors end the section with a fairly shameless plug for insurance coverage of these surgeries. This is another long-time goal of the weight loss industry that has made its way into these guidelines.I think this is a good time for a reminder that thin kids get the same health issues for which higher-weight kids are referred to these surgeries and thin kids are NOT asked to take the risks of these surgeries or to have their digestive systems permanently altered. They just get the ethical, evidence-based treatment for the health issue they actually have. Also, remember that the authors' research methodology specifically excluded research about weight-neutral intervention to see if any health benefits that the surgeries might create could be achieved without the significant (and, from a long-term perspective, largely unknown) risks of these surgeries, and perhaps be more lasting?But there is more to this in terms of informed consent. There are many of the same issues that we see with adults (which I wrote about here). With kids, there is another layer. In the state of California, for example, it is illegal to give a tattoo to someone under the age of 18, even with parental permission. But an eighth grader can make the decision to have their digestive system permanently altered, impacting their life and quality of life in myriad ways, many of which are unknown, and with no prognostics? Given all of this, is informed consent even possible for these kids? I would argue that it is not.Even worse, how many kids' parents, in some combination of weight stigma, concern for their child, and acquiescence to a doctor who may be pressuring them, will make this decision for their child?While I'm sure that there are adolescents who had the surgery and are happy with their outcome, I'm equally sure that there are adolescents who had terrible outcomes and would give anything to not have had the surgery (I know because I hear from them). And I know that the research can't tell us why anyone has the outcome they have. When you combine that with the total lack of long-term follow-up (I'm completely unwilling to consider 5 years “long term” for a lifelong intervention,) I think what we have here are, at best, experimental procedures, not procedures that should receive the kind of blanket recommendations that these guidelines provide for kids as young as 13.Ok, there's a lot more to discuss in these guidelines but I will save that for another newsletter. I hope that the outcry against these guidelines is loud, sustained, and successful in getting them rescinded. Kids deserve far better than this.Finally, I just want to give a quick shout-out to my paid subscribers (I know not everyone can/wants to have a paid subscription and that's totally fine - absolutely no shame at all if you are reading this for free as a subscriber or randomly!) those who are able to pay are allowed me to spend HOURS this week going through these guidelines and creating Thursday's post and this post, I'm just super grateful for the support.I'll be posting additional deep-dives into the research they cite and I'll keep a list here:“New insights about how to make an intervention in children and adolescents with metabolic syndrome” Pérez et al.Did you find this post helpful? You can subscribe for free to get future posts delivered direct to your inbox, or choose a paid subscription to support the newsletter and get special benefits! Click the Subscribe button below for details:Liked this piece? Share this piece:More research and resources:https://haeshealthsheets.com/resources/*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings Fearing the Black Body – the Racial Origins of Fat Phobia and Da'Shaun Harrison Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this. Get full access to Weight and Healthcare at weightandhealthcare.substack.com/subscribe

Non-Executive Board Director, Researcher, Author and Advisor Karen Loon. Karen will share her story, her own experience and her research about Culturally Diverse Leadership. A corresponding Blogpost can be found on Digoshen.Com/blog

What does Elon Musk's potential takeover of Twitter mean for women's opportunities to engage in public debate? What's the best way to deal with online trolls and abuse? And what does John Howard calling the Teal independents 'anti-Liberal groupies' say about the state of the Liberal party?Joining Virginia Haussegger to cast a razor-sharp gender lens over week three of an Australian Federal election campaign that already feels like it's lasted a lifetime is a stellar panel of outstanding commentators.Yasmin Poole is an award-winning speaker, writer and youth advocate, and a newly minted Rhodes Scholar. She is Plan International's National Ambassador, and a Non-Executive Board Director of OzHarvest, and YWCA, a national feminist organisation that has supported women and girls for 140 years. She has appeared on television programs such as Q+A, The Drum and The Project. In 2019, Yasmin was the youngest member of the Australian Financial Review 100 Women of Influence and Top 40 Under 40 Most Influential Asian Australians.Jane Caro AM is a Walkley Award winning author and columnist who is standing as a candidate for Reason Australia for the Senate in the upcoming election.Georgie Dent is a journalist, editor, author, and prominent advocate for women's empowerment, gender equality and mental health. She is the Executive Director of The Parenthood and the author of Breaking Badly.BroadTalk is presented by Virginia Haussegger AM and is a production of BroadTalk Media. It is produced by Martyn Pearce.Say hello to us on Instagram! You can find us as broadtalkers.Email us at hello@broadtalk.net See acast.com/privacy for privacy and opt-out information.

Joining me in conversation on the State of Mind Podcast is Lynn Dang. When Lynn was only a child, she and her family fled war-torn Vietnam on a boat in the middle of the night to seek refuge from the persecution they experienced under the ruling regime. Today, Lynn is the HR Leader for Microsoft Singapore & Vietnam, and she also operates as a Non-Executive Board Director for the UN Refugee Agency (UNHCR) for Australia. In this episode, she shares her powerful story of growing up as a refugee in Australia and how it shaped her into becoming the optimistic, big-thinking and inclusive person she is now. Lynn and I spoke about: The vital need for greater representation and inclusion, and how we can use our privilege to accomplish this The experiences that led her into a career where she can focus on empowering everyone to reach their fullest potential, regardless of the circumstances they were born into How practising self-care and kindness towards yourself can help you and others through times of great uncertainty The power to be found in pushing ourselves outside of our comfort zone, especially when we feel great fear about doing so.

Mark is Co-founder and Chief Marketing Officer of SKOOTIn this episode Mark shares how he believes courageous leadership is being able to make uncomfortable choices. He has a passion for learning and his drive to believe there is always a better way keeps him and his team progressing. He shares more on how his company deal with accountability, culture and values and why his aim is to be the kindest agency. Mark Stringer (aka Strings) is a marketing specialist having spent nearly 30 years Agency and Client-side working for numerous world renowned brands. With a passion and love of start-ups, launching brands and developing campaigns that create a strong emotional connection, alongside driving sales. Mark founded PrettyGreen In 2008 when Red Bull asked if they could give him Wiings. With an original vision for PrettyGreen to be an integrated Communications Agency alongside being a business that helped start-ups, with the Agency based out of Red Bull's office for the first six months. The Agency focuses on delivering “Less Ordinary” Comms, having worked with the likes of Red Bull (including 4 years on the Stratos Project), Snapchat, LEGO, Three, Under Armour, John Lewis, Nintendo, and Nando's to name but a few. Mark is now Chair of comms Agency group, PrettyGreen (PrettyGreen (PR) The Producers (Events) and What They Said (Influencer). Mark plays an active part in the marketing industry, judging numerous Awards, writing and commenting for various publications. He sat on PRCA Council a number of times and spent 6 years on the Channel 4 Britdoc Film Foundation as a Non Executive Board Director. Mark is co-founder of Metropolitan Spirits, which has a portfolio of Absinthe's, La Maison Fontaine. Distributed globally through 5* and premium bars and has created the world's most Awarded blanche Absinthe.  Topics covered include:Doing what you love and identifying that Difficult decisionsBuilding a diverse team Learning from othersSelf drive and ambitionThirst for knowledgeBuilding a safe environment for people to do their best work AccountabilityCulture & valuesKindnessRecognising destructive habits & behaviours There's always a better way Leadership is responsibility Follow Joanna Howes and The Change Creators: website: https://www.thechangecreators.comlinkedin: https://www.linkedin.com/in/joannahowes/For Leadership and team coaching and training, you can message me at joanna.howes@thechangecreators.com and we can book a call. website: https://www.thechangecreators.com linkedin: https://www.linkedin.com/in/joannahowes/youtube: https://www.youtube.com/channel/UC2kZ-x8fDHKEVb222qpQ_NQ

Welcome to the 45th Episode of the #100MasterCoaches​ Show. In this episode, Mel interviews Catherine Tanneau, MCC. Catherine is the Chair of the ICF Global Board for Professional Coaches 2021 and the Past-President of the ICF French chapter, the CEO of Variations International, and Dean of Activision Coaching Institute, an ACTP Coaching Training Program. She is specialized in executive coaching and organizational transformation, and is a Leadership Professor & Academic Director at HEC Executive Education in Paris, rated #1 business school by Financial Times, she is also a speaker and an author of various books and articles. She is also the co-founder of the digital platform Welead Grow (coaching and micro-learning). As a Certified Board Member since 2013, she acts as Non-Executive Board Director for an industrial international holding company in Luxembourg and for a Non-Profit Organization in France (Foundation for Childhood Protection), she is also a permanent member of the Strategic and Digital Committees in startups and Investment funds. She has published a few books out of which the very recent “Coaching for Leaders” (March 21), in French for now; she is also the author of articles and academic publications on leadership, coaching, and digital transformation. She has been invited as a keynote speaker in coaching and leadership events and conferences in France and abroad including China. Catherine believes in the power of creative vision and of human potential. Having spent more than 16 years abroad, she is multicultural and is fluent in four European languages: French, English, Italian and Portuguese. She has recently acquired notions of Estonian as she is based between Paris and Tallinn and works over the 3 continents regularly. Her main coaching specialties are Executive Coaching, Digital Transformation, and Governance. Become a Master Certified Coach like Catherine. Start your journey today at Catalyst Coach. www.catalystcoach.live

Imposter syndrome and perfectionism often go hand in hand, and something many introverted women leaders experience. Mel Stanley talks about turning them into a benefit, about women trying to act like men in order to be accepted as leaders, and more... Mel Stanley is a specialist in Career, Leadership and Personal Brand Strategy working with aspiring professional women who want a fulfilling, purposeful career. Mel has 25 years experience of Marketing and Brand building in large network agencies and blue-chip Corporates. She secured her first Advertising Agency Board position aged 33 and on the Corporate side has headed up the Consumer Retail team at BT and was latterly Head of Marketing and Brand at EDF in the UK and a Non -Executive Board Director of Smart Energy GB. She is also an Ambassador for Women on Boards (www.womenoneboards.net) and mentors' future leaders as part of the Women's Utilities Network (WUN) and Women and Communications Network London (WACL) Mel started FirstWoman because she was frustrated by the lack of diversity at senior levels and was tired of seeing brilliant, talented women being overlooked for promotion and opportunities, with many including herself leaving the workplace to start their own ventures. In response she decided to use her years of Brand and Marketing experience to help other women overcome their barriers to progression by developing an authentic and consistent leadership brand, based on their own unique and very personal strengths. Find out more about Mel at www.FirstWoman.rocks

E28: Jerry Gamez is former Global CEO and Board Director at Le Pain Quotidien Group.  The group consisted of the restaurant brand operating in 21 countries with over 7,000 team members with 5 offices (United States, Belgium, United Kingdom, France, and Spain) and a manufacturing company with six facilities in Europe and across the US.    He's also served in senior leadership roles at publicly-traded companies like Burger King, Walmart, and UPS. He's also had leadership roles in private equity-backed companies.  His passion and extensive food experience have placed him in a unique position to aggregate growth channels.  With the implications of the new normal and the rapidly evolving eating habits, he is at the center of the global acceleration away from animal protein to more plant-based food. Jerry is currently a Non-Executive Board Director of a European restaurant group and Board Advisor of a prominent North American workforce management SAAS company.   Jerry's LinkedIn Profile: https://www.linkedin.com/in/jerry-gamez-65ab0430/ (https://www.linkedin.com/in/jerry-gamez-65ab0430/ ) WHAT YOU WILL LEARN FROM THIS EPISODE: Jerry's interesting path from Southern California to Switzerland. Two ways to go about identifying and contacting potential mentors. Why you're never too high in your career to find new mentors. The simple way to frame your meeting with a mentor. Why being in the inaugural Walmart Executive Leadership Academy (only 15 selected) was like an” MBA on Steroids”.  The intense strategies Walmart uses to accelerate the growth of their high-potential leaders. What Jerry learned as an expat that he applied to make his expat experience even more successful.   What it was like leading the growth of Burger King across EMEA. The biggest lesson from being Global CEO of Le Pain Quotidien. Jerry's go-to strategy for handling the stress of the CEO role. The advice that Jerry wishes he'd received early on in his career. The one trait he'd instill in every employee. The part of employee turnover “value-chain” that often gets missed. Books, Association, and TEDx recommendations for every leader. HIGHLIGHTS: How Walmart Executive Leadership Academy teaches to accelerate student's growth: They have an interactive, hands-on program. They assign senior executive mentors. Studies are heavily based on business case studies. Students solve business problems in small groups. Things Jerry would have added earlier in his career: Learn more languages. Live outside your home country. Proactively ask for mentorship. QUOTES: “There are two things you should be able to deliver: hard work and integrity.” “The good mentors are always busy, so you must seek them out.” “The skills you've acquired are never as relevant as the skills you can develop today and tomorrow.” RESOURCES: TED Videos on Sustainability https://www.ted.com/topics/sustainability (https://www.ted.com/topics/sustainability ) Seba Castiglioni – Sustainability leader in the plant-based space. https://www.linkedin.com/in/sebastianocc/?originalSubdomain=ch (https://www.linkedin.com/in/sebastianocc/?originalSubdomain=ch)  YPO Europe https://www.ypo.org/europe/ (https://www.ypo.org/europe/ ) Quiet Strength, Tony Dungy https://www.amazon.com/Quiet-Strength-Principles-Practices-Priorities/dp/1414318022 (https://www.amazon.com/Quiet-Strength-Principles-Practices-Priorities/dp/1414318022 ) ------------------- https://www.benfanning.com/the-ceo-sessions/ (Apply to be on the show) ------------------- https://www.benfanning.com/the-ceo-sessions/ (Connect with Ben:) https://www.linkedin.com/in/benfanning/ (https://www.linkedin.com/in/benfanning/) https://www.instagram.com/benfanning1/ (https://www.instagram.com/benfanning1/) https://twitter.com/BenFanning1 (https://twitter.com/BenFanning1)

Internal communications are often left behind in workplaces. This week on GovComms, contentgroup CEO, David Pembroke, sat down with a local internal communications expert. Our guest this week is the Team Leader for Change and Communications at ACT Policing, Andrew Babington. They discuss the new $34m Police Services model, which sees ACT Policing taking a system-wide approach to crime prevention, disruption and response. Andrew talks us through how he is rolling out this program on the inside - helping police stay informed and stay connected. Andrew has over 10 years’ experience in journalism and government communication. He’s worked for Fairfax as a photojournalist and in the Indigenous affairs and social services sectors as a communications manager. He has led communication strategies for the 2018-19 and 2019-20 Federal Budgets, Enterprise Agreement bargaining for the Public Service’s largest workforce and was the communications adviser on the Parliamentary Enquiry in to ‘Robo-Debt’. He is also currently sitting as Non-Executive Board Director of Communications for the Youth Coalition of The ACT. Discussed in this episode: Adopting internal communication strategies Communication and implementation of the new Police Services Model Working with partners to deliver targeted messages How to effectively engage with communities 

Internal communications are often left behind in workplaces. This week on GovComms, contentgroup CEO, David Pembroke, sat down with a local internal communications expert. Our guest this week is the Team Leader for Change and Communications at ACT Policing, Andrew Babington. They discuss the new $34m Police Services model, which sees ACT Policing taking a system-wide approach to crime prevention, disruption and response. Andrew talks us through how he is rolling out this program on the inside - helping police stay informed and stay connected. Andrew has over 10 years' experience in journalism and government communication. He's worked for Fairfax as a photojournalist and in the Indigenous affairs and social services sectors as a communications manager. He has led communication strategies for the 2018-19 and 2019-20 Federal Budgets, Enterprise Agreement bargaining for the Public Service's largest workforce and was the communications adviser on the Parliamentary Enquiry in to ‘Robo-Debt'. He is also currently sitting as Non-Executive Board Director of Communications for the Youth Coalition of The ACT. Discussed in this episode: Adopting internal communication strategies Communication and implementation of the new Police Services Model Working with partners to deliver targeted messages How to effectively engage with communities  Hosted on Acast. See acast.com/privacy for more information.

Selling -- or exiting -- your business is THE dream for many entrepreneurs, but it’s not an easy nor a common path. In this episode, we talk to entrepreneur, investor, and author Jackie Fast about stamina, sponsorship, and why working on what you're passionate about is key to success. Jackie, a trailblazer in sponsorship and former contestant on The Apprentice, also discusses her latest entrepreneurial venture: RebelPi ice wine. Follow us, Instagram: @ialsopodcast, Twitter: @IAlsoPodcast Buy Jackie’s book PinPoint: https://jackiefast.com Speaker Bio: Jackie Fast is recognised as a trailblazer within the sponsorship and known as a well established entrepreneur in the wider business community. Having sold her first business Slingshot Sponsorship in 2016 for millions less than 6 years after bootstrapping it in her bedroom with only a laptop to her name. Recognising that the shift in marketing and impact of the recession has created an opportunity for brands and rights holders to capitalise, Jackie went against convention and developed a bespoke commercialisation framework for the sponsorship industry that supported how to successfully deliver results in today’s changing landscape. Following the sale of Slingshot, she took a year off to publish a book on effective strategies in raising significant funding titled 'Pinpoint' which quickly became an Amazon bestseller. She now speaks and writes regularly on entrepreneurship, sponsorship, technology, and scaling high growth businesses. She has been featured in Forbes Magazine and currently act as Non-Executive Board Director of fintech disruptor The Money Platform and remains Chairman of the European Sponsorship Association Awards. In 2018 she also participated on the BBC UK Apprentice, series 13.She is currently writing her second book Rule Breaker: Rebellious Leadership for the Future of Work which outlines the shifting business landscape driven by technological innovation and the importance for future leaders to execute differently. The book is due out on 3 March 2021 in the UK and 28 March 2021 in the US.Follow Jackie Fast’s life and work on Instagram @jackiefast and Twitter @jackiefast or say hello at https://jackiefast.com.

Rosanna Iacono is a purpose-led strategic advisor, Non-Executive Board Director and former C-Level Executive with global experience building iconic brands in leading organisations across premium and luxury consumer goods and retail.She is highly experienced and talented in delivering visionary leadership and mobilising teams across multiple geographies to deliver exceptional results. Rosanna has diverse experience in Private Equity exits, M&A's, start-ups, turn-arounds and growth acceleration in mature businesses.She has lived and worked in 4 countries, is multi-lingual and culturally savvy. She is highly tech-literate, working with big data and future-focused technology. She is purpose-driven and a passionate Board Director in not-for-profit and business. She is a diversity and conscious capitalism advocate, Partner of The Growth Activitsts, a wife, mum of twins and prolific shoe collector.In this episode, we cover:Building a successful corporate career and the journey to becoming a C-Suite Executive and Board MemberGlobal opportunities and adjusting to living and working in different countries and culturesFinding your purpose, and driving purpose-led organisationsOvercoming challenges and adversityDeveloping a growth mindset, building confidence and the importance of investing in yourselfYou can learn more about what Rosanna and The Growth Activists are up to by visiting www.growthactivists.com or The Growth Activists via Linkedin.You can find more tools, information and resources on Boss in Heels via www.bossinheels.com

Each week I invite one of my speakers to talk about their life, work, passions and leisure so that you can get to know the person who is the speaker behind the mic. Today we are going to find out about the commercial advantages of B2B sponsorship and the importance of being relentless in your quest for success.  My guest is author and entrepreneur, Jackie Fast. Jackie sold her sponsorship agency for millions just 6 years after starting it in her bedroom with £2k, she now covets clients including Sir Richard Branson and the Rolling Stones along with FTSE 100 brands.  More recently she’s launched a global ice wine brand to create a new drinks category for the masses.  And if you are a fan of The Apprentice, we are going to ask the questions that you are dying to ask. Bio Jackie Fast, former Young Entrepreneur of the Year and Media Disrupter of the Year recipient is no stranger in utilising change to amplify growth.  She directs leaders on how to succeed through the power of sponsorship in the current era of disruptive media fragmentation. Arriving from Canada in 2007 with the intent to backpack Europe, Jackie ended up staying in London and launching her career. Her first business – Slingshot Sponsorship – was started in her bedroom in 2010 with just a laptop and £2,000. A relentless 6 years later with offices worldwide, Jackie sold Slingshot for millions, having worked with notable international clients including Sir Richard Branson, the Rolling Stones, Shell, Red Bull and many more. Jackie Fast has now launched her latest disrupter business REBEL Pi, an ice wine brand. Relatively unknown, ice wine production is the rarest and riskiest in the world. Taking an exceptional product from her hometown in Canada, Jackie is determined to turn REBEL Pi into a global drinks brand that will create a new drinking moment for audiences with a bold and discerning palate. Jackie continues to travel the world presenting on the future of business and entrepreneurship with her best-selling business book PINPOINT. The book shows you the pitfalls to avoid to ensure how virtually anyone can succeed. Jackie is also a Non-Executive Board Director of the European Sponsorship Association, one of the youngest Board Directors in the association’s history. Jackie Fast is a regular keynote speaker within Europe and has spoken at global marketing conventions in Australasia, the Middle East, and throughout North America.  From sharing exciting stories on Sir Richard Branson’s Necker Island to marathons in India, Jackie has the ability to utilise real-world case studies to truly capture an audience through her enthusiasm and vision.  Interactive, energetic and exciting makes every speaking engagement a memorable experience and one that gets talked about. Due to her diverse experience, Jackie has the capability to speak on a broad range of topics – from women in business to how to sell sponsorship more effectively.  Not one to shy away from controversy, she also regularly sits and chairs panels. Recorded: 3rd December 2018 Links: More about Jackie Fast More about Pinpoint - Jackie's book More about Maria Franzoni Ltd Connect with Maria on Linkedin Connect with Maria on FaceBook To book any of the speakers featured on the Speaking Business podcast, click here

Marina Go is chair of the Wests Tigers NRL Club and has been named by Boss magazine as one of the country’s 20 True Leaders. She is author of the business book for women, Break Through: 20 Success Strategies for Female Leaders and has forged a successful board career after spending decades as a leading figure in the media industry. Marina is Chair of Ovarian Cancer Australia, a non-executive director of Energy Australia, Auto-sports Group, 7-Eleven, Pro-Pac, and The Walkley Foundation.  Starting her career as a journalist, Marina then went on to a successful career in the media and was previously Head of Hearst Australia at Bauer Media. With an MBA under her belt, she is also Chair of the Advisory Board for the Centre For Media Transition at the University of Technology Sydney. https://www.linkedin.com/in/marinago/ https://ovariancancer.net.au/ https://newstories.net.au/marina-go/

Joining me on the podcast this month is Melinda Cruz. Melinda is the Founder and a Non-Executive Board Director of Miracle Babies Foundation; Australia’s leading organisation supporting premature and sick newborns, their families and the hospitals caring for them. The incredible difference Melinda has made to thousands along with her impact as a successful entrepreneur has seen her win numerous awards including the 2011 EY Social Entrepreneur of the Year and be a regular guest on radio, TV and speaker at national and international conferences. She was inducted into the 2013 Australian Businesswomens Hall of Fame and was a 2015 NSW Woman of the Year - Premiers Award finalist. She is a trusted expert to medical professionals. In 2012, she was awarded the title of Honorary Research Associate by the University of Sydney, Medical School and was the first parent to be invited as an Associate Investigator on a National Health and Medical Research Council (NHMRC) funded neonatal trial. In 2014, Melinda joined the Perinatal Society of Australia & New Zealand's (PSANZ) Consumer Advisory Panel as the inaugural Chair and accepted a position on the PSANZ Clinical Trials executive committee. In 2016, she was asked to join the NHMRC Clinical Trials Ready Development Committee and in 2017, was part of an award-winning global trial improving the lives of millions of premature newborns and facilitated the appointment of the first consumer representatives to take positions on the Australian and New Zealand’s Neonatal Network (ANZNN) Executive Committee. In 2014, Melinda ran the New York Marathon with 18 others raising more than $230,000 for Miracle Babies. So what did I learn from talking to Melinda – a woman than inspires and encourages so many, that is leaving a significant mark on the planet and who every day in every way is making a difference… - Every little thing you do layers up to build something so much bigger – so have a focus - Story is an incredible gift – sharing stories helps you and others. - Get clear on “How you want to feel each day” Grab a cuppa, download and listen in.

This is "Explorig Leaders" episode 15 with Dr Anastassia Lauterbach, an Experienced international Digital leader and Non Executive Board Director , sharing insights and inspiring you to take leadership in the digital age. Interview by Liselotte Engstam and production by Joel North

Episode #122 Dealing with Conflict, Anger and Upset w/ Anand Sharma Welcome to the show! Today I'm back with my friend and co-creator Anand Sharma with another installment in our series Achieve What Matters Most. Today we are talking about conflict, anger and upset and the damage it causes.   In today's episode Anand and I discuss: Why we get angry, Why we stay angry, What we need to do to release our anger, Managing conflict and why it's so important, What causes us to get hurt and how to get past it, Why we need to cultivate forgiveness and empathy, And so much more! Guest Bio Anand Sharma is in the new phase of life wherein his mission is to help people to achieve what really matters to them. What matters to him is a 'meaningful fun'.  Coaching and mentoring is not a career for him but a spiritual path to living a fulfilled and balanced life He says he likes to be 'easy busy' and not 'crazy busy'.    He is Founder and CEO of Growth Angle Ltd UK.  He is a professional & personal Coach, business consultant, speaker, trainer, facilitator, entrepreneur and an investor based in London, UK. He has more than 40 years of corporate experience spanning the UK, Europe, India, USA, and Asia. He has been a speaker at many international conferences in Europe, India, Australia, and Russia. He was the Global Director-Healthcare for Reckitt Benckiser Plc UK, one of the top global company of FMCG and healthcare brands. He was the Non-Executive Board Director of a pharmaceutical company based in Oxford UK and a Trustee of a Children's charity in the UK. He has B.SC; MBA and coaching qualifications besides he is a licensed Master NLP Practioner trained by Dr. Ricahrd Bandler, the co-creator of NLP. He is also a Master NLP Practioner trained by Ian McDermott, the coach of coaches.   Linked In:  https://www.linkedin.com/in/anand-sharma-639888/

Episode #121 Dealing with Overwhelm w/ Anand Sharma Welcome to the show! Today I'm back with my friend and co-creator Anand Sharma with another installment in our series Achieve What Matters Most. Today we are talking about the all-important topic, overwhelm and this is especially close to me right now. In today's episode Anand and I discuss: What overwhelm really is and why we function this way, Why we take on so much, The demands in our lives and how they've increased, What we can do to simplify and why it's important, And so much more!     Guest Bio Anand Sharma is in the new phase of life wherein his mission is to help people to achieve what really matters to them. What matters to him is a 'meaningful fun'.  Coaching and mentoring is not a career for him but a spiritual path to living a fulfilled and balanced life He says he likes to be 'easy busy' and not 'crazy busy'.    He is Founder and CEO of Growth Angle Ltd UK.  He is a professional & personal Coach, business consultant, speaker, trainer, facilitator, entrepreneur and an investor based in London, UK. He has more than 40 years of corporate experience spanning the UK, Europe, India, USA, and Asia. He has been a speaker at many international conferences in Europe, India, Australia, and Russia. He was the Global Director-Healthcare for Reckitt Benckiser Plc UK, one of the top global company of FMCG and healthcare brands. He was the Non-Executive Board Director of a pharmaceutical company based in Oxford UK and a Trustee of a Children's charity in the UK. He has B.SC; MBA and coaching qualifications besides he is a licensed Master NLP Practioner trained by Dr. Ricahrd Bandler, the co-creator of NLP. He is also a Master NLP Practioner trained by Ian McDermott, the coach of coaches.   Linked In:  https://www.linkedin.com/in/anand-sharma-639888/  

Episode #116 Wrangling Indecision w/ Anand Sharma Welcome to the show! Today my friend and business coach and I will continue on our series Achieve What Matters Most as we discuss indecision. Indecision can be a tricky beast. Somewhere along the way we seem to lose our ability to trust ourselves, Sometimes we have too many choices, Sometimes we chose not to make a decision, But at the end of the day, decisions are important in moving us forward. Those are just a few of the things we'll be talking about on the podcast today!   Don't forget to take a look at the Voices of Success online, live program I'm starting the first of March. http://www.captivatetheroom.com   Guest Bio Anand Sharma is in the new phase of life wherein his mission is to help people to achieve what really matters to them. What matters to him is a 'meaningful fun'.  Coaching and mentoring is not a career for him but a spiritual path to living a fulfilled and balanced life He says he likes to be 'easy busy' and not 'crazy busy'.    He is Founder and CEO of Growth Angle Ltd UK.  He is a professional & personal Coach, business consultant, speaker, trainer, facilitator, entrepreneur and an investor based in London, UK. He has more than 40 years of corporate experience spanning the UK, Europe, India, USA, and Asia. He has been a speaker at many international conferences in Europe, India, Australia, and Russia. He was the Global Director-Healthcare for Reckitt Benckiser Plc UK, one of the top global company of FMCG and healthcare brands. He was the Non-Executive Board Director of a pharmaceutical company based in Oxford UK and a Trustee of a Children's charity in the UK. He has B.SC; MBA and coaching qualifications besides he is a licensed Master NLP Practioner trained by Dr. Ricahrd Bandler, the co-creator of NLP. He is also a Master NLP Practioner trained by Ian McDermott, the coach of coaches.   Linked In:  https://www.linkedin.com/in/anand-sharma-639888/

Episode #115 Thriving vs. Surviving w/ Anand Sharma Welcome to the show! Today I'm back with business coach and friend Anand Sharma as we continue our series Achieve What Matters in Your Life. Thriving vs. Surviving is the topic for today. Anand and I discuss on today's show: What it means to thrive, Why so many chose to survive instead of thriving, What we can do to thrive, And so much more! If you want to get a voice of success, don't forget to check out my new online live course starting the first of March.  http://www.captivatetheroom.com   Guest Bio Anand Sharma is in the new phase of life wherein his mission is to help people to achieve what really matters to them. What matters to him is a 'meaningful fun'.  Coaching and mentoring is not a career for him but a spiritual path to living a fulfilled and balanced life He says he likes to be 'easy busy' and not 'crazy busy'.    He is Founder and CEO of Growth Angle Ltd UK.  He is a professional & personal Coach, business consultant, speaker, trainer, facilitator, entrepreneur and an investor based in London, UK. He has more than 40 years of corporate experience spanning the UK, Europe, India, USA, and Asia. He has been a speaker at many international conferences in Europe, India, Australia, and Russia. He was the Global Director-Healthcare for Reckitt Benckiser Plc UK, one of the top global company of FMCG and healthcare brands. He was the Non-Executive Board Director of a pharmaceutical company based in Oxford UK and a Trustee of a Children's charity in the UK. He has B.SC; MBA and coaching qualifications besides he is a licensed Master NLP Practioner trained by Dr. Ricahrd Bandler, the co-creator of NLP.

Episode #114 Fear and Courage w/ Anand Sharma Welcome to the show! Today I'm starting a series with Anand Sharma, a former client, and incredible business coach.  In this series, we're going to be talking about ways to Achieve What Matters in Your Life and that means in your work, your personal life, what you do and how you use your voice. In today's episode, we're talking about courage and fear, Why we need to move away from fear and how to move towards courage, How fear affects us on a negative level and can keep us from using our voice, Negativity, insecurity and so much more! If you're interested in learning more about my new online live course Voices of Success, make sure you check out the work with me section at http://www.captivatetheroom.com   Guest Bio Anand Sharma is in the new phase of life wherein his mission is to help people to achieve what really matters to them. What matters to him is a 'meaningful fun'.  Coaching and mentoring is not a career for him but a spiritual path to living a fulfilled and balanced life He says he likes to be 'easy busy' and not 'crazy busy'.    He is Founder and CEO of Growth Angle Ltd UK.  He is a professional & personal Coach, business consultant, speaker, trainer, facilitator, entrepreneur and an investor based in London, UK. He has more than 40 years of corporate experience spanning the UK, Europe, India, USA, and Asia. He has been a speaker at many international conferences in Europe, India, Australia, and Russia. He was the Global Director-Healthcare for Reckitt Benckiser Plc UK, one of the top global company of FMCG and healthcare brands. He was the Non-Executive Board Director of a pharmaceutical company based in Oxford UK and a Trustee of a Children's charity in the UK. He has B.SC; MBA and coaching qualifications besides he is a licensed Master NLP Practioner trained by Dr. Ricahrd Bandler, the co-creator of NLP. He is also a Master NLP Practioner trained by Ian McDermott, the coach of coaches.   Linked In:  https://www.linkedin.com/in/anand-sharma-639888/

CliffCentral.com — Work is hard to find... and when you have it it is even harder to climb to the top, especially for women. Phumi speaks to executive search specialists Mosima Selekisho and Ignacio Bao from Signup and Talent Africa, and Non-Executive Board Director at Meropa about how to make the jump from middle management into the C-suite of executives.

Our guest today is Denise Koopmans, Denise is a non-executive board director at several companies. Denise believes diversity, understanding of digital business transformation and change, as well as continued monitoring of strategy and competition are critical areas for corporate boards going forward. his episode focuses on her leadership journey and areas she believes we need to monitor. This episode Interview by Liselotte Engstam. Production by Joel North.