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Have family or friends in assisted living facilities? Finding the right gift can be complicated. Health issues may rule out some gifts: cross off sweets or chocolates for those who need to keep blood sugar under control. There isn’t much space for extra belongings in the apartment or room. In some cases, your giftee’s physical or mental capabilities (or both) are declining.

"Any gift you give will probably be appreciated," says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center. "But it helps if it’s something the person can really use and will enjoy. Tailor it to their particular ailments, needs, and interests." Below is a roundup that can help you select a great gift for the holidays — or any other occasion.

Gifts for social engagement

"Many people feel lonely and isolated in assisted living facilities. Keeping loved ones socially connected combats that, and also helps ward off chronic disease and cognitive decline," Salamon notes. Gifts that may fit the bill include:

• A simple phone. The easier a phone is to operate, the more likely your loved one will be able to use it. That could be a landline phone with large, easy-to-read numbers ($25 and up), a flip phone ($35 and up), or a smartphone with few buttons and apps ($50 and up). Remember that cell phones come with monthly service costs; prices depend on the carrier.
• A smart speaker. If phone use is too hard for your loved one, consider a smart speaker ($20 and up) that can be programmed to dial important numbers (like yours). Commands can be said aloud at any time to make a call. Check if your loved has internet service, which is needed for smart speaker use.
• A photo book. A loose-leaf photo album (less than $20) or easily created photo book ($10 and more) with recent photos of family and friends may be a warm reminder of connections, or can be a gift to share with others in the assisted living facility. That social interaction is important for health. Plus, it will make the person feel good to see all of those photos of people who love them.

Gifts to aid independence

Health problems can make simple activities challenging. These gifts can give your loved one a little independence.

• Adaptive tools. Your loved one may be able to take back some control of dressing with a long-handled shoehorn, a button hook, or a zipper pull (less than $10 each).
• A magnifying glass. Especially handy for those with impaired vision (and who hasn’t misplaced reading glasses?), having a magnifying glass ($5 and up) is handy for reading or seeing small objects. For a nice upgrade, make it a lighted magnifying glass ($15).
• Handwriting aids. Hand arthritis or neurodegenerative conditions (such as Parkinson’s disease) make writing difficult. Ergonomically-shaped adaptive pens ($10 and up) can help your loved one jot down information or thoughts.

Gifts for sharper thinking skills

"Challenging your brain or learning new information promotes new brain cell connections, which help protect and maintain cognition," Dr. Salamon says. Give your loved one something that will make the process easy and fun, such as the following:

• A daily trivia calendar. (About $15)
• Large-print nonfiction or fiction books. ($5 and up). Audio selections are enjoyable, too.
• Large-print books of brain games and puzzles. ($5 and up)
• A print subscription to a health publication, such as the Harvard Health Letter ($24).

Gifts to ease health issues

A well-chosen gift can bring comfort and help ease health issues. Try addressing someone’s aches and pains with gifts such as:

• A microwavable heat wrap ($15 and up).
• A handheld massager ($5 and up).

Or you could address circulatory problems that make people feel cold or increase the risk for blood clots in the legs. Ideas include:

• A soft fleece blanket ($10 and up).
• Warm slippers with slip-resistant soles ($20 and up).
• Brightly patterned compression stockings with fun designs ($15 and up). Be sure to check the size so they aren’t too small for your loved one.

Gifts to track health

Even though assisted living facility staffers monitor residents’ health, your loved one may find it useful to have one of the following gifts:

• A blood pressure monitor ($30 and up). Look for one with a cuff that goes around the upper arm; inflates automatically; has a lighted background with large numbers; and is certified by the Association for the Advancement of Medical Instrumentation, the British Hypertension Society, or the European Society of Hypertension.
• A digital "stick" thermometer ($10 and up). The right one will be large and easy to hold, with a lighted background and large numbers.

Not quite right?

Keep thinking. A nice, warm fleece sweater ($20 and up)? Extra reading glasses to place in favorite nooks ($15 and up)? If none of these ideas is right, consider giving a healthy treat. A great choice right now is fresh citrus (send a box for $30 and up). "Avoid grapefruit, which can interfere with certain medications," Dr. Salamon advises, "but oranges or tangerines are sweet and rich in vitamin C, which supports a healthy immune system. And that’s a great gift."

Some things are not debatable. Rain falls from the sky. Elevators go up and down. Orange traffic cones are orange. But because we interpret the world through our experiences, a lot isn’t so definitive.

The boss might say, “Good job,” and we wonder why they didn’t say, “Great job.” We see someone looking in our direction and they seem angry, so we believe that they’re mad at us, and no other explanation makes sense.

What’s happening is that we’re distorting our experience, jumping to conclusions, mind reading, and going to the worst-case scenario. When we do this, we shrink our successes and maximize our “failures,” and because it can be an automatic process, it’s hard to tell when it’s happening. “You don’t know you’re wearing magnifying glasses,” says Dr. Luana Marques, associate professor of psychology at Harvard Medical School.

So what can you do to see things more clearly and with a more balanced perspective? It takes practice and a willingness to tolerate discomfort, but as with addressing any problem, it starts with awareness.

What’s happening when we magnify failures and jump to negative conclusions?

We like to process information quickly, and we use filters to help do that. If we believe, “I’m no good,” all words and behaviors that support that contention just make everything easier.

“The brain doesn’t want to spend energy trying to fight that,” Marques says. And the brain responds depending on the distortion. If something causes anxiety, say from a curious look or comment, the limbic system is activated and we’re in fight-or-flight mode, hyper-focused on the threat, not thinking creatively or considering alternative, less threatening options.

But sometimes, there’s no threat in play. We’re just thinking, probably overthinking, when we question our abilities and minimize our accomplishments.

So what can you do about it?

Label the type of thinking distortion

It helps to define our distortions, the common ones being:

• Catastrophizing: Taking a small incident and going to the worst-case scenario.
• Black-and-white thinking: Seeing only all-or-nothing possibilities.
• Jumping to conclusions: Assuming what will happen rather than waiting to see what will actually happen.
• Mind reading: Assuming what someone is thinking without much evidence.

When you label it, you can better understand and recognize what your go-to distortion is, because “we tend to do one more than another,” Marques says.

After that, it helps to take your emotional temperature by asking: Am I stressed? Am I sweating? Is my heart pounding or my breathing shallow? It brings you more into the moment and it allows you to think about what you were doing that brought on the response, such as, “I was trying to guess the outcome.” It’s another way to pinpoint the distortion you tend to favor, she says.

Challenge the distortion

Whichever distortion it is, you want to examine your assumption by looking for other evidence. If you question your boss’s reaction to you, ask yourself: What does my boss really say? What does this person say about other people? Have I received raises and promotions? Am I given good projects?

An easy trap with distortions is that they’re plausible. A person who is mad at me would give me a look. A person who hated me wouldn’t text me back. Maybe so, but think of five other possible explanations, Marques says. This exercise engages the prefrontal cortex, which takes you out of the fight-or-flight mode and expands your thinking. You’re then problem-solving and not solely keyed on one option.

You also want to ask an essential question: is this thinking helpful? You might realize that all your thinking/wondering/worrying does is make you anxious. Gaining that presence might be enough to get you off the path of distorted thinking. “Asking and answering the question about your thinking pauses the brain, and you potentially see the world differently,” she says.

Being balanced and kind to ourselves

As you examine and attempt to control your distortions, be mindful of how you treat yourself. Self-criticism is a really easy trap to fall into, but try talking to yourself as you would a friend. Better yet, imagine you’re speaking to a child. Your language would be considerate, supportive, and you wouldn’t use words such as “stupid” or “dumb.” This approach also shifts you into the detached, third person. “You get out of your head,” Marques says. “We’re cleaning our magnifying glasses a little bit.”

Lastly, realize that you’re not looking to switch your attitude from “I’m unworthy” to “I’m super-great.” That’s just trading one extreme for another. All you want is to counterbalance your distortion, then let it go. Countering thinking distortions is a lot like meditation, where you practice acknowledging your thoughts without getting hooked onto them.  “You don’t have to magnify or minimize.” Marques says.

Last winter, my wife shooed the dog and visiting toddlers away from our poinsettia plants, saying "they’re poisonous, you know."

I did not know. But it turns out that the belief that poinsettias are deadly is widespread. The same could be said for mistletoe and holly. But are their reputations for danger well-deserved? Since these plants are especially popular to brighten up homes or give as gifts during the holidays, I decided to look into it.

The risks of poinsettia

Could a plant so common and so well-liked in the winter holidays also be so dangerous? If it is dangerous, what problems does it cause? Must it be eaten to cause problems, or is it harmful to just be nearby? And if it’s not dangerous, why does the myth live on?

The answers to these questions are not easy to find. In fact, the bad reputation may have started in 1919, when an army officer’s child reportedly died after eating part of a poinsettia plant. It is unclear if the plant was responsible, though: many other reports describe mild symptoms, such as nausea or vomiting, but no deaths.

Decades ago, a study in the American Journal of Emergency Medicine analyzed nearly 23,000 cases of people eating poinsettia and found

• no fatalities
• nearly all cases (96%) required no treatment outside the home
• most cases (92%) developed no symptoms at all.

According to one estimate, a 50-pound child would have to eat more than 500 poinsettia leaves to approach a dose that could cause trouble. Similarly, pets may develop gastrointestinal symptoms after eating poinsettia, but these plants pose no major threat to animals.

The risks of mistletoe

The story is much the same for mistletoe. It’s not particularly dangerous, but may cause an upset stomach if eaten. In fact, mistletoe has been used for centuries as a remedy for arthritis, high blood pressure, infertility, and headache. The evidence isn’t high-quality for any of these uses, though.

Interest also centers on this plant’s potential as an anticancer treatment. Some extracts of mistletoe contain chemicals shown to kill cancer cells in the laboratory and to stimulate human immune cells. For example, a substance called alkaloids has similar properties as certain chemotherapy drugs used in the past to fight leukemia and other forms of cancer. However, a two-part 2019 review found that adding mistletoe extracts to conventional cancer treatments did not improve survival or quality of life.

No one suggests it's a good idea to eat this plant, accidentally or otherwise. But eating one to three berries or one or two leaves is unlikely to cause serious illness, according to the authors of a 1986 review of multiple studies. And no significant symptoms or deaths were described in one report of more than 300 cases of eating mistletoe. However, some sources warn that serious problems or even death may occur if enough is ingested. The specific dose required to cause death is unknown but, fortunately, it appears to be so high that consuming enough to be lethal is extremely rare.

The risks of holly

This plant can be dangerous to people and pets. The berries of holly plants are poisonous. If eaten, they may cause crampy abdominal pain, drowsiness, vomiting, and diarrhea. While no one would recommend eating holly, it is unlikely to cause death. And for at least one type of holly, knowing the Latin name would be enough to discourage ingestion: the yaupon holly is also called Ilex vomitoria.

The bottom line

No one should eat poinsettias, mistletoe, and holly, but if small amounts are consumed, they are unlikely to cause serious illness. It seems to me that the dangers of these plants appear to be vastly overestimated.

Perhaps the most dangerous thing about mistletoe and poinsettias is the choking hazard the berries pose for young kids, although that risk is not unique to plants: any small object poses similar risks. Try to keep holiday plants out of the reach of small children and pets. And keep in mind that berries may fall from these plants and wind up on the floor.

If a child or pet eats leaves or berries from these holiday plants, or any other plants, check in with poison control, your pediatrician, or your veterinarian. But unless a particularly large "dose" is consumed, don’t be surprised if the recommendation is to simply watch and wait.

Still concerned even if you know the risks are low? You can always regift holiday plants you receive to friends with no children or pets, or find other ways to decorate your home for the holidays.

All of us know that motivation is a key ingredient to accomplishing goals in our personal and professional lives. But if you wait for motivation to strike like a sudden lightning storm, you’re a lot less likely to take a single step toward any goal. Even if you have a much-desired goal in mind, it’s all too easy to deplete motivation through feeling overwhelmed, procrastination, or impatience. The steps below can help you increase your motivation to accomplish the goals that matter to you.

The meaning of your goal

Before setting a goal, it is critical to clearly identify meaning — that is, why is successfully reaching this goal important to you? What will this achievement mean to you? For example, telling yourself “I want to lose 10 pounds so I have more energy to play with my grandchildren” conveys far more meaning than “I want to lose weight.” Or maybe your goal is to paint a room a different color because you feel that color will bring more joy into your life. That’s very different than setting a goal of “paint room.”

If you set a goal and find yourself procrastinating or not achieving it, revisit the meaning of the goal you have set. Is this a goal that continues to matter to you? If so, consider the meaning behind the procrastination or the difficulties that you are experiencing.

Operationalize your goal

Write out a detailed plan to achieve the goal. Use the SMART acronym to guide this plan:

• Specific (What exactly do you want to accomplish?)
• Measurable (How will you know when you have succeeded?)
• Achievable (Is the goal you have set possible?)
• Realistic (Does setting this goal make sense for you right now?)
• Time-bound (What is the specific time frame to accomplish this goal?)

For example, a goal of “exercise more” is too vague, and will not set you up for success. Instead, set a goal of walking 50 steps in the next hour, or taking a 15-minute walk Wednesday morning. This goal is specific, measurable, achievable, realistic, and time-bound.

Set up a to-do list — and tick it off

Once you identify a specific goal, make a to-do list to accomplish it.

• What resources do you need?
• What are the steps you’ll take toward your goal? Break down tasks into manageable mini-tasks and write each one down.
• Set deadlines for each task. Make a schedule to accomplish these tasks, being sure to include regular breaks and realistic time frames.
• Cross off each mini-task as you complete it. Step by step, you’ll see you’re making progress toward your goals.

If you are having difficulty breaking down your goal into smaller tasks, just begin working toward it. For example, if you set a goal of increasing the number of steps you walk each day, but have difficulty identifying the ideal number of steps as a goal, just start walking. You can figure out that ideal number later.

Include others

Invite a team to help you with your goal. You could join a running club, or ask family and friends to check on your progress in achieving tasks related to your overall goal. Perhaps friends can send email or text message reminders to keep you accountable. Finally, surround yourself by other people who are actively working on their own goals. Their efforts may inspire you, too.

Visualize success

Create an image of yourself achieving this goal. This image could be in your mind, or perhaps you could draw a picture of yourself achieving your goal. Imagine what achieving this goal will mean for you. How will you experience the success? How will it feel for you? Remember these positive emotions as you are completing the tasks on your to-do list to help fuel motivation.

Avoid distractions

Try to choose a space that is organized, free of clutter, and with minimal distractions. Focus on one task at a time, not multitasking. Close email and place your phone on silent. Avoid social media sites that make goals seem very easy to attain.

Track progress and time spent

Decide how often you’ll track progress toward your overall goal through your to-do list. Are you meeting the timeline you initially established? If not, identify stumbling blocks. Revisit the importance and meaning of this goal and how you initially set up your SMART model. If necessary, reconsider challenging aspects of your goal and make changes in your plan.

Think creatively about how to expand available time to work on your goal. Can you make certain tasks more routine in your life? Can you link unenjoyable tasks with more pleasurable activities? For example, if you dread your goal of taking 100 additional steps each day, could you listen to music or a podcast that you enjoy while you are taking these steps?

Embrace empathy

Be kind to yourself when tracking progress toward achieving your goal. Practice self-compassion on occasions when you fall short. Build small rewards into the process, and consider how to celebrate all your accomplishments.

That recurring sound that you hear but nobody else does? It’s not all in your head. Well, not exactly.

You may be one of the estimated 50 million-plus people who suffer from tinnitus. The mysterious condition causes a sound in the head with no external source. For many it’s a high-pitched ringing, while for others it’s whistling, whooshing, buzzing, chirping, hissing, humming, roaring, or even shrieking.

The sound may seem to come from one ear or both, from inside the head, or from a distance. It may be constant or intermittent, steady or pulsating. One approach to managing this condition is different forms of sound therapy intended to help people tune out the internal soundtrack of tinnitus.

What causes tinnitus?

There are many possible causes of tinnitus. Long-term exposure to loud noises is often blamed. But other sources include middle ear problems like an infection, a tumor or cyst pinching nerves in the ear, or something as simple as earwax buildup. Tinnitus also can be a symptom of Meniere’s disease, a disorder of the balance mechanism in the inner ear.

Even old-fashioned aging can lead to tinnitus, which is common in people older than age 55. As people get older, the auditory nerve connecting the ear to the brain starts to fray, diminishing normal sounds.

“Neurons (nerve cells) in areas of the brain that process sound make up for this loss of input by increasing their sensitivity,” says Daniel Polley, director of the Lauer Tinnitus Research Center at Harvard-affiliated Massachusetts Eye and Ear. “The sensitivity knobs are turned up so high that neurons begin to respond to the activity of other nearby neurons. This creates the perception of a sound that does not exist in the physical environment. It’s a classic example of a feedback loop, similar to the squeal of a microphone when it is too close to a speaker.”

At times, everyone experiences the perception of a phantom sound. If it only lasts for a few seconds or minutes, it’s nothing to worry about. However, if it pulsates in sync with your heart rate, it’s definitely something to get checked out by a physician, says Polley. If it’s a relatively continuous sound, you should see an audiologist or otolaryngologist (ears, nose, throat specialist).

Can sound therapy help tune out tinnitus?

There is no cure for tinnitus, but it can become less noticeable over time. Still, there are ways to ease symptoms and help tune out the noise and minimize its impact. Treatments are a trial-and-error approach, as they work for some people but not others.

One often-suggested strategy is sound therapy. It uses external noise to alter your perception of or reaction to tinnitus. Research suggests sound therapy can effectively suppress tinnitus in some people. Two common types of sound therapy are masking and habituation.

• Masking. This exposes a person to background noise, like white noise, nature sounds, or ambient sounds, to mask tinnitus noise or distract attention away from it. Listening to sound machines or music through headphones or other devices can offer temporary breaks from the perception of tinnitus. Household items like electric fans, radios, and TVs also can help. Many people with tinnitus also have some degree of hearing loss. Hearing aids can be used to mask tinnitus by turning up the volume on outside noises. This works especially well when hearing loss and tinnitus occur within the same frequency range, according to the American Tinnitus Association.
• Habituation. Also known as tinnitus retraining therapy, this process trains your brain to become more accustomed to tinnitus. Here, you listen to noise similar to your tinnitus sound for long periods. Eventually your brain ignores the tone, along with the tinnitus sound. It’s similar to how you eventually don’t think about how glasses feel on your nose. The therapy is done with guidance from a specialist and the time frame varies per person, usually anywhere from 12 to 24 months.

Additional approaches may help with tinnitus

Depending on your diagnosis, your doctor also may recommend addressing issues that could contribute to your tinnitus.

• Musculoskeletal factors. Jaw clenching, tooth grinding, prior injury, or muscle tension in the neck can sometimes make tinnitus more noticeable. If tight muscles are part of the problem, massage therapy may help relieve it.
• Underlying health conditions. You may be able to reduce the impact of tinnitus by treating conditions like depression, anxiety, and insomnia.
• Negative thinking. Adopting cognitive behavioral therapy and hypnosis to redirect negative thoughts and emotions linked to tinnitus may also help ease symptoms.
• Medication. Tinnitus can be a side effect of many medications, especially when taken at higher doses, like aspirin and other nonsteroidal anti-inflammatory drugs and certain antidepressants. The problem often goes away when the drug is reduced or discontinued.

How well are you protecting yourself against heart disease, the nation’s leading cause of death? A check of five important numbers can give you a good idea.

“For my patients, I typically look at their blood pressure, blood sugar, LDL cholesterol and triglycerides values, and their waist circumference,” says Harvard Heart Letter editor-in-chief Dr. Deepak L. Bhatt, who directs interventional cardiovascular programs at Harvard-affiliated Brigham and Women’s Hospital. Those values provide a picture of a person’s overall health and, more specifically, what factors they may need to address to lower their chance of a heart attack or stroke, he says.

Below are the ideal values for each measurement, along with why they’re important and targeted advice for improving them. Universal suggestions for improving all five measurements appear at the very end.

How do your heart health numbers stack up?

While the ideal values are good goals for most people, your doctor may recommend different targets based on your age or other health conditions.

Blood pressure

Less than 120/80 mm Hg

Blood pressure readings tell you the force of blood pushing against your arteries when your heart contracts (systolic blood pressure, the first number) and relaxes (diastolic blood pressure, the second number). Your blood pressure reflects how hard your heart is working (when you’re resting or exercising, for example) and the condition of your blood vessels. Narrowed, inflexible arteries cause blood pressure to rise.

Why it matters to heart health: High blood pressure accelerates damage to blood vessels, encouraging a buildup of fatty plaque (atherosclerosis). This sets the stage for a heart attack. High blood pressure forces the heart’s main pumping chamber to enlarge, which can lead to heart failure. Finally, high blood pressure raises the risk of strokes due to a blocked or burst blood vessel in the brain.

What helps: A diet rich in potassium (found in many vegetables, fruits, and beans) and low in sodium (found in excess in many processed and restaurant foods); minimizing alcohol.

LDL cholesterol

Less than 100 mg/dL

A cholesterol test (or lipid profile) shows many numbers. Doctors are usually most concerned about low-density lipoprotein (LDL) cholesterol, particles that makes up about two-thirds of the cholesterol in the blood.

Why it matters to heart health: Excess LDL particles lodge inside artery walls. Once there, they are engulfed by white blood cells, forming fat-laden foam cells that make up atherosclerosis.

What helps: Limiting saturated fat (found in meat, dairy, and eggs) and replacing those lost calories with unsaturated fat (found in nuts, seeds, and vegetable oils).

Triglycerides

Less than 150 mg/dL

Perhaps less well-known than cholesterol, triglycerides are the most common form of fat in the bloodstream. Derived from food, these molecules provide energy for your body. But excess calories, alcohol, and sugar the body can’t use are turned into triglycerides and stored in fat cells.

Why it matters to heart health: Like high LDL cholesterol, elevated triglyceride values have been linked to a higher risk of heart attack and stroke.

What helps: Limiting foods that are high in unhealthy fats, sugar, or both; eating foods rich in omega-3 fatty acids (such as fish); avoiding alcohol.

Blood sugar

Less than 100 mg/dL

High blood sugar defines the diagnosis of diabetes. Type 2 diabetes is most common. It occurs when the body develops insulin resistance (insulin enables cells to take in sugar) and does not produce enough insulin to overcome the resistance.

Why it matters to heart health: High blood sugar levels damage blood vessel walls and cause sugar (glucose) to attach to LDL. This makes LDL more likely to oxidize — another factor that promotes atherosclerosis. Excess sugar in the blood also makes cell fragments called platelets stickier so they’re more likely to form clots, which can trigger a heart attack or stroke.

What helps: Avoiding sugary beverages and foods high in sugar; eating whole, unprocessed grains instead of foods made with refined grains (white flour, white rice).

Waist circumference

Whichever number is lower:

Less than half your height in inches

OR

Women: Less than 35 inches

Men: Less than 40 inches

Measure your waist around your bare abdomen just above your navel (belly button). A big belly — what doctors call abdominal or visceral obesity — usually means fat surrounding internal organs.

Why it matters to heart health: Visceral fat secretes hormones and other factors that encourage inflammation, which triggers the release of white blood cells involved in atherosclerosis.

What helps: Consuming fewer calories, especially those from highly processed foods full of sugar, salt, and unhealthy types of fat.

Universal advice to improve all five measures of heart health

If one or more of your numbers is above ideal levels, you’re far from alone. Most Americans are overweight or obese and have bigger-than-healthy bellies. Excess weight and waist circumference affect blood pressure, LDL cholesterol, triglycerides, and blood sugar. Eating a healthy, plant-based diet can help. Regular exercise also helps: aim for at least 30 minutes of moderate-intensity exercise like brisk walking most days. Other lifestyle habits that can lower your heart disease risk include getting seven to eight hours of sleep nightly and managing your stress level.

The Biggest Loser was a popular reality television show that ran on NBC for over a decade starting in 2004. In it, participants with obesity competed with each other through intense physical challenges and ate a reduced-calorie diet to see who could lose the highest percentage of body weight.

Prior findings from studies of The Biggest Loser contestants showed not only that metabolism slows drastically following significant weight loss, but also that regaining the lost weight does not restore metabolism back to its pre-weight loss levels. This means people who have lost large amounts of weight must adhere to an extremely low-calorie intake in order to maintain that weight loss. One show contestant lost 239 pounds and achieved a weight of 191 pounds, yet six years later, after regaining 100 pounds of that lost weight, had to consume an 800-calorie-per-day diet to maintain his weight.

New research about physical activity and metabolic rate

A more recent study by the same researcher aims to explain and interpret the findings from The Biggest Loser in light of an energy conservation model. In what he calls the “constrained model of human energy expenditure,” Dr. Kevin Hall theorizes that because the contestants engaged in large, sustained periods of intense physical activity, their metabolisms slowed substantially in order to reduce their metabolic rates and thereby minimize changes in total energy expenditure. In other words, their bodies made automatic compensatory changes to maintain energy balance.

Of particular interest is the fact that at the end of The Biggest Loser competition, the degree of metabolism reduction was not related to contestants’ subsequent weight regain, and in fact, the contestants that maintained the greatest weight loss six years after the competition actually had the greatest amount of metabolism adaptation. This suggests that metabolic adaptation is a response to the change in lifestyle, namely the dramatic increase in physical activity observed in those who maintained the most weight loss. Fortunately for those trying to maintain significant weight loss, the compensatory mechanisms do not completely counteract lifestyle changes, so it is possible to keep off substantial amounts of weight.

What have we learned about weight loss from studying The Biggest Loser contestants?

Taken together, what we’ve learned from these studies on The Biggest Loser contestants is that while short-term reductions in resting metabolic rate are related to the extreme calorie restriction at the time of active weight loss, the larger, persistent metabolic adaptation that takes place later is related to substantial sustained increases in physical activity.

Results from the National Weight Control Registry (established in 1993 to determine characteristics of individuals successful at keeping weight off) have long demonstrated that physical activity is a key component of successful weight maintenance. What we don’t yet know is how sustained increases in physical activity lead to improved maintenance of lost weight, despite the compensatory long-term reduction in resting metabolic rate. Dr. Hall theorizes this could potentially be because of the effect of physical activity on lowering appetite.

But as is always the case, additional studies are needed to fully clarify the relationship between body composition, physical activity, energy regulation, and weight maintenance. In the meantime, we should continue to follow the well-founded advice to eat healthy whole foods in moderation, avoid processed foods, and engage in regular physical activity to maintain a healthy body weight.

The COVID-19 pandemic has been hard on so many people in so many ways. For babies born during this pandemic, a study published in JAMA Pediatrics suggests that the damage has potential to be lifelong.

The first three years of life are crucial for brain development. And it’s not just the health of babies that matters, but the interactions between babies and their caregivers. Babies need to be touched, held, spoken to, smiled at, played with. As they receive and respond to those interactions, in a “serve and return” kind of way, neural connections are built in the brain. When babies don’t have those interactions, or enough of them, their brains don’t develop as they should — and can even be literally smaller.

When you are a stressed or depressed parent or caregiver, it can be hard to find the time, let alone the energy or interest, to talk to and play with your infant. There are multiple studies showing that maternal depression, poverty, and other family stressors can change the development of a child forever.

How was the study done?

In this study, part of an ongoing study of mothers and babies, researchers from Columbia University looked at the development of three groups of 6-month-old babies. Two of the groups were born during the COVID-19 pandemic; the mothers of one group had COVID-19, while the mothers of the other did not. The third group was a historical cohort (a group of babies who were born before the pandemic).

Mothers participating in the study used an Ages and Stages Questionnaire (ASQ-3) to record their babies’ development. The researchers noted no difference in the development of the two groups of babies born during the pandemic, suggesting that prenatal exposure to COVID-19 doesn’t affect development, which is great news. But the babies born during the pandemic scored lower in gross motor, fine motor, and social-emotional development than the babies born before the pandemic. Examples of developmental tasks for infants this age are rolling from back to tummy (gross motor), reaching for or grasping a toy with both hands (fine motor), and acting differently to strangers than to parents or familiar people (social-emotional development).

What does it suggest about infant development during the pandemic?

It’s just one study, and we need to do more research to better understand this, but the findings are not really surprising given what we know about infant development. The COVID-19 pandemic has caused a lot of stress — emotional, financial, and otherwise — for so many families. It has also markedly affected the number and kind of interactions we have with other people. Babies are on average interacting with fewer people (and seeing fewer faces because of masking) than they did before the pandemic.

Even though we need to do more research, this study should serve as an alarm bell for us as a society. The children of this pandemic may carry some scars forever if we don’t act now. We’ve been seeing the emotional and educational effects on children; we need to be aware of the developmental effects on babies, too. All of these could permanently change their lives.

What can we do to address these challenges?

We need to find ways to support families with young children, financially and emotionally. We need to be energetic and creative, and work every angle we can. While our government should play a role, communities and individuals can help too.

We need to refer families to and fund early intervention programs around the country that support the development of children from birth to 3 years of age. Because of the pandemic, many of these programs have moved to virtual visits, which can make them less effective. So we need to get creative here, too. We can’t just wait for the pandemic to be over.

And parents and caregivers of infants and toddlers need to know about this research — and ask for help. It’s understandable and natural for parents to think that babies are too small and unaware to be affected by the pandemic. But they are affected, in ways that could be long-lasting. Talk to your doctor about what you can do to help yourself, your family, and your baby’s future.

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Did you know that of the 6.2 million people with Alzheimer’s disease who are age 65 or older in this country, almost two-thirds are women? This means that Alzheimer’s disease is almost twice as common in women compared to men. Why is Alzheimer’s disease more common in women?

Women live longer

The first and most important reason is that women tend to live longer than men. If you look at actuarial life tables, you can see that a baby girl born in 2019 is likely to live five years longer than a baby boy: 81 versus 76 years.

The greatest risk factor for Alzheimer’s disease is age: the older you are, the more likely you are to develop Alzheimer’s disease. For example, out of 1,000 people, the incidence (the number who develop Alzheimer’s each year) depends on age:

• 4 out of 1,000 people ages 65 to 74 develop Alzheimer’s each year
• 32 out of 1,000 people ages 75 to 84 develop Alzheimer’s each year
• 76 out of 1,000 people ages 85 and older develop Alzheimer’s each year.

So, one reason that there are more women with Alzheimer’s disease than men is simply that there are more older women than older men living in our society — 5.7 million more of them — and the older you are, the more likely you are to develop Alzheimer’s disease.

But that’s not the whole answer.

The incidence of Alzheimer’s is greater in women

Your chances of developing Alzheimer’s disease late in life are somewhat greater if you are a woman than a man. One study followed 16,926 people in Sweden and found that, beginning around age 80, women were more likely to be diagnosed with Alzheimer’s disease than men of the same age. Similarly, a study based in Taiwan found that one’s chances of developing Alzheimer’s disease over seven years was greater in women compared to men. And a meta-analysis examining the incidence of Alzheimer’s disease in Europe found that approximately 13 women out of 1,000 developed Alzheimer’s each year, compared to only seven men.

So, women living longer than men cannot be the whole answer as to why women are more likely than men to develop Alzheimer’s disease, because even among individuals who are living and the same age, women are more likely to be diagnosed with Alzheimer’s than men.

The incidence of non-Alzheimer’s dementia is not greater in women

One clue to the answer to this puzzle is that your chances of developing dementia from a cause other than Alzheimer’s disease is not greater if you are a woman. For example, the study examining dementia rates in Sweden found that both women and men were equally likely to develop a non-Alzheimer’s dementia as they aged. That rates of Alzheimer’s disease differ by gender, whereas rates of non-Alzheimer’s dementias do not, suggests that there must be a specific interaction between Alzheimer’s disease and gender.

Amyloid deposition in Alzheimer’s may be fighting infections

Another clue to this puzzle comes from the work of Harvard researchers, who have suggested that amyloid, one component of Alzheimer’s disease pathology, may be deposited in order to fight off infections in the brain. If their suggestion turns out to be correct, we might think of Alzheimer’s disease as a byproduct of our brain’s immune system.

Autoimmune disorders are more common in women

The last piece of the puzzle is that women are about twice as likely to have an autoimmune disease compared to men. The reason for this difference is not entirely clear, but it is clear that the immune system is generally stronger in women than men, and many autoimmune diseases are more common during pregnancy. It may be that women’s stronger immune system developed through evolution to protect the fetus from infections. So, as part of their stronger immune systems, women may end up having more amyloid plaques than men.

Putting the pieces together

By combining all of this information, one possible explanation as to why women’s risk of Alzheimer’s disease is greater than men’s — in addition to women living longer — is:

• The amyloid plaques that cause Alzheimer’s disease may be part of the brain’s immune system to fight against infections.
• Women have stronger immune systems than men.
• As part of their stronger immune systems, women may end up having more amyloid plaques than men.
• Because they may have more amyloid plaques than men, this theory may explain why women end up having a greater risk of developing Alzheimer’s disease.

Please note the italicized words "may" that I have used. Although the ideas I have presented here are logical, coherent, and form the basis of a good theory, they have not yet been proven to be correct. More research is needed!

The bottom line

You are more likely to develop Alzheimer’s disease over your lifetime if you are a woman, because women live longer than men and, possibly, because women have stronger immune systems compared to men.

Does that mean that if you’re a woman, you’re more likely to develop Alzheimer’s disease and there’s nothing you can do about it? Not at all! You can do many things to reduce your risk of Alzheimer’s today.

• Engage in aerobic exercise such as brisk walking, jogging, biking, swimming, or aerobic classes at least 30 minutes per day, five days per week.
• Eat a Mediterranean menu of foods including fish, olive oil, avocados, fruits, vegetables, nuts, beans, whole grains, and poultry. Eat other foods sparingly.
• Sleep well — and clean those Alzheimer’s plaques out of your brain.
• Participate in social activities and novel, cognitively stimulating activities.

Let’s file this under unsurprising news: many American adults report drinking more since the pandemic began in March 2020, according to a survey on alcohol use in the time of COVID-19. If you’re among them, you might want to start 2022 on a healthy note by joining the millions who abstain from alcohol during Dry January. Your heart, liver, memory, and more could be the better for it.

What did this survey find?

The researchers asked 832 individuals across the US about their alcohol intake over a typical 30-day period. Participants reported drinking alcohol on 12.2 days and consuming almost 27 alcoholic drinks during that time. More than one-third reported engaging in binge drinking (consuming five or more drinks for men and four or more drinks for women in about two hours).

Moreover, nearly two-thirds of the participants said their drinking had increased compared to their consumption rates before COVID. Their reasons? Higher stress, more alcohol availability, and boredom.

But we can’t blame COVID entirely for the recent rise in alcohol consumption. Even before the pandemic, alcohol use among older adults had been trending upward.

Why try Dry January?

If you recognize your own behavior in this survey and wish to cut down on your alcohol intake, or simply want to begin the new year with a clean slate, join in the Dry January challenge by choosing not to drink beer, wine, or spirits for one month. Dry January began in 2012 as a public health initiative from Alcohol Change UK, a British charity. Now millions take part in this health challenge every year.

While drinking a moderate amount of alcohol is associated with health benefits for some people in observational studies, heavier drinking and long-term drinking can increase physical and mental problems, especially among older adults. Heart and liver damage, a higher cancer risk, a weakened immune system, memory issues, and mood disorders are common issues.

Yet, cutting out alcohol for even a month can make a noticeable difference in your health. Regular drinkers who abstained from alcohol for 30 days slept better, had more energy, and lost weight, according to a study in BMJ Open. They also lowered their blood pressure and cholesterol levels and reduced cancer-related proteins in their blood.

Tips for a successful Dry January

A month may seem like a long time, but most people can be successful. Still, you may need assistance to stay dry in January. Here are some tips:

• Find a substitute non-alcoholic drink. For social situations, or when you crave a cocktail after a long day, reach for alcohol-free beverages like sparkling water, soda, or virgin beverages (non-alcoholic versions of alcoholic drinks.)

  Non-alcoholic beer or wine also is an option, but some brands still contain up to 0.5% alcohol by volume, so check the label. "Sugar is often added to these beverages to improve the taste, so try to choose ones that are low in sugar," says Dawn Sugarman, a research psychologist at Harvard-affiliated McLean Hospital in the division of alcohol, drugs, and addiction.

• Avoid temptations. Keep alcohol out of your house. When you are invited to someone’s home, bring your non-alcoholic drinks with you.
• Create a support group. Let friends and family know about your intentions and encourage them to keep you accountable. Better yet, enlist someone to do the challenge with you.
• Use the Try Dry app. This free app helps you track your drinking, set personal goals, and offers motivational information like calories and money saved from not drinking. It’s aimed at cutting back on or cutting out alcohol, depending on your choices.
• Don’t give up. If you slip up, don't feel guilty. Just begin again the next day.

Check your feelings

Sugarman recommends people also use Dry January to reflect on their drinking habits. It’s common for people to lose their alcohol cravings and realize drinking need not occupy such an ample space in their lives. If this is you, consider continuing for another 30 days, or just embrace your new attitude toward drinking where it’s an occasional indulgence.

If you struggle during the month, or give up after a week or so, you may need extra help cutting back. An excellent resource is the Rethinking Drinking site created by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). For the record, NIAAA recommends limiting alcohol to two daily drinks or less for men and no more than one drink a day for women.

Be aware of problems that might crop up

Dry January can reveal potential alcohol problems, including symptoms of alcohol withdrawal ranging from mild to serious, depending on how much you usually drink. Mild symptoms include anxiety, shaky hands, headache, nausea, vomiting, sweating, and insomnia. Severe symptoms often kick in within two or three days after you stop drinking. They can include hallucinations, delirium, racing heart rate, and fever. "If you suffer alcohol withdrawal symptoms at any time, you should seek immediate medical help," says Sugarman.