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International Life Sciences Institute, a nonprofit, is accused of being a front group for Coca-Cola and other junk food giants.

In 2019, a series of reviews was published in the Annals of Internal Medicine that concluded the same thing that past reviews have concluded: Adhering to dietary patterns that are lower in red or processed meat intake may result in decreased risks for premature death, cardiometabolic disease and mortality (meaning the risk of getting and dying of diseases like heart disease and type 2 diabetes), and getting cancer and dying from it. Therefore, they concluded in their Dietary Guideline Recommendations, “continue current unprocessed red meat consumption” and “continue current processed meat consumption.” Wait, what? Despite the increased risks of premature death, cancer, heart disease, and diabetes, the advice was essentially keep eating burgers and bacon?

To understand what happened, we have to go back to 2015. The Dietary Guidelines for Americans had just had the audacity to recommend people reduce their sugar intake. Imagine you work for the sugar industry. The evidence is overwhelmingly against you; so, what do you do? Well, what did the tobacco industry do? One method involved the tobacco industry’s “funding of and involvement in seemingly unbiased scientific groups to manipulate political and scientific debate concerning tobacco and health”—groups like the International Life Sciences Institute (ILSI), which “has enjoyed a long and serious collaboration with the tobacco industry.” That same industry group shapes food policy worldwide.

Technically a nonprofit “with an innocuous sounding name,” the International Life Sciences Institute “has been quietly infiltrating government health and nutrition bodies around the world.” The group was created by a top Coca‑Cola executive and “is almost entirely funded by Goliaths of the agribusiness, food and pharmaceutical industries.” “After decades largely operating under the radar, ILSI is coming under increasing scrutiny by health advocates in the United States and abroad who say it is little more than a front group advancing the interests of the 400 corporate members that provide its $17 million budget,” including Coca-Cola and PepsiCo.

So, when the 2015 U.S. dietary guidelines recommended eating less sugar, the soda-funded International Life Sciences Institute sponsored a review concluding that the sugar guidelines were simply not trustworthy. Who did they pick for this hatchet job? Bradley Johnston. The Annals of Internal Medicine published “The Scientific Basis of Guideline Recommendations on Sugar Intake,” which concluded there basically wasn’t one: “Guidelines on dietary sugar do not meet criteria for trustworthy recommendations and are based on low-quality evidence.”

“This comes right out of the tobacco industry’s playbook: cast doubt on the science,” said professor Marion Nestle. “This is a classic example of how industry funding biases opinion. It’s shameful.” Yes, the paper was paid for by the likes of Hershey, Red Bull, Coca-Cola, and the makers of Oreos, but the authors swore they “wrote the protocol and conducted the study independently from ILSI.” It turns out that was a lie, forcing the journal to publish a corrected version after the Associated Press obtained emails showing the industry front group “requested revisions,” as you can see below and at 4:00 in my video How Big Sugar Undermines Dietary Guidelines. It also came out that a co-author conveniently forgot to mention directly receiving a $25,000 grant from Coca-Cola.

You know it’s bad when candy bar companies criticize an industry-funded paper on sugar. Mars, the maker of Snickers, Skittles, and M&M’s, broke ranks with other food companies and denounced the industry-funded paper. What’s more, Mars itself was a member of ILSI, but telling people to ignore guidelines to cut down on sugar? That just makes us all look bad.

If you look at the relationship between funding sources and conclusions in nutrition-related scientific articles, there are about seven or eight times the odds that the conclusion will skew favorably compared to studies with no industry funding. For interventional studies, the proportion of industry-funded studies that reached unfavorable conclusions about their own products was a whopping 0%, which should not surprise anyone.

So, what can journals do to counter tactics industries often use to promote the safety of harmful products or “question the integrity of science that calls their products into question?” To push back against the tobacco industry’s influence over scientific discourse, leading journal editors have “refused to be passive conduits for articles funded by the tobacco industry.” They just won’t accept tobacco industry-funded studies, period. “Accordingly, high-quality journals could refrain from publishing studies on health effects of added sugars funded by entities with commercial interests in the outcome”—like soda and cookie companies. But they’re not, as evidenced by the ILSI-sponsored review on sugar intake that was published in the Annals of Internal Medicine.

Fast forward four years, back to the beginning of this blog: The next batch of Dietary Guidelines for Americans is on the way, and the last scientific report of the guidelines committee encouraged people to eat diets not just lower in sugar but lower in meat as well. So, Big Beef decided to follow in the footsteps of Big Butterfinger—the recommendations to continue eating processed and unprocessed meat were published in the same journal, with the same guy, scientist-for-hire Bradley Johnston, as lead author, and the rest is history. We’ll dig into exactly how he pulled it off next.

Doctor’s Note

This is the first in an eight-blog series on how industries impact dietary and health guidelines—stay tuned.

Sadly, sometimes corporate influence infiltrates the scientific Dietary Guidelines Advisory Committee itself. See Dietary Guidelines: Advisory Committee Conflicts of Interest. For a fascinating history, see The McGovern Report.

Please note: This blog and its accompanying video discuss the important and troubling issue of weight bias and discrimination, which may be a sensitive topic for some readers.

How might weight stigma be a vicious cycle?

Although total fasting can dramatically increase blood levels of the stress hormone cortisol, as much as doubling within five days, dieting alone does not. There is, however, a way stress and obesity could turn into a vicious cycle: weight stigma.

Across thousands of individuals followed for four years, those reporting discriminatory experiences had more than twice the odds of becoming obese. Those who started out obese had more than three times the odds of staying that way compared to those who started at the same weight but did not experience discrimination. Now, this could be from stress-induced eating on one side of the calorie-balance equation or stigma-induced exercise avoidance on the other.

Obese individuals with more frequent experiences with weight stigma report greater avoidance of exercising in public, feeling judged and embarrassed. These “too fat to exercise” fears may be well-grounded. Strong anti-fat biases have been documented in both fitness professionals and regular gym-goers, “which may translate into an unwelcoming environment at fitness centers and health clubs.”

Whichever side of the calorie equation that gets tipped, those who experience weight stigma can also end up suffering health consequences independent of any added weight. Those reporting more frequent weight-based discrimination exhibit higher levels of depression, show higher levels of inflammation, experience higher levels of oxidative stress, and have a shorter lifespan. Two studies following nearly 20,000 people both found about a 50% increase in mortality risk among those reporting greater daily discrimination. “[W]eight discrimination may shorten life expectancy.” Despite these hazards, some scholars advocate for even more fat-shaming.

The President Emeritus of the prestigious Hastings Center infamously advocated for “a kind of stigmatization lite,” using social pressures to compel people to lose weight without resorting to “outright discrimination.” After all, he argued, what else has the potential to counter the persuasive force of the billions spent in advertising every year by the food and beverage industries? It worked against tobacco. He recalls his own battle with addiction: “The force of being shamed and beat upon socially was as persuasive for me to stop smoking as the threats to my health.” The public health campaign to stigmatize cigarette smoking turned “what had been considered simply a bad habit into reprehensible behavior.”

When such campaigns have been tried, they have been met with fierce resistance, though. Georgia’s Strong4Life campaign featured billboards of morose-looking obese children with captions like “Warning: Chubby kids may not outlive their parents” or “It’s hard to be a little girl if you’re not,” which you can see below and at 3:16 in my video The Impacts of Weight Bias in Health Care.

The campaign sponsors defended the ads as an attempt to break through the denial in a state with some of the highest recorded childhood obesity rates. It’s only defensible, though, if it works.

Yale researchers found that when normal-weight women are provided with bowls of M&M’s, jelly beans, and chips to snack on after watching clips of stigmatizing material like clumsy, loud, lazy stereotypes getting teased about their weight, they eat about the same amount compared to watching neutral material, such as insurance commercials. But when overweight women watch the same two sets of videos, they triple their calorie intake after watching the stigmatizing scenes, as you can see below and at 3:56 in my video.

The researchers concluded, “This directly challenges the notion that pressure to lose weight in the form of weight stigma will have a positive, motivating effect on overweight individuals.” In other words, it could make matters worse. Being labeled “too fat” during childhood was associated with a higher risk of becoming obese, compared to children of the same weight who were never told that. But does that mean we should just ignore concerns about obesity? Many doctors apparently think so.

Just as veterinarians have been found to be reluctant to tell people their pets are obese, fewer than a quarter of parents of overweight children report having been told by pediatricians about their child’s weight status. One might think it would be obvious, but a Gallup Survey found that parents appear to be “notoriously poor judges of their children’s weight.” Similarly, the percentage of adults who describe themselves as overweight has remained essentially unchanged over the past few decades, despite skyrocketing obesity. “All of this helps ‘paint a picture of mass delusion in the United States about its rising weight,’” Gallup concluded.

I think patients have the right to be informed. Those told by their doctor that they are overweight have about four times the odds of attempting weight loss and about twice the odds of succeeding.

Just as smoking physicians are less likely to challenge their smoking patients, overweight physicians are less likely to bring up the subject of weight loss or even document obesity in their charts.

Ironically, overweight patients trust diet advice from overweight doctors more than from doctors of normal weight. Unfortunately, primary care physicians appear to have little to offer in terms of specifics. Fewer than half who were surveyed said they provide specific advice to their patients. Just telling patients to “watch what they eat” is unlikely to be particularly helpful, but many primary care physicians may not even go that far. Most physicians said they would spend more time working with patients on weight management if only their time was “reimbursed appropriately.” Maybe we could offer a bonus to refrain from blaming the victim. As one pair of commentators wrote in response to the pro-stigma camp, “If shaming reduced obesity, there would be no fat people.”

I want to end this weight stigma series with the jaw-dropping findings of a study that I think best illustrates how hard it is to live inside an obese body. If this doesn’t foster sympathy among my medical colleagues, I don’t know what will. Researchers talked to men and women who had lost and kept off more than 100 pounds to tap into their unique insight, having personally experienced what it was like to be morbidly obese and then, on average, 126 pounds lighter. Forty-seven people were interviewed.

They were asked to think back to when they were heavier and make a choice: “If someone offered you a couple of million dollars if you stayed morbidly obese forever, would you have chosen the money? Or would you have chosen to be normal weight no matter what?”

Option 1 was “I would have chosen no money and being normal weight. It would have taken me one second to decide.” Option 2: “I probably would have chosen being normal weight. But the possibility of having that much money would make me think about the choice.” Option 3: “I wanted to be normal weight, but I could really use the money. If I could be a multimillionaire, I think I could live with being morbidly obese.”

One of the 47 had to think about it, but the other 46 jumped at option 1. No one chose option 3. They all said they would give up being a multimillionaire to be normal weight.

If that shocked you, buckle your seatbelts. They were then asked about being obese compared to other disabilities. Normally, when you ask people to choose between living with their own disability or switching to a different one, there is a strong proclivity to prefer their existing condition. For example, even though most people would rather be deaf than blind, blind people prefer to remain blind by a large margin, rather than having sight without sound. They already know how to live with their own disability, so there’s safety in familiarity. However, the exact opposite happened when the 47 formerly obese individuals were asked to choose.

Every single one of the 47 said they’d rather be deaf, dyslexic, diabetic, or have very bad acne or heart disease for the rest of their lives than be obese. More than 90% said they’d rather have a leg amputated, and similarly, about 9 out of 10 said they’d rather be legally blind than be obese. Obesity appears to be the only handicap where nearly everyone wants to switch, no matter what the cost. To quote one person in the study: ”When you’re blind, people want to help you. No one wants to help you when you’re fat.”

Doctor’s Note

If you missed the previous installment in this two-part series, see Weight Bias in Health Care. The information is drawn from my book How Not to Diet. 

Last updated on 31 DEC 2025

For almost three decades, Canada stood as a model for successful disease control, celebrated for its near-perfect record of keeping measles at bay. That record was broken when health officials confirmed that Canada had officially lost its measles elimination status, becoming the first country in the Americas to do so since the COVID-19 pandemic. The Pan American Health Organization (PAHO) made the announcement in late 2025 after determining that the same strain of the measles virus had been spreading continuously within Canada for more than a year.

The news has raised concern not just within Canada but across the continent, especially in the United States, where declining vaccination rates have created fertile ground for outbreaks. The question is no longer hypothetical. With more than 1,600 measles cases reported in the U.S. this year alone, could America be next to lose its elimination status? The answer depends not only on vaccines but also on public trust, access to care, and community-level health decisions that ripple across generations.

What “Elimination Status” Really Means

To understand the significance of this development, it is important to clarify what “elimination” actually means in public health terms. Elimination does not mean a disease has been wiped off the planet. That is eradication, and only one disease, smallpox, has ever achieved that distinction. Elimination refers to a state in which a disease no longer spreads continuously within a country or region. In simple terms, imported cases can occur, but sustained community transmission cannot.

Canada achieved elimination in 1998, two years before the United States. For years, both countries enjoyed the security that came with high vaccination coverage. But in 2024, the chain of protection began to fray. The current outbreak, which began in New Brunswick, has now reached more than 5,000 confirmed cases. Two babies, infected while still in the womb, were born prematurely and did not survive. According to Dr. Jarbas Barbosa, head of PAHO, this loss of status represents a setback but not a permanent defeat. He emphasized that elimination can be restored once transmission is halted and vaccination rates are brought back up to the threshold needed for herd immunity. Canada’s Public Health Agency has already outlined a plan to strengthen vaccination programs and disease surveillance. Yet the challenge runs deeper than logistics. It involves confronting misinformation and reestablishing public confidence in science and health institutions.

A Region on Edge

The resurgence of measles is not confined to Canada. Across the Americas, cases have multiplied at an alarming rate. As of late 2025, more than 12,000 confirmed infections have been reported throughout the region, thirty times higher than in the previous year. The majority of those cases have been concentrated in Canada, Mexico, and the United States, signaling a troubling regional pattern.

In Mexico, nearly 4,000 people have been infected since February, and the outbreak in the northern state of Chihuahua accounts for more than ninety percent of those cases. Twenty-three deaths have already been confirmed. South of the U.S. border, health authorities are scrambling to contain community transmission and prevent further spread into Central America.

Meanwhile, in the United States, measles has made a fierce comeback. What began in January as an isolated outbreak in West Texas quickly spread to neighboring New Mexico and beyond. By autumn, 41 states had reported confirmed cases. Three Americans, including two young girls, have died. According to the Centers for Disease Control and Prevention, the 1,681 confirmed cases recorded in 2025 mark the highest national total in more than thirty years. The virus has exploited the cracks in the nation’s vaccine coverage, which has steadily declined since 2019.

Why Vaccination Rates Are Falling

The drop in vaccination rates is one of the most pressing health challenges of our time. It cannot be blamed on a single cause but rather on an interconnected web of cultural, social, and systemic factors. The COVID-19 pandemic disrupted pediatric care, delaying or canceling countless routine vaccinations. Many families missed scheduled checkups and have yet to catch up. At the same time, misinformation about vaccines spread widely on social media, filling the void left by overwhelmed health systems.

In some cases, vaccine hesitancy has been fueled by distrust in government institutions or pharmaceutical companies. In others, it stems from religious or philosophical beliefs, or simply the belief that measles is a harmless childhood illness. The truth is that measles is not harmless. It is one of the most contagious viruses known, capable of infecting ninety percent of unvaccinated people who come into contact with it. A single case in an unprotected community can ignite a large outbreak within weeks.

Access also plays a role. Rural and low-income areas often have fewer healthcare providers and lower public health funding. Parents who want to vaccinate their children may face logistical barriers, from long travel distances to scheduling conflicts. Without strong community outreach and education, those small obstacles add up to widespread vulnerability.

Why Measles Still Matters

To understand why health experts are so alarmed, it helps to remember what measles can do to the human body. The virus spreads through droplets released when an infected person coughs or sneezes and can linger in the air for up to two hours after that person has left the room. Anyone entering that space without immunity is almost guaranteed to be infected.

Symptoms typically begin with high fever, cough, runny nose, and red, watery eyes, followed by a rash that spreads over the body. But the danger goes far beyond the rash. Measles can cause severe complications, including pneumonia, brain inflammation, and permanent hearing loss. In some cases, it can even lead to death. Children, pregnant women, and people with weakened immune systems are especially vulnerable.

Another lesser-known consequence is the virus’s effect on long-term immunity. Measles can actually erase the body’s immune memory, making people more susceptible to other infections for months or even years afterward. This phenomenon, known as “immune amnesia,” is one reason why public health experts consider measles outbreaks a serious setback for overall community health.

A Global Step Backward

Canada’s loss of elimination status also has symbolic meaning. When one country in the Americas loses its status, the entire region is considered to have lost it collectively. It signals to the world that decades of progress toward disease control are beginning to unravel. According to PAHO, vaccination coverage for both doses of the measles-mumps-rubella vaccine across the Americas averaged just seventy-nine percent in 2024. That is far below the ninety-five percent threshold needed to prevent outbreaks.

Globally, the trend is similar. The World Health Organization has reported rising measles activity in more than 150 countries, particularly in regions of conflict, displacement, or vaccine shortages. Experts warn that if current patterns continue, the virus could regain the strong foothold it once held before the introduction of the vaccine in the 1960s.

This backslide underscores how fragile progress can be when public health systems lose funding, coordination, or credibility. Eradication may be a distant goal, but elimination requires constant vigilance.

Rebuilding Immunity and Restoring Trust

Public health authorities are now racing to repair the gaps in immunity through catch-up vaccination programs, community education, and better disease surveillance. But the fight is not just about logistics. It is about rebuilding the relationship between science and society.

Rebuilding immunity starts with accurate information. Misinformation spreads faster than any virus, and the only effective antidote is education that meets people where they are. Community leaders, faith-based organizations, and healthcare providers all have a role in rebuilding trust. Transparent communication about vaccine safety, benefits, and side effects is essential. People do not just need facts; they need context, empathy, and reassurance that their concerns are heard.

Healthcare systems also need support. Many regions lack adequate staff and infrastructure for large-scale vaccination drives. Mobile clinics, school-based immunization programs, and partnerships with local organizations can make vaccines more accessible to families who face barriers.

Strengthening Immunity Naturally

While vaccines remain the cornerstone of measles prevention, strengthening the immune system through nutrition and lifestyle is equally valuable for overall health. A strong immune system helps the body respond more effectively to infections and vaccinations alike.

Start with food. A diet rich in vitamins A, C, and zinc supports the immune response and can shorten recovery time when illness strikes. Foods like carrots, citrus fruits, bell peppers, spinach, and almonds provide essential nutrients that protect cells from oxidative stress. Vitamin A is particularly important in the context of measles because deficiency has been linked to more severe cases in children.

Gut health also matters. Roughly seventy percent of the immune system resides in the gut. Incorporating probiotic-rich foods such as yogurt, kefir, miso, and sauerkraut can improve the balance of beneficial bacteria that support immunity.

Sleep and stress management are often overlooked but play powerful roles. Chronic stress releases cortisol, a hormone that suppresses immune function. Mindfulness, meditation, and moderate physical activity help regulate this response. Meanwhile, consistent, quality sleep gives the body time to regenerate immune cells and strengthen its defenses.

Finally, limit processed foods and added sugars. Excessive sugar intake has been shown to weaken immune response by reducing the activity of white blood cells. Choosing whole, nutrient-dense foods helps maintain stable energy levels and supports the body’s natural defense mechanisms.

The Fragility of Collective Protection

Canada’s experience reveals how quickly progress can unravel when vaccination coverage declines. Herd immunity is not a permanent shield; it is a living agreement among citizens to protect one another. Once too many people opt out, that protection collapses, and the consequences can be devastating.

The United States now faces a similar test. With cases rising, regional clusters forming, and vaccine hesitancy spreading, the country could lose its elimination status just as Canada did. Preventing that outcome requires cooperation, empathy, and a renewed sense of shared responsibility. Public health measures and natural wellness practices are not opposing forces. They are complementary parts of the same goal: keeping communities healthy, strong, and connected.

The future of measles control will depend on whether societies can rebuild both immunity and trust. Science provides the tools, but only collective action will determine whether they are used in time.

Last updated on 31 DEC 2025

Something invisible might be threatening your family’s health right now. It floats through your kitchen, settles on your counters, and infiltrates every breath you take indoors. Most people blame dust or pollen when allergies flare up at home, but new research points to a far more disturbing culprit living in the shadows of your cabinets and baseboards.

Scientists at North Carolina State University just uncovered a direct link between cockroach infestations and dangerous levels of bacterial toxins contaminating indoor air. Their findings reveal that these common household pests do far more damage than anyone realized.

NC State Research Links Roach Numbers to Toxic Air Levels

Researchers discovered a clear connection between infestation size and the concentration of harmful substances filling homes. Larger cockroach populations correlate with higher levels of both allergens and endotoxins measured in household dust and air samples. When pest control professionals eliminated the insects, both pollutants dropped dramatically.

Scientists conducted their study in multi-unit apartment complexes throughout Raleigh, North Carolina. They measured cockroach populations while simultaneously tracking allergen and endotoxin concentrations. Before any treatment began, researchers collected both settled dust from floors and airborne particles to establish baseline readings.

Results showed that homes with roach problems contained alarmingly high amounts of these biological contaminants. Homes without infestations measured far lower levels of the same substances. After extermination removed the pests, formerly infested apartments saw their toxic load plummet to levels approaching those of pest-free units.

What Endotoxins Are and Why They Matter for Your Lungs

Endotoxins represent fragments of bacterial cell walls that are released into the environment when bacteria die. Cockroaches carry extraordinarily rich and diverse gut microbiomes because they consume virtually anything. Previous research documented that these insects shed massive quantities of endotoxins through their droppings.

Coby Schal, the Blanton J. Whitmire Distinguished Professor of Entomology at NC State and study co-author, explained the health implications. “Endotoxins are important to human health, as inhalation of these components has been shown to provoke allergic responses,” Schal said.

Past surveys across the United States homes found endotoxin levels much higher in residences where occupants reported cockroach problems. That association is stronger in low-income housing compared to single-family homes. While household pets and humans also produce endotoxins, researchers determined that cockroach feces accounted for the majority of these toxins detected in household dust samples from infested homes.

Breathing in these bacterial fragments can trigger allergic reactions and worsen asthma symptoms, particularly in children. Children living in low-income urban households face especially high risks, as cockroach allergens rank among the most important factors in developing and maintaining allergic rhinitis and asthma in young people.

Female Roaches Pack Double the Toxic Punch

Laboratory measurements revealed startling differences between male and female cockroaches. Female specimens excrete approximately 2,900 endotoxin units per milligram of feces. Males produce roughly 1,400 endotoxin units per milligram, about half the female output.

Madhavi Kakumanu, an NC State research scholar working in Schal’s laboratory and study co-author, explained the disparity. “Female cockroaches eat more than males, so more endotoxins are shed from their fecal matter,” Kakumanu said.

Increased food consumption by females drives their higher toxin production. Larger appetites lead to more bacterial activity in their digestive systems, which then produces more endotoxin-laden waste. Each female roach becomes a concentrated source of indoor air pollution simply by going about her daily activities.

Your Kitchen Bears the Biggest Burden

Room-by-room analysis showed kitchens contained far more endotoxins than bedrooms. Cockroaches congregate where they find abundant food sources. Cabinets, pantries, and spaces behind appliances provide ideal habitats with easy access to crumbs, grease, and organic matter.

Bedrooms typically offer fewer attractive food options for roaches, so populations there remain smaller. Lower roach numbers translate directly to reduced endotoxin and allergen concentrations. Yet even bedrooms in heavily infested homes measured concerning levels of both substances.

Air circulation systems can spread contaminants from kitchens throughout entire living spaces. Heating, ventilating, and air conditioning filters collected during the study showed high contamination levels in infested homes. HVAC systems essentially distribute cockroach-generated pollutants to every room.

How Researchers Measured the Problem

Scientists divided participating homes into three categories for the study. One group consisted of infested apartments that would receive no treatment. A second group included infested units scheduled for professional extermination. A third control group comprised apartments with no cockroach problems.

Researchers returned at three-month and six-month intervals to collect follow-up samples. They counted live cockroaches and gathered both floor dust and airborne particle samples at each visit. Samples went to laboratories for analysis, measuring cockroach allergen Bla g 2 and endotoxin concentrations.

Baseline measurements confirmed that infested homes started with dramatically higher contamination levels. Scientists could then track how those levels changed over time with or without intervention. Control homes maintained consistently low readings throughout the entire study period.

Extermination Brings Dramatic Air Quality Improvements

Professional pest control made a decisive difference. Most infested homes that received extermination services became completely free of cockroaches within the study timeframe. Allergen levels in those treated homes dropped substantially after roaches disappeared.

Endotoxin concentrations also fell sharply in homes where pest control eliminated the insects. Measurements taken at three and six months post-treatment confirmed sustained reductions. Homes cleared of roaches approached the cleaner air quality found in apartments that never had infestations.

Meanwhile, untreated infested homes showed no improvement whatsoever. Both allergen and endotoxin levels remained dangerously high at every measurement point. Cockroach populations in these control units continued producing toxic waste and shedding allergens without interruption.

Partial Solutions Don’t Work

Half measures fail to solve the problem. Schal noted an important finding about incomplete pest control. “When you eliminate cockroaches, you eliminate their allergens. Small decreases in cockroaches don’t lower allergen levels because the remaining live cockroaches deposit more allergens,” he said.

Complete elimination proves necessary to achieve meaningful health benefits. A few surviving roaches continue contaminating the home at rates that negate any gains from reducing the population. Each live insect keeps producing allergens and endotoxins daily through its normal biological processes.

Schal added that endotoxins decreased only in homes where cockroaches were fully eliminated. His paper demonstrates that cockroaches represent the most important source of endotoxin deposits in infested residences. No other household source comes close to matching their toxic output.

Airborne Toxins Spread Beyond Dust

Both allergens and endotoxins can become airborne, not just settle into floor dust. Kakumanu confirmed that air samples collected during the study detected both contaminants floating freely. Walking across floors, opening cabinets, or any activity that disturbs settled dust can launch particles into the breathing zone.

Airborne distribution means even people who avoid direct contact with contaminated surfaces still inhale these substances. Children playing on floors face particularly high exposure risks. Air currents and household activities keep recycling particles back into suspension throughout the day.

HVAC filter analysis supported the airborne transmission findings. Filters captured significant amounts of both allergens and endotoxins in infested homes. Every time heating or cooling systems ran, they pulled contaminated air through ducts and potentially redistributed particles to other rooms.

Low-Income Homes Face Greater Risk

Economic factors compound the health threat. Research consistently shows stronger associations between cockroach presence and elevated endotoxin levels in low-income housing versus single-family homes. Multi-unit apartment buildings often struggle more with pest control than standalone houses.

Shared walls and common spaces in apartment complexes allow roaches to migrate between units. One infested apartment can compromise air quality in neighboring homes. Professional extermination works best when entire buildings receive treatment simultaneously, but cost barriers often prevent comprehensive approaches.

Children in low-income urban households already face higher asthma rates. Adding cockroach allergens and endotoxins to their environment creates a perfect storm for respiratory problems. Access to quality pest control services becomes a public health issue with real consequences for vulnerable populations.

What Comes Next for Asthma Research

Scientists plan to examine how allergens and endotoxins interact in animal models. Future studies will use mice bred to develop asthma symptoms when exposed to these substances. Researchers want to determine whether combined exposure produces worse outcomes than either contaminant alone.

Evidence suggests that allergens and endotoxins together might trigger more severe asthma attacks than either substance by itself. Schal noted that implications exist for worsened asthma due to interactions between the two. Mouse models will help clarify whether that hypothesis holds under controlled laboratory conditions.

Understanding these interactions could reshape how doctors and public health officials approach asthma management in homes with cockroach problems. If combined exposure proves more dangerous, recommendations for pest control might become even more urgent for families with asthmatic children.

Multiple organizations funded the research, including the U.S. Department of Housing and Urban Development Healthy Homes program, the Alfred P. Sloan Foundation, and the National Institute of Environmental Health Sciences. Additional support came from the National Institute of Allergy and Infectious Diseases, the U.S. Department of Agriculture National Institute of Food and Agriculture, and the Blanton J. Whitmire Endowment at North Carolina State University.

Please note: This blog and its accompanying video discuss the important and troubling issue of weight bias and discrimination, which may be a sensitive topic for some readers.

How common is weight stigmatization in health care?

Described as the last “acceptable” form of bias, weight stigma is the rampant discrimination and stereotyping of overweight individuals. Fifty overweight women were asked to keep a diary of all the times they felt they were being stigmatized for their weight. Over a single week, more than a thousand instances were recorded. An overweight woman may expect to be harassed (such as being called names or insulted), run into physical barriers (like being unable to fit into public seats), or discriminated against (such as receiving perceived poorer service at restaurants or stores) on average about three times a day. Obese men report three times less discrimination than women of the same size, so it may be only a daily occurrence for them.

They’re not just being paranoid. Studies using professional actors posing as job applicants made up with theatrical prostheses to appear overweight were significantly more likely to face discrimination than when appearing at their normal weight. This employment bias was found to be especially prejudiced against overweight women compared to men.

Attitudes can also be explored in surveys. In a comparison of 16 stigmatized social groups, such as people experiencing homelessness, “only drug addicts and smokers were seen as more disgusting than obese people,” as you can see below and at 1:42 in my video Weight Bias: Hating Their Guts.

The researchers did note, however, there was effectively a tie: “[O]bese people were rated just as disgusting as politicians.”

This weight stigma starts surprisingly young. Children as young as three years old describe overweight peers as “mean,” “stupid,” “lazy,” and “ugly.” The negative language increases with age, as you can see below and at 2:14 in my video.

Then, there was that famous study published in 1961. Children in summer camps and schools across a swath of different social, cultural, and ethnic backgrounds in California, Montana, and New York were shown pictures of different children and asked to rank who they liked best. The images included a child with crutches and a leg brace, a child in a wheelchair, a child missing a hand, a facially disfigured child, and an obese child. In every group of kids tested, there was “remarkable uniformity.” The obese child always came in dead last.

That was ages ago, though. In 2003, researchers published the 40-year follow-up. The study was repeated, and the title of the study gives it away: “Getting Worse: The Stigmatization of Obese Children.” The obese child was liked even less in the follow-up study than in 1961! This parallels trends throughout society, with a near 70% jump in perceived weight discrimination recorded in national surveys since the mid-1990s.

Attitudes among teachers may not be helping. More than a quarter of teachers and other school staff surveyed felt that becoming obese is “one of the worst things that could happen to a person.” Even parents can be biased, providing less support for college for their overweight daughters compared to thinner siblings, for example. As two prominent obesity researchers commented, “It is strong prejudice indeed when parents discriminate against their own children.”

What about doctors? One representative national survey found that more than half of physicians “viewed obese patients as awkward, unattractive, ugly, and noncompliant.” About a quarter of nurses agreed or strongly agreed with the statement: “Caring for an obese patient usually repulses me.”

This antagonism can have serious health consequences for those who may need it the most. For example, obese women are at higher risk for developing cervical cancer, as well as developing endometrial and ovarian cancers, yet they are less likely to be screened. Morbidly obese patients have only about half the odds of getting their recommended pelvic exams. Part of this may be avoidance on the part of the patient, but some doctors turn obese patients away. The Sun Sentinel polled OB/GYN practices in Florida and found that as many as one in seven refused to see heavier women and set weight cut-offs for new patients beginning at 200 pounds.

Even doctors who welcome obese patients have been found to give them short shrift. Physicians randomized to receive a medical chart of a migraine patient who was either presented as average weight, overweight, or obese said they would give the obese patient about 28% less of their time. And it’s less quality time. Recorded doctors’ visits found that physicians tend to build “less emotional rapport with overweight and obese patients.”

Even obesity specialists profess increasingly explicit anti-fat attitudes. Worsening in surveys taken between 2001 and 2013, obesity specialists “described fat people as significantly more lazy…stupid…and worthless…compared to thin people.” Even in the medical literature, you’ll find lines like this, an example from Annals of Internal Medicine: “Obesity is an aesthetic crime: it is ugly.”

The good news is that they appear able to hide their disdain. In a study entitled “Obese Patients Overestimate Physicians’ Attitudes of Respect,” despite the negative attitudes doctors harbored toward their obese patients, the same patients expressed their satisfaction with their providers. The researchers concluded, “While physicians may be successfully playing the part, the lack of true respect suggests…the authenticity of the patient-physician relationship should be questioned.”

Doctor’s Note

The next blog in this two-part series is The Burden of Weight Bias.

Both blogs in the series are drawn from my book How Not to Diet.