TIME ebola

CDC Expands Ebola Alert to Passengers on Both Flights Nurse Took

The Frontier Airlines plane that Amber Vinson flew from Cleveland to Dallas on Monday, flies out of Cleveland Hopkins International Airport Wednesday, Oct. 15, 2014, in Cleveland.
The Frontier Airlines plane that Amber Vinson flew from Cleveland to Dallas on Monday, flies out of Cleveland Hopkins International Airport Wednesday, Oct. 15, 2014, in Cleveland. Tony Dejak—AP

The Centers for Disease Control (CDC) asked passengers on Frontier Airlines flight 1142 from Dallas to Cleveland on Oct. 10 to call their hotline

The Centers for Disease Control expanded precautionary efforts Thursday night by reaching out to passengers on an earlier flight that Ebola patient Amber Vinson took before she had reported any symptoms of the virus.

The CDC said anyone on Frontier Airlines flight 1142, which flew from Dallas to Cleveland on Oct. 10, should call the agency at 800-CDC-INFO (800-232-4636). Amber Vinson, the second nurse to test positive with Ebola in the U.S., took that flight after taking care of the U.S.’s first diagnosed Ebola patient, Thomas Eric Duncan, who died on Oct. 8.

The passengers will be interviewed by CDC officials about the flight and about any potential symptoms they may have developed since flying. “Individuals who are determined to be at any potential risk will be actively monitored,” the CDC said in a statement about the notification.

Ebola is transmitted by an infected person when that person is symptomatic, and only through direct contact with that individual’s body fluids, which include blood, saliva, vomit or diarrhea. Vinson had a slight fever of 99.5 degrees before flying Oct 13 from Cleveland to Dallas. CDC director Dr. Tom Frieden said that passengers on the flight from Cleveland back to Dallas were being notified out of an abundance of caution. He said that they were at very low risk of exposure since Vinson presumably did not vomit or spread body fluids during the flight.

Now the agency says, “Based on additional information obtained during interviews of close contacts to the second healthcare worker from Texas Presbyterian Hospital who tested positive for Ebola, the … CDC is expanding its outreach to airline passengers now to include those who flew from Dallas/Fort Worth to Cleveland on Frontier flight 1142 on Oct. 10.”

TIME ebola

Here’s Who Is Being Monitored for Ebola

Contact monitoring after the U.S. Ebola cases

The key to containing spread of a virus like Ebola, public health experts tell us, is tracking down every person with whom an infected person had direct contact. Such contact tracing includes people in their family who might have shared hugs or kisses, or health care workers who handled any specimens.

Who is currently being traced in this way? Here’s what we know.

How many people are being monitored?

48 people who had direct contact with Thomas Eric Duncan

For now, officials at the Centers for Disease Control (CDC) say that 48 people had direct contact with Thomas Eric Duncan before he was isolated on Sept. 28 and diagnosed on Sept. 30. CDC has not clarified where those people might have had contact with Duncan. Four members of his immediate family who were staying in the same apartment as Duncan since he arrived in the U.S. have been quarantined for 21 days, the incubation period for the Ebola virus. But it’s not clear whether the remaining 44 include public citizens in the same apartment building or whether it also includes others in the community.

76 health care workers who cared for Duncan

Between Sept. 28, when Duncan was put into isolation at Texas Health Presbyterian Hospital, and Oct. 8, when he died, 76 health care workers participated in his care, performing duties that potentially exposed them to his infectious body fluids. All are being monitored, according to the CDC. At the minimum, that involves having the health care workers take their own temperature twice daily, and report any fever above 100.4F or any other symptoms of Ebola, including nausea, headache, vomiting and diarrhea.

It’s not clear how many, if any, are being actively monitored, which involves public health officials performing the temperature checks twice daily and asking detailed questions about any other possible symptoms.

Can contacts travel?

According to CDC director Tom Frieden, people who are part of contact tracing are advised not to use public transport. They are limited to so-called controlled movement, such as a personal car.

Amber Vinson, the second nurse to test positive, however, traveled by plane from Dallas to Cleveland on Oct. 10, two days after Duncan’s death. Vinson had apparently been intimately involved in Duncan’s care while he was alive, including drawing his blood and inserting catheters. Even if she did not have a fever before she boarded the plane, Frieden said, “because she was in a group of individuals known to have exposure to Ebola, she should not have traveled on a commercial airline.”

While in Cleveland, Vinson reported a temperature of 99.5F. That is below the CDC threshold of 100.4F for Ebola isolation, but because of her direct contact with Duncan’s body fluids, Vinson was told by CDC to return to Dallas, according to a CDC spokesperson. She did, on Oct. 13, on a commercial flight.

Frieden said on Oct. 15 that Vinson reported no symptoms of Ebola; Ebola patients can only spread their disease when they are symptomatic and through direct contact with their body fluids, including vomit, diarrhea or blood.

Why isn’t every contact of Duncan’s under quarantine?

Because Ebola only spreads through contact with body fluids when the patient is symptomatic, the risk of contracting Ebola through casual interactions is very low. Passengers on the plane that brought Duncan into the U.S., for example, are not at risk because he was not symptomatic during this trip.

Passengers on Vinson’s flight from Cleveland to Dallas, however, are being monitored out of an abundance of caution. Because she had a fever, the CDC notified Frontier Airlines, the carrier, that Vinson “may have been symptomatic earlier than initially suspected, including the possibility of possessing symptoms while on board the flight,” according to Reuters. Those passengers are now being monitored for Ebola symptoms.

Duncan’s family members are under quarantine because they were in direct contact with Duncan when he first became ill, and have a high chance of having touched his infectious body fluids.

Health care workers are also at high risk, since they handled Duncan’s body fluids as he became more and more symptomatic in the hospital. They are supposed to be protected from exposure by personal protective equipment, but Frieden acknowledged that the gear used by health workers in the Duncan’s early hospitalization was “variable” and that both Vinson and Nina Pham, the first nurse to test positive for Ebola, might have been infected during this time.

TIME ebola

5 Reasons Ebola Was Contained in the Congo

Researchers report on another cluster of Ebola cases in the Democratic Republic of Congo, where Ebola first emerged

While the world rightly focused on the growing number of Ebola cases emerging from Africa’s west coast this summer, the virus made another appearance in the heart of the continent: in the Democratic Republic of Congo (DRC), where Ebola was first identified in the 1970s. That outbreak—which was of another strain of Ebola Zaire—spread to just 69 people, however, and a report in the New England Journal of Medicine, has some answers as to why.

The DRC outbreak began with a pregnant woman who butchered and ate a dead monkey her husband had found in the Inkanamongo village, near a remote, forested area in the equatorial province. Presumably, the monkey was infected with Ebola; the woman became ill on July 26 and died on August 11. A local doctor and three health workers who performed a Cesarean section to remove the fetus before burial were also infected and died of Ebola.

Nearly two dozen others who were infected had direct contact with the woman, and most of them had helped care for her after she became sick. Forty nine of the 69 people who either had confirmed or suspected infection died. The number of cases was kept to a minimum, say the study authors, for five reasons, which could help inform how to contain the epidemic in the west.

1. While both regions practice similar cultural rituals surrounding burial, including touching the bodies of the dead, some behaviors in the equatorial DRC differ from those in West Africa, and thus help to limit spread of the virus from person to person.

2. The strain circulating in DRC is also genetically different from that in Guinea, Sierra Leone and Liberia, and may have a different disease trajectory.

3. The remote and relatively isolated locations of villages in DRC helped to contain the virus and prevent it from spreading as quickly as it does in large, mobile populations.

4. The DRC may have a stronger health response to Ebola given its longer history with the virus. Since it first appeared there in 1976, the Congo has weathered six outbreaks and may have more experience in responding quickly and educating its citizens about how to control infection.

5. Finally, because the virus has circulated among the people in DRC, they may have more immunity to it, and could be in a better position to fight off infection.

The DRC outbreak provides a stark contrast to the way Ebola has erupted in West Africa; it shows how an experienced and prepared community might be one of the most important ways to help stop spread of a deadly disease. Similar strategies have helped to contain the epidemic in Nigeria and Senegal, which neighbor the most heavily affected countries in West Africa but are close to declaring their outbreaks over.

Read next: Lawmakers Grill Obama Administration Over Ebola Outbreak

TIME Exercise/Fitness

The Drug-Free Way to Fight Depression

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Exercising throughout adulthood can help to keep depression at bay Jupiterimages—Getty Images

A 50-year study shows that physical activity may help fight the disease

Exercise can do a lot of physical good, from making hearts healthy to keeping weight down—and now there’s strong new evidence that it can give a mental boost as well.

In a study appearing in JAMA Psychiatry, researchers from the UK and Canada found that people who were more physically active throughout most of their adult years experienced fewer depressive symptoms than those who were less active. That finding is familiar, but these results are extremely affirming because they involved both a large number of same-aged people—11,000, who were born the same week in March 1958—and a long period of time—50 years.

The volunteers answered questions about how many times they exercised a week on average at four points during the study: when they were 23, 33, 42 and 50 years old. They also took standardized tests that measured depressive symptoms such as depressed mood, fatigue, irritability and anxiety.

At every stage, those who reported more physical activity also had fewer depressive symptoms. What’s more, those who became more active between the recordings also showed fewer signs of depression. That means someone who exercised more each week at 42 than they did at 33 also benefited from having fewer depressive symptoms at 42. In fact, getting more physically active at any age—going from never working out to working out three times a week—lowered the chances of depression by 19% five years later.

The results add to previous studies that found similar associations between exercise and lower depression rates among younger and older people, but this study shows that the connection exists throughout adulthood.

Understanding the link could help doctors better treat both obesity and depression; with some people, depression could be a barrier to becoming physically active, while with others, being overweight could feed into cycle of depression. “Our study suggests that practitioners helping patients to recover from depression might address activity within their treatment plan for lifestyle factors,” the authors write.

TIME medicine

Stem Cells Allow Nearly Blind Patients to See

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Stem cells could lead to new treatments for eye disorders Photography by Peter A. Kemmer—Getty Images/Flickr RF

Embryonic stem cells can be turned into a therapy to help the sight of the nearly blind

In a report published in the journal Lancet, scientists led by Dr. Robert Lanza, chief scientific officer at Advanced Cell Technology, provide the first evidence that stem cells from human embryos can be a safe and effective source of therapies for two types of eye diseases—age-related macular degeneration, the most common cause of vision loss in people over age 60, and Stargardt’s macular dystrophy, a rarer, inherited condition that can leave patients legally blind and only able to sense hand motions.

In the study, 18 patients with either disorder received transplants of retinal epithelial cells (RPE) made from stem cells that came from human embryos. The embryos were from IVF procedures and donated for research. Lanza and his team devised a process of treating the stem cells so they could turn into the RPE cells. In patients with macular degeneration, these are the cells responsible for their vision loss; normally they help to keep the nerve cells that sense light in the retina healthy and functioning properly, but in those with macular degeneration or Stargardt’s, they start to deteriorate. Without RPE cells, the nerves then start to die, leading to gradual vision loss.

MORE: Stem Cell Miracle? New Therapies May Cure Chronic Conditions Like Alzheimer’s

The transplants of RPE cells were injected directly into the space in front of the retina of each patient’s most damaged eye. The new RPE cells can’t force the formation of new nerve cells, but they can help the ones that are still there to keep functioning and doing their job to process light and help the patient to see. “Only one RPE can maintain the health of a thousand photoreceptors,” says Lanza.

The trial is the only one approved by the Food and Drug Administration involving human embryonic stem cells as a treatment. (Another, the first to gain the agency’s approval, involved using human embryonic stem cells to treat spinal cord injury, but was stopped by the company.) Because the stem cells come from unrelated donors, and because they can grow into any of the body’s many cells types, experts have been concerned about their risks, including the possibility of tumors and immune rejection.

MORE: Early Success in a Human Embryonic Stem Cell Trial to Treat Blindness

But Lanza says the retinal space in the eye is the ideal place to test such cells, since the body’s immune cells don’t enter this space. Even so, just to be safe, the patients were all given drugs to suppress their immune system for one week before the transplant and for 12 weeks following the surgery.

While the trial was only supposed to evaluate the safety of the therapy, it also provided valuable information about the technology’s potential effectiveness. The patients have been followed for more than three years, and half of the 18 were able to read three more lines on the eye chart. That translated to critical improvements in their daily lives as well—some were able to read their watch and use computers again.

“Our goal was to prevent further progression of the disease, not reverse it and see visual improvement,” says Lanza. “But seeing the improvement in vision was frosting on the cake.”

TIME ebola

CDC Deploys Ebola SWAT Team to Dallas

The agency says it will send a team of Ebola experts to any hospital with an Ebola case in the future

A team of experts with experience treating Ebola patients in Africa and containing outbreaks there is now in Dallas working to contain the deadly disease after the first two diagnoses on U.S. soil, a top health official said Tuesday.

Tom Frieden, the director of the Centers for Disease Control and Prevention (CDC), said the team is helping officials at Texas Health Presbyterian, and was joined by two nurses from Emory University Hospital, where U.S. aid workers were successfully treated for Ebola. The team’s job is to enhance safety and infection control measures at the hospital.

“A single infection in a health care workers is unacceptable,” Frieden said. “What we are doing at this point is looking at everything we can do to minimize the risk so those caring for her can do so safely and effectively.”

Frieden said that it’s still not clear how a nurse, Nina Pham, got infected while caring for Thomas Eric Duncan, the first patient diagnosed on U.S. soil who later died. But every step in how Ebola patients are handled will be scrutinized and improved, Frieden said.

Asked why the CDC didn’t send a team as soon as Duncan was diagnosed, Frieden said: “We did send some expertise in infection control but think in retrospect, with 20-20 hindsight, we could have sent a more robust hospital infection control team, and been more hands on at the hospital on day one about exactly how this [case] should be managed. We will do that from now on any time we have a confirmed case.”

In an encouraging sign, health officials said Pham has only had direct contact with one person— and that person isn’t sick, but is being monitored. Dozens of people who had direct or indirect contact with Duncan are still being monitored. “It is decreasingly likely that any of them will develop Ebola,” Frieden said.

TIME ebola

Nurses ‘Infuriated’ By Suggestion of Dallas Ebola Protocol Breach

The National Nurses Union is pushing for the CDC to mandate better gowns, masks and training to prepare them for treating Ebola

When Thomas Duncan, the first person to be diagnosed with Ebola in the U.S. was admitted to Texas Health Presbyterian Hospital, the nurses and doctors who took over his care became the frontline in the battle with the virus. According to the Centers for Disease Control (CDC), proper infection control procedures should have protected those health care workers from getting infected, and should have stopped the virus from spreading any further than Duncan and anyone he may have had direct contact with before falling ill.

But they didn’t. Nina Pham, one of the nurses assigned to care for Duncan before he died, tested positive for Ebola on Oct 13. Initially, CDC director Dr. Tom Frieden attributed the infection to a “breach in protocol.”

“That infuriated me,” says Karen Higgins, co-president of National Nurses United (NNU) and a nurse at Boston Medical Center. “What it should have been attributed to was a breakdown in the system. It never should have been stated. Instead, we should figure out what the problem was and fix it, not say that it was her fault that she didn’t follow protocol and that’s why it happened.”

MORE: 5 Ways U.S. Hospitals Need to Get Ready For Ebola

CDC has since acknowledged that they and the Texas health department are still investigating how the infection occurred, but according to the nurses’ group, there are serious gaps in the country’s preparedness for treating Ebola patients. For one, there is no standard protocol for what a hospital needs to have in place and how a hospital should handle an Ebola case. The CDC has published guidelines on its website, but it’s up to each hospital to decide how to implement those recommendations. And according to a recent survey of more than 2,200 nurses in 46 states, those policies vary widely and are haphazard. Eighty five percent of the nurses questioned felt their hospitals had not provided education about Ebola in a format in which they could ask questions and learn more about best practices for protecting themselves, the patient and their communities. Most were directed to a video or website or handed a piece of paper informing them of Ebola’s symptoms and urging them to ask patients with fevers about their recent travel history. Some were provided a Hazmat suit in the breakroom and told to try it on if they had time. Most said their hospitals did not have Hazmat suits for the nurses. Forty percent of them said their hospitals did not have enough protective equipment, including face shields or the fluid-barrier gowns that are required when treating infectious patients. “Are we prepared for infectious diseases? Yes we are. Are we prepared for Ebola? No we are not,” says Higgins.

The fact that two hospitals in the U.S.—Emory University Hospital and Nebraska Medical Center—successfully treated Ebola patients without any spread of the virus supports Frieden’s conviction that it’s possible to contain Ebola and protect health care workers.

MORE: Ebola Health Care Workers Face Hard Choices

But in order to do that, the NNU says a strong mandate is needed from the CDC and public health departments that specifies exactly what type of equipment health care providers should be wearing, how they should put the equipment on and take it off, and how they should dispose of them once they have been contaminated. That’s especially important if the CDC expects every hospital to be able to properly care for Ebola patients, something that Frieden says is possible. “We are challenging the CDC and saying we are past the time of guidelines and recommendations,” says Higgins. “What we need are standards, high standards of care. Say that this is now what is expected of your equipment, the right gloves, the right outfits, masks and covers.”

Specifically, the nurses want Hazmat suits for anyone who will be treating an Ebola patient. Health departments and the CDC have been reluctant to mandate these, since putting them on or taking them off improperly may put health care workers at greater risk of contamination. But with training, the nurses say, the suits could prevent further spread of the virus, like what happened in Dallas. “The equipment is one thing, but training has to be the second part,” says Higgins. “And not just a web site or a video, but people working with people one on one to make sure everyone understands what they are doing, how to get in and out of the equipment, and how to do it right.”

At Boston Medical Center, hospital staff have recognized that current procedures aren’t enough, and in the past week have increased hands-on training and drills to make sure health care workers are prepared to properly handle an Ebola patient, should one walk through the door. Those procedures include making sure that anyone gowning to go into an infectious patient’s room has a buddy to observe or gown with them, and point out any missed steps or improperly worn protective gear.

MORE: Ebola Lessons We Need To Learn From Dallas

Waste from a potential Ebola patient is also getting the same stepped-up vigilance. Previously, the waste wasn’t given any additional care beyond the usual treatment for hazardous materials—a separate bin and a separate removal process that generally ended in incineration. But now, the hospital is requiring any Ebola material to be double or triple bagged and put in a separate box to be removed by a properly trained hazardous waste management team who will dispose of it in the right way to prevent further contamination.

For now, the nurses aren’t confident that they are able to properly protect themselves and their community from Ebola, but they’re convinced that with the proper equipment and training, they can be. “This is our test and we need to do it right,” says Higgins. “We feel extremely upset that any [healthcare worker] got infected. Hopefully she will be fine, but we don’t want to have to face another person or family that ends up getting infected because we are not as good as we should be in treating patients.”

Read next: CDC Chief Urges U.S. Hospitals to ‘Think Ebola’

TIME neuroscience

This Alzheimer’s Breakthrough Could Be a Game Changer

Scientists recreated what goes on in the brains of Alzheimer’s patients in a 3D culture dish that could speed development of new drugs for the disease

Researchers have overcome a major barrier in the study of Alzheimer’s that could pave the way for breakthroughs in our understanding of the disease, a new report shows—and that new understanding could, in turn, pave the way for drugs that treat or interrupt the progression of the neurodegenerative condition.

For decades, animals have been the stand-ins for studying human disease, and for good reason. Their shorter lifespans mean they can model human conditions in weeks or months, and their cells can be useful for testing promising new drug treatments.

But they haven’t been so helpful in studying Alzheimer’s disease. Two factors contribute to the neurodegenerative condition — the buildup of sticky plaques of the protein amyloid, and the toxic web of another protein, tau, which strangles healthy nerve cells and leaves behind a tangled mess of dead and dying neurons. Despite attempts by scientists to engineer mice who exhibit both factors, they haven’t been able to generate the tau tangles that contribute to the disease.

Now, Dr. Rudolph Tanzi and Dr. Doo Kim at the Mass General Institute for Neurodegenerative Diseases at Massachusetts General Hospital, have devised a work-around that doesn’t involve animals. They have developed a way to watch the disease progress in a lab dish.

“In this new system that we call ‘Alzheimer’s-in-a-dish,’ we’ve been able to show for the first time that amyloid deposition is sufficient to lead to tangles and subsequent cell death,” said Tanzi in a statement.

MORE: Blood Test for Alzheimer’s

While autopsies showed evidence of both amyloid and tau in the brain, Alzheimer’s experts have been debating for years which came first — do amyloid plaques trigger the formation of tau tangles, or does the presence of tau cause amyloid to get stickier and bunch together in the brain? Tanzi and his colleagues showed definitively for the first time that amyloid is the first step in the Alzheimer’s process, followed by tau tangles. When he blocked the formation of amyloid in the culture with a known amyloid inhibitor, tau tangles never formed.

The disease-in-a-dish model is an emerging way of understanding conditions that either can’t be recapitulated accurately in animals, or diseases that make it difficult to study and test in human patients. In recent years, for example, scientists have successfully recreated the process behind amyotrophic lateral sclerosis (ALS), or Lou Gehrig’s disease, using stem cells from patients and allowing them to develop into the motor neurons that are affected by the disease. The technique led to a breakthrough in understanding that a certain population of nerve cells known as glial cells poison the motor neurons and impede their normal function. Now experts are focusing on finding ways to control the glial cell activity as possible treatment for ALS.

MORE: How Moodiness and Jealousy May Lead to Alzheimer’s

Tanzi and his team are hoping that something similar will come from their model of Alzheimer’s.

While the genes responsible for the inherited form of Alzheimer’s differ slightly from those involved in the more common form that affects people as they age, the end result — the build up of amyloid plaques and tau tangles — are the same. So now that they can see both the clumps of amyloid and the tau tangles, form, they can start to tease apart the processes that link the two processes together.

That will open the way toward finding drugs or other ways of interrupting the process more quickly than they could working with animals. It took six to eight weeks for the cells in the dish to form plaques and then tangles, compared to a year or so in mice. “We can now screen hundreds of thousands of drugs in this system that recapitulates both plaques and tangles…in a matter of months,” Tanzi said. “This was not possible in mouse models.” The system also makes it possible to test these drug compounds at one-tenth the cost of evaluating them in mice, he said. And that means that finding a way to prevent Alzheimer’s may come both faster and cheaper than scientists had expected.

TIME Obesity

How Family Dynamics at the Dinner Table Affect Kids’ Weight

A stock photograph of a family dinner
Getty Images

It's not just what kids eat, but who they eat with that matters when it comes to their weight

“Eat together” is a mantra that doctors and nutritionists use regularly when they talk with families about eating healthy and maintaining normal weight. Children who eat regular family meals tend to have lower rates of obesity and eat more nutritiously. A new study published Monday morning in the journal Pediatrics takes a novel look at why.

A team led by Jerica Berge, in the department of family medicine and community health at University of Minnesota, asked the families of 120 children aged 6 to 12 to record eight days of meals. The families didn’t have to eat every meal together, and didn’t even have to eat dinner together every one of those nights, but did have to share at least three meals during that time. Half of the children were overweight or obese, and half were normal weight.

To tease out what features of the family meal might be influence weight, Berge’s team laboriously coded the interactions occurring at the table into two broad groups — those relating to the emotional atmosphere at the meal, such as how much the family members seemed to be enjoying the time together, how much hostility the diners showed one another, and how many uncomfortable silences or awkward pauses occurred — and those involving food specifically, including how much hostility emerged from discussions about food, including weight issues, and how much the parents controlled or limited what and how much children ate.

Children who were overweight or obese had family meals that included more negative emotional interactions — hostility, poor quality interactions, little communication and more controlling behavior from their parents — compared to children who weren’t obese. Their meals tended to have a warmer, more communicative atmosphere. For example, these children were given positive reinforcements to eat, and were encouraged to eat foods to get stronger or run faster, while heavier children experienced more negative pressures including threats and made to feel guilty about those in the world who can’t afford to eat three meals a day. If parents or caregivers talked constantly throughout the meal about food, and lectured about homework or attempted to control what the children ate, the youngsters were also more likely to be heavy.

“I was surprised by how consistent the patterns were,” says Berge. “Almost every single one of the emotional factors we coded were in the right direction, and there were really clear patterns in how much positive or negative interactions were associated with overweight and non overweight.”

The analysis also revealed other things that distinguished the family meals of overweight children and normal weight youngsters. Heavier children tended to have shorter meals — spending 13.5 minutes on average eating with their family compared to 18.2 minutes for non obese kids. Children who weren’t obese were also more likely to have a father or step-father at the table. The reason, says Berge, may be practical. “It might be a matter of having one more person at the table for crowd control, another person to help make the meal and be a model for children to emulate,” she says.

The team only coded the types of interactions between the family members during the meal, and did not include an in-depth look at what the families were eating. But that’s the focus of their next study.

In the meantime, the current data suggests that simply sitting down at the same table at the same time isn’t enough to influence obesity. And it’s up to pediatricians and family doctors to help families understand how to take full advantage of breaking bread together. “There is clear evidence that family meals are important in protecting kids against overweight,” says Berge, “so it’s important to start the conversation with families. It’s important to focus on making the meal environment more positive.” And, as her study showed, it doesn’t take lengthy repasts either — just 20 minutes as many times a week as possible.

Read next: Why I Don’t Eat With My Kids

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