CNN
 — 

Monica Puig won more than 300 matches during her tennis career and the feeling afterwards was often the same: relief, excitement, and satisfaction that the weeks and months of sacrifice and preparation had paid off.

Today, exactly a year after shoulder issues forced her to retire aged 28, Puig is still able to revisit some of those winning emotions without picking up a tennis racket or stepping foot on a court.

She’s turned to running marathons – first in New York City, then in Boston and London on back-to-back weekends earlier this year and is already halfway towards her goal of completing all six of the world’s marathon majors by the end of 2024.

“Every time I cross the finish line of a marathon and I get a new personal best time, I get emotional, I’ve cried,” Puig tells CNN Sport.

“I’ve just felt in awe of what I’ve been doing because I could easily just be sitting on the couch crying and feeling sorry for myself. But I tried to channel all of that energy that I have towards whatever I had been feeling about my career into something more productive.”

Completing a marathon, Puig says, feels “very similar and very different” to winning a tennis match. With tennis, the stakes felt higher when rankings points, global recognition, and prize money were on the line.

But the sense of personal satisfaction she gets from running has endured, helping to ease the lingering pain of her retirement from tennis.

“It’s more about showing myself that I didn’t let myself fall into this big black hole of depression and sadness when I had to finish my career so early,” Puig adds.

“I was able to pick myself back up and find something else that motivates me to get out of bed every day, that motivates me to continue to be strong, fit, and have fun at the same time.”

Puig reached a career-high ranking of No. 27 in the world and won one WTA Tour title in 2014. Her crowning moment arrived two years later when she won Olympic gold in Rio – Puerto Rico’s first-ever gold medal at the Games.

As a tennis player, Puig always saw running as a form of punishment – never enjoyment. It became a means to clear her head when she was rehabbing from injuries and, over time, she started to increase the distance of her runs – three miles became five, five became eight, then eight became half and full marathons.

Now, Puig has also set her sights on competing in triathlons, as well as running the remaining marathon majors in Chicago, Berlin, and Tokyo. Her first half Ironman – a 1.2-mile swim, 56-mile bike, and 13.1-mile run – is in Augusta, Georgia, in September, and she plans to race another back home in Puerto Rico next year.

An amateur runner and triathlete, it’s a sharp transition from her life as one of the best tennis players in the world, though Puig thinks her experience of the latter has benefited the former.

“You are competing against yourself,” she says of all three disciplines, “you are your biggest enemy or supporter out there. What you think can either push you or it can limit you.

“In tennis, I’m not going to say my mental fortitude was my strength because a lot of the time I didn’t know how to deal with negative thoughts, but I feel like everybody matures at their own time mentally.

“Doing the marathons and triathlon has really helped my mentality to grow and to develop this can-do attitude towards everything that I do. It’s also thanks to tennis that I have a certain discipline … All of that discipline has really helped me to stay in shape and stay true to my goals.”

Elbow surgery in 2019 followed by three shoulder surgeries in three years ultimately signaled the end to Puig’s tennis career. She played her first match since 2020 at the Madrid Open last year, but the shoulder problems persisted.

There were times, Puig says, that she couldn’t sleep on the affected side, such was the pain in her shoulder. Moreover, the mental toll of constant rehab and almost four years away from regularly competing on the tour was starting to mount.

“It felt like I was pushing a stone up a mountain and the stone kept squashing me as I kept getting further and further,” says Puig.

“I obviously believed that I could come back, I believed in myself enough. Last year, I had full intention of playing again competitively.

“But when I saw my surgeon after the last time I was on the court, he said, ‘Look, I have to be honest with you, your shoulder – it’s not doing well. And we can’t just keep opening up your shoulder to fix it every single time it goes wrong.”

Not ready to walk away from tennis entirely, Puig still hopes to play exhibition matches in the future. She returned to the practice court recently and had to temper expectations from fans, who interpreted footage posted on social media as the start of a competitive comeback.

But Puig has remained involved with the sport as a broadcaster, enabling her to engage with the game in a different way compared to her playing days.

“When I commentate or I’m watching matches, I’ve noticed that my understanding of the game has gotten a lot better,” she says. “I feel like I’m smarter and I can see things, I can notice things. I study the game a lot better than when I was playing.

“My understanding for tennis has grown and I wish that I was still playing so I could implement some of the things that I see and have that knowledge translate onto what I do on the court.”

Puig adds that she still misses tennis, particularly when she watches her contemporaries thrive at grand slams.

With her shoulder never going to be as it was prior to the surgeries, she’s come to accept her body’s limitations and is honing her swimming technique to withstand the rigors of Ironman-distance triathlons.

“I’ve learned to handle my shoulder in a different way and knowing that, if there is pain, then it’s okay to stop, it’s okay to take a break, it’s okay to say that you’re not feeling 100%,” says Puig.

“Usually, when I was trying to come back last year, I would play through pain and that wasn’t necessarily something that felt very good. It was very challenging and involved a lot of tears.”

What she has instead developed over the past year is “a new life” and “a new way of doing things.”

“I want to continue to do this for my whole life; I see people well into their fifties, sixties, still doing triathlon and doing Ironman,” says Puig.

“That’s something that I want to continue to do … I don’t know how far I’ll get or anything like that, but the sky’s the limit.”

CNN
 — 

Now that the Fall-Winter 2023 catwalks have been disassembled, it’s clear one trend was more pervasive than any collective penchant for ruffles, pleated skirts or tailored coats.

Across runways in New York, London, Milan and Paris, there was a notable scarcity of plus-size models. This comes at a time when there are five injectable medications which can be used as appetite suppressants currently available by prescription in the US, stirring much conversation; a sixth medication, Rybelsus, is taken as an oral pill. Two are officially approved in the UK — the largest influx of weight loss medication seen in the country in almost a decade.

In recent months, injectables such as Wegovy and Ozempic — which share the same active ingredient, semaglutide — have been widely reported as Hollywood’s worst-kept weight loss secret. (Ozempic is intended for use primarily to treat Type 2 diabetes.) Comedian Chelsea Handler claimed her “anti-aging doctor just hands (Ozempic) out to anybody” while appearing on a podcast in January. Even Elon Musk tweeted last year about being on Wegovy.

For many fashion commentators and diversity advocates, the Fall-Winter 2023 runways were in sharp contrast to the (albeit limited) progress and heady promise of recent seasons. This rollback has been widely criticized in the style media as such. And its potential impact is being assessed more broadly: With the rise of these weight loss panaceas, the pursuit of size zero is now just a prescription away.

In 2020, Jill Kortleve and Paloma Elsesser became the first models outside of a sample size to walk for the Italian fashion house Fendi. (Traditionally, a sample size falls between a US 0-4.) British label Erdem entered the plus-size market in 2021, extending its offering to a UK size 22 (or US size 18). And in January 2022, Valentino made headlines after its haute couture show featured a broad spectrum of body types. But this season, there was a visible lack of curve bodies on their runways — or many others.

Fendi and Valentino did not respond when contacted by CNN, while Erdem declined to comment.

According to fashion search engine Tagwalk, the number of mid and plus-size models dropped by 24% in comparison to Spring-Summer 2023. Similarly, a size inclusivity report conducted by Vogue Business found that 95.6% of all looks presented for Fall-Winter 2023 were in a size US 0-4. For context, industry market firm Plunkett Research estimated in 2015 that 68% of American women wear a size US 14 or above.

“It was a definitive backslide,” said IMG model agent Mina White, who represents plus-size and curve supermodels including Elsesser and Ashley Graham. “It was frustrating to see some of these designers not using curved bodies where they had in the past.” Fendi and Valentino did not respond when contacted by CNN, while Erdem declined to comment.

“Watching somebody like Ashley Graham attend the front row for so many of these major houses in full looks (provided by the designer), it was frustrating,” White continued. “They wanted to utilize her image and her social following to command a certain space in the market, but they didn’t want to be reflective on their runways.”

For others, even the term “backslide” was too generous. “Slipping back from… what? A glorious time when the average American woman (size 16) was as present on the runways as she is in everyday life? A time when fashion ads cast as many ‘plus-size’ and ‘mid-size’ women as ‘straight-size’ women?” fashion journalist Amy Odell wrote in her Substack newsletter of this past season’s runways. “No one needed any data to understand that representing a wide array of body shapes and sizes in runway shows or in fashion imagery is not a priority for the industry.”

That said, a handful of — mostly smaller — brands pushed ahead this season. In London, emerging labels Di Petsa, Karoline Vitto and Sinead O’Dwyer showcased lineups of size-diverse models. Inclusivity at Christian Siriano, Coach, Kim Shui, Collina Strada and Bach Mai stood out in New York; while in Paris, Belgian brand Esther Manas — a consistent flag-bearer for size diversity — staged one of the city’s most refreshing runways with an assortment of fun, sensual, feminine looks that complimented a range of bodies.

There was also a smattering of mid- and plus-size castings to be seen elsewhere: Off-White and Michael Kors, for example, featured a few such models. At Harris Reed’s debut for Nina Ricci, Precious Lee opened the show — which also featured three more plus- and mid-size models.

Fashion samples and sample size pieces are one-off garments made before an item is mass-produced, typically to be worn during runway shows. Prioritizing the same body type in sample sizes means runway models are more easily interchangeable, saving fashion houses time and money if someone were to drop out or get sick during or after the casting process for a show.

It’s also partly why, according to White, casting curve models is still an uphill battle. She says she introduces brands to new faces months in advance of runway season, with their specific measurements up-top and easy to read in all correspondence. “I want to be ahead of that,” White said. “So I’m never told ‘Oh, we wanted to make it work, but we didn’t have her size’ or whatever that conversation might look like.”

But despite her efforts, she says she’s frequently told it’s too much of a “financial lift” to make larger samples — even by legacy brands. “I get very upset when brands say that,” White said. “I don’t believe that it is, I believe that it’s people not being properly educated on how to do this right.”

Beyond the lack of representation, White notes it’s painful for plus-size consumers to watch brands leverage resources to create custom, made-to-fit pieces for celebrities — all the while claiming the pot is empty for more inclusive runway samples.

London-based stylist and editor Francesca Burns agrees sample sizes are part of the problem. In 2020, Burns went viral after she posted on Instagram about a fashion job gone wrong. She says she was sent five looks to style from Celine, none of which fit the size UK 8 (US 4) model booked for the shoot— an 18-year-old on her first job in the business. The experience left her “horrified,” Burns told CNN, recalling what she saw as the model’s shame and embarrassment. “Looking into this girl’s eyes,” Burns said, “she shouldn’t have felt like that.”

Burns’ post, which called the current system “unacceptable,” was picked up widely in the fashion media. (When reached by CNN, Celine declined to comment on the incident.) “Ultimately, the desire to see change has to be there,” Burns said. “And I wonder whether luxury has that desire?”

Progress has been slow, but not entirely inexistent. Across fashion campaigns, magazine covers and editorial shoots, there is a growing enthusiasm for inclusivity. “I see the options rolling in for the plus-sized talent, and they’re great offerings,” said White. “Great, strong editorials and covers and campaigns. But I do feel like without the clothes, we are going to go back to see more naked curve stories, or lingerie curve stories or a curve girl in a trench coat. That’s what I don’t want.”

For British Vogue’s April issue, unveiled March 16, Elsesser, Lee and Jill Kortleve were dubbed “The New Supers.” Preceding the cover story is a letter written by editor-in-chief, Edward Enninful commending the models for “leading the way” and holding “powerful space” in the industry.

“Catwalks are once again under scrutiny for a stark lack of body diversity,” read the magazine’s Instagram caption, unveiling the cover. “But this cover was not conceived as a statement. It is a crowning of an all-powerful trio, the supermodels for a new generation.”

But many online were quick to point out the disconnect: Two of the Saint Laurent Spring-Summer 2023 dresses were modeled by plus-size women, though they are not available to buy in most plus sizes.

In his own social media post, Enninful wrote about his disappointment at the Fall-Winter 2023 runways. “I thought I had gotten into a time machine. Show after show dominated by one body type, so many limited visions of womanhood… one prescribed notion of beauty prevailed again, and it felt like the reality of so many women around the world were being ignored.”

But for White, the power rests within the entire industry — not just at the feet of brands. “I really do believe there should be an industry standard between the (Council of Fashion Designers of America), the British Fashion Council and key editors at some of these major mass market magazines,” she continued. “If there was a call-to-action from these figureheads saying, moving forward samples need to be readily available for a few different body types, we would see significant and impactful change.”

Burns agrees there must be a trickle-down effect. “I think a lot of responsibility is put on young designers to solve all these issues around sustainability or issues around body inclusivity,” she said. “It’s important that the big powerhouses, which have the capacity to action change, really take some responsibility.”

On March 8, Wegovy — developed primarily as a treatment for those living with obesity and weight-related conditions — was approved in the UK. It’s the second injectable weight management medication to be made available with a prescription via the country’s National Health Service (NHS) in about 3 years, after almost a decade of quiet. Before 2020, the last weight loss medication was approved in the UK was in 2010.

Similarly, the US has now approved three weight management injections: Wegovy, Saxenda and IMCIVREE. Medications for type-2 diabetes like Mounjaro and Ozempic are not FDA-approved for weight loss, though some doctors are issuing them at their own discretion.

While these medicines are a revolutionary tool for those who struggle to lose weight for genetic or medical reasons, they are at risk of being abused.

Semaglutide, the active ingredient in Wegovy and Ozempic, was originally developed for treating type-2 diabetes. It quells hunger signals to the brain by mimicking the hormone glucagon-like peptide-1 (GLP-1). “It can slow how quickly your stomach empties out and may give you a little more feeling of feeling full,” said Dr. Robert Lash, an endocrinologist and Chief Medical Officer of the Endocrine Society in Washington, D.C. In clinical trials, over a period of 68 weeks, participants who used the medication in conjunction with eating fewer calories and increasing their physical activity on average lost around 15% of their body weight compared to 2.4% of those using a placebo, according to the manufacturer Novo Nordisk.

On March 13, the European Medicines Agency issued a statement warning of an Ozempic shortage that could continue through the year, urging doctors to prioritize prescriptions to diabetics. “Any other use, including for weight management, represents off-label use and currently places the availability of Ozempic for the indicated population at risk,” read the release.

Patients typically need a BMI of 27 or higher (along with another weight-related condition like high blood pressure or diabetes) or have a genetic predisposition towards obesity to be prescribed such appetite suppressant medication by their doctor. But talk of these injectables has been sweeping the West. In January, the New York Times reported on the term “Ozempic Face,” coined by a New York-based dermatologist who reported treating several patients with a hollowed-out appearance that can come with rapid weight loss. By the end of February, the medication had made it to the cover of New York Magazine in a feature titled “Life After Food?” Adverts for GLP-1 injections are even blanketing New York City subway stations.

And across social media, online forums and private group chats, some people looking to lose weight for primarily aesthetic purposes are searching for a way to skirt the requirements.

“I was just looking for a way to lose a few pounds, like 10 to 15 at most,” said one 30-year-old American woman, who wished to remain anonymous, in a phone interview. She scoured social media and forums for guidance on securing a weight loss drug. “I’m certainly a normal BMI, I just have a trip to Mexico coming up and I want to look really good,” she said.

Although she says she found a way to access Wegovy, she decided against the medication after considering the cost (which can reach more than $1,000 a month without insurance). “I’ve always very much fit the societal standard but lately I was just like f*ck it, I want to be skinny,” she told CNN.

Dr. Lash emphasized the importance of taking weight loss drugs only with medical supervision and a valid prescription. “If somebody was a normal weight and they took this drug because they thought they could be even thinner than they are now, that could lead to complications,” he told CNN, warning of nausea, vomiting, diarrhea and even gallbladder problems. “These drugs are not benign, they do have side effects involving the GI tract. There’s no such thing as a free lunch.”

Every body is invited

Fashion has long promoted size 0 as the ultimate virtue — regardless of its viability for many people, or any health risks. And now with the accessibility of accelerated weight loss medication, the stakes are even higher. For Burns and White, the industry is responsible for amplifying a new, more inclusive vision of beauty.

“There’s a very archaic way of looking at women over a size 16 and just assuming that they’re unhealthy or uneducated or unstylish. Or don’t have the resources to buy into luxury,” said White. “The reality is the same women these brands are alienating in their fashion space are the same women running out to buy their handbags, shoes, perfumes, cosmetics and skincare.”

Not only do designers need to create clothes with this consumer in mind, according to White, but they need to be seen on the runway, too.

“It shouldn’t be a conversation. It should just be normalized that we’re not just looking at a single view of beauty,” echoed Burns.

Ester Manas and Balthazar Delepierre, whose bridal-inspired Fall-Winter 2023 collection was one of this season’s most size-diverse runways, summarized it best in their accompanying show notes: “The body is not the subject. Because, obviously, at a wedding, everybody is invited. And all to the party. That is where the designer duo Ester and Balthazar take their stand.”

CNN
 — 

A new study found a moderately higher risk of autism spectrum disorder in children born to pregnant people exposed to tap water with higher levels of lithium, but experts caution that this association does not show a direct link between the two.

About 1 in 36 children in the US is diagnosed with autism spectrum disorder (ASD) each year, according to data from the US Centers for Disease Control and Prevention.

Scientists still don’t know the exact cause of autism, a developmental disorder. Genetics may be a factor, but some have been looking at potential environmental causes, too.

Cases may be on the rise, but that is also unclear. One study published this year on cases in the New York-New Jersey area found that autism diagnosis rates tripled among certain age groups between 2000 and 2016. A 2021 report found similar increases in cases, but the CDC says the increased number of cases is most likely linked to more doctors screening for the condition.

Lithium is an alkali metal that can be found naturally in some food and ground water. It’s used in batteries, grease and air conditioners, as well as in the treatment of bipolar disorder and some blood disorders. Its levels in US drinking water are not regulated, according to the US Geological Survey.

A new study, published Monday in the journal JAMA Pediatrics, found a small association between lithium and autism diagnosis in Denmark, where the researchers say the level of lithium in drinking water is similar to that in American water systems.

The researchers checked a database of people with psychiatric disorders for children born between 2000 and 2013 to find information on 8,842 cases of ASD and 43,864 participants who did not have ASD. They then measured the concentration of lithium in 151 public waterworks that served more than half of the Danish population and mapped out where pregnant people lived in relation.

As lithium levels in water increased, there was a modest increased risk of an ASD diagnosis. Specifically, compared with people at the lowest exposure level, those who had the second and third highest exposure during pregnancy had a 24% to 26% higher risk of ASD diagnosed in children. The group with the highest exposure had a 46% higher risk than those at the lowest level of exposure.

The researchers could not tell how much water the pregnant people drank, but they picked Denmark in part because residents there consume some of the lowest amounts of bottled water in Europe.

Experts say it’s important to note that the research can’t show that lithium exposure leads directly to an autism diagnosis.

Further study is required, said study co-author Dr. Beate Ritz, a professor of neurology in the David Geffen School of Medicine at UCLA, and a professor of epidemiology and environmental health at the UCLA Fielding School of Public Health.

“Any drinking water contaminants that may affect the developing human brain deserve intense scrutiny,” Ritz said in a news release. She added that the research would need to be replicated in other countries to look for a similar connection.

The implications of the findings are complex as far as public health policy is concerned, according to an editorial published alongside the study. Lithium levels in water, at concentrations that the study associated with a potential ASD risk, have also been linked with health benefits such as lower rates of hospitalization for psychiatric disorders and suicide.

“If all these of associations are valid, the wisdom of Solomon will be required to develop guidelines for lithium in drinking water that are maximally protective of the entire population,” wrote Dr. David C. Bellinger, a professor of neurology and psychology at Harvard Medical School. “Until the basic biology of ASD is better understood, it will be difficult to distinguish causal from spurious associations.”

Dr. Max Wiznitzer, director of the Rainbow Autism Center at University Hospitals Rainbow Babies and Children’s Hospital in Cleveland, points to other research on the effects of lithium on pregnant people who take it for mental health disorders. Those studies – which look at people exposed to much higher levels than are found in drinking water – do not show a connection with autism spectrum disorder.

“It’s an interesting association, but causation is definitely not proven,” said Wiznitzer, who was not involved in the new research. “We have to see if there’s a viable and biologically plausible mechanism by which a small amount of lithium in the water supply can somehow do this, yet pharmacologic dosing of lithium in women with bipolar disorder has not been reported to be causing increased risk of ASD.”

Other studies have also suggested connections between ASD and environmental exposures to things like pesticides, air pollution and phthalates. But none of them points to any of these factors as a direct cause of the disorder.

A link between environmental exposure and ASD is hard to prove, Wiznitzer said. With research showing that increased exposure to air pollution raises the risk of giving birth to a child with ASD, for example, he often wonders whether pollution is the determining factor or if it’s just the populations who live in more polluted areas.

“There’s a lot of speculation about about environmental factors, but how many of them are truly causally associated?” Wiznitzer said. “We are bombarded with a variety of environmental stressors in our everyday lives. We have to figure out how to basically safely navigate them, and this is probably not one that’s high on our list.”

CNN
 — 

Tennis star Naomi Osaka announced her pregnancy on Wednesday, posting a photo of an ultrasound scan on her social media accounts.

“The past few years have been interesting to say the least, but I find that it’s the most challenging times in life that may be the most fun,” the four-time major champion wrote alongside the photo.

“These few months away from the sport [have] really given me a new love and appreciation for the game I’ve dedicated my life to.”

Osaka said she plans to return to tennis in 2024 for next year’s Australian Open, a tournament she has won on two previous occasions.

“I know that I have so much to look forward to in the future,” she added. “One thing I’m looking forward to is for my kid to watch one of my matches and tell someone, ‘that’s my mom.’”

The 25-year-old’s withdrawal from the upcoming Australian Open was announced by the competition’s organizers on Sunday.

Osaka has not played since the Toray Pan Pacific Open in Tokyo in September last year.

She took some time away from competitive tennis and made several highly publicized disclosures about her struggles with mental health following an incident in August 2021, where she was visibly stressed and emotional while addressing the media during a mandatory news conference at Roland Garros.

Osaka subsequently pulled out of the French Open that year and revealed she had “suffered long bouts of depression” since winning her first major championship in 2018.

“I don’t think there’s a perfectly correct path to take in life but I always felt that if you move forward with good intentions you’ll find your way eventually,” Osaka added in her statement on Wednesday.