By Sono Motoyama, Pittsburgh Post-Gazette

PITTSBURGH — Depending on where you shop and in which aisle, you may have noticed the colorful packaging of “gut sodas” taking up shelf space.

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These sodas may contain probiotics or prebiotics and they may or may not contain sugar or sugar substitutes. But as the newest category of “functional beverages,” they do seem to suggest that they will help your digestive system.

Recently, big players like Coca-Cola and PepsiCo have gotten into the game, as well as celebrity investors Gwyneth Paltrow, Mindy Kaling and the Jonas Brothers.

“Fizzy, fruity, tangy, spicy, gutsy,” proclaims the wording on a can of Culture Pop.

“Trust your gut!” says Cove Soda.

“Soda’s back,” the Poppi can says, implicitly acknowledging that we all know the empty calories of the previous generation of sugared sodas are not good for you.

During a quick drive around the Pittsburgh area, I found the widest selection and most prominent display of gut sodas at Whole Foods. The Target and Walmart I went to both had the sodas, but they were not as conspicuous. At the big-box stores, pride of place still seems to be reserved for another type of functional beverage that’s been around awhile: “energy drinks,” i.e., drinks loaded with caffeine.

Gut sodas were absent at the gas stations I visited. Maybe that’s understandable.

When you’re trapped in your car, you may not want to be thinking about what the “1 billion CFU [colony-forming units] probiotics” in Cove Soda are doing to your intestines.

Deciphering the label

Your digestive system contains trillions of microorganisms — the gut microbiome. Maintaining a healthy gut is important for overall health via factors like facilitating proper digestion and maintaining metabolism and immunity, according to the American Medical Association.

If you’re interested enough in your health to be curious about gut sodas, presumably you’d want to know what’s in them and how they work.

But as the three brands I tried demonstrated, figuring that out is not so easy. They all have different stuff in them, so you must be able to read and comprehend the small type.

An advanced degree in biology would not be amiss — and a pair of reading glasses.

For help, I turned to Paige Langhals-Totino, a nutrition specialist who works in Allegheny Health Network’s gastroenterology division. She also sees patients who are interested in weight management.

First of all, what’s the difference between prebiotics and probiotics?

“Probiotics are usually live microorganisms that are meant to rebuild the healthy gut bacteria,” she said.

They may come in capsules, powders, liquids and in drinks such as kombucha.

What about those 1 billion CFUs in Cove Soda? That sounds like a lot.

“It sounds like a lot,” Langhals-Totino agreed.

The theory goes that the more CFUs there are, the more likely it is that some of those beneficial organisms will survive your stomach acid and do some good in your gut, she said. The problem is that we do not know how many organisms will guarantee that benefit.

“You could take 1 billion versus 5 billion and still have the same outcome,” she said.

Prebiotics, on the other hand, are fiber alternatives or fiber-based products, Langhals-Totino said.

“It’s a food source that is meant to fuel the good bacteria that is already in the GI tract.”

Do they help?

That all sounds very scientific, but is there evidence that drinking a soda or taking a supplement actually has a health benefit?

Langhals-Totino said that for both prebiotic and probiotic supplements, “we have very much mixed data.”

The prebiotic soda Poppi ran into trouble with its exhortation to “Be Gut Happy. Be Gut Healthy.” The company, which was acquired by PepsiCo this month, faced a class-action lawsuit for false health claims. It settled for $8.9 million.

There are studies that say prebiotics and probiotics are helpful, but others that show no benefit. In the case of prebiotics, there is also evidence that promoting only one strain of beneficial bacteria — as these sodas may do — can in fact create an imbalance in the multitude of species in your gut if consumed over a long period of time, according to the academic medical center Henry Ford Health.

If there is an existing imbalance, it is difficult to know which strain may be of most benefit to you.

Langhals-Totino takes a case-by-case approach.

“Usually what I counsel my patients is, how do they feel when they’re taking it?” she said. “There’s no harm in doing a probiotic or doing a prebiotic that is not causing them new symptoms or worsening of any GI symptoms they already have.”

She said prebiotics, like fiber in general, can lead to bloating and discomfort. Carbonation in the soda may have the same effect. Particularly for patients with irritable bowel syndrome, she recommends caution.

“They’re the ones who are going to be at highest risk to see the side effects of bloating, increased gas production, nausea and discomfort,” she said of IBS patients.

Then there’s the question of sugar substitutes, which some studies paradoxically suggest may actually lead to weight gain, rather than the opposite. Some have also been linked to a reduction in the diversity of the microbiome.

How do they taste?

In my weeklong trial, I can’t say I noticed any particular effects — either positive or negative — on my, uh, gut health. The factors more likely to influence my drinking them in the future are their price and taste.

They are all more expensive than a regular can of soda, but hovering at around $2 each, they’re affordable as an occasional indulgence.

Though I don’t mind the taste of Coke Zero (which contains the sweeteners sucralose and acesulfame-k), generally speaking, I dislike the aftertaste of most sugar substitutes. That put a strike against two out of the three sodas I tried immediately.

–Cove Soda, Dr. Cove flavor. At $2.21 at Whole Foods, this was the most expensive of the sodas I tried. It contains 0 calories, using erythritol as a sugar substitute, and the aforementioned billion CFUs of the probiotic Bacillus subtilis DE111, according to the can. It had an odd orange-brown color and produced a high orange-colored head. It is a reasonable facsimile of Dr. Pepper, though it does not contain caffeine.

–Culture Pop, orange, mango and lime flavor. $1.88. I immediately loved this soda, from the pleasing peach-pink color that made me feel like I was drinking a cosmopolitan to the light fizziness and subtle flavor. Sweetened with fruit juice, it has 45 calories (compared to 140 in a can of regular Coke) and live Bacillus subtilis cultures, according to the can. Its Amazon listing further explains that each can contains “billions of CFUs of live probiotics at the time of canning.” A soda for adults, this was easily my favorite of those I tried (and also the cheapest).

–Poppi, strawberry-lemon flavor. $1.99. On the opposite end of the flavor spectrum from Culture Pop was the aggressive, candy-like taste of the Poppi strawberry-lemon soda. With 6% juice, it contains 30 calories and is also sweetened with agave inulin (both a prebiotic and sweetener) and stevia leaf extract. Besides agave inulin, it also includes cassava root fiber, presumably for its prebiotic and other potential health benefits. It was like drinking a Starburst fruit chew, but with that stevia aftertaste.

The takeaway

Rather than for any gut-health benefit, Langhals-Totino would more likely recommend these sodas to patients who are trying to lose weight, as a substitute for sugary sodas.

“If the patient likes it, if they’re seeing a benefit, I encourage them to continue it as a step to stay away from regular soda,” she said. But she wouldn’t “prescribe” them.

For digestive health, she suggests fermented foods like kombucha, sauerkraut or kimchi. For a hit of both probiotics and prebiotics, she recommends a low-sugar yogurt with live cultures mixed with berries or other fruit.

©2025 PG Publishing Co. Visit at post-gazette.com. Distributed by Tribune Content Agency, LLC.

By Madyson Fitzgerald, Stateline.org

While on her way home from a co-working space in Denver last year, Colorado state Rep. Jenny Willford says she was sexually assaulted by her Lyft driver.

In her lawsuit filed against Lyft in January, Willford alleges she was “subjected to unwelcome, nonconsensual sexual contact, touching” and lewd comments during the ride.

Willford was picked up by a different driver than the person identified in the Lyft app, according to the suit.

Her experience — and those that other survivors shared with her after hearing her story — prompted Willford, a Democrat, to introduce legislation this year that aimed to require safety measures for both riders and drivers using ridesharing apps.

“In my mind, all of these things are very basic when it comes to safety,” Willford said. “They’re just so common sense that it’s been really disheartening and frustrating to me that Uber … threatened to leave the state if the bill becomes law.”

Her bill would have required rideshare companies to conduct more regular background checks for drivers, to create a program for passengers or drivers who want to audio or video record their rides and to develop other safety policies.

But following Uber’s threats to leave the state if the measure passed, Colorado Democratic Gov. Jared Polis vetoed it in late May. The bill would jeopardize rideshare services in Colorado “to an untenable degree, and could very well lead to companies that Coloradans rely on exiting the market, raising prices, or reducing the number of drivers,” his veto letter said.

Colorado isn’t alone. State and city leaders across the country are looking for ways to make rideshares safer. But lobbying campaigns from Uber and Lyft in many cases are blocking legislation meant to strengthen protections for both drivers and passengers.

Uber and Lyft, the two companies that dominate the U.S. rideshare industry, argue they have sufficient safety features within their apps.

“At Uber, we put safety at the heart of our operations, using technology, transparency, and accountability to help protect riders, drivers, and the broader community, with robust background checks and safety features like Audio and Video Recording, the Emergency Button, PIN verification, and RideCheck,” Uber wrote in a statement to Stateline.

“We remain committed to this work, and to dialogue with bill sponsors on sensible policies that keep people safe while protecting privacy and access.”

But there’s still a gap in regulations for rideshare companies because of their evolving technologies, said Lorena Roque, the interim director of education, labor and worker justice at The Center for Law and Social Policy, a left-leaning anti-poverty advocacy organization.

“Working on an app-based platform — like with delivery workers and rideshare workers — that sort of work is relatively new, so there’s not a clear standard,” Roque said.

Uber and Lyft are employing lobbyists at the state and local levels. In Rhode Island, another state where legislators are pushing rideshare safety bills that the companies have objected to, Uber is on pace to spend $50,000 this year on lobbyists, according to the state’s lobbying database. Lyft has been spending $5,000 monthly on lobbyists in Rhode Island.

Across the country, Uber and Lyft have testified against measures in state legislative hearings and city council meetings. In Colorado’s case, a number of officials representing Uber spoke out against Willford’s legislation at committee hearings, while Lyft sent a letter to Polis urging him to veto it. Jerry Golden, Lyft’s chief policy officer, wrote in the letter that the legislation’s requirements “ignore and ultimately will not improve conditions for riders and drivers.”

Uber told the state Senate it would be “impossible” for rideshare companies to comply with the bill’s requirements immediately upon approval and that the audio and video requirement is “not possible to enforce.”

“The intention of my legislation was never to drive out Uber or Lyft,” Willford said. “The intention was always to require a higher level of accountability and safety from them. But we can’t do that if they’re going to throw tantrums and pick up their toys and go home every time somebody asks them to do better.”

Safety for passengers

As a part of Lyft’s safety measures, drivers must complete annual background checks and mandatory driver safety education. The app is also programmed to check in with riders when drivers take long stops or deviate from the route they were assigned.

Uber conducts periodic criminal screenings for all active drivers and requires drivers to regularly verify their identity by sharing a selfie with Uber using the app. Both companies offer live emergency assistance to riders.

Between 2020 and 2022, Lyft reported 23 fatal physical assaults of people using the Lyft platform and 2,651 instances of the five most serious categories of sexual assault, according to its 2024 Safety Transparency Report. While incidents of sexual assault had decreased 21% since the last report, which covered 2017-19, fatal physical assaults jumped by 185%.

Uber saw 36 physical assault fatalities in 2021 and 2022 and 2,717 incidents of the most serious categories of sexual assault, according to the company’s most recent safety report. Despite a 22% decline in sexual assault and misconduct, there was an increase in fatal physical assaults since its 2019-20 report.

State lawmakers in several states have tried to address rideshare safety concerns with varying degrees of success.

Pending legislation in New Jersey and Massachusetts aims to prevent sexual assault and misconduct against passengers.

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The New Jersey measure would require rideshare companies to share information concerning sexual misconduct investigations into a driver and would allow companies to ban drivers during an investigation. It remains in committee.

The bill in Massachusetts, introduced by Democratic state Sen. Rebecca Rausch, would create a specific criminal penalty for the sexual assault of a passenger by a rideshare driver. The bill also would deem any rideshare passenger incapable of consenting to any sexual contact during a ride. A hearing on the bill took place this month.

“We need to be able to make sure that people are safe and that people can trust those kinds of spaces to be safe,” Rausch said.

In May, Florida Republican Gov. Ron DeSantis signed legislation that creates criminal penalties for impersonating a rideshare driver. Starting July 1, the crime counts as a second-degree misdemeanor. Uber supported the legislation.

But in Rhode Island, Lyft is pushing against legislation that would require fingerprinting as part of criminal background check. Brendan Joyce, the Lyft public policy manager, testified against the measure in April, saying the fingerprinting requirement relies on the FBI’s Criminal Justice Information System, which Joyce said has incomplete data. He also asserted that fingerprint checks “disproportionately impact and have potential discriminatory effects on communities of color.” Uber also testified against the proposal.

Rhode Island legislators introduced another measure that would prevent people under the age of 16 from using a rideshare service alone. Both bills are being held for further study.

Driver protections

JC Muhammad, 57, has been a rideshare driver in and around Chicago since about 2016.

Now, he works full time as an organizer for faith-based organizations and groups that support rideshare drivers, including The People’s Union, a membership-driven organization aimed at supporting workers in the city.

Muhammad was attacked by a passenger during a Lyft ride in 2022, he said. The passenger asked to borrow Muhammad’s phone and opened its Cash App. The passenger also hit him over the head twice, he said, and threw a brick at his car, denting the side.

“I was angry as hell,” Muhammad said. “I really wanted to engage the kid, but I said, ‘No, let me get back in my car.’”

After sharing the incident with Lyft, the company responded by saying it would not match him with that passenger again. But the person who rode with Muhammad did not match the profile of the person who originally requested the ride, he said.

Muhammad also said he couldn’t go to the police because he did not know the identity of the person who was in his car — and Lyft would not share the identity of the account holder who ordered the Lyft.

Uber and Lyft customers have the option to verify their account, but not everyone does, Muhammad said.

“That gives us some measure of comfort, but it really doesn’t do enough, especially when it comes to calling rides for other people,” Muhammad said. “The account holder may not be the actual passenger.”

Rideshare drivers across the country — especially those of color — are frequently harassed, according to a 2023 report from the Strategic Organizing Center. The center is a coalition of labor unions representing more than 2.5 million workers across the country.

The survey of over 900 app-based rideshare drivers found the majority had been verbally abused and more than a quarter of respondents were threatened with physical harm. Nearly 15% of the drivers were grabbed, groped or hit, according to the report.

There have been several incidents in Chicago where drivers are lured by a false account to a location where they are then robbed or attacked, said Deana Rutherford, the communications manager at the Chicago Gig Alliance, a subset of The People’s Lobby.

“These drivers just show up and they have no idea who’s about to get into their car,” Rutherford said. “And Uber doesn’t know who they are either.”

To address some of the safety and labor issues drivers were facing, the Chicago City Council began considering an ordinance backed by The People’s Lobby that would require passenger verification.

If passed, the ordinance would have also set a minimum wage for drivers, require companies to be more transparent about fares, have them disclose the details of driver account deactivations and more. Both Uber and Lyft initially opposed the ordinance. Uber warned the measure’s sponsor that the changes in pay rates would drive up costs for customers and force the company to cut 10,000 drivers, according to a letter Uber sent to a city alderman that was obtained by Stateline.

But Uber this month agreed to a deal that scraps Chicago’s ordinance in exchange for the company’s support for state legislation that would allow rideshare drivers to unionize, the Chicago Sun Times reported.

©2025 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By CEDAR BURNETT, Associated Press

In this age of heightened anxiety, many of us turn to our pets for emotional support. But is our behavior increasing our furry friends’ fears?

The answer isn’t simple, says Frankie Jackson, a veterinary nurse and animal behavior consultant, and the owner of Canine Counseling in Smyrna, Georgia. She said she’s seen an increase in anxiety among her animal and human clients, but that it’s hard to unwind the cause and effect.

“Dogs are incredibly responsive to our expressions, our body language and our scent,” she says. “There is a feedback loop — the owners are nervous; the dog gets nervous. Our cortisol levels rise and fall in tandem.”

Dr. Becky Peters, a veterinarian and owner of Bath Veterinary Hospital in Bath, New York, has also noticed a link between the anxiety of pets and their owners, particularly in the exam room.

“If owners try to over comfort them — lots of ‘you’re OK!’” in anxious voices, the animals do get more anxious. If we stay calm and quiet, they do too,” Peters says.

This undated photo released by Dr. Becky Peters, a veterinarian and owner of Bath Veterinary Hospital in Bath, N.Y., shows Peters with her dog. (AP Photo/Becky Peters)

Peters attributes much of the rise in pet anxiety to the social upheaval of the COVID years. Many animals who were acquired during the pandemic had limited opportunities to socialize with other people and pets during their peak developmental stages. After COVID, pets who were used to having their family at home experienced separation anxiety as their owners returned to work and school.

“A lot of pet anxiety comes from changes to their households,” Peters says. “It can also occur from a lack of routine and structure and not enough physical activity.”

Other components that could contribute to our pets’ anxiety include unmet needs, past trauma and insufficient open spaces.

“We are asking our dogs to live in a world that isn’t made for them,” she says.

Try to get at the cause of your pet’s anxiety

Low-level stress responses in dogs, such as eating less and excessive self-grooming, are forms of communication that precede lunging and barking, Jackson says. Trying to solve reactive behaviors through obedience training without addressing the root cause can make dogs’ anxiety worse.

“It’s important to understand what the dogs are saying and why they’re behaving the way they are. Manners and life skills are important, but it won’t create happy dogs,” Jackson says.

Anxiety in cats can be harder to spot, according to Jackson, because they’re hard-wired to hide it. While dogs seek out their support people, cats don’t feel safe expressing their vulnerability. Urinating in the house, scratching, hiding under the bed and overgrooming can be signs that your kitty is anxious.

First, see a vet

If your animal companion is suddenly acting out or on a licking binge, Jackson advises seeing a veterinarian to rule out a medical cause, such as pain or allergies.

Veterinarians can also prescribe anti-anxiety medication and complementary treatments to promote sleep and relaxation. Peters recommends supplements for her canine clients including probiotics and the amino acids l-theanine and tryptophan (yes, the turkey coma one).

For cats, she suggests using a product like Feliway that diffuses calming pheromones into the air.

Learn about the breed

A dog’s breed might also play a part in developing anxiety. Peters says that while every dog is different, the more active herding and working breeds like shepherds and border collies can become anxious and destructive without an outlet for their energy.

“Herding breeds need space to run and jobs to do,” she says.

When Tacoma, Washington, resident Shelani Vanniasinkam got her Australian shepherd puppy, Roo, she didn’t know about the breed’s reputation for anxiety. Her previous dog had been an easygoing husky who enjoyed pats from strangers and visits to the dog park. She quickly realized Roo was not that type of dog.

“He had a lot more needs than we anticipated,” Vanniasinkam says. “We couldn’t leave him alone for more than 30 minutes.”

This undated photo released by Shelani Vanniasinkam shows her dog Roo appears by an obstacle course at one of his favorite Sniffspots in Puyallup, Wash. Sniffspots are locations that pet owners can rent by the hour for solo off-leash dog play. (AP Photo/Shelani Vanniasinkam)

Vanniasinkam and her husband, Jesus Celaya, reached out to a local pet behavioralist, but it became clear that Roo’s anxiety was so acute he needed medication before he could start behavior training.

Should you consider meds for an anxious pet?

Medication can be important in behavioral treatment, but it shouldn’t be the only approach, says Peters. She usually suggests that her clients try training and routine modification first, unless their pet is causing harm to themselves or others.

“If I’m going to use meds, it’s part of a greater process,” Peters says.

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Roo’s veterinarian put him on Fluoxetine, or “doggie Prozac,” an antidepressant commonly given to anxious pets. He also prescribed Trazodone, another antidepressant, for particularly stressful events, such as trips to the vet or a night of fireworks.

After starting his medication, Roo received eight months of behavior training, during which Vanniasinkam and her husband not only changed their own approach to dog parenting but also set boundaries with friends and family. They limited Roo’s interaction with other dogs, asked people to stop using their doorbell and requested that others ignore Roo when he barks.

Now, when they want to take Roo for off-leash play, they book time at a local Sniffspot, which Vanniasinkam describes as “an Airbnb for anxious and reactive dogs.” The company, which launched in 2016, allows homeowners to rent out their yards or property by the hour for solo, off-leash play or doggie playdates.

“It’s sad when you can’t take your dog to a dog park,” Vanniasinkam says. “So, this option is really nice.”

She says that while it was initially difficult to navigate Roo’s anxiety, he is loving, family-oriented and worth the effort.

“It’s hard having an anxious dog, but you can figure it out,” she says. “It’s just important to understand your dog, so you’re set up for success.”

By Claire Sibonney, KFF Health News

Ali Foley Shenk still remembers the panic when her 10-year-old son, Dean, finished a 20-ounce box of raisins in the seconds the cupboard was left unlocked. They rushed to the emergency room, fearing a dangerous bowel impaction.

The irony stung: When Dean was born, he was so weak and floppy he survived only with feeding tubes because he couldn’t suck or swallow. He was diagnosed as a baby with Prader-Willi syndrome — a rare disorder sparked by a genetic abnormality. He continued to be disinterested in food for years. But doctors warned that as Dean grew, his hunger would eventually become so uncontrollable he could gain dangerous amounts of weight and even eat until his stomach ruptured.

“It’s crazy,” said Foley Shenk, who lives in Richmond, Virginia. “All of a sudden, they flip.”

Prader-Willi syndrome affects up to 20,000 people in the U.S. The most striking symptom is its most life-threatening: an insatiable hunger known as hyperphagia that prompts caregivers to padlock cupboards and fridges, chain garbage cans and install cameras. Until recently, the only treatment was growth hormone therapy to help patients stay leaner and grow taller, but it didn’t address appetite.

In March, the Food and Drug Administration approved Vykat XR, an extended-release version of the existing drug diazoxide choline, which eases the relentless hunger and may offer insights into the biology of extreme appetite and binge eating. This breakthrough for these patients comes as other drugs are revolutionizing how doctors treat obesity, which affects more than 40% of American adults. GLP-1 agonist medications Ozempic, Wegovy and others also are delivering dramatic results for millions.

But what’s becoming clear is that obesity isn’t one disease — it’s many, said Jack Yanovski, a senior obesity researcher at the National Institutes of Health, who co-authored some of the Vykat XR studies. Researchers are learning that obesity’s drivers can be environmental, familial or genetic. “It only makes sense that it’s complex to treat,” Yanovski said.

Obesity medicine is likely heading the way of treatments for high blood pressure or diabetes, with three to five effective options for different types of patients. For example, up to 15% of patients in the GLP-1 trials didn’t respond to those drugs, and at least one study found the medications didn’t significantly help Prader-Willi patients.

Yet, researchers say, efforts to understand how to treat obesity’s many causes and pathways are now in question as the Trump administration is dismantling the nation’s infrastructure for medical discovery.

While Health and Human Services Secretary Robert F. Kennedy Jr. promotes a “Make America Healthy Again” agenda centered on diet and lifestyle, federal funding for health research is being slashed, including some grants that support the study of obesity. University labs face cuts, FDA staffers are being laid off en masse, and rare disease researchers fear the ripple effects across all medical advances. Even with biotech partnerships — such as the work that led to Vykat XR — progress depends on NIH-funded labs and university researchers.

“That whole thing is likely to get disrupted now,” said Theresa Strong, research director for the Foundation for Prader-Willi Research.

HHS spokesperson Andrew Nixon said in a statement that no NIH awards for Prader-Willi syndrome research have been cut. “We remain committed to supporting critical research into rare diseases and genetic conditions,” he said.

But Strong said that already some of the contacts at the FDA she’d spent nearly 15 years educating about the disorder have left the agency. She’s heard that some research groups are considering moving their labs to Europe.

Ali Foley Shenk, left, and her son Dean, at their home in Richmond, Virginia. (Parker Michels-Boyce/KFF Health News/TNS)

Early progress in hunger and obesity research is transforming the life of Dean Shenk. During the trial for Vykat XR, his anxiety about food eased so much that his parents began leaving cupboards unlocked.

Jennifer Miller, a pediatric endocrinologist at the University of Florida who co-led the Vykat XR trials, treats around 600 Prader-Willi patients, including Dean. She said the impact she’s seen is life-changing. Since the drug trial started in 2018, some of her adult patients have begun living independently, getting into college, and starting jobs — milestones that once felt impossible. “It opens up their world in so many ways.”

Over 26 years in practice, she’s also seen just how severely the disease hurts patients. One patient ate a four-pound bag of dehydrated potato flakes; another ingested all 10 frozen pizzas from a Costco pack; some ate pet food. Others have climbed out of windows, dived into dumpsters, even died after being hit by a car while running away from home in search of food.

Low muscle tone, developmental delays, cognitive disabilities and behavioral challenges are also common features of the disorder.

Dean attends a special education program, his mother said. He also has narcolepsy and cataplexy — a sudden loss of muscle control triggered by strong emotions. His once-regular meltdowns and skin-picking, which led to deep, infected lesions, were tied to anxiety over his obsessive, almost painful urge to eat.

In the trial, though, his hyperphagia was under control, according to Miller and Dean’s mother. His lean muscle mass quadrupled, his body fat went down, and his bone mineral density increased. Even the skin-picking stopped, Foley Shenk said.

Vykat XR is not a cure for the disease. Instead, it calms overactive neurons in the hypothalamus that release neuropeptide Y — one of the body’s strongest hunger signals. “In most people, if you stop secreting NPY, hunger goes away,” said Anish Bhatnagar, CEO of Soleno Therapeutics, which makes the medication, the company’s first drug. “In Prader-Willi, that off switch doesn’t exist. It’s literally your brain telling you, ‘You’re starving,’ as you eat.”

GLP-1 drugs, by contrast, mimic a gut hormone that helps people feel full by slowing digestion and signaling satiety to the brain.

Vykat XR’s possible side effects include high blood sugar, increased hair growth and fluid retention or swelling, but those are trade-offs that many patients are willing to make to get some relief from the most devastating symptom of the condition.

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Still, the drug’s average price of $466,200 a year is staggering even for rare-disease treatments. Soleno said in a statement it expects broad coverage from both private and public insurers and that the co-payments will be “minimal.” Until more insurers start reimbursing the cost, the company is providing the drug free of charge to trial participants.

Soleno’s stock soared 40% after the FDA nod and has held fairly steady since, with the company valued at nearly $4 billion as of early June.

While Vykat XR may be limited in whom it can help with appetite control, obesity researchers are hoping the research behind it may help them decode the complexity of hunger and identify other treatment options.

“Understanding how more targeted therapies work in rare genetic obesity helps us better understand the brain pathways behind appetite,” said Jesse Richards, an internal medicine physician and the director of obesity medicine at the University of Oklahoma-Tulsa’s School of Community Medicine.

That future may already be taking shape. For Prader-Willi, two other notable phase 3 clinical trials are underway, led by Acadia Pharmaceuticals and Aardvark Therapeutics, each targeting different pathways. Meanwhile, hundreds of trials for general obesity are currently recruiting despite the uncertainties in U.S. medical research funding.

That brings more hope to patients like Dean. Nearly six years after starting treatment, the now-16-year-old is a calmer, happier kid, his mom said. He’s more social, has friends, and can focus better in school. With the impulse to overeat no longer dominating his every thought, he has space for other interests — “Star Wars,” “American Ninja Warrior” and a healthy appreciation for avocados among them.

“Before the drug, it just felt like a dead end. My child was miserable,” Foley Shenk said. “Now, we have our son back.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.