Sex to burn calories? Authors expose obesity myths

Fact or fiction? Sex burns a lot of calories. Snacking or skipping breakfast is bad. School gym classes make a big difference in kids' weight.

All are myths or at least presumptions that may not be true, say researchers who reviewed the science behind some widely held obesity beliefs and found it lacking.

Their report in Thursday's New England Journal of Medicine says dogma and fallacies are detracting from real solutions to the nation's weight problems.

"The evidence is what matters," and many feel-good ideas repeated by well-meaning health experts just don't have it, said the lead author, David Allison, a biostatistician at the University of Alabama at Birmingham.

Independent researchers say the authors have some valid points. But many of the report's authors also have deep financial ties to food, beverage and weight-loss product makers — the disclosures take up half a page of fine print in the journal.

"It raises questions about what the purpose of this paper is" and whether it's aimed at promoting drugs, meal replacement products and bariatric surgery as solutions, said Marion Nestle, a New York University professor of nutrition and food studies.

"The big issues in weight loss are how you change the food environment in order for people to make healthy choices," such as limits on soda sizes and marketing junk food to children, she said. Some of the myths they cite are "straw men" issues, she said.

But some are pretty interesting.

Sex, for instance. Not that people do it to try to lose weight, but claims that it burns 100 to 300 calories are common, Allison said. Yet the only study that scientifically measured the energy output found that sex lasted six minutes on average — "disappointing, isn't it?" — and burned a mere 21 calories, about as much as walking, he said.

That's for a man. The study was done in 1984 and didn't measure the women's experience.

Among the other myths or assumptions the authors cite, based on their review of the most rigorous studies on each topic:

—Small changes in diet or exercise lead to large, long-term weight changes. Fact: The body adapts to changes, so small steps to cut calories don't have the same effect over time, studies suggest. At least one outside expert agrees with the authors that the "small changes" concept is based on an "oversimplified" 3,500-calorie rule, that adding or cutting that many calories alters weight by one pound.

—School gym classes have a big impact on kids' weight. Fact: Classes typically are not long, often or intense enough to make much difference.

—Losing a lot of weight quickly is worse than losing a little slowly over the long term. Fact: Although many dieters regain weight, those who lose a lot to start with often end up at a lower weight than people who drop more modest amounts.

—Snacking leads to weight gain. Fact: No high quality studies support that, the authors say.

—Regularly eating breakfast helps prevent obesity. Fact: Two studies found no effect on weight and one suggested that the effect depended on whether people were used to skipping breakfast or not.

—Setting overly ambitious goals leads to frustration and less weight loss. Fact: Some studies suggest people do better with high goals.

Some things may not have the strongest evidence for preventing obesity but are good for other reasons, such as breastfeeding and eating plenty of fruits and vegetables, the authors write. And exercise helps prevent a host of health problems regardless of whether it helps a person shed weight.

"I agree with most of the points" except the authors' conclusions that meal replacement products and diet drugs work for battling obesity, said Dr. David Ludwig, a prominent obesity research with Boston Children's Hospital who has no industry ties. Most weight-loss drugs sold over the last century had to be recalled because of serious side effects, so "there's much more evidence of failure than success," he said.

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Online:

Obesity info: http://www.cdc.gov/obesity/data/trends.html

New England Journal: http://www.nejm.org

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Man behind Manti Te'o hoax wants to 'heal'

The 22-year-old Palmdale man who created Manti Te'o's fake girlfriend broke his silence for the first time, saying he perpetrated the elaborate hoax to build a relationship with the football star.

Ronaiah Tuiasosopo pretended to be Te'o's girlfriend, Lennay Kekua, for months, communicating on the phone and through social media. Tuiasosopo went so far as to disguise his voice to sound like a woman's when he spoke to Te'o on the phone, his attorney, Milton Grimes, said in an interview with The Times.

Grimes said his client decided to come clean about the hoax in an attempt to "heal."

"He knows that if he doesn't come out and tell the truth, it will interfere with him getting out of this place that he is in," Grimes said.

TV talk show host Dr. Phil McGraw, who spoke with Tuiasosopo for an interview set to air this week, described the 22-year-old as "a young man that fell deeply, romantically in love" with Te'o. McGraw, speaking on the "Today" show, said he asked Tuiasosopo about his sexuality, and Tuiasosopo said he was "confused."

In a short clip of the "Dr. Phil" interview, Tuiasosopo told McGraw that he wanted to end his relationship with Te'o because he "finally realized that I just had to move on with my life."

"There were many times where Manti and Lennay had broken up before," Tuiasosopo said. "They would break up, and then something would bring them back together, whether it was something going on in his life or in Lennay's life — in this case, in my life."

Tuiasosopo's comments add another twist to a story so bizarre that reporters from across the country have converged on Tuiasosopo's home in the Antelope Valley. News of the hoax was first reported earlier this month on the website Deadspin.com.

Tuiasosopo, the report said, was the mastermind behind the hoax and used photos from an old high school classmate and social media to connect Kekua with Te'o.

During the college football season, Te'o repeatedly spoke to the media, including The Times, about his girlfriend, the car accident that left her seriously injured and the leukemia that led to her September death. The tale became one of the most well-known sports stories of the year as Te'o led his team to an undefeated season and championship berth.

Te'o has denied any role in the ruse, saying he spent hours on the phone with a woman he thought was Kekua.

Those who know Tuiasosopo said they were baffled when they first learned of his involvement in the hoax. Neighbors and former high school coaches described him as popular, faith-driven and family-oriented.

"I've done a lot of thinking about it," Jon Fleming, Tuiasosopo's former football coach at Antelope Valley High, said in the days after the ruse was revealed. "It's all speculation. He's goofy just like any other kid. The question that comes up in my mind is: 'What could he possibly gain from doing something like this?' It would really surprise me. What would he gain?"

Te'o said in an interview with ESPN that Tuiasosopo called to apologize for the hoax.

"I hope he learns," Te'o said. "I hope he understands what he's done. I don't wish an ill thing to somebody. I just hope he learns. I think embarrassment is big enough."

Diane O'Meara, the Long Beach woman whose photos were used to represent the fake girlfriend, said in an interview with The Times that Tuiasosopo was a high school classmate.

She said he repeatedly asked her for photos and videos of herself.

O'Meara, 23, said that during a six-day period in December, Tuiasosopo contacted her through social media, texting and phone calls about 10 times, asking her to send a photo of herself. Then, after she sent the photo, in part to "get this guy off my back," she said Tuiasosopo messaged her asking for a video clip or another photo.

By that time, his requests were "kind of annoying, kind of pestering," O'Meara said.

Tuiasosopo is seeing a medical professional and "feels as though he needs therapy," Grimes said.

"Part of that therapy is to … tell the truth," he added. "He did not intend to harm [Te'o] in any way. It was just a matter of trying to have a communication with someone."

Grimes said he warned his client that he could face legal consequences for admitting that he falsified his identity on the Internet. But Tuiasosopo insisted that going public was something he had to do.

"This is part of my public healing," Grimes quoted Tuiasosopo as saying.

matt.stevens@latimes.com

ann.simmons@latimes.com

kate.mather@latimes.com

Times staff writers Kevin Baxter and Lance Pugmire contributed to this report.

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Lens Blog: Lynsey Addario's Photographs of Women in Combat

Lynsey Addario, a  photographer for The New York Times, has extensively covered the war in Afghanistan, often focusing on female soldiers. She spoke with James Estrin about the Pentagon’s recent lifting of the ban on women in combat. The conversation, which took place via Skype from her home in London has been edited.

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When I heard about the lifting of the ban on women in combat, I thought about your coverage of female soldiers for The Times, and also about the interview we did about women covering conflict after you were freed from captivity in Libya. What was your reaction to the announcement?

Profile

Lynsey Addario

Lynsey Addario, who freelances for The New York Times, The New York Times Magazine and others, has previously appeared on Lens Blog.

It is a huge step historically, of course, but it’s actually just stating publicly what has been happening little by little over the past decade. Women have been fighting this war more and more, whether we acknowledge it or not.

They’re at bases all across Afghanistan, and they’re playing different roles – from black ops pilots to doing triage in forward-operating medical centers. They’re engaging women in villages of Helmand that are covered with landmines. They are getting shot at. They are dying, and they are getting injured.

Everyone can fight about whether women should be on the front lines, but the fact is that they are out there. So, at some point, you have to acknowledge it and compensate them for it or at least give them the dignity of saying “O.K., you’re out there, and thank you for it.” Instead of saying, “No, they’re not allowed,” but really, they are.

You’ve often focused on female soldiers.

Mostly in 2009 and 2010. Most of the work I shot on assignment for The New York Times when I was doing a series with Elisabeth Bumiller. And then when I was doing the big National Geographic story on women in Afghanistan, I did a few embeds focusing on female soldiers who would meet Afghan women. That work is so dear to me, and I loved shooting it.

Who are these women joining the military and wanting to be in combat?

They’re women who don’t feel inhibited by their sex, by their gender. I mean, they’re women who don’t feel limited by the fact that they were born women. They believe in fighting for their country. They want to be doing something to help fight the wars that we’ve been fighting for over a decade. And they want to be out there.

They’re no different than any of us. They have a goal, and they want to accomplish it. And they don’t want to be told they can’t do it because they’re women.

A lot of them are extremely ambitious, very dedicated. They work out all the time, very intelligent.

What made you want to do this story to pursue it so deeply?

One of the biggest challenges as a photographer is to take a subject that’s been covered for decades and to try to bring something new to it. I’ve been going on these embeds for years, and it’s very hard to make a compelling picture or something new that the reader hasn’t seen before.

When I started seeing women on the front line, I was intrigued.  It felt so strange to me, and I immediately got pulled in. I also had access to them because I was often put in the same tent or made to sleep in the room with all the women. I was always sort of pushed off with the women because on military bases, there’s a real separation. You know, you have to have separate sleeping quarters for women.

What is that you learned as you pursued this story?

I think the longer these wars go on, and the more women are inserted in these nontraditional roles in the military, the more we have to accept the fact that there are actually women on the front lines.

I myself am a woman, and I’ve been embedding for years with the military. And granted, I’m not carrying thousands of rounds of ammunition and the packs that they carry. But I do go on the same patrols that the men go on and I am able to keep up.

There are great differences between men and women in terms of strength and what we can carry and what we can keep up with, but I don’t think it’s necessary for men and women to be equal. I think that women can play a role on the front line without having to hold up the same amount of weight as men.

You said that you don’t have to look at men and women as being equal for women to contribute on the front line. What exactly did you mean?

Well, I think one of the arguments a lot of people have is that women can’t hold their own the way men can. For example, if you have a fellow soldier who’s been shot, can you carry his body alone back to a safe place? And one of the arguments is that a woman couldn’t do that. So therefore, she shouldn’t be out there.

I don’t know how you work around that. I’m not really sure what the answer is. The fact is that women are not as strong as a lot of men. There are some women who are, but I think, over all, it’s going to be a challenge to find women who can keep up with the physical endurance tests that men can. That said, I’m not sure how important that is anymore because the war is changing. The war we fight now is not the same war that was fought 40 years ago.

This is a war on terror, this is a war where the front lines are nebulous.

When we talked about your being on the front lines shortly after you were freed from Libya, you pointed to specific things you thought a woman could bring to the table. A woman may not have the same access to men, but they’re going to have much stronger access to women. And different perspectives. Is there a similar situation for female soldiers on the front line?

This gets back into the discussion about what is the front line. The female engagement teams were created to engage with Afghan women — 50 percent of the population — that we didn’t have access to before. That’s part of the whole counterinsurgency project. So, if you’re trying to win over a population and you don’t have access to 50 percent of the people, it’s going to be very hard.

You can’t do that with men because, traditionally in Afghanistan, men cannot go into a house and sit down with Afghan women. The female engagement teams went in, and they were able to sit down, drink tea and talk to Afghan women.

How much was accomplished is obviously up for discussion. Some people say not that much was accomplished and that they just went and drank tea. Some people say, “Well, they were able to gain trust of families that didn’t before believe that Americans were good people.”

If your doctrine is counterinsurgency, if you’re trying to win over the population, it’s probably worth the effort to go out and try to engage in a country that’s very segregated by the sexes.

I’m older than you, and I remember when there weren’t many women in the military. And there were heated discussions about how women can’t be in the military, how women can’t be captured, how it would harm the other soldiers and it would hurt morale.

Well, I remember when Elizabeth Rubin and I went to the Korengal Valley to embed with the 173rd Airborne. This was for The New York Times Magazine. And Elizabeth wanted to do a story about why, with all the firepower that we had, we weren’t winning the war? And how come there was so much collateral damage? And so basically, we lived on the side of a mountain for two months of the Korengal Outpost.

But when we first asked the press guys with the military to go to that base, they said, “It is not a place fit for women. You cannot go.” And Elizabeth and I said that’s exactly where we want to go. Now we really want to go.

And so finally, we fought so much that they sent us to the Korengal, and we were the only two women there for months. This was before the female engagement teams, and that particular outpost saw heavy fighting all the time. I mean, we were basically shot at or mortared almost on a daily basis.

We kept up with all the patrols. We went on six, seven hour a day patrols. We carried our own stuff. We were out there getting shot at as well. Now, were we carrying guns and ammunition? No. So it’s a very different thing. But we were able to keep up and we were able to live out there.

I think when you start challenging the norms and when you start pushing the boundaries a little, you realize that the boundaries can really be pushed.

Is there anything that you can think of that is a realistic boundary between male and female soldiers?

Yes. I mean, there are times where you need someone who can carry the soldier if he gets shot. Or you need someone who physically can carry a certain amount of rounds of ammunition. I’m not a commander in the military, so there’s a lot I don’t understand.

There are situations where women aren’t really fit to be in certain roles. Special Forces, for example. Do I think women can be in Special Forces? I’m not sure. The demand on the body and spending extended periods of time in the middle of nowhere, I don’t know if that’s O.K. for women.

But I do think there is space for women on the front lines, but it is always going to be defined by what exactly is that front line. Because it’s not Vietnam, we’re in a very different war.  It’s different from 30 years ago, or 20 years ago.

Is the situation of a female foreign correspondent or photojournalist on the front lines similar to that of female soldiers?

It’s different, because the military has layers and layers and layers of command. And so they take decisions as a group.

You know, when you’re dealing with the military, those are decisions that are made at a very high level and passed down. Me, I’m in charge of my own destiny. So I can decide, to a certain extent, how much I want to be in the middle of combat.

One time, we were shot at as I was walking around with one of the female engagement teams. Just because legally, they weren’t allowed to be on the front lines, they were still being shot at on the front lines.

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Follow @lynseyaddario, @JamesEstrin and @nytimesphoto on Twitter. Lens is also on Facebook.

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New BlackBerry to Be ‘Most Comprehensive in Mobile History’

RIM is finally ready with its answer to Apple’s iPhone and the many Android smartphones. After months of delays, RIM CEO Thorsten Heins, along with others from the company, will take the stage Wednesday in New York to unveil the final version of BlackBerry 10, the next version of RIM’s phone software, and the phones that will run it.

“We expect tomorrow to really be the kickoff for the introduction of Blackberry 10,” RIM’s Chief Marketing Officer Frank Boulben told ABC News in a phone interview. “We have been engaged for quite a period of time with the two main constituents — the carriers and the developers — and we’ve already said we are in the labs of more than 150 carriers around the world.”

Column: BlackBerry Burden: What RIM Must Do to Come Back

With more than 150 wireless carriers around the world planning to offer the latest BlackBerry, Boulben says it will be the most “comprehensive launch,” not only for the company, but in the history of the mobile industry.

“This makes it the most comprehensive launch in mobile history. There has never been a platform launching with that many carriers,” he said. When the iPhone 5 made its debut in September it actually had more — Apple said there would be 240 carriers by December. But Boulben points out that BlackBerry 10 is an entirely new operating system that doesn’t share a single line of code with previous BlackBerry software; the iPhone 5 and iOS 6, by contrast, was essentially an upgrade.

At Wednesday’s event the company will show its new handsets in detail. RIM is expected to release a touch-screen device called the Z10 and another with a physical keyboard. AT&T, T-Mobile and Verizon have said they will carry devices that run the new software. Boulben also said RIM will highlight major differences between BlackBerry 10 and the other leading mobile phone platforms.

“We are highly differentiated in four areas,” Boulben said. The first is with communications — RIM has designed the software around a messaging hub and new multitasking features. The second: the touch keyboard, which predicts words as you are typing them. Lastly, RIM says its BlackBerry Messenger and its BlackBerry Balance feature, which separates work from personal uses on the phone, set it apart.

Boulben would not address specifically how much market share RIM is hoping to gain back in the U.S., having lost the lead it had in the last decade. According to Kantar Worldpane ComTech’s data released in November 2012, the BlackBerry brand only had 1.6 percent of the American smartphone market. The iPhone had 48.1 percent of the market and Android had 46.7.

“It’s a change in smartphone experience — the dominant paradigm, introduced six years ago, was great and revolutionary at the time. But six years is a long time for a technology cycle, with a new user experience with a clear focus we have the opportunity to take market share back,” Boulben said.

RIM CMO: BlackBerry 10 Will Make Others Look Outdated

While RIM is of course bullish about its new products, it faces one big challenge it might not be able to control: apps. While the platform might be innovative, it will trail behind the Apple App Store and Google Play Store in variety of apps. Boulben says the momentum around apps is strong and that Wednesday the BlackBerry World store will launch with 70,000 new apps.

RIM BlackBerry 10 Launch

Apps that worked on previous BlackBerry 7 devices won’t work on the BlackBerry 10 platform, since it is completely new. Analysts say that apps are bound to be the pain point for the platform, but it’s not too late to rule out RIM from taking back at least some of what it has lost.

“Given the speed that the market is moving, it’s hard to be dismissive of RIM given the strength of their brand and continued loyalty of many users,” Michael Gartenberg, Gartner Research Director, told ABC News. “It will be important for RIM to show tomorrow how they’ve evolved the BlackBerry to meet the challenges of other platforms and at the same time show positive differentiation.”

And that seems to be exactly RIM’s plan. “The time was right to switch to a new platform, one that will allow us to continue true to our DNA but also take it to the next level,” Boulben said. “It is a major undertaking for the company. It has been two years in the making, but we are ready.”

RIM’s BlackBerry 10 event begins at 10:00 a.m. ET on Jan. 30, 2013. ABC News will be reporting on the news throughout the day.

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Ashley Judd Splits from Husband Dario Franchitti

01/29/2013 at 08:05 PM EST

Ashley Judd and Dario Franchitti

Robin Marchant/Wireimage

Ashley Judd and Dario Franchitti are splitting after more than a decade of marriage.

"We have mutually decided to end our marriage. We'll always be family and continue to cherish our relationship based on the special love, integrity, and respect we have always enjoyed," Judd, 44, and Franchitti, 39, tell PEOPLE exclusively in a statement on Tuesday.

After being engaged for about two years, the Missing star and the racecar driver tied the knot in a highly private ceremony in Scotland in 2001.

Judd's sister, Wynonna Judd, served as maid of honor, while the groom's brother Mario was the best man. – Julie Jordan

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Soldier with new arms determined to be independent

BALTIMORE (AP) — After weeks of round-the-clock medical care, Brendan Marrocco insisted on rolling his own wheelchair into a news conference using his new transplanted arms. Then he brushed his hair to one side.

Such simple tasks would go unnoticed in most patients. But for Marrocco, who lost all four limbs while serving in Iraq, these little actions demonstrate how far he's come only six weeks after getting a double-arm transplant.

Wounded by a roadside bomb in 2009, the former soldier said he could get by without legs, but he hated living without arms.

"Not having arms takes so much away from you. Even your personality, you know. You talk with your hands. You do everything with your hands, and when you don't have that, you're kind of lost for a while," the 26-year-old New Yorker told reporters Tuesday at Johns Hopkins Hospital.

Doctors don't want him using his new arms too much yet, but his gritty determination to regain independence was one of the chief reasons he was chosen to receive the surgery, which has been performed in the U.S. only seven times.

That's the message Marrocco said he has for other wounded soldiers.

"Just not to give up hope. You know, life always gets better, and you're still alive," he said. "And to be stubborn. There's a lot of people who will say you can't do something. Just be stubborn and do it anyway. Work your ass off and do it."

Dr. W.P. Andrew Lee, head of the team that conducted the surgery, said the new arms could eventually provide much of the same function as his original arms and hands. Another double-arm transplant patient can now use chopsticks and tie his shoes.

Lee said Marrocco's recovery has been remarkable, and the transplant is helping to "restore physical and psychological well-being."

Tuesday's news conference was held to mark a milestone in his recovery — the day he was to be discharged from the hospital.

Next comes several years of rehabilitation, including physical therapy that is going to become more difficult as feeling returns to the arms.

Before the surgery, he had been living with his older brother in a specially equipped home on New York's Staten Island that had been built with the help of several charities. Shortly after moving in, he said it was "a relief to not have to rely on other people so much."

The home was heavily damaged by Superstorm Sandy last fall.

"We'll get it back together. We've been through a lot worse than that," his father, Alex Marrocco, said.

For the next few months, Marrocco plans to live with his brother in an apartment near the hospital.

The former infantryman said he can already move the elbow on his left arm and rotate it a little bit, but there hasn't been much movement yet for his right arm, which was transplanted higher up.

Marrocco's mother, Michelle Marrocco, said he can't hug her yet, so he brushes his left arm against her face.

The first time he moved his left arm was a complete surprise, an involuntary motion while friends were visiting him in the hospital, he said.

"I had no idea what was going through my mind. I was with my friends, and it happened by accident," he recalled. "One of my friends said 'Did you do that on purpose?' And I didn't know I did it."

Marrocco's operation also involved a technical feat not tried in previous cases, Lee said in an interview after the news conference.

A small part of Marrocco's left forearm remained just below his elbow, and doctors transplanted a whole new forearm around and on top of it, then rewired nerves to serve the old and new muscles in that arm.

"We wanted to save his joint. In the unlucky event we would lose the transplant, we still wanted him to have the elbow joint," Lee said.

He also explained why leg transplants are not done for people missing those limbs — "it's not very practical." That's because nerves regrow at best about an inch a month, so it would be many years before a transplanted leg was useful.

Even if movement returned, a patient might lack sensation on the soles of the feet, which would be unsafe if the person stepped on sharp objects and couldn't feel the pain.

And unlike prosthetic arms and hands, which many patients find frustrating, the ones for legs are good. That makes the risks of a transplant not worth taking.

"It's premature" until there are better ways to help nerves regrow, Lee said.

Now Marrocco, who was the first soldier to survive losing all four limbs in the Iraq War, is looking forward to getting behind the wheel of his black 2006 Dodge Charger and hand-cycling a marathon.

Asked if he could one day throw a football, Dr. Jaimie Shores said sure, but maybe not like Baltimore Ravens quarterback Joe Flacco.

"Thanks for having faith in me," Marrocco interjected, drawing laughter from the crowd.

His mother said Marrocco has always been "a tough cookie."

"He's not changed that, and he's just taken it and made it an art form," Michelle Marrocco said. "He's never going to stop. He's going to be that boy I knew was going to be a pain in my butt forever. And he's going to show people how to live their lives."

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Associated Press Chief Medical Writer Marilynn Marchione in Milwaukee and AP writer David Dishneau in Hagerstown, Md., contributed to this report.

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California residents reflect national divide on immigration

ESCONDIDO, Calif. — Vincent Gazzara wants gun towers along the border and guards with orders to shoot.

"The point is some would have to lose their lives," said the 70-year-old retired administrator, who sings in his church choir. "But when they realized that they can't cross without being shot, they would stop."

Talk about boosting border security, albeit with less extreme measures, is common in Escondido, a working-class city in northern San Diego County, 40 miles from Mexico. But the decades-long patchwork of remedies to halt the flow of illegal immigrants has proved so frustrating that residents like Gazzara expressed qualified support for broad reforms such as those championed by President Obama in his immigration policy speech Tuesday.

They include a path to citizenship for those brought to the United States illegally as children and the possibility of legal status for millions of other undocumented immigrants, provided they pass a background check and meet other criteria.

An estimated 2.5 million illegal immigrants live and work in California, embedded in such bulwarks of the state economy as agriculture and the service industry. The state's voters tilt toward Democrats for president, but in some regions elect conservative Republican congressmen — such as Darrell Issa (R-Vista), whose district includes Escondido, and Kevin McCarthy (R-Bakersfield). Their support will be key to getting any immigration plan through a fractious House of Representatives.

Immigration reform activists greeted Obama's speech with broad enthusiasm. The president was tackling nothing less than "a defining civil and human rights issue of our time," said Wade Henderson, president and chief executive of the Leadership Conference on Civil and Human Rights.

But the mixed reactions of Californians suggest the fraught terrain legislators must navigate to bring an immigration reform bill to Obama's desk.

"Anyone applying for citizenship should pay a penalty," said Gazzara, the retired administrator. "If you don't respect our laws then you should pay the consequences."

Gazzara was getting a haircut at Del's Barber Shop in Escondido in the company of other self-described conservative Republicans, while immigrant women pushed baby strollers by the American flag that fluttered outside.

Escondido is one of the few cities in the country where immigration enforcement agents monitor and respond to police traffic stops, resulting in hundreds of deportation proceedings.

One passing woman, an illegal immigrant with three children who gave her name only as Maria, said she didn't drive in the city because she feared getting pulled over at a traffic checkpoint.

But she has common ground with the men in the barbershop, and with Obama's proposal, in calling for background checks.

"I tell my friends that everyone should get the opportunity to apply for citizenship, but there must be conditions," she said. "They can't be pushed through really fast. They need to check people's backgrounds thoroughly."

At El Gallo Giro restaurant in Huntington Park, a heavily Latino city, the tables and chairs reflect the colors of the Mexican flag, and the Virgin of Guadalupe has a shrine.

But only one man in the lunchtime crowd showed interest when Obama's speech came on the television Tuesday, interrupting a Spanish-language celebrity talk show.

Felipe Velasquez, 56, who came from Sinaloa, Mexico, said he crossed into the country illegally in the early 1980s. Years later he was among millions of immigrants who received amnesty in the last major overhaul of immigration law.

He applauded Obama's call for broader paths to citizenship. "People come here thinking it means a future. It's a fantasy," Velasquez said. "The only ones who do well are banks and big companies. The rest of us struggle all our lives to get ahead."

Further north in Kern County, a place both heavily Republican and heavily dependent on farm labor, reaction was mixed.

Randy Hubble, 55, a construction worker who was having lunch at Cope's Knotty Pine Cafe in Bakersfield, has clear views on what to do with the country's estimated 11 million illegal immigrants: "Put them on the bus, and put them back where they came from."

The local congressman, McCarthy, is a staunch conservative and the House majority whip, and he will alienate voters like Hubble if he supports Obama's plan.

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Hiroshi Nakajima, Leader of World Health Organization, Dies at 84

Dr. Hiroshi Nakajima, a Japanese physician who as leader of the World Health Organization started campaigns to fight malaria and other infectious diseases but whose tenure, from 1988 to 1998, was marred by repeated accusations of mismanagement, died on Saturday in Poitiers, France. He was 84.

He died after a short illness, the organization said.

Besides his efforts to fight infectious diseases, including AIDS, tuberculosis and dengue fever, Dr. Nakajima enlarged the organization’s focus on preventive medicine and vaccinations for children, and tried to rally international support to end ritual female genital mutilation. In a statement on Monday, Dr. Margaret Chan, the current W.H.O. director general, praised his efforts to defeat polio.

But he came under frequent criticism. The United States and other Western nations twice opposed his election as director general of the agency, which is part of the United Nations. They argued that he had not infused the agency with a clear sense of direction and had let its budget and bureaucracy balloon.

In 1992, when Washington was fighting Dr. Nakajima’s re-election, Louis W. Sullivan, the secretary of health and human services, wrote, “It appears that W.H.O. is losing its reputation as the world’s leader in health matters at a time when serious global health problems present daunting challenges to us all.”

Dr. Nakajima was again cast in a harsh light when Dr. Jonathan Mann, the widely respected commander of the United Nations’s fight against AIDS, resigned in 1990. In an interview with The New York Times, Dr. Mann said he resigned over “issues of principle” and “major disagreements” with Dr. Nakajima, who wanted to de-emphasize AIDS prevention and put more effort into other diseases, like malaria.

Dr. June Osborn, chairwoman of the National Commission on AIDS, called the resignation of Dr. Mann, who died in 1998, “a world tragedy.”

In the 1992 director general election, the United States accused Japan of overly aggressive tactics in promoting Dr. Nakajima’s candidacy. The State Department said Japan had threatened to cut off fish imports from the Maldives and coffee imports from Jamaica if those countries did not support Dr. Nakajima. A spokesman for Japan’s Foreign Ministry denied the accusations.

There were also allegations that Japan had awarded research contracts to 23 of the 31 W.H.O executive board members who recommended Dr. Nakajima’s re-election. A W.H.O. audit found that the contracts — the largest of which was $150,000 — were technically legal but presented “a problem of ethics,” in the words of the board chairman, Jean-François Girard of France.

Dr. Nakajima defeated Dr. Mohammed Abdelmoumene of Algeria, who had been his deputy, in a 93-58 vote. It was the first time in the organization’s history that an incumbent director had been challenged by another W.H.O. official.

In 1997, Dr. Nakajima announced that he would not seek a third term, in part because he had lost support from African nations after he had explained the relative scarcity of Africans in executive positions at the agency by suggesting that Africans had difficulty conceptualizing and writing reports.

The Economist magazine said the remark “was particularly odd coming from Dr. Nakajima, who has himself been accused of quasi-incomprehensibility, even when he speaks Japanese.”

Dr. Nakajima was born in Chiba-shi, Japan, on May 16, 1928. He graduated from Tokyo Medical University in 1955, representing the 10th generation of his family to produce a doctor. After studying psychiatry and pharmacology at the University of Paris, he returned to Tokyo Medical University to earn a Ph.D. in medical sciences. He then became research director for Nippon Roche, the Japanese subsidiary of Hoffmann-LaRoche.

Dr. Nakajima joined the W.H.O. in 1974, and worked to improve getting medical supplies to the third world. He helped develop the concept of “essential medicines,” drugs that satisfy the health care needs of most of a population. In 1979, the Western Pacific nations elected him regional director, and he served two terms.

Dr. Nakajima is survived by his wife, the former Martha Ann DeWitt, and two sons.

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His cat, his lunch and a high five: Harper’s day chronicled on Twitter

OTTAWA – One of the cardinal rules of social media: no one cares what you had for lunch. Unless, perhaps, you’re the prime minister.

The people behind Stephen Harper‘s Twitter account are using the first day of Parliament’s winter sitting to provide an intimate look at how the prime minister spends his day.

The posts include a video of Harper’s ride to work, photos of breakfast with his cat Stanley and a lunch that included fruit and a Diet Coke at his desk.

The behind-the-scenes look is the latest move by Harper’s team to bolster his presence on social media platforms.

Digital public affairs analyst Mark Blevis says it’s likely an effort to rebrand Harper in the lead-up to the next election, where he’ll face off against politicians far more adept online.

Social Media News Headlines – Yahoo! News

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Soldier who lost 4 limbs has double-arm transplant

On Facebook, he describes himself as a "wounded warrior...very wounded."

Brendan Marrocco was the first soldier to survive losing all four limbs in the Iraq War, and doctors revealed Monday that he's received a double-arm transplant.

Those new arms "already move a little," he tweeted a month after the operation.

Marrocco, a 26-year-old New Yorker, was injured by a roadside bomb in 2009. He had the transplant Dec. 18 at Johns Hopkins Hospital in Baltimore, his father said Monday.

Alex Marrocco said his son does not want to talk with reporters until a news conference Tuesday at the hospital, but the younger Marrocco has repeatedly mentioned the transplant on Twitter and posted photos.

"Ohh yeah today has been one month since my surgery and they already move a little," Brendan Marrocco tweeted Jan. 18.

Responding to a tweet from NASCAR driver Brad Keselowski, he wrote: "dude I can't tell you how exciting this is for me. I feel like I finally get to start over."

The infantryman also received bone marrow from the same dead donor who supplied his new arms. That novel approach is aimed at helping his body accept the new limbs with minimal medication to prevent rejection.

The military sponsors operations like these to help wounded troops. About 300 have lost arms or hands in Iraq or Afghanistan.

Unlike a life-saving heart or liver transplant, limb transplants are aimed at improving quality of life, not extending it. Quality of life is a key concern for people missing arms and hands — prosthetics for those limbs are not as advanced as those for feet and legs.

"He was the first quad amputee to survive," and there have been four others since then, Alex Marrocco said.

The Marroccos want to thank the donor's family for "making a selfless decision ... making a difference in Brendan's life," the father said.

Brendan Marrocco has been in public many times. During a July 4 visit last year to the Sept. 11 Memorial with other disabled soldiers, he said he had no regrets about his military service.

"I wouldn't change it in any way. ... I feel great. I'm still the same person," he said.

The 13-hour operation was led by Dr. W.P. Andrew Lee, plastic surgery chief at Johns Hopkins. It was the seventh double-hand or double-arm transplant done in the United States.

Lee led three of those earlier operations when he worked at the University of Pittsburgh, including the only above-elbow transplant that had been done at the time, in 2010.

Marrocco's "was the most complicated one" so far, Lee said in an interview Monday. It will take more than a year to know how fully Marrocco will be able to use the new arms.

"The maximum speed is an inch a month for nerve regeneration," he explained. "We're easily looking at a couple years" until the full extent of recovery is known.

While at Pittsburgh, Lee pioneered the immune-suppression approach used for Marrocco. The surgeon led hand-transplant operations on five patients, giving them marrow from their donors in addition to the new limbs. All five recipients have done well, and four have been able to take just one anti-rejection drug instead of combination treatments most transplant patients receive.

Minimizing anti-rejection drugs is important because they have side effects and raise the risk of cancer over the long term. Those risks have limited the willingness of surgeons and patients to do more hand, arm and even face transplants.

Lee has received funding for his work from AFIRM, the Armed Forces Institute of Regenerative Medicine, a cooperative research network of top hospitals and universities around the country that the government formed about five years ago. With government money, he and several other plastic surgeons around the country are preparing to do more face transplants, possibly using the new immune-suppression approach.

Marrocco expects to spend three to four months at Hopkins, then return to a military hospital to continue physical therapy, his father said. Before the operation, he had been fitted with prosthetic legs and had learned to walk on his own.

He had been living with his older brother in a specially equipped home on New York's Staten Island that had been built with the help of several charities. Shortly after moving in, he said it was "a relief to not have to rely on other people so much."

The home was heavily damaged by Superstorm Sandy last fall.

Despite being in a lot of pain for some time after the operation, Marrocco showed a sense of humor, his father said. He had a hoarse voice from the tube that was in his throat during the long surgery and decided he sounded like Al Pacino. He soon started doing movie lines.

"He was making the nurses laugh," Alex Marrocco said.

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Associated Press Writer Stephanie Nano in New York contributed to this report.

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Online:

Army regenerative medicine:

http://www.afirm.mil/index.cfm?pageid=home

and http://www.afirm.mil/assets/documents/annual_report_2011.pdf

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Follow Marilynn Marchione at http://twitter.com/MMarchioneAP .

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