Woman Loses Half Her Body Weight on "Extreme Makeover"

Brand X Pictures/Thinkstock(NEW YORK) -- Ashley Johnson weighed 323 pounds, and in a family of thin people, the temptation of food was everywhere.

“When I try to tell them, ‘You’re not helping,’ they keep telling me that it’s up to me to really have that willpower,” she said during her appearance Sunday night on ABC’s Extreme Makeover: Weight Loss Edition.

But food was just one of the many issues weighing her down.

“This is a sad insecure person. This is so hard. I’m so ashamed of it,” she said.

When trainer Chris Powell surprised Johnson on her 20th birthday, she was desperate for a fresh start.

Months of crushing workouts were just one challenge.  Her family was another.  There was junk food in the house, and there were fights with her mother.  It all affected Johnson’s progress.

After six months, things had reached a boiling point.

“When she [Ashley] finally admitted that she is a compulsive eater, that she is a food addict, that is when her real healing began,” Powell said Monday on ABC's Good Morning America.  “But unfortunately she also realized that she can’t change the people around her.”

Johnson moved out of her house and in with a friend who offered to let her stay rent-free. With that healthy distance between Johnson and her family, she was able to kick her weight loss into high gear.

A year later, she had undergone a profound transformation.  At her final weigh-in at the end of the show, Johnson had lost 156 pounds.

“She’s doing great. She’s so happy right now,” Powell said of Johnson on Monday.

Johnson is continuing on her weight loss journey using tips from Powell that, he says, anyone can use on their own.

“The one thing I recommend for everyone is to find a fitness-minded community like a yoga group or a tennis club or a basketball league or walking groups,” Powell said.  “They’re everywhere.  A quick Google search will lead you to some kind of fitness group within a mile of your home.”

Powell also recommends that people use a principle called F.I.T.T. -- Frequency, Intensity, Time and Training -- to ramp up their weight loss efforts.

“The basic rule we’re talking about is that your body will adapt to everything that we do so after five or six of the same kind of workout your body begins to adapt,” he said.  ”If you want to get continued results and do extreme stuff like losing a lot of weight, you have to increase.”

“I do this with all of my people,” Powell said.  ”Just constantly changing up things, that’s the F.I.T.T. principle.”

Copyright 2012 ABC News Radio

Unlocking Emotional Issues May Be Key to Extreme Weight Loss

ABC/CRAIG SJODIN(NEW YORK) -- Chris Powell, the man who orchestrates each jaw-dropping weight transformation on ABC’s Extreme Makeover: Weight Loss Edition, says his secret as a hard-charging trainer has less to do with exercising people's bodies than exorcising their demons.

"There is a tie to some kind of emotional trauma, in the past, of people I've worked with, and that trauma is typically unaddressed," he said.

Powell has helped 11 super-obese people lose more than a ton of weight on the show: 2,198 pounds, to be exact. But in addition to helping people shrink to half their size, Powell also has gotten them to open up about a whole range of psychological issues, including sexual abuse and alcoholism.

Although he admits he is "absolutely not" professionally qualified to advise on these issues, Powell said he approaches it like a friend would.

"I know what's out of my scope of practice with some of these deep-rooted psychological issues," he said. "That's why we have therapists on board with us."

"I think we all have a desire to feel significant in the world," he said. "It's not about me doing nice things for other people. I get something out of this, and its fulfillment. This is the best addiction in the world."

Watch the full story on ABC’s Nightline Friday at 11:35 ET/PT.

Copyright 2012 ABC News Radio

Man Loses 255 Pounds on "Extreme Makeover: Weight Loss Edition"

Photodisc/Thinkstock(NEW YORK) -- At 28 years old, Mike Giannulis was 493 pounds and so obese that he missed out on things others might take for granted, like kissing a girl or even experiencing a first date.

The only time he would step foot outside his house was to visit nearby family.

“I don’t have a full-length mirror anywhere in the whole entire house, and if I can just avoid seeing myself … out of sight out of mind,” Giannulis said.  “I mean, who would want to see this?  I just feel like no girl deserves this.”

Giannulis’ brother, Mark, feared for his life.

“I really think he can’t get up off the couch sometimes because of his weight,” he said.

That’s when Chris Powell and Extreme Makeover: Weight Loss Edition entered his life and set a goal for Giannulis to lose half his body weight -- 246 pounds -- in the next year.

Powell was with Giannulis through the tough workouts and at the 90-day mark, he lost a staggering 129 pounds.  By the six-month mark, Giannulis was a brand new man with a new lady in his life.

“I’ve got a brand new girlfriend and things are going awesome,” Giannulis said.

Giannulis had lost so much weight that he was not only off the couch but was able to compete in a triathlon, a feat that would have been impossible just a few months before.

“I know how hard Michael has worked at this triathlon.  You don’t find many people like him,” said Giannulis’ girlfriend, Meghan.  “I love him so much.  I’m just so proud of everything he’s done.”

At the final weigh-in, 12 months after Powell came into Giannulis’ life, he weighed 238 pounds, down more than half his original weight.

“In all the 29 years I have lived,” Giannulis said, “this has been the best year of my life.”

After the show concluded, however, he found himself giving into temptations and slipping back into old habits.  Refusing to let that happen, Giannulis made a drastic move: He left his home in Tarpon Springs, Fla., to move closer to Powell in Phoenix.

“He caught himself,” Powell said.  “He realized that he what he was doing, especially after he lost his purpose, he fell back into some of his old patterns and some of those triggers he was experiencing.  Those social triggers.  They were feeding the addiction again.  So he picked up from Florida and moved and he’s actually living down the street from me now.”

Powell also believes it’s important to realize one is never on the weight-loss journey alone.

“You have to realize that no man is an island,” he said.  “You can’t do it alone.  As we go through this process, real life happens, and we need to talk about it.  We need to share in order to heal.  It’s really important to reach out to those different people or there are incredible online sites as well.”

Copyright 2012 ABC News Radio

What’s the Secret to Paula Deen’s Weight Loss?

Michael N. Todaro/Getty Images(NEW YORK) -- Paula Deen made a name for herself, and made herself a small fortune, by dishing up indulgent treats like a doughnut-topped bacon burger and deep-fried anything on her Food Network TV show, in her magazine and even aboard cruise ships with her fans.

When in January she announced she had type 2 diabetes, she was hit hard by critics who denounced her for hiding her diagnosis from the public for three years and only coming forward after signing a deal with diabetes drug-maker Novo Nordisk.

Now the Southern chef is firing back, on the scale, announcing to People magazine that she has lost 30 pounds in six months, and she’s not stopping.

“It took me a couple of years to get to this point,” Deen tells the magazine in this week’s cover story out Friday.  “If you make a few small changes, they can add up to big results.”

So how did the 65-year-old chef lose the equivalent of 120 sticks of her beloved, and well-used, butter? For one thing, instead of hitting the deep fryer, she started hitting the weights.

“For the first time since she was a high school cheerleader, Paula has started working out,” People magazine’s Lesley Messer told ABC News.  “She says it’s really helping her feel better.”

Deen herself visited the ABC food show The Chew to show off her new figure and reveal her diet secrets. “It’s really about moderation,” she said on the show.  “I’ve said it for so long but I really started to practice that.

“I double my salad, double my green beans and the carbs are like this,” she said, pointing to a small portion size.  “I wasn’t about to change my life but I have made simple changes in my life.”

After she went public with her diabetes in January, Deen launched a new campaign, “Diabetes in a New Light,” a partnership with Novo Nordisk. Deen reportedly takes the company’s drug Victoza to help her maintain proper blood-sugar levels.

Deen, who says she has gone from a size 18 to a size 10, told People the key to her weight-loss success has been dropping white foods like potatoes from her diet, and swapping out others, like using mustard instead of ketchup.

Now, instead of skipping breakfast altogether, Deen says she’ll enjoy a fruit smoothie.  For dinner, instead of fried chicken or worse, baked chicken or fish and Greek salad instead of chips are on the table at the Deen household.

The woman famous for making Chocolate Gooey Butter Cookies now enjoys sugar-free ice cream for dessert instead. “I do think differently now” about food,” Deen said. “I’m more aware.”

While it remains to be seen what kind of inspiration Deen is providing to her fans who loyally tuned in to see what kind of over-the-top indulgences she had cooked up, her weight loss is forcing her own family to keep up.

Her husband, Michael Groover, is reportedly drinking four shakes per day to lose 100 pounds and her oldest son, Jamie, 44, has dropped 40 pounds himself.

Copyright 2012 ABC News Radio

FDA Approves Weight Loss Drug Belviq

George Doyle/Stockbyte/Thinkstock(WASHINGTON) -- The U.S. Food and Drug Administration approved the weight loss drug Belviq for people who are overweight or obese and have one or more weight-related health problems, the agency announced today.

"Obesity threatens the overall well-being of patients and is a major public health concern," Dr. Janet Woodcock, director of the FDA's Center for Drug Evaluation and Research, said in a statement. "The approval of this drug, used responsibly in combination with a healthy diet and lifestyle, provides a treatment option for Americans who are obese or are overweight and have at least one weight-related comorbid condition."

The drug, made by Arena Pharmaceuticals, acts on a receptor in the brain to help people eat less and feel fuller, according to the FDA statement.

In clinical trials people who took Belviq were twice as likely to lose 5 percent or more of their weight than people who took a placebo. The drug was also linked to improvements in blood pressure, cholesterol and blood sugar levels.

In 2010, the FDA decided not to approve Belviq, citing concerns that the drug carried heart-valve risks and increased brain and breast tumor development in rats given seven times the recommended dose.

But new studies by Arena Pharmaceuticals found no increased risk of heart valve problems and only a small risk of cancer. And in May 2012, an FDA panel voted 18 to four to approve the drug, stating the benefits of Belviq outweigh the potential risks when used in a population of overweight and obese people.

Obesity is becoming an epidemic of massive proportions. According to the World Health Organization, by 2015 2.3 billion adults will be overweight, and more than 700 million will be obese. Obesity is associated with a host of health problems, including high blood pressure, diabetes, heart attacks, asthma, cancers and strokes. Indeed, obesity, along with tobacco, is a leading cause of preventable death.

The main treatments for obesity are diet and exercise. If those interventions are not effective, then a person can consider medical therapy or bariatric surgery. However, bariatric surgery, though effective in leading to weight loss, is also a surgical procedure with serious risks.

The most common side effects of Belviq are headache, nausea and dizziness. And people taking Belviq were twice as likely to have neuropsychiatric and cognitive side effects.

Copyright 2012 ABC News Radio

For Calories, It's All About Quality over Quantity, Harvard Study Says

iStockphoto/Thinkstock(BOSTON) -- When is a calorie not just a calorie? When it comes to losing weight, according to a new study from Harvard University. The results found that the number of calories consumed is not necessarily as important as the quality of those calories: That is to say, the kind of calories the body gets may affect how efficiently people burn their body's energy, which can be key for losing weight and keeping it off.

"It's not that calories don't matter, but the quality of the calories going in can affect the number of calories going out," said study author Dr. David Ludwig, at Boston Children's Hospital.

The researchers studied 21 overweight and obese adults, starting each on a diet that helped them lose at least 12.5 percent of their body weight. Then, to help them maintain that weight loss, the researchers put the participants on a cycle of three diets, and they were to stick to each for four weeks.

One was a low-fat diet, similar to the one recommended by the American Heart Association, which had participants reduce their dietary fat, that emphasized eating whole grains and plenty of fruits and vegetables.

Another was modeled on the Atkin's Diet, a plan in which participants ate more protein and fat but severely curbed their consumption of breads, pastas and other carbohydrates.

The final diet was a low-glycemic index plan, a model based on regulating the body's blood sugar levels used in many commercial diet plans, such as Nutrisystem and the Zone diet. The plan didn't require the participants to reduce the fat or carbohydrates in their diets but focused on the quality of the carbohydrates they ate. The plan pushed participants to replace some grain products and starches with vegetables, legumes, fruits and foods rich in healthy fats.

The results weren't good news for low-fat diet aficionados. When dieters followed that plan, their bodies burned fewer calories than when they were following the low-carb or low-glycemic index diets. And the low-fat diet changed certain metabolic factors in their bodies that typically predicted weight regain.

The low-carb diet seemed to help participants burn the most calories. But it also increased certain markers of stress and inflammation in the body, such as the stress hormone cortisol, which are risk factors for cardiovascular disease and other health problems.

In the end, the researchers found that the low-glycemic index diet struck the right balance for the participants. It helped the dieters burn more calories, though not as many as the low-carb diet, but didn't seem to increase disease-causing stress markers in the body.

The study was published Tuesday in the Journal of the American Medical Association.

The results provide physiological evidence for a growing consensus among doctors and diet specialists that low-fat diets, a longtime staple of advice for shedding pounds, aren't as beneficial as many once thought.

"There is a growing feeling that we need to go beyond low-fat diets, that was too simplistic a vision," Ludwig said. "Instead, focus on reducing highly processed carbohydrates."

Heavily processed carbohydrates like white bread, white rice and some breakfast cereals, to name a few make sugar readily accessible, rather than securing it to more healthy elements, like the fiber in an apple. Ludwig said easily absorbable sugar leads to a rapid surge and crash in blood sugar after a meal, which can wreak havoc on weight loss.

Other studies have found results in favor of weight-loss diets based on the glycemic index, including one study published in the New England Journal of Medicine in 2010 that found that the diet plan was the most effective in helping people maintain their weight loss.

Dr. Louis Aronne, director of the Comprehensive Weight Control Program at New York Presbyterian Hospital, said the glycemic index has become a key part of his practice in helping obese patients lose weight.

"Many obesity specialists who treat patients all day long, as we do, favor low glycemic diets, those with less sugar and starch, because patients seem to do better," he said.

But not everyone favors the diet plan. Critics argue that the nutrition standards of the glycemic index are out of whack compared with what people know are healthier choices, giving foods like candy and soda healthier ratings than potatoes or rice. Dr. Xavier Pi-Sunyer, director of the New York Obesity Nutrition Research Center, said the concept is too confusing for most consumers to follow for the long-term.

The study did not follow patients for the long term, and the authors note that it's difficult to say whether the dieters would have maintained their weight loss outside of the study's highly controlled setting.

Ultimately, doctors agree that balanced diets that cut out junk are the most healthful ones. Sarah Bleach, an assistant professor at the Johns Hopkins Bloomberg School of Public Health, said the best weight loss advice boils down to a simple message: eat fewer calories than you burn through exercise.

"Even if the type of calorie matters for maintaining weight loss, it still boils down to simple arithmetic -- eat less, exercise more," she said.

Copyright 2012 ABC News Radio

Appetite for Food, Cocaine Linked to Same Spot in Brains of Mice

iStockphoto/Thinkstock(NEW HAVEN, Conn.) -- In the global fight against obesity, scientists have become particularly interested in the parts of the brain that make us want to eat, and sometimes to eat too much.

Many researchers have noted that hunger and satiety stimulate the brain's reward system. But scientists at Yale University have discovered that the same brain cells behind hunger drive another circuit of reward, the one stimulated by highly addictive drugs like cocaine.

The drive to eat lies in a couple hundred brain cells, called neurons, in the hypothalamus, a tiny structure at the very center of the brain.

"In order for you to feel hungry, these neurons have to be active," said Tamas Horvath, one of the authors of the study published Sunday.

Horvath and his colleagues found that when these brain cells were made to be inactive in the brains of mice, the mice became far less interested in food and became leaner. But at the same time, they became more interested in exploring new environments and they became very interested in cocaine.

The findings, published in the journal Nature Neuroscience, suggest that in mice, and possibly in humans, there is an overlap between addiction and obesity in the brain. But perhaps not in the way many scientists may have thought.

Researchers studying the root of obesity in the brain have suggested that the brain's reward system, which gets jazzed by actions like eating, is less active in animals and people who are obese, meaning they eat more in order to satisfy those brain cells.

But Horvath said his findings suggest the opposite.

"If you make these [brain cells] less active, you're less interested in food, you're leaner, and more interested in novelty and when provided the opportunity for cocaine, you're very interested in cocaine," he said.

So far, the findings apply only to mice, and only more research can show if they apply to humans.

Scott Sternson, who studies the neurological processes behind hunger at Howard Hughes Medical Institute, said the findings are unexpected and mean that scientists need to think more carefully about the wiring of the brain's reward system when it comes to food.

Dr. Deborah Mash, a professor of neurology and pharmacology at the University of Miami School of Medicine, said the findings shake up the current thinking about drug addiction in the brain. Typically, scientists don't consider the bundle of hunger-driving brain cells in the hypothalamus as a part of the system that gets hooked on drugs like cocaine.

"We really don't understand the rules of this system yet," Mash said. "If we could begin to see how the circuitry is disregulated in addiction, we may be able to come up with a druggable target" for treating cocaine addiction.

Mash, who studies the brains of cocaine addicts after their deaths, said the study also highlights some intriguing parallels in human drug addicts.

"Most cocaine-addicted individuals are very thin. When people come off of cocaine, they eat and eat and eat," she said.

Horvath said he will continue to study the overlap between hunger and addiction in the brain, and he hopes that other scientists will consider how even the most fundamental structures of the brain can influence complex behaviors.

Copyright 2012 ABC News Radio

Astrologist Uses Horoscope as Weight-Loss Tool

iStockphoto/Thinkstock(NEW YORK) -- Horoscopes usually forecast the future, offering love or career advice in just a few sentences.  But could they actually help you lose weight?  Sharon Ward, an astrologist with over 20 years experience, believes that a horoscope can reveal more than whether your relationship will last.  She believes it offers the key to weight loss.

“Astrology works on the premise that when you are emotionally balanced and happy then you are physically well and healthy and vice versa,” writes Ward on her website.

“Medical astrology holds the key to re-balancing our bodily systems and bringing to us a greater sense of health and well being. We each have a Moon sign, just as we have a Sun sign. The Moon governs the inner self and the emotions and as we often use food as a response to life’s stresses and strains, it makes sense to find out where our weaknesses lie and what types of food are best for us according to our Moon Sign.”

Here are a few of her horoscope-guided tips:

Aquarius:  Ward recommends foods high in vitamin B or taking a supplement.  “Many healthy foods contain these, however a B complex supplement, which contains a balance of all the B vitamins, is often a good idea to ensure an adequate intake.”

Pisces:  “Water is very healing for you and highly beneficial, whether it is ensuring that you drink enough on a daily basis, or bathing or swimming in it – it will help calm and soothe you and restore your inner balance,” writes Ward.  She suggests avoiding foods that increase water retention like excessive salt or alcohol.

Capricorn:  Ward emphasizes that this sign needs extra calcium from foods like cheese, sardines and green vegetables.

Sagittarius:  Vitamin B6 and chromium are what Ward advises for Sagittarians.  “Foods that contain this are meat, fish, potatoes, bananas and legumes, such as dried beans, peas, lentils and soy products.”

Leo:  Ward recommends exercise for Leos:  “You probably have a slow to average metabolic rate and so need a fair amount of exercise to balance out those large portions.”

Gemini:  Gemini’s should eat foods that contain B12, such as “liver, red meat, poultry, fish, eggs, milk and dairy products.”

Aries:  “Avoid caffeine, as this may raise the blood pressure and/or create headaches – it also increases adrenaline which could make you a little irritable,” she suggests.

Virgo:  B1 is what Ward suggests for the nervous system:  “marmite, liver and whole grains. Egg yolk, potatoes, peas, oranges and often fortified breakfast cereals.”

Scorpio:  Hi-fiber diets are recommended for Scorpio’s to clean out their colons.  Ward suggests foods like wheat germ, oat or rice bran.

Cancer:  Ward suggests foods with potassium for Cancer signs such as “spinach, bananas, tomatoes red pepper, peaches, apricots, radish, papaya and red wine, (the last one in moderation please!)”

Taurus:  “Steer clear of food that contains added sugar (always check the labels, you’d be amazed how much is added to processed foods) and try to cut down on the heavy carbohydrates and red meat,” she warns Taurus signs.

Libra:  Ward advises cutting out added sugar, “Just like your Taurus Moon siblings, you also need to limit your sugar intake, or cut it out altogether.”

Copyright 2012 ABC News Radio

Eating Disorders Common in Older Women, Study Finds

George Doyle/Stockbyte/Thinkstock(CHAPEL HILL, N.C.) -- Eating disorders have no boundaries when it comes to age, according to a new study published in the International Journal of Eating Disorders.

While people may associate eating disorders with teen girls and young women, there may be a growing number of older people who experience the same struggles.

Researchers from the University of North Carolina surveyed more than 1,800 women 50 and older to see how many had eating disorders and to assess the impact of disordered eating in women who engaged in these practices.  Sixty-two percent of the women reported that their weight negatively impacted their lives, 8 percent reported purging and 70 percent said they were in the process of dieting or trying to lose weight.

This study “really busts the myths that disordered eating is the province of adolescent and young adult women,” said Dr. Cynthia Bulik, director of the University of North Carolina Eating Disorders Program and lead author of the study.  “We have very little clinical research on mid- and late-life eating disorders.  The most important thing for clinicians is to keep eating disorders on their radar screen regardless of a patient’s age.”

The women reportedly turned to several unhealthy methods of weight loss, including diet pills, diuretics, laxatives, vomiting and excessive exercise.

Whether there is more awareness and diagnoses remains unclear, but researchers said eating disorders can be “common” among women over 50.

The triggers may be different among different age groups, but traumatic life events tend to trigger or contribute to eating disorders, no matter the age, according to experts at the National Eating Disorders Association (NEDA).  When an older person experiences the illness, it is usually because an earlier eating disorder has resurfaced, but not always.  Disorders can be triggered by divorce, death of a loved one or children moving away.

“It can be hard to come forward because some older patients are concerned about the stigma of having a younger person’s disorder, but we know that eating disorders persist into older adulthood, eating disorders relapse during older adulthood and we know that late onset occurs, too,” said William Walters, helpline manager at NEDA.

“Late onset isn’t at all surprising,” he added.  “Midlife can be hard, and just as difficult a transition as the teens and early adulthood, in its own way.”

Copyright 2012 ABC News Radio

Bariatric Surgery for More Than Just Weight Loss?

Keith Brofsky/Thinkstock(NEW YORK) -- Gone may be the days of limiting bariatric surgery just to helping patients lose weight.  A slew of new research suggests weight loss surgeries can also be used to help reverse medical complications of obesity, not just eliminate obesity itself.

These procedures may reduce the risk of chronic disease, and even help patients better qualify for organ transplants, according to studies presented Wednesday at the American Society for Metabolic and Bariatric Surgery's annual meeting.

An estimated 72 million Americans are considered obese and nearly 200,000 Americans undergo bariatric surgery each year, according to the American Society for Metabolic and Bariatric Surgery.

Obesity can lead to chronic illnesses like heart disease and diabetes, which can cause organ damage.  But many who are morbidly obese and in need of a new organ do not qualify for transplants because of the increased risk of complications from medications and surgery.

"We tend to see obesity as a lifestyle problem, but it's really leading to worse medical problems," said Dr. Jaime Ponce, president-elect of the American Society of Metabolic and Bariatric Surgery.  "Eventually it becomes a vicious cycle of deteriorating health."

Some forms of weight loss surgery, which have grown to be less invasive and therefore less risky than procedures like transplant surgery, are not only regarded by surgeons as a way to shed dangerous pounds, but also reverse the complications of metabolic diseases.

"[Bariatric surgery] has been widely accepted in the medical field, but now we're trying to apply it to specific patient groups," said Dr. Matthew Lin, a bariatric surgeon at the University of California, San Francisco.

In one pilot study of 26 morbidly obese patients waiting for a kidney or liver transplant, researchers at UCSF found laproscopic sleeve gastrectomy, a procedure where a majority of the stomach is removed and reshaped into a small tube or sleeve, significantly improved the chances of having successful organ transplants.

"The reason why physicians are skittish about bariatric surgery for organ transplant is that these patients have more medical comorbities," said Lin, who is the lead author of the study.  "But our study shows that it is safe to proceed."

One of the patients in the study was even taken off the transplant list because his kidney function improved, according to the findings.

Not all cases of bariatric surgery will see a reverse in symptoms, or even reversal in damage of organs.  Patients who have endured the weight and the metabolic diseases for longer may have less chance to see any type of reversal, said Ponce.

However, there are many factors to the surgery that contribute to changes, he said.

"We're not just treating the weight; we're actually treating the metabolic damage by doing this surgery," said Ponce.  "It changes their hormones and how their organs work in their body."

In other studies, presented at the meeting on Wednesday, bariatric surgery was shown to reverse kidney disease, stave off heart attacks by nearly a decade, and help manage diabetes.

"We can treat increased blood sugars with medications, but we are reversing complications [with surgery]," said Dr. Robin Blackstone, current president of the American Society for Metabolic and Bariatric Surgery.  "We are moving away from treating people just because they are obese and now we have disease specific indications for surgery such as heart disease, cancer, and diabetes."

Copyright 2012 ABC News Radio