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Mortality risk predicts global, local, and individual patterns of human reproduction

Human reproductive dynamics in the post-industrial world are typically explained by economic, technological, and social factors including the prevalence of contraception and increasing numbers of women in high...

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Understanding mediated sports consumption by Irish children: a qualitative study exploring their exposure and understanding of gambling marketing, risks and harms

Gambling marketing communications create a public health risk by increasing the normalisation of gambling in sports. In a context where broad level studies report significant underage gambling, currently no ev...

Organizational change: challenges for workplace psychosocial risks and employee mental health

Constant organizational change is the norm in many companies today. At present, evidence on the impact of organizational change on psychosocial risks at work and employee mental health is limited. We investiga...

Effectiveness of a home-based, post-discharge early intervention program for very preterm infants in reducing parental stress: a randomized controlled trial

This study aims to evaluate the impact of a home-based, post-discharge early intervention (EI) program on reducing parental stress levels in families with preterm infants born between 28 + 0 and 31 + 6 weeks gestat...

Burden of non-communicable diseases attributable to high temperature in a changing climate from 1990 to 2019: a global analysis

With global climate change, the health threats of ambient high temperature have received widespread attention. However, latest spatio-temporal patterns of the non-communicable diseases (NCDs) burden attributab...

Associations of tobacco and alcohol use with sexual behaviors among adolescents in 59 countries: a population-based study

Sexual behaviors, particularly risky sexual behavior, has become a serious public health concern among adolescents worldwide, presenting a substantial obstacle to the prevention of sexually transmitted infecti...

Associations between retirement, social security policies and the health of older people: a systematic review

As people age, they are more likely to experience several health conditions which are circumstances that arise throughout life that can interfere with an individual’s ability to work, leading them to demand th...

The effect of socioeconomic factors on malnutrition in Syrian children aged 0–6 years living in Turkey: a cross-sectional study

This study was conducted to examine the prevalence of malnutrition in Syrian immigrant children living in Turkey.

Prevalence and determinants of skilled birth attendance among young women aged 15–24 years in Northern Nigeria: evidence from multiple indicator cluster survey 2011 to 2021

Childbirth among adolescents and young mothers has been linked to various complications, including perinatal mortality, preterm births, low birth weight, and infections, which collectively contribute to the hi...

Iran’s health insurance ecosystem: challenges and strategies

Identifying and exploiting stewardship and financing challenges in Iran’s health insurance system as an ecosystem is essential to achieving predetermined goals. This study aimed to determine the challenges and...

Impact of awareness of sports policies, school, family, and community environmental on physical activity and fitness among children and adolescents: a structural equation modeling study

Understanding the impact of environmental factors on physical activity (PA) and physical fitness (PF) is crucial for promoting a healthy lifestyle among children and adolescents. This study examines how awaren...

Development and validation of the mpox stigma scale (MSS) and mpox knowledge scale (MKS)

Few validated brief scales are available to measure constructs that may hinder mpox-related prevention and care engagement, such as knowledge and stigma. Both are highly salient barriers to infectious disease ...

Tropical oils consumption and health: a scoping review to inform the development of guidelines in tropical regions

Tropical oils such as palm and coconut oils are renowned for their high saturated fat content and culinary versatility. However, their consumption has sparked debate regarding their health benefits and product...

Development and validation of the COVID-19 vaccine beliefs scale for the Chinese population

At present, there is no culturally appropriate scale designed to measure Chinese people’s attitudes and beliefs about COVID-19 vaccines. Understanding people’s attitudes and beliefs about vaccines can help pol...

Mirror, mirror on my screen: Focus on self-presentation on social media is associated with perfectionism and disordered eating among adolescents. Results from the “LifeOnSoMe”-study

Social media use, perfectionism, and disordered eating have all increased over the last decades. Some studies indicate that there is a relationship between self-presentation behaviors and being exposed to othe...

Mental disorders in adults from Ribeirão Preto, Brazil: a cross-sectional analysis of two birth cohorts

In Brazil, the prevalence of mental disorders is heterogeneous, with most studies conducted in large cities with high population density. This study aimed to assess the prevalence of mental disorders and psych...

Investigating the psychometric properties of the Persian version of the Quality of Life Questionnaire for Women Infected with HPV (EQUALI-HPV)

People with human papiloma virus (HPV) struggle with numerous challenges and needs in physical, and psychological aspects of quality of life related to this virus. Several studies have recommended counseling i...

Seroprevalence of hepatitis C, hepatitis B, hiv and syphilis among blood donors at a tertiary care hospital in Mogadishu-Somalia in 2020–2022: a retrospective study

The safety of blood donation requires screening for transfusion-transmitted infections, including human immunodeficiency virus (HIV), syphilis, hepatitis B virus (HBV) and hepatitis C virus (HCV). This study a...

Associations between smartphone addiction, parenting styles, and mental well-being among adolescents aged 15–19 years in Gujarat, India

The pervasive use of smartphones among adolescents has raised concerns about addiction and its impact on mental well-being. This study investigates the prevalence of smartphone addiction and its associations w...

Invitation strategy of vaginal HPV self-sampling to improve participation in cervical cancer screening: a systematic review and meta-analysis of randomized trials

Human papillomavirus (HPV) self-sampling is recognized as a feasible option for enhancing screening for cervical cancer, particularly among hard-to-reach women. The magnitude of the effectiveness of screening ...

Isotemporal substitution analysis of time between sedentary behavior, and physical activity on sleep quality in younger adults: a multicenter study

To evaluate the effects of replacing time spent in sedentary behavior (SB) with moderate to vigorous physical activity on sleep quality in young adults.

The impact of fear of falling on health-related quality of life in community-dwelling older adults: mediating effects of depression and moderated mediation effects of physical activity

The fear of falling is a common issue among older adults that negatively affects physical and psychological aspects of health-related quality of life, regardless of actual fall events. Interventions aimed at r...

Human factors methods in the design of digital decision support systems for population health: a scoping review

While Human Factors (HF) methods have been applied to the design of decision support systems (DSS) to aid clinical decision-making, the role of HF to improve decision-support for population health outcomes is ...

Monkeypox pandemic in Sudan, surveillance epidemiologic report, 2022

Mpox, is a zoonosis that is known to be endemic in several Central and West African countries. Recently, in 2022, it has emerged in Europe and United States, what raised the alarm to be declared in late June 2...

Determinants of exclusive breastfeeding among infants under six months in Nepal: multilevel analysis of nationally representative household survey data

The benefits of exclusive breastfeeding (EBF) have been universally documented, with evidence of positive impacts on a child’s optimal growth, development, and survival. However, EBF practices in Nepal have fl...

Association between meeting 24-hour movement behavior guidelines and quality of life in adolescents with idiopathic scoliosis

Meeting the 24-hour movement behavior (24-HMB) guideline helps enhance quality of life (QOL) of adolescents. This study aimed to assess the associations between the 24-HMB (physical activity, screen time, slee...

The correlation between daily temperature, diurnal temperature range, and asthma hospital admissions in Lanzhou city, 2013–2020

With the backdrop of global climate change, the impact of climate change on respiratory diseases like asthma is receiving increasing attention. However, the effects of temperature and diurnal temperature range...

Exploring the impact of housing insecurity on the health and wellbeing of children and young people in the United Kingdom: a qualitative systematic review

Housing insecurity can be understood as experiencing or being at risk of multiple house moves that are not through choice and related to poverty. Many aspects of housing have all been shown to impact children/...

Tuberculosis patients’ satisfaction with directly observed treatment short course strategy and associated factors in Southern Ethiopia: a mixed method study

Tuberculosis (TB) is a second major global public health problem and the leading infectious cause of death in Ethiopia. Patients under directly observed treatment short-courses (DOTs) have a higher treatment s...

The effects of a blended learning model on the physical fitness of Chinese university students: a cluster randomized controlled trial in basketball education

The university period is a critical stage of personal development, and improving the physical fitness of university students is crucial to their academic performance, quality of life, and future. However, in r...

Trends of older gastric cancer incidence, mortality, and survival in the highest gastric cancer risk area in China: 2010–2019 and prediction to 2024

Gastric cancer is a major health problem worldwide, with a high incidence among older adults. Given the aging overall population, it was crucial to understand the current burden and prospective trend of older ...

Association of life’s essential 8 with chronic cardiovascular-kidney disorder: a prospective cohort study

The coexistence of cardiovascular disease and chronic kidney disease, termed chronic cardiovascular-kidney disorder (CCV-KD), is increasingly prevalent. However, limited studies have assessed the association b...

A quantitative content analysis of topical characteristics of the online COVID-19 infodemic in the United States and Japan

The COVID-19 pandemic has spurred the growth of a global infodemic. In order to combat the COVID-19 infodemic, it is necessary to understand what kinds of misinformation are spreading. Furthermore, various loc...

Relationship between mixed exposure to phenyl hydroxides, polycyclic aromatic hydrocarbons, and phthalates and the risk of arthritis

To determine the relationship between mixed exposure to three types of endocrine-disrupting chemicals (EDCs), namely phenyl hydroxides, polycyclic aromatic hydrocarbons (PAHs), and phthalates (PAEs), and risk ...

“The police came in white protective suits and with batons, it was pure disaster” – a multi-stakeholder perspective on infection control in reception centers for asylum seekers during the COVID-19 pandemic in Germany

The COVID-19 pandemic presented unprecedented challenges, particularly for vulnerable populations residing in confined settings such as refugee shelters: Physical distancing measures were challenging to implem...

Factors associated with age at first screening for cervical cancer among adult Cape Verdean women: a cross-sectional study

Cervical cancer ranks third in terms of cancer incidence and mortality in Cape Verde. Understanding the factors associated with the age of cervical cancer screening (CCS) is essential because it helps identify...

Theoretically framing views of people who smoke in understanding what might work to support smoking cessation in coastal communities: adapting the TIDieR checklist to qualitative analysis for complex intervention development

People living in coastal communities have some of the worst health outcomes in the UK, driven in part by high smoking rates. Deprived coastal communities include socially disadvantaged groups that struggle to ...

Migration background and use of preventive healthcare services: Findings of the German Ageing Survey

This study aimed to investigate the relationship between migration background and the utilization of preventive healthcare services.

Effectiveness of WhatsApp based debunking reminders on follow-up visit attendance for individuals with hypertension: a randomized controlled trial in India

Individuals with high blood pressure in India often miss essential follow-up visits. Missed visits contribute to gaps across the hypertension care continuum and preventable cardiovascular disease. Widespread m...

Perceptions of HIV self-testing promotion in black barbershop businesses: implications for equitable engagement of black-owned small businesses for public health programs

HIV self-testing (HIVST) offers an innovative and promising approach to increasing HIV testing among Black men in the United States, a population disproportionately affected by HIV. However, engaging Black men...

Socioeconomic inequalities in uptake of outreach mammography before and after accessibility improvement of Taiwan’s national universal breast cancer screening policy

Taiwan implemented the Cancer Screening Quality Improvement Program (CAQIP) in 2010. The program sought to enhance mass breast cancer screening accessibility. This study aimed to examine socioeconomic disparit...

The National Cancer Aid monitoring (NCAM-online) of ultraviolet radiation risk and protection behavior: a population-based observational trend study with four annual online survey waves

Ultraviolet (UV) radiation is the most important risk factor for skin cancer development. Sunlight is the main source of UV radiation in the general population. In addition, tanning beds are a source of artifi...

Workplace violence and turnover intention among Chinese nurses: the mediating role of compassion fatigue and the moderating role of psychological resilience

Workplace violence is a global public health issue and a major occupational hazard cross borders and environments. Nurses are the primary victims of workplace violence due to their frontline roles and continuo...

Prevalence of Methamphetamine (Mkpurummiri) use in south east Nigeria: a community-based cross-sectional study

Methamphetamine (MA) (Mkpurummiri) is seen as the most common, accessible and new drug of use/abuse in south east Nigeria. Despite the overwhelming evidence of the dire consequences of this drug to the users, ...

Cancer risk among air transportation industry workers in Korea: a national health registry-based study

Flight attendants face various risk factors in their working environments, particularly occupational exposure to cosmic radiation. This study aimed to assess cancer risk among air transportation industry worke...

Association between the atherogenic index of plasma and abdominal aortic calcification in adults: a cross-sectional study

Atherogenic index of plasma (AIP) index is an important marker of insulin resistance and a significant risk factor for cardiovascular disease. Abdominal aortic calcification (AAC) is significantly associated w...

Impact of adiposity indices changes across the lifespan on risk of diabetes in women: trajectory modeling approach

The impact of life-course different adiposity indices on diabetes mellitus (DM) is poorly understood. We aimed to do trajectory analysis with repeated measurements of adiposity indices in the development of DM...

Results from a retrospective case finding and re-engagement exercise for people previously diagnosed with hepatitis C virus to increase uptake of directly acting antiviral treatment

Direct acting antivirals (DAAs) for the Hepatitis C virus (HCV) have shifted the World Health Organisation global strategic focus to the elimination of HCV by 2030. In England, the UK Health Security Agency (U...

Global, regional, and national burden of intracerebral hemorrhage and its attributable risk factors from 1990 to 2021: results from the 2021 Global Burden of Disease Study

Intracerebral hemorrhage (ICH) results from the rupture of blood vessels causing bleeding within the brain and is one of the major causes of death and long-term disability globally, particularly in low- and mi...

Predominant approaches to measuring pregnancy-related anxiety in Sub-saharan Africa: a scoping review

Pregnancy-related anxiety significantly impacts maternal and fetal health in low- and middle-income countries (LMICs), including those within Sub-Saharan Africa (SSA). Most studies conducted to evaluate pregna...

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What are the trending topics in Public Health and related disciplines?

You can identify some of the most discussed and influential topics with the help of Altmetric attention scores, which take into account several outlets including social media, news articles, and policy documents.

Drawing from a selection of Public Health and Medicine journals, we have compiled a list of the articles that have been mentioned the most over the past few months.

Discover the articles that are trending right now, and catch up on current topics in Public Health and related disciplines. We will update our collection every few weeks; come back to this page to be on top of the latest conversations in Public Health and Medicine. Previously featured articles are listed here .

You can also sign up for e-alerts to make sure you never miss the latest research from our journals.

*Last updated October 2021*

Age and Ageing

Alcohol and alcoholism, american journal of epidemiology, annals of work exposures and health, epidemiologic reviews, european journal of public health, family practice, health education research, health policy and planning, health promotion international, international health, international journal of epidemiology, international journal for quality in health care, journal of public health, journal of travel medicine, journal of tropical pediatrics, nicotine & tobacco research, transactions of the royal society of tropical medicine & hygiene.

There is moderate-certainty evidence that behaviour change interventions are associated with increased physical activity levels among older hospitalised patients.

This study from Canada found that one in three young adults with ADHD had a lifetime alcohol use disorder, and that young adults with ADHD were also three times more likely to develop a substance use disorder. Targeted outreach and interventions for this extremely vulnerable population are warranted.

According to this study, resuming evictions in summer 2020 was associated with increased COVID-19 incidence and mortality in US states, with an estimated 433,700 excess cases and 10,700 excess deaths. Explore more research on COVID-19 in a curated collection from the AJE: https://academic.oup.com/aje/pages/covid-19

The British Occupational Hygiene Society (BOHS) developed a control banding matrix for employers and others to help assess the risks of COVID-19 infection, and calls for further work to validate the reliability of the tool. Browse the Annals' collection on occupational hygiene for virus protection: https://academic.oup.com/annweh/pages/covid-19 

In 1777, George Washington ordered a mandatory inoculation program for his troops, in what would become the first mass immunization mandate in the US. This archival article discussess and contextualizes immunization practices for US Armed Forces.

Responding to concerns that that face mask use could elicit a false sense of security and lead to riskier behaviours, this study from Denmark found that mask use overall correlated positively with protective behaviours.

While medical practice is often undermined by subsequent investigation, randomized trials relevant to primary care generally hold up over time.

This study shows the potential for using social media influencers to inspire positive engagements on pro-vaccine health messaging. For more content on accurate information's importance for public health, browse the latest article collection from HER: https://academic.oup.com/her/pages/covid-19

Current emergency response planning does not have adequate coverage to maintain health systems functionality for essential health service delivery alongside emergency-specific interventions and healthcare. The findings from this study can help align health emergency planning with broader population health needs.

This case study shows that that ongoing efforts are needed to improve sustainability of nutrition policy and programmes to address all diet-related diseases.

This review article outlines evidence for a range of institutional measures and behaviour-change measures, and highlights research and knowledge gaps.

The COVID-19 pandemic triggered significant mortality increases in 2020 of a magnitude not witnessed since World War II in Western Europe or the breakup of the Soviet Union in Eastern Europe.

The authors propose an update to the Equator’s Consolidated criteria for reporting qualitative research (COREQ) checklist, with the aim of enhancing inclusivity.

This study confirms previous findings on a low risk of SARS-CoV-2 reinfection. If confirmed, these findings suggest that more targeted restriction policies can be applied to the subjects that recovered after a first infection. Read highly cited papers on COVID-19 from the Journal of Public Health: https://academic.oup.com/jpubhealth/pages/covid-19

Given the Delta variant's high reproductive number associated with higher transmissibility, in a context of globally still low vaccine coverage rates and lower vaccine effectiveness, public health and social measures will need to be substantially strengthened. A high reproductive number also means that much higher vaccine coverage rates need to be achieved compared to the originally assumed.

Neurological complications are rare in children suffering from COVID-19. Still, these children are at risk of developing seizures and encephalopathy, more in those suffering from severe illness.

The researchers examined support for and perceived impact of e-cigarette sales restrictions. Findings suggest that bans on flavored vape products could have a positive impact on lower-risk users, but that other young adult user subgroups may not experience benefit.

An editorial from the earlier stages of the pandemic highlights the importance of properly fitted respirators for worker safety and outlines occupational hygiene measures.

Guidelines for safe mass drug administration for neglected tropical diseases were developed in a COVID-19 context; training and implementation were assessed through an observation checklist.

For more research on the impact of COVID-19 on NTDs, explore the March 2021 special issue: https://academic.oup.com/trstmh/issue/115/3

Previously featured

Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study

Trajectories of Alcohol Use and Related Harms for Managed Alcohol Program Participants over 12 Months Compared with Local Controls: A Quasi-Experimental Study

Estimating the Effect of Social Distancing Interventions on COVID-19 in the United States

Selecting Controls for Minimizing SARS-CoV-2 Aerosol Transmission in Workplaces and Conserving Respiratory Protective Equipment Supplies

What Do We Know About the Association Between Firearm Legislation and Firearm-Related Injuries?

Denialism: what is it and how should scientists respond?

Acute cooling of the feet and the onset of common cold symptoms

The effect of falsely balanced reporting of the autism–vaccine controversy on vaccine safety perceptions and behavioral intentions

Climate change: an urgent priority for health policy and systems research

Power, control, communities and health inequalities I: theories, concepts and analytical frameworks

Research ethics in context: understanding the vulnerabilities, agency and resourcefulness of research participants living along the Thai–Myanmar border

Tobacco smoking and mortality among Aboriginal and Torres Strait Islander adults in Australia

Quality and safety in the time of Coronavirus: design better, learn faster

Years of life lost associated with COVID-19 deaths in the United States

In-flight transmission of SARS-CoV-2: a review of the attack rates and available data on the efficacy of face masks

Stability of the Initial Diagnosis of Autism Spectrum Disorder by DSM-5 in Children: A Short-Term Follow-Up Study

Impact of Tobacco Smoking on the Risk of COVID-19: A Large Scale Retrospective Cohort Study

Mental health of staff working in intensive care during COVID-19

The benefits and costs of social distancing in high- and low-income countries

A classification tree to assist with routine scoring of the Clinical Frailty Scale

Recent Advances in the Potential of Positive Allosteric Modulators of the GABAB Receptor to Treat Alcohol Use Disorder

The recent oubreak of smallpox in Meschede, West Germany

Your Hair or Your Service: An Issue of Faith for Sikh Healthcare Professionals During the COVID-19 Pandemic

Emerging Infections: Pandemic Influenza

Identifying the views of adolescents in five European countries on the drivers of obesity using group model building 

Novel multi-virus rapid respiratory microbiological point-of-care testing in primary care: a mixed-methods feasibility evaluation

Public health crisis in the refugee community: little change in social determinants of health preserve health disparities

In search of ‘community’: a critical review of community mental health services for women in African settings

COVID-19, a tale of two pandemics: novel coronavirus and fake news messaging 

Disrupting vaccine logistics

Use of directed acyclic graphs (DAGs) to identify confounders in applied health research: review and recommendations

Measurement and monitoring patient safety in prehospital care: a systematic review

Black Lives Matter protests and COVID-19 cases: relationship in two databases

The positive impact of lockdown in Wuhan on containing the COVID-19 outbreak in China

Severe Malnutrition and Anemia Are Associated with Severe COVID in Infants

A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes

Healthcare workers and protection against inhalable SARS-CoV-2 aerosols

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The topic in brief

• There is an ongoing debate about whether social media and the use of digital devices are detrimental to mental health.

• Adolescents tend to be heavy users of these devices, and especially of social media.

• Rates of teenage depression began to rise around 2012, when adolescent use of social media became common (Fig. 1).

• Some evidence indicates that frequent users of social media have higher rates of depression and anxiety than do light users.

• But perhaps digital devices could provide a way of gathering data about mental health in a systematic way, and make interventions more timely.

Figure 1 | Depression on the rise. Rates of depression among teenagers in the United States have increased steadily since 2012. Rates are higher and are increasing more rapidly for girls than for boys. Some researchers think that social media is the cause of this increase, whereas others see social media as a way of tackling it. (Data taken from the US National Survey on Drug Use and Health, Table 11.2b; go.nature.com/3ayjaww )

JONATHAN HAIDT: A guilty verdict

A sudden increase in the rates of depression, anxiety and self-harm was seen in adolescents — particularly girls — in the United States and the United Kingdom around 2012 or 2013 (see go.nature.com/2up38hw ). Only one suspect was in the right place at the right time to account for this sudden change: social media. Its use by teenagers increased most quickly between 2009 and 2011, by which point two-thirds of 15–17-year-olds were using it on a daily basis 1 . Some researchers defend social media, arguing that there is only circumstantial evidence for its role in mental-health problems 2 , 3 . And, indeed, several studies 2 , 3 show that there is only a small correlation between time spent on screens and bad mental-health outcomes. However, I present three arguments against this defence.

First, the papers that report small or null effects usually focus on ‘screen time’, but it is not films or video chats with friends that damage mental health. When research papers allow us to zoom in on social media, rather than looking at screen time as a whole, the correlations with depression are larger, and they are larger still when we look specifically at girls ( go.nature.com/2u74der ). The sex difference is robust, and there are several likely causes for it. Girls use social media much more than do boys (who, in turn, spend more of their time gaming). And, for girls more than boys, social life and status tend to revolve around intimacy and inclusion versus exclusion 4 , making them more vulnerable to both the ‘fear of missing out’ and the relational aggression that social media facilitates.

Second, although correlational studies can provide only circumstantial evidence, most of the experiments published in recent years have found evidence of causation ( go.nature.com/2u74der ). In these studies, people are randomly assigned to groups that are asked to continue using social media or to reduce their use substantially. After a few weeks, people who reduce their use generally report an improvement in mood or a reduction in loneliness or symptoms of depression.

The best way forward

Third, many researchers seem to be thinking about social media as if it were sugar: safe in small to moderate quantities, and harmful only if teenagers consume large quantities. But, unlike sugar, social media does not act just on those who consume it. It has radically transformed the nature of peer relationships, family relationships and daily activities 5 . When most of the 11-year-olds in a class are on Instagram (as was the case in my son’s school), there can be pervasive effects on everyone. Children who opt out can find themselves isolated. A simple dose–response model cannot capture the full effects of social media, yet nearly all of the debate among researchers so far has been over the size of the dose–response effect. To cite just one suggestive finding of what lies beyond that model: network effects for depression and anxiety are large, and bad mental health spreads more contagiously between women than between men 6 .

In conclusion, digital media in general undoubtedly has many beneficial uses, including the treatment of mental illness. But if you focus on social media, you’ll find stronger evidence of harm, and less exculpatory evidence, especially for its millions of under-age users.

What should we do while researchers hash out the meaning of these conflicting findings? I would urge a focus on middle schools (roughly 11–13-year-olds in the United States), both for researchers and policymakers. Any US state could quickly conduct an informative experiment beginning this September: randomly assign a portion of school districts to ban smartphone access for students in middle school, while strongly encouraging parents to prevent their children from opening social-media accounts until they begin high school (at around 14). Within 2 years, we would know whether the policy reversed the otherwise steady rise of mental-health problems among middle-school students, and whether it also improved classroom dynamics (as rated by teachers) and test scores. Such system-wide and cross-school interventions would be an excellent way to study the emergent effects of social media on the social lives and mental health of today’s adolescents.

NICK ALLEN: Use digital technology to our advantage

It is appealing to condemn social media out of hand on the basis of the — generally rather poor-quality and inconsistent — evidence suggesting that its use is associated with mental-health problems 7 . But focusing only on its potential harmful effects is comparable to proposing that the only question to ask about cars is whether people can die driving them. The harmful effects might be real, but they don’t tell the full story. The task of research should be to understand what patterns of digital-device and social-media use can lead to beneficial versus harmful effects 7 , and to inform evidence-based approaches to policy, education and regulation.

Long-standing problems have hampered our efforts to improve access to, and the quality of, mental-health services and support. Digital technology has the potential to address some of these challenges. For instance, consider the challenges associated with collecting data on human behaviour. Assessment in mental-health care and research relies almost exclusively on self-reporting, but the resulting data are subjective and burdensome to collect. As a result, assessments are conducted so infrequently that they do not provide insights into the temporal dynamics of symptoms, which can be crucial for both diagnosis and treatment planning.

By contrast, mobile phones and other Internet-connected devices provide an opportunity to continuously collect objective information on behaviour in the context of people’s real lives, generating a rich data set that can provide insight into the extent and timing of mental-health needs in individuals 8 , 9 . By building apps that can track our digital exhaust (the data generated by our everyday digital lives, including our social-media use), we can gain insights into aspects of behaviour that are well-established building blocks of mental health and illness, such as mood, social communication, sleep and physical activity.

Stress and the city

These data can, in turn, be used to empower individuals, by giving them actionable insights into patterns of behaviour that might otherwise have remained unseen. For example, subtle shifts in patterns of sleep or social communication can provide early warning signs of deteriorating mental health. Data on these patterns can be used to alert people to the need for self-management before the patterns — and the associated symptoms — become more severe. Individuals can also choose to share these data with health professionals or researchers. For instance, in the Our Data Helps initiative, individuals who have experienced a suicidal crisis, or the relatives of those who have died by suicide, can donate their digital data to research into suicide risk.

Because mobile devices are ever-present in people’s lives, they offer an opportunity to provide interventions that are timely, personalized and scalable. Currently, mental-health services are mainly provided through a century-old model in which they are made available at times chosen by the mental-health practitioner, rather than at the person’s time of greatest need. But Internet-connected devices are facilitating the development of a wave of ‘just-in-time’ interventions 10 for mental-health care and support.

A compelling example of these interventions involves short-term risk for suicide 9 , 11 — for which early detection could save many lives. Most of the effective approaches to suicide prevention work by interrupting suicidal actions and supporting alternative methods of coping at the moment of greatest risk. If these moments can be detected in an individual’s digital exhaust, a wide range of intervention options become available, from providing information about coping skills and social support, to the initiation of crisis responses. So far, just-in-time approaches have been applied mainly to behaviours such as eating or substance abuse 8 . But with the development of an appropriate research base, these approaches have the potential to provide a major advance in our ability to respond to, and prevent, mental-health crises.

These advantages are particularly relevant to teenagers. Because of their extensive use of digital devices, adolescents are especially vulnerable to the devices’ risks and burdens. And, given the increases in mental-health problems in this age group, teens would also benefit most from improvements in mental-health prevention and treatment. If we use the social and data-gathering functions of Internet-connected devices in the right ways, we might achieve breakthroughs in our ability to improve mental health and well-being.

Nature 578 , 226-227 (2020)

doi: https://doi.org/10.1038/d41586-020-00296-x

Twenge, J. M., Martin, G. N. & Spitzberg, B. H. Psychol. Pop. Media Culture 8 , 329–345 (2019).

Article   Google Scholar  

Orben, A. & Przybylski, A. K. Nature Hum. Behav. 3 , 173–182 (2019).

Article   PubMed   Google Scholar  

Odgers, C. L. & Jensen, M. R. J. Child Psychol. Psychiatry https://doi.org/10.1111/jcpp.13190 (2020).

Maccoby, E. E. The Two Sexes: Growing Up Apart, Coming Together Ch. 2 (Harvard Univ. Press, 1999).

Google Scholar  

Nesi, J., Choukas-Bradley, S. & Prinstein, M. J. Clin. Child. Fam. Psychol. Rev. 21 , 267–294 (2018).

Rosenquist, J. N., Fowler, J. H. & Christakis, N. A. Molec. Psychiatry 16 , 273–281 (2011).

Orben, A. Social Psychiatry Psychiatr. Epidemiol. https://doi.org/10.1007/s00127-019-01825-4 (2020).

Mohr, D. C., Zhang, M. & Schueller, S. M. Annu. Rev. Clin. Psychol. 13 , 23–47 (2017).

Nelson, B. W. & Allen, N. B. Perspect. Psychol. Sci. 13 , 718–733 (2018).

Nahum-Shani, I. et al. Ann. Behav. Med. 52 , 446–462 (2018).

Allen, N. B., Nelson, B. W., Brent, D. & Auerbach, R. P. J. Affect. Disord. 250 , 163–169 (2019).

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Competing Interests

N.A. has an equity interest in Ksana Health, a company he co-founded and which has the sole commercial licence for certain versions of the Effortless Assessment of Risk States (EARS) mobile-phone application and some related EARS tools. This intellectual property was developed as part of his research at the University of Oregon’s Center for Digital Mental Health (CDMH).

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11 global health issues to watch in 2023, according to IHME experts

Published December 20, 2022

As the year 2022 winds down, what is next on the horizon for global health? We turned to our IHME experts for their takes on the most critical health issues to watch in 2023. Entering our fourth year grappling with COVID-19, most of our experts pointed to issues that were impacted in some way by the pandemic, like long COVID and mental health. They also offered potential interventions to address the threats. 

The faculty members and research scientists who shared their insights are professor Mohsen Naghavi , assistant professor Hwme Kyu , assistant professor Angela Micah , affiliate professor Michael Brauer , affiliate assistant professor Alize Ferrari , lead research scientist Liane Ong , lead research scientist Sarah Wulf Hanson, postdoctoral scholar Christian Razo, postdoctoral scholar Ewerton Cousin, and researcher Emma Nichols. Their comments have been lightly edited for clarity.

1. Long COVID

“Long COVID is absolutely a health issue to watch in 2023. The health impact of long COVID often disrupts a person’s ability to engage with school, work, or relationships for months at a time.   “People with long COVID need diagnostic and proper rehabilitation support from primary care physicians. We desperately need more research to find effective treatments as well as preventive measures to reduce the risk of developing long COVID.” — Sarah Wulf Hanson, lead research scientist of the non-fatal and risk quality enhancement team and lead author of the JAMA paper on long COVID     

2. Mental health

“Mental disorders are a leading cause of disability worldwide, with no evidence of a decrease in this burden since 1990. The impact of the COVID-19 pandemic, war, and violence on mental health remains a priority, specifically understanding how these have impacted the prevalence and burden of mental disorders in 2022 onward and how countries should be adapting their mental health response accordingly. 

“Currently in the GBD study, we investigate childhood sexual abuse, intimate partner violence, and bullying victimization as risk factors for mental disorders. Going forward, we need a better understanding of the other risk factors for mental disorders, how these vary across different populations, and how to offer the best opportunities for prevention at the population level.” — Alize Ferrari, affiliate assistant professor and team lead for estimating the burden of mental disorders     

3. Impact of climate change

“Climate change is already affecting the health of millions of people all over the world, and more importantly, climate change will worsen throughout this century. People are experiencing both the direct effects of extreme heat that we measure in the GBD and a myriad of indirect effects. Flooding can force people from their homes and affect their mental health, droughts and storms can impact food security and water availability, and wildfire smoke episodes can increase air pollution. As we know from the pandemic, preparedness is key, and we are far from prepared for the health impacts of a warmer climate.

“Most of the emphasis to date on climate change – and rightly so – has been on what we call mitigation: reducing the emissions that lead to global warming. Yet to date these efforts have been far too modest. We are now at a point where climate change is clearly with us, and much more attention needs to be put on minimizing the impacts on global health through adaptation or enhancing resilience. 

“One aspect of this is improving overall health and enhancing socioeconomic development because we know that those who are more vulnerable will suffer the most. In addition, there are technological solutions that can support adaptation , such as the use of drought-resistant crops, increasing vegetation in cities to reduce the urban heat island effect, or repurposing land use to adapt to rising sea levels. 

“Air pollution is one of the leading global risk factors that we evaluate in the GBD – currently responsible for about 8% of all global mortality – yet it is a problem with known solutions. Increasing the speed at which we address air pollution will save lives today. Those solutions will move the world closer to the net-zero carbon emissions goals that we need to ultimately address the causes of climate change.” — Michael Brauer, affiliate professor and team lead for estimating the burden of environmental, occupational, and dietary risk factors     

4. Cardiovascular disease

“Cardiovascular diseases such as ischemic heart disease and stroke are the leading causes of death globally, accounting for 28% of total deaths in 2021. Additionally, cardiovascular diseases substantially contribute to health loss and the economic burden on health care systems. Most cardiovascular diseases can be prevented by addressing modifiable cardiovascular risk factors such as high blood pressure, high cholesterol, obesity, dietary risks, smoking, and air pollution.” — Christian Razo, postdoctoral scholar on the team estimating cardiovascular disease burden and lead author of a Burden of Proof study on the effects of elevated systolic blood pressure on ischemic heart disease     

5. Lower respiratory infections

“Lower respiratory infections (LRI), especially respiratory syncytial virus (RSV) and influenza, are health issues to watch in 2023.   “ We saw a general decline in influenza and RSV infections in 2020 due to COVID-19 mitigation measures such as mask use and social distancing. With the relaxation of these measures, many young children who haven’t been exposed to RSV in the past couple of years are being infected, resulting in RSV outbreaks . Countries have also experienced a surge in influenza across all ages.    “ Annual influenza vaccination provides an opportunity to reduce the LRI burden attributable to flu. There is no vaccine yet to prevent RSV, but promising vaccine trials are underway . ” — Hmwe Kyu, assistant professor and team lead for estimating the burden of HIV, TB, and select infectious diseases    “ After experiencing significant disruptions to health care systems worldwide due to the COVID-19 pandemic, the increases in respiratory infections and other communicable diseases have been added to the existing burden of chronic non-communicable diseases, creating a dual burden of disease exacerbated by social inequalities observed globally.” — Christian Razo     

6. Poverty’s role in health

“It seems that poverty is the mother of inequality in health. The unequal distribution of resources has expanded due to climate change and increasing violence. Low- and middle-income countries experience worse health outcomes than high-income countries: the life expectancy is 34 years lower, the under-5 mortality around 100 times higher, deaths due to interpersonal violence and suicide are 30 times higher, and deaths attributable to antimicrobial resistance (AMR) are 12 times higher. We must urgently address the impact of poverty on health, life, and death.” — Mohsen Naghavi, professor and team lead for causes of death, shocks, intermediate causes and estimating the burden of AMR     

7. Health systems strengthening

“Strengthening health systems globally remains a critical aspect of what is needed for resilient health systems. This will be particularly relevant as countries refocus their resources and attention after the acute phase of the COVID-19 pandemic.

“I think what is needed is a longer-term commitment from donors and governments – financial and human resources, governance structures, management, information systems – to ensure that interventions are set up for long-term sustainability and can deliver the outcomes that are aspired to across health systems.” — Angela Micah, assistant professor and co-lead of the development assistance for health resource tracking team

“Given the immense strain of COVID-19 on primary care and hospital systems the past two-and-a-half years, attention should be paid to building back up the health care system and enabling frontline workers to do their jobs effectively. Public health leaders and policymakers need to reflect on lessons learned from the pandemic to prevent health care system collapse in the next crisis and to ensure that people who need care can access quality health care.” — Sarah Wulf Hanson     

8. Diabetes

“Diabetes is the fourth main cause of DALYs in Latin America and the Caribbean, and among the top five causes, it is the only one that shows an increase in the age-standardized rate compared to 1990. The burden of diabetes in the Americas is large, increasing, heterogeneous, and expanding, especially in countries in Central Latin America and the Caribbean. 

“Population-based interventions such as taxes and incentives, more informative food labeling, improving the built environment to facilitate exercise, and greater advocacy to inform people of the risk diabetes poses, combined with expanded health education to combat diabetes risk factors, seem the best options. Policies aimed to help avoid weight gain and improve dietary quality are also paramount. 

“Another important aspect is improving the response of health systems in terms of access and quality care. These should include universal access to low-cost insulin and oral anti-diabetic medication to decrease avoidable deaths from acute complications. Health systems should also strive to furnish feedback from their administrative data systems to providers to help orient diabetes care.” — Ewerton Cousin, postdoctoral scholar on the neglected tropical diseases team and lead author of The Lancet Diabetes & Endocrinology paper on diabetes burden in the Americas     

9. Road injuries

“Road injuries are still an important and preventable injury. For people 15-49 years old, road injuries are the leading cause of death .

“Interventions such as helmets, seatbelts, airbags, speed limits, and laws discouraging alcohol-impaired driving do work. But implementation is not the only thing that determines their success – human behavior must adhere to those policies to make them effective." — Liane Ong, lead research scientist and team lead for estimating the burden of injuries, chronic respiratory diseases, neurological disorders, substance use disorders, diabetes and kidney diseases, sensory organ diseases, musculoskeletal disorders, and impairments (BIRDS)     

10. Dementia

“Anticipated trends in population growth and population aging are expected to lead to large increases in the number of people affected by dementia globally, underscoring the public health importance of dementia. To adequately care for those with dementia, appropriate planning for the necessary supports and services required is needed.

“Interventions targeting modifiable risk factors, such as low education, smoking, and high blood sugar, have the potential to reduce the overall societal burden and should be prioritized.” — Emma Nichols, researcher on the BIRDS team and lead author of The Lancet Public Health paper on dementia forecasting     

11. Population aging

“Adapting health systems to support older populations’ needs should be front of mind in 2023. Globally, the proportion of the population that is above 65 is expected to increase in the coming years. While a lot of attention (and rightfully so) has historically focused on diseases that affect children, it will be prudent to begin thinking through and systematically planning for some of these upcoming changes in demography as well, especially in low- and middle-income countries.” — Angela Micah

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Identifying health problems and health research priorities in developing countries

Affiliation.

• 1 London School of Hygiene and Tropical Medicine, UK.
• PMID: 2661849

When we were invited to prepare this background paper on the health problems of the developing countries for the Commission on Health Research for Development, our first thought was to compile and organize available data on the causes of morbidity and mortality affecting different age groups in various populations. It soon became clear that this would not be especially useful. There are major gaps in the available data, particularly from the poorer countries and for people above 5 years of age. The data that are available are often of poor or uncertain quality, collected from unrepresentative or undefined subpopulations, and not strictly comparable due to different definitions and data-collection methods. Additionally, in the absence of agreed definitions and analytical frameworks, it is not clear what could or should be done with the data on health problems so amassed. More fundamentally, we have come to doubt whether the current array of epidemiological concepts and tools is sufficient for the task. We therefore decided that, while giving an overview of current knowledge on levels and trends of morbidity and mortality, the emphasis of this paper should be more towards concepts, methods, and data deficiencies. In Section 1, we set out definitions and frameworks for considering health problems and health research; we review recent conceptual models for the analysis of the determinants of child survival; and we outline a framework, focusing on modifiable determinants of health and life-cycle health effects, which is used in subsequent sections. In Section 2, relationships between national and societal level determinants and health are reviewed and then set aside. In Section 3, we review available data on world patterns and trends of morbidity and mortality, highlighting the data deficiencies and lacunae. In Section 4, we follow the life of a woman in a developing country and examine the health problems, and their determinants, which she and her children face. In Section 5, we draw these strands together and, having reviewed current approaches to prioritizing health problems and suggested some ways in which they could be improved, in Section 6 identify several research priorities, emphasizing the need for methodological research. This paper was commissioned in March 1987; prepared in draft and presented to a meeting at Chateau de Bossey, Geneva, Switzerland during 15-17 July; and revised and completed in September 1987. It is in no sense definitive or final.(ABSTRACT TRUNCATED AT 400 WORDS)

PIP: The fact that economic progress has a bearing on health can be seen in most developing countries where widespread poverty causes poor health and high mortality. Childhood mortality is highest in Africa and in Southern Asia. The rate of decline in mortality has decreased in these areas since the 1950s. In Sri Lanka, approximately 5% of the children 5 years old die, yet yearly 1/3 of the children 5 Afghanistan and a few West African countries die. In less developed countries, adult mortality is high: in places where the life expectancy of a 15-year-old is under 50 years, 30-40% will die before age 60. 80-90% of the deaths from water and food borne diseases are accounted for by diarrhea and dysentery, and 60-70% of the deaths from airborne diseases by pneumonia and bronchitis. Present estimates from 4 localities indicate that measles, malaria, tetanus, and acute respiratory infection account for more than 90% of all child mortality. Various estimates suggest that there are 100-300 million cases of malaria and 1-2 million malaria-related deaths annually. Estimates indicate a ratio of abortions varying between 9/1000 live births in East Africa to 325/1000 live births in Latin America. 1986 WHO data indicate that induced abortion is responsible for 7-50% of all maternal deaths in developing countries. More than 90 countries now that operational diarrheal disease control programs, 47 countries are producing oral rehydration solutions, 8450 health personnel have been trained in diarrhea program supervisory skills, and oral rehydration use rates are slowly rising.

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• [Morbidity and mortality and maternal-child health in the Dominican Republic]. Morillo Perez A. Morillo Perez A. Poblac Desarro. 1993;(3):9-122. Poblac Desarro. 1993. PMID: 12178315 Spanish.
• [Current malaria situation in the Republic of Kazakhstan]. Bismil'din FB, Shapieva ZhZh, Anpilova EN. Bismil'din FB, et al. Med Parazitol (Mosk). 2001 Jan-Mar;(1):24-33. Med Parazitol (Mosk). 2001. PMID: 11548308 Russian.
• Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence. Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA. Bhutta ZA, et al. Pediatrics. 2005 Feb;115(2 Suppl):519-617. doi: 10.1542/peds.2004-1441. Pediatrics. 2005. PMID: 15866863 Review.
• [A decade of child health research in developing countries]. Orne-Gliemann J, Perez F, Leroy V, Newell ML, Dabis F. Orne-Gliemann J, et al. Sante. 2003 Apr-Jun;13(2):69-75. Sante. 2003. PMID: 14530116 Review. French.
• Epidemiology's contribution to health service management and planning in developing countries: a missing link. Unger JP, Dujardin B. Unger JP, et al. Bull World Health Organ. 1992;70(4):487-97. Bull World Health Organ. 1992. PMID: 1394783 Free PMC article.

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Obesity: Risk factors, complications, and strategies for sustainable long‐term weight management

Sharon m. fruh.

1 College of Nursing, University of South Alabama, Mobile, Alabama

Background and Purpose

The aims of this article are to review the effects of obesity on health and well‐being and the evidence indicating they can be ameliorated by weight loss, and consider weight‐management strategies that may help patients achieve and maintain weight loss.

Narrative review based on literature searches of PubMed up to May 2016 with no date limits imposed. Search included terms such as “obesity,” “overweight,” “weight loss,” “comorbidity,” “diabetes,” cardiovascular,” “cancer,” “depression,” “management,” and “intervention.”

Conclusions

Over one third of U.S. adults have obesity. Obesity is associated with a range of comorbidities, including diabetes, cardiovascular disease, obstructive sleep apnea, and cancer; however, modest weight loss in the 5%–10% range, and above, can significantly improve health‐related outcomes. Many individuals struggle to maintain weight loss, although strategies such as realistic goal‐setting and increased consultation frequency can greatly improve the success of weight‐management programs. Nurse practitioners have key roles in establishing weight‐loss targets, providing motivation and support, and implementing weight‐loss programs.

Implications for Practice

With their in‐depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in weight‐management strategies deployed in clinical practice.

Introduction

Obesity is an increasing, global public health issue. Patients with obesity are at major risk for developing a range of comorbid conditions, including cardiovascular disease (CVD), gastrointestinal disorders, type 2 diabetes (T2D), joint and muscular disorders, respiratory problems, and psychological issues, which may significantly affect their daily lives as well as increasing mortality risks. Obesity‐associated conditions are manifold; however, even modest weight reduction may enable patients to reduce their risk for CVD, diabetes, obstructive sleep apnea (OSA), and hypertension among many other comorbidities (Cefalu et al., 2015 ). A relatively small and simple reduction in weight, for example, of around 5%, can improve patient outcomes and may act as a catalyst for further change, with sustainable weight loss achieved through a series of incremental weight loss steps. In facilitating the process of losing weight for patients, nurse practitioners play an essential role. Through assessing the patient's risk, establishing realistic weight‐loss targets, providing motivation and support, and supplying patients with the necessary knowledge and treatment tools to help achieve weight loss, followed by tools for structured lifestyle support to maintain weight lost, the nurse practitioner is ideally positioned to help patient's achieve their weight‐loss—and overall health—targets.

The obesity epidemic

The World Health Organization (WHO) defines overweight and obesity as abnormal or excessive fat accumulation that presents a risk to health (WHO, 2016a ). A body mass index (BMI) ≥25 kg/m 2 is generally considered overweight, while obesity is considered to be a BMI ≥ 30 kg/m 2 . It is well known that obesity and overweight are a growing problem globally with high rates in both developed and developing countries (Capodaglio & Liuzzi, 2013 ; WHO, 2016a , 2016b ).

In the United States in 2015, all states had an obesity prevalence more than 20%, 25 states and Guam had obesity rates >30% and four of those 25 states (Alabama, Louisiana, Mississippi, and West Virginia) had rates >35% (Centres for Disease Control and Prevention, 2016 ; Figure ​ Figure1). 1 ). Approximately 35% and 37% of adult men and women, respectively, in the United States have obesity (Yang & Colditz, 2015 ). Adult obesity is most common in non‐Hispanic black Americans, followed by Mexican Americans, and non‐Hispanic white Americans (Yang & Colditz, 2015 ). Individuals are also getting heavier at a younger age; birth cohorts from 1966 to 1975 and 1976 to 1985 reached an obesity prevalence of ≥20% by 20–29 years of age, while the 1956–1965 cohort only reached this prevalence by age 30–39 years (Lee et al., 2010 ). Additionally, the prevalence of childhood obesity in 2‐ to 17‐year‐olds in the United States has increased from 14.6% in 1999–2000 to 17.4% in 2013–2014 (Skinner & Skelton, 2014 ). Childhood obesity is an increasing health issue because of the early onset of comorbidities that have major adverse health impacts, and the increased likelihood of children with obesity going on to become adults with obesity (50% risk vs. 10% for children without obesity; Whitaker, Wright, Pepe, Seidel, & Dietz, 1997 ).

U.S. obesity epidemic 2015.

Source . Figure adapted from Centers for Disease Control and Prevention (CDC). Retrieved from https://www.cdc.gov/obesity/data/prevalence-maps.html .

Association of obesity with mortality and comorbid disease

Obesity is associated with a significant increase in mortality, with a life expectancy decrease of 5–10 years (Berrington de Gonzalez et al., 2010 ; Kuk et al., 2011 ; Prospective Studies Collaboration et al., 2009 ). There is evidence to indicate that all‐cause, CVD‐associated, and cancer‐associated mortalities are significantly increased in individuals with obesity, specifically those at Stages 2 or 3 of the Edmonton Obesity Staging System (EOSS; Kuk et al., 2011 ; Figure ​ Figure2). 2 ). Mortality related to cancer is, however, also increased at Stage 1, when the physical symptoms of obesity are marginal (Figure ​ (Figure2). 2 ). Recently, a large‐scale meta‐analysis that included studies that had enrolled over 10 million individuals, indicated that, relative to the reference category of 22.5 to <25 kg/m 2 , the hazard ratio (HR) for all‐cause mortality rose sharply with increasing BMI (The Global BMI Mortality Collaboration, 2016 ). For a BMI of 25.0 to <30.0 kg/m 2 , the HR was 1.11 (95% confidence interval [CI] 1.10, 1.11), and this increased to 1.44 (1.41, 1.47), 1.92 (1.86, 1.98), and 2.71 (2.55, 2.86) for a BMI of 30.0 to <35.0, 35.0 to <40.0, and 40.0 to <60.0 kg/m 2 , respectively.

Association between EOSS stage and risk of all‐cause (A), CVD (B), cancer (C), and non‐CVD or noncancer mortality (D) in men and women. © 2011.

Source . Reproduced with permission from NRC Research Press, from Kuk et al. ( 2011 ). CVD, cardiovascular disease; NW, normal weight.

Comorbidities

Obesity is a chronic disease that is associated with a wide range of complications affecting many different aspects of physiology (Dobbins, Decorby, & Choi, 2013 ; Guh et al., 2009 ; Martin‐Rodriguez, Guillen‐Grima, Marti, & Brugos‐Larumbe, 2015 ; summarized in Table ​ Table1). 1 ). To examine these obesity‐related morbidities in detail is beyond the scope of this review and therefore only a brief overview of some of the key pathophysiological processes is included next.

Morbidities associated with obesity (Hamdy, 2016 ; Petry, Barry, Pietrzak, & Wagner, 2008 ; Pi‐Sunyer, 2009 ; Sakai et al., 2005 ; Smith, Hulsey, & Goodnight, 2008 ; Yosipovitch, DeVore, & Dawn, 2007 )

The progression from lean state to obesity brings with it a phenotypic change in adipose tissue and the development of chronic low‐grade inflammation (Wensveen, Valentic, Sestan, Turk Wensveen, & Polic, 2015 ). This is characterized by increased levels of circulating free‐fatty acids, soluble pro‐inflammatory factors (such as interleukin [IL] 1β, IL‐6, tumor necrosis factor [TNF] α, and monocyte chemoattractant protein [MCP] 1) and the activation and infiltration of immune cells into sites of inflammation (Hursting & Dunlap, 2012 ). Obesity is also usually allied to a specific dyslipidemia profile (atherogenic dyslipidemia) that includes small, dense low‐density lipoprotein (LDL) particles, decreased levels of high‐density lipoprotein (HDL) particles, and raised triglyceride levels (Musunuru, 2010 ). This chronic, low‐grade inflammation and dyslipidemia profile leads to vascular dysfunction, including atherosclerosis formation, and impaired fibrinolysis. These, in turn, increase the risk for CVD, including stroke and venous thromboembolism (Blokhin & Lentz, 2013 ).

The metabolic and cardiovascular aspects of obesity are closely linked. The chronic inflammatory state associated with obesity is established as a major contributing factor for insulin resistance, which itself is one of the key pathophysiologies of T2D (Johnson, Milner, & Makowski, 2012 ). Furthermore, central obesity defined by waist circumference is the essential component of the International Diabetes Federation (IDF) definition of the metabolic syndrome (raised triglycerides, reduced HDL cholesterol, raised blood pressure, and raised fasting plasma glucose; International Diabetes Federation, 2006 ).

Obesity is also closely associated with OSA. To start, a number of the conditions associated with obesity such as insulin resistance (Ip et al., 2002 ), systemic inflammation, and dyslipidemia are themselves closely associated with OSA, and concurrently, the obesity‐associated deposition of fat around the upper airway and thorax may affect lumen size and reduce chest compliance that contributes to OSA (Romero‐Corral, Caples, Lopez‐Jimenez, & Somers, 2010 ).

The development of certain cancers, including colorectal, pancreatic, kidney, endometrial, postmenopausal breast, and adenocarcinoma of the esophagus to name a few, have also been shown to be related to excess levels of fat and the metabolically active nature of this excess adipose tissue (Booth, Magnuson, Fouts, & Foster, 2015 ; Eheman et al., 2012 ). Cancers have shown to be impacted by the complex interactions between obesity‐related insulin resistance, hyperinsulinemia, sustained hyperglycemia, oxidative stress, inflammation, and the production of adipokines (Booth et al., 2015 ). The wide range of morbidities associated with obesity represents a significant clinical issue for individuals with obesity. However, as significant as this array of risk factors is for patient health, the risk factors can be positively modified with weight loss.

Obesity‐related morbidities in children and adolescents

As was referred to earlier, children and adolescents are becoming increasingly affected by obesity. This is particularly concerning because of the long‐term adverse consequences of early obesity. Obesity adversely affects the metabolic health of young people and can result in impaired glucose tolerance, T2D, and early‐onset metabolic syndrome (Pulgaron, 2013 ).There is also strong support in the literature for relationships between childhood obesity and asthma, poor dental health (caries), nonalcoholic fatty liver disease (NAFLD), and gastroesophageal reflux disease (GERD; Pulgaron, 2013 ). Obesity can also affect growth and sexual development and may delay puberty in boys and advance puberty in some girls (Burt Solorzano & McCartney, 2010 ). Childhood obesity is also associated with hyperandrogenism and polycystic ovary syndrome (PCOS) in girls (Burt Solorzano & McCartney, 2010 ). Additionally, obesity is associated with psychological problems in young people including attention deficit hyperactivity disorder (ADHD), anxiety, depression, poor self‐esteem, and problems with sleeping (Pulgaron, 2013 ).

Modest weight loss and its long‐term maintenance: Benefits and risks

Guidelines endorse weight‐loss targets of 5%–10% in individuals with obesity or overweight with associated comorbidities, as this has been shown to significantly improve health‐related outcomes for many obesity‐related comorbidities (Cefalu et al., 2015 ; Figure ​ Figure3), 3 ), including T2D prevention, and improvements in dyslipidemia, hyperglycemia, osteoarthritis, stress incontinence, GERD, hypertension, and PCOS. Further benefits may be evident with greater weight loss, particularly for dyslipidemia, hyperglycemia, and hypertension. For NAFLD and OSA, at least 10% weight loss is required to observe clinical improvements (Cefalu et al., 2015 ).

Benefits of modest weight loss. Lines demonstrate the ranges in which weight loss has been investigated and shown to have clinical benefits. Arrows indicate that additional benefits may be seen with further weight loss.

Source . Figure adapted from Cefalu et al. ( 2015 ).

Importantly, the weight‐loss benefits in terms of comorbidities are also reflected in improved all‐cause mortality. A recent meta‐analysis of 15 studies demonstrated that relatively small amounts of weight loss, on average 5.5 kg in the treatment arm versus 0.2 kg with placebo from an average baseline BMI of 35 kg/m 2 , resulted in a substantial 15% reduction in all‐cause mortality (Kritchevsky et al., 2015 ).

Cardiovascular health

Weight loss is associated with beneficial changes in several cardiovascular risk markers, including dyslipidemia, pro‐inflammatory/pro‐thrombotic mediators, arterial stiffness, and hypertension (Dattilo & Kris‐Etherton, 1992 ; Dengo et al., 2010 ; Goldberg et al., 2014 ; Haffner et al., 2005 ; Ratner et al., 2005 ). Importantly, weight loss was found to reduce the risk for CVD mortality by 41% up to 23 years after the original weight‐loss intervention (Li et al., 2014 ; Figure ​ Figure4). 4 ). Evidence including the biological effects of obesity and weight loss, and the increased risk for stroke with obesity indicates that weight loss may be effective for primary‐ and secondary‐stroke prevention (Kernan, Inzucchi, Sawan, Macko, & Furie, 2013 ).

Reduction in cardiovascular mortality with modest weight reduction. Cumulative incidence of CVD mortality during 23 years of follow‐up in the Da Qing study (Li et al., 2014 ). Figure © 2014 Elsevier.

Source . Reproduced with permission from Li et al. ( 2014 ).

Type 2 diabetes

Three major long‐term studies, the Diabetes Prevention Program (DPP), the Diabetes Prevention Study (DPS), and the Da Qing IGT and Diabetes (Da Qing) study, have demonstrated that modest weight loss through short‐term lifestyle or pharmacologic interventions can reduce the risk for developing T2D by 58%, 58%, and 31%, respectively, in individuals with obesity and prediabetes (DPP Research Group et al., 2009 ; Pan et al., 1997 ; Tuomilehto et al., 2001 ). Long‐term benefits were maintained following the interventions; for example, in the DPP, the risk reduction of developing T2D versus placebo was 34% at 10 years and 27% at 15 years following the initial weight‐loss intervention (DPP Research Group, 2015 ; DPP Research Group et al., 2009 ). Weight loss increased the likelihood of individuals reverting from prediabetes to normoglycemia (DPP Research Group et al., 2009 ; Li et al., 2008 ; Lindstrom et al., 2003 , 2006 ; Tuomilehto et al., 2001 ), and also improved other aspects of glycemic control including fasting and postprandial glucose, and insulin sensitivity (Haufe et al., 2013 ; Li et al., 2008 ).

Sleep apnea

Data indicate that weight loss is beneficial, although not curative, in patients with obesity who experience OSA. Meta‐analyses of patients who underwent treatment with either intensive lifestyle intervention (Araghi et al., 2013 ) or bariatric surgery (Greenburg, Lettieri, & Eliasson, 2009 ) demonstrated improvements in apnea‐hypopnea index (AHI) following treatment. In the first of these meta‐analyses, in randomized controlled trials, lifestyle intervention lead to a mean reduction in BMI of 2.3 kg/m 2 , which was associated with a decrease in mean AHI of 6.0 events/h. As expected, weight loss was much higher in the second meta‐analysis that investigated the effect of bariatric surgery on measures of OSA, and this was associated with greater reductions in AHI; the mean BMI reduction of 17.9 kg/m 2 resulted in AHI events being reduced by a mean of 38.2 events/h. Once these improvements in AHI have occurred, they seem to persist for some time, irrespective of a certain degree of weight regain. In one study, an initial mean weight loss of 10.7 kg resulted in a persistent improvement in AHI over a 4‐year period despite weight regain of approximately 50% by Year 4 (Kuna et al., 2013 ).

Intentional weight loss of >9 kg reduced the risk for a range of cancers including breast, endometrium, and colon in the large‐scale Iowa Women's Health Study (Parker & Folsom, 2003 ). The overall reduction in the incidence rate of any cancer was 11% (relative risk, 0.89; 95% CI 0.79, 1.00) for participants who lost more than 9 kg compared with those who did not achieve a more than 9 kg weight loss episode. Additionally, weight loss in participants with obesity has been established to be associated with reductions in cancer biomarkers including soluble E‐selectin and IL‐6 (Linkov et al., 2012 ).

Additional health benefits

The substantial weight loss associated with bariatric surgery has been shown to improve asthma with a 48%–100% improvement in symptoms and reduction in medication use (Juel, Ali, Nilas, & Ulrik, 2012 ); however, there is a potential threshold effect so that modest weight loss of 5%–10% may lead to clinical improvement (Lv, Xiao, & Ma, 2015 ). Similarly, modest weight loss of 5%–10% improves GERD (Singh et al., 2013 ) and liver function (Haufe et al., 2013 ). A study utilizing MRI scanning to examine the effects of weight loss on NAFLD has reported a reduction in liver fat from 18.3% to 13.6% ( p = .03), a relative reduction of 25% (Patel et al., 2015 ). Taking an active role in addressing obesity through behavioral modifications or exercise can also reduce the symptoms of depression (Fabricatore et al., 2011 ), improve urinary incontinence in men and women (Breyer et al., 2014 ; Brown et al., 2006 ), and improve fertility outcomes in women (Kort, Winget, Kim, & Lathi, 2014 ). Additionally, weight loss can reduce the joint‐pain symptoms and disability caused by weight‐related osteoarthritis (Felson, Zhang, Anthony, Naimark, & Anderson, 1992 ; Foy et al., 2011 ).

Mitigating risks

Despite the array of benefits, weight loss can also be linked with certain risks that may need to be managed. One such example is the risk for gallstones with rapid weight loss, which is associated with gallstone formation in 30%–71% of individuals. Gallstone formation is particularly associated with bariatric surgery when weight loss exceeds 1.5 kg/week and occurs particularly within the first 6 weeks following surgery when weight loss is greatest. Slower rates of weight loss appear to mitigate the risk for gallstone formation compared to the general population but may not eliminate it entirely; as was noted in the year‐long, weight‐loss, SCALE trial that compared liraglutide 3.0 mg daily use to placebo and resulted in gallstone formation in 2.5% of treated subjects compared to 1% of subjects taking placebo. For this reason, the risk for cholethiasis should be considered when formulating weight‐loss programs (Weinsier & Ullmann, 1993 ).

Strategies to help individuals achieve and maintain weight loss

Rogge and Gautam have covered the biology of obesity and weight regain within another section of this supplement (Rogge & Gautam, 2017 ), so here we focus on some of the clinical strategies for delivering weight loss and weight loss maintenance lifestyle programs. Structured lifestyle support plays an important role in successful weight management. A total of 34% of participants receiving structured lifestyle support from trained‐nursing staff achieved weight loss of ≥5% over 12 weeks compared with approximately 19% with usual care (Nanchahal et al., 2009 ). This particular structured program, delivered in a primary healthcare setting, included initial assessment and goal setting, an eating plan and specific lifestyle goals, personalized activity program, and advice about managing obstacles to weight loss. Additionally, data from the National Weight Control Registry (NWCR), which is the longest prospective compilation of data from individuals who have successfully lost weight and maintained their weight loss, confirm expectations that sustained changes to both diet and activity levels are central to successful weight management (Table ​ (Table2). 2 ). Therefore, an understanding of different clinical strategies for delivery‐structured support is essential for the nurse practitioner.

Lifestyle factors associated with achieving and maintaining weight loss

Note . Data from (NWCR, 2016 ).

a Walking was the most common activity undertaken.

Realistic weight‐loss targets

From the outset, a patient's estimate of their achievable weight loss may be unrealistic. Setting realistic weight‐loss goals is often difficult because of misinformation from a variety of sources, including friends, media, and other healthcare professionals (Osunlana et al., 2015 ). Many individuals with obesity or overweight have unrealistic goals of 20%–30% weight loss, whereas a more realistic goal would be the loss of 5%–15% of the initial body weight (Fabricatore et al., 2007 ). Promoting realistic weight‐loss expectations for patients was identified as a key difficulty for nurse practitioners, primary care nurses, dieticians, and mental health workers (Osunlana et al., 2015 ). Visual resources showing the health and wellness benefit of modest weight loss may thus be helpful (Osunlana et al., 2015 ). Healthcare practitioners should focus on open discussion about, and re‐enforcement of, realistic weight‐loss goals and assess outcomes consistently according to those goals (Bray, Look, & Ryan, 2013 ).

Maintaining a food diary

The 2013 White Paper from the American Nurse Practitioners Foundation on the Prevention and Treatment of Obesity considers a food diary as an important evidence‐based nutritional intervention in aiding weight loss (ANPF). Consistent and regular recording in a food diary was significantly associated with long‐term weight‐loss success in a group of 220 women (Peterson et al., 2014 ). This group lost a mean of 10.4% of their initial body weight through a 6‐month group‐based weight‐management program and then regained a mean of 2.3% over a 12‐month follow‐up period, during which participants received bimonthly support in person, by telephone, or by e‐mail (Peterson et al., 2014 ). Over the 12‐month follow‐up, women who self‐monitored consistently (≥50% of the extended‐care year) had a mean weight loss of 0.98%, while those who were less consistent (<50%) gained weight (5.1%; p < .01). Therefore, frequent and consistent food monitoring should be encouraged, particularly in the weight‐maintenance phase of any program.

Motivating and supporting patients

Motivational interviewing is a technique that focuses on enhancing intrinsic motivation and behavioral changes by addressing ambivalence (Barnes & Ivezaj, 2015 ). Interviews focus on “change talk,” including the reasons for change and optimism about the intent for change in a supportive and nonconfrontational setting, and may help individuals maintain behavioral changes.

For patients that have achieved weight loss, the behavioral factors associated with maintaining weight loss include strong social support networks, limiting/avoiding disinhibited eating, avoiding binge eating, avoiding eating in response to stress or emotional issues, being accountable for one's decisions, having a strong sense of autonomy, internal motivation, and self‐efficacy (Grief & Miranda, 2010 ). Therefore, encouraging feelings of “self‐worth” or “self‐efficacy” can help individuals to view weight loss as being within their own control and achievable (Cochrane, 2008 ).

Strengthening relationships with patients with overweight or obesity to enhance trust may also improve adherence with weight‐loss programs. Patients with hypertension who reported having “complete trust” in their healthcare practitioner were more than twice as likely to engage in lifestyle changes to lose weight than those who lacked “complete trust” (Jones, Carson, Bleich, & Cooper, 2012 ). It may be prudent to ensure the healthcare staff implementing weight‐loss programs have sufficient time to foster trust with their patients.

Continued support from healthcare staff may help patients sustain the necessary motivation for lifestyle changes. A retrospective analysis of 14,256 patients in primary care identified consultation frequency as a factor that can predict the success of weight‐management programs (Lenoir, Maillot, Guilbot, & Ritz, 2015 ). Individuals who successfully maintained ≥10% weight loss over 12 months visited the healthcare provider on average 0.65 times monthly compared with an average of 0.48 visits/month in those who did not maintain ≥10% weight loss, and 0.39 visits/month in those who failed to achieve the initial ≥10% weight loss ( p < .001; Lenoir et al., 2015 ).

Educational and environmental factors

It is important to consider a patient's education and environment when formulating a weight loss strategy as environmental factors may need to be challenged to help facilitate weight loss. A family history of obesity and childhood obesity are strongly linked to adult obesity, which is likely to be because of both genetic and behavioral factors (Kral & Rauh, 2010 ). Parents create their child's early food experiences and influence their child's attitudes to eating through learned eating habits and food choices (Kral & Rauh, 2010 ). Families can also impart cultural preferences for less healthy food choices and family food choices may be affected by community factors, such as the local availability and cost of healthy food options (Castro, Shaibi, & Boehm‐Smith, 2009 ). Alongside this, genetic variation in taste sensation may influence the dietary palate and influence food choices (Loper, La Sala, Dotson, & Steinle, 2015 ). For example, sensitivity to 6‐n‐propylthiouracil (PROP) is genetically determined, and PROP‐tasting ability ranges from super taster to nontaster. When offered buffet‐style meals over 3 days, PROP nontasters consumed more energy, and a greater proportion of energy from fat compared with super tasters. So it is possible that a family's genetic profile could contribute to eating choices. To address behavioral factors, it is important to ensure that families have appropriate support and information and that any early signs of weight gain are dealt with promptly.

A healthy home food environment can help individuals improve their diet. In children, key factors are availability of fresh fruit and vegetables at home and parental influence through their own fresh fruit and vegetable intake (Wyse, Wolfenden, & Bisquera, 2015 ). In adults, unhealthy home food environment factors include less healthy food in the home and reliance on fast food ( p = .01) are all predictors of obesity (Emery et al., 2015 ).

Family mealtimes are strongly associated with better dietary intake and a randomized controlled trial to encourage healthy family meals showed a promising reduction in excess weight gain in prepubescent children (Fulkerson et al., 2015 ). Another study showed that adolescents with any level of baseline family meal frequency, 1–2, 3–4, and ≥5 family meals/week, had reduced odds of being affected by overweight or obesity 10 years later than adolescents who never ate family meals (Berge et al., 2015 ). Community health advocates have identified the failure of many families to plan meals or prepare food as a barrier to healthy family eating patterns (Fruh, Mulekar, Hall, Fulkerson et al., 2013 ). Meal planning allows healthy meals to be prepared in advance and frozen for later consumption (Fruh, Mulekar, Hall, Adams et al., 2013 ) and is associated with increased consumption of vegetables and healthier meals compared with meals prepared on impulse (Crawford, Ball, Mishra, Salmon, & Timperio, 2007 ; Hersey et al., 2001 ).

The role of the nurse practitioner

The initial and ongoing interactions between patient and nurse practitioner are keys for the determination of an effective approach and implementation of a weight loss program and subsequent weight maintenance. The initial interaction can be instigated by either the nurse practitioner or the patient and once the decision has been made to manage the patient's weight, the evaluation includes a risk assessment, a discussion about the patient's weight, and treatment goal recommendations (American Nurse Practitioner Foundation, 2013 ). Across this process, it may be advantageous to approach this using objective data and language that is motivational and/or nonjudgmental. Patients may struggle with motivation, and therefore, ongoing discussions around the health benefits and improvements to quality of life as a result of weight loss may be required (American Nurse Practitioner Foundation, 2013 ). It may be valuable to allocate personalized benefits to the weight loss such as playing with children/grandchildren (American Nurse Practitioner Foundation, 2013 ). Treatment approaches encompass nonpharmacological and pharmacological strategies; however, it is important to remember that any pharmacological agent used should be used as an adjunct to nutritional and physical activity strategies (American Nurse Practitioner Foundation, 2013 ). Pharmacotherapy options for weight management are discussed further in the article by Golden in this supplement.

Conclusions/summary

The importance of obesity management is underscored both by the serious health consequences for individuals, but also by its increasing prevalence globally, and across age groups in particular. Obesity promotes a chronic, low‐grade, inflammatory state, which is associated with vascular dysfunction, thrombotic disorders, multiple organ damage, and metabolic dysfunction. These physiological effects ultimately lead to the development of a range of morbidities, including CVD, T2D, OSA, and certain cancers along with many others, as well as causing a significant impact on mortality.

However, even modest weight loss of 5%–10% of total body weight can significantly improve health and well‐being, and further benefits are possible with greater weight loss. Weight loss can help to prevent development of T2D in individuals with obesity and prediabetes and has a positive long‐term impact on cardiovascular mortality. Beneficial, although not curative, effects have also been noted on OSA following >10% weight loss. In addition, weight loss reduces the risk for certain cancer types and has positive effects on most comorbidities including asthma, GERD, liver function, urinary incontinence, fertility, joint pain, and depression.

Weight‐loss programs that include realistic weight loss goals, frequent check‐in, and meal/activity diaries may help individuals to lose weight. Setting realistic weight‐loss goals can be difficult; however, visual resources showing the health and wellness benefit of weight loss may be helpful in discussing realistic goals, and help motivate the patient in maintaining the weight loss. Techniques such as motivational interviewing that focus on addressing resistance to behavioral change in a supportive and optimistic manner may help individuals in integrating these changes to allow them to become part of normal everyday life and thus help with maintaining the weight loss. Positive reinforcement in terms of marked early‐weight loss may also assist in improving adherence, so this should be a key goal for weight‐loss programs. Encouraging feelings of “self‐worth” or “self‐efficacy” can help individuals to view weight loss as being within their own control.

Nurse practitioners play a major role in helping patients achieve weight loss through all aspects of the process including assessment, support, motivation, goal‐setting, management, and treatment. With their in‐depth understanding of the research in the field of obesity and weight management, nurse practitioners are well placed to effect meaningful changes in the weight‐management strategies deployed in clinical practice.

List of helpful resources

Acknowledgments

The authors are grateful to Watermeadow Medical for writing assistance in the development of this manuscript. This assistance was funded by Novo Nordisk, who also had a role in the review of the manuscript for scientific accuracy. The author discussed the concept, drafted the outline, commented in detail on the first iteration, made critical revision of later drafts, and has revised and approved the final version for submission.

Dr. Sharon Fruh serves on the Novo Nordisk Obesity Speakers Bureau. In compliance with national ethical guidelines, the author reports no relationship with business or industry that would post a conflict of interest.

Writing and editorial support was provided by Watermeadow Medical, and funded by Novo Nordisk.

The copyright line in this article was changed on 9 August 2018 after online publication.

• American Nurse Practitioner Foundation . (2013). Nurse practitioners and the prevention and treatment of adult obesity—A White Paper of the American Nurse Practitioner Foundation (electronic version) . Summer. Retrieved from https://international.aanp.org/Content/docs/ObesityWhitePaper.pdf
• Araghi, M. H. , Chen, Y. F. , Jagielski, A. , Choudhury, S. , Banerjee, D. , Hussain, S. , … Taheri, S. , et al. (2013). Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): Systematic review and meta‐analysis . Sleep , 36 ( 10 ), 1553–1562, 1562a–1562e. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Barnes, R. D. , & Ivezaj, V. (2015). A systematic review of motivational interviewing for weight loss among adults in primary care . Obesity Reviews , 16 ( 4 ), 304–318. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Berge, J. M. , Wall, M. , Hsueh, T. F. , Fulkerson, J. A. , Larson, N. , & Neumark‐Sztainer, D. (2015). The protective role of family meals for youth obesity: 10‐year longitudinal associations . Journal of Pediatrics , 166 ( 2 ), 296–301. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Berrington de Gonzalez, A. , Hartge, P. , Cerhan, J. R. , Flint, A. J. , Hannan, L. , MacInnis, R. J. , … Thun, M. J. , et al. (2010). Body‐mass index and mortality among 1.46 million white adults . New England Journal of Medicine , 363 ( 23 ), 2211–2219. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Blokhin, I. O. , & Lentz, S. R. (2013). Mechanisms of thrombosis in obesity . Current Opinion in Hematology , 20 ( 5 ), 437–444 [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Booth, A. , Magnuson, A. , Fouts, J. , & Foster, M. (2015). Adipose tissue, obesity and adipokines: Role in cancer promotion . Hormone Molecular Biology and Clinical Investigation , 21 ( 1 ), 57–74. [ PubMed ] [ Google Scholar ]
• Bray, G. , Look, M. , & Ryan, D. (2013). Treatment of the obese patient in primary care: Targeting and meeting goals and expectations . Postgraduate Medical Journal , 125 ( 5 ), 67–77. [ PubMed ] [ Google Scholar ]
• Breyer, B. N. , Phelan, S. , Hogan, P. E. , Rosen, R. C. , Kitabchi, A. E. , Wing, R. R. , … the Look AHEAD Research Group , et al. (2014). Intensive lifestyle intervention reduces urinary incontinence in overweight/obese men with type 2 diabetes: Results from the Look AHEAD trial . Journal of Urology , 192 ( 1 ), 144–149. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Brown, J. S. , Wing, R. , Barrett‐Connor, E. , Nyberg, L. M. , Kusek, J. W. , Orchard, T. J. , … Diabetes Prevention Program Research Group , et al. (2006). Lifestyle intervention is associated with lower prevalence of urinary incontinence: The Diabetes Prevention Program . Diabetes Care , 29 ( 2 ), 385–390. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Burt Solorzano, C. M. , & McCartney, C. R. (2010). Obesity and the pubertal transition in girls and boys . Reproduction , 140 ( 3 ), 399–410. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Capodaglio, P. , & Liuzzi, A. (2013). Obesity: A disabling disease or a condition favoring disability ? European Journal of Physical and Rehabilitation Medicine , 49 ( 3 ), 395–398. [ PubMed ] [ Google Scholar ]
• Castro, F. G. , Shaibi, G. Q. , & Boehm‐Smith, E. (2009). Ecodevelopmental contexts for preventing type 2 diabetes in Latino and other racial/ethnic minority populations . Journal of Behavioral Medicine , 32 ( 1 ), 89–105. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Cefalu, W. T. , Bray, G. A. , Home, P. D. , Garvey, W. T. , Klein, S. , Pi‐Sunyer, F. X. , … Ryan, D. H. , et al. (2015). Advances in the science, treatment, and prevention of the disease of obesity: Reflections from a diabetes care editors' expert forum . Diabetes Care , 38 ( 8 ), 1567–1582. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Centres for Disease Control and Prevention . (2016). Overweight and obesity . Retrieved from https://www.cdc.gov/obesity/
• Cochrane, G. (2008). Role for a sense of self‐worth in weight‐loss treatments: Helping patients develop self‐efficacy . Canadian Family Physician , 54 ( 4 ), 543–547. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Crawford, D. , Ball, K. , Mishra, G. , Salmon, J. , & Timperio, A. (2007). Which food‐related behaviours are associated with healthier intakes of fruits and vegetables among women ? Public Health Nutrition , 10 ( 3 ), 256–265. [ PubMed ] [ Google Scholar ]
• Dattilo, A. M. , & Kris‐Etherton, P. M. (1992). Effects of weight reduction on blood lipids and lipoproteins: A meta‐analysis . American Journal of Clinical Nutrition , 56 ( 2 ), 320–328. [ PubMed ] [ Google Scholar ]
• Dengo, A. L. , Dennis, E. A. , Orr, J. S. , Marinik, E. L. , Ehrlich, E. , Davy, B. M. , & Davy, K. P. (2010). Arterial destiffening with weight loss in overweight and obese middle‐aged and older adults . Hypertension , 55 ( 4 ), 855–861. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Diabetes Prevention Program ( DPP) Research Group . (2015). Long‐term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15‐year follow‐up: The Diabetes Prevention Program Outcomes Study . Lancet Diabetes & Endocrinology , 3 ( 11 ), 866–875. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Diabetes Prevention Program ( DPP) Research Group , Knowler, W. C. , Fowler, S. E. , Hamman, R. F. , Christophi, C. A. , Hoffman, H. J. , … Nathan, D. M. , et al. (2009). 10‐year follow‐up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study . Lancet , 374 ( 9702 ), 1677–1686. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Dobbins, M. , Decorby, K. , & Choi, B. C. (2013). The association between obesity and cancer risk: A meta‐analysis of observational studies from 1985 to 2011 . ISRN Preventive Medicine , 2013 , 680536 10.5402/2013/680536. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Eheman, C. , Henley, S. J. , Ballard‐Barbash, R. , Jacobs, E. J. , Schymura, M. J. , Noone, A. M. , … Edwards, B. K. , et al. (2012). Annual Report to the Nation on the status of cancer, 1975–2008, featuring cancers associated with excess weight and lack of sufficient physical activity . Cancer , 118 ( 9 ), 2338–2366. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Emery, C. F. , Olson, K. L. , Lee, V. S. , Habash, D. L. , Nasar, J. L. , & Bodine, A. (2015). Home environment and psychosocial predictors of obesity status among community‐residing men and women . International Journal of Obesity , 39 ( 9 ), 1401–1407. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Fabricatore, A. N. , Wadden, T. A. , Higginbotham, A. J. , Faulconbridge, L. F. , Nguyen, A. M. , Heymsfield, S. B. , & Faith, M. S. (2011). Intentional weight loss and changes in symptoms of depression: A systematic review and meta‐analysis . International Journal of Obesity , 35 ( 11 ), 1363–1376. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Fabricatore, A. N. , Wadden, T. A. , Womble, L. G. , Sarwer, D. B. , Berkowitz, R. I. , Foster, G. D. , & Brock, J. R. (2007). The role of patients' expectations and goals in the behavioral and pharmacological treatment of obesity . International Journal of Obesity , 31 ( 11 ), 1739–1745. [ PubMed ] [ Google Scholar ]
• Felson, D. T. , Zhang, Y. , Anthony, J. M. , Naimark, A. , & Anderson, J. J. (1992). Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study . Annals of Internal Medicine , 116 ( 7 ), 535–539. [ PubMed ] [ Google Scholar ]
• Foy, C. G. , Lewis, C. E. , Hairston, K. G. , Miller, G. D. , Lang, W. , Jakicic, J. M. , … the Look AHEAD Research Group , et al. (2011). Intensive lifestyle intervention improves physical function among obese adults with knee pain: Findings from the Look AHEAD trial . Obesity (Silver Spring) , 19 ( 1 ), 83–93. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Fruh, S. M. , Mulekar, M. S. , Hall, H. R. , Adams, J. R. , Lemley, T. , Evans, B. , & Dierking, J. (2013). Meal‐planning practices with individuals in health disparity zip codes . Journal for Nurse Practitioners , 9 ( 6 ), 344–349. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Fruh, S. M. , Mulekar, M. S. , Hall, H. R. , Fulkerson, J. A. , Hanks, R. S. , Lemley, T. , … Dierking, J. , et al. (2013). Perspectives of community health advocates: Barriers to healthy family eating patterns . Journal for Nurse Practitioners , 9 ( 7 ), 416–421. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Fulkerson, J. A. , Friend, S. , Flattum, C. , Horning, M. , Draxten, M. , Neumark‐Sztainer, D. , … Kubik, M. , et al. (2015). Promoting healthful family meals to prevent obesity: HOME Plus, a randomized controlled trial . International Journal of Behavioral Nutrition and Physical Activity , 12 , 154. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Goldberg, R. B. , Temprosa, M. G. , Mather, K. J. , Orchard, T. J. , Kitabchi, A. E. , & Watson, K. E. , for the Diabetes Prevention Program Research Group . (2014). Lifestyle and metformin interventions have a durable effect to lower CRP and tPA levels in the diabetes prevention program except in those who develop diabetes . Diabetes Care , 37 ( 8 ), 2253–2260. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Greenburg, D. L. , Lettieri, C. J. , & Eliasson, A. H. (2009). Effects of surgical weight loss on measures of obstructive sleep apnea: A meta‐analysis . American Journal of Medicine , 122 ( 6 ), 535–542. [ PubMed ] [ Google Scholar ]
• Grief, S. N. , & Miranda, R. L. (2010). Weight loss maintenance . American Family Physician , 82 ( 6 ), 630–634. [ PubMed ] [ Google Scholar ]
• Guh, D. P. , Zhang, W. , Bansback, N. , Amarsi, Z. , Birmingham, C. L. , & Anis, A. H. (2009). The incidence of co‐morbidities related to obesity and overweight: A systematic review and meta‐analysis . BMC Public Health , 9 , 88. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Haffner, S. , Temprosa, M. , Crandall, J. , Fowler, S. , Goldberg, R. , Horton, E. , … Diabetes Prevention Program Research Group , et al. (2005). Intensive lifestyle intervention or metformin on inflammation and coagulation in participants with impaired glucose tolerance . Diabetes , 54 ( 5 ), 1566–1572. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hamdy, O. (2016). Obesity . Retrieved from https://emedicine.medscape.com/article/123702-overview
• Haufe, S. , Haas, V. , Utz, W. , Birkenfeld, A. L. , Jeran, S. , Bohnke, J. , … Engeli, S. , et al. (2013). Long‐lasting improvements in liver fat and metabolism despite body weight regain after dietary weight loss . Diabetes Care , 36 ( 11 ), 3786–3792. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Hersey, J. , Anliker, J. , Miller, C. , Mullis, R. M. , Daugherty, S. , Das, S. , … Olivia, A. H. , et al. (2001). Food shopping practices are associated with dietary quality in low‐income households . Journal of Nutrition Education , 33 ( Suppl 1 ), S16–S26. [ PubMed ] [ Google Scholar ]
• Hursting, S. D. , & Dunlap, S. M. (2012). Obesity, metabolic dysregulation, and cancer: A growing concern and an inflammatory (and microenvironmental) issue . Annals of the New York Academy of Sciences , 1271 , 82–87. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• International Diabetes Federation . (2006). The IDF consensus worldwide definition of the metabolic syndrome (electronic version). Retrieved from https://www.idf.org/webdata/docs/IDF_Meta_def_final.pdf
• Ip, M. S. , Lam, B. , Ng, M. M. , Lam, W. K. , Tsang, K. W. , & Lam, K. S. (2002). Obstructive sleep apnea is independently associated with insulin resistance . American Journal of Respiratory and Critical Care Medicine , 165 ( 5 ), 670–676. [ PubMed ] [ Google Scholar ]
• Johnson, A. R. , Milner, J. J. , & Makowski, L. (2012). The inflammation highway: Metabolism accelerates inflammatory traffic in obesity . Immunological Reviews , 249 ( 1 ), 218–238. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Jones, D. E. , Carson, K. A. , Bleich, S. N. , & Cooper, L. A. (2012). Patient trust in physicians and adoption of lifestyle behaviors to control high blood pressure . Patient Education and Counseling , 89 ( 1 ), 57–62. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Juel, C. T. , Ali, Z. , Nilas, L. , & Ulrik, C. S. (2012). Asthma and obesity: Does weight loss improve asthma control? A systematic review . Journal of Asthma and Allergy , 5 , 21–26. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kernan, W. N. , Inzucchi, S. E. , Sawan, C. , Macko, R. F. , & Furie, K. L. (2013). Obesity: A stubbornly obvious target for stroke prevention . Stroke , 44 ( 1 ), 278–286. [ PubMed ] [ Google Scholar ]
• Kort, J. D. , Winget, C. , Kim, S. H. , & Lathi, R. B. (2014). A retrospective cohort study to evaluate the impact of meaningful weight loss on fertility outcomes in an overweight population with infertility . Fertility and Sterility , 101 ( 5 ), 1400–1403. [ PubMed ] [ Google Scholar ]
• Kral, T. V. , & Rauh, E. M. (2010). Eating behaviors of children in the context of their family environment . Physiology & Behavior , 100 ( 5 ), 567–573. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kritchevsky, S. B. , Beavers, K. M. , Miller, M. E. , Shea, M. K. , Houston, D. K. , Kitzman, D. W. , & Nicklas, B. J. (2015). Intentional weight loss and all‐cause mortality: A meta‐analysis of randomized clinical trials . PLoS One , 10 ( 3 ), e0121993. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Kuk, J. L. , Ardern, C. I. , Church, T. S. , Sharma, A. M. , Padwal, R. , Sui, X. , … Blair, S. N. , et al. (2011). Edmonton obesity staging system: Association with weight history and mortality risk . Applied Physiology, Nutrition, and Metabolism , 36 ( 4 ), 570–576. [ PubMed ] [ Google Scholar ]
• Kuna, S. T. , Reboussin, D. M. , Borradaile, K. E. , Sanders, M. H. , Millman, R. P. , Zammit, G. , … Sleep AHEAD Research Group of the Look AHEAD Research Group , et al. (2013). Long‐term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes . Sleep , 36 ( 5 ), 641–649A. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lee, J. M. , Pilli, S. , Gebremariam, A. , Keirns, C. C. , Davis, M. M. , Vijan, S. , … Gurney, J. G. , et al. (2010). Getting heavier, younger: Trajectories of obesity over the life course . International Journal of Obesity , 34 ( 4 ), 614–623. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lenoir, L. , Maillot, M. , Guilbot, A. , & Ritz, P. (2015). Primary care weight loss maintenance with behavioral nutrition: An observational study . Obesity (Silver Spring) , 23 ( 9 ), 1771–777. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Li, G. , Zhang, P. , Wang, J. , An, Y. , Gong, Q. , Gregg, E. W. , … Bennett, P. H. , et al. (2014). Cardiovascular mortality, all‐cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing Diabetes Prevention Study: A 23‐year follow‐up study . Lancet Diabetes & Endocrinology , 2 ( 6 ), 474–480. [ PubMed ] [ Google Scholar ]
• Li, G. , Zhang, P. , Wang, J. , Gregg, E. W. , Yang, W. , Gong, Q. , … Bennett, P. H. , et al. (2008). The long‐term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: A 20‐year follow‐up study . Lancet , 371 ( 9626 ), 1783–1789. [ PubMed ] [ Google Scholar ]
• Lindstrom, J. , Eriksson, J. G. , Valle, T. T. , Aunola, S. , Cepaitis, Z. , Hakumaki, M. , … Tuomilehto, J. , et al. (2003). Prevention of diabetes mellitus in subjects with impaired glucose tolerance in the Finnish Diabetes Prevention Study: Results from a randomized clinical trial . Journal of the American Society of Nephrology , 14 ( 7 Suppl 2 ), S108–S113. [ PubMed ] [ Google Scholar ]
• Lindstrom, J. , Ilanne‐Parikka, P. , Peltonen, M. , Aunola, S. , Eriksson, J. G. , Hemio, K. , … Finnish Diabetes Prevention Study Group , et al. (2006). Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: Follow‐up of the Finnish Diabetes Prevention Study . Lancet , 368 ( 9548 ), 1673–1679. [ PubMed ] [ Google Scholar ]
• Linkov, F. , Maxwell, G. L. , Felix, A. S. , Lin, Y. , Lenzner, D. , Bovbjerg, D. H. , … DeLany, J. P. , et al. (2012). Longitudinal evaluation of cancer‐associated biomarkers before and after weight loss in RENEW study participants: Implications for cancer risk reduction . Gynecologic Oncology , 125 ( 1 ), 114–119. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Loper, H. B. , La Sala, M. , Dotson, C. , & Steinle, N. (2015). Taste perception, associated hormonal modulation, and nutrient intake . Nutrition Reviews , 73 ( 2 ), 83–91. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Lv, N. , Xiao, L. , & Ma, J. (2015). Weight management interventions in adult and pediatric asthma populations: A systematic review . J Pulm Respir Med , 5 ( 232 ), pii: 1000232. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Martin‐Rodriguez, E. , Guillen‐Grima, F. , Marti, A. , & Brugos‐Larumbe, A. (2015). Comorbidity associated with obesity in a large population: The APNA study . Obesity Research & Clinical Practice , 9 ( 5 ), 435–447. [ PubMed ] [ Google Scholar ]
• Musunuru, K. (2010). Atherogenic dyslipidemia: Cardiovascular risk and dietary intervention . Lipids , 45 ( 10 ), 907–914. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Nanchahal, K. , Townsend, J. , Letley, L. , Haslam, D. , Wellings, K. , & Haines, A. (2009). Weight‐management interventions in primary care: A pilot randomised controlled trial . British Journal of General Practice , 59 ( 562 ), e157–e166. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Osunlana, A. M. , Asselin, J. , Anderson, R. , Ogunleye, A. A. , Cave, A. , Sharma, A. M. , & Campbell‐Scherer, D. L.. (2015). 5As team obesity intervention in primary care: Development and evaluation of shared decision‐making weight management tools . Clinical Obesity , 5 ( 4 ), 219–225. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pan, X. R. , Li, G. W. , Hu, Y. H. , Wang, J. X. , Yang, W. Y. , An, Z. X. , … Howard, B. V. , et al. (1997). Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and diabetes study . Diabetes Care , 20 ( 4 ), 537–544. [ PubMed ] [ Google Scholar ]
• Parker, E. D. , & Folsom, A. R. (2003). Intentional weight loss and incidence of obesity‐related cancers: The Iowa Women's Health Study . International Journal of Obesity and Related Metabolic Disorders: Journal of the International Association for the Study of Obesity , 27 ( 12 ), 1447–1452. [ PubMed ] [ Google Scholar ]
• Patel, N. S. , Doycheva, I. , Peterson, M. R. , Hooker, J. , Kisselva, T. , Schnabl, B. , … Loomba, R. , et al. (2015). Effect of weight loss on magnetic resonance imaging estimation of liver fat and volume in patients with nonalcoholic steatohepatitis . Clinical Gastroenterology and Hepatology , 13 ( 3 ), 561–568 e561. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Peterson, N. D. , Middleton, K. R. , Nackers, L. M. , Medina, K. E. , Milsom, V. A. , & Perri, M. G. (2014). Dietary self‐monitoring and long‐term success with weight management . Obesity (Silver Spring) , 22 ( 9 ), 1962–1967. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Petry, N. M. , Barry, D. , Pietrzak, R. H. , & Wagner, J. A. (2008). Overweight and obesity are associated with psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions . 70 ( 3 ), 288–297. [ PubMed ] [ Google Scholar ]
• Pi‐Sunyer, X. (2009). The medical risks of obesity . Postgraduate Medicine , 121 ( 6 ), 21–33. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Prospective Studies Collaboration , Whitlock, G. , Lewington, S. , Sherliker, P. , Clarke, R. , Emberson, J. , … Peto, R. , et al. (2009). Body‐mass index and cause‐specific mortality in 900 000 adults: Collaborative analyses of 57 prospective studies . Lancet , 373 ( 9669 ), 1083–1096. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Pulgaron, E. R. (2013). Childhood obesity: A review of increased risk for physical and psychological comorbidities . Clin Ther 35 ( 1 ), A18–A32. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Ratner, R. , Goldberg, R. , Haffner, S. , Marcovina, S. , Orchard, T. , Fowler, S. , … Diabetes Prevention Program Research Group , et al. (2005). Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the diabetes prevention program . Diabetes Care , 28 ( 4 ), 888–894. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Rogge, M. M. , & Gautam, B. (2017). Biology of obesity and weight regain: Implications for clinical practice . Journal of the American Association of Nurse Practitioners , 29 (Supplement 1), S15–S29. [ PubMed ] [ Google Scholar ]
• Romero‐Corral, A. , Caples, S. M. , Lopez‐Jimenez, F. , & Somers, V. K. (2010). Interactions between obesity and obstructive sleep apnea: Implications for treatment . Chest , 137 ( 3 ), 711–719. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Sakai, R. , Matsui, S. , Fukushima, M. , Yasuda, H. , Miyauchi, H. , & Miyachi, Y. (2005). Prognostic factor analysis for plaque psoriasis . Dermatology , 211 ( 2 ), 103–106. [ PubMed ] [ Google Scholar ]
• Singh, M. , Lee, J. , Gupta, N. , Gaddam, S. , Smith, B. K. , Wani, S. B. , … Sharma, P. , et al. (2013). Weight loss can lead to resolution of gastroesophageal reflux disease symptoms: A prospective intervention trial . Obesity (Silver Spring) , 21 ( 2 ), 284–290. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Skinner, A. C. , & Skelton, J. A. (2014). Prevalence and trends in obesity and severe obesity among children in the United States, 1999–2012 . JAMA Pediatrics , 168 ( 6 ), 561–566. [ PubMed ] [ Google Scholar ]
• Smith, S. A. , Hulsey, T. , & Goodnight, W. (2008). Effects of obesity on pregnancy . J Obstet Gynecol Neonatal Nurs , 37 ( 2 ), 176–184. [ PubMed ] [ Google Scholar ]
• The Global BMI Mortality Collaboration . (2016). Body‐mass index and all‐cause mortality: Individual participant‐data meta‐analysis of 239 prospective studies in four continents . Lancet , 388 , 734–736. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• The National Weight Control Registry ( NWCR) . (2016). NCWR facts . Retrieved from https://www.nwcr.ws/
• Tuomilehto, J. , Lindstrom, J. , Eriksson, J. G. , Valle, T. T. , Hamalainen, H. , Ilanne‐Parikka, P. , … Finnish Diabetes Prevention Study Group , et al. (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance . New England Journal of Medicine , 344 ( 18 ), 1343–1350. [ PubMed ] [ Google Scholar ]
• Weinsier, R. L. , & Ullmann, D. O. (1993). Gallstone formation and weight loss . Obesity Research , 1 ( 1 ), 51–56. [ PubMed ] [ Google Scholar ]
• Wensveen, F. M. , Valentic, S. , Sestan, M. , Turk Wensveen, T. , & Polic, B. (2015). The "Big Bang" in obese fat: Events initiating obesity‐induced adipose tissue inflammation . European Journal of Immunology , 45 ( 9 ), 2446–2456. [ PubMed ] [ Google Scholar ]
• Whitaker, R. C. , Wright, J. A. , Pepe, M. S. , Seidel, K. D. , & Dietz, W. H. (1997). Predicting obesity in young adulthood from childhood and parental obesity . New England Journal of Medicine , 337 ( 13 ), 869–873. [ PubMed ] [ Google Scholar ]
• World Health Organization (WHO) . (2016a). 10 Facts on obesity . Retrieved from https://www.who.int/features/factfiles/obesity/facts/en/
• World Health Organization (WHO) . (2016b). Obesity . Retrieved from https://www.who.int/topics/obesity/en/
• Wyse, R. , Wolfenden, L. , & Bisquera, A. (2015). Characteristics of the home food environment that mediate immediate and sustained increases in child fruit and vegetable consumption: Mediation analysis from the Healthy Habits cluster randomised controlled trial . International Journal of Behavioral Nutrition and Physical Activity , 12 , 118. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Yang, L. , & Colditz, G. A. (2015). Prevalence of overweight and obesity in the United States, 2007–2012 . JAMA Internal Medicine , 175 ( 8 ), 1412–1413. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Yosipovitch, G. , DeVore, A. , & Dawn, A. (2007). Obesity and the skin: Skin physiology and skin manifestations of obesity . J Am Acad Dermatol , 56 ( 6 ), 901–916; quiz 917–920. [ PubMed ] [ Google Scholar ]

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NPR fact-checked the Harris-Trump presidential debate. Here's what we found

Vice President and Democratic presidential candidate Kamala Harris and former President and Republican presidential candidate Donald Trump speak during a presidential debate. Saul Loeb/AFP via Getty Images hide caption

Vice President Harris and former President Donald Trump faced off Tuesday in their first — and possibly only — debate of the 2024 campaign, taking questions on key issues like the border, the economy and abortion.

With the candidates virtually tied in the polls, and just 55 days until Election Day, Trump and Harris sought to define their visions for America in front of a national audience and deflect attacks from the other side.

NPR reporters fact-checked the candidates' claims in real time . Here's what they found:

TRUMP: "I had no inflation, virtually no inflation. They had the highest inflation, perhaps in the history of our country, because I've never seen a worse period of time. People can't go out and buy cereal or bacon or eggs or anything else."

Inflation soared to a four-decade high of 9.1% in 2022, according to the consumer price index. While inflation has since fallen to 2.9% (as of July), prices — particularly food prices — are still higher than many Americans would like.

Other countries have also faced high inflation in the wake of the pandemic, as tangled supply chains struggled to keep pace with surging demand. Russia’s invasion of Ukraine also fueled inflation by driving up energy and food prices worldwide.

Government spending in the U.S. under both the Biden-Harris administration and Trump also may have contributed, putting more money in people’s pockets and enabling them to keep spending in the face of high prices.

While high prices are a source of frustration for many Americans, the average worker has more buying power today than she did before the pandemic. Since February 2020 (just before the pandemic took hold in the U.S.), consumer prices have risen 21.6% while average wages have risen 23%.

Many prices were depressed early in the pandemic, however, so the comparison is less flattering if you start the clock when President Biden and Vice President Harris took office. Since early 2021, consumer prices have risen 19.6%, while average wages have risen 16.9%. Wage gains have been outpacing price increases for over a year, so that gap should eventually close.

— NPR economics correspondent Scott Horsley

2024 Election

Taylor swift endorses kamala harris in instagram post after the debate.

HARRIS: "Donald Trump left us the worst unemployment since the Great Depression."

At the height of the Great Depression in 1933, the national unemployment rate was near 25%, according to the Franklin D. Roosevelt Presidential Library.

At the start of the COVID pandemic, the unemployment rate peaked at 14.8% in April 2020, a level not seen since 1948, according to the Congressional Research Service.

But by the time Trump left office, unemployment had fallen to a lower, but still elevated, level. The January 2021 unemployment rate was 6.3%.

— NPR producer Lexie Schapitl

Immigration

TRUMP: "You see what's happening with towns throughout the United States. You look at Springfield, Ohio, you look at Aurora in Colorado. They are taking over the towns. They're taking over buildings. They're going in violently. These are the people that she and Biden let into our country, and they're destroying our country. They're dangerous. They're at the highest level of criminality, and we have to get them out."

Trump attacked Harris and Biden's records on immigration, arguing that they're failing to stem people from other countries from entering the U.S. and causing violence.

In the last two years, more than 40,000 Venezuelan immigrants have arrived in the Denver metro area. And it is true that many now live in Aurora.

A few weeks ago, a video of gang members in an Aurora, Colo., apartment building had right-wing media declaring the city's takeover by Venezuelan gangs. NPR looked into these claims .

Indian migrants drive surge in northern U.S. border crossings

Shortly after the video appeared, Colorado's Republican Party sent a fundraising letter claiming the state is under violent attack, and Venezuelan gangs have taken over Aurora.

It's also true Aurora police have recently arrested 10 members of a Venezuelan gang called Tren de Aragua. But Aurora's interim police chief, Heather Morris, says there's no evidence of a gang takeover of apartment buildings in her city.

What's more, violent crime — including murder, robbery and rape — is way down nationwide, according to the most recent data from the FBI . Notably, analysts predict violent crime rates this year will fall back down to where they were before they surged during the pandemic and may even approach a 50-year low.

Trump also claims that migrants are driving up crime rates in the U.S. That is not true. Researchers from Stanford University found that since the 1960s, immigrants have been 60% less likely to be incarcerated than people born in the U.S. The Cato Institute, a libertarian think tank, found undocumented immigrants in Texas were 37% less likely to be convicted of a crime.

— NPR immigration correspondent Jasmine Garsd and criminal justice reporter Meg Anderson

TRUMP: "In Springfield, they're eating the dogs. The people that came in, they're eating the cats. They're eating the pets of the people that live there."

This remark refers to a debunked, dehumanizing claim that Haitian migrants living in Springfield, Ohio, are abducting pets and eating them .

Untangling Disinformation

Jd vance spreads debunked claims about haitian immigrants eating pets.

The claim, which local police say is baseless, first circulated among far-right activists, local Republicans and neo-Nazis before being picked up by congressional leaders, vice presidential candidate JD Vance and others. A well-known advocate for the Haitian community says she received a wave of racist harassment after Vance shared the theory on social media.

The Springfield News-Sun reported that local police said that incidents of pets being stolen or eaten were "not something that's on our radar right now." The paper said the unsubstantiated claim seems to have started with a post in a Springfield Facebook group that was widely shared across social media.

The claim is the latest example of Trump leaning into anti-immigrant rhetoric. Since entering the political arena in 2015, Trump accused immigrants of being criminals, rapists, or "poisoning the blood of our nation."

— NPR immigration correspondent Jasmine Garsd

TRUMP: "A lot of these illegal immigrants coming in, [Democrats] are trying to get them to vote."

It is illegal for noncitizens to vote in federal elections, and there is no credible evidence that it has happened in significant numbers, or that there is an effort underway to illegally register undocumented immigrants to vote this election.

Voter registration forms require voters to sign an oath — under penalty of perjury — that they are U.S. citizens. If a noncitizen lies about their citizenship on a registration form and votes, they have created a paper trail of a crime that is punishable with jail time and deportation.

“The deterrent is incredibly strong,” David Becker, executive director of the Center for Election Innovation and Research, told NPR.

Illegal crossings hit Biden-era low as migrants wait longer for entry

Election officials routinely verify information on voter registration forms, which ask registrants for either a driver’s license number or the last four digits of Social Security numbers.

In 2016, the Brennan Center for Justice surveyed local election officials in 42 jurisdictions with high immigrant populations and found 30 cases of suspected noncitizens voting out of 23.5 million votes cast, or 0.0001%.

Georgia Secretary of State Brad Raffensperger launched an audit in 2022 that found fewer than 1,700 suspected noncitizens had attempted to register to vote over the past 25 years. None were able to vote.

— NPR disinformation reporter Jude Joffe-Block

TRUMP: "[Harris] was the border czar. Remember that she was the border czar."

Republicans have taken to calling Harris the "border czar" as a way to blame her for increased migration to the U.S. and what they see as border security policy failures of the Biden administration.

There is no actual "border czar" position. In 2021, President Biden tasked Harris with addressing the root causes of migration from Central America.

As Republicans attack Harris on immigration, here’s what her California record reveals

The "root causes strategy ... identifies, prioritizes, and coordinates actions to improve security, governance, human rights, and economic conditions in the region," the White House said in a statement. "It integrates various U.S. government tools, including diplomacy, foreign assistance, public diplomacy, and sanctions."

While Harris has been scrutinized on the right, immigration advocates have also criticized Harris, including for comments in 2021 where she warned prospective migrants, "Do not come."

TRUMP: "You could do abortions in the seventh month, the eighth month, the ninth month, and probably after birth."

As ABC News anchor Linsey Davis mentioned during her real-time fact check, there is no state where it is legal to kill a baby after birth (Trump called it "execution"). A report from KFF earlier this year also noted that abortions “after birth” are illegal in every state.

According to the Pew Research Center, the overwhelming majority of abortions — 93% — take place during the first trimester. Pew says 1% take place after 21 weeks. Most of those take place before 24 weeks, the approximate timeline for fetal viability, according to a report by KFF Health News.

Trump repeats the false claim that Democrats support abortion 'after birth' in debate

A separate analysis from KFF earlier this year noted that later abortions are expensive to obtain and offered by relatively few providers, and often occur because of medical complications or because patients face barriers earlier in their pregnancies.

“Nowhere in America is a woman carrying a pregnancy to term and asking for an abortion. That isn’t happening; it’s insulting to the women of America,” Harris said.

Harris also invoked religion in her response, arguing that “one does not have to abandon their faith” to agree that the government should not control reproductive health decisions.

As Davis also noted, Trump has offered mixed messages about abortion over the course of the campaign. He has bragged about his instrumental role in overturning Roe v. Wade , while appearing to backpedal on an issue that polling makes clear is a liability for Republicans.

— NPR political correspondent Sarah McCammon

Afghanistan

TRUMP: The U.S. withdrawal from Afghanistan "was one of the most incompetently handled situations anybody has ever seen."

Trump and Republicans in Congress say President Biden is to blame for the fall of Kabul to the Taliban three years ago, and the chaotic rush at the airport where 13 U.S. troops died in a suicide bomb attack that killed nearly 200 Afghan civilians trying to flee. Of late, Republicans have been emphasizing Harris’ role . But the Afghanistan war spanned four U.S. presidencies , and it's important to note that it was the Trump administration that signed a peace deal that was basically a quick exit plan.

Trump regularly claims there were no casualties in Afghanistan for 18 months under his administration, and it’s not true, according to Pentagon records.

— NPR veterans correspondent Quil Lawrence

Military policy

HARRIS: “There is not one member of the military who is in active duty in a combat zone in any war zone around the world for the first time this century.”

This is a common administration talking point, and it's technically true. But thousands of troops in Iraq and on the Syrian border are still in very dangerous terrain. U.S. troops died in Jordan in January on a base that keeps watch over the war with ISIS in Syria.

HARRIS: "I will not ban fracking. I have not banned fracking as vice president United States, and in fact, I was the tie-breaking vote on the inflation Reduction Act which opened new leases for fracking."

When she first ran for president in 2019, Harris had said she was firmly in favor of banning fracking — a stance she later abandoned when she joined President Biden’s campaign as his running mate.

In an interview with CNN last month, Harris attempted to explain why her position has changed from being against fracking to being in favor of it.

“What I have seen is that we can grow, and we can increase a clean energy economy without banning fracking,” Harris told CNN’s Dana Bash.

Harris says she won't ban fracking. What to know about the controversial topic

Under the Biden-Harris administration, the U.S. produced a record amount of oil last year — averaging 12.9 million barrels per day. That eclipsed the previous record of 12.3 million barrels per day, set under Trump in 2019. 2023 was also a record year for domestic production of natural gas . Much of the domestic boom in oil and gas production is the result of hydraulic fracturing or “fracking” techniques .

In addition to record oil and gas production, the Biden-Harris administration has also coincided with rapid growth of solar and wind power . Meanwhile, coal has declined as a source of electricity.

Health care

TRUMP: "I had a choice to make: Do I save [the Affordable Care Act] and make it as good as it can be, or do I let it rot? And I saved it."

During his presidency, Trump undermined the Affordable Care Act in many ways — for instance, by slashing funding for advertising and free "navigators" who help people sign up for a health insurance plan on HealthCare.gov. And rather than deciding to "save" the ACA, he tried hard to get Congress to repeal it, and failed. When pushed Tuesday on what health policy he would put in its place, he said he has "concepts of a plan."

Shots - Health News

Amid medicaid's 'unwinding,' many states work to expand health care access.

The Biden administration has reversed course from Trump's management of the Affordable Care Act. Increased subsidies have made premiums more affordable in the marketplaces, and enrollment has surged. The uninsurance rate has dropped to its lowest point ever during the Biden administration.

The Affordable Care Act was passed in 2010 and is entrenched in the health care system. Republicans successfully ran against Obamacare for about a decade, but it has faded as a campaign issue this year.

— NPR health policy correspondent Selena Simmons-Duffin