搜索结果：Obesity research & clinical practice

Obesity is a significant risk factor for cardiovascular disease (CVD) and attributed to two-thirds of mortality linked to CVD worldwide. Expert position papers call for clinicians to screen for, identify, and treat this modifiable CVD risk factor. However, there is reluctance by many clinicians to initiate often-challenging clinical conversations. For researchers, identifying a robust methodology to collect sensitive data within this area can be difficult. One such methodology is factorial survey design, which incorporates variables of interest into clinical vignettes, which are then disseminated as a survey. Vignettes that replicate the realities of practice have been extensively authenticated through international studies and are particularly appropriate when exploring sensitive topics. This methods paper discusses implementing factorial design within an Internet-Mediated platform using the innovative approach of embedding photographs within clinical vignettes. The recruitment of a large, complete, multiprofessional dataset (n = 427) indicated that clinicians engaged easily with the Internet Mediated platform and viewed virtual vignettes with integrated patient photographs as authentic, reflecting the complexities of clinical practice.

Oral semaglutide, the first oral glucagon-like peptide-1 (GLP-1) receptor agonist therapy approved for the treatment of type 2 diabetes, is now approved for obesity management and cardiovascular risk reduction in adults, demonstrating weight loss comparable to that of subcutaneous GLP-1 therapies, alongside improvements in cardiometabolic risk factors. The availability of oral semaglutide for the treatment of obesity provides healthcare professionals with additional opportunities to individualize therapy based on patient preferences, lifestyle, and clinical circumstances. However, the oral semaglutide formulation requires specific administration conditions to optimize absorption and effectiveness. Notably, oral semaglutide tablets should be taken first thing in the morning on an empty stomach with no more than half a glass of plain water (up to 120 mL or 4 fl oz), followed by 30 min before eating food, drinking additional fluids, or ingesting other oral medications. Person-centered clinical discussions between healthcare professionals (HCPs) and patients prior to treatment initiation are important to ensure patients understand administration requirements and why they are necessary, establish realistic expectations for obesity treatment targets, and cover approaches to maintain adherence. HCP-patient consultations should also include discussion of strategies to help patients minimize, prepare for, and manage adverse events. In this article, we provide practical guidance for incorporating oral semaglutide into obesity management, drawing on evidence from clinical trials, including the OASIS 4 trial, and the authors' clinical insights. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are medications that are prescribed for the treatment of obesity to help people lose weight by reducing their appetite and feelings of hunger. Most GLP-1RAs are injected into the fatty layer of tissue below the skin, which helps the body absorb the medication into the bloodstream. The GLP-1RA semaglutide has been available in an injectable format for the treatment of obesity for several years and is now also available as a tablet for adults who prefer not to use injections. In clinical trials, people who used the tablet form of semaglutide had similar weight loss to people who used injectable semaglutide. Semaglutide tablets have been designed in a way that resists break down by stomach acid, allowing more of the medication to be absorbed into the body, but there are important steps to follow when taking the tablet to ensure the medication works as well as possible. Based on learnings from clinical trials and the clinical experience of the authors, this article provides practical advice to support healthcare professionals in guiding their patients through these steps. It also covers important topics to discuss with patients before they start taking semaglutide tablets, including possible changes to how they take other medications, how to limit and manage potential side effects, and ways for patients to stay consistent with their treatment schedule.

Sarcopenic obesity (SO) is defined as the coexistence of low muscle mass and excess adiposity. Despite growing international attention, SO remains under-researched and under-recognized in Nordic countries, particularly in primary care, where body mass index (BMI)-driven approaches dominate and muscle health is rarely assessed. The objective of this study is to discuss opportunities for integrating SO screening and treatment into everyday clinical care in primary care settings. Limited prevalence data and inconsistent diagnostic criteria make SO difficult to detect in Nordic primary care settings. The increasing use of pharmacological weight-loss therapies further highlights the need for age- and muscle-informed approaches. Most studies are cross-sectional and conducted in hospitals/community samples, limiting insights into disease trajectories and intervention effects and widening the gap between research and clinical practice. Although muscle loss and obesity jointly worsen health outcomes, current obesity strategies rarely assess muscular health, creating a critical blind spot in clinical practice for older adults. Moreover, few clinical guidelines offer age-specific recommendations, limiting recognition and management of SO and contributing to suboptimal care for a growing older population. Nordic primary care represents a key setting for integrating SO case finding into existing preventive frameworks. We propose that primary care adopts pragmatic diagnostic pathways for SO based on a simple case-finding approach combining basic functional tests, nutritional risk assessment, and anthropometric measures alongside BMI, without additional resources. This should be supported by clinician education and cross-sector collaboration to ensure that both adiposity and muscle decline are addressed. Ultimately, bridging the gap between research and practice remains crucial to improving outcomes for older adults with SO.

Weight stigma is a social determinant that negatively impacts the quality of medical care, particularly when it manifests in clinical decisions that prioritize body weight as the primary indicator of health. This practice, referred to as weight-centered care, can lead to inappropriate interventions and reinforce health inequities. To identify the personal and professional variables that predict a weight-centered approach in a simulated clinical case of low back pain, using a standardized vignette. Cross-sectional and correlational study with 79 medical residents in Chile. A validated clinical vignette was used along with scales assessing attributional beliefs and attitudes toward obesity treatment. A hierarchical multiple linear regression was conducted in four blocks, with bootstrap resampling (5,000 iterations) applied for robust estimations. The final model explained 52.5% of the variance in clinical weight-centeredness. Beliefs that individually blame patients for their obesity (β= 0.382; p*= 0.021) and negative attitudes toward its treatment (β= 0.276; p*= 0.087) were the most relevant predictors. Sociodemographic variables such as gender or BMI lost significance when these attitudinal factors were considered. No significant effects were found for professional variables. Findings show that internalized beliefs and attitudes about obesity are key to understanding weight-centered decision-making in clinical settings, even when weight is not relevant to the presenting complaint. This study provides local empirical evidence on an underexplored phenomenon in Chile and underscores the need to incorporate training frameworks that promote critical, non-stigmatizing, and person-centered care. Future research could explore educational interventions and the impact of weight-centered approaches on longitudinal clinical decisions.

Metabolic bariatric surgery (MBS) is a highly effective but underused treatment for obesity. Greater understanding of diagnosis and referral pathways are needed to help inform appropriate treatment options for obesity. To examine factors associated with uptake of MBS among individuals with incident obesity diagnosis. This cohort study used insurance claims data from the Merative MarketScan Commercial Claims and Encounters Database to identify a cohort of individuals aged 18 to 64 years with an incident obesity diagnosis (index) in inpatient and outpatient settings between January 1, 2018, and December 31, 2022, as well as MBS uptake within 12 months of index to December 31, 2023. Diagnoses classified using Agency for Healthcare Research and Quality Clinical Classifications Software Refined and therapeutic classes (Red Book) of drugs taken within the 12-month period prior to index date, as well as sociodemographic and health care factors determined at the index date. Factors associated with MBS uptake were examined using machine learning methods and multivariable logistic regression. Exclusion criteria included pregnancy-related visits; missing International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, body mass index (BMI) Z-code; or prior MBS. The top 25 factors identified by a random forest model were ranked by Shapley Additive Explanation (SHAP) values, and odds ratios (ORs) were estimated for each top factor in a multivariable logistic regression model. In this study of 109 849 individuals (mean [SD] age, 41.4 [11.8] years; 63 992 women [58.3%]) with an initial obesity diagnosis, 3268 (3.0%) received MBS within 12 months of index. The area under the receiver operating characteristic curve score was 0.88 (95% CI, 0.87-0.90). The top factors identified by the random forest model included surgeon (not elsewhere classified [NEC]) as provider (which includes medical institutions and organizations as well as health care professionals) (mean SHAP value, 0.00918 [95% CI, 0.00893-0.00945]), BMI category (mean SHAP value, 0.00501 [95% CI, 0.00499-0.00503]), family practice as provider (mean SHAP value, 0.00372 [95% CI, 0.00370-0.00374]), and female sex (mean SHAP value, 0.00370 [95% CI, 0.00368-0.00371]). Surgeon (NEC) as provider had the largest OR (18.97 [95% CI, 17.11-21.02]), followed by other provider types (orthopedic surgeon: OR, 5.33 [95% CI, 4.54-6.24]; dietitian: OR, 2.51 [95% CI, 1.97-3.20]). Several medication (antidiabetic agents, miscellaneous: OR, 1.42 [95% CI, 1.25-1.62]; psychotherapeutics, antidepressants: OR, 1.13 [95% CI, 1.01-1.25]), diagnostic (depressive disorders: OR, 1.16 [95% CI, 1.02-1.33]), and sociodemographic variables (female sex: OR, 2.45 [95% CI, 2.22-2.71]) were also significantly associated with MBS. There was a significant decrease in MBS uptake for individuals with incident obesity diagnosis in more recent year-quarters from 2019 through 2022. In this cohort study of individuals with an initial obesity diagnosis, uptake of MBS was patterned by demographic, clinical, and health care factors. This finding suggests substantial opportunity to improve access to MBS through targeted policies and interventions.

Obesity and depression as chronic diseases increase the burden on society, and they often co-exist, interacting to worsen prognosis. However, the long-term trends in obesity prevalence specifically among the growing population of individuals with depression remain unclear. Investigating these trends is crucial for informing targeted treatment and public health strategies. Clinical data on adults aged&#x2009;&#x2265;&#x2009;20 years with depression were extracted from the National Health and Nutrition Examination Survey 2005-2023. The primary outcome was obesity prevalence [body mass index (BMI)&#x2009;&#x2265;&#x2009;30&#xa0;kg/m2]. Trends in the prevalence of obesity among depressed adults in the US were assessed by a trend test. The study included 4035 adults aged&#x2009;&#x2265;&#x2009;20 years with depression in the United States population, with an average age of 46.9 (&#xb1;&#x2009;16.3). The age-standardized prevalence of obesity among depressed Americans increased from 42.8% in 2005-2008 to 46.3% in 2021-2023 (P for trend&#x2009;<&#x2009;0.001). This upward numerical trajectory was particularly pronounced in the female depression population (44.0%-52.1%; P for trend&#x2009;=&#x2009;0.198) and the 45-64 age group showed a higher prevalence of obesity compared to other age groups. Furthermore, the prevalence of grade II obesity (35&#xa0;kg/m2&#x2009;&#x2264;&#x2009;BMI&#x2009;<&#x2009;40&#xa0;kg/m2) and grade III obesity (BMI&#x2009;&#x2265;&#x2009;40&#xa0;kg/m2) showed a significant increasing trend in both males and females, while grade I obesity (30&#xa0;kg/m2&#x2009;&#x2264;&#x2009;BMI&#x2009;<&#x2009;35&#xa0;kg/m2) exhibited a significant decreasing trend overall (from 21.0% to 19.0%; P for trend&#x2009;=&#x2009;0.002). Notably, among Mexican Americans with depression, there was a significant decrease in the prevalence of grade I obesity from 30.2% in 2005-2008 to 10.3% in 2021-2023 (P for trend&#x2009;<&#x2009;0.001). From 2005 to 2023, the prevalence of obesity among US adults with depression increased, and this increase has been especially pronounced among female patients. Among women, the prevalence of obesity grade I, II, and III all increased. Among men, only the prevalence of obesity grade II and III increased. These findings underscore the urgent need for integrated clinical and public health interventions that address weight management as a core component of depression care to mitigate the compounded health burden. Not applicable.

Obesity is a complex, chronic disease requiring multifactorial management; however, gaps remain between clinical guidelines and real-world practice. Given the high prevalence of obesity in the Gulf region, understanding Healthcare Providers' (HCPs) awareness and perceived barriers is essential for better, tailored regional treatment strategies. This study aimed to address the existing knowledge gaps through exploring HCP awareness, perspectives and expectations on the complexities of obesity management across various medical specialties and seeking to refine management strategies. A cross-sectional electronic survey was conducted among HCPs attending the joint 21st International Congress of Endocrinology (ICE 2024) and 14th Emirates Diabetes and Endocrinology Congress (EDEC) held in Dubai, United Arab Emirates (UAE). Thirteen multiple-choice questions assessed HCPs' views on the contributing factors, barriers to effective management, and expectations for future care of obesity. Of approximately 3200 attendees, 565 participated (17.7% response rate). Confidence in diagnosing obesity was high (85.1%). Body Mass Index (BMI) was used as the sole diagnostic tool by 43.9% of the respondents. The rising prevalence of obesity was attributed primarily to inappropriate dietary habits and sedentary lifestyles (60.4%). Key barriers to effective obesity management reported were the cost of treatment (52.3%) and lack of patient awareness (35.5%).To enhance the quality of obesity care, HCPs emphasized the need for improved understanding of obesity pathophysiology (64.9%) and advocated for individualized treatment approaches (49.6%). Addressing barriers to obesity care and enhancing HCP education are important steps toward more effective and patient-centered obesity management.

Childhood obesity is a growing public health concern with significant long-term implications for cardiometabolic health. Without effective intervention, the global burden of childhood and adolescent obesity is projected to increase substantially in the coming decades. This study aimed to synthesise current evidence on the epidemiology, pathophysiology, causal mechanisms, longitudinal outcomes, social and commercial determinants, and preventive strategies related to childhood obesity and adult cardiometabolic disease from a public health perspective. A narrative review was conducted and reported in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) framework. Literature was identified through searches of PubMed/MEDLINE, Scopus, and Google Scholar from January 2000 to January 31, 2026. A total of 348 records were identified, of which 38 sources were retained for citation. Landmark pre-2000 studies were additionally identified through targeted hand searching. This review examined the epidemiology, pathophysiology, longitudinal tracking, causal mechanisms, metabolic phenotyping, social and commercial determinants, and preventive strategies related to childhood obesity and adult cardiometabolic disease. Consistent evidence was identified linking childhood obesity to elevated long-term cardiometabolic risk. Both metabolically healthy and metabolically unhealthy obesity phenotypes in childhood are associated with increased cardiometabolic risk in adulthood. Socioeconomic and ethnic inequalities in childhood obesity continue to widen across diverse settings, while emerging evidence highlights a growing dual burden of undernutrition and excess adiposity in transitional populations. Weight normalisation before adulthood appears to substantially reduce future cardiometabolic risk and remains an important clinical objective. Childhood obesity is associated with an increased risk of adult cardiometabolic disease through interconnected biological, social, environmental, and commercial pathways. Clinical practice should incorporate systematic cardiometabolic risk assessment in children with obesity regardless of current metabolic status. Future research should prioritise trans-ethnic causal studies, long-term cardiometabolic outcome trials in paediatric populations, and evaluation of structural policy interventions.

To evaluate 24-week weight changes with lower-dose semaglutide in routine care among Chinese adults with obesity and to examine whether diabetes and ectopic fat in the liver and pancreas are associated with heterogeneity in weight-loss response. Adults with obesity were enrolled from the HARMONY study, a real-world observational cohort in China. Participants received once-weekly subcutaneous semaglutide, titrated to a maintenance dose (0.5 or 1.0&#x2009;mg) based on clinical response and tolerability, alongside lifestyle counselling and periodic metabolic monitoring. The primary endpoint was the percentage change in body weight from baseline at weeks 12 and 24. Subgroup analyses were conducted according to baseline type 2 diabetes status and ectopic fat status in the liver and pancreas. Overall, 143 participants were included at week 12 and 113 at week 24. Mean percent weight change was -7.3% at week 12 and -9.9% at week 24, corresponding to mean absolute weight losses of 6.7 and 9.1&#x2009;kg, respectively. By week 24, 76.1% of participants achieved 5% weight loss or more. At week 24, participants with type 2 diabetes experienced lower weight change than those without diabetes (-7.4% vs. -12.4%, p&#x2009;<&#x2009;0.001). Weight loss also differed by baseline intrapancreatic fat deposition (IPFD) status, with attenuated weight change among patients with baseline IPFD (-9.0% with IPFD vs. -11.6% without IPFD, p&#x2009;=&#x2009;0.043). In routine clinical care, lower doses of semaglutide were associated with clinically meaningful 24-week weight loss in Chinese adults with obesity.

To assess the knowledge, understanding, clinical practices, and challenges of physicians in Pakistan concerning Gastroesophageal reflux disease (GERD), and to identify areas for improvement to enhance patient outcomes. This cross-sectional survey was conducted among 435 physicians across Pakistan, including general practitioners, gastroenterologists, and internal medicine specialists. A structured, self-administered questionnaire collected data on demographics, knowledge of GERD risk factors and symptoms, diagnostic practices, management approaches, and perceived challenges. Among 435 surveyed physicians, 80.2% reported being very familiar with GERD diagnosis and management, yet there were notable gaps in recognizing atypical and extra-esophageal symptoms. While acid regurgitation (91.5%) and heartburn (82.8%) were the most commonly recognized symptoms, less frequent acknowledgment was found for dysphagia (42.8%), cough (47.6%), and sore throat (37.7%). Only 14.0% of respondents consistently considered extra-esophageal symptoms in the context of GERD. Additionally, risk factors such as diet (82.3%), obesity (78.9%), and smoking (77.5%) were widely recognized, but challenges like poor treatment adherence (73.1%) and medication costs (46.0%) were reported. A majority of respondents requested more training (61.8%) and availability of updated national guidelines (57.2%). These findings highlight gaps in symptom recognition and the need for enhanced education and research to improve GERD diagnosis and management practices. While most physicians demonstrated adequate knowledge of GERD, significant gaps in recognizing atypical symptoms, utilization of advanced diagnostics, and addressing management challenges were noted. Tailored interventions, including updated national GERD guidelines, focused training programs, and enhanced access to diagnostic and management tools, are essential to improving care quality and patient outcomes in Pakistan.

The "2026 AHA/ACC/ADA/ASN Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome" retires, replaces, and expands upon the "2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults." The primary intended audience for this guideline is clinicians who care for patients across the spectrum of cardiovascular-kidney-metabolic syndrome, an interrelated condition characterized by the interconnections among metabolic risk factors (including obesity and type 2 diabetes), chronic kidney disease, and cardiovascular disease. A comprehensive literature search was conducted from October 29, 2024, to April 14, 2025, to identify clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human subjects that were published since 2015 in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. The focus of this clinical practice guideline is to create a living, working document that provides current knowledge in the field of cardiovascular-kidney-metabolic syndrome aimed at all practicing cardiologists, endocrinologists, nephrologists, and primary care and specialty clinicians who manage these patients.

Introduction: Managing obesity and lipid levels is essential for the prevention of chronic diseases. Despite clinical guidelines emphasizing lifestyle interventions, the long-term sex- and age-specific trends in walking, obesity and triglyceride in South Korea insufficiently understood. Methods: This study analyzed national data to assess trends in walking practice, hypertriglyceridemia (hyperTG), and obesity among Korean adults aged 40-69 years from 2005 to 2023. Data were drawn from the Korea National Health and Nutrition Examination Survey (KNHANES), including 52,741 individuals for walking, 42,181 for hyperTG, and 54,079 for obesity. Joinpoint regression was used to identify trend changes and calculate annual percent changes (APCs) with 95% confidence intervals (CIs). Results: Results show that walking practice declined in men aged 40-49 years between 2005 and 2011 (APC: -10.2%), while women aged 50-69 years showed significant increases after 2012. HyperTG prevalence in men aged 40-49 years rose until 2020 (APC: 1.5%), but declined significantly in both sexes aged 50-69 years after 2011. Obesity steadily increased in men aged 40-59 years (APCs: 1.7% and 2.4%, respectively), whereas women aged 50-69 years experienced consistent declines (APCs: -1.9% and -1.5%). Conclusion: While walking practice has improved among older women, middle-aged men - especially those aged 40-49 years - face worsening trends in walking, obesity, and hyperTG. These research findings highlight the need for public health strategies tailored to the age and sex of middle-aged adults.

Weight stigma and misconceptions about obesity among healthcare professionals (HCPs) may negatively affect healthcare quality and access for people living with obesity (PLWO). However, no previous research has examined these attitudes and beliefs in Spanish HCPs. This cross-sectional online study examined weight stigma and obesity-related beliefs among 922 HCPs recruited via Spanish professional and academic obesity-related organizations ((74.1% female, mean BMI&#x2009;=&#x2009;23.73 kg/m2 (SD 3.89), mean age&#x2009;=&#x2009;43.73 years (SD 12.45), range 23-75, 88.7% provide care for PLWO)). Anti-fat attitudes were measured using the Dislike subscale of the Anti-Fat Attitudes questionnaire (AFA) and the Fat Phobia Scale (F-Scale). ANOVAs adjusted for sociodemographic variables, weight status, and weight bias internalization were conducted. Overall, Spanish HCPs surveyed reported negative attitudes toward PLWO. Lower weight status was consistently associated with higher stigma scores. Younger age (F-Scale) and working in the private sector (Dislike) were associated with higher scores. Differences across specialties were observed, with obesity physicians reporting the lower stigma levels. A substantial proportion of HCPs endorsed beliefs emphasizing personal responsibility: 38% attributed overeating to individual causes, 66% believed obesity could be entirely prevented by a healthy lifestyle, and 59% believed it could be cured through lifestyle changes. Many also attributed weight loss difficulties, poor compliance, and weight regain to lack of motivation and lifestyle choices, and over half considered lifestyle or psychological interventions the most effective treatment for severe obesity. Endorsement of these beliefs was consistently associated with higher stigma scores. These findings provide national evidence that weight stigma among Spanish HCPs is present and linked to beliefs framing obesity as primarily under individual control. These attitudes and knowledge gaps may contribute to inappropriate care and unfair treatment of PLWO. Addressing responsibility-focused beliefs may be a key step towards reducing stigma and improving the quality of obesity care in Spain.

How caregiver infant-feeding practices and infant-feeding environment outcomes are measured in obesity prevention intervention trials is crucial to accurately examine intervention effects. This scoping review identified what and how outcome measurement instruments (OMIs) are used to measure eight infant-feeding practice and two feeding environment outcomes that are included in a core outcome set. Embase, MEDLINE, CINAHL, and PsycINFO databases were searched from inception to&#x2009;18.09.23, with an updated search conducted 18.09.25. Eligible trials included infants &#x2264;&#x2009;1&#x2009;year old and at least one infant-feeding practice or infant-feeding environment OMI. Article titles, abstracts, and full texts were screened independently in duplicate. Data were narratively synthesized. Twenty-five trials in 26 articles were included. Questionnaires were the most used OMI (n&#x2009;=&#x2009;18); individual questions (n&#x2009;=&#x2009;7), ecological momentary assessment (n&#x2009;=&#x2009;1), vignettes (n&#x2009;=&#x2009;1), and ratings of videotaped parent-child interactions (n&#x2009;=&#x2009;2) were also used. OMIs were predominantly researcher-administered and completed in caregivers' homes. Responsive infant-feeding and pressuring the child to eat were the most examined infant-feeding practices outcomes; the feeding environment was only examined in five trials. Reporting of OMIs often lacked clarity/completeness. The findings provide an essential first step to improve the measurement of infant-feeding practices and feeding environment to prevent childhood obesity.

Weight stigma is pervasive in maternity care, contributing to negative health outcomes and disengagement among larger-bodied women. To reduce weight stigma and promote respectful, individualized care, a weight-inclusive approach prioritizes overall well-being rather than focusing on weight as a key health indicator. How maternity care providers adopt weight-inclusive approaches remains underexplored. This study aimed to investigate the perspectives and practices of weight-inclusive maternity care providers. Semi-structured interviews were conducted online with medical, midwifery, and allied health maternity care providers, nominated by consumers or peers for their weight-inclusive practice. Interviews were audio recorded, transcribed, and analyzed thematically. Twenty-four professionals were interviewed, with three themes generated to describe their weight-inclusive approaches: (1) Time and space for reflection-participants described a gradual shift from weight-centric to weight-inclusive care, often prompted by personal or professional experiences of weight stigma; (2) Questioning weight science-participants questioned the value of body mass index or weight as indicators of individual health, favoring holistic assessments; and (3) Taking action to make change-participants had made specific changes to their practice, including to clinical environments, communication, and in responding to weight-centric systems. Our findings map how some maternity care providers describe enacting weight-inclusive maternity care. Despite systemic barriers such as weight-centric education and clinical guidelines, maternity care providers made meaningful change through deliberate reflection and compassionate practice. Reform in education and clinical guidelines is needed. Extending existing frameworks, our study describes maternity-specific enactments to address weight stigma and support broader adoption of weight-inclusive approaches.

Vitamin D deficiency is a common global health problem and remains highly prevalent in T&#xfc;rkiye, where limited food fortification and heterogeneous clinical practices contribute to variability in testing and supplementation strategies. To provide T&#xfc;rkiye-specific best practice recommendations for defining clinically relevant serum 25-hydroxyvitamin D [25(OH)D] thresholds, identifying adult risk groups for targeted testing, and recommending evidence-based prevention, treatment, and monitoring approaches while minimizing under-treatment and inappropriate high-dose use. This national expert consensus document was developed by endocrinologists from across T&#xfc;rkiye using a structured, modified Delphi methodology. Draft statements informed by systematic literature reviews were rated via online surveys using a 9-point Likert scale, followed by two Delphi rounds and a face-to-face consensus meeting in &#x130;stanbul in October 2025. Recommendations addressed sun exposure, laboratory assessment, screening, supplementation, treatment, and follow-up. Serum 25(OH)D <20 ng/mL was defined as deficiency and <12 ng/mL as severe deficiency, with a target range of 20-50 ng/mL. Routine population-wide screening was not recommended; instead, targeted testing in high-risk adults and symptom-driven biochemical evaluation were endorsed. Empiric supplementation was recommended for selected high-risk groups, with cholecalciferol as the preferred agent. Higher individualized doses were suggested in obesity or malabsorption, while loading regimens were reserved for specific clinical indications, such as severe deficiency or certain medical conditions that impair vitamin D metabolism. Reassessment of 25(OH)D at 8-12 weeks was recommended. These consensus-based recommendations provide a practical, context-specific framework for assessing, preventing, treating, and monitoring vitamin D deficiency in adults in T&#xfc;rkiye.

Sarcopenic obesity (Sa-O) is an emerging prognostic factor in patients with cirrhosis, yet its diagnostic criteria and clinical significance remain incompletely defined. This narrative review synthesizes evidence from the past five years on the pathogenesis, diagnostic criteria, and prognostic implications of Sa-O in cirrhosis. Diagnostic criteria were categorized according to their definitions of sarcopenia and obesity, and the clinical utility of assessment tools was evaluated. Prognostic value was examined across seven clinical domains. Existing evidence indicates that Sa-O is associated with increased mortality and adverse post-transplant outcomes. Limited data suggest potential links with classic cirrhosis complications, while cardiovascular events remain underexplored as primary endpoints. Current studies on acute-on-chronic liver failure focus on sarcopenia or obesity in isolation rather than their coexistence. Health-related quality of life and the integration of Sa-O into established prognostic score models are rarely addressed. In summary, Sa-O should be recognized as a key prognostic factor in cirrhosis and represents a modifiable target for early lifestyle intervention.

Contemporary guidelines recommend aggressive low-density lipoprotein cholesterol (LDL-C) lowering in patients with atherosclerotic cardiovascular disease (ASCVD), yet significant treatment gaps persist in clinical practice. We evaluated lipid-lowering therapy (LLT) use, LDL-C control, and prevelance of cardiovascular risk factors among patients with coronary artery disease (CAD), peripheral artery disease (PAD), cerebral atherosclerosis (CAS) and those with all three (polyvascular disease) using real-world data from the NIH-run All of Us Research Program. We analyzed electronic health records from 26,935 patients with ASCVD (CAD 21,573; PAD 4752; CAS 6864; and polyvascular 902) enrolled between 2018 and 2023. We assessed baseline LLT use, LDL-C levels, and prevalence of uncontrolled cardiovascular risk factors, defined as blood pressure &#x2265;130/80&#xa0;mmHg, hemoglobin A1c&#xa0;&#x2265;&#xa0;7%, waist-height ratio (WHtR)&#xa0;&#x2265;&#xa0;0.5, and current smoking. Among patients with LDL-C >70&#xa0;mg/dL, we visualized risk factor intersections using Euler diagrams. Despite high statin use across all cohorts (81% CAD, 82% PAD, 83% CAS, 93% Polyvascular), only 36-47% achieved LDL-C <70&#xa0;mg/dL and 22-31% had LDL-C &#x2265;100&#xa0;mg/dL. Combination LLT was markedly underutilized (10-21%), with ezetimibe prescribed in 10-20% and PCSK9 inhibitors in only 1-3% of patients. Among those with LDL-C &#x2265;70&#xa0;mg/dL, central obesity was ubiquitous (86-89%), more than half had uncontrolled blood pressure (59-63%), 16-26% had hemoglobin A1c&#xa0;&#x2265;&#xa0;7%, and 14-20% were active smokers. Patients with polyvascular disease had higher LLT use and LDL-C control but lower risk factor control. Uncontrolled risk factors frequently co-occurred: 29-31% had concurrent obesity and uncontrolled hypertension, and 7-9% harbored the triad of obesity, poor glycemic control, and uncontrolled hypertension. In this large, diverse cohort of patients with ASCVD, substantial gaps persist in achieving guideline-recommended LDL-C targets and controlling cardiovascular risk factors. The marked underutilization of combination LLT and the high coexistence of metabolic risk factors represent significant opportunities for treatment intensification and comprehensive risk factor management.

Long wait-times for orthopaedic consultation in public hospitals, particularly for knee osteoarthritis patients, may be ameliorated when Advanced Practice Physiotherapists (APPs) are integrated into clinical pathways. APPs provide expert comprehensive assessment, accurately identifying patients not requiring surgery. This study aimed to quantify wait-time between general practitioner (GP) referral and consultation with an APP or surgeon outcomes following service changes including increased resourcing of the APP clinics. This knowledge translation project was evaluated by comparing wait-time to consultation for three, 6-month cohorts from 1 March to 30 September, totalling 563 patients, at baseline in 2022, and post-intervention at year 1 (2023) and year 2 (2024). Evidence-based service changes included expanding APP clinic capacity and improving referral pathways to community osteoarthritis and obesity programs. The proportion of patients seen by APPs rose from 20% at baseline (2022) to 81% in 2023 and 76% in 2024. Concurrently, the health service implemented a digital medical records system. Data were analysed for patient characteristics, wait-times, care pathways (APP, surgeon, or both), and consultation outcomes. Compared to 2022, wait-times to consultation significantly reduced. Median wait-time fell from 114 days in 2022 to 45 days (86% less) in 2023 and 46 days (90% less) in 2024. Patients seen by APPs experienced fewer delays (Incidence risk ratio (IRR): 0.55; 95% CI: 0.43-0.72), including those seen in both APP and surgeon clinics (IRR: 0.54; 95% CI: 0.41-0.70). Total patients listed for surgery declined from 48% in 2022, to 36% in 2023, and 35% in 2024, while patients directed to a surgeon were twice as likely to need knee replacement in 2023, 2024. Shorter wait-times appear linked to increased APP clinic activity, improved digital systems, and enhanced access to community programs. These changes supported clinical standards and timely care for patients with knee osteoarthritis.