Reimagining Urban Spaces: Green Spaces, Obesity, and Health Resilience in an Era of Extreme Heat.

Record-breaking heat waves intensified by climate change pose both environmental and health threats, necessitating a balance between urban sustainability and well-being. Extreme heat and limited green space access are drivers of obesity prevalence, with decreased proximity to green spaces correlating with higher rates of obesity in nearby communities. In contrast, access to such green spaces fosters physical activity, well-being, and community cohesion, especially crucial in marginalized communities facing health disparities due to historical policies like redlining and underinvestment in social gathering spaces. Despite challenges, green space investment offers healthcare savings and environmental gains, necessitating a shift in perception towards viewing green spaces as essential for urban living. As heat waves persist, integrating health and sustainability in urban planning is paramount. Health and medical communities must play an active role in advocating for equitable access to urban green spaces, as they possess influential positions to address climate-related health disparities through localized advocacy.

Financial crossroads of care: physicians' struggle and patient outcomes.

In 2024, physicians face significant financial challenges due to declining Medicare reimbursement rates and high student loan interest rates, which will impact health care delivery and access.

A Women's health perspective on managing obesity.

While the prevalence of obesity in US men and women is nearly equivalent, obesity management in women requires a different approach that considers age and life stage in development including sexual maturation/reproduction, menopause and post-menopause. In this review, the diagnosis and treatment of obesity using lifestyle modification, pharmacotherapy and metabolic and bariatric surgery are discussed from a women's health perspective, with emphasis on management during pregnancy and post-partum.

Pharmacologic Treatment of Obesity in Reproductive Aged Women.

Purpose of Review: This report will review existing literature on weight loss outcomes for various anti-obesity medications (AOMs) as well as their effects on human fertility, pregnancy, or breastfeeding. Recent Findings: There is a paucity of research on the effects of AOMs on human pregnancy and fertility. The majority of AOMs are not recommended during pregnancy and breastfeeding due to known or unclear risks of harm to offspring. Summary: As the prevalence of obesity rises, AOMs have proven to be effective tools for weight loss in the general adult population. When prescribing AOMs to reproductive-aged women, providers should consider both the cardiometabolic benefits of these medications and potential effects that AOMs might have on hormonal contraception, pregnancy, or breastfeeding. Animal studies in rats, rabbits, and monkeys have suggested teratogenic effects of several medications discussed in this report. However, a lack of data on the use of many AOMs during human pregnancy or lactation makes it difficult to comment on the safety of their use in these time periods. Some AOMs show promise in promoting fertility while others might decrease the efficacy of oral contraceptives, highlighting some of the special considerations that must be taken when prescribing AOMs to reproductive-aged women. More research into the risks and benefits of AOMs in the context of reproductive-aged women's unique healthcare needs is an important step in improving this population's access to effective treatments for obesity.

Disparities in Access and Quality of Obesity Care.

Obesity is a chronic disease and a significant public health threat predicated on complex genetic, psychological, and environmental factors. Individuals with higher body mass index are more likely to avoid health care due to weight stigma. Disparities in obesity care disproportionately impact racial and ethnic minorities. In addition to this unequal disease burden, access to obesity treatment varies significantly. Even if treatment options are theoretically productive, they may be more difficult for low-income families, and racial and ethnic minorities to implement in practice secondary to socioeconomic factors. Lastly, the outcomes of undertreatment are significant. Disparities in obesity foreshadow integral inequality in health outcomes, including disability, and premature mortality.

Equity in Obesity Review.

Obesity disproportionately affects racial and ethnic minoritized populations and those of lower socioeconomic status. Similarly, disparities exist in the development of its downstream consequences, such as type 2 diabetes and hypertension. The causes of these disparities are multifactorial and are influenced by structural factors such as segregation and healthcare access, and individual-level factors such as weight stigma. Interventions to decrease disparities in obesity should consider macro-level, community, and individual-level factors that might reduce disparities and improve equity in obesity care. Clinicians must also recognize the chronic nature of obesity, and how bias and stigma may impact patient care.

Obesity and Eligibility for Obesity Treatments Among Adults With Disabilities in the U.S.

INTRODUCTION: Obesity has been associated with disability; yet, the proportion who meet clinical criteria for obesity treatment among adults with disabilities remains poorly defined. Characterization of obesity and treatment eligibility by disability type may prioritize high-need groups. This study assessed the prevalence of obesity and eligibility for antiobesity pharmacotherapy and/or bariatric surgery in adults with disability. METHODS: This cross-sectional weighted analysis of the 2019 National Health Interview Survey, including self-reported health and sociodemographic information, was conducted in 2021. Burden of obesity defined by BMI and odds of meeting consensus criteria for antiobesity pharmacotherapy and/or surgery were calculated by functional disability type: vision, hearing, cognition, communication, mobility, and self-care. RESULTS: From 29,170 community-dwelling adult respondents (59.1% response), the overall prevalence of disability was 10%. The prevalence of obesity among adults with a disability was 40.1% vs 30.5% for U.S. adults overall (p<0.0001). An estimated 17.1% with disability met the criteria for both bariatric surgery and antiobesity pharmacotherapy; another 39.8% were eligible for pharmacotherapy alone (vs 7.9% and 33.2%, respectively, for adults overall; p<0.0001). In fully adjusted models, disability was associated with greater ORs for mild obesity (OR=1.2; 95% CI=1.1, 1.4), moderate‒severe obesity (OR=2.1; 95% CI=1.8, 2.3), and criteria for bariatric surgery (OR=2.4; 95% CI=2.1, 2.7) and pharmacotherapy (OR=1.3; 95% CI=1.2, 1.4). Mobility, self-care, and cognition disabilities were associated with eligibility for bariatric surgery and antiobesity pharmacotherapy. CONCLUSIONS: Individuals with disabilities have higher odds of obesity and eligibility for antiobesity treatments. Comorbidities should be considered, accommodations should be provided, and insurance coverage should be expanded to ensure access to antiobesity treatments for adults with disabilities.