Lifestyle Options Research Articles

Renal Denervation for the Treatment of Hypertension: A Scientific Statement From the American Heart Association.

Hypertension is a leading risk factor for cardiovascular morbidity and mortality. Despite the widespread availability of both pharmacological and lifestyle therapeutic options, blood pressure control rates across the globe are worsening. In fact, only 23% of individuals with high blood pressure in the United States achieve treatment goals. In 2023, the US Food and Drug Administration approved renal denervation, a catheter-based procedure that ablates the renal sympathetic nerves, as an adjunctive treatment for patients in whom lifestyle modifications and antihypertensive medications do not adequately control blood pressure. This approval followed the publication of multiple randomized clinical studies using rigorous trial designs, all incorporating renal angiogram as the sham control. Most but not all of the new generation of trials reached their primary end point, demonstrating modest efficacy of renal denervation in lowering blood pressure across a spectrum of hypertension, from mild to truly resistant. Individual patient responses vary, and further research is needed to identify those who may benefit most. The initial safety profile appears favorable, and multiple ongoing studies are assessing longer-term efficacy and safety. Multidisciplinary teams that include hypertension specialists and adequately trained proceduralists are crucial to ensure that referrals are made appropriately with full consideration of the potential risks and benefits. Incorporating patient preferences and engaging in shared decision-making conversations will help patients make the best decisions given their individual circumstances. Although further research is clearly needed, renal denervation presents a novel treatment strategy for patients with uncontrolled blood pressure.

Preferences, enablers, and barriers for 1.5°C lifestyle options: Findings from Citizen Thinking Labs in five European Union countries

The Horizon 2020 project EU 1.5°C Lifestyles aims to mainstream lifestyles aligned with the aspirational target of the Paris Agreement. The project analyzes lifestyle perspectives at the household level and links them to studies of relevant political and socio-economic structures at various levels of government. Within this project, Citizen Thinking Labs were organized in five EU countries to explore the acceptance of and motivations and barriers to changes that could lead to lifestyles compatible with the 1.5°C target. Through a unique mixed-methods approach, including an exploratory board game (the Climate Puzzle), this research generated insights into citizen acceptance by exploring motivations and barriers associated with the acceptance of key lifestyle changes toward 1.5°C. The results confirm previous research in that citizens are more accepting of lower-impact lifestyle options requiring financial investment (e.g., changing lighting and using efficient devices) than higher-impact options that require more substantial behavior changes. Citizens were also motivated by perceived co-benefits for example, concerning health. The research developed insight into the conditions underlying the acceptance of the least preferred options that included plant-based eating and smaller housing. The results also indicated that citizens’ acceptance could be shaped by discussing options with other citizens. Thus, we note the important role citizens may play in devising solutions for overcoming barriers to the acceptance of less-preferred lifestyle options in various contexts. While this study focused on individuals, the findings also underscore the limitations of individual and household agency and the importance of modifying the socio-technical context that shapes behavioral patterns and environmental impacts.

O-111 Premature ovarian insufficiency: new data and updated guidance

Abstract Premature ovarian insufficiency (POI) presents a significant challenge to women's health, with significant implications both physically and emotionally. Despite its life-altering impact, there remain substantial unknowns in the causes this condition and how to optimally manage its various sequelae While such unknows provide direction for future research, they also underscore the need for clinical guidance. In 2015, under the auspices of ESHRE, a group of experts evaluated the existing best evidence and published the first European guideline on the management of premature ovarian insufficiency. The update of this Guideline was performed in an international collaboration of experts representing American Society for Reproductive Medicine (ASRM), International Menopause Society (IMS), and the Centre for Research Excellence in Women’s Health in Reproductive Life (CRE WHiRL). The recent update of the POI guideline covers 40 clinical questions on diagnosis of the condition, the different sequelae, including musculoskeletal health, cardiovascular health, neurological health, sexual function and general well being, and treatment options, including hormone therapy. The list of clinical questions was expanded from the questions included in the guideline from 2015. Based on a scoping survey and appreciation of emerging knowledge of POI, questions were added on the role of AMH in the diagnosis of POI, fertility preservation, muscle health, and specific considerations for hormone treatment in iatrogenic POI. Additionally, the topic on complementary treatments was extended with specific focus on non-hormonal treatments and lifestyle management options. The draft guideline published for stakeholder review includes a total of 142 recommendations. One third of these recommendations were formulated as good practice points. Of the evidence-based recommendations, almost 80% were formulated as strong recommendations, even if the evidence base for most evidence-based recommendations was limited to observational data (level very low or low), supporting a call for future research. The guideline group hope that the new POI Guideline will improve the clinical management of this devastating condition.

Abstract 17308: Patient and Primary Care Provider Experiences From an Implementation Study of a Risk Prediction Tool Integrating a Polygenic Risk Score and the QRISK2 Cardiovascular Risk Calculator

Introduction: We have previously shown that combining a polygenic risk score (PRS) for cardiovascular disease (CVD), with standard clinical risk calculators such as QRISK®2, results in improved CVD risk prediction via an integrated risk tool (CVD-IRT). Research Question: The objective of this study was to explore the implementation of CVD-IRT within routine practice in the UK National Health Service (NHS), through participant and healthcare provider (HCP) surveys and interviews. Methods: The Healthcare Evaluation of Absolute Risk Testing Study (HEART) (NCT05294419), a prospective, single-arm pragmatic trial, enrolled 836 participants undergoing health checks across 12 NHS general practices. QRISK2 and CVD-IRT scores were returned to participants via HCPs. The primary outcome of the study was feasibility of CVD-IRT implementation. This was assessed by a mixed methods approach (quantitative and qualitative methods). Results: After the results were reported and discussed, 520 surveys were completed by participants and 824 surveys were completed by HCPs. Subsequently, 21 participants were interviewed and 13 HCPs attended focus groups or interviews to explore their experiences. 23 HCPs completed a final questionnaire (34.8% physician, 21.7% research nurse, 43.5% other). For 90.7% of reports, HCPs indicated that the CVD-IRT could be incorporated into routine primary care in a straightforward manner. 80% of HCPs agreed that having these tests could lead to better health outcomes for patients, and 68.4% believed that the CVD-IRT could help them manage their patients through a shared decision making process covering lifestyle and treatment options. Participants found the report personally useful (98.5%) and easy to understand (94.3%); agreed that genetic measures are important to identify the risks of developing CVD (85.2%); thought that the test should be widely made available (interview summaries); and would recommend to friends and family (86.8%). Conclusion: The implementation of the CVD-IRT into routine health-checks was recommendable, feasible and well received by both HCPs and participants, who felt that the information was useful, could support clinical decisions, and easy to understand.

Psycho-emotional state of patients with chronic non-communicable diseases: important aspects of therapy

Psycho-emotional disorders such as depression and anxiety disorders are important modifiable risk factors for the development and complicated course of many common chronic non-communicable diseases. A particular feature of such comorbidity is the significant impact of psycho-emotional disorders on the motivation and adherence of patients to a healthy lifestyle and various therapy options, which increases the risks of complications and, as a consequence of this, the healthcare expenditures. The topicality of the issues of screening and management of psycho-emotional disorders in the general practitioner practice is caused, on the one hand, by high rate of these disorders in patients with chronic non-communicable diseases, deterioration in quality of life and an increase in adverse outcomes, and on the other hand, inadequate awareness of the possibilities to manage the psycho-emotional state of patients with comorbidities. The therapy for psycho-emotional disorders includes both drug and non-drug methods, however, the effectiveness of such therapy in relation to the clinical course and prognosis in patients with different comorbidities is not the same. This review presents the most common comorbidities of psycho-emotional disorders and somatic diseases in therapeutic practice. A buspirone and tofisopam therapy for psycho-emotional disorders in patients with various comorbidities was discussed. The efficacy and safety of tofisopam and buspirone have been studied in numerous studies in patients with chronic diseases and a wide range of anxiety disorders, including a long-term administration.

Challenges in Achieving 1.5-Degree Lifestyle Mitigation Options—Insights from a Citizen-Participatory Household Experiment in Japan

Recent studies have highlighted the significant role of lifestyle changes in achieving climate change targets. However, implementing substantial changes in people’s lifestyles is challenging due to the varying availability of goods and services and the influence of the surrounding environment. To address this challenge and promote low-carbon and decarbonised lifestyles on a societal scale, a two-week household experiment was conducted in four representative Japanese cities (Kyoto, Yokohama, Kitakyushu, and Kagoshima). The experiment was based on 65 carbon reduction/mitigation options proposed in previous studies. A total of 84 participants participated in the household experiments: 29 in Kyoto, 22 in Yokohama, 12 in Kitakyushu, and 21 in Kagoshima. Due to constraints imposed by the COVID-19 pandemic, implementation was monitored through a ‘household experiment diary’. The household experiments examined the status of implementation of each option and assessed the potential for improvement over a short period. Furthermore, the study identified barriers, enabling contexts and proposed support measures for implementing household mitigation actions. This study also provided policy implications for co-creating decarbonised lifestyles.

Obesity and male infertility.

The worldwide prevalence of obesity is increasing among both sexes, with associated impacts on chronic health and medical comorbidities. Similarly, the effects of obesity on reproductive health are increasingly being recognized. Adiposity is associated with reduced fertility in men, with a complex and multifactorial etiology. The reported effects of obesity on semen parameters and impaired fertility are contrasting, with some studies showing a clear reduction in reproductive outcomes associated with increased body mass index, while others do not show such impacts. These controversies may be due to the complex pathophysiology and interplay between gonadotropins and end organs, as well as genetic and epigenetic changes and oxidative stress on male fertility and function. These different aspects have led to heterogeneous participants in studies and varying implications for assisted reproductive outcomes as well as offspring health. Treatment modalities to manage obesity include lifestyle, medical, and surgical options, with emerging and effective medical treatments showing promise in reproductive outcomes.

New boundaries for fertility sparing management in endometrial cancer.

The increasing rates of endometrial cancer in premenopausal women that accompanies modern lifestyle options that enhance the prevalence of obesity as well as the trend of delayed childbearing are expected to increase the need for fertility sparing techniques. Currently, the cornerstone of fertility sparing treatment is hormonal handling with progestin treatment and is reserved for women with well differentiated endometrioid lesions that are limited in the myometrial layer. Innovative approaches in the surgical treatment of patients with the use of operative hysteroscopy seem to offer decreased intervals to remission of lesions and longer progression free survival. Recent small case series also dictate that patients with endometrioid lesions of medium differentiation as well as those with superficial myometrial invasion may be adequately treated with the use of operative hysteroscopy. Moreover, the novel classification system may help better understand patients that will likely respond better to hormonal treatment. In the near future, further data from clinical trials will be available that will help optimize patient selection as well select surgical and medical options that will help establish a personalized approach of fertility preservation in endometrial cancer patients.

Религиозная идентичность в парадигме современной культуры

The article analyzes the nature and essence of religious identity in modern culture. Since modern culture tends more and more towards individualization and the development of personal lifestyle options, the format of the social existence of religious ideas is also changing. The authors define the specificity of religious identity in the paradigm of modern culture through the transition from the ways of defining the subjects of social relations in traditional society to modern. It is demonstrated that in traditional societies the method of external prescription of static roles that set the limits of the freedoms and opportunities of the individual prevailed, while in modern societies the form of self-determination dominates, when the individual independently and arbitrarily builds his identity from the resources provided to him by culture. Thus, thanks to the philosophical analysis of sociological data, the substantive interpretation of religious identity within the framework of traditional culture and its constructivist (narrative) rethinking within the framework of modern culture are substantiated. In modern society, religion becomes a matter of personal choice, along with the choice of clothing style, cultural activities, reading circle, music playlist, etc. Ultimately, there is an inversion of cause and effect. In a traditional society, the religious worldview was the center of the subject's identity and largely determined its values and characteristics; in modern society, religious identity is shifting to the periphery of the field of free autonomous action of the subject, driven by the mechanisms of intrinsic value and selfjustification of the European humanism of the New Time.

Effects of Four Different Dietary Fibre Supplements on Weight Loss and Lipid and Glucose Serum Profiles during Energy Restriction in Patients with Traits of Metabolic Syndrome: A Comparative, Randomized, Placebo-Controlled Study.

Obesity and its associated complications require various lifestyle changes and treatment options. Dietary supplements are considered an attractive alternative to traditional therapy, mainly because they are accessible to the general population. The aim of this study was to investigate the additive effects of a combination of energy restriction (ER) and four dietary supplements on changes in the anthropometric and biochemical parameters in 100 overweight or obese participants who were randomly assigned one of the dietary fibre supplements containing different dietary fibres or a placebo for 8 weeks. The results confirmed that fibre supplements plus ER significantly (p < 0.01) reduced the body weight, body mass index (BMI), fat mass, and visceral fat and ameliorated the lipid profile and inflammation at 4 and 8 weeks after the start of the study, while in the placebo group, significant differences in some parameters were observed only after 8 weeks of ER. A fibre supplement containing glucomannan, inulin, psyllium, and apple fibre was the most effective at reducing the BMI, body weight, and CRP (p = 0.018 for BMI and body weight and p = 0.034 for CRP compared to placebo at the end of the intervention). Overall, the results suggest that dietary fibre supplements in combination with ER may have additional effects on weight loss and the metabolic profile. Therefore, taking dietary fibre supplements may be a feasible approach to improve weight and metabolic health in obese and overweight individuals.

A very low-carbohydrate diabetes prevention program for veterans with prediabetes: a single-arm mixed methods pilot study.

All Veterans Affairs (VA) Medical Centers offer the MOVE! Weight Management Program to help patients achieve and maintain a healthy weight through a calorie-restricted, low-fat diet and increased physical activity. Yet, most MOVE! participants do not achieve clinically significant weight loss of ≥5%. A carbohydrate-restricted diet may help more Veterans to achieve ≥5% weight loss. This was a single-arm explanatory sequential mixed methods pilot study conducted in one VA health care system. Veterans with prediabetes and body mass index ≥25 kg/m2 were invited to participate in a group-based, virtual, very low-carbohydrate Diabetes Prevention Program (VLC-DPP) consisting of 23 sessions over 12 months. Participants were taught to follow a very low-carbohydrate eating pattern, defined as 20-35 grams of net carbohydrates per day. The primary outcomes were measures of feasibility and acceptability, including program uptake and session attendance. Secondary outcomes included change in weight, hemoglobin A1c, lipids, and patient-reported measures of food cravings, stress eating, perceived health status, and motivation. Interviews were conducted at 6 months to identify factors that facilitated or hindered participants' achievement of ≥5% weight loss. Among 108 screened Veterans, 21 enrolled in the study (19%), and 18 were included in the analytic cohort. On average, participants attended 12.4/16 weekly sessions and 3.6/8 bimonthly or monthly sessions. At 12 months, mean percent weight loss was 9.4% (SD = 10.7) with 9 participants (50%) achieving ≥5% weight loss. Three factors facilitated achievement of ≥5% weight loss among 10/16 interviewees: (1) enjoyment of low-carbohydrate foods; (2) careful monitoring of carbohydrate intake; and (3) reduced hunger and food cravings. Three factors hindered achievement of ≥5% weight loss among 6/16 interviewees: (1) food cravings, particularly for sweets; (2) challenges with maintaining a food log; and (3) difficulty with meal planning. A VLC-DPP is feasible and acceptable and shows preliminary efficacy among Veterans with prediabetes. The program's weight loss effectiveness compared to standard MOVE! should be evaluated in a larger-scale trial. Such a program may be offered in addition to the standard MOVE! program to expand the menu of evidence-based lifestyle counseling options for Veterans. https://clinicaltrials.gov/ct2/show/NCT04881890, identifier NCT04881890.

Bridging the Gap in Cancer-Related Stroke Management: Update on Therapeutic and Preventive Approaches.

The underlying aetiopathophysiology of cancer-related strokes and thromboembolisms differs from that of noncancer-related strokes, which makes treating cancer-related strokes and thromboembolisms a distinct clinical challenge. This necessitates the development of novel, individualised diagnostic and treatment strategies. However, limited guidelines are available for the management of cancer-related strokes and the prevention of acute strokes or other thromboembolic events in this patient population. In this article, we present an updated overview of the therapeutic and preventive strategies for strokes in cancer settings. These strategies include acute reperfusion therapy, anticoagulant therapy, antiplatelet therapy, and lifestyle management options. We also outline comprehensive pathways and highlight gaps in the evidence-based clinical management of cancer-related strokes or thromboembolisms. Additionally, future recommendations for the management of strokes in cancer patients are provided.

Culturally-tailored cookbook for promoting positive dietary change among hypertensive Filipino Americans: a pilot study.

Among all Asian American subgroups, Filipino-Americans have consistently been shown to have the highest rates of hypertension, raising risks of heart attack and stroke. Despite this alarming fact, little has been done to investigate culturally-sensitive interventions to control hypertension rates in this vulnerable population. To address the lack of culturally-relevant lifestyle options for blood pressure management currently available to the Filipino community, this exploratory pilot study used a design thinking approach informed by culinary medicine to develop a culturally-tailored, heart-healthy, and low sodium recipe cookbook for Filipino Americans with hypertension and evaluate its feasibility as a hypertension intervention. Our team developed a cookbook using participatory methods and design thinking, utilizing input from five Filipino culinary experts and a Registered Dietitian. The cookbook incorporates traditional Filipino recipes, excerpts from community members' interviews, and nutrient analyses. Twenty Filipinx-identifying individuals* who self-reported physician-diagnosed hypertension were recruited from Filipino community-based organizations, enrolled into this study, provided with the cookbook, and asked to cook at least one recipe. Pre- and post-intervention surveys were conducted and centered around behavior change and features of the cookbook. This study provided evidence for the cookbook's acceptability and feasibility, with participants' open-ended responses revealing that the recipes, nutrition labels, illustrations, and cultural aspects of the cookbook increased motivation to achieve dietary change, including reducing sodium in their diet to improve their blood pressure. Participant responses also indicated positive behavior change as a result of using the cookbook, with participants reporting increased likelihood of adopting recommended actions to lower their BP after utilizing the cookbook ( = 80.83%), compared to before ( = 63.75%, p < 0.008), according to Hypertension Self-Care Management scaled scores. In conclusion, the results of this pilot study demonstrated acceptability of this unique cookbook and provide preliminary findings consistent with increased motivation in participants to make dietary changes and improve personal health, drawing attention to the importance of considering future culturally-tailored health interventions. Next steps should include a robust, randomized controlled trial design comparing measured blood pressure outcomes of an intervention vs. control group. *Filipinx is an inclusive term representing the gender identities of all participants in our study.

A glycemic diet improves the understanding of glycemic control in diabetes patients during their follow-up.

A glycemic diet improves the understanding of glycemic control in diabetes patients during their follow-up.

Content and Readability of Online Recommendations for Breast Implant Size Selection.

Using a depersonalized, anonymous query to Google search engine, the terms "breast implant size factors" and "breast implant size decision" were searched, and 52 plastic surgery private practice webpages were identified. Webpages were analyzed for reported decision-making factors of implant size selection. Readability analyses of webpages were performed with Readability Studio and Hemingway Editor. The two major decision-making factors for implant size selection reported by webpages were body/tissue-based measurements and surgeon input. Ten factors related to patient lifestyle, surgical goals, and procedural options were also identified. Average webpage scores for five readability measures exceeded recommended levels for medical information. Reported decision-making factors for implant size selection emphasize a plastic surgeon's expertise but may enhance the patient's role in preoperative planning. Webpages describing breast implant size selection exceed the sixth and eighth grade reading levels recommended by the AMA and NIH, respectively. Improving the readability of webpages will refine the role of online medical information in preoperative planning of breast augmentation.

Patients' Opinions Toward Healthcare Quality and Improvement in Aseer Health: A Cross-Sectional Study.

Introduction Population health is crucial to government planning. The 2030 national vision is transforming all Saudi sectors. The health sector revolution intends to boost life expectancy by reducing mortality due toroad traffic accidents and morbidity due to chronic illness. Health services will change from treatment-basedto person-centered and preventive care, empower the population, increase access to healthcare and improve service quality by offering high customer satisfaction. This study establishes a baseline assessment for public awareness, behavior, healthcare access, and quality. Method A cross-sectional study was conducted in the Aseer region in southwestern Saudi Arabia in 2022, September and October. Using the Aseer region's2.1 million people to calculate the sample needed, the minimal sample size was 664. The study used cluster random sampling and a structured self-administered questionnaire to meet health transformation strategy requirements. All study variables underwent descriptive and bivariateanalysis. Result The survey received 1,381 responses, with 97.2% of participants being Saudi and 84.4% being male. 312 (22.6%) of participants self-reported their health status as weak; 615 (44.5%) self-reported as having a good health status; and 667 (48.3%) reported having high knowledge. 740 people (53.6%) said that health was very important in their daily lives. The evaluation rate for Ministry of Health services in primary healthcare centers was 585 (42.4%) medium and 398 (28.8%) media for inpatient services. Evaluation for surgical procedure availability was 388 (28.1%) media. The results showedthere is a statistically significant relationship (p-value < 0.05) between health status and age, gender, knowledge, and the importance of a healthy lifestyle. And there is a statistically significant relationship between the availability and quality of the health service profile, including inpatient, outpatient, and virtual care. Nationality appears to be statistically insignificant. Conclusion Health promotion is effective because people are health conscious. The importance of health and lifestyle presents a tremendous opportunity to incorporate health into all policies and improve the availability of healthy lifestyle options and surroundings to support healthy behaviors that will reduce preventable disease and risk mortality and morbidity. Health status was also linked to healthcare availability and quality.

Measuring the direct and indirect effects of low-carbon lifestyles using financial transactions

This study investigates the net effect of four low-carbon lifestyle options that could potentially be adopted by many individuals and households to achieve substantial cuts in greenhouse gas emissions: not owning a car, not flying, not living in a detached house, and having a vegan diet. We evaluated the direct and indirect effects of these options on the carbon footprints of a sample of 715 individuals. Their emissions were calculated using a carbon calculator app that estimates the footprint associated with their consumption, based on financial transaction data from their bank(s) in combination with a lifestyle survey and data from official databases. This data also provides the basis for a detailed analysis of how differences in spending and greenhouse gas emissions in one consumption domain can rebound and/or spillover into other domains. Our results show that these four lifestyle options are associated with substantial net emission reductions, ranging from 0.5 to 1.5 tonnes of CO2eq/cap/yr each. The results also suggest that, contrary to the theory of economic rebound effects, the indirect effects of these practices are related to further emission reductions in other consumption domains, except for people who do not fly, for whom we saw a very limited rebound effect. The sample has on average relatively strong pro-environmental personal norms, which limits the generalizability of the results and calls for further research.

Avicenna’s Points in Improving Female Urinary Incontinence with Lifestyle Options

Urinary Incontinence (UI) is a significant reason for the decline in women's quality of life. The unexpected occurrence of UI and its high costs around the world are evident. Numerous methods are used for the management of UI; however, there is no worldwide agreement on any of these methods. Traditional medicines are a source of human medical experiences and this study is a review on the books of the most famous Persian medicine (PM) physician, Avicenna, to find about his approach to UI. Keywords such as: "female urinary incontinence", "lifestyle", and “nutrition” were selected. As a library research, Avicenna’s (980- 1037 AD) "the Canon of Medicine" (Al-Qanun Fi al-Tibb), was reviewed and coded. Some other PM famous books like "the Great Continens" (Al-Hawi fi Al-Tibb) of Rhazes (865- 925 AD) and "The Comprehensive Book on Medicine" (Al-Shamil fi Al-Sana'a Al-Tibbiya) of Ibn al-Nafis al-Qarshi (1213- 1288 AD) were used as a help to interpret the codes just in case it was required. Modern literature was searched with the same keywords at electronic databases such as Google Scholar, PubMed, and Magiran. Finally, the results were compared. Recent studies care on conservative and lifestyle management in the treatment of UI. In PM, principles of lifestyle management (Setteh-e-zarurieh) is one of the main characteristics of prevention and treatment with six essential principles including weather, eating and drinking, sleep and wakefulness, movement and rest, evacuation and retention, and psychological and mental reactions. In healthy people, these six axes are designed by temperament and personal characteristics. In this manuscript, we discussed five mentioned subtypes. These managements are appropriate for designing various pieces of clinical trials to survey their effects on female UI.

Obesity in South and Southeast Asia-A new consensus on care and management.

Obesity is a chronic disease in which the abnormal or excessive accumulation of body fat leads to impaired health and increased risk of mortality and chronic health complications. Prevalence of obesity is rising rapidly in South and Southeast Asia, with potentially serious consequences for local economies, healthcare systems, and quality of life. Our group of obesity specialists from Bangladesh, Brunei Darussalam, India, Indonesia, Malaysia, Philippines, Singapore, Sri Lanka, Thailand, and Viet Nam undertook to develop consensus recommendations for management and care of adults and children with obesity in South and Southeast Asia. To this end, we identified and researched 12 clinical questions related to obesity. These questions address the optimal approaches for identifying and staging obesity, treatment (lifestyle, behavioral, pharmacologic, and surgical options) and maintenance of reduced weight, as well as issues related to weight stigma and patient engagement in the clinical setting. We achieved consensus on 42 clinical recommendations that address these questions. An algorithm describing obesity care is presented, keyed to the various consensus recommendations.

The design and development of an encounter tool to support shared decision making about preventing cardiovascular events

Patients at high risk for cardiovascular disease (CVD) tend to receive less intensive preventive care. Clinical practice guidelines recommend shared decision making (SDM) to improve the quality of primary CVD prevention. There are tools for use during the clinical encounter that promote SDM, but, to our knowledge, there are no SDM encounter tools that support conversations about available lifestyle and pharmacological options that can lead to preventive care that is congruent with patient goals and CVD risk.Using the best available evidence and human-centered design (iterative design in the context of ultimate use with users), our team developed a SDM encounter tool, CV Prevention Choice. Each subsequent version during the iterative development process was evaluated in terms of content, usefulness, and usability by testing it in real preventive encounters. The final version of the tool includes a calculator that estimates the patient’s risk of a major atherosclerotic CVD event in the next 10 years. Lifestyle and medication options are presented, alongside their pros, cons, costs, and other burdens. The risk reduction achieved by the selected prevention program is then displayed to support collaborative deliberation and decision making.A U.S. multicenter trial is estimating the effectiveness of CV Prevention Choice in achieving risk-concordant CV prevention while identifying the best strategies for increasing the adoption of the SDM encounter tool and its routine use in practice.