Striking increase in obesity observed among youth between 2011 and 2023

Embargoed for release until 5:00 p.m. ET on Monday 30 June 2025   

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. Striking increase in obesity observed among youth between 2011 and 2023

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00389

URL goes live when the embargo lifts             

A brief research report evaluated obesity among U.S. children and adolescents from 2011 to August 2023 and compared changes before and during the COVID-19 pandemic. The study found that the overall prevalence for obesity increased for all groups from January 2011 to August 2023. The increase was most pronounced among Black youth. While the pandemic presented obesity risk factors including the loss of safe spaces for physical activity, increased food insecurity, and heightened stress linked to family economic hardship, the authors found no overall increase in obesity after accounting for secular trends. The findings are published in Annals of Internal Medicine. 

Researchers from the Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center in Boston, MA studied serial cross-sectional data from the 2011 to August 2023 survey cycles of the NHANES (National Health and Nutrition Examination Survey). The participants studied were 17,507 children (ages 2 to 11 years) and adolescents (ages 12 to 19 years). The researchers calculated the unadjusted prevalence of obesity and severe obesity overall, as well as by age and self-reported race and ethnicity. They also estimated changes during the COVID-19 pandemic (August 2021 to August 2023) relative to the prepandemic period (January 2011 to March 2020). The researchers found the overall prevalence of obesity increased from 20.3% in January 2011 to March 2020 to 22.0% in August 2021 to August 2023. By the end of the study period (August 2021-August 2023), the prevalence of obesity was highest among Black (from 22.4% to 35.8%), Mexican American (from 26.4% to 28.1%), and Other Hispanic (from 24.0% to 25.9%) youth. Currently, more than in 1 in 3 Black youth, more than 1 in 4 Hispanic youth, nearly 1 in 5 White youth, and 1 in 10 Asian youth meet the criteria for obesity.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Rishi K. Wadhera, MD, MPP, MPhil, please email Katherine Brace at Katie.Brace@bilh.org.    

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2. Risk for microscopic colitis in older adults not associated with medications like statins and NSAIDs

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00268

URL goes live when the embargo lifts             

A series of six target trial emulations were conducted to examine the potential causal effects of previously implicated medications on risk for microscopic colitis (MC) in older adults. The study found no evidence of a causal relationship between most previously suspected medications and the risk of MC. The results differ from numerous prior studies showing a consistent association between certain pharmacological treatments and MC. The study is published in Annals of Internal Medicine.

Researchers from Massachusetts General Hospital, Karolinska Institutet, and colleagues studied data from Swedish adults aged 65 or older between 2006 and 2017 with no history of inflammatory bowel disease or MC. They linked this cohort of older adults in Sweden to the ESPRESSO study, which contains data on gastrointestinal (GI)-related biopsies from all 28 pathology departments in Sweden from January 1965 until April 2017. They used these observational data to emulate six target trials of six suspected medications and MC risk among older adults: nonsteroidal anti-inflammatory drugs (NSAIDs), proton-pump inhibitors (PPIs), statins, angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARBs), and selective serotonin receptor inhibitors (SSRIs). For NSAIDS, statins, and PPIs, they compared initiation of the medications versus no initiation. For ACE-I and ARB, they compared the initiation of each medication to the initiation of a calcium-channel blocker (CCB). For SSRIs, they compared the initiation of an SSRI with initiation of Mirtazapine. The primary outcome was histologic diagnosis of MC derived from the ESPRESSO cohort. The researchers found that the 12- and 24- months cumulative incidences of MC were less than 0.5% under all treatment strategies, with risk differences close to null for all treatment strategies except SSRIs. For SSRI vs mirtazapine initiation, the estimated 12- and 24-month risk differences were .04 and .06 percentage points. The researchers suggest that the apparent increased risk of MC with SSRI use as reported in previous studies could be due to surveillance bias. They suggest that clinicians should carefully balance the intended benefits of these medication classes against the very low likelihood of a causal relationship with MC.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Hamed Khalili, MD, MPH, please email Tori Roberts at vroberts1@mgb.org.        

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3. Catheter ablation reduces risk for stroke, mortality, and heart failure, demonstrating advantage over surgical ablation

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00253

URL goes live when the embargo lifts             

A systematic review and meta-analysis aimed to determine the effect of ablation on stroke, death and hospitalization for heart failure (HF). The review found that catheter ablation reduces stroke risk at 30 days as well as mortality and heart failure hospitalization. Surgical ablation had an uncertain benefit, except for stroke. The study is published in Annals of Internal Medicine.

Researchers from Washington University in St. Louis and colleagues studied data from 63 randomized controlled trials of catheter or surgical ablation versus no ablation with a total of 11,161 participants. The primary end point was the rate of ischemic strokes that occurred more than 30 days after randomization or initiation of treatment. Secondary outcomes included rates of ischemic stroke at or before 30 days, total all-cause mortality, and total HF hospitalizations. Of the 63 trials included, 39 compared catheter ablation versus control therapy. The analysis found that catheter ablation reduced the relative risk of ischemic stroke after 30 days. However, the rates of ischemic stroke at or before 30 days were higher with catheter ablation. Versus medical therapy. Catheter ablation also reduced all-cause mortality after 30 days, total risk of ischemic stroke, total mortality, and HF hospitalization. Surgical ablation reduced the risks for ischemic stroke and stroke from any cause but had uncertain benefits for other outcomes. The results suggest that catheter ablation provides durable benefits, especially in patients with HF.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Brian F. Gage, MD, MSc please email Julia Sandvoss at jsandvoss@wustl.edu.

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4. ACP issues recommendations for optimizing risk adjustment, encouraging adoption of standardized methods and the interoperability of health care data

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00280

URL goes live when the embargo lifts             

In a new policy paper published in Annals of Internal Medicine, the American College of Physicians (ACP) says optimizing risk adjustment would improve health equity. ACP offers recommendations for improving this component of health care financing and reimbursement through proactive measures that promote a more equitable and effective modern health care system.

To enhance the fairness and effectiveness of health care financing systems, in the paper, ACP recommends that health care programs and sectors use standardized methods of risk adjustment, so all health care entities understand how it works and how decisions are made. This would prevent discrepancies in how patient needs are evaluated and funded and would encourage unbiased use of resources. ACP encourages the interoperability of health care data and investment in health information technology to adopt common data standards, which would promote accurate risk adjustment and prevent the siloing of health data. Health care entities should collaborate to enact policy changes that prevent patient data used in adjusting risk from being reset annually.

Additionally, physicians, patient advocacy groups, and public and private payers should participate in routine evaluations and feedback that integrates valid and reliable metrics into risk adjustment models. ACP also calls for a strategic effort to limit opportunities to “game” the system by aligning economic incentives with the goal of high-quality, patient-focused care.

In a key recommendation, ACP advocates for research to develop validated methods for measuring the cost of caring for patients who experience health care disparities and inequities and maintains that it is essential that all risk adjustment approaches do not reinforce or perpetuate stereotypes. Patients experiencing health care disparities and non-medical drivers of health often face higher barriers to accessing care, which can lead to worsened health conditions and increased health care needs over time. This recommendation aims to foster a more holistic understanding of health.

Finally, advanced analytics and machine learning have the potential to revolutionize risk adjustment by providing access to more accurate data and predictive analytics. They should be used to improve upon risk adjustment models and methodologies. Prospective and current risk adjustment models have strengths that can be leveraged through hybrid models, enabling a more comprehensive view of health over time and better capturing patient complexities.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To speak with someone at ACP, please contact Jacquelyn Blaser at jblaser@acponline.org.        

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Also new this issue:

Licensing Internationally Trained Physicians: Advisory Commission Leaders Share Initial Progress

Humayun J. Chaudhry, DO, MS; John R. Combes, MD; Eric S. Holmboe, MD; Katie L. Templeton, JD; George M. Abraham, MD, MPH

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00936

Does Anyone Remember the German Measles?

Bruce Farber, MD

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01726  

GRADE Certainty Ratings: Thresholds Rather Than Categories of Contextualization

Monica Hultcrantz, et al.

Research and Reporting Methods

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00548