1. Obesity prevalence varies significantly for Asian American subgroups
Findings have important implications for future public health efforts addressing obesity
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A cross-sectional study of more than 70,000 Asian Americans has found that the prevalence of obesity in Asian American subgroups varies substantially. These findings have important implications for directing and adapting obesity prevention and intervention strategies for Asian American populations. The study is published in Annals of Internal Medicine.
Obesity increases risk for cardiovascular and metabolic disease, and the risk occurs at lower body mass index (BMI) in Asian adults compared to White adults. This risk also varies within Asian subgroups, but most obesity estimates combine all Asian Americans into one group.
Researchers from Northwestern University Feinberg School of Medicine and the Centers for Disease Control and Prevention analyzed self-reported height, weight, and demographic data for more than more than 2.8 million adults who participated in the 2013–2020 Behavioral Risk Factor Surveillance System survey to quantify obesity prevalence in Asian American subgroups based on standard BMI standards (BMI ≥30 kg/m2) and those tailored to Asian populations (BMI ≥27.5 kg/m2). Based on the standard threshold, Asian Americans as a combined demographic group had a 11.7 percent obesity prevalence compared to 39.7 percent and 29.4 percent obesity prevalence in Black and in White adults, respectively. However, using a combined Asian American cohort and standard BMI threshold masked significant variance among subgroups, and underrecognized obesity among Asian American adults. By calculating obesity prevalence in a combined Asian American cohort using the modified BMI threshold, the prevalence of obesity was 22.4 percent, with a range from 13.2% in Chinese Americans to 28.7% in Filipino Americans. Identifying and addressing the Asian subgroup-specific factors that contribute to high obesity prevalence and differences in obesity prevalence among subgroups is necessary to mitigate the potential lifetime consequences of overweight and obesity.
An accompanying editorial from Annals deputy editor Christina Wee, MD, MPH argues that these findings highlight the limits of BMI as an indirect measure for body fat, because the correlations between BMI and adiposity vary substantially across populations and are influenced by factors such as age, sex, and ethnicity. She highlights that this study also adds new complexity to existing research indicating that Asian Americans meet criteria for obesity at lower BMI thresholds than White Americans. She adds that while some guidelines have begun to acknowledge the influence of race and ethnicity on overweight and obesity thresholds, guidelines provide little guidance specific to Asian American populations. She notes that because clinicians and payers look to guidelines to guide practice and reimbursement for weight loss interventions, the lack of recommendations specific to patients of Asian descent puts them at risk for delayed treatment.
2. SGLT2 inhibitors and GLP1 receptor antagonists improve type-2 diabetes outcomes, but are not cost effective
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A cost-effectiveness study of sodium–glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP1) receptor agonists has found that the use of these medications as first-line treatment for type-2 diabetes would improve outcomes, but their costs would need to decrease by at least 70 percent to be cost-effective. The study is published in Annals of Internal Medicine.
Type-2 diabetes affects more than 30 million Americans and costs $327 billion annually, up from $174 billion in 2007. The cost increase is partially attributed to the increased use of SGLT2 and GLP1, which have been demonstrated to reduce atherosclerotic cardiovascular disease (ASCVD), microvascular disease, and mortality in addition to improvements in glycated hemoglobin (HbA1c) and cardiovascular risk factors. These medications have been recommended for second-line therapy in both American and European guidelines but may be a prohibitively expensive treatment option for some payers.
Researchers from the University of Chicago Department of Medicine created an individual patient-level model to simulate the lifetime incidence, prevalence, mortality, and costs associated with having type-2 diabetes. They created several treatment outcomes, including the first-line use of metformin and second-line use of SGLT2 or GLP1, the first-line use of SGLT2, and the first-line use of GLP1. After conducting analyses, the authors found that first-line SGLT2 inhibitors and GLP1 receptor agonists had lower lifetime rates of congestive heart failure, ischemic heart disease, myocardial infarction, and stroke compared with metformin. However, they also found that the costs for SGLT2 inhibitors would need to be reduced by 70 percent and by 90 percent for oral GLP1 receptor agonists to be cost-effective compared to metformin. According to the authors, their study results indicate the need to reduce SGLT2 inhibitor and GLP1 receptor agonist medication costs substantially for patients with type 2 patients to improve health outcomes and prevent exacerbating diabetes health disparities.
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3. History of nation’s first gender-affirming surgery clinic offers both a lesson and cautionary tale
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An essay about the creation and subsequent closure of the nation’s first gender-affirming surgery (GAS) clinic in the United States offers a unique history lesson about and cautionary tale for physicians treating transgender persons in the face of both existing institutional transphobia and renewed cultural backlash. The piece is published in Annals of Internal Medicine.
The nation’s first GAS clinic was opened at Johns Hopkins Hospital in 1966. Its creation was accompanied by both general academic interest in and the creation of other university GAS clinics across the country. GAS at Johns Hopkins was banned in 1979, with the hospital citing a study claiming that GAS was ineffective despite criticism of the study’s methodology and contemporaneous research demonstrating that GAS improved mental health outcomes for patients.
Walker Magrath of the Johns Hopkins School of Medicine presents a spatial argument and analysis for how the closure of the first GAS clinic was not based in empirical data alone but was manipulated to fuel political and institutional agendas. An analysis of archival documents demonstrates the shifting priorities and biases of the clinic’s leadership years before its closure, citing repeated public and private transphobic statements from both the clinic’s founding surgeon and the Johns Hopkins Chief of Psychiatry. The author also notes that during the same period, plastic surgery achieved several significant medical milestones, including the first kidney transplant and the appointment of a plastic surgeon as Surgeon General in 1969. Archival documents speculate that the clinic’s closure was related to political and social pressures to distance plastic surgery and the institution more broadly from increasingly controversial and less-respected medical procedures.
An accompanying editorial reiterates the importance of including transgender and gender-diverse persons in every step and every level in the design, planning, implementation, expansion, and sustainment of clinical services, training curricula, research studies, and policy agendas of gender-affirming care. The authors also call on physicians to name and denounce institutional or governmental efforts to reduce access to gender-affirming care, offer welcoming and inclusive environments to transgender and gender-diverse patients, and request that healthcare systems enforce nondiscrimination policies that are explicit about gender identity and expression.
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Heterogeneity in Obesity Prevalence Among Asian American Adults
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