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Nilson EAF, Gianicchi B, Ferrari G, Rezende LFM. The projected burden of non-communicable diseases attributable to overweight in Brazil from 2021 to 2030. Sci Rep 2022; 12:22483. [PMID: 36577769 PMCID: PMC9795442 DOI: 10.1038/s41598-022-26739-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
Although studies have quantified the current burden of diseases attributable to overweight and obesity in Brazil, none have estimated its burden in the future. The study aimed to estimate the potential impact of different scenarios of changes in the prevalence of overweight on non-communicable diseases (NCD) in the Brazilian adult population until 2030. We developed a multistate life table model including 11 body mass index (BMI) related diseases to estimate attributable NCDs cases and deaths under the following scenarios of changes in overweight over a 10-year simulation: (1) the continuity of the current trajectory of BMI increases, (2) reducing the rate of increase by half, (3) stopping future BMI increases, and (4) the reduction of the prevalence of overweight by 6.7%. In Brazil, if the current trends of BMI increase are maintained from 2021 to 2030, approximately 5.26 million incident cases and 808.6 thousand deaths from NCDs may occur due to overweight. If the annual increase in overweight was reduced by half until 2030, 1.1% of new NCD cases and 0.2% of deaths could be prevented (respectively, 29,600 cases and 1900 deaths). Alternatively, if the current prevalence of overweight is maintained, as set as a national goal in Brazil until 2030, the incident NCD cases and the deaths could be reduced by respectively 3.3% (92,900) and 1.5% (12,100) compared to continuation of current trends. If the prevalence of overweight is reduced by 6.7% until 2030, 6.5% (182,200) of NCD cases and 4.2% (33,900) of deaths could be prevented. The epidemiologic burden of overweight in Brazil tends to increase if bold policy interventions are not adopted in Brazil.
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Affiliation(s)
- Eduardo A. F. Nilson
- grid.11899.380000 0004 1937 0722Center for Epidemiological Research in Nutrition and Public Health, University of São Paulo, São Paulo, Brazil
| | - Beatriz Gianicchi
- grid.411249.b0000 0001 0514 7202Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Gerson Ferrari
- grid.412179.80000 0001 2191 5013Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Universidad de Santiago de Chile (USACH), Las Sophoras 175, Estación Central, Santiago, Chile
| | - Leandro F. M. Rezende
- grid.411249.b0000 0001 0514 7202Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Gómez EJ. Getting to the root of the problem: the international and domestic politics of junk food industry regulation in Latin America. Health Policy Plan 2021; 36:1521-1533. [PMID: 34436571 PMCID: PMC8597956 DOI: 10.1093/heapol/czab100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 12/22/2022] Open
Abstract
In response to non-communicable diseases (NCDs) in Latin America, governments have introduced impressive prevention programmes However, the purpose of this article is to better explain why several governments have yet to address arguably the 'root of the problem': i.e. implementing effective regulatory policies restricting the food industries' ability to market and sale their products. Introducing a political science analytical framework merging international relations and domestic politics theory, this article claims that most governments have failed to achieve this process because of their reluctance to transfer their beliefs in human rights to health from the area of NCD prevention to regulation, thus achieving what the author refer to as 'normative transferability'. The research design for this study entailed a documentary analysis of 44 qualitative primary and secondary documentary data sources (combined), i.e. articles, books, policy reports and the usage of these data sources for a comparative case study analysis of Chile, Brazil and Mexico. These qualitative data sources were also used to illustrate the potential efficacy of the author's proposed analytical framework, developed from the political science and public policy literature. Quantitative epidemiological data from the World Health Organization global health observatory were used to provide a contextual backdrop of the obesity and diabetes situation in these countries. Comparing these three countries, Chile was the only one capable of achieving 'normative transferability' due to a strong linkage between activists, supportive institutions and policy advocates within government viewing regulatory policy as a human right to protection from aggressive industry marketing and sales tactics. To better understand differences between nations in achieving normative transferability processes and effective NCD regulatory policy outcomes, political scientists and public health scholars should work together to develop alternative analytical frameworks in the commercial determinants of health.
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Affiliation(s)
- Eduardo J Gómez
- College of Health, Lehigh University, 1 Steps Building, Bethlehem, PA 18015, USA
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3
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Gómez EJ. The international and domestic politics of type 2 diabetes policy reform in Brazil. BMJ Glob Health 2020; 5:bmjgh-2020-002457. [PMID: 32873596 PMCID: PMC7467506 DOI: 10.1136/bmjgh-2020-002457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/15/2022] Open
Abstract
Introduction Understanding the international and domestic political factors influencing the evolution of type 2 diabetes policies and primary care institutions is a new area of scholarly research. This article contributes to this area of inquiry by illustrating how a government’s shifting foreign policy aspirations, that is, to establish the government’s reputation as an internationally recognised leader in type 2 diabetes policy, and presidential electoral incentives provide alternative insights into the evolution of type 2 diabetes treatment policies and primary care institutional reforms. Methods I conduct a single-case study analysis with the usage of qualitative data; quantitative statistical data on epidemiological trends and government policy spending is also provided as supportive evidence. Results The case of Brazil illustrates how a reduction in foreign policy commitment to international reputation building in health as well as presidential electoral incentives to use diabetes policy as an electoral strategy account for a decline in sustaining policy and primary care institutional innovations in response to type 2 diabetes. Conclusion Future scholars interested in understanding the lack of sustainability and effectiveness in type 2 diabetes programmes should consider investigating the complex international and domestic political factors influencing political interests, incentives and commitment to reform.
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Affiliation(s)
- Eduardo J Gómez
- College of Health, Lehigh University, Bethlehem, Pennsylvania, USA
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Clarke B, Swinburn B, Sacks G. Understanding the LiveLighter® obesity prevention policy processes: An investigation using political science and systems thinking. Soc Sci Med 2019; 246:112757. [PMID: 31927475 DOI: 10.1016/j.socscimed.2019.112757] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/05/2019] [Accepted: 12/18/2019] [Indexed: 11/19/2022]
Abstract
The health and economic burden associated with overweight and obesity warrants comprehensive policy action; however, to date, there has been limited policy progress globally. This study sought to advance obesity prevention policy research and practice by applying theories of the policy process to study decision-making processes involved in the adoption of the contentious LiveLighter® social marketing campaign by the Victorian government in Australia. Through analysis of documents and interviews with policy makers, this qualitative study aimed to gain a better understanding of the dynamic influences on policy decision-making. Multiple theories of the policy process were used to elucidate policy drivers and Causal Loop Diagramming methods were used to illustrate the LiveLighter® policy decision-making systems. Findings highlighted a number of key influences including: various external events, evidence of the problem and intervention effectiveness, resistance from various stakeholders and the political capabilities of central policy makers. The policy systems map provided insight into the difficulties experienced by policy actors in achieving policy change, as well as to develop a conceptual framework for identifying potential leverage points to influence future obesity prevention policy decisions. Together the findings can inform future advocacy efforts for improving the implementation of obesity prevention policy action.
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Affiliation(s)
- Brydie Clarke
- Deakin University, Global Obesity Centre, Institute for Health Transformation, 221 Burwood Highway, Burwood, Victoria, 3125, Australia; Population Health and Prevention Strategy Branch, Department of Health and Human Services, 50 Lonsdale Street, Victoria, 3000, Australia.
| | - Boyd Swinburn
- School of Population Health, University of Auckland, Victoria Street West, Auckland, 1142, New Zealand.
| | - Gary Sacks
- Deakin University, Global Obesity Centre, Institute for Health Transformation, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
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Klepac Pogrmilovic B, O’Sullivan G, Milton K, Biddle SJH, Bauman A, Bull F, Kahlmeier S, Pratt M, Pedisic Z. A global systematic scoping review of studies analysing indicators, development, and content of national-level physical activity and sedentary behaviour policies. Int J Behav Nutr Phys Act 2018; 15:123. [PMID: 30486826 PMCID: PMC6263060 DOI: 10.1186/s12966-018-0742-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/25/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND National policy approaches to physical activity (PA) promotion and sedentary behaviour (SB) reduction are needed to address rising rates of non-communicable diseases. Understanding the policy process and impact through robust research and evaluation is crucial for facilitating successful reforms in national health policy. This scoping review, therefore, aimed to map the evidence on indicators, development, and content of national PA and/or SB policies globally. METHODS A systematic search of academic and grey literature was conducted through six bibliographic databases, Google, and websites of three large organisations for PA promotion. RESULTS Out of 24,872 screened documents, 203 publications from 163 studies were selected. The selected studies investigated PA/SB policies in 168 countries worldwide, and we provided summary results for each of the countries. Overall, 69, 29, and 2% of the analyses of national PA/SB policies were conducted for high-, middle-, and low-income countries, respectively. Twenty-two percent of the studies mentioned SB policies as part of their analysis, with only one study focusing solely on assessing SB policies. Operational definitions of policy were found in only 13% of publications. Only 15% of the studies used a conceptual or theoretical framework. A large variety of methods were used for data collection and analysis of PA/SB policy. CONCLUSIONS We found that PA policy research is much more developed than it was considered several years ago. Research around SB policies is still in its infancy, but it seems to have experienced some positive progress in the last few years. Three key issues were identified that should be addressed in further research: [i] there is a lack of PA/SB policy research in low- and middle-income countries, which is an important limitation of the current body of evidence; [ii] the definition of policy varied significantly across studies, and most studies did not rely on any theoretical framework, which may impede cross-study comparisons; and [iii] studies have used a variety of methods to analyse policy, which may also cause problems with comparability. Future PA/SB policy research should aim towards a clearer conceptualisation of policy, greater reliance on existing theoretical frameworks, and the use and further development of standardised methods for PA/SB policy analysis.
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Affiliation(s)
- Bojana Klepac Pogrmilovic
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC 3001 Australia
| | - Grant O’Sullivan
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC 3001 Australia
| | - Karen Milton
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ UK
| | - Stuart J. H. Biddle
- Institute for Resilient Regions, University of Southern Queensland, 37 Sinnathamby Boulevard, Springfield Central, QLD 4300 Australia
| | - Adrian Bauman
- Sydney School of Public Health, University of Sydney, Camperdown, Sydney, NSW Australia
| | - Fiona Bull
- Surveillance and Population Based Prevention, Prevention of Noncommunicable Disease, World Health Organization, Geneva 27, Switzerland
- Faculty of Human Science, The University of Western Australia, Perth, Australia
| | - Sonja Kahlmeier
- Epidemiology, Biostatistics, and Prevention Institute, University of Zürich, Hirschengraben 84, 8001 Zürich, Switzerland
| | - Michael Pratt
- San Diego School of Medicine, University of California, 9500 Gilman Drive, San Diego, USA
| | - Zeljko Pedisic
- Institute for Health and Sport, Victoria University, Ballarat Road, Footscray, Melbourne, VIC 3001 Australia
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Political party ambitions and type-2 diabetes policy in Brazil and Mexico. HEALTH ECONOMICS POLICY AND LAW 2018; 15:261-276. [PMID: 30394254 DOI: 10.1017/s1744133118000415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the Americas, next to the United States, Brazil and Mexico have the highest prevalence of type-2 diabetes. In contrast to most studies, this article compares and analyzes the politics behind the implementation of type-2 diabetes self-care management programs (DSM), which is a new area of scholarly research. This article claims that Brazil outpaced Mexico with respect to the implementation of effective DSM programs, the product of positive policy spillover effects associated with the president and governing political party's popular anti-poverty programs, and the enduring legacy of centralized ministry of health financial and human resource assistance to primary care programs in a context of decentralization. Brazil also benefited from having a strong partnership with international health agencies. None of these factors was present in Mexico. Findings suggest that more research needs to go into understanding the complex political and inter-governmental contexts facilitating DSM program implementation, which is a neglected area of research.
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Clarke B, Swinburn B, Sacks G. Understanding Health Promotion Policy Processes: A Study of the Government Adoption of the Achievement Program in Victoria, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112393. [PMID: 30380619 PMCID: PMC6265848 DOI: 10.3390/ijerph15112393] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 12/25/2022]
Abstract
Despite the growing health and economic burden associated with overweight and obesity, preventive policy progress has been deficient globally. This study investigated the policy process involved in the adoption of the Achievement Program, a settings-based health promotion intervention that was a key pillar of the Healthy Together Victoria obesity prevention initiative. The qualitative study utilised multiple theories of the policy process, as well as Causal Loop Diagramming (CLD) methods, to understand the policy systems underlying the decision to adopt the Achievement Program. Factors that impacted this obesity prevention policy adoption included problem prioritisation at Federal and state government levels; political risks regarding policy action and inaction, and framing used by policy advocates to reduce risks and highlight the opportunities related to the Achievement Program policy implementation. The use of CLD methods was advantageous to further conceptualise potential leverage points and effective ways to influence obesity prevention policy in future. As such, the findings contribute to the obesity prevention policy evidence base and toward developing a number of recommended actions for policy actors seeking to increase future policy action.
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Affiliation(s)
- Brydie Clarke
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Burwood 3220, Australia.
- Prevention and Population Health Branch, Department of Health and Human Services, Melbourne 3000, Australia.
| | - Boyd Swinburn
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Burwood 3220, Australia.
- School of Population Health, University of Auckland, Auckland 1010, New Zealand.
| | - Gary Sacks
- Global Obesity Centre, Centre for Population Health Research, Deakin University, Burwood 3220, Australia.
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Miraldo M, Propper C, Williams RI. The impact of publicly subsidised health insurance on access, behavioural risk factors and disease management. Soc Sci Med 2018; 217:135-151. [PMID: 30321836 DOI: 10.1016/j.socscimed.2018.09.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 08/16/2018] [Accepted: 09/16/2018] [Indexed: 12/11/2022]
Abstract
In 2006, the Massachusetts healthcare reform was introduced to mandate health insurance, extend eligibility of publicly subsidised health insurance, improve quality and access to care and develop preventive health services. The objective of this study was to determine the impact of expanding publicly subsidised health insurance through the Massachusetts reform on access to primary care, disease management and behavioural risk factors. Using cross-sectional data from the Behavioural Risk Factor Surveillance System (BRFSS) from 2001 to 2010 and exploiting the selective introduction of the healthcare reform, we assessed its impact on primary care access, behavioural risk factors, such as obesity, and receipt of diabetes management tests. We did so using a differences-in-differences methodology by comparing Massachusetts with other New England States for 131,002 adults under 300% of the federal poverty level and by race/ethnicity within this group. Triple difference estimates were also conducted to control for potential within state time varying confounding factors. The results suggest that increasing publicly subsidised health insurance had a positive impact on primary care access for lower income adults, particularly those that are white. However, with the exception of improvements in alcohol consumption for one specific group (lower income whites) the reform had no effect on behaviour risk factors or diabetes disease management. The aims of the reform were to improve access to care and through this, behavioural risk factors and diabetes management. This study suggests that while access to care was increased, reducing risk factors attributed to health risky behaviour and diabetes cannot be sufficiently done simply by extending health insurance coverage and the provision of preventive services. This suggests that more targeted interventions are required.
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Affiliation(s)
- Marisa Miraldo
- Imperial College Business School, South Kensington Campus, Exhibition Road, London, SW7 2AZ, United Kingdom; Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, United Kingdom.
| | - Carol Propper
- Imperial College Business School, South Kensington Campus, Exhibition Road, London, SW7 2AZ, United Kingdom; Centre for Health Economics & Policy Innovation (CHEPI), Imperial College Business School, United Kingdom; Centre for Economic Policy Research (CEPR), United Kingdom.
| | - Rachael I Williams
- Imperial College London, School of Public Health, Medical School Building, St Mary's Hospital, Norfolk Place, London, W2 1PG, United Kingdom.
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Clarke B, Swinburn B, Sacks G. The application of theories of the policy process to obesity prevention: a systematic review and meta-synthesis. BMC Public Health 2016; 16:1084. [PMID: 27737707 PMCID: PMC5064928 DOI: 10.1186/s12889-016-3639-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 09/04/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Theories of the policy process are recommended as tools to help explain both policy stasis and change. METHODS A systematic review of the application of such theoretical frameworks within the field of obesity prevention policy was conducted. A meta-synthesis was also undertaken to identify the key influences on policy decision-making. RESULTS The review identified 17 studies of obesity prevention policy underpinned by political science theories. The majority of included studies were conducted in the United States (US), with significant heterogeneity in terms of policy level (e.g., national, state) studied, areas of focus, and methodologies used. Many of the included studies were methodologically limited, in regard to rigour and trustworthiness. Prominent themes identified included the role of groups and networks, political institutions, and political system characteristics, issue framing, the use of evidence, personal values and beliefs, prevailing political ideology, and timing. CONCLUSIONS The limited application of political science theories indicates a need for future theoretically based research into the complexity of policy-making and multiple influences on obesity prevention policy processes.
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Affiliation(s)
- Brydie Clarke
- Global Obesity Centre, Centre for Population Health Research, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia. .,Population Health & Prevention Strategy Unit, Prevention, Population, Primary and Community Health Branch, Department of Health and Human Services, 50 Lonsdale Street, Melbourne, Victoria, 3000, Australia.
| | - Boyd Swinburn
- Global Obesity Centre, Centre for Population Health Research, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia.,Population Nutrition and Global Health, University of Auckland, Victoria Street West, Auckland, 1142, New Zealand
| | - Gary Sacks
- Global Obesity Centre, Centre for Population Health Research, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia
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Fournier MN, Hallock J, Mihalko WM. Preoperative Optimization of Total Joint Arthroplasty Surgical Risk: Obesity. J Arthroplasty 2016; 31:1620-4. [PMID: 27143019 DOI: 10.1016/j.arth.2016.02.085] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/03/2016] [Indexed: 02/01/2023] Open
Abstract
Obesity is a problem that is increasing in prevalence in the United States and in other countries, and it is a common comorbidity in patients seeking total joint arthroplasty for degenerative musculoskeletal diseases. Obesity, as well as commonly associated comorbidities such as diabetes mellitus, cardiovascular disease, and those contributing to the diagnosis of metabolic syndrome, have been shown to have detrimental effects on total joint arthroplasty outcomes. Although there are effective surgical and nonsurgical interventions which can result in weight loss in these patients, concomitant benefit on arthroplasty outcomes is not clear. Preoperative optimization of surgical risk in obese total joint arthroplasty patients is an important point of intervention to improve arthroplasty outcomes.
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MESH Headings
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/statistics & numerical data
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/statistics & numerical data
- Bariatric Surgery
- Comorbidity
- Diabetes Mellitus/epidemiology
- Humans
- Metabolic Syndrome/epidemiology
- Obesity/epidemiology
- Obesity/therapy
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/surgery
- Postoperative Complications/prevention & control
- Preoperative Care/standards
- Prevalence
- Risk Factors
- United States/epidemiology
- Weight Reduction Programs
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Affiliation(s)
- Matthew N Fournier
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
| | - Justin Hallock
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
| | - William M Mihalko
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, Memphis, Tennessee
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