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New insights into understanding obesity: from measures to mechanisms

Data to knowledge to improvement: creating the learning health system

Paige McDonald and colleagues detail key domains, tools, and actions required to enact learning health systems for continuous intelligent improvement in healthcare Despite an increased focus on quality improvement in healthcare over the past 50 years, many of the same problems persist. This disconnect has been described as the 60-30-10 challenge: only 60% of care, on average, aligns with evidence or consensus based guidelines; another 30% of care is waste or of low value; and 10% of patients experience adverse events.1 These statistics have persisted for over three decades.2 Even with technology providing increasing volumes of data and more sophisticated analytical techniques such as machine learning and artificial intelligence, progress continues to be painfully slow. Learning health systems provide a pathway towards continuous improvement and innovation in healthcare through the routine collection, analysis, and more timely use of data. The US Institute of Medicine first proposed

Rethinking self-care through an Indigenous lens—the importance of community

Insights from Indigenous health systems in Australia show why relational self-care is important for the wellbeing of people, communities, and the planet, argue Pat Dudgeon and colleagues Western self-care tends to centre on practices that are aimed at supporting the health of individuals. Activities such as self-medication, rehabilitation, and accessing healthcare services are all generally focused on preventing disease and managing health in an individual. Indigenous self-care, on the other hand, includes these practices but also engages in a continuum of healing that supports the collective wellbeing of communities and the environment. The holistic, collective, and relational approach to health and wellbeing that underpins Indigenous self-care can enrich the understanding of self-care taught by mainstream medicine and improve public and environmental health. Relational self-care is a practice that aligns with the Indigenous ethical principle of collective flourishing or “living w

"Two eyed seeing"—embracing both Indigenous and western perspectives in healthcare

Nel Wieman and Unjali Malhotra call for a “two eyed seeing” approach to healthcare, informed by both Indigenous and biomedical knowledge In Canada, genocidal policies and systems have devastated Indigenous peoples’ determinants of health.1 For example, as a consequence of the Indian Reserve System many Indigenous peoples live in isolated areas with limited or no access to healthcare, education, or employment opportunities.2 Furthermore, the colonial legacy of anti-Indigenous racism is prevalent across Canada, including its healthcare systems, so many Indigenous people fear accessing healthcare services.34 One way to make healthcare more equitable and effective for Indigenous peoples is to incorporate their knowledge, beliefs, values, practices, medicines, and models of health and healing alongside those of western medicine in delivering healthcare. Known as “two eyed seeing,” this approach to healthcare sees from one eye with the strengths of Indigenous knowledge and ways o

Evidence for clinical interventions targeting the gut microbiome in cardiometabolic disease

Tarini Shankar Ghosh and Ana Maria Valdes evaluate the evidence for clinical effects of microbiome altering interventions on cardiometabolic traits ### Key messages Cardiometabolic diseases are one of the main causes of morbidity and mortality in western countries and are increasing in low and middle income countries.1 Dietary intake is one of the main determinants of cardiometabolic health1 and of microbiome composition.2 The gut microbiome is known to play an important part in the development of cardiometabolic diseases, including hypertension, diabetes, and obesity.2 This is thought to be linked with the ability of the gut microbiome to modulate inflammation, insulin sensitivity, and blood lipid levels, and is hypothesised to be mediated by specific microbially produced metabolites such as short chain fatty acids (SCFAs), secondary bile acids, phenylacetylglutamine, and trimethylamine-N-oxide.2 As well as their direct influence, gut microbes can also modulate the response of the