Fiscal policies to fight obesity such as taxation of unhealthy foods or sugar-sweetened beverages (SSBs) have gained considerable attention in recent years. Many studies modelling the impact of various magnitudes of taxes on SSB purchasing and their potential effects on various health outcomes have been published; however, legislation and implementation of such taxes have encountered many obstacles in the countries that have implemented them to date. We investigated the perceptions and views of key opinion leaders, policy makers and various other Israeli stakeholders on taxation of SSBs and unhealthy snacks. We also evaluated the challenges and barriers that may be expected for initiating such a policy. A qualitative study based on 39 in-depth interviews with Israeli stakeholders in the fields of health, nutrition, economics, public advocacy and policymaking. All stakeholders viewed obesity as a combined societal and personal issue that should be under government responsibility. Only stakeholders from economic sectors thought that taxation of SSBs and unhealthy snacks would reduce their consumption, while the prevailing notion among non-economists was that such a tax would not be acceptable because the higher price would not decrease consumption. Concerns were raised that the tax would mostly affect individuals from low socioeconomic backgrounds. Some of the stakeholders indicated that they would support such a tax only if its revenue would be directed to specific causes such as health-promoting plans. Potential barriers to taxation include: opposition of various sectors, technical and bureaucratic obstacles impeding tax implementation, difficulties in defining which products to tax, and opposition of the treasury to earmark tax revenue for health education. Taxation should be a part of a multipronged strategy rather than a sole measure for fighting obesity. Dedicating tax revenues to specific predefined causes should be considered, particularly towards health promotion activities, obesity treatment and prevention, education, and subsidies of healthy food.

Health-related quality of life (QoL) is a comprehensive, multidimensional construct encompassing physical and psychosocial wellbeing. Physicians frequently assess QoL as part of their decision making process without specifically asking their patients. This study examined the degree and predictors of concordance between physician and patient assessments of QoL among patients with diabetes in primary care and in multi-disciplinary diabetes clinics. Patients completed a questionnaire regarding overall and diabetes-specific QoL before entering their physician’s office. After the visit, the physician completed the same questionnaire in order to evaluate how he/she perceived that patient’s QoL. In addition, medical data relating to the patient’s health status were collected from the medical records. The concordance between patient-reported QoL and physician-estimated QoL was evaluated. Stepwise regression analysis was conducted to determine which factors contributed to the difference between physicians’ and patients’ assessment of QoL. A total of 136 patients and 39 treating physicians were surveyed. Patients’ response rate was 95%. A strong concordance was found between patients’ and physicians’ ratings of current health status (r = 0.79, p < 0. 01); however, physicians perceived their patients’ QoL as worse than the QoL assessed by the patients themselves. Primary care physicians were better at assessing their patients’ overall wellbeing while diabetes-specialists were better at assessing their patients’ diabetes-specific QoL. In addition, the longer the duration of diabetes, the more difficult is was for the physicians to accurately assess QoL. When entered in the regression analysis, familiarity did not explain physicians’ ability to assess health-related QoL or diabetes-specific QoL. Physicians make reasonable assessments of their patients’ QoL, however as the patients’ disease progresses, it becomes harder for physicians to assess QoL. Primary care physicians are better at assessing overall well-being whereas diabetes specialists are better at assessing diabetes-specific QoL. Not registered. Assuta Medical Center institutional review board approval number 2009103.

Diabetes mellitus poses major public health and economic challenges which necessitate national‐level intervention. The ultimate goal of the Israel National Diabetes Program is to ensure that all people with diabetes, or at high risk of developing diabetes, will live well and have access to high‐quality services that meet their individual needs. The integrated National Diabetes Program in Israel was established in 2014. Prevailing needs were identified and working groups assigned to delineate deficiencies and propose mode of action. Program leaders summarized and prioritized the needs, and identified main targets of action for the preliminary years. The program was achieved by a combined approach: top‐bottom, having the Director General of the Ministry of Health (MoH) personally involved, and bottom‐up, by routine meetings with representatives of the health organizations, clinical experts, patient representatives and other stakeholders. Main achievements during the first five years of the program included setting up a novel funding mechanism for diabetes prevention, substantiating the field of diabetes education in Israel, designing the infrastructure of diabetic foot care in Israel, updating the national health‐budget allocation formula with incentives to improve provision of services, and promoting a mandatory system for judgemental labelling of food products. The program is in progress with ongoing monitoring, evaluation and improvement with particular emphasis on translational learning. Although there is much to be done, diabetes care in Israel has taken an enormous step forward in the past five years.

Background Social media networks have been found to provide emotional, instrumental, and social support, which may contribute to improved adherence to postbariatric surgery care recommendations. Objectives This study aimed to evaluate the impact of an online social media-based, health care professional-led, educational and support program on patients' long-term engagement with and adherence to follow-up guidelines, self-care recommendations, and weight management after bariatric surgery. Methods An observational cohort study, employing mixed methods, accompanied a 12-week interactive, structured, social media psychoeducational intervention program delivered on Facebook. Program participants, who had undergone one bariatric surgery within the past 1 to 7 years and were at least 18 years old at the time of surgery, were invited to join the program via posts online. Interested individuals were provided information about the program and the accompanying evaluation study, and those who met requirements completed study questionnaires before and after the program. Questionnaires included demographic and anthropometric information; postoperative recommendations received and their clarity and implementation; attitudes toward recommendation adherence; and well-being. Daily system data on program engagement were collected from the Facebook website. Results Of the 214 participants enrolled in the program, 101 (80.2% female, mean age 43.8 ± 9.1 years and mean body mass index 30.2 ± 6.8 kg/m², 1–7 years after bariatric surgery) completed both baseline and end-of-program questionnaires and were included in the analysis. Following the program, improvements were observed in most aspects of participants' adherence to postoperative recommendations and well-being. Close to half of the participants (44.6%) reported reaching their postoperative target weight at the end of the program or maintaining it throughout the program. Video posts drew higher participant engagement than other media, and content about proteins received the highest number of reactions. However, participants' active engagement gradually declined over time. Conclusion Interactive health support on social media can positively enhance patient engagement, adherence to treatment recommendations, health outcomes, and overall well-being. The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was approved by the Sheba Medical Center Ethics Committee (approval number: 202019582, dated December 20, 2020). All data were anonymized prior to analysis. Completed questionnaires were stored in an encrypted folder on a secure server with restricted access at the institution of one of the researchers. ^* Equal contribution. Received: 26 March 2024 Accepted: 17 August 2024 Accepted Manuscript online: 20 August 2024 Article published online: 13 November 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Purpose People living with obesity are susceptible to weight gain during periods of extreme stress. Identifying modifiable risk factors is crucial in regions affected by frequent conflict. Methods We therefore sent a survey to patients followed in a weight management clinic shortly after the 2023 onset of the Israel-Hamas war. Results Responses (n = 285) were collected for analysis a median of 58 days (IQR 48–58) after the conflict erupted and compared between subjects who did and did not experience acute, significant weight gain (≥ 3%). Median age was 57 (IQR 46–67) and 66.5% were female. Baseline median BMI was 33.2 kg/m² (IQR 29.8–39.0), and 67.6% were taking anti-obesity medications (AOMs). Roughly two-thirds reported reduced sleep quality and increased stress or anxiety. Approximately half reported both reduced exercise and more anxiety-driven eating, whereas roughly 40% reported consuming more sweets or snacks, and these behaviors were associated with significant weight gain, experienced by 25.4% of respondents. According to multivariate analysis, anxiety-driven eating and less exercise were associated with weight gain (OR 4.48, p < 0.001 and OR = 2.50, p = 0.020, respectively), whereas AOMs were protective (OR = 0.39, p = 0.015). Conclusion Given that one quarter of subjects with overweight or obesity reported significant weight gain within two months of the outbreak of war, and that we identified modifiable risk factors, emphasis must be placed on maintaining healthy exercise and eating behaviors with consideration of AOMs. Level of evidence IV- cross-sectional retrospective study.

Background: Obesity is a heterogeneous chronic disease, yet it is still commonly defined and managed using body mass index alone. Identifying clinically meaningful subgroups may support more efficient, precise and practical care. Objective: To identify and characterize population-level heterogeneity among adults with obesity in a large Israeli healthcare cohort. Methods: In this cross-sectional study, we analyzed deidentified electronic health record data from the Leumit Obesity Registry. Adults with obesity who had at least one documented weight measurement and height or BMI record during 2024 were included. Demographic, socioeconomic, lifestyle, clinical, and treatment variables were analyzed using K-prototypes cluster analysis to identify subgroups within a mixed-data population. Results: The study included 68,203 adults with obesity. Five distinct patient clusters were identified: metabolically healthy young adults, 19% of the cohort; adults with low comorbidity, 18%; middle-aged adults with moderate comorbidity, 23%; multimorbid seniors with socioeconomic disadvantage, 24%; and higher socioeconomic status advanced age with high clinical burden, 16%. The clusters differed substantially in age, comorbidity burden, socioeconomic status, and obesity-treatment utilization. GLP-1 use was most common in the older multimorbid clusters, particularly among low SES. Dietitian use was lower in the oldest and sickest cluster, despite high disease burden. Bariatric surgery was overall relatively rare and was concentrated mainly in the younger clusters. Conclusions: Adults with obesity in this large population-based registry did not represent a single clinical group, but rather several distinct phenotypes with different clinical and treatment patterns. These findings support a shift toward more phenotype-informed obesity care and resource planning.