The complications associated with adult obesity are overwhelming national healthcare systems. No country has yet implemented a successful population-level strategy to reverse the rising trends of obesity. This article presents epidemiological data on the complications of adult obesity and discusses some of the challenges associated with managing this disease at a population and individual level.

Background The COVID-19 pandemic has drastically changed the delivery of secondary care services. Self-collection of capillary blood at home can facilitate the monitoring of patients with chronic disease to support virtual clinics while mitigating the risk of SARS-CoV-2 infection and transmission. Objective To investigate the comparability of whole blood capillary and plasma venous samples for 15 routinely used biochemical analytes and to develop and pilot a use-friendly home-collection kit to support virtual outpatient clinical services. Methods To investigate the comparability of whole blood capillary and plasma venous samples for 15 routinely requested biochemical analytes, simultaneous samples of venous and capillary blood were collected in EDTA and lithium-heparin plasma separation tubes that were of 4-6mL and 400-600µL draw volume, respectively. Venous samples were analysed within 4 hours of collection while capillary samples were kept at ambient temperature for 3 days until centrifugation and analysis. Analyte results that were comparable between the matrices were then piloted in a feasibility study in three outpatient clinical services. Results HbA1c, lipid profile and liver function tests were considered comparable and piloted in the patient feasibility study. The home-collect kit demonstrated good patient usability. Conclusion Home collection of capillary blood could be a clinically-useful tool to deliver virtual care to patients with chronic disease.

Obesity has reached epidemic levels in the United Kingdom. Obesity is associated with important gastrointestinal and hepatic complications which are common and can present sooner than cardiometabolic disease but often the underlying obesity remains untreated. Given that gastroenterologists and hepatologists will be at the forefront of obesity management we present an overview encompassing obesity pathophysiology, medical and surgical treatment options as well as the role of endobariatrics and the gut microbiome.

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2) by the stage of the second embryo (3) in women <38 (4) in women R38.RESULTS: 4,640 IVF cycles were analyzed. Patients with a DET were 2.5 years older than SET (P<0.01). In none of the analyses did transferring a second poor quality embryo negatively affect birth rate. In the primary analysis, transferring a second poor embryo increased live birth by 6% and the twin rate by 15%. Analyzing by stage, the addition of a poor quality blastocyst or early blastocyst markedly increased the twin rate by 22-27% with slight increases in live birth. The addition of a morula did not increase live birth but resulted in 12% more twins. In women <38, DET increased birth by 7% but resulted in 18% more twins. In women R 38, DET increased pregnancy by 9% with a 15% increase in twins.CONCLUSIONS: Addition of a poor quality embryo did not have a detrimental effect relative to transfer of a single high quality blastocyst. In patients <38 whom ASRM recommends SET, transferring a second poor quality embryo increases the risk of twins with minimal increase in live birth.