From the Stacks
There are literally thousands of journals published around the world that relate to the disability community. It is virtually impossible to capture even a fraction of them. HELEN receives "stacks" of journals and selectively earmarks what we feel are "must read" articles of interest for our readers. It's a HELEN perk.
Health Care Transition: Transitioning to Adult Health Care with Confidence
Curators of the University of Missouri
To help prepare youth and young adults with intellectual and developmental disabilities (ID/DD) for their health care transition, six toolkits were developed under the leadership of Family Voices, in collaboration with the LifeCourse Nexus, SPAN, and Got Transition. This project is supported by the Administration of Community Living, U.S. Department of Health and Human Services. For additional health care transition resources for youth and young adults with ID/DD, their families/caregivers, and clinicians and direct support workers, visit the Center for Transition to Adult Health Care for Youth with Disabilities.
Difficult, Challenging, and Worse Quality of Life: Health Care Professionals’ Beliefs about People with IDD
By Carli Friedman, CQL Director of Research
CQL The Council on Quality and Leadership ⎸ September 16, 2025
Health care professionals’ knowledge, beliefs, and attitudes contribute to the ways they provide services and supports to people with intellectual and developmental disabilities (IDD). It also has a significant impact on people with IDD’s outcomes, contributing to disparities among people with IDD. For these reasons, the aims of this study were to examine how health care professionals’ intersectional implicit attitudes about disability and race impact their beliefs about people with IDD. The second aim was to see if there are any differences in healthcare professionals’ intersecting implicit attitudes based on their demographics. To do so, I had 784 health care professionals take the Intersecting Disability and Race Attitudes Implicit Association Test (IDRA-IAT) and also answer questions about their beliefs about people with IDD.
There was a relationship between health care professionals’ implicit attitudes about disability and race, and their likelihood to believe that people with IDD are more difficult patients in health care, that people with IDD are more likely to exhibit challenging behaviors, and that people with IDD have a lower quality of life than nondisabled people. More specifically, the more health care professionals implicitly preferred nondisabled white people and nondisabled people of color, and the less they preferred disabled white people and disabled people of color, the more likely they were to think people with IDD are more difficult patients in health care. In addition, health care professionals were more likely to believe people with IDD are more likely to exhibit challenging behaviors when they implicitly favored nondisabled people and when they had negative implicit attitudes about disabled white people and disabled people of color. It was a bit different when it came to perceptions about quality of life. While more favorable attitudes about nondisabled white people were associated with health care professionals believing people with IDD have a worse quality of life, it was only their negative implicit attitudes towards disabled people of color, not disabled white people, that were associated with believing people with IDD have a worse quality of life.
In addition to examining the relationship between implicit attitudes and beliefs about people with IDD, I also examined if there were differences among health care professionals’ implicit attitudes. In doing so, I found differences based on occupational role, race, age, gender, education level, and family relationships with disabled people of color. Specifically,
Occupational role:
People in ‘other’ allied health professions had more positive attitudes about disabled white people than people in general medicine, but more negative attitudes about nondisabled people of color.
People in nursing had more negative attitudes about nondisabled people of color than people in general medicine.
People in personal care/support had more negative attitudes about nondisabled people of color than those in general medicine, but more positive attitudes about disabled people of color.
Race:
Asian health care professionals had more positive attitudes towards disabled people of color than health care professionals who were not Asian.
People from ‘other’ races had more negative attitudes towards nondisabled people of color.
Age:
As health care professionals’ ages increased, they were more likely to have positive attitudes about nondisabled white people and more likely to have negative attitudes about disabled people of color.
Gender:
Cisgender women had more negative attitudes about nondisabled white people than cisgender men, but they had more positive attitudes about disabled people of color.
Education level:
People with high school degrees had more positive attitudes about nondisabled white people and more negative attitudes about disabled people of color than those with graduate degrees.
People with Bachelors degrees had more negative attitudes about disabled white people than people with graduate degrees.
Family relationships:
Health care professionals who had close family that were disabled people of color had more positive attitudes about nondisabled people of color than health care professionals without these family relationships.
“Health care professionals’ biases impact how they treat and serve people with intellectual and developmental disabilities, as well as the outcomes of people with intellectual and developmental disabilities… Thus, intervening in health care professionals’ assumptions, stereotypes, and biases is critical for the health equity of people with intellectual and developmental disabilities. In this study, we found many of the assumptions health care professionals make about people with intellectual and developmental disabilities, which would likely go on to inform their interactions with people with intellectual and developmental disabilities and treatment decisions, were linked to their implicit attitudes not only about disability, but disability and race. The more we understand about how health care professionals’ biases work, the better equipped we are to work to improve these attitudes; intersectionality must be a cornerstone of doing so. Until we eradicate these biases, these biases will continue to threaten the health and quality of life of people with intellectual and developmental disabilities” (Friedman, 2025, p. 13).
NCI® Updates: Spring 2026
National Core Indicators- Aging and Disabilities
NCI ⎸ March 2026
HSRI and Advancing States are excited to annouce the release of the 2024-25 NCI-Aging and Disabilities Adult Consumer Survey National Report. NCI-AD is the most comprehensive source of data on older adults and people with physical disabilities using publicly funded supports. In 2024-25, we heard from over 2,000 people in 24 states, including individuals using HCBS waivers, nursing facilities, PACE, and Older Americans Act programs. Some key takeaways from the report are described below.
Access to community: 92% of respondents say they always have transportation to get to medical appointments, while 73% always have transportation to do things they want outside of the home. About 2 in 3 respondents (68%) take part in activities they like to do as much as they want.
Relationships: Nearly all respondents (95%) say they are always able to see or talk to friends or family when they want. At the same time, nearly 1 in 5 (17%) say they often feel lonely.
Health and Access to Health Care: The vast majority of respondents have access to healthy foods (89%), mental health services if they want them (89%), and physical exams/wellness visits in the past year (87%). Nevertheless, 2 in every 5 respondents (42%) went to the emergency room in the past year, and 1 in 4 (26%) stayed overnight in a hospital or rebab/nursing facility in the past year. Overall, just 14% describe their health as excellent or very good.
Workforce: As staffing shortages at provider agencies continue, many LTSS users report using family members to provide support. In fact, 2 in 5 people (40%) say that a paid family member or friend is the person who helps them most often. Further, 22% of respondents say that their paid staff change too often.
Services meet needs: The data suggest that publicly-funded services are making a positive difference, with 89% saying that services and supports help them live the life they want. However, there is still some room for improvement, as 3 in 4 people surveyed (72%) say that their services meet all needs and goals, and among those with unmet needs, just over half (55%) say their case manager talked with them about services to help with unmet needs.
NCI State of the Workforce AD 2024 Report
National Core Indicators- Aging and Disabilities
NCI ⎸ April 2026
HSRI and ADvancing States are excited to announce the release of the NCI State of the Workforce for AD 2024 report. The NCI State of the Workforce for AD is a one-of-a-kind report on provider agencies and the Direct Service Worker (DSW) workforce providing direct support to the AD population.
In 2024, we collected data from 966 provider agencies representing 100,631 DSWs in 7 states (Illinois, Indiana, Missouri, Nebraska, New Hampshire, North Dakota, Oklahoma). Some key takeaways include:
Across the nation, the median hourly wage for DSWs is $16.00. This is unchanged from the 2023 report. Of note, no state has median DSW wages that are above living wage for a single adult, emphasizing the importance of continued efforts to increase wages.
The weighted average turnover ratio was 45%. Among DSWs who left their employer in 2024, 70% had been employed for less than one year. These early separations point to the importance of benefits, recruitment, and retention strategies.
Fewer than half of agencies offered paid time off to some or all DSWs (49%), and only 37% offered health insurance to their DSWs. These numbers are notably lower than IDD provider agencies in 2024: 70% of IDD agencies offered paid time off and 57% offered health insurance to DSPs.
Overall, 18% of agencies reported turning away or stopping accepting new service referrals due to staffing issues. This is down from 29% in 2023 rates, and of the three states that participated in the 2023 State of the Workforce for AD, all experienced decreases.
The report also details recruitment and retention strategies in which provider agencies in participating states are engaged such as realistic job previews, apprenticeship programs, training and credentials, bonuses, and more.
Lived Experience Is Expertise: Why Patient Voices Belong in Healthcare Education
Tameka Simmons
Social Health Network⏐April 15, 2026
I didn’t enter the healthcare world with a degree, a title, or a plan to become an advocate. I entered it as a mother trying to understand what was happening to her child.
When my daughter's medical journey began, I found myself in a world I knew nothing about. Suddenly there were specialists, medical terminology, complex care plans, and decisions that felt impossibly heavy. Like many caregivers of children with rare and complex medical needs, I quickly realized that surviving this journey meant learning fast.
What started as a desperate search for answers slowly became something more
Over time, I learned how to read medical charts and ask better questions during appointments. I learned how to research conditions, understand treatment options, and track patterns in my daughter’s health. I learned how to advocate when something didn’t feel right and how to ensure her voice was represented in rooms where she could not speak for herself.
Somewhere along the way, something shifted
I stopped seeing myself as someone simply trying to keep up with the medical system. I realized I had become an essential part of my daughter’s care team.
The truth is that caregivers and patients often gain a depth of understanding that cannot be taught in a classroom. We see the day-to-day reality of living with illness. We notice the small changes that don’t always show up in medical exams. We experience firsthand the gaps in systems, the emotional toll of navigating healthcare, and the ways support can make all the difference.
For many families, this lived experience becomes a form of expertise
For years, though, patient and caregiver voices were often invited into conversations only as “stories.” While storytelling is powerful, our experiences also carry insight. They reveal how healthcare systems function in the real world and what families actually need to feel supported.
This is why patient leadership matters
When healthcare organizations invite patients and caregivers to share their perspectives in education, advocacy, and policy spaces, healthcare becomes more collaborative. Clinicians gain insight into the lived realities of the people they care for. Systems become more responsive to the needs of the communities they serve.
I may not have entered the healthcare world with credentials, but a decade of caregiving gave me something just as powerful. It gave me lived experience, determination, and a deep understanding of what families truly need.
That realization is what eventually led me into advocacy.
Through my work with my nonprofit organization, Through Evely’s Eyes, I have had the privilege of connecting with many families navigating rare disease and complex medical journeys. Again and again, I hear the same theme: parents who never expected to become advocates are suddenly navigating insurance systems, coordinating care across multiple specialists, and educating others about their child’s condition.
These families are experts in ways that are rarely recognized.
Patient leaders are innovators, problem-solvers, and educators
They build communities so other families do not have to walk this road alone. They use their voices to push for better understanding, better care, and more inclusive support systems.
Patient leadership doesn't replace medical expertise, but it does strengthen healthcare by including the voices of those who live within it every day.
When clinicians, researchers, and advocates listen to patient perspectives, they gain insight that textbooks alone simply cannot provide. They gain a deeper understanding of the human side of medicine. They get to see the part that shapes how care is experienced beyond diagnoses and treatment plans.
For those who are just beginning their advocacy journey, I want to offer this encouragement: your lived experience matters.
You do not need a formal title to have a voice
The lessons you learn through caregiving or living with illness hold value. Your perspective can help improve understanding, build community, and influence how healthcare evolves.
Sometimes advocacy begins in the quietest moments. Whether a question asked in an appointment, a story shared with another parent, or a voice raised to ensure someone is heard.
Over time, those moments grow into something bigger.
And when patient voices are welcomed into healthcare conversations, they don’t just share stories.
They help shape the future of care.
Parents of Kids with Neurodevelopmental Disorders May be at Increased Risk of Cardiovascular Disease
Jennifer Henderson
MedPage Today ⎸ April 13, 2026
“Parents of kids with neurodevelopmental disorders may be at increased risk of cardiovascular disease, a national cohort study from Sweden suggested.” Investigators found that “compared with parents whose children didn’t have a neurodevelopmental disorder, those who did had an increased risk of any cardiovascular disease over a mean follow up of 16 years (hazard ratio [HR] 1.27, 95% CI 1.25-1.29 for mothers and HR 1.20, 95% CI 1.18-1.22 for fathers).” The risk increased “with the number of affected children, with HRs among mothers of 1, 2, or 3 children at 1.22, 1.39, and 1.66, respectively, and among fathers 1.16, 1.33, and 1.50.”
Study Demonstrates the Impact of Traumatic Brain Injury in Children Extends Beyond Initial Injury
NationWide Children’s ⎸ April 13, 2026
(COLUMBUS, Ohio) – A new study, published today in JAMA Network Open, reveals that school-age children and adolescents with medically diagnosed traumatic brain injury (TBI) have significantly higher rates of anxiety/depression, and strong family support and resilience helps alleviate some of it.
Researchers at the Center for Injury Research and Policy of the Abigail Wexner Research Institute at Nationwide Children’s Hospital, The Ohio State University, and University of Washington analyzed associations between medically diagnosed TBI and mental (anxiety and depression) and physical (frequent headaches and chronic pain) health outcomes among U.S. children and teens aged 6-17 years and evaluated whether these associations varied by level of family resilience. They found that children and teens with TBI had a significantly higher prevalence of poor health than those without TBI, along with increased odds of current anxiety, frequent headaches and chronic pain.
“Our study shows that the impact of traumatic brain injury in children often extends well beyond the initial injury,” said Henry Xiang, MD, MPH, PhD, MBA, principal investigator in the Center for Injury Research and Policy and senior author of the study. “Children who experience TBI face increased risks of mental health challenges such as anxiety and depression, highlighting the importance of routine mental health screening and long-term follow-up care.”
The study also found that family resilience was associated with decreased odds of depression after TBI. Family resilience describes how families respond to stress, communicate effectively, and mobilize collective strengths when facing crisis or major family events. “One of the most encouraging findings from our research is that family resilience appears to play an important role in a TBI patient’s recovery,” said Xiang. “Children recovering from traumatic brain injury who grow up in supportive families may have lower risks of long-term mental health problems. Strengthening family support systems and resilience may be an important pathway to improving TBI patients’ long-term outcomes.”
These findings underscore the importance of strategies families can use to build resilience during recovery.
“Recovery following brain injury in children is about so much more than the child themselves – recovery happens in many contexts with many people, with home and primary caregivers being some of the most important,” said Christine Koterba, PhD, ABPP, pediatric neuropsychologist at Nationwide Children’s, who was not involved in this study. “I see how recovery actually happens outside the brain, in environments where children spend their time surrounded by the steady caregivers in their lives. This study opens the door for future research focused on caregiver resilience.”
This cross-sectional study used data from the 2022 and 2023 National Survey of Children’s Health (NSCH), a nationally representative, cross-sectional survey conducted by the U.S. Census Bureau and sponsored by the Health Resources and Services Administration Maternal and Child Health Bureau. The NSCH collects caregiver-reported data on health and well-being, health care access, family environments, and social determinants of health for children and adolescents aged 0 to 17 years across all 50 states and the District of Columbia.
The Center for Injury Research and Policy (CIRP) of the Abigail Wexner Research Institute at Nationwide Children’s Hospital works globally to reduce injury-related pediatric death and disabilities. With innovative research at its core, CIRP works to continually improve the scientific understanding of the epidemiology, biomechanics, prevention, acute treatment, and rehabilitation of injuries. CIRP serves as a pioneer by translating cutting edge injury research into education, policy, and advances in clinical care. For related injury prevention materials or to learn more about CIRP, visit www.injurycenter.org. Follow CIRP on Instagram @CIRPatNCH.
About The Abigail Wexner Research Institute at Nationwide Children’s Hospital
Named to the Top 10 Honor Roll on U.S. News & World Report’s 2025-26 list of “Best Children’s Hospitals,” Nationwide Children’s Hospital is one of America’s largest not-for-profit free-standing pediatric health care systems providing unique expertise in pediatric population health, behavioral health, genomics and health equity as the next frontiers in pediatric medicine, leading to best outcomes for the health of the whole child. Integrated clinical and research programs are part of what allows Nationwide Children’s to advance its unique model of care. As home to the Department of Pediatrics of The Ohio State University College of Medicine, Nationwide Children’s faculty train the next generation of pediatricians, scientists and pediatric specialists. The Abigail Wexner Research Institute at Nationwide Children’s Hospital is one of the Top 10 National Institutes of Health-funded free-standing pediatric research facilities in the U.S., supporting basic, clinical, translational, behavioral and population health research. The AWRI is comprised of multidisciplinary Centers of Emphasis paired with advanced infrastructure supporting capabilities such as technology commercialization for discoveries; gene- and cell-based therapies; and genome sequencing and analysis. More information is available at NationwideChildrens.org/Research.
The Role of Physical Activity in the Prevention and Management of Obesity: A Position Statement From the World Obesity Federation
Zoe Gowers, Bai Li, Santi F. Gómez, Angela Jackson-Morris, Mychelle Farmer, Rachel Thompson, Kent Buse
World Obesity ⎸ April 6, 2026
ABSTRACT
This position statement is intended to synthesize and interpret current consensus and salient developments regarding the relationship between obesity and physical activity. It draws from the latest evidence and guidelines to update and share the World Obesity Federation's stance with policymakers, healthcare professionals, public health stakeholders, and civil society organizations. This statement identifies the critical role of physical activity in the prevention and management of obesity, highlights the lived experience of people with obesity, summarizes global recommendations, and considers the emerging connections between obesity, climate change, and physical activity.
Box 1: Methods and Limitations
This position statement is intended to synthesize and interpret current consensus and salient developments rather than provide a systematic review of the literature. We therefore used a targeted search and expert consultation approach to update the World Obesity Federation‘s stance. Between June 2025 and September 2025, we searched PubMed/Medline and Google Scholar and screened recent guidance from international public-health bodies for terms related to physical activity, obesity prevention/management, implementation, equity, and climate co-benefits. We prioritized high quality syntheses and guidelines (e.g., umbrella reviews, consensus statements), recent primary studies with policy relevance, and low- and middle- income country (LMIC) relevant examples. References were supplemented through citation chasing and consultation with four subject-matter experts (clinical, public-health, implementation). Inclusion was based on relevance, recency (typically ≥ 2018), and applicability to policy and practice; no formal risk-of-bias assessment was undertaken. We share this method‘s limitations (risk of omission and selection bias).
Based on the latest evidence and guidelines, this statement outlines the critical role of physical activity in the prevention and management of obesity. Intended for policymakers, healthcare professionals, and public health stakeholders, the statement also highlights the lived experiences of people with obesity, summarizes global recommendations, and considers the emerging connections between obesity, climate change, and physical activity.
Physical activity is defined as “any bodily movement produced by skeletal muscles that requires energy expenditure” [1].
For the purposes of this statement, the term “physical activity” will be used to encompass all domains of movement. This includes physical activity undertaken for any purpose including transport, occupation, and leisure. Sport and exercise are terms typically used to describe structured, purposeful activities; for example, practicing martial arts, lifting weights in a gym, or playing football [1]. Physical activity for leisure is a broader term that encompasses sport and exercise activities but also everyday activities such as walking, climbing stairs, housework, and gardening.
1 The Systemic Drivers of Obesity
Obesity is a multifactorial chronic disease caused by the complex interplay of biological, genetic, psychological, sociocultural, economic, and environmental factors. Yet the view that obesity is simply a lack of individual willpower to “eat less, move more” persists, contributing to the stigma experienced by people living with obesity.
This false and pervasive narrative is shaped in part by the well-documented tactics of transnational food and beverage corporations, who seek to divert attention away from the root causes of obesity and align their brands with sport and health. It is no coincidence that McDonald's and Coca-Cola are long-standing sponsors of the Olympic Games. Such practices promote multiple misconceptions and exemplify the influence of the commercial determinants of health on obesity narratives [2].
The World Obesity Federation (World Obesity) seeks to shift the narrative from individual blame and responsibility. Dietary and physical activity behaviors are strongly influenced by commercial, societal and environmental determinants, including structural inequities, that limit access to healthy food and safe and supportive spaces for physical activity [3]. The systemic drivers of obesity and physical inactivity are the starting point for this position statement.
2 Physical Activity: The Benefits
Regular physical activity contributes to both prevention and management of obesity [4], and produces diverse health benefits. Physical activity is associated with lower mortality in adults with obesity [5]. Early promotion of physical activity is an important strategy in obesity prevention, given that children with obesity are approximately five times more likely to become adults with obesity [6]. Evidence indicates that adherence to recommended activity guidelines during childhood may improve body mass and body composition in school-age children and adolescents with overweight or obesity [7]. While there is evidence that higher levels of more intense physical activity are associated with attenuated weight gain in adults [8] and in reducing visceral adipose tissue, nonetheless, the effect of physical activity on weight loss has been found to be modest without concurrent calorie restrictions [9]. Moreover, owing to the complex nature of obesity as a chronic relapsing disease with multifactorial origins, sustained weight loss at the population level requires coordinated, multisectoral action to address environmental influences and provide appropriate support and treatment [10].
Physical activity is a critical component of obesity interventions due to its wide-ranging benefits for overall health. Moreover, given that obesity commonly coexists with, and contributes to the onset of many non-communicable diseases (NCDs), physical activity has a dual role (“win win”) in both prevention and long-term management of NCDs [11]. The physiological benefits of regular physical activity include reduced blood pressure, triglyceride levels, and blood glucose, and improved HDL cholesterol levels [12], while additionally improving musculoskeletal and organ function, enhancing insulin sensitivity, and regulating inflammation [13]. Physical activity benefits mental health—reducing depression and anxiety symptoms, preventing cognitive decline, and enhancing overall mood [14].
New weight-loss therapies such as GLP-1 receptor agonist medications have emerged on the global market. These treatments have shown significant efficacy, and a global guideline by the World Health Organization (WHO) recommending these medications for long term treatment of adults living with obesity was released in December 2025 [15]. Yet, alongside the need for more equitable access, physiological issues include rapid weight gain on terminating treatment, and evidence suggests these medications may also engender muscle loss. Research therefore recommends that all patients receiving these medications participate in comprehensive treatment programs, with physical activity—particularly resistance training to minimize muscle mass loss, alongside dietary support [16].
3 Global Physical Activity Recommendations
The global target for physical activity is for a relative reduction in the prevalence of physical inactivity among adults and adolescents of 15% by 2030 from the 2010 year baseline [3]. However, updated estimates show that global levels of insufficient physical activity increased from 26.4% in 2010 to 31.3% in 2022, making the target unlikely to be achieved if current trends persist [17].
WHO recommends that all children and adults engage in regular physical activity, emphasizing that any activity is better than none. Most age groups are advised to do at least 150–300 min of moderate-intensity aerobic physical activity throughout the week, with activity below this threshold considered insufficient [11]. However, engagement in all levels of physical activity is encouraged, recognizing some individuals may have limited ability or opportunity for more intensive activity, and that there are some benefits associated with light-intensity physical activities such as slow walking. This aligns well with the 24-h movement paradigm, which considers how time is compositionally allocated across sleep, sedentary behavior, and all intensities of physical activity within a 24-h day [18]. In contrast, it is recommended that sedentary behavior, such as sitting or lying down, should be limited [11].
4 Recommendations for Governments
Addressing physical inactivity at a population level necessitates coordinated, multisectoral policy and systemic interventions [19]. Since the publication of the Global Action Plan on Physical Activity (GAPPA) 2018–2030 [3], WHO has led efforts to reduce physical inactivity through strategic, system-level policy guidance for countries and technical support. The Global Status Report on Physical Activity identified limited, inconsistent progress and highlighted the need for enhanced implementation and investment in physical activity [1]. To catalyze action, the WHO Acceleration Plan to Stop Obesity [20] positioned physical activity as a core prevention strategy, while the WHO Best Buys [21] reaffirmed physical activity as a cost-effective intervention to reduce NCDs, recommending approaches such as community campaigns, school-based programs, and urban (re)design.
These WHO policy guidelines are grounded in the four strategic GAPPA objectives [3], which the World Obesity Federation supports and promotes in policy and practice:
Active societies: Building public awareness and shifting social norms toward valuing physical activity. Key actions include promoting the co-benefits of physical activity (mental health, social connection), organizing mass participation events, and building workforce capacity to support these goals.
Active environments: Creating safe and inclusive spaces for activity. This includes expanding access to public open spaces, as well as developing walking and cycling networks.
Active people: Supporting inclusive participation through programs that cater to all ages and abilities. Physical activity should be embedded into school curricula, workplace wellness initiatives, services for older adults and health care delivery.
Active systems: Strengthening governance, advocacy, data systems, research capacity and sustainable financing to support implementation and accountability.
5 Equitable Access to Physical Activity Opportunities
There are clear disparities in who benefits from physical activity policies and programs [22]. Barriers such as cost, availability, and cultural norms must be addressed. Globally, women are less physically active than men—in 2022, there was a 5% gap [17]. The gendered physical inactivity gap, which mirrors the gender gap in obesity, persists for various reasons, which vary with context, but are often linked to gender norms that prescribe women's caregiving roles, reducing their time and energy for physical activity; safety concerns in public spaces; lack of culturally appropriate facilities or clothing options; lower levels of encouragement or access to sports in youth; and lack of menstrual hygiene options [23]. Gender-responsive policies are required to reverse this inequity.
People living with disabilities are significantly less likely to meet recommended physical activity guidelines, even though they face elevated risks for health conditions associated with inactivity. Barriers to physical activity for these individuals may include physical and mental fatigue, limited social support, and constraints related to the accessibility and availability of suitable activities. Efforts to reduce physical inactivity for this population are often left to individual health care providers because of specialty needs. Policies must adopt a population-wide approach that is more inclusive and addresses the economic, political, and social determinants limiting access to physical activity for people with disabilities [24].
Additionally, individuals from lower socioeconomic groups can face reduced access to safe, affordable opportunities for physical activity. Targeted strategies, supported by appropriate resourcing and informed by community needs, are required to ensure that physical activity policies benefit all population groups and are capable of eliminating the current inequities [25].
To ensure no one is left behind, policies, programs, and investments must target diverse populations. Regulatory interventions that target environments and take the emphasis off individual responsibility for lack of physical activity provide an important tool to address inequities related to physical activity (see Section 6).
Box 2: Examples of Regulatory Policies to Promote Physical Activity
China introduced nationwide, multi-sectoral regulations in 2021 aiming to promote physical activity among children and young people by limiting excessive time spent on sedentary activities. The regulations included: (1) the amount of homework schools can assign; (2) when (and for how long) online gaming businesses can provide access to young people; and (3) when tutoring businesses can provide lessons. A natural experiment evaluation using longitudinal data found that 1 month following implementation, pupils had reduced mean daily sedentary behavior time by almost 1 h per day [26]. A large qualitative (unpublished) evaluation of the regulations (n = 103) indicated that the regulations provided Chinese pupils with more time and opportunities for free play and structured sport or exercise—a benefit reported by pupils, parents, carers, and school teachers [27].
Spain recently launched a national strategy for the promotion of sport against sedentary lifestyle and physical inactivity (2025–2030). Aligned with this, the regional government of Catalonia is investing in prescribing physical activity to patients seen in primary health care level. Physical activity specialists will support patients to take up appropriate indoor and outdoor physical activity opportunities [28].
Colombia: Bogotá municipal government passed a legally binding decree closing streets to motorized vehicles, thereby open exclusively for pedestrians, cyclists, and recreation. The “Ciclovia” mandates weekly closure of over 120 km of major city streets every Sunday and public holidays. It is enforced by barricades to prevent vehicular traffic and traffic police, and health and sports departments organize structured physical activities. A 2021 study estimates that between 600,000 and 1,750,000 people participate on a given Sunday, approximately 30% of whom are overweight. The program also attracts high participation from women and from people in lower-to-middle socioeconomic groups, who globally have the highest rates of insufficient physical activity [29].
6 Planetary Health, Obesity, and Physical Activity
Obesity, physical inactivity, and climate change share common systemic drivers and solutions. Increasing global temperatures are discouraging outdoor physical activity, which may contribute to increased obesity rates [30]. At the same time, the socio-ecological determinants of physical activity levels, such as urban planning, transportation systems, and land use, are themselves contributors to climate change.
By 2050, it is predicted that 68% of the world's population will live in urban areas [31]. Increased urbanization contributes to loss of green open space for physical activity [32]—a phenomenon underway for decades and accelerating in many LMICs and low-income communities worldwide. Too often weak regulations and a failure of urban planning to reflect the societal value of public parks and community open spaces restrict opportunities for physical activity [33]. There is also evidence that air pollution (actual and perceived) and heavy traffic (road safety concerns) are barriers to physical activity and play among children [34]. Urban environments that prioritize walking, cycling, and public transport over car use can have several co-benefits: to increase daily movement, reduce overweight, and reduce greenhouse gas emissions [35].
Challenging corporate interests that undermine access to physical activity is also part of the planetary health solution [36]. For example, urban development companies may prioritize or lobby policymakers to accept low-cost construction options instead of creating homes and environments that promote physical activity. Also, the automotive industry lobbies for and promotes electric vehicles as the primary climate mitigation strategy, diverting attention away from other modes of travel that promote physical activity, such as walking, cycling, rail, and trams [36, 37].
7 Physical Activity and People Living With Obesity
People living with obesity can face physical, psychological, and social barriers to physical activity, including pain, mobility limitations [38], low fitness levels, stigma, and self-consciousness, which can reduce motivation and participation levels. Successful physical activity promotion requires the activity to align with individual preferences and capabilities. Low-impact, accessible options like walking are often favored and programs should be adapted in intensity, duration, and type to suit people living with obesity [39].
Supportive environments and mindset shifts are needed. Reducing weight stigma, promoting the mental and physical benefits of physical activity and fostering positive, inclusive spaces can help improve commitment and enjoyment [40]. For people living with obesity and other NCDs, physical activity can be prescribed within primary health care (see the Spain example above) [41].
8 In Summary, the World Obesity Federation Takes the Position That
Physical activity is essential to prevent and manage obesity and reduce the risk of other NCDs, such as type 2 diabetes, cardiovascular disease, and various cancers. Regular activity also contributes to improved mental health, cognitive function, and overall well-being.
More countries need to implement the WHO recommendation that all individuals should engage in regular physical activity (with age and health status adaptations). Governments are recommended to more consistently apply global frameworks for multi-sectoral, systemic approaches to promote physical activity to enable coordinated, adequately resourced, prioritized, and equity-oriented physical activity policy interventions.
At country level, integrated planning for physical activity and climate-related interventions can generate co-benefits for public and planetary health, thereby contributing to reducing obesity and carbon emissions.
Acknowledgments
Johanna Ralston, CEO, World Obesity Federation (WOF), and the wider members of the WOF Policy and Prevention Committee, for their review and comments.
Brain Study Reveals Hidden Link Between Autism and ADHD
Patricia Segura, Marco Pagani, Somer L. Bishop, Phoebe Thomson, Stan Colcombe, Ting Xu, Zekiel Z. Factor, Emily C. Hector, So Hyun Kim, Michael V. Lombardo, Alessandro Gozzi, Xavier F. Castellanos, Catherine Lord, Michael P. Milham, Adriana Di Martino
The Child Mind Institute ⎸ April 9, 2026
A study published in Molecular Psychiatry suggests that autism and ADHD may be connected at a biological level in ways that go beyond traditional diagnostic labels. While it is well known that the two conditions often occur together, the underlying mechanisms they may share have remained unclear.
Researchers from the Child Mind Institute and partner institutions found that the severity of autism-related symptoms, rather than whether a child is formally diagnosed with autism or ADHD, is linked to specific patterns of brain connectivity and gene activity. These patterns appeared in children diagnosed with either autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD). The findings add to a growing shift in research that focuses on understanding neurodevelopmental conditions along a spectrum rather than as separate categories.
Brain Connectivity Patterns Linked to Autism Traits
The study was led by Adriana Di Martino, MD, Founding Director of the Autism Center at the Child Mind Institute and Senior Research Scientist. The team analyzed brain connectivity using resting-state functional MRI in 166 verbal children ages 6-12 diagnosed with autism or ADHD (without autism).
Children with more pronounced autism symptoms showed stronger connections between key brain networks, including the frontoparietal (FP) and default-mode (DM) systems. These networks play an important role in social thinking and executive function.
In typical development, connections between these networks tend to decrease over time, allowing the brain to specialize. However, the study found that this reduction may not occur in the same way in children with more severe autism traits, pointing to differences in how the brain matures. Notably, these patterns were seen regardless of whether a child had an autism or ADHD diagnosis.
Shared Genetic Signals Across Conditions
The researchers also found that these brain connectivity patterns align with regions of gene expression linked to neural development. Many of these genes have previously been associated with both autism and ADHD. This overlap suggests that similar biological processes may contribute to traits seen across both conditions.
"We see in the clinic that some children with ADHD share symptoms qualitatively similar to those observed in autism, even if they do not fully meet the diagnostic criteria for ASD," says Dr. Adriana Di Martino. "By focusing on shared brain-gene expression patterns linked to autism symptoms across both ASD and ADHD, we can point towards a shared biological basis of these clinical observations. Our findings provide a more nuanced, dimensional understanding of neurodevelopmental conditions."
Advanced Methods Reveal Brain and Gene Overlap
To uncover these connections, the team used an integrative approach that combined advanced brain imaging with in silico spatial transcriptomic analysis -- a computational technique that compares brain connectivity data with maps of gene activity across the brain. This method allowed researchers to directly link patterns of neural communication with underlying genetic expression.
Such approaches could help identify biological markers, or biomarkers, that improve how these conditions are recognized and studied in the future.
Key Findings From the Study:
Autism symptom severity is linked to similar brain connectivity patterns in children with ASD and in some children with ADHD who do not have an autism diagnosis
Differences in connectivity correspond with regions where genes involved in brain development are active
Shared clinical traits between autism and ADHD are associated with overlapping genetic mechanisms
Brain network maturation processes may play a key role in the development of autism-related symptoms in both groups
The findings support using both dimensional and categorical models to understand neurodevelopmental conditions
The research may guide future efforts to identify biomarkers and better understand vulnerability to autism traits
Implications for Diagnosis and Treatment
These findings highlight the value of focusing on specific symptoms and their biological basis rather than relying only on diagnostic categories. This approach could lead to more personalized strategies for identifying and treating neurodevelopmental conditions based on each individual's brain profile.
The study also supports a broader shift in psychiatry toward dimensional and data-driven frameworks that cut across traditional diagnoses. Initiatives such as the Child Mind Institute’s Healthy Brain Network reflect this direction by providing large-scale brain imaging and behavioral data, along with free diagnostic evaluations for families.
Together, these efforts may help reshape how autism and ADHD are understood, moving toward a more precise and biologically informed model of care.
Prioritizing Health Disparities in Medical Education to Improve Care
Temitope Awosogba, Joseph R Betancourt, F Garrett Conyers, Estela S Estapé, Fritz Francois, Sabrina J Gard, Arthur Kaufman, Mitchell R Lunn, Marc A Nivet, Joel D Oppenheim, Claire Pomeroy, Howa Yeung
PubMed ⎸ May 9, 2013
Abstract
Despite yearly advances in life-saving and preventive medicine, as well as strategic approaches by governmental and social agencies and groups, significant disparities remain in health, health quality, and access to health care within the United States. The determinants of these disparities include baseline health status, race and ethnicity, culture, gender identity and expression, socioeconomic status, region or geography, sexual orientation, and age. In order to renew the commitment of the medical community to address health disparities, particularly at the medical school level, we must remind ourselves of the roles of doctors and medical schools as the gatekeepers and the value setters for medicine. Within those roles are responsibilities toward the social mission of working to eliminate health disparities. This effort will require partnerships with communities as well as with academic centers to actively develop and to implement diversity and inclusion strategies. Besides improving the diversity of trainees in the pipeline, access to health care can be improved, and awareness can be raised regarding population-based health inequalities.
Introduction
Individual Americans—subject to a large number of social, cultural, economic, or geographical factors influencing their health—may find themselves in vastly different situations with regard to health outcomes and health care. For example, according to a 2011 U.S. Department of Health and Human Services report, the percentage of Americans with two or more chronic health conditions correlates strongly with poverty level, and this correlation is growing. While income inequities are responsible for much of the health disparities in the United States, there are many other factors, of which only some can be readily explained. An African American child is more likely to develop asthma than a white child within the same income bracket. While obesity does not show much correlation with the highest education obtained by an individual, childhood obesity is strongly correlated with the highest education obtained by the head of the household. At any income level, Hispanic and Asian Americans are less likely to have health insurance than African Americans or non-Hispanic whites. The distribution of doctors across the United States is far from uniform: whereas there are 40 doctors for every 10,000 people in Massachusetts, there are 17 in Idaho.
The conference “Prioritizing Health Disparities in Medical Education to Improve Care”, held on October 2, 2012, convened medical school faculty and administrators, educators, and students to discuss how to create real solutions at the level of medical schools. In his introductory remarks, Fitzhugh Mullan (the George Washington University) recounted the roots of the struggle against health disparities during the civil rights movement of the 1960s, and how academic study of health disparity finally attained legitimacy with the publication of the Institute of Medicine’s 2003 report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
Medical schools have long operated on the bases of research, education, and patient care. Each of these pillars suggests an ethical imperative for universities to actively pursue the social mission of disparities reduction. According to Mullan, this social mission would include mainstreaming diversity, assessing graduates’ goals and career development (with an eye toward underserved communities), advancing access to care, and raising awareness of health disparities. Two distinct but complementary tactics were highlighted by numerous speakers: a process of increasing communication, outreach, and, ultimately, aligning the needs of the community with the resources of the university; and new initiatives not only to increase the numbers of underrepresented minorities entering medical education, but also to encourage those that have to stay within academic spheres of medicine.
Recognizing and Addressing Loneliness in Autistic Seniors
Haley Johannpeter
Autism Spectrum News ⎸ January 5, 2026
Loneliness is a challenge many seniors face, but for autistic seniors, it can manifest differently and have unique consequences. Understanding these nuances is key to providing effective support and improving quality of life.
Loneliness in Autistic Seniors
Autistic individuals often experience social interactions differently from neurotypical peers. For seniors on the spectrum, the social networks they relied on earlier in life may shrink due to retirement, health issues, or the loss of loved ones. This can increase isolation, particularly if they rely on structured routines and familiar environments.
Loneliness in autistic seniors isn’t always visible. While some may openly express sadness or frustration, others might appear content but quietly struggle with disconnection. Sensory sensitivities or communication differences can make traditional social activities overwhelming, further limiting engagement.
Signs That Loneliness May Be Affecting an Autistic Senior
Recognizing loneliness in autistic seniors may require looking beyond typical signs:
Withdrawal from Preferred Activities: A senior may stop engaging in hobbies or routines they once enjoyed, especially if those activities involve social interaction.
Changes in Routine or Behavior: Unexpected shifts in sleep, eating habits, or daily structure can indicate emotional stress.
Increased Anxiety or Irritability: Heightened stress, agitation, or overreaction may signal that social needs are unmet.
Difficulty Communicating Needs: Autistic seniors may struggle to articulate feelings of loneliness directly, instead showing it through subtle behavioral cues.
Reliance on Familiar Environments: While seeking comfort in routines is common, rigidly avoiding new experiences may indicate fear of social judgment or anxiety.
Practical Ways to Support Autistic Seniors
Regular socialization, even in small or structured ways, can play a key role in preventing loneliness and supporting emotional well-being for autistic seniors. Providing opportunities for connection that respect their routines, and sensory preferences can make a meaningful difference.
Maintain Consistent Social Contact: Regular phone calls, video chats, or socially distanced visits provide stability and reassurance. Even brief interactions can reduce feelings of isolation.
Offer Structured Opportunities for Engagement: Activities that follow clear routines, like weekly group games or online interest-based clubs, can make socializing less stressful.
Respect Sensory Needs: Loud, crowded, or unfamiliar environments can be overwhelming. Providing quiet spaces or controlled sensory experiences encourages participation without stress.
Encourage Purposeful Connections: Volunteering, mentoring, or contributing to projects aligned with personal interests can foster meaningful engagement.
Use Communication Tools: Visual supports like visual schedules, written instructions, or digital platforms may help seniors express their needs and connect with others.
Encouraging Autonomy While Reducing Isolation
It’s important to balance support with respect for autonomy. Encourage seniors to make choices about their social interactions and activities. Ask their preferences, listen to feedback, and collaborate on solutions. Even small acts of agency—choosing a group activity, scheduling a call, or exploring a hobby—can significantly improve emotional well-being.
Promoting Positivity and Support: What Helps Today
Loneliness in autistic seniors is often overlooked, yet it can profoundly affect mental and physical health. By recognizing subtle signs and providing tailored support, caregivers, family members, and community programs can help autistic seniors maintain meaningful connections, preserve routines, and live fulfilling lives.
Supporting autistic seniors is not just about preventing loneliness, it’s about honoring their unique ways of experiencing the world while ensuring they feel seen, valued, and connected.