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The Global Obesity Landscape: Not a Uniform EpidemicA continuing rise in obesity around the world is not inevitable, research suggests, with rates in some countries levelling off or potentially in decline. Researchers say focusing on what has been described as a global epidemic of obesity hides large variations in trends across different countries, sexes and age groups.Majid Ezzati, a professor of global environmental health at Imperial College London and author of the study, said: "I think the thing that's really important is this diversity exists even across countries that have really similar economic, environmental, technological features. So countries may look the same on the surface of it but obesity looks different."Comprehensive Analysis Reveals Complex PatternsWriting in the journal Nature, the international team, which involved a network of almost 2,000 researchers, described how for each country they calculated the change in the prevalence of obesity each year between 1980 and 2024. They drew on data from 4,050 population-based studies involving 232 million participants aged five years and above.They found that the prevalence of obesity increased in almost all countries over the 45-year period. However, in most high-income countries, a rapid rise in the prevalence of obesity has been replaced by a slower increase, a plateau, or a potential decline.Regional Variations in Obesity PrevalenceThe rate of growth in obesity is slowing in adults in the US and UK, reaching a prevalence of 40-43% and 27-30% respectively in 2024. Obesity is increasing steadily in Finland, has plateaued in Germany and may have started to decline in France, where 24-25%, 20-23% and 11-12% of adults respectively were thought to have the condition in 2024.Slowdowns were often seen in children and adolescents before adults. For the former group, the slowdown started as early as 1990 in Denmark and rates stabilised in most high-income countries by the mid-2000s. Obesity has plateaued in boys and girls in the UK, US, Germany and Japan at prevalences of 10-12%, 20-23%, 7-12% and 3-7% respectively.Meanwhile, obesity among young people and adults in many low-income and middle-income countries continues to rise and in some cases this is accelerating.Understanding the Drivers Behind Divergent TrendsThe team say it is important now to unpick what is behind the trends in different countries. The situation is complex: while there may be shared reasons for obesity, such easy access to unhealthy foods or a decrease in physical activity, the team say country-specific factors rooted in social, economic and policy considerations could also be important, from perceptions around body image to the presence or absence of interventions such as healthy school meals.Naveed Sattar, a professor of metabolic medicine at the University of Glasgow, who was not involved in the work, said the study highlighted how obesity trends were diverging sharply across countries. "English-speaking nations are doing particularly poorly, with the UK now among the countries with the highest obesity levels worldwide," he said.Sattar said it was encouraging that some countries appeared to have reached a plateau in obesity rates. "Understanding what has worked in those settings is crucial as it could help shape more effective public health strategies for the UK," he said, although he noted there could be country-specific aspects or customs at play.Future Outlook and Potential InterventionsHe said the rapid rise in obesity across many developing countries was especially concerning, not least as it could result in increases in diabetes and cardiovascular conditions.He added: "Looking ahead, it will be important to see how wider use of effective weight-loss medicines affects obesity trends, particularly in the UK and the United States. Recent signs of stabilisation in the USA suggest there may be room for cautious optimism. Combining evidence-based medicines with strong public health measures could begin to shift obesity rates in the right direction."

The Shift in Strategic Focus: From Iran to GazaIsrael has pivoted its military strategy, redirecting its firepower from Iran back to the besieged Gaza Strip following the suspension of joint US-Israel strikes. This strategic shift marks a significant escalation in the ongoing conflict, as the Israeli military shifts its primary operational focus back to the Palestinian enclave after a period of targeting Iranian assets.The ACLED Report and Rising ViolenceConflict monitor ACLED has documented a clear uptick in hostilities in the region. The report indicates that Israel has carried out 35 percent more attacks in April compared to March. This surge in activity suggests that despite the cessation of joint bombing campaigns against Iran, the intensity of the war in Gaza has not diminished.Quantifying the Surge: 35% Increase and CasualtiesAttack Frequency: A 35% increase in Israeli attacks in April versus March.Palestinian Casualties: 120 Palestinians killed since the US-Israel war on Iran halted on April 8, representing a 20 percent increase compared to the previous five weeks.Total Toll Since Ceasefire: Approximately 850 Palestinians have been killed since the ceasefire took effect.Israeli Casualties: At least 4 Israeli soldiers have been killed by Palestinian armed groups during the same period.The 'Ceasefire' Illusion: Ground Reality vs. Political DeclarationThe situation on the ground contradicts the political narrative of a truce. While a “ceasefire” agreement mediated by the US and Qatar aimed to halt major fighting, Israeli forces have not withdrawn from the territory. The military continues to occupy more than half of Gaza’s territory, demolishing buildings and ordering residents out.“It stopped in the announcement, but in reality and on the ground, the war has not stopped,” said Lafi al-Najjar, a blind Palestinian whose son was killed in an attack on April 28. Living in a shelter in the ruins of Khan Younis, al-Najjar represents the civilian reality of a population living under severe restrictions on aid and in damaged structures.The Enduring Conflict: A War Without a PauseThe conflict shows no signs of abating. With Hamas fighters maintaining de facto control and Israeli forces continuing their ground invasion and air campaign, the region remains volatile. The simultaneous escalation in Lebanon further complicates the security landscape, indicating that the broader regional war remains a persistent threat despite the temporary suspension of strikes against Iran.

The UN's Call for Accountability in Civilian DeathsThe United Nations human rights chief has demanded independent investigations into reports that separate air attacks by the Nigerian and Chadian forces in northern Nigeria killed more than 100 civilians. Nigeria's military has been battling "bandits" in the northwest and an armed rebellion in the northeast for 17 years, while Chadian forces have been targeting Boko Haram camps in the Lake Chad region.Market Massacre and Fishermen DeathsThe Nigerian military and the "bandit" gangs killed at least 100 civilians on Sunday in one of the bloodiest days in the state's conflict against armed groups, according to Amnesty International. Citing witnesses, Amnesty said many of those killed were women and children, and urged authorities to immediately investigate the attack on a crowded market in Tumfa village.Meanwhile, the bombardment by Chadian jets against Boko Haram camps on remote islands in the vast marshland shared by Nigeria, Cameroon, Niger and Chad has reportedly killed dozens of Nigerian fishermen working on islands under Boko Haram control. Footage verified by the AFP news agency showed several fishermen with severe burns being treated at a hospital in Bosso, Niger.Mounting Casualty FiguresAmnesty International confirmed that at least 100 civilians were killed in the Nigerian military airstrikes on a market in Zamfara state on May 10, with many more injured. The Chadian attacks since Friday have also resulted in significant civilian casualties among fishermen who were forced to pay taxes to the armed group controlling the islands.Regional Security ImplicationsThe incidents highlight the complex security challenges in West Africa's Sahel region, where military operations against terrorist groups like Boko Haram and the Islamic State West Africa Province (ISWAP) increasingly threaten civilian populations. The Lake Chad region has been particularly volatile, with cross-border military operations creating humanitarian concerns as civilians become caught between armed groups and national militaries.Future Investigations and Potential RepercussionsAs international pressure mounts for investigations, the Nigerian military maintains there is no evidence of civilian casualties, claiming their strikes targeted confirmed high-level gatherings of terrorists. The UN's demand for independent probes could lead to increased scrutiny of military operations in the region and potentially affect international support for counter-terrorism efforts in West Africa.

The Recent Tremors A series of nine small earthquakes struck the Pardis area east of Tehran overnight, Iran’s Mehr news agency reported on Wednesday, renewing fears among experts and residents that the Iranian capital could face a major seismic disaster. Concerns Over Accumulated Tectonic Pressure The repeated activity has revived concerns that accumulated tectonic pressure beneath and around the capital, which lies close to several active fault lines, could at some point in the future trigger a much larger earthquake. The Mosha Fault: A Major Seismic Zone The tremors, recorded over a single night in eastern Tehran province, were felt in an area close to the Mosha fault, one of Iran’s most active seismic zones. The fault, about 150km (93 miles) in length, is one of the major active faults of the country, located approximately 40km (25 miles) from the capital. No Casualties or Damage Reported State media reported that the magnitude of one of the earthquakes was 4.6, but the mild seismic activity did not cause casualties or material damage. Warnings of Future Risk Semi-official Mehr news agency quoted seismologist Mehdi Zare as saying it was not clear whether the tremors represented a release of built-up seismic energy that would reduce future risk or instead were warning signs of stronger future activity along the fault system near Tehran. Zare warned that Tehran’s vulnerability is amplified not only by active fault lines but also by dense urban development, population concentration and limited preparedness. He said even relatively small earthquakes can cause disruption in the capital due to fragile infrastructure and congestion, complicating emergency response. Tehran's Vulnerability Tehran, a metropolitan area of more than 14 million people, lies near major active faults, including the North Tehran, Mosha and Rey. Iranian experts have repeatedly warned that a major earthquake near Tehran could have catastrophic consequences. Iran is among the world’s most quake-prone countries, and memories remain vivid of the 2003 Bam earthquake, which killed more than 30,000 people.

The World's Longest Football DerbyCarlisle and Barrow will play each other next season in the Cumbrian derby in the National League. The clubs are located at opposite ends of Cumbria and the distance between the two grounds is some 78 miles by car. But this is not the greatest distance between two teams involved in a 'derby'.When considering derbies, we are looking for matches between teams that are linked based upon their proximity or geography, rather than simply historical rivalries like the 'clásico' between Real Madrid and Barcelona.UK Derbies: The Cumbrian ContenderWithin the UK, the Cumbrian derby certainly looks the furthest derby by distance. If we are staying in England, the closest we can get to 78 miles is the A49 derby between Shrewsbury Town and Hereford United, separated by 51 miles, although it should be said that the two teams have not met since the latter was dissolved in 2014.In England, thoughts immediately go to Crystal Palace and Brighton, dubbed the M23 derby, but a quick search reveals that Selhurst Park is a mere 46 miles from the Amex Stadium. It is also 46 miles that separate the stadiums of Plymouth Argyle and Exeter City, the Devon derby. Just behind are Ipswich and Norwich – the East Anglian derby (AKA El Tractico or the Old Farm) – with Portman Road and Carrow Road 45 miles apart.International Long-Distance DerbiesFarther afield, we must mention the derby between Persib Bandung and Persija Jakarta, who take part in the Indonesia derby, or Laga Klasikal as it is locally known, with Persib's Gelora Bandung Lautan Api Stadium lying 108 miles away from Persija's Jakarta International Stadium in Indonesia's capital.Italy is fertile ground for a host of famous derbies, and it is here that we find some of the longest-distance derbies. Of course there is the Derby d'Italia between Milan and Juventus, with 85 miles separating San Siro and Juve's Allianz Arena in Italy's north-west. The Derby di Sicilia between Palermo and Catania spans a whopping 134 miles across the breadth of Sicily, while the Derby delle Isole (Derby of the Islands) between Palermo and Sardinian club Cagliari goes even further – a full 250 miles across the Tyrrhenian Sea.The Champion: New Zealand's 386-Mile DerbyOur winner, though, comes from New Zealand's North Island. With Auckland FC only entering the A-League Men in 2024-25, the New Zealand derby between themselves and Wellington Phoenix is still very much in its infancy but has already blossomed into something substantial. In February, just the sixth edition of the derby, a comical own goal from Wellington goalkeeper Josh Oluwayemi sparked a 5-0 thrashing by Auckland, prompting Phoenix coach Giancarlo Italiano to resign immediately after the defeat. With 386 miles between the two grounds, the NZD is our clear winner.The Evolution of Geographic DerbiesThe existence of such long-distance derbies challenges our traditional understanding of what constitutes a local rivalry. In an era where football has become increasingly globalized, these geographic matchups represent unique connections between communities separated by vast distances. The New Zealand derby, in particular, showcases how even in a country with a relatively small population, football can create intense rivalries across significant geographical divides.The Future of Long-Distance DerbiesAs football continues to evolve, we may see more long-distance derbies emerge, particularly in regions with expanding leagues or where new clubs are formed to serve underserved areas. The New Zealand derby between Auckland and Wellington Phoenix is a prime example of how modern football infrastructure and scheduling can create meaningful rivalries regardless of distance. With the increasing popularity of travel and fan engagement, these long-distance derbies may become even more significant in the future of football culture.Double Winners in FootballDeji Elerewe has won the title with both Bromley (League Two) and Lincoln (League One) this season. Has any other player managed the same feat?We covered this answer 10 years ago in a previous Knowledge, but regular contributor Dirk Maas has come in clutch with some additions, although he does clarify that he has limited his search to the top five leagues in Europe in this century.There are several examples of players winning titles with different teams in the same season, including:Jonas Urbig with Köln (2. Bundesliga) and Bayern Munich (Bundesliga) in 2024-25Leigh Griffiths with Celtic (Scottish Premiership) and Wolverhampton (League One) in 2013-14Urby Emanuelson with Ajax and Milan in 2010-11Daniel Amartey with Leicester City and FC Copenhagen in 2015-16Timothy Weah with Paris Saint-Germain and Celtic in 2018-19Khvicha Kvaratskhelia with Napoli and PSG in 2024-25There are also alternative cases where seasons happen at different times of year, such as David Beckham achieving this by picking up an MLS winner's medal with LA Galaxy and a Ligue 1 winner's medal with Paris Saint-Germain in 2012-13.

The Escalating Crisis in Blue Nile StateRecent clashes in Sudan's Blue Nile State have triggered a mass displacement crisis, with thousands of civilians forced to abandon their homes amid escalating violence. The conflict, which has intensified in recent weeks, has created urgent humanitarian needs as families seek safety from the fighting.Humanitarian Impact and Displacement FiguresThe United Nations reports that over 15,000 people have been displaced in Blue Nile State alone since the beginning of this month, with many seeking refuge in neighboring areas or across the border into Ethiopia. The displacement crisis is straining already limited resources in host communities and creating conditions ripe for disease outbreaks and food insecurity.Regional Security ImplicationsThe conflict in Blue Nile State represents a significant challenge to regional stability, with potential spillover effects into neighboring countries. The fighting involves multiple armed groups and has complicated efforts to establish a lasting peace in Sudan, which has been grappling with various conflicts since the country's independence.International Response and Future OutlookInternational humanitarian organizations are struggling to access affected areas due to security concerns and bureaucratic obstacles. The coming weeks will be critical in determining whether the conflict can be de-escalated and whether displaced populations can return to their homes safely, or if the crisis will further deepen, potentially leading to even larger displacement and increased humanitarian needs.

Study Shows Fetal Exposure to Vegetable Flavours Influences Post‑Birth PreferencesThe research team gave pregnant volunteers powdered kale or carrot capsules during the third trimester and later measured their children’s facial reactions to the same smells. Reactions were recorded via ultrasound before birth, repeated at three weeks, and again when the children were about three years old.Methodology: Kale and Carrot Powder Capsules Administered to Expectant MothersParticipants were asked to swallow a capsule each day containing either kale or carrot powder. The study avoided large volumes of juice, which many volunteers found unpalatable, opting for a low‑cost capsule format.Capsules administered in late pregnancy (around 32 weeks gestation).Initial chemosensory response captured with ultrasound imaging.Follow‑up assessments at 3 weeks and 3 years post‑birth.Sample Size and Observed Reactions Reveal Early Flavor MemoryAlthough the cohort was modest, the findings were consistent:12 children were observed at age three.Infants exposed to carrot powder smiled when presented with a carrot scent and grimaced at kale, and vice‑versa for the kale group.The same preference pattern was evident in the ultrasound scans before birth.These results suggest that flavour exposure in utero can create a durable chemosensory memory.Potential Public‑Health Benefits of Early Dietary ConditioningIf replicated on a larger scale, the approach could offer a low‑cost strategy for improving population nutrition:Reducing childhood resistance to vegetables may lower long‑term risks of obesity and diet‑related diseases.Capsules are inexpensive and could be integrated into routine prenatal supplements.The concept is adaptable to different cultural diets, as noted by the researchers’ interest in fish‑rich Japanese diets.Next Steps: Larger Trials and Cross‑Cultural ApplicationsThe authors acknowledge the need for a bigger, funded study to confirm the effect across diverse populations. Future research aims to:Expand the sample size to hundreds of mother‑child pairs.Test additional flavours and odourants, including artificial sweeteners.Explore policy pathways for incorporating flavour‑exposure capsules into prenatal care guidelines.Published in Developmental Psychobiology, the paper titled “Do Human Fetuses Form Long‑Lasting Chemosensory Memories?” opens a new avenue for early nutritional interventions.

The Cooking Gas Crisis in AsiaIn the ramshackle lanes of a south Delhi slum, Afshana Khatoon crouched wearily on her haunches and began lighting a small pile of firewood. She had just returned from six hours spent trudging through the urban forests and dry parks of India's capital looking for kindling to turn into a makeshift stove. As the unforgiving summer heat soared above 40C, she had walked for miles, piling the sticks and fallen branches into a bundle on her head while sweat ran down her face.Just a few weeks ago, the 35-year-old had been preparing meals for her four children on a small gas stove with little fuss. But as the crisis in the Middle East has choked India's vital supplies of imported liquefied petroleum gas (LPG) – used by more than 60% of the country's population for cooking – refills have been scarce and prices have risen far beyond what is widely affordable.Return to Traditional FuelsKhatoon, like growing numbers of people in India and more widely across Asia, has been forced to cook with crude, dirty fuels such as firewood and coal in order to survive. "It already feels like hell," she said, as she bustled about, filling a pot with water. "I'm not eating properly, and I have to work much more than before. My whole day now is about collecting firewood and cooking."The return to fuels such as firewood and coal is not only deepening the economic strain of the war on ordinary civilians in countries across Asia, but raising concerns about public health, air pollution and the fragility of the energy transition.Supply Chain Disruption and Price SurgeIndia imports about 60% of its LPG needs, of which about 90% usually comes through the strait of Hormuz, the critical shipping route still blockaded amid the ongoing conflict between Iran and the US. Official data shows India's LPG consumption fell by 2.2m tonnes in April, the sharpest decline in years.As the war has dragged on, cooking gas prices in informal markets have surged. In Khatoon's dimly lit shanty, her 5kg gas canister sat empty and forlorn in the corner. She said LPG had become prohibitively expensive for her family, rising to more than four times what she used to pay. "My husband earns 400 to 500 rupees a day. We can't spend 1,000 rupees just on gas for a week," she said.While the Indian government insists there is no shortage, in a speech this week the prime minister, Narendra Modi, called on people to adopt austerity measures including limiting their use of fuel and petrol. According to the defence minister, India has petroleum gas reserves to last just 45 days.Health and Environmental ConsequencesOnce Khatoon's fire stove is lit, thick smoke rises from the flames. It stings the eyes and throat but she has no option but to breathe it in as she cooks. She put her head in her hands, admitting she felt utterly exhausted. "We just want to cook as quickly as possible," she said.The return to biomass is raising alarms about air quality in cities across the region. Solid fuels such as wood and charcoal come with a range of health and environmental risks. They emit a dangerous set of pollutants that have been linked to respiratory problems, such as chronic obstructive pulmonary disease and lung cancer, strokes and heart disease.The combined effects of ambient air pollution and household air pollution are associated with 6.7 million premature deaths annually, according to the World Health Organization. Women and children, widely responsible for household chores such as cooking or collecting firewood, are the most vulnerable.Reversal of Environmental ProgressDelhi already ranks among the world's most polluted cities, and years of policy have focused on promoting cleaner fuels such as LPG and compressed natural gas to reduce emissions.Environmental activists fear years of progress toward widespread use of cleaner fuels is being reversed as the war in the Middle East drags on. With shortages deepening, authorities in Delhi have temporarily relaxed restrictions on the use of coal and firewood."When prices rise, it's the poorest who are forced to switch back to biomass," said Harjeet Singh, a climate activist and the founding director of the Satat Sampada Climate Foundation. "Biomass burning is a major source of fine particulate pollution."Future OutlookAs the conflict in the Middle East continues to disrupt global energy supplies, the health implications of reverting to traditional cooking methods across Asia are likely to worsen. Without immediate intervention to either increase LPG supplies or provide affordable alternatives, public health crises in major urban centers could escalate, potentially reversing years of progress in air quality improvement.The situation highlights the vulnerability of energy-dependent nations to geopolitical conflicts and underscores the urgent need for diversified energy sources and more resilient supply chains in the region.

ACCESS: Medicare’s First AI‑Enabled Outcome‑Based Payment Model Pair Team was announced on April 30 as one of 150 organizations accepted into ACCESS (Advancing Chronic Care with Effective, Scalable Solutions), a CMS initiative that launches on July 5. The program shifts reimbursement from traditional time‑based fees to payments tied to measurable health outcomes such as lower blood pressure or reduced pain, covering conditions like diabetes, hypertension, chronic kidney disease, obesity, depression, and anxiety. Revenue Scale and Funding Behind Pair Team Staff: roughly 850 clinical professionals, the largest community‑health workforce in California. Revenue: exceeds nine figures (>$100 million) annually. Capital raised: about $30 million from investors including Kleiner Perkins, Kraft Ventures, and Next Ventures. Patient reach: partnerships give access to ~500,000 potential patients, with a goal of 1 million within three years. Industry context: digital‑health funding hit its highest Q1 total since the pandemic, with AI firms capturing the bulk of new capital. How Outcome‑Based Payments Could Redefine Chronic Care Delivery The ACCESS model creates the first federal mechanism to pay for AI agents that monitor patients between visits, coordinate social services, and ensure medication adherence. Flora, Pair Team’s voice‑AI assistant, now handles 24/7 intake, referrals, and check‑ins, delivering hour‑long conversations that act as both clinical touchpoints and companionship for high‑needs patients. Peer‑reviewed research in the Journal of General Internal Medicine shows Pair Team’s community‑integrated approach cuts avoidable emergency and inpatient utilization, with one‑in‑four hospital visits and one‑in‑two ER visits averted for its members. Risks remain: the program funnels highly sensitive data into a federal system with a history of breaches, and past CMS innovation pilots have drawn criticism for increasing federal spending without delivering projected savings. What’s Next for AI‑First Health Providers Under ACCESS Batlivala argues that lower per‑patient reimbursement rates are intentional, forcing providers to adopt lean, AI‑driven operations. As the program scales, success will hinge on: Automating patient interactions to keep costs below payment thresholds. Demonstrating measurable outcome improvements across the covered chronic conditions. Managing data‑privacy concerns to maintain trust among vulnerable populations. Attracting additional capital as investors watch the first AI‑centric Medicare payment model unfold. If Pair Team and its peers can prove the model’s efficacy, ACCESS could become a template for nationwide AI‑enabled, outcome‑based reimbursement, reshaping how Medicare incentivizes technology in health care.