 When we think about poverty and hunger, many of us immediately picture the tragic scenes from areas afflicted by famine –people too weak to walk with ribs that can be counted and children with the skinny limbs and swollen bellies characteristic of kwashiorkor. However, in the US, and many other settings, the face of hunger is much more likely to have chubby cheeks.
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 What if your experiences as a baby – even before you were born – helped determine whether you were overweight or obese later in life? There is evidence to suggest that this may be the case, and that the prenatal environment and the first two years of life are very important in the development of overweight and obesity. Our early life environments help determine our biological make-up for the rest of our lives. Some of this programming may occur in the bacteria in our stool, also known as the microbiome.
 by Avik Chatterjee, MD John had gotten out of prison just a couple months before, but already felt that he was losing muscle and gaining fat. In prison, he felt he had a routine, and could lift weights and control his diet. As a homeless man, he struggled on both fronts. “Doc, I’m trying to be good, you know, low carb and stuff, but what are some other ways to eat better, you know, like Paleo?”
Obesity and obesity related disease have created a tremendous burden on the health care system, and in my practice with homeless patients, I talk about obesity, weight loss, nutrition, and exercise all the time. The sheer variety of fad diets is dizzying, and countless people, even homeless men like John, are considering trying them. So one would think that medical school and residency would be full of teaching about nutrition. You would be wrong.  by Kristina Lewis, MD In 2008, Los Angeles passed a unique ordinance aimed at improving the health of residents in one of its poorer areas – South L.A. The city council enacted a zoning law that banned new fast-food restaurants (or the expansion of existing ones) in this lower-income community, home to mostly racial and ethnic minorities. The idea was relatively simple – sort of a reverse play on Costner’s “If you build it, they will come”. I assume the thinking went something like this: Fast food is bad for you; poor people eat fast food because it is affordable and plentiful in their neighborhoods; poor people are more likely to have negative health consequences as a result of worse diets; ergo, remove fast food from poor neighborhoods and people will be healthier. What’s not to love, right?
 by Jason Block, MD, MPH What was a desert became a flood. From 1999 to 2012, the FDA did not approve any new weight loss medications. With the removal of sibutramine (Meridia) from the market in 2010, orlistat (Alli, Xenical) and phentermine were the only routinely-used medications FDA approved for the treatment of obesity. Then came lorcaserin (Belviq) and phentermine/topiramate (Qsymia) in 2012 and naltrexone/bupropion (Contrave) and liraglutide (Saxenda) in 2014. On average, these medications result in 3% to 3.7%, 8.9%, 4.1%, and 4.5% more baseline body weight lost than placebo after 1 year of treatment, respectively. But, the FDA wasn’t finished.
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