Obesity is a multifactorial, chronic condition that substantially affects individual and public health, reduces life expectancy, and increases the risk for a wide range of comorbid conditions (eg, cardiovascular disease, hypertension, depression, liver disease, type 2 diabetes, certain cancers). It is defined using body mass index in adults and further stratified into classes. In children and adolescents, obesity is defined using body mass index at or above the 95th percentile for age and sex. In the United States, more than 40% of adults and approximately 20% of children and adolescents are affected by obesity. Disparities persist, with higher rates among Hispanic and non-Hispanic Black populations and individuals with lower socioeconomic status. Other risk factors include adverse childhood experiences, behavioral influences, certain drugs, genetic predisposition, and medical conditions. Obesity-related stigma and social determinants of health pose barriers to effective care. Effective management requires a respectful, patient-centered approach that includes comprehensive assessment and multidisciplinary support. Recognizing obesity as an adiposity-based chronic disease may enhance care delivery and reduce bias, promoting better out- comes and health equity across populations.

Acute appendicitis is one of the most common causes of emergency abdominal surgery in adults and children. Although tenderness at the McBurney point is the most specific symptom, diagnosing appendicitis clinically is challenging. Diagnosis should include the use of laboratory testing, including white blood cell count with differential, C-reactive protein level, and neutrophil-to-lymphocyte ratio, in addition to use of clinical prediction tools such as the Appendicitis Inflammatory Response score and diagnostic imaging. Although ultrasonography is a reasonable first-line imaging modality, its outcomes are user-dependent and studies are often nondiagnostic (ie, unable to rule out appendicitis). Computed tomography is commonly used in the United States to diagnose acute appendicitis and has the additional benefit of being able to evaluate for multiple etiologies of abdominal pain. Based on imaging findings, acute appendicitis can be subcategorized as uncomplicated (ie, inflammatory changes without signs of necrosis or abscess) or complicated (ie, signs of necrosis with perforation or abscess formation). Patients with appendicolith on imaging and pregnant patients should be managed surgically. The standard of care for uncomplicated acute appendicitis remains laparoscopic appendectomy, whereas complicated appendicitis in stable patients may initially be managed nonoperatively with antibiotic therapy and percutaneous abscess drainage before consideration of interval appendectomy.

Adolescents Well-child visits in adolescence (ages 13-17 years) are intended to assess growth and development, promote emotional well-being, and counsel patients and their families on safe behaviors at a time when youth are increasingly making independent choices that affect their health. All adolescents should be offered time alone with their physician for discussion of confidential health concerns, including but not limited to sexual health, mental health, substance use, and peer relationships. Minor consent laws vary by state. Adolescents who are sexually active should be provided with behavioral counseling on sexually transmitted infection prevention as well as offered screening for sexually transmitted infections. Sexually active adolescents who could become pregnant should be counseled on the range of contraceptive options, including long-acting reversible contraception. Vaccines should be offered and completed on time. Adolescents should be screened for depression and anxiety and offered treatment, including cognitive behavior therapy and pharmacotherapy. Adolescents should be counseled on getting 1 hour/day of physical activity and 8 to 12 hours/night of sleep, and setting goals for healthy media use, including having media-free times and spaces, including the bedroom.

The health impact of the conditions in which people are born, grow, work, live, and age have been recognized for centuries. However, widespread acceptance of this impact remains contentious, as inequities in morbidity and mortality represent the enduring legacies of displacement, oppression, and systemic discrimination. The World Health Organization estimates that social and structural determinants are responsible for 30% to 55% of all health outcomes. Social determinants of health, structural determinants of health, structural violence, and the need for structural competency are four codependent concepts that must be explored together to develop responsive clinical interventions. Social and structural determinants of health include wealth and social status, geography and neighborhood, employment and labor, and education. Racism is a major driver of social and structural determinants of health in the United States. It is important to differentiate between upstream and downstream approaches to addressing health inequities because addressing upstream factors has a greater impact.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a likely underdiagnosed chronic pain syndrome consisting of pelvic pain lasting longer than 6 weeks plus lower urinary tract symptoms in the absence of infection or other identifiable cause. It is more common after 40 years of age. The etiology is unclear, but some patients have inflammatory findings in the bladder known as Hunner lesions. Due to its variable presentation, there is no standardized evaluation for diagnosis of IC/BPS. The history should include pain and urinary symptoms; associated comorbid disorders, including autoimmune and mental health conditions; and symptoms suggestive of other causes (eg, infection). Cystoscopy is not required but should be considered for patients with refractory symptoms and when Hunner lesions are suspected, such as in those older than 50 years or with comorbid autoimmune disorders and/or bladder-centric presentation (eg, predominance of urgency, frequency, low urine volumes). Treatment is often multimodal, including behavior modifications, stress management, and nonpharmacologic therapy (eg, pelvic floor physical therapy). Oral pharmacotherapy can be considered, but no guidelines exist on preferred agents. Referral for procedural treatments can also be considered for refractory cases. Patients should understand that no treatments are definitively successful, and recurrences and flare-ups often occur.

Exposures to pollutants and contaminants can occur through water or soil, which can be contaminated naturally or through human activities. The toxicity and adverse health effects of these substances depend on exposure route, quantity, and duration. Mechanisms of water contamination include runoff, flooding, infrastructure failures, and contamination from air and surface water pollution. Pesticides and organophosphates commonly are used in agricultural and residential applications, frequently cause water contamination, and commonly cause poisoning in agricultural workers and gardeners. Soil contamination disproportionately affects minority and low-income populations because they are more likely to live in proximity to a pollution source. Fetuses, children, and individuals with preexisting medical conditions are more vulnerable to adverse health effects of soil contamination compared with healthy adults. Some of the most common soil pollutants are heavy metals, pesticides, and polychlorinated biphenyls. Preventing exposure to contaminated soil involves avoidance of historically contaminated sites and ingestion of soil. Approaches to cleanup depend on the extent of contamination, location, and planned future use of the land. Remediation strategies include containment, bioremediation, chemical oxidation, soil washing, and thermal treatment.

Vertigo, an unexpected feeling of self-motion, is no longer characterized simply by symptom quality but by using triggers and timing. Evaluating vertigo by triggers and timing not only distinguishes serious central causes from benign peripheral causes, but also narrows the differential diagnosis by further classifying vertigo as spontaneous episodic vestibular syndrome, triggered episodic vestibular syndrome, or acute vestibular syndrome. A targeted physical examination can then be used to further delineate the cause within each of these three vestibular categories. Neuroimaging and vestibular testing are not routinely recommended. In the management of vertigo, vestibular hypofunction can be treated with vestibular rehabilitation, which can be self-administered or directed by a physical therapist. Pharmacotherapy sometimes is indicated for vertigo based on triggers, timing, and the specific condition, but it is not always beneficial and is used more often for symptom reduction than as a cure. Transtympanic corticosteroid or gentamicin injections are recommended for patients who do not benefit from nonablative therapy. Surgical ablative therapy is reserved for patients who have not benefited from less definitive therapy and have nonusable hearing.