Tough on crime, tough on the causes of crime

This (in)famous slogan could summarise much of the content in this themed edition of ClinMed on the subject of obesity. It is clear that the notion of obesity being caused by excess calorie consumption is badly outdated and scientifically absurd. Progress on understanding the multifactorial aetiology of the problem has been equalled by the expansion of our understanding of the complications of obesity. And while the causes may stem from failures of policy, the impact is borne both by the individuals and by society more widely. What is the role of the physician in this? It is to translate the rapidly increasing body of knowledge both into our daily practice with the patients we treat, but also to use that to influence wider public health. Obesity is a complex disease that presents to physicians in all specialisms. The invited special editors for this edition are Anjali Zalin and Tahseen Chowdhury who have produced an edition that covers this wide spectrum of aetiology¹ and prevention,² assessment,³ management and care,^4–9 electronic health,¹⁰ and the management of complications.^11–14 It forms a remarkable compilation, like a mini textbook or a summary of a state-of-the-art conference.

Another topic that has complex causation and desperate impact is homelessness. Such is the effect, that this topic could be the subject of a future special edition: people experiencing long-term homelessness have some of the poorest health outcomes in society and frequently die prematurely from preventable causes. One paper in this edition is a summary of an audit of experience in acute hospitals in London,¹⁵ and the other documents the same in homeless hostels.¹⁶ This pair of complementary manuscripts underline the importance of reflecting on how we provide care for those most in need. Too often we treat according to the processes and towards the ‘targets’ of the organisation we work in, abandoning thinking about the need to provide equitable care reflecting the individual needs of each patient. It is hard to provide truly equitable care in a system which prioritises politicised targets over tailored individual care in an increasingly hard-pressed healthcare system: it is one of the great challenges for physicians in the era ahead. A holistic way of reading the slogan of the title is that rather than viewing disease as related to exclusively personal deficits, it is related to the strength and cohesion of the community we live in.

Finally, ClinMed has just begun the process to appoint a new editor-in-chief. The new editor will take the lead in shaping a progressive editorial strategy for the journal, to include expanding our publication of high-quality research content. Please visit www.rcp.ac.uk/education-practice/volunteering/appointment-new-editor-chief-clinical-medicine-0 for more information. This is an exciting moment in the life of the journals in the RCP, so please do contact me at clinicalmedicine@rcp.ac.uk if you would like to arrange an informal discussion about the role.