SPAWNING MIGRATION OF LABEOBARBUS SPP. (PISCES: CYPRINIDAE) OF LAKE TANA TO ARNO-GARNO RIVER, LAKE TANA SUB-BASIN, ETHIOPIA

The spawning migration of Labeobarbus species of Lake Tana to Arno-Garno River was studied from July to December 2010. Five sampling sites, based on the nature, flow-rate of the river, human interference and suitability for fish spawning were selected by preliminary survey. Fish were sampled monthly in the non-peak spawning season (July, November and December) and bimonthly in the peak spawning season (August to October) using 6, 8, 10, 12 and 14 cm stretched mesh size gillnets. A total of 1077 Labeobarbus specimens were collected. Labeobarbus intermedius, L. brevicephalus, L. nedgia and L. tsanensis were the dominant species, contributing 93.03% of the total catch. The monthly gonado-somatic index indicated that the peak spawning season for Labeobarbus species was from August to October. Labeobarbus intermedius and L. tsanensis were the first species to aggregate at the river mouth starting from July and L. brevicephalus and L. nedgia aggregate starting from September. Labeobarbus intermedius was the first to migrate to the upstream sites starting from the end of July followed by L. tsanensis. The last migrant species was L. brevicephalus starting from the fourth week of August. Pairwise comparison of the Labeobarbus spp. showed temporal segregation in all sampling months, except L. intermedius and L. brevicephalus that did not show temporal segregation with L. nedgia. The best management option to protect these species is closed season that should be strictly implemented during the spawning season (from July to October)

Spawning migration of Labeobarbus species to some tributary rivers of Lake Tana, Ethiopia

Spawning migration of Labeobarbus species was studied from August to December 2013 in some tributary rivers (Qimon, Guanta, Shini, and Chibirna) of Lake Tana. Fish specimens and physico-chemical parameters were measured bimonthly in August and September but monthly from October to December. Adult fish specimens were caught using 6 and 8 cm stretched mesh size monofilament gillnets and 6, 8, 10 and 12 cm mesh size multifilament gillnets. A total of 933 adult Labeobarbus specimens were collected during the study period. Labeobarbus intermedius was the most abundant species followed by L. brevicephalus. The peak spawning season of L. intermedius was from fourth week of August to end of September and for L. brevicephalus it was from fourth week of August to beginning of October. Both species were found to spawn in all sampling rivers. However L. truttiformis spawned only at Guanta and Qimon Rivers during August while L. nedgia in Shini and Chibirna Rivers at the end of September. This implies the presence of micro-spatial segregation among species. Pair-wise comparison of Labeobarbus species showed temporal segregation in all sampling months, except L. brevicephalus and L. nedgia. The present findings showed that small tributary rivers and streams are the main spawning grounds for Labeobarbus species of Lake Tana. Therefore, main spawning grounds or routes should be protected from the deleterious effects of anthropogenic activities like illegal fishing, irrigation and sand mining for wise use of the fish resources.Keywords: Fecundity, Fish, Migration, River, Spawnin

Comparison of otolith readability and reproducibility of counts of translucent zones using different otolith preparation methods for four endemic Labeobarbus species in Lake Tana, Ethiopia

The analysis of fish age data is vital for the successful conservation of fish. Attempts to develop optimal management strategies for effective conservation of the endemic Labeobarbus species are strongly affected by the lack of accurate age estimates. Although methodological studies are key to acquiring a good insight into the age of fishes, up to now, there have not been any studies comparing different methods for these species. Thus, this study aimed at determining the best method for the endemic Labeobarbus species. Samples were collected from May 2016 to April 2017. Asteriscus otoliths from 150 specimens each of L. intermedius, L. tsanensis, L. platydorsus, and L. megastoma were examined. Six methods were evaluated; however, only three methods resulted in readable images. The procedure in which whole otoliths were first submerged in water, and subsequently placed in glycerol to take the image (MO1), was generally best. Except for L. megastoma, this method produced the clearest image as both the coefficient of variation and average percentage error between readers were lowest. Furthermore, except for L. megastoma, MO1 had high otolith readability and no systematic bias. Therefore, we suggest that MO1 should be used as the standard otolith preparation technique for the first three species, while for L. megastoma, other preparation techniques should be evaluated. This study provides a reference for researchers from Africa, particularly Ethiopia, to develop a suitable otolith preparation method for the different tropical fish species

A drivers-pressure-state-impact-responses framework to support the sustainability of fish and fisheries in Lake Tana, Ethiopia

Lake Tana, Ethiopia's largest lake, has a remarkable and conservation-worthy assemblage of fish species, requiring fisheries management for sustainable exploitation. However, due to anthropogenic impacts, many of these fish species are threatened. Hence, an improved management of these resources is recommended. To allow a more sustainable exploitation of natural resources, a better understanding of the cause-effect relationships between anthropogenic impacts and environmental components is fundamental. The Drivers-Pressure-State-Impact-Responses (DPSIR) framework is a useful tool to describe these links in a meaningful way to managers and policy makers. Despite its potential, application of DPSIR is virtually lacking in developing countries. This paper assessed the potential of the DPSIR framework and used it to comprehensively describe the available knowledge and management needs in the lake catchment. Rapid population growth and the economic transformation are the main driving forces leading to various pressures such as water quality and wetlands degradation as well as declining fish community, which is detrimental to the socio-economic state and health of the local inhabitants. As feedback to the driving forces, pressures, state changes and impacts, optimal multi-level responses are developed. This study aims at providing policy makers a better understanding of the lake catchment in order to bridge the gap between science and decision-making

Scientific methods to understand fish population dynamics and support sustainable fisheries management

Fisheries play a significant role in the livelihoods of the world population, while the dependence on fisheries is acute in developing countries. Fisheries are consequently a critical element for meeting the sustainable development (SDG) and FAO goals to reduce poverty, hunger and improve health and well-being. However, 90% of global marine fish stocks are fully or over-exploited. The amount of biologically unsustainable stocks increased from 10% in 1975 to 33% in 2015. Freshwater ecosystems are the most endangered ecosystems and freshwater fish stocks are worldwide in a state of crisis. The continuous fish stock decline indicates that the world is still far from achieving SDG 14 (Life Below Water), FAO’s Blue Growth Initiative goal and SDG 15 (Life on Land, including freshwater systems). Failure to effectively manage world fish stocks can have disastrous effects on biodiversity and the livelihoods and socio-economic conditions of millions of people. Therefore, management strategies that successfully conserve the stocks and provide optimal sustainable yields are urgently needed. However, successful management is only possible when the necessary data are obtained and decision-makers are well informed. The main problem for the management of fisheries, particularly in developing countries, is the lack of information on the past and current status of the fish stocks. Sound data collection and validation methods are, therefore, important. Stock assessment models, which support sustainable fisheries, require life history traits as input parameters. In order to provide accurate estimates of these life history traits, standardized methods for otolith preparation and validation of the rate of growth zone deposition are essential. This review aims to assist researchers and fisheries managers, working on marine and freshwater fish species, in understanding concepts and processes related to stock assessment and population dynamics. Although most examples and case studies originate from developing countries in the African continent, the review remains of great value to many other countries

The endemic species flock of Labeobarbus spp. in L. Tana (Ethiopia) threatened by extinction : implications for conservation management

The endemic Labeobarbus species in Lake Tana are severely affected by anthropogenic pressures. The implementation of fisheries management is, therefore, vital for their sustainable exploitation. This study aimed at investigating the catch distribution and size at 50% maturity (FL50%) of the Labeobarbus species. Samples were collected monthly from May 2016 to April 2017 at four sites. The relative abundance, catch per unit effort (CPUE), and size distribution of these species was computed, and logistic regression was used to calculate FL50%. Of the 15 species observed, five species constituted 88% of the total catch. The monthly catch of the Labeobarbus spp. declined by more than 85% since 1993 and by 76% since 2001. Moreover, the CPUE of Labeobarbus has markedly decreased from 63 kg/trip in 1991-1993 to 2 kg/trip in 2016-2017. Additionally, large size specimens (>= 30 cm fork length) were rarely recorded, and FL50% of the dominant species decreased. This suggests that the unique species flock may be threatened by extinction. Given the size distribution of the species, the current social context, and the need for a continuous supply of fish for low-income communities, a mesh-size limitation represents a more sustainable and acceptable management measure than a closed season. This paper illustrates the tension between sustainable development goal (SDGs) 1-No Poverty, 2-Zero Hunger, and 8-Decent Work and Economic Growth in Bahir Dar City on the one hand, and SDG's 11-Sustainable Cities and Communities, 12-Responsible Consumption and Production, and 14-Life Below Water on the other hand. A key for the local, sustainable development of the fisheries is to find a balance between the fishing activities and the carrying capacity of the Lake Tana. Overfishing and illegal fishing are some of the major threats in this respect

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Funding: Bill & Melinda Gates Foundation

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions