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Andersen LB, Mota J et al. www.thelancet.com; Published online 27 July 2016 http://dx.doi.org/10.1016/S0140-6736(16)30960-6

The role that dental care professionals have in shaping patient's lifestyle is growing. Referral for those who wish to quit smoking is now part of a dentist's care repertoire, but should a dentist counsel a patient who is overweight? An approach that may chime with patient expectations is to link this non-communicable disease with dental disease. In those who are overweight, there is a small increased risk of developing periodontitis (J Clin Periodontol 2015;42: 495–505). Then, if as a consequence of weight loss for a relatively trivial disease, such would also minimise the risk of an high impact condition (cancer, diabetes or cardiovascular disease), both the aims of dental and general health are met.

This Comment, summarising four substantive papers and other commentaries published in the same issue of The Lancet, updates the first series of papers on physical inactivity published in this same journal back in 2012. In these historical papers, the key conclusion was that physical inactivity is an important modifiable '...risk factor for non-communicable diseases such as obesity and tobacco.'

In this most recent series of papers, one paper reported (Lancet 2016; published online July 27. http://dx.doi.org/10.1016/S0140-6736(16)30383-X) high-income countries bear a larger proportion of economic burden, whereas low-income and middle-income countries have a larger proportion of the disease burden. It was also reported (Lancet 2016; published online July 27. http://dx.doi.org/10.1016/S0140-6736(16)30728-0) that although physical activity interventions are effective in a research setting, initiatives must be implemented from a range of different sectors in the community in order to facilitate a population shift.

The systematic review and meta analysis of over one million subjects (Lancet 2016; published online July 27. http://dx.doi.org/10.1016/S0140-6736(16)30370-1) has received considerable comment in the press. The investigators found the mortality risk associated for sitting more than 8 hours each day can be counteracted '... by more than 35·5 MET-h per week of activity' (MET is the Metabolic Equivalent of Task (MET) with a value of 7 for jogging). But making links between physical inactivity and premature death are fraught with mixed messages (Am J Clin Nutr 10.3945/ajcn.114.100065).

Returning to periodontal disease, as compliance/adherence with supportive periodontal therapy is sub-optimal in those that smoke (J Clin Periodontol 2014;41: 473–480), some adopt more conservative therapies until they quit. Should a similar approach be adopted for those who are overweight but are not taking on the necessary lifestyle change in order to lose weight?