{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T16:54:21Z","timestamp":1789750461625,"version":"4.0.1"},"reference-count":102,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:p>Engel's Bio-Psycho-Social (BPS) model (1977) reframed healthcare by integrating biological, psychological, and social perspectives. Despite its influence, the model has been criticized for insufficient specificity in domains critical to precision health, including nutrition, lifestyle, socioeconomic, environmental, and structural factors. To address these limitations, we propose the Personalized Health Determinants Model (PHDm), a comprehensive nine-dimension framework, Biological, Psychological, Social, Cultural, Environmental, Economic, Political, Spiritual, and Lifestyle, synthesized from Engel's BPS model, the WHO Commission on Social Determinants of Health, CDC frameworks, and related literature. Section 2.0 provides a detailed evidence-based rationale for the dimensions and their relationship to prior frameworks. The PHDm organizes each dimension hierarchically into categories, sub-categories, and measurable health elements (theoretical maximum \u221272,000), with only tailored, clinically relevant subsets applied in practice. Using obesity as a case study, we illustrate operationalization through a Bayesian Network and a complementary rule-based scoring system. Four exemplar factors, insulin sensitivity, dietary fiber, caloric intake, and activity frequency, are mapped into both models, enabling individualized obesity risk quantification and intervention simulation. Preliminary evaluation on NHANES data yielded \u221285% predictive accuracy for the Bayesian Network and \u221280% concordance for the rule-based system. This manuscript presents the PHDm as a conceptual framework with illustrative operationalization. While the Bayesian Network and rule-based approaches demonstrate promising preliminary performance on NHANES data, the current model, based on four simplified factors and binary thresholds, remains a proof-of-concept prototype and is not yet a clinically validated decision-support tool. Further development, external validation, and integration into electronic health records will be required before clinical deployment.<\/jats:p>","DOI":"10.3389\/fdgth.2026.1763691","type":"journal-article","created":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:40:41Z","timestamp":1781070041000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["From Engel's Bio-Psycho-Social model to the personalized health determinants model: a comprehensive framework and illustrative operationalization for precision health"],"prefix":"10.3389","volume":"8","author":[{"given":"Nazanin","family":"Abbaspour","sequence":"first","affiliation":[{"name":"Family Health Centers of San Diego","place":["San Diego, CA, United States"]},{"name":"NutraLumina Integrative & Functional Nutrition","place":["San Diego, CA, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mory","family":"Ghomshei","sequence":"additional","affiliation":[{"name":"Tecto Energy Inc, Vancouver, BC, Canada"},{"name":"Carnotech Energy Inc","place":["Vancouver, BC, Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ario Saeid","family":"Vaghefi","sequence":"additional","affiliation":[{"name":"Department of Geography, University of Zurich","place":["Zurich, Switzerland"]},{"name":"WMO","place":["Geneva, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Abbaspour","sequence":"additional","affiliation":[{"name":"2w2e Consulting, GmbH","place":["D\u00fcbendorf, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1126\/science.847460","article-title":"The need for a new medical model: a challenge for biomedicine","volume":"196","author":"Engel","year":"1977","journal-title":"Science"},{"key":"B2","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1370\/afm.245","article-title":"The biopsychosocial model 25 years later: principles, practice, and scientific inquiry","volume":"2","author":"Borrell-Carri\u00f3","year":"2004","journal-title":"Ann Fam Med"},{"key":"B3","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-11899-0","article-title":"Chapter 1, the biopsychosocial model 40 years on","volume-title":"The Biopsychosocial Model of Health and Disease: New Philosophical and Scientific Developments","author":"Bolton","year":"2019"},{"key":"B4","year":"2025"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1192\/bjb.2022.29","article-title":"The biopsychosocial model: not dead, but in need of revival","volume":"46","author":"Williamson","year":"2022","journal-title":"BJPsych Bull"},{"key":"B6","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1080\/20476965.2022.2029584","article-title":"The biopsychosociotechnical model: a systems-based framework for human-centered health improvement","volume":"12","author":"Card","year":"2022","journal-title":"Health Syst"},{"key":"B7","doi-asserted-by":"publisher","first-page":"725045","DOI":"10.3389\/fpsyt.2021.725045","article-title":"The biobehavioral family model: an evidence-based approach to biopsychosocial research, residency training, and patient care","volume":"12","author":"Wood","year":"2021","journal-title":"Front Psychiatry"},{"key":"B8","doi-asserted-by":"publisher","first-page":"86","DOI":"10.3109\/00048679809062712","article-title":"A critical review of the biopsychosocial model","volume":"32","author":"McLaren","year":"1998","journal-title":"Aust N Zeal J Psychiatry"},{"key":"B9","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1177\/10398562211037333","article-title":"The biopsychosocial model \u2013 history, controversy and engel","volume":"30","author":"Lugg","year":"2021","journal-title":"Aust Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","first-page":"4399","DOI":"10.1038\/s41380-025-03072-3","article-title":"Practical AI application in psychiatry: historical review and future directions","volume":"30","author":"Sun","year":"2025","journal-title":"Mol Psychiatry"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e75238","DOI":"10.2196\/75238","article-title":"Applications of artificial intelligence in psychiatry and psychology education: scoping review","volume":"11","author":"Pr\u00e9gent","year":"2025","journal-title":"JMIR Med Educ"},{"key":"B12","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1186\/s12888-025-06957-3","article-title":"AI For mental health: clinician expectations and priorities in computational psychiatry","volume":"25","author":"Fischer","year":"2025","journal-title":"BMC Psychiatry"},{"key":"B13","author":"Lucente","year":"2025"},{"key":"B14","doi-asserted-by":"publisher","first-page":"37","DOI":"10.3390\/biomedinformatics5030037","article-title":"Generative artificial intelligence in healthcare: applications, implementation challenges, and future directions","volume":"5","author":"Rabbani","year":"2025","journal-title":"BioMedInformatics"},{"key":"B15","doi-asserted-by":"publisher","first-page":"113568","DOI":"10.1016\/j.socscimed.2020.113568","article-title":"Making the biopsychosocial model more scientific-its general and specific models","volume":"272","author":"Smith","year":"2021","journal-title":"Soc Sci Med"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e0000941","DOI":"10.1371\/journal.pdig.0000941","article-title":"Integrating equity, diversity, and inclusion throughout the lifecycle of artificial intelligence for healthcare: a scoping review","volume":"4","author":"Wang","year":"2025","journal-title":"PLOS Digit Health"},{"key":"B17","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1177\/02692155177098","article-title":"The biopsychosocial model of illness: a model whose time has come","volume":"31","author":"Wade","year":"2017","journal-title":"Clin Rehabil"},{"key":"B18","doi-asserted-by":"publisher","first-page":"100755","DOI":"10.1016\/j.newideapsych.2019.100755","article-title":"The past, present, and future of the biopsychosocial model: a review of the biopsychosocial model of health and disease: new philosophical and scientific developments by derek bolton and grant gillett","volume":"57","author":"Frazier","year":"2020","journal-title":"New Ideas in Psychol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e12039","DOI":"10.1002\/ccs3.12039","article-title":"The signaling pathways in obesity-related complications","volume":"18","author":"Chandrasekaran","year":"2024","journal-title":"J Cell Commun Signal"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2403","DOI":"10.1016\/j.apsb.2023.01.012","article-title":"Pathophysiology of obesity and its associated diseases","volume":"13","author":"Jin","year":"2023","journal-title":"Acta Pharm Sin B"},{"key":"B21","doi-asserted-by":"publisher","first-page":"455S","DOI":"10.3945\/ajcn.2008.26717B","article-title":"Regulation of skeletal muscle mitochondrial fatty acid metabolism in lean and obese individuals","volume":"89","author":"Holloway","year":"2009","journal-title":"Am J Clin Nutr"},{"key":"B22","year":"2008"},{"key":"B23","year":""},{"key":"B24","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1161\/CIRCRESAHA.121.319811","article-title":"Social determinants of cardiovascular disease","volume":"130","author":"Powell-Wiley","year":"2022","journal-title":"Circ Res"},{"key":"B25","doi-asserted-by":"crossref","DOI":"10.56021\/9781421437903","volume-title":"The Political Determinants of Health","author":"Dawes","year":"2020"},{"key":"B26","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1093\/geront\/42.suppl_3.24","article-title":"A biopsychosocial\u2013spiritual model for the care of patients at the end of life","volume":"42","author":"Sulmasy","year":"2002","journal-title":"Gerontologist"},{"key":"B27","doi-asserted-by":"publisher","first-page":"79","DOI":"10.3390\/medicines4040079","article-title":"Are we ready for a true biopsychosocial\u2013spiritual model? The many meanings of \u201cspiritual\u201d","volume":"4","author":"Saad","year":"2017","journal-title":"Medicines"},{"key":"B28","doi-asserted-by":"publisher","first-page":"2561","DOI":"10.1152\/physrev.00022.2022","article-title":"Physiology of sedentary behavior","volume":"103","author":"Pinto","year":"2023","journal-title":"Physiol rev"},{"key":"B29","doi-asserted-by":"publisher","first-page":"104696","DOI":"10.1016\/j.appet.2020.104696","article-title":"Processed food consumption is associated with diet quality, but not weight status, in a sample of low-income and ethnically diverse elementary school children","volume":"151","author":"Bleiweiss-Sande","year":"2020","journal-title":"Appetite"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e2452185","DOI":"10.1001\/jamanetworkopen.2024.52185","article-title":"Aerobic exercise and weight loss in adults: a systematic review and dose-response meta-analysis","volume":"7","author":"Jayedi","year":"2024","journal-title":"JAMA Netw Open"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.3390\/nu14081549","article-title":"Sleep deprivation: effects on weight loss and weight loss maintenance","volume":"14","author":"Papatriantafyllou","year":"2022","journal-title":"Nutrients"},{"key":"B32","doi-asserted-by":"publisher","first-page":"265","DOI":"10.3390\/nu15020265","article-title":"High added sugars intake among US adults: characteristics, eating occasions, and top sources, 2015\u2013201 8","volume":"15","author":"Lee","year":"2023","journal-title":"Nutrients"},{"key":"B33","year":"2024"},{"key":"B34","volume-title":"Probabilistic Reasoning in Intelligent Systems","author":"Pearl","year":"1988"},{"key":"B35","doi-asserted-by":"crossref","DOI":"10.1002\/9781118548387","volume-title":"Applied Logistic Regression","author":"Hosmer","year":"2013"},{"key":"B36","article-title":"Nutrition: macronutrient intake, imbalances, and interventions","volume-title":"StatPearls","author":"Espinosa-Salas","year":"2025"},{"key":"B37","doi-asserted-by":"publisher","first-page":"100468","DOI":"10.1016\/j.afres.2024.100468","article-title":"Fermentation\u2019s pivotal role in shaping the future of plant-based foods: an integrative review of fermentation processes and their impact on sensory and health benefits","volume":"4","author":"Abbaspour","year":"2024","journal-title":"Appl Food Res"},{"key":"B38","doi-asserted-by":"publisher","first-page":"244","DOI":"10.15406\/aowmc.2015.03.00068","article-title":"Role of fiber and healthy dietary patterns in body weight regulation and weight loss","volume":"3","author":"Dreher","year":"2015","journal-title":"Adv Obes Weight Manag Control"},{"key":"B39","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1186\/s12986-016-0141-7","article-title":"Effect on body weight and composition in overweight\/obese Australian adults over 12 months consumption of two different types of fibre supplementation in a randomized trial","volume":"13","author":"Pal","year":"2016","journal-title":"Nutr Metab"},{"key":"B40","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1111\/j.1753-4887.2001.tb07001.x","article-title":"Dietary fiber and weight regulation","volume":"59","author":"Howarth","year":"2001","journal-title":"Nutr Rev"},{"key":"B41","doi-asserted-by":"publisher","first-page":"329","DOI":"10.3945\/ajcn.2009.28191","article-title":"Dietary fiber and subsequent changes in body weight and waist circumference in European men and women","volume":"91","author":"Du","year":"2010","journal-title":"Am J Clin Nutr"},{"key":"B42","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1038\/oby.2011.171","article-title":"Lifestyle factors and 5-year abdominal fat accumulation in a minority cohort: the IRAS family study","volume":"20","author":"Hairston","year":"2012","journal-title":"Obesity (Silver Spring)"},{"key":"B43","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.3390\/nu5041417","article-title":"Fiber and prebiotics: mechanisms and health benefits","volume":"5","author":"Slavin","year":"2013","journal-title":"Nutrients"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1510564","DOI":"10.3389\/fnut.2024.1510564","article-title":"Dietary fiber influence on overall health, with an emphasis on CVD, diabetes, obesity, colon cancer, and inflammation","volume":"13","author":"Alahmari","year":"2024","journal-title":"Front Nutr"},{"key":"B45","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1080\/19490976.2015.1134082","article-title":"Formation of short chain fatty acids by the gut microbiota and their impact on human metabolism","volume":"7","author":"Morrison","year":"2016","journal-title":"Gut Microbes"},{"key":"B46","doi-asserted-by":"publisher","first-page":"100070","DOI":"10.1016\/j.medmic.2022.100070","article-title":"The gut microbiome: linking dietary fiber to inflammatory diseases","volume":"14","author":"Zhang","year":"2022","journal-title":"Med Microecol"},{"key":"B47","doi-asserted-by":"publisher","first-page":"2297864","DOI":"10.1080\/19490976.2023.2297864","article-title":"Elucidating the role of diet in maintaining gut health to reduce the risk of obesity, cardiovascular and other age-related inflammatory diseases: recent challenges and future recommendations","volume":"16","author":"Aziz","year":"2024","journal-title":"Gut Microbes"},{"key":"B48","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1001\/archinte.167.5.502","article-title":"Effect of a high-fiber diet vs a fiber-supplemented diet on C-reactive protein level","volume":"167","author":"King","year":"2007","journal-title":"Arch Intern Med"},{"key":"B49","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1017\/S0007114518003872","article-title":"Associations between dietary insulin load with cardiovascular risk factors and inflammatory parameters in elderly men: a cross-sectional study","volume":"121","author":"Mozaffari","year":"2019","journal-title":"Br J Nutr"},{"key":"B50","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1177\/2150131913520328","article-title":"Insulin sensitivity following exercise interventions: systematic review and meta-analysis of outcomes among healthy adults","volume":"5","author":"Conn","year":"2014","journal-title":"J Prim Care Community Health"},{"key":"B51","doi-asserted-by":"publisher","first-page":"e282","DOI":"10.1038\/nutd.2017.31","article-title":"Enhanced insulin sensitivity in successful, long-term weight loss maintainers compared with matched controls with no weight loss history","volume":"7","author":"Clamp","year":"2017","journal-title":"Nutr Diabetes"},{"key":"B52","doi-asserted-by":"publisher","first-page":"789","DOI":"10.1038\/oby.2004.95","article-title":"Exercise-induced reduction in obesity and insulin resistance in women: a randomized controlled trial","volume":"12","author":"Ross","year":"2004","journal-title":"Obes Res"},{"key":"B53","doi-asserted-by":"publisher","first-page":"e32","DOI":"10.1038\/nutd.2012.5","article-title":"Effect of moderate weight loss on hepatic, pancreatic and visceral lipids in obese subjects","volume":"2","author":"Rossi","year":"2012","journal-title":"Nutr & Diabetes"},{"key":"B54","doi-asserted-by":"publisher","first-page":"e70586","DOI":"10.1002\/fsn3.70586","article-title":"Intermittent fasting and hormonal regulation: pathways to improved metabolic health","volume":"13","author":"Shkorfu","year":"2025","journal-title":"Food Sci Nutr"},{"key":"B55","doi-asserted-by":"publisher","first-page":"930","DOI":"10.1001\/jamainternmed.2017.0936","article-title":"Effect of alternate-day fasting on weight loss, weight maintenance, and cardioprotection among metabolically healthy obese adults: a randomized clinical trial","volume":"177","author":"Trepanowski","year":"2017","journal-title":"JAMA intern Med"},{"key":"B56","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s11154-013-9283-3","article-title":"Adiponectin and energy homeostasis","volume":"15","author":"Lee","year":"2014","journal-title":"Rev Endocr Metab Disord"},{"key":"B57","doi-asserted-by":"publisher","first-page":"118388","DOI":"10.1016\/j.biopha.2025.118388","article-title":"Targeting the root cause of obesity-related comorbidities through weight independent and dependent actions on insulin sensitivity: benefits of dual amylin and calcitonin receptor agonists","volume":"190","author":"Larsen","year":"2025","journal-title":"Biomed Pharmacother"},{"key":"B58","doi-asserted-by":"publisher","first-page":"55","DOI":"10.3390\/diseases13020055","article-title":"The human energy balance: uncovering the hidden variables of obesity","volume":"13","author":"Theodorakis","year":"2025","journal-title":"Diseases"},{"key":"B59","year":"2000"},{"key":"B60","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1016\/S0140-6736(11)60812-X","article-title":"Quantification of the effect of energy imbalance on bodyweight","volume":"378","author":"Hall","year":"2011","journal-title":"Lancet"},{"key":"B61","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1001\/jama.2011.1918","article-title":"Effect of dietary protein content on weight gain, energy expenditure, and body composition during overeating: a randomized controlled trial","volume":"307","author":"Bray","year":"2012","journal-title":"JAMA"},{"key":"B62","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1186\/s12944-018-0887-1","article-title":"Metabolomics identifies increases in the acylcarnitine profiles in the plasma of overweight subjects in response to mild weight loss: a randomized, controlled design study","volume":"17","author":"Kang","year":"2018","journal-title":"Lipids Health Dis"},{"key":"B63","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1016\/j.jand.2014.02.003","article-title":"Time to correctly predict the amount of weight loss with dieting","volume":"114","author":"Thomas","year":"2014","journal-title":"J Acad Nutr Diet"},{"key":"B64","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1007\/s13679-016-0237-4","article-title":"Changes in energy expenditure with weight gain and weight loss in humans","volume":"5","author":"M\u00fcller","year":"2016","journal-title":"Curr Obes Rep"},{"key":"B65","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/j.cmet.2015.07.021","article-title":"Calorie for calorie, dietary fat restriction results in more body fat loss than carbohydrate restriction in people with obesity","volume":"22","author":"Hall","year":"2015","journal-title":"Cell Metab"},{"key":"B66","doi-asserted-by":"publisher","first-page":"3294","DOI":"10.2337\/dc14-1433","article-title":"High calorie intake is associated with worsening insulin resistance and \u03b2-cell function in hispanic women after gestational diabetes mellitus","volume":"37","author":"Chen","year":"2014","journal-title":"Diab Care"},{"key":"B67","first-page":"3","article-title":"Study on dietary constituents, hs-CRP serum levels and investigation of correlation between them in excess weight adolescents","volume":"23","author":"Karampola","year":"2019","journal-title":"Hippokratia"},{"key":"B68","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1007\/s10552-017-0869-z","article-title":"Energy balance and obesity: what are the main drivers?","volume":"28","author":"Romieu","year":"2017","journal-title":"Cancer Causes Control"},{"key":"B69","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1037\/amp0000517","article-title":"Lifestyle modification approaches for the treatment of obesity in adults","volume":"75","author":"Wadden","year":"2020","journal-title":"Am. Psychol"},{"key":"B70","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1186\/s12966-025-01754-3","article-title":"Effect of physical activity on changes in weight and aerobic capacity during an 18-month behavioral weight loss intervention","volume":"22","author":"Creasy","year":"2025","journal-title":"Int J Behav Nutr Phys Act"},{"key":"B71","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1158\/1055-9965.EPI-16-0545","article-title":"Reallocating time to sleep, sedentary time, or physical activity: associations with waist circumference and body mass index in breast cancer survivors","volume":"26","author":"Boyle","year":"2017","journal-title":"Cancer Epidemiol Biomark Prev"},{"key":"B72","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1123\/jpah.2017-0585","article-title":"Energy expenditure and intensity of group-based high-intensity functional training: a brief report","volume":"16","author":"Willis","year":"2019","journal-title":"J Phys Act Health"},{"key":"B73","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1055\/s-0030-1249621","article-title":"Effects of one year aerobic endurance training on resting metabolic rate and exercise fat oxidation in previously untrained men and women. Metabolic endurance training adaptations","volume":"31","author":"Scharhag-Rosenberger","year":"2010","journal-title":"Int J Sports Med"},{"key":"B74","doi-asserted-by":"publisher","first-page":"E503","DOI":"10.1152\/ajpendo.00338.2023","article-title":"Sedentary time associates detrimentally and physical activity beneficially with metabolic flexibility in adults with metabolic syndrome","volume":"326","author":"Garthwaite","year":"2024","journal-title":"Am J Physiol Endoctrinol Metab"},{"key":"B75","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1186\/s40798-022-00541-9","article-title":"Associations between wearable-specific indicators of physical activity behaviour and insulin sensitivity and glycated haem.oglobin in the general population: results from the ORISCAV-LUX 2 study","volume":"8","author":"Backes","year":"2022","journal-title":"Sports Med Open"},{"key":"B76","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1152\/japplphysiol.00707.2003","article-title":"Effect of the volume and intensity of exercise training on insulin sensitivity","volume":"96","author":"Houmard","year":"2004","journal-title":"J Appl Physiol"},{"key":"B77","doi-asserted-by":"publisher","first-page":"34","DOI":"10.20463\/pan.2023.0035","article-title":"Effect of physical activity levels on blood lipids, insulin resistance, and adipokines in children with obesity","volume":"27","author":"Sohn","year":"2023","journal-title":"Phys Act Nutr"},{"key":"B78","doi-asserted-by":"publisher","first-page":"8328","DOI":"10.3390\/ijerph19148328","article-title":"The long-term association between physical activity and weight regain, metabolic risk factors, quality of life and sleep after bariatric surgery","volume":"19","author":"Santos","year":"2022","journal-title":"Int J Environ Res Pub Health"},{"key":"B79","doi-asserted-by":"publisher","first-page":"1550","DOI":"10.1001\/archinte.168.14.1550","article-title":"Effect of exercise on 24-month weight loss maintenance in overweight women","volume":"168","author":"Jakicic","year":"2008","journal-title":"Arch Intern Med"},{"key":"B80","article-title":"WISP-1 in obesity and metabolic dysfunction: the modulatory role of exercise training- A narrative review","volume":"3","author":"Dehghan","year":"2026","journal-title":"Health Nexus"},{"key":"B81","doi-asserted-by":"publisher","first-page":"34","DOI":"10.61838\/kman.hn.3.2.5","article-title":"The effect of selected exercises on the motor development of overweight and obese Iraqi children aged 8 to 9 years: the moderating role of gender","volume":"3","author":"Bayyat Mohammad","year":"2025","journal-title":"Health Nexus"},{"key":"B82","doi-asserted-by":"publisher","first-page":"1602600","DOI":"10.3389\/fnut.2025.1602600","article-title":"Association between dietary fiber intake and obesity in US adults: from NHANES 1999\u20132018","volume":"12","author":"Lai","year":"2025","journal-title":"Front Nutr"},{"key":"B83","doi-asserted-by":"publisher","first-page":"1591677","DOI":"10.3389\/fendo.2025.1591677","article-title":"Evaluating indices of insulin resistance and estimating the prevalence of insulin resistance in a large biobank cohort","volume":"16","author":"Aliyu","year":"2025","journal-title":"Front Endocrinol"},{"key":"B84","author":"Emmerich","year":"2024"},{"key":"B85","year":""},{"key":"B86","doi-asserted-by":"publisher","first-page":"100210","DOI":"10.1016\/j.jcte.2019.100210","article-title":"Association between obesity phenotypes of insulin resistance and risk of type 2 diabetes in African Americans: the Jackson heart study","volume":"19","author":"Lee","year":"2019","journal-title":"J Clin Transl Endocrinol"},{"key":"B87","doi-asserted-by":"publisher","first-page":"2595","DOI":"10.1210\/jc.2004-0372","article-title":"Obesity, metabolic syndrome, and cardiovascular disease","volume":"89","author":"Grundy","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"B88","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/S0140-6736(18)31809-9","article-title":"Carbohydrate quality and human health: a series of systematic reviews and meta-analyses","volume":"393","author":"Reynolds","year":"2019","journal-title":"Lancet"},{"key":"B89","doi-asserted-by":"publisher","first-page":"3236","DOI":"10.1146\/annurev.nutr.24.012003.132155","article-title":"The insulin resistance syndrome: definition and dietary approaches to treatment","volume":"90","author":"Reaven","year":"2005","journal-title":"J Clin Endocrinol Metab"},{"key":"B90","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1186\/s12889-025-21404-4","article-title":"Risk factors for progression to type 2 diabetes in prediabetes: a systematic review and meta-analysis","volume":"25","author":"Hu","year":"2025","journal-title":"BMC Pub Health"},{"key":"B91","doi-asserted-by":"publisher","first-page":"327","DOI":"10.3305\/nh.2010.25.3.4459","article-title":"Dietary fibre: influence on body weight, glycemic control and plasma cholesterol profile","volume":"25","author":"Babio","year":"2010","journal-title":"Nutr Hosp"},{"key":"B92","doi-asserted-by":"publisher","first-page":"1968","DOI":"10.1038\/s41598-024-52263-5","article-title":"Dietary insulin index, dietary insulin load and dietary patterns and the risk of metabolic syndrome in hoveyzeh cohort study","volume":"14","author":"Elyasi","year":"2024","journal-title":"Sci Rep"},{"key":"B93","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1007\/s44187-025-00422-6","article-title":"New insight on dietary strategies to increase insulin sensitivity and reduce diabetes prevalence: an expert perspective and recommendation","volume":"5","author":"Nurkolis","year":"2025","journal-title":"Discov Food"},{"key":"B94","author":"Fryar","year":"2020"},{"key":"B95","first-page":"1","article-title":"Pgmpy: a python toolkit for Bayesian networks","volume":"25","author":"Ankan","year":"2024","journal-title":"J Mach Lear Res"},{"key":"B96","doi-asserted-by":"publisher","first-page":"1597864","DOI":"10.3389\/fnut.2025.1597864","article-title":"Machine learning with decision curve analysis evaluates nutritional metabolic biomarkers for cardiovascular-kidney-metabolic risk: an NHANES analysis","volume":"12","author":"Huang","year":"2025","journal-title":"Front Nutr"},{"key":"B97","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v035.i03","article-title":"Learning Bayesian networks with the bnlearn R package","volume":"35","author":"Scutari","year":"2010","journal-title":"J Stat Software"},{"key":"B98","article-title":"Evidence-Based medicine","volume-title":"StatPearls","author":"Tenny","year":"2025"},{"key":"B99","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1038\/s41576-021-00414-z","article-title":"The genetics of obesity: from discovery to biology","volume":"23","author":"Loos","year":"2022","journal-title":"Nat Rev Genet"},{"key":"B100","doi-asserted-by":"publisher","first-page":"846","DOI":"10.7326\/0003-4819-141-11-200412070-00008","article-title":"Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite","volume":"141","author":"Spiegel","year":"2004","journal-title":"Ann Intern Med"},{"key":"B101","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1016\/j.sleh.2014.12.010","article-title":"National sleep foundation\u2019s sleep time duration recommendations: methodology and results summary","volume":"1","author":"Hirshkowitz","year":"2015","journal-title":"Sleep Health"},{"key":"B102","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/S0140-6736(03)15268-3","article-title":"Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies","volume":"363","year":"2004","journal-title":"Lancet"}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2026.1763691\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T05:40:47Z","timestamp":1781070047000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2026.1763691\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,10]]},"references-count":102,"alternative-id":["10.3389\/fdgth.2026.1763691"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2026.1763691","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,10]]},"article-number":"1763691"}}