Obesity in adults: a clinical practice guideline

Grandmaternal perinatal serum polychlorinated biphenyls and prevalence of obesity in adult daughters and granddaughters

OBJECTIVE

We investigated in utero exposure to polychlorinated biphenyl (PCB) 138, PCB 153, and PCB 180 and obesity at reproductive age in a three-generation human cohort, i.e., the Child Health and Development Studies.

METHODS

We used logistic models to estimate associations of PCBs in grandmothers' (F0) archived perinatal serum with obesity in daughters (F1) at age 30 years and granddaughters (F2) at age 26 years, accounting for family clustering (n = 258 triads). In order to reflect mixture exposures, we modeled PCBs as a ratio of the sum of PCB 138 + PCB 180 to PCB 153 (i.e., "PCB ratio").

RESULTS

An increase in the PCB ratio from the first to the third tertile corresponded to a 1.73 (95% CI: 1.06-2.82) increase in the odds of F1 obesity and a 1.96 (95% CI: 1.12-3.42) increase in the odds of F2 obesity. The association with F2 obesity differed by F0 BMI (p value for interaction = 0.08). F1 obesity was also associated with F2 obesity (odds ratio, 4.12, 95% CI: 1.95-8.72).

CONCLUSIONS

Grandmothers' perinatal serum levels of mixtures of PCBs may have triggered a multigenerational cycle of obesity in daughters and granddaughters. Resultant obesity among women of reproductive age could further perpetuate obesity in subsequent generations.

Management and impact of obesity in Canada: A real-world survey of people with obesity and their physicians

Background

Obesity is a chronic relapsing disease associated with multiple complications. This study described real-world demographic/clinical characteristics, including obesity-related complications (ORCs), prescribing rationale, and patient-reported outcome measures (PROMs) for adults living with obesity in Canada accessing treatment.

Methods

This was a cross-sectional survey of physicians and consulting people with obesity (PwO) in Canada with retrospective data capture in a real-world setting. Canadian data were drawn between July and November 2022 from the multinational Adelphi Real World Obesity Disease Specific Programme™. Consulting PwO were required to be on a weight management program and/or have a current body mass index of ≥30 kg/m2. Physicians completed questionnaires for the next 3-5 consecutive PwO seen in their routine clinical practice. A quota was applied for obesity management medication (OMM). PROMs including Work Productivity and Activity Impairment (WPAI) questionnaire were provided voluntarily by PwO. Analyses were descriptive.

Results

Overall, 50 physicians (35 general practitioners, 15 endocrinologists) and 199 PwO were analyzed. More than 85 % of PwO had ≥1 ORC. The most common ORCs were hypertension, dyslipidemia, depression, and type 2 diabetes, and one-quarter to one-half of ORCs were not optimally controlled. Approximately two-thirds of the cohort were employed full-time, almost half had private insurance, and almost 70 % were classified as high socio-economic status. Mean number of weight-reduction attempts over the past 3 years was 2.9. Pharmacological treatment for obesity was common among those with ORCs. A general trend towards greater work impairment among people with ORCs than for PwO without ORCs was observed.

Conclusions

Among PwO participating in our study, ORCs were common, often uncontrolled, and their presence impacted the likelihood of obesity treatment and possibly impaired work productivity. Medical treatment for obesity was often delayed until ORCs developed, suggesting that preventative healthcare measures are not the norm for PwO in Canada. A large proportion of PwO had high socioeconomic status, suggesting that PwO who access treatment may not be representative of the overall population of PwO in Canada.

Exploring beyond numeric weight loss: The metabolic effects of semaglutide

The global burden of overweight and obesity has increased by threefold since the 1970s, which led to increased incidences of cardiovascular disease and type 2 diabetes. This review aimed to explore the metabolic impacts of semaglutide, including its effects on hunger and satiety, weight loss maintenance and regain, body composition, lipid profile, and glycemic control. Studies have shown that semaglutide reduced fat mass, particularly visceral fat, while preserving lean muscle mass, as the proportion relative to total body mass decreased by 3.5 % and 2.0 % for total and visceral fat mass, respectively, while it increased by 3.0 % for lean body mass. Also, it enhanced glycemic control, as evidenced by significant reductions in hemoglobin A1C (HbA1c) with the 0.5 mg and 1.0 mg doses. From a baseline range of 8.1-8.7 %, 0.5 mg dose lowered HbA1c by 1.2-1.5 %, while the 1.0 mg dose reduced it by 1.4-1.8 %. Furthermore, semaglutide was the only effective Glucagon Like Peptide-1 Receptor Agonist in reducing Low-Density Lipoprotein and total cholesterol levels, with mean differences of -0.16 mmol/L and -0.48 mmol/L, respectively. Evidence shows that withdrawing semaglutide led to weight regain, while continued treatment resulted in further weight loss. Semaglutide also slowed weight regain and promoted weight loss after failed bariatric surgery. It also significantly reduced ad libitum energy intake, decreased hunger, and increased satiety in multiple trials. Overall, these findings underscore the potential of semaglutide as a comprehensive treatment for obesity and type 2 diabetes.

Characterizing obesity: A qualitative study

Background

The prevalence of obesity among US adults has risen over the past several decades. In addition to bariatric surgery and behavioral weight management, several effective anti-obesity medications have emerged in the last ten years and become increasingly available. The goal of this qualitative study is to explore the perspectives of people with obesity (PwO), health professionals (HPs), and payors on obesity management and treatments.

Methods

This was a 3-group interview study using a qualitative description approach with a target sample size of 40 PwO, 30 HPs who provide care to PwO (10 primary care providers; 10 providers specializing in obesity medicine; and 10 nurse practitioners, physician assistants, or dieticians/nutritionists), and 10 payors. PwO were eligible if they had a Body Mass Index (BMI) ≥30 kg/m2 using self-reported height and weight and the National Institutes of Health (NIH) BMI calculator and were recruited via an online research registry. Health professionals and payors were recruited via direct contact from the research team and sponsor's professional networks in the United States.

Results

A total of 38 PwO, 30 HPs, and 6 payors were interviewed, with PwO interviews occurring from October 2023 to March 2024 and HP/payor interviews occurring from November 2023 to May 2024. The majority of participants in each group accepted the idea of obesity as a chronic disease and that discussing obesity and weight management was important in medical contexts; however, they also acknowledged that stigma around obesity negatively impacted PwO health and health care. All participants described a treatment landscape beginning with lifestyle interventions followed by pharmaceutical or surgical treatment options.

Conclusion

This qualitative study of people with obesity, health professionals, and payors demonstrated current views of addressing and treating obesity in clinical settings. These findings could spur person-centered, less stigmatizing methods to craft plans for weight management.

The Critical Role of Lifestyle With the Use of Contemporary Obesity Management Medications

The emergence of the latest generation of obesity management medications (OMMs) or commonly referred to as "GLP-1s," are proving to be highly efficacious for the reduction of excess body weight. A comprehensive obesity care strategy in which patients are prescribed both lifestyle and medication therapy to promote holistic health and well-being are recommended. Lifestyle modification, through changes in eating and exercise behaviors, has long been a cornerstone of obesity treatment; however, there is a lack of evidence to fully demonstrate the role that lifestyle plays with the latest generation of OMMs compared to previous obesity pharmacotherapies. While obesity continues to be a significant public health problem, medical treatments for obesity have entered a new era with a promising outlook. However, there are key aspects that warrant further consideration to treat patients with obesity in a comprehensive manner that includes medical management, lifestyle, and behavioral health. Highlighted throughout are evidence-based aspects of obesity care, areas where there are gaps in evidence and critical questions remain, and opportunities for enhancing comprehensive obesity treatment.

Comparative effectiveness of various exercise interventions on cardiorespiratory fitness in adults living with overweight or obesity: A systematic review and Bayesian network meta-analysis

This study evaluated how different exercise interventions affect maximal oxygen uptake (VO2max) in adults with overweight or obesity. We systematically searched five databases from inception to February 2025 to identify relevant randomized controlled trials (RCTs). We used the Cochrane risk of bias tool. A Bayesian network meta-analysis with a random-effects model was conducted. A total of 93 RCTs involving 4,446 participants were included. The network meta-analysis showed high-intensity interval training (HIIT) ranked highest (Surface Under the Cumulative Ranking Curve [SUCRA]: 82.5%; Standardized Mean Difference [SMD]: 4.85; 95%Credible Interval [CrI]: 3.90, 5.80), followed by high-intensity aerobic training (HAT) (SUCRA: 76.7%; SMD: 4.72; 95%CrI: 3.78, 5.68), and combined aerobic and resistance training (CT) (SUCRA: 69.1%; SMD: 4.52; 95%CrI: 3.48, 5.60), with resistance training (RT) least effective (SUCRA: 18.3%; SMD: 2.57; 95%CrI: 1.32, 3.86). All six interventions effectively improved VO2max in overweight or obese adults. Among them, HIIT was most beneficial. Coaches and fitness professionals should consider these findings to help adults with overweight or obesity achieve optimal outcomes.

The Effect of Parental Collaboration on Diabetes Self-efficacy, Quality of Life and HbA1c Level in Adolescents Diagnosed with Type 1 Diabetes

Objective

Type 1 diabetes mellitus (T1D) is a chronic disease that is diagnosed relatively often in childhood and adolescence. However, care and metabolic control are difficult for both adolescents and their parents. Parental participation in the care and treatment process, especially when adolescents are developing autonomy and taking responsibility for self-care, affects both the adolescent’s perception of autonomy and may cause difficulties in self-management. This study was conducted to determine the effect of parental support on adolescents’ self-efficacy, quality of life (QoL) and glycaemic control in adolescents with T1D.

Methods

This study was descriptive and cross-sectional. Descriptive questionnaires, The Collaborative Parental Involvement Scale for Adolescents with T1D, Diabetes Management Self-efficacy Scale for Adolescents with T1D and QoL Scale in Children with Diabetes Mellitus (PedsQL 3.0) were administered to 79 adolescents with T1D. Laboratory health records were examined about participants hemoglobin A1c (HbA1c) levels measured in the last 3 months.

Results

There was no relationship between parental collaboration and adolescent’s HbA1c levels. However, there was a moderate positive relationship between parental collaboration and adolescent’s QoL (p=0.043) and a strong positive relationship between parental collaboration and adolescent’s diabetes management self-efficacy (p<0.001).

Conclusion

Adolescents who self-managed diabetes with the support of both parents, especially their fathers, who were not school absentees and had regular blood glucose measurements had better QoL. There was no relationship between HbA1c levels and parental co-operation, but there was a strong relationship between parental cooperation and adolescent self-efficacy.

Discrepancies Between Recommendations in Evidence-Based Guidelines for the Management of Obesity in Adolescents and Adults: An Evidence Map

BACKGROUND/AIM

The aim of this evidence map is to provide a systematic overview of evidence-based guidelines for the management of obesity and to highlight discrepancies between recommendations for the pediatric and adult populations. Knowing about these discrepancies may be relevant during the transition from pediatrics to adult healthcare to enable a structured, successful transfer.

METHODS

We used two already existing guideline synopses of the Institute for Quality and Efficiency in Health Care as a basis and additionally searched Embase and Medline as well as guideline portals for creating a systematic overview of evidence-based pediatric and adult guidelines on obesity management. The quality of the identified guidelines was assessed using AGREE II.

RESULTS

Thirty-nine guidelines (published 08/2017 to 08/2023), containing 1248 recommendations, were included in the review and allocated to nine different healthcare categories. Discrepancies between the pediatric and adult populations were mainly identified in diagnostics and health behavior lifestyle treatment. Gaps were found in recommendations for bariatric surgery, pharmacotherapy, and emergency (-contraception).

CONCLUSION

The unique characteristics of adolescence are insufficiently addressed in current evidence-based guidelines. Therefore, healthcare professionals may benefit from considering the discrepancies and gaps identified in this review when providing recommendations during the transition of healthcare for this age group.

Smoking, Obesity, and Post-Cessation Weight Gain: Neurobiological Intersection and Treatment Recommendations

In the US, 28.8 million adults currently smoke cigarettes, and approximately 1.25 billion people use tobacco globally. Unfortunately, post-cessation weight gain is a substantial barrier to smoking cessation and sustained abstinence. Among people who smoke, 36% meet the body mass index (BMI) criteria for obesity and over 50% meet the waist circumference criteria for central obesity. Despite this, primary care providers currently have limited guidance on how to best treat their patients who want to quit smoking without post-cessation weight gain. There are common neurobiologic and endocrine dysregulations in nicotine dependence and weight gain. For example, nicotine dependence and obesity are both associated with dysregulation in hypothalamic neuropeptide systems and dopaminergic pathways. Medications for nicotine dependence act on dopaminergic pathways and hypothalamic pro-opiomelanocortin (POMC) cells. Similarly, medications for obesity may increase dopamine and norepinephrine signaling and stimulate POMC activity. A unique medication, the fixed-dose extended-release combination of naltrexone and bupropion, supports both smoking cessation and weight loss by increasing dopamine and norepinephrine signaling and stimulating POMC-producing cells. This narrative review outlines neurobiologic mechanisms common to smoking and obesity and compares the effects of available pharmacotherapies on dopaminergic system and neuroendocrine dysregulation. Finally, this review outlines factors that primary care professionals should consider when treating people who want to stop smoking but are at risk of post-cessation weight gain.

Obesity Management Medications as Adjuncts to Metabolic and Bariatric Surgery: Consensus Recommendations from India

Obesity is a global health concern, with weight regain (WR) common after bariatric surgery. Clear guidelines on post-surgical medication use are essential. This expert consensus evaluates the role of obesity management medications (OMMs) in optimizing weight loss (WL) and preventing WR in individuals undergoing metabolic and bariatric surgery (MBS). Using a modified Delphi approach, a panel of 12 experts reviewed evidence and formulated consensus recommendations. Two voting rounds led to consensus on 11 of 15 statements, covering preoperative WL strategies and postoperative weight management. The recommendations guide OMM selection, timing, and effectiveness in enhancing WL outcomes. Integrating OMMs into bariatric care protocols can help clinicians improve long-term success rates in obesity management.

Weight stigma and bias: standards of care in overweight and obesity-2025

Weight bias involves negative attitudes and stereotypes towards individuals based on their weight, which can be explicit or implicit. This bias contributes to weight stigma, or the mistreatment and social devaluation of individuals based on weight. Weight stigma is linked to adverse physical and mental health outcomes, leading to reduced access and quality of healthcare for individuals with obesity. The American Diabetes Association (ADA)'s Obesity Association developed guidelines on recognizing and addressing weight bias and stigma. All healthcare professionals and staff should receive training on weight bias and stigma to improve care for individuals with obesity. Training should start early and continue throughout medical education and practice. Multicomponent training that combines education with hands-on learning is recommended to reduce explicit and implicit weight bias. Clinical practices, a potential source of stigmatization for people living with obesity, should be equipped with appropriate furniture and equipment to establish an inclusive environment. Privacy and sensitivity during anthropometric measurements are essential to minimize stigmatization. Healthcare professionals should use person-centered, non-judgmental language and engage individuals in shared decision-making to consider their health and goals. Asking permission to discuss weight and respecting individual preferences is crucial. The ADA's Obesity Association encourages adopting these guidelines to reduce weight bias and stigma, emphasizing education, inclusive clinical environments, and effective communication to improve obesity care.

Effects of multi-strain probiotics supplementation on body adiposity and metabolic profile in individuals with hypertension and overweight following an energy-restricted diet: A randomized clinical trial

BACKGROUND & AIMS

Recent evidence suggests that gut microbiota has a potential role in the pathophysiology of obesity and other cardiovascular disease (CVD) risk factors, including hypertension, dyslipidemia, and type 2 diabetes. However, clinical trials evaluating the effects of probiotics supplementation on these outcomes have found inconsistent results, probably due to the wide heterogeneity in trial designs. In addition, there is a lack of studies investigating whether probiotics can enhance the beneficial effects of caloric restriction in individuals with increased risk of CVD as individuals with hypertension and excess body adiposity. Thus, the aim of this study was to evaluate the effects of multi-strain probiotics supplementation on body adiposity, glycemic homeostasis, lipid profile, and serum adipokine levels in individuals with hypertension and excess body weight following an energy restricted diet.

METHODS

A randomized, double-blind, placebo controlled clinical trial was conducted for 12 weeks. Were included 66 individuals aged between 40 and 65 years; both sexes; body mass index (BMI) ≥ 25 and < 40 kg/m2 and diagnosis of hypertension. Were excluded smokers; individuals using probiotics, prebiotics, symbiotics and antibiotics in the last 3 months; presenting diabetes, chronic kidney disease or liver failure; and pregnant and lactating women. Participants were allocated into 2 groups: group with supplementation of 8 probiotic strains in capsules (3 × 1010 CFU/day) or control group (placebo capsules). Both groups followed a low-calorie diet. Participants underwent anthropometric, body composition (dual-energy radiological absorptiometry) and biochemical (glucose metabolism, lipid profile, adiponectin, and leptin) evaluation at baseline and at the end of the study.

RESULTS

After 12 weeks of intervention, the probiotics group presented: a) reduction of body weight, BMI, circumferences of waist, hip and neck and waist-to-height ratio; b) decrease in total fat mass (kg); and c) reduction of glycated hemoglobin (HbA1c). In the control group, it was observed: a) significant reduction in all anthropometric variables; b) significant reduction in total fat mass (kg and %), trunk fat mass (kg), visceral fat and load capacity index. In the comparison between groups, there was a higher decrease in HbA1c in the probiotics group (p < 0.05).

CONCLUSION

Multi-strain probiotics supplementation associated with energy restriction in individuals with excess body weight and hypertension promoted a significant improvement in glucose homeostasis assessed by HbA1c. The clinical trial was registered at www.ensaiosclinicos.gov.br: RBR-7jw4ry.

Comparative effectiveness of semaglutide versus liraglutide, dulaglutide or tirzepatide: a systematic review and meta-analysis

Background

This study seeks to compare the effectiveness of Semaglutide compared to Liraglutide, Dulaglutide, or Tirzepatide. Additionally, it aims to investigate the implications of transitioning from Dulaglutide or Liraglutide to Semaglutide.

Methods

We searched PubMed, Scopus, Cochrane Library, Google Scholar, and Web of Science (ClinicalTrials.gov for unpublished records) from their inception to 5 February 2025, including observational cohort studies and randomized controlled trials. Analyses were conducted using Review Manager (RevMan) version 5.4.1 and STATA 17.

Results

The meta-analysis comprised 16 studies and 5,997 patients. Semaglutide significantly reduced hemoglobin A1c (HbA1c) levels compared to Liraglutide (0.56; 95% CI: 0.19-0.94; p < 0.001). However, no significant differences were observed between Semaglutide and Liraglutide in terms of fasting blood sugar (FBS), body mass index (BMI), and weight change. In comparison to Dulaglutide, Semaglutide displayed superior efficacy in reducing HbA1c levels (3.72; 95% CI: 0.02-7.41; p = 0.05) and FBS (2.66; 95% CI: 0.26-5.07; p = 0.03). However, no significant differences were found in weight and BMI change. Tirzepatide exhibited a notable advantage over Semaglutide in reducing HbA1c levels (-0.45; 95% CI: -0.88 to -0.02; p = 0.04). However, no clear superiority was observed for weight and FBS change. Transitions from Liraglutide to Semaglutide did not significantly impact HbA1c levels. However, weight loss (2.48; 95% CI: 0.45-4.51; p = 0.02) and reduced FBS levels (10.76; 95% CI: 0.55-20; p = 0.04) were observed. Transitioning from Dulaglutide to Semaglutide did not significantly affect HbA1c levels and weight change.

Conclusion

While the precise source of heterogeneity remains elusive across most studies, analyses consistently demonstrate Semaglutide's superior efficacy compared to Liraglutide in reducing both HbA1c levels and weight. Moreover, it presents advantages over Dulaglutide, specifically in lowering FBS levels. However, Tirzepatide surpasses Semaglutide in its efficacy for reducing HbA1c levels.

A pilot pragmatic randomized controlled trial of a 12-month Healthy Lifestyles Program: A collaborative care model for chronic conditions addressing behavioural change

BACKGROUND

Lifestyle or behavioural changes can help to address the burden associated with chronic diseases. However, they take time and use of multiple techniques or strategies tailored to a person's needs. The primary objective of this study was to assess the feasibility of the Healthy Lifestyles Program (HLP), a novel 12-month complex intervention based in cognitive behavioural therapy and theories of behaviour change, delivered in a community-based setting in Hamilton, Canada. The secondary objective of the study was to explore implementation factors of the HLP.

METHODS

This pilot pragmatic randomised controlled trial used quantitative and qualitative evaluation methods. Participants were randomly allocated to either intervention group (n = 15) or comparator group (n = 15). The intervention group attended weekly group education sessions and met with the program intervention team monthly to create and review personalized health goals and action plans. The comparator group met with a trained research assistant every three months to develop health goals and action plans. We assessed program feasibility by measuring recruitment, participation and retention rates, missing data, and attendance. Implementation was assessed in accordance with the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Participant-directed and clinical outcome measures were analyzed for between and within group changes using Generalized Estimating Equations (GEE). Thematic analysis was conducted for qualitative data.

RESULTS

Retention rate was 60% (9/15) for the intervention group and 47% (7/15) for the comparator group. Less than 1% of participant-directed and clinical outcomes were missing for those that completed the study. Participants attended an average of 29 of 43 educational sessions and 100% of one-to-one sessions. The program intervention team valued the holistic approach to care, increased time and interaction with participants, professional collaboration, and the ability to provide counselling and health support. Location accessibility was an important factor facilitating implementation. Reducing the number of psycho-social education sessions and having access to a gym could improve retention and program delivery for a larger trial.

CONCLUSION

This study demonstrated the feasibility of the HLP with minor modifications recommended for a larger trial and for the intervention.

Tirzepatide and health-related quality of life in adults with obesity or overweight: Results from the SURMOUNT-3 phase 3 randomized trial

AIMS

Tirzepatide reduced weight significantly more than placebo in adults with obesity/overweight who had already achieved ≥5% weight reduction with a 12-week intensive lifestyle intervention (randomized population) in SURMOUNT-3, a phase 3, 72-week, randomized, double-blind clinical trial. This analysis evaluated health-related quality of life (HRQoL) with tirzepatide versus placebo treatment in the SURMOUNT-3 randomized population and selected subgroups.

MATERIALS AND METHODS

The randomized population received placebo (N = 292) or tirzepatide maximum tolerated dose (N = 287) for 72 weeks. HRQoL was assessed from randomization to week 72 using the Short Form-36 Version 2 Health Survey acute form, Impact of Weight on Quality of Life-Lite Clinical Trials Version, 5-level EQ-5D version Health State Index, EQ visual analogue scale and the Patient Global Impression of Status (PGIS) for Physical Activity. In tirzepatide recipients, changes in HRQoL scores from randomization to week 72 were descriptively summarized by achievement of weight reduction thresholds, and for those with versus without physical function limitations at randomization (identified with PGIS for Physical Activity).

RESULTS

Tirzepatide was associated with significantly larger improvements than placebo in most HRQoL measures from randomization to 72 weeks. Improvements in tirzepatide recipients were generally numerically larger in those who met greater weight reduction thresholds. HRQoL score changes showed greater improvements for adults with versus without physical function limitations for all measures.

CONCLUSIONS

Tirzepatide improved HRQoL in adults with obesity/overweight and was generally associated with larger improvements in adults meeting greater weight reduction thresholds and in adults with versus without reported physical function limitations at randomization.

PLAIN LANGUAGE SUMMARY

What is the context and purpose of this research study? In a clinical trial called SURMOUNT-3, tirzepatide was significantly better than placebo for reducing weight in adults with obesity/overweight who had already lost ≥5% weight following a 12-week intensive lifestyle programme. This analysis looked at the effects of tirzepatide compared with placebo for 72 weeks on quality of life (QoL) in SURMOUNT-3. In addition, among tirzepatide recipients, the relationship between meeting different weight reduction thresholds and changes in QoL was described as was the association of tirzepatide with QoL in study participants who had physical limitations at randomization. What was done? Eligible adults with obesity/overweight were enrolled in a 12-week intensive lifestyle programme. Those who lost ≥5% of initial weight at the end of the 12 weeks were invited to continue participating in the study and were randomly assigned to receive injections of either their maximum tolerated dose of tirzepatide (10 or 15 mg) or placebo for 72 weeks via single-dose pens. QoL was measured using a number of well-established surveys that assessed general health, the impact of weight on QoL and the impact of health on the level of physical ability in day-to-day life. These surveys were completed by the study participants when they were first assigned treatment with tirzepatide or placebo (randomization) and again after 72 weeks of treatment. The difference in scores from randomization to week 72 was then calculated to determine whether or not the QoL of participants had improved with treatment. In addition, in participants who took tirzepatide, changes in QoL scores from randomization to week 72 were summarized by weight reduction thresholds (≥5%, ≥10%, ≥15%, ≥20%, ≥25%), and for those with versus without physical limitations at randomization. What were the main results? Adults with obesity/overweight who had already lost ≥5% weight with a 12-week intensive lifestyle programme who then took tirzepatide for 72 weeks not only had significantly more weight loss compared with those taking placebo, but they also had significantly improved QoL. These improvements in QoL were generally larger with greater weight loss and in adults who reported physical limitations at randomization compared to those who reported no such limitations. The improvements in QoL were observed in physical function as well as in general mental health and weight-related psychological and social functions. What is the originality and relevance of this study? Findings of this study show that in addition to reducing weight in people who have already lost ≥5% weight after lifestyle interventions, tirzepatide improved QoL. This is important because other studies have shown that people with obesity have reduced QoL. Tirzepatide was generally associated with improved QoL the most in adults who had greater weight loss and in adults who reported physical limitations at randomization.

The Interplay Between Psychological and Neurobiological Predictors of Weight Regain: A Narrative Review

Introduction: Obesity is a global health problem requiring effective interventions to achieve weight loss and maintain it in the long term. A major challenge for clinicians is weight regain (WR), defined as progressive weight gain following successful weight loss. WR is affected by multiple factors, including psychological traits linked to specific brain alterations. Understanding these mechanisms is crucial in developing strategies to prevent WR and to ensure effective weight control. Objectives: This narrative review aims to gather current findings on the psychological and neurobiological determinants of WR and to discuss the interplay between these factors. Methods: A literature search was conducted on PubMed, Medline, and Web of Science for English-language studies published between December 1990 and November 2024. Results: WR is driven by interconnected psychological and neurobiological factors that influence eating behavior and the regulation of body weight. Certain personality traits and emotional patterns are associated with specific changes in brain activity, which together affect vulnerability to WR. Although distinct mechanisms can be identified, the complexity of homeostatic and nonhomeostatic appetite control suggests that no single factor predominates. Conclusions: This review highlights the dynamic interplay between psychological and neurobiological predictors of WR. However, due to the narrative nature of this review, the focus on selected determinants, and the limited quality and size of the available studies, further research is needed to comprehensively understand causality and to improve relapse prevention strategies.

Ethnic differences in weight loss during a clinical obesity management program

To examine ethnic differences in how individuals respond to obesity management therapies, a retrospective chart review of the Wharton Medical Weight Management Clinic electronic medical records was used (n = 21 709; 14 695 patients with weight loss data). South and East Asian, Middle Eastern and Other ethnicities had a significantly lower body mass index (BMI) at enrollment than White adults (39.7 vs. 35.4-38.7 kg/m2), with higher or similar BMIs in Indigenous and Black adults (39.9-42.2 kg/m2). Whites, East Asians and Other Ethnicities had the greatest weight loss (4.3-4.9 kg), while Blacks (3.3 kg), Latin (3.0 kg), Middle Eastern (2.7 kg), and South Asians (3.5 kg) lost significantly less weight as compared to Whites (4.9 kg) (p < .05). There were also weight loss differences between Black sub-groups. African American females lost the least weight (1.4 kg), while West Indian Black females lost much more weight (4.3 kg, p = .01). African American males also lost the least amount of weight (0.9 kg), while African Black males lost the most (7.4 kg, p = 0.01). There are differences in the weight loss achieved during a clinical obesity management program between individuals of various ethnicities.

What is the Role of Primary Prevention of Obesity in an Age of Effective Pharmaceuticals?

PURPOSE OF REVIEW

To examine the evidence and continuing role of strategies for the primary prevention and treatment of obesity in the context of effective obesity pharmacotherapies, through a narrative review.

RECENT FINDINGS

Global policies to improve nutritional labelling and reduce sugar-sweetened beverages consumption have been implemented worldwide (> 45 countries) with some success which varies by population and environment. Tailored behavioural interventions are effective and essential to reduce individual risk of progression from preclinical to clinical obesity. Pharmacotherapies are powerful treatment agents for clinical obesity but must consider nutritional and metabolic risks of use and discontinuation. The obesogenic environment continues to undermine individual agency to adopt healthier dietary and physical activity patterns. Population health informatics tools could inform tailored interventions based on real-time risk and contribute to obesity prevention and treatment. Efforts to rebalance investment towards obesity prevention must continue to improve population health and reduce healthcare burden.

Weight-neutral interventions for people with obesity and the perspective of patients, carers and healthcare professionals: a mixed methods review

OBJECTIVES

This is a protocol for a Cochrane Review (prototype). The objectives are as follows: To assess the effects of weight-neutral interventions for managing obesity in children and adults (quantitative data). To explore the views, perspectives and experiences of children and adults receiving the intervention, their close family members or, if appropriate, carers, and healthcare personnel who recommend or deliver weight-neutral interventions to determine their feasibility and acceptability and any factors that create barriers and facilitators to optimal implementation (qualitative data). To determine whether the programme theories, components and delivery of interventions take account of the views, perspectives and experiences of intervention recipients and whether patient-centred interventions have greater effects.

Association of body roundness index with uterine fibroids in women of childbearing age: a cross-sectional analysis of NHANES 1999-2006

BACKGROUND AND AIM

Previous studies have shown an association between obesity and uterine fibroids (UF). Body roundness index (BRI) is an anthropometric measure associated with obesity. However, the association with UF has not been thoroughly elucidated, and further investigation is required to explore the possible link. Our study investigated the possible link between BRI and UF in women aged 20 to 44 years, with a view to providing effective scientific evidence for health management and disease prevention in this population.

METHODS

This cross-sectional study analysis included data from 4043 women of childbearing age from the National Health and Nutrition Examination Survey (NHANES) database 1999-2006.We applied multiple regression analysis to study the association between BRI and UF, subgroup analysis was used to ensure broad applicability and representativeness of conclusions, and finally linear correlation between BRI and UF was explored by smooth curve fitting.

RESULTS

This study involved 4,043 female participants aged 20-44 years, of whom 331 (8.19%) had fibroids. After controlling for all potential confounders, each additional unit of BRI increased the prevalence of UF by 7% (OR = 1.07,95% CI: 1.01,1.12), Sensitivity analysis by dividing BRI into four groups found a 54% increase in the prevalence of UF within the fourth quartile (Q4) of BRI compared with the first quartile (Q1) of BRI (OR = 1.54, 95% CI: 1.08, 2.20).The link between BRI and UF maintained in subgroup analyses. Furthermore, the study showed a linear positive correlation between BRI and the probability of UF prevalence.

CONCLUSIONS

Higher levels of BRI may be linked to a higher prevalence of UF, according to studies conducted on American women of childbearing age. The study's conclusions highlight how important BRI is for managing and preventing UF.

The Meal Type Rather than the Meal Sequence Affects the Meal Duration, Number of Chews, and Chewing Tempo

BACKGROUND/AIM

Obese individuals are often said to eat fast. Given that obese individuals are often reported to consume fast food more frequently, we hypothesized that fast food can be eaten more quickly. This study aimed to examine the effects of meal type on meal duration, considering meal sequence.

METHODS

Meal duration, number of chews and bites, and chewing tempo were measured among 41 participants (18 males, 23 females; average age, 41.1 years) using two meals: pizza (301 kcal) and hamburger steak bento (hamburger, rice and broccoli, 304 kcal; two eating sequences: vegetables first or last).

RESULTS

Compared with pizza, bento meals (vegetables first or last) were associated with longer meal durations (sec) (mean differences in pizza-bento (vegetable first): -182 [-245.6, -118.9], p < 0.0001; pizza-bento (vegetables last): -216.0 [-273.3, -158.7], p < 0.0001). In contrast, no differences in meal duration (sec) were observed regardless of the order of vegetable consumption (p = 0.14). These findings were consistent with the number of chews and chewing tempos across both sexes. The number of bites was similar among pizza, bento (vegetable fast), and bento (vegetable last). Meal duration was positively associated with the number of chews and bites and meal type and negatively associated with age and sex. BMI was not associated with meal duration.

CONCLUSIONS

Meal type affected meal duration, the number of chews, and the chewing tempo, independent of meal sequence. To eat more slowly, it is important to pay attention to the meal type.

Determinants of adherence to obesity medication: A narrative review

The increasing prevalence of obesity, complex nature of this chronic disease, and risks of developing obesity-related comorbidities outline the need for sustainable and effective management for people living with obesity. In addition to behavioral interventions, obesity medications (OMs) are increasingly considered an integral part of management of people living with obesity. OM adherence is essential to achieve the health benefits of these medications. Adherence to medications, defined as the process by which patients take their medications as prescribed, is determined by a range of factors and can be broken down into phases: initiation, implementation, and persistence (the persistence phase includes discontinuation/stopping treatment). Obesity-specific challenges exist to optimize OM adherence, which may explain varying OM adherence compared with medication for other chronic diseases (diabetes, hypertension, dyslipidemia, and osteoporosis). However, lessons can be learned from other chronic diseases to improve OM adherence, for example from type 2 diabetes and hypertension. This review aims to provide practical guidance for identifying OM- and obesity-specific determinants of adherence and discusses adherence determinants per adherence phase and obesity management phase (weight gain, weight loss, and weight stabilization/regain). This practical guidance will assist with developing obesity-specific interventions to improve OM adherence. PRACTITIONER POINTS: OMs are increasingly considered as an integral part of obesity management; however, like with all chronic disease medications, low adherence to these medications is often observed, impacting their therapeutic effect. Adherence to obesity medication can be affected at any phase of obesity management (weight gain, weight loss, and weight stabilization/regain) so considering the disease phase can help identify potential reasons for low adherence. Future initiatives to improve adherence to obesity medication should be a key focus of discussions at each opportunity with healthcare professionals, including thorough evaluation and targeted education, all in a supportive and stigma-free manner.

The EBBS Questionnaire (Eating Behavior After Bariatric Surgery) Is a Useful Tool for Identifying Individuals at Risk of Long-Term Weight Regain After Sleeve Gastrectomy

PURPOSE

Bariatric surgery (BS) is an effective treatment for severe obesity, yet weight regain (WR) affects a significant proportion of patients in the long term. The lack of useful and standardized tools makes the follow-up of these patients more difficult. The Eating Behavior after Bariatric Surgery (EBBS) questionnaire was designed to assess adherence to post-surgical lifestyle recommendations, which may predict successful weight maintenance. This study aimed to adapt the EBBS for Spanish-speaking patients and evaluate its utility in assessing adherence to long-term lifestyle changes and its association with weight outcomes.

MATERIAL AND METHODS

A total of 100 patients who underwent a sleeve gastrectomy (mean follow-up 90.4 ± 46 months) were included. The EBBS was administered to evaluate food, drink, behavior, and lifestyle domains.

RESULTS

Significant weight regain was observed in 70% of participants, and emotional eating (65%) and depression (53%) were common. The EBBS demonstrated good internal consistency (Cronbach's alpha = 0.662). Higher total EBBS scores were significantly associated with greater excess weight loss (EWL), particularly for patients maintaining over 50% EWL (p = 0.04). Logistic regression revealed that EBBS scores > 13.5 predicted EWL > 50% (OR = 17.8, p = 0.010), underscoring the value of this tool in identifying patients at risk for WR.

CONCLUSIONS

The Spanish version of the EBBS is a reliable tool for assessing post-BS diet and lifestyle patterns and predicting long-term weight outcomes. Tailored interventions based on EBBS results may improve adherence to dietary and lifestyle recommendations, reducing the risk of WR.

Real-world use and effectiveness of tirzepatide among individuals without type 2 diabetes: Results from the Optum Market Clarity database

AIMS

To understand real-world tirzepatide utilization and effectiveness (change in weight and body mass index [BMI]) among people without type 2 diabetes (T2D) in the United States.

MATERIALS AND METHODS

This retrospective, observational study used Optum's de-identified Market Clarity database (index date: first-observed tirzepatide claim; index period: 13 May 2022-30 September 2023). Outcomes were assessed in 3 cohorts: (1) Overall cohort: age ≥18 years; ≥1 tirzepatide claim; no baseline T2D diagnosis codes, anti-diabetes medication use (except metformin) or glycated haemoglobin ≥6.5%; continuous medical and pharmacy enrolment for ≥12 months pre-index. (2) Utilization cohort: all above criteria and anti-obesity medication (AOM)-eligible individuals (BMI ≥30 kg/m2, or ≥27 kg/m2 with ≥1 obesity-related complication [ORC]) for assessment of tirzepatide utilization (persistence, discontinuation, dose escalation and switching 6 months post-index). (3) Effectiveness cohort: all above criteria and AOM-eligible glucagon-like peptide-1 receptor agonist (GLP-1 RA)-naive individuals persistent on tirzepatide for ≥6 months with pre- and post-index weight and BMI measurements for assessment of tirzepatide effectiveness (mean absolute and percent bodyweight/BMI change from baseline and bodyweight/BMI reduction ≥5%, ≥10%, ≥15% and ≥20%). All analyses were descriptive.

RESULTS

Overall cohort included 20,998 individuals (mean age: 47.4 years, female: 74.9%, mean BMI: 36.9 kg/m2). At index, 66.0% of individuals had ≥1 ORC, while 44.4% had ≥2 ORCs. Persistence in the utilization cohort was 55.4%; 30.8% switched to a different AOM/GLP-1 RA analogue or restarted tirzepatide after discontinuation, and by the sixth prescription fill, 74.2% were on <10 mg tirzepatide. Mean weight reduction in the effectiveness cohort was 11.9% at 6 months post-index (≥5%: 85.8%; ≥10%: 61.5%).

CONCLUSIONS

Real-world evidence suggests multimorbidity is common among tirzepatide initiators. While tirzepatide dose escalation was slower than in clinical trials, individuals achieved weight reduction at 6 months, consistent with clinical trials.

Real-world use and effectiveness of tirzepatide among people without evidence of type 2 diabetes in the United States

AIM

To understand treatment patterns and effectiveness of tirzepatide among people without type 2 diabetes (T2D) in the US.

METHODS

This retrospective, observational, descriptive study used the Healthcare Integrated Research Database (index date: first-observed tirzepatide claim; index period: May 13, 2022-May 24, 2023). Key eligibility criteria were: age ≥ 18 years; ≥ 1 tirzepatide claim; no T2D diagnosis codes or glycated hemoglobin ≥ 6.5 %, no anti-diabetes medications (except metformin); and continuous medical/pharmacy enrollment for ≥ 12 months pre-index (Overall cohort). Tirzepatide persistence and utilization (6-months post-index) were assessed among obesity management medication (OMM)-eligible individuals (body mass index [BMI] ≥ 30 kg/m2, or ≥ 27 kg/m2 with ≥ 1 obesity-related complication [ORC]; OMM-eligible cohort). Tirzepatide effectiveness was assessed among individuals who were OMM-eligible, naive to glucagon-like peptide-1 receptor agonists, and persistent on tirzepatide for ≥6 months (Persistent+GLP-1 naive cohort).

RESULTS

The overall cohort included 4,177 individuals with mean age 46.0 years, 75.6 % female, and mean BMI 37.1 kg/m2. At baseline, 73.8 % of individuals had ≥ 1 ORC while 51.0 % had ≥ 2 ORCs. Persistence in the OMM-eligible cohort was 73.8 %; by the sixth prescription fill, 56.2 % were receiving < 10 mg tirzepatide. Individuals in the Persistent+GLP-1 naive cohort with pre- and post-index weight and BMI measurements (n = 200) achieved mean weight reduction of 12.9 % at 6-months post-index (≥ 5 %: 88.5 %; ≥ 10 %: 69.0 %).

CONCLUSION

Real-world evidence suggests multimorbidity among tirzepatide initiators, slower tirzepatide dose escalation than in clinical trials, and clinically meaningful weight reduction among people persisting on tirzepatide for ≥ 6 months.

Validation of the 2024 European Association for the Study of Obesity diagnostic criteria: A comprehensive assessment of obesity-related mortality risks

AIMS

Obesity is a global public health challenge, and the traditional WHO-proposed diagnostic criteria based on body mass index (BMI) often fail to fully assess related health risks. The European Association for the Study of Obesity (EASO) has proposed new criteria that combine BMI, waist-to-height ratio (WtHR) and complications to more accurately evaluate obesity-related health risks.

MATERIALS AND METHODS

This study utilized data from the National Health and Nutrition Examination Survey database, covering the years 1999-2018. The study validated the new EASO criteria for diagnosing obesity, defined as BMI ≥25 kg/m2, WtHR ≥0.5 and the presence of 12 obesity-related complications. The associations between obesity and mortality were assessed using Kaplan-Meier survival curves and Cox proportional hazards regression analyses. Mediation analysis was conducted to explore potential mechanisms by which obesity impacts patient prognosis.

RESULTS

A total of 39 066 participants were included, with a mean age of 43.6 years; 51.3% were male. Over a median follow-up period of 141 months, 3708 deaths were recorded. The prevalence of obesity was 63.04% according to the new EASO criteria. The obesity rate based on BMI ≥30 is only 35.55%. The EASO criteria achieved a C-index of 0.5549, which surpasses the predictive accuracy of the traditional BMI ≥30 kg/m2 criterion, with a C-index of 0.5265. Cox regression analysis indicated that when using the traditional BMI ≥30 criterion to diagnose obesity, it was associated with all-cause mortality and cardiovascular disease (CVD)-related mortality, but it did not predict cancer-related mortality. Obesity diagnosed by EASO criteria was significantly associated with an increased risk of all-cause mortality (hazard ratio [HR] and 95% confidence interval [CI]: 1.13 [1.02, 1.24]), CVD mortality (HR and 95% CI: 1.48 [1.20, 1.83]) and cancer mortality (HR and 95% CI: 1.26 [1.03, 1.54]). When using simplified BMI ≥25 kg/m2, WtHR ≥0.5 and any of the top five complications (diabetes mellitus, hypertension, CVD, metabolic syndrome and ageing) as diagnostic criteria, which had the highest C-index (0.612), obesity remained an independent prognostic factor for poor overall survival (HR and 95% CI for all-cause mortality: 1.41 [1.26, 1.58], HR for CVD mortality: 2.08 [1.61, 2.68] and HR for cancer mortality: 1.32 [1.06, 1.65]).

CONCLUSIONS

This study confirms the prognostic value of the new obesity diagnostic criteria proposed by EASO, suggesting that these criteria offer a more accurate assessment of obesity-related health risks.

Characterization of the effect of naltrexone/bupropion on body composition

AIMS

Oral treatment extended-release naltrexone/bupropion (NB) leads to significant weight loss, but its effect on body composition remains unclear. We investigated changes in body composition with dual-energy x-ray absorptiometry after treatment with NB or placebo in a subgroup of participants from a randomized control phase 3 study (COR-I).

MATERIALS AND METHODS

Observed changes from baseline to week 52 were estimated for total, lean, and fat mass. Changes in body composition were evaluated using linear regression and adjusted for baseline covariates.

RESULTS

The analysis included 82 participants (placebo, n = 26; NB, n = 56) with comparable baseline characteristics (age, BMI, sex). The NB group experienced a significant -7.8% change of total mass (-12.9% change in fat mass and -4.1% in lean mass), compared with a -2.8% change of total mass (-4.8% change in fat mass and -1.4% in lean mass) in the placebo group. The adjusted changes in lean-to-fat mass ratio of 0.069 in the NB group and -0.056 in the placebo group were significantly different (p < 0.05).

CONCLUSIONS

NB-induced weight loss is associated with significant reductions in total percent fat mass, increase in total percent lean mass, and change in lean-to-fat mass ratio, in comparison to placebo. Larger studies are needed to further elucidate the clinical significance of these changes and impact of a potentially healthier metabolism.

Improving Timely Medication Access for Endocrinology and Diabetes Patients: A Quality Improvement Initiative

Introduction

Managing chronic conditions such as endocrinology and diabetes requires consistent access to medications. Traditional methods of medication refill often involve in-person visits to healthcare providers or pharmacies, posing challenges for patients. Online medication refill services offer a promising solution to improve accessibility and convenience.

Methods

This is a digital-based solution using online medication refill services to enhance the management of endocrinology and diabetes medication refills. It examines the process of online medication refill, including patient registration, refill request submission, verification, provider input, processing, and pickup or delivery.

Results

Online medication refill services empower patients to easily request refills from the comfort of their homes, streamlining the refill process, and reducing walk-in pressure in clinics. The online medication refill with the option for home delivery option eliminates the need for patients to visit the hospital, further enhancing the patient experience. Before implementing the online medication refill solution, 26 patients will come to the clinic as walk-ins to request medication refills. The average waiting time for each patient is 45 minutes. Each provider will be interrupted for an average of 10 minutes to accommodate the request. The overall processing time required for each walk-in patient to submit the medication request is 1 hour on average. After implementing the online medication refill intervention, zero patients come to the clinic as walk-ins and hence, no interruption to the daily regular clinics. The overall processing time required for submitting the online medication request is now 2 minutes. These interventions promote medication adherence and patient engagement by facilitating access to medications and offering educational resources.

Conclusion

Online medication refill services represent a valuable tool in the comprehensive management of endocrinology and diabetes. They offer accessibility, convenience, and patient empowerment, potentially improving health outcomes and enhancing the overall patient experience.

The Efficacy and Safety of Tirzepatide in Patients with Diabetes and/or Obesity: Systematic Review and Meta-Analysis of Randomized Clinical Trials

Background: Obesity and type 2 diabetes (T2D) are major public health concerns. Tirzepatide has shown promise in recent clinical trials. This systematic review and meta-analysis aim to evaluate the efficacy and safety of tirzepatide in adults with obesity or type 2 diabetes, compared to placebo, GLP-1 receptor agonists (GLP-1 RAs), and insulin. Method: PubMed, Embase, and the Cochrane Library were searched on 17 January 2024, focusing on phase II and III randomized controlled trials (RCTs). We included studies involving adults with T2D or obesity, comparing tirzepatide to placebo, GLP-1 RAs, or insulin. The primary outcomes were the proportion of participants achieving ≥5%, ≥10%, and ≥15% weight loss targets. Secondary outcomes included changes in body weight, waist circumference, HbA1c levels, and blood pressure. Safety outcomes focused on adverse event rates. Meta-analyses were performed, and risk of bias was assessed using the Cochrane Risk-of-Bias tool version 2. Results: Fourteen RCTs involving 14,713 patients were included. Tirzepatide significantly increased the proportion of participants achieving weight loss targets, and reduced body weight, waist circumference, HbA1c, and blood pressure versus placebo and insulin. Compared with GLP-1 RAs, tirzepatide provided comparable or better outcomes in weight loss, waist circumference, and glycemic control. The incidence of gastrointestinal adverse events was significantly higher at all doses of tirzepatide compared to placebo and insulin. When compared with GLP-1 RAs, higher doses of tirzepatide were associated with increased risk of nausea, diarrhea, and decreased appetite, but not vomiting. Conclusions: Tirzepatide is an effective option for managing weight and improving metabolic outcomes in patients with T2D or obesity. However, it is associated with an increased risk of gastrointestinal adverse events, especially at higher doses. Therefore, close monitoring should be considered in clinical practice. Registration: PROSPERO CRD42021283449.

New Approaches to the Treatment of Severe Obesity-Prehabilitation as the Key to Success

PURPOSE OF REVIEW

Bariatric surgery (BS) has emerged as a crucial and effective treatment for severe obesity (SO), providing significant and sustained weight loss and improving comorbidities. Optimizing perioperative careparticularly through structured prehabilitation is crucial for improving surgical outcomes and long-term weight management. This review examines the role of prehabilitation, nutrition, psychological support, physical activity, and pharmacologic treatment in improving the effectiveness of BS.

RECENT FINDINGS

Despite the benefits of prehabilitation, there are significant differences in the way it is implemented in different healthcare centers. Protocols vary widely in terms of duration, components and intensity, leading to inconsistencies in patient preparation and postoperative recovery. Many patients still do not receive multidisciplinary support from dietitians, psychologists or physiotherapists prior to surgery, which can affect long-term outcomes. Barriers to effective prehabilitation include a lack of standardized guidelines, insufficient healthcare resources and limited patient adherence due to lack of awareness, low motivation or logistical constraints. Despite its proven benefits, structured prehabilitation lasting at least 3-6 months is not available to all patients, as access remains unequal and suboptimal in many healthcare settings. Prehabilitation is an important but underutilized component of BS preparation. Standardizing protocols and ensuring multidisciplinary, patient-centered support are essential to maximizing surgical benefit. Overcoming barriers such as healthcare system limitations, patient motivation and knowledge gaps is critical to integrating prehabilitation into routine bariatric care. This review emphasizes the need for evidence-based, multimodal prehabilitation strategies to improve perioperative care and long-term outcomes for BS patients.

Guidelines for antenatal and preoperative care in cesarean delivery: Enhanced Recovery After Surgery Society recommendations (part 1)-2025 update

BACKGROUND

Enhanced recovery after cesarean delivery protocols include evidence-based interventions designed to improve patient experience, pregnancy, and neonatal outcomes while reducing healthcare-related costs. This is the first update of the Enhanced Recovery After Surgery Society guidelines for antenatal and preoperative care before cesarean delivery after the original publication in 2018.

METHODS

Interventions were selected based on expert consensus using the Delphi method. An updated literature search was conducted in September 2024 using the Embase, PubMed, MEDLINE, EBSCO CINAHL (Cumulative Index of Nursing and Allied Health Literature), Scopus, and Web of Science databases. Targeted searches were performed by a medical librarian to identify relevant articles published since the 2018 Enhanced Recovery After Surgery Society guidelines publication, which evaluated each antenatal and preoperative enhanced recovery after cesarean delivery intervention, focusing on randomized clinical trials and large observational studies (≥800 patients) to maximize search feasibility and relevance. Following a review of the evidence, a consensus was reached regarding the quality of evidence and the strength of recommendation for each proposed intervention according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system.

RESULTS

The 6 recommended enhanced recovery after cesarean delivery interventions are (1) antenatal pathway patient education for scheduled caesarean delivery (evidence low to very low, recommendation strong); (2) multidisciplinary medical and surgical staff education regarding enhanced recovery after cesarean delivery support, intervention implementation, and measurement (evidence low, recommendation strong); (3) optimization of the medical care for pregnant patients with comorbid conditions, such as anemia, obesity, hypertension, prepregnancy and gestational diabetes, smoking (tobacco, cannabis, vaping), congenital heart disease, epilepsy, autoimmune disease, and asthma (evidence moderate, recommendation strong); (4) abdominal skin preparation with chlorhexidine gluconate impregnated cloth (evening before scheduled cesarean delivery) (evidence moderate; recommendation weak); (5) the duration of preoperative fasting based on the content intake (evidence low, recommendation weak); (6) the use of a preoperative, nonparticulate carbohydrate drink (evidence low-moderate, recommendation strong).

CONCLUSION

The first 3 recommendations are for use in the antenatal period (10-38 weeks of gestation), which allow for the optimization of patient comorbidities, whereas the remaining 3 recommendations are for preoperative interventions (skin preparation, preoperative fasting directives, and preoperative carbohydrate supplementation). Educational tools for cesarean delivery with well-designed shared decision-making focus on comorbidity management should be developed. These management tasks are viewed as routine care; however, the measurable success and impact have clinical variance. The enhanced recovery after cesarean delivery goal for patients who are undergoing a scheduled caesarean delivery is to maximize the quality of the pregnant patient's recovery and the fetal-neonatal outcome.

The GIRO Guideline: a key tool to approach the obesity challenge and its impact on digestive health

The recently published second edition of the GIRO Guideline (Guía española de manejo integral de la obesidad) edited by the Sociedad Española para el Estudio de la Obesidad (SEEDO), whose preparation involved the participation of 35 representatives of different scientific societies, including the Sociedad Española de Patología Digestiva (SEPD), focuses on the cross-cutting and multidisciplinary nature of obesity, a condition experienced by many of our patients that decisively impact their health status, and that we must understand and manage adequately.

Current and Emerging Parenteral and Peroral Medications for Weight Loss: A Narrative Review

Obesity is a growing global health challenge, necessitating effective treatment options beyond lifestyle interventions. This narrative review explores established and emerging pharmacotherapies for weight management, including parenteral agents like Liraglutide, Semaglutide, Setmelanotide, and Tirzepatide, as well as peroral medications such as Phentermine, Phentermine/Topiramate, Bupropion/Naltrexone, Orlistat, and Metformin. Newer treatments like Cagrilintide and Bimagrumab show promise for enhancing weight loss outcomes. Parenteral GLP-1 receptor agonists demonstrate superior efficacy compared to traditional peroral medications, with gastrointestinal side effects being the most common. Artificial intelligence presents intriguing opportunities to enhance weight loss strategies; however, its integration into clinical practice remains investigational and requires rigorous clinical validation. While current anti-obesity medications deliver significant benefits, future research must determine the efficacy, safety, and cost-effectiveness of AI-driven approaches. This includes exploring how AI can complement combination therapies and tailor personalized interventions, thereby grounding its potential benefits in robust clinical evidence. Future directions will focus on integrating AI into clinical trials to refine and personalize obesity management strategies.

Cardiovascular-Kidney-Metabolic Syndrome: A New Paradigm in Clinical Medicine or Going Back to Basics?

Cardiovascular, renal, and metabolic diseases are pathophysiologically interdependent, posing a significant global health challenge and being associated with a substantial increase in morbidity and mortality. In 2023, the American Heart Association (AHA) defined this complex network of interconnected health conditions as the cardiovascular-kidney-metabolic (CKM) syndrome. This syndrome is based on common pathophysiological mechanisms, including chronic inflammation, oxidative stress, hyperglycemia and insulin resistance, activation of the renin-angiotensin-aldosterone system (RAAS), and neurohormonal dysfunction, which trigger a vicious cycle where the impairment of one organ contributes to the progressive deterioration of the others. An integrated approach to these conditions, rather than treating them as separate entities, supports a holistic management strategy that helps to reduce the burden on public health and improve patients' quality of life. Existing management focuses on lifestyle modification, glycemic and lipid control, and the use of nephroprotective and cardioprotective therapies. This narrative review aims to synthesize and contextualize existing information on the complex interactions between these systems and on diagnostic approaches, as well as to provide an overview of the available therapeutic options.

Is liraglutide safe and effective in the elderly obese patients?: A single center experience

The prevalence of Obesity is increasing globally, including in Türkiye, and affects all age groups, including the elderly. Previous clinical trials have shown the efficacy and safety of liraglutide in reducing the body weight of older adults. This study aimed to evaluate the effectiveness of liraglutide on weight loss and to identify any adverse effects in elderly individuals with obesity. This retrospective cohort study included patients aged ≥ 60 years with a body-mass index (BMI) ≥ 27 or greater and other comorbidities, as well as those with an initial BMI ≥ 30. All patients referred from a private tertiary clinic were prescribed liraglutide for obesity treatment. Data were collected from September 2023 to September 2024, with metabolic and anthropometric parameters recorded at the first appointment, followed by the monitoring of body weight and adverse effects during treatment. The mean age of the 32 patients was 63.78 years (± 10.50 years), with 90.6% of patients being female. Their mean weight and BMI were 94.31 ± 14.82 kg and 36.49 ± 5.34 kg/m², respectively. The body weight loss percentages were 5.96% at week 4, 10.06% at week 8, 13.85% at week 12, and 15.80% at week 24 (all P < .0001). At week 24, 100% of the patients lost more than 5% and 10% of their initial weight, respectively. Nausea was the most common adverse effect observed, with no reported instances of pancreatitis. This study corroborates the findings of previous research in this field. Evidence indicates that liraglutide is both efficacious and safe for treating obesity in the elderly population.

Visceral adiposity index, premature mortality, and life expectancy in US adults

IMPORTANCE

Visceral adiposity index (VAI) vividly reflects body fat distribution through comprehensively integrating body mass index, sex, waist circumference, triglycerides, and high-density lipoprotein cholesterol. While VAI is an established predictor of various clinical outcomes, its relationship with premature mortality and life expectancy remains unclear.

OBJECTIVE

To explore the association between VAI and premature mortality or life expectancy in a nationally representative cohort of US adults.

METHODS

This study included adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, linked to the National Death Index through December 31, 2019. Data were analyzed from August to October, 2024. VAI was categorized into quartiles from the lowest Q1 to the highest Q4. Primary endpoints were premature mortality (death before 80 years of age) and life expectancy.

RESULTS

A total of 43,672 participants (women: 22,164; men: 21,508) aged > 20 years were included. Over a median follow-up of 9.2 years (IQR: 4.9-13.8), 3,187 premature deaths were documented. Higher VAI quartiles were significantly associated with increased multi-adjusted premature mortality risk compared to Q1 (Q3 vs. Q1: hazard ratio [HR], 95% confidence interval [CI]: 1.30, 1.05 to 1.61; Q4 vs. Q1: 1.68, 1.34 to 2.11). This association was particularly pronounced in women (Q3 vs. Q1: 1.53, 1.01 to 2.30; Q4 vs. Q1: 2.36, 1.52 to 3.68), with significant linear trends (P < 0.001). Estimated life expectancy at age 40 years was 41.45 (95% CI: 41.24 to 41.66), 41.32 (41.11 to 41.53), 40.55 (40.35 to 40.75), and 39.26 (39.08 to 39.45) years in Q1, Q2, Q3, and Q4 of VAI, respectively. By sex, estimated life expectancy at age 40 in Q4 was reduced by 3.33 years in women and 1.24 years in men, compared to Q1. By race and ethnicity, it was shortened by 3.90 years in Black participants and 1.68 years in White participants in Q4 group, compared to Q1.

CONCLUSIONS

In this nationwide cohort study, higher VAI was significantly associated with an increased risk of premature mortality and reduced life expectancy at age 40 among US adults. These associations we heterogeneous by sex, race and ethnicity, more pronounced in women and Black participants.

Obesity-Related Disorders in Türkiye: A Multi Center, Retrospective, Cross-Sectional Analysis from the OBREDI-TR Study

Objectives: Obesity is a significant public health concern, as it is associated with the development of numerous chronic diseases. The prevalence of obesity and attendant diseases has been increasing over recent years. This study attempted to ascertain the frequency of chronic diseases in obese patients in Türkiye for the first time on this scale. Methods: A retrospective study was conducted, with patients admitted to the internal medicine outpatient clinics or obesity centers between December 2023 and December 2024 included in this study. Participants were recruited from seven regions, 20 provinces, and 28 centers, and the inclusion criteria were met by those aged 18 years and over with a body mass index (BMI) of 30 kg per square meter (kg/m2) or above. Their status, with respect to chronic diseases, and their anthropometric parameters were documented. Results: The total number of patients was 10,121, with a mean age of 45.2 ± 13.92. Of these, 7222 (71.35%) were female. The prevalence of type 2 diabetes mellitus (T2DM), hypertension (HT), dyslipidemia (DL), coronary artery disease (CAD), obstructive pulmonary disease (OPD), obstructive sleep apnea syndrome (OSAS), and fatty liver disease (FLD) was found to be 35.01%, 78.19%, 12.37%, 10.32%, 5.88%, and 75.12%, respectively. A subsequent analysis of the prevalence of these diseases by region revealed a statistically significant variation between regions (p < 0.001 for all regions). Conclusions: This study represents a substantial contribution to the existing body of knowledge in this field, particularly with regard to the identification of the current chronic disease rate of obese patients in Türkiye.

Managing obesity in children: a clinical practice guideline

BACKGROUND

Obesity is a complex, chronic, stigmatized disease whereby abnormal or excess body fat may impair health or increase the risk of medical complications, and can reduce quality of life and shorten lifespan in children and families. We developed this guideline to provide evidence-based recommendations on options for managing pediatric obesity that support shared decision-making among children living with obesity, their families, and their health care providers.

METHODS

We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We used the Guidelines International Network principles to manage competing interests. Caregivers, health care providers, and people living with obesity participated throughout the guideline development process, which optimized relevance. We surveyed end users (caregivers, health care providers) to prioritize health outcomes, completed 3 scoping reviews (2 on minimal important difference estimates; 1 on clinical assessment), performed 1 systematic review to characterize families' values and preferences, and conducted 3 systematic reviews and meta-analyses to examine the benefits and harms of behavioural and psychological, pharmacologic, and surgical interventions for managing obesity in children. Guideline panellists developed recommendations focused on an individualized approach to care by using the GRADE evidence-to-decision framework, incorporating values and preferences of children living with obesity and their caregivers.

RECOMMENDATIONS

Our guideline includes 10 recommendations and 9 good practice statements for managing obesity in children. Managing pediatric obesity should be guided by a comprehensive child and family assessment based on our good practice statements. Behavioural and psychological interventions, particularly multicomponent interventions (strong recommendation, very low to moderate certainty), should form the foundation of care, with tailored therapy and support using shared decision-making based on the potential benefits, harms, certainty of evidence, and values and preferences of children and families. Pharmacologic and surgical interventions should be considered (conditional recommendation, low to moderate certainty) as therapeutic options based on availability, feasibility, and acceptability, and guided by shared decision-making between health care providers and families.

INTERPRETATION

This guideline will support children, families, and health care providers to have informed discussions about the balance of benefits and harms for available obesity management interventions to support value- and preference-sensitive decision-making.

Doctor-patient communication in obesity disease - the perspective of Polish primary care physicians

BACKGROUND

Obesity is a chronic disease that is affecting an increasing number of patients. The prevalence of obesity, the age of patients affected, and the range of associated comorbidities suggest that general practitioners will engage with this patient group extensively throughout their professional careers. It is regrettable that numerous obstacles impede the efficacious treatment of obesity by primary care physicians. These include inadequate training in obesity management and communication with patients, as well as a pervasive and problematic bias in the approach to the treatment of patients with obesity.

METHODS

The objective of the study was to examine the knowledge, self-assessment, experiences and perceptions of primary care doctors in Poland with regard to the communication and management of obesity. The data were collected via computer-assisted telephone interviewing (CATI). The sample was deliberately random selected from the available database of numbers. The inclusion criteria were aged 24 or over and active working as a primary care doctor in Poland. The research sample comprised 150 primary care doctors with various medical specialties, including the following: family medicine, internal medicine, pediatrics, endocrinology, diabetology, and others. An even distribution of participants was not ensured with respect to the parameters considered.

RESULTS

The findings of our study indicate that primary care physicians mostly disagreed with the view that patients living with obesity are less hardworking or more demanding but just over half disagreed that these patients are lazier than others. Doctors reported rarely using fear-based language or blaming excessive food consumption for obesity. Instead, many emphasized that obesity is a disease and considered the patient's perspective. Doctors who rated their communication skills and medical knowledge needed for conversations with patients living with obesity more highly were more likely to address this topic during a visit for an unrelated medical condition. Those who avoided the topic often felt they lacked the skills or knowledge to engage patients effectively. Almost half of the surveyed physicians had not received any training in communicating with patients living with obesity and only 11% had the issue addressed in a course for specialization.

CONCLUSIONS AND IMPLICATIONS

The study indicates a necessity for changes in the curricula of both pre- and postgraduate education, including an enhancement of the knowledge and abilities of primary care providers in the domain of communication during visits with patients with obesity, the encouragement of lifestyle modifications and the implementation of efficacious treatments for obesity, as well as activities designed to modify the negative attitudes of primary care physicians towards patients living with obesity which should not appear in healthcare at all.

The association of motivational factors with weight loss and treatment time in a publicly funded weight management clinic

The objective of the study is to explore differences in weight loss (WL) and treatment time with having health, mobility, and/or aesthetics motivations for attempting WL. Data from 7540 adults with overweight or obesity who participated in a publicly funded weight management programme at the Wharton Medical Clinic were analysed. Patients' WL motivations were categorised into six groups: Health only; Health and Aesthetics; Health and Mobility; Health, Mobility and Aesthetics; No Health; and None. Women with Health, Mobility and Aesthetics or No Health motivations had marginally higher WL goals compared to other groups, with no differences in men. Men with Health and Aesthetics or Health and Mobility motivations showed marginally higher 6-month attendance rates. Men who discontinued after one visit were 40% less likely to have a Health and Aesthetics motivation as opposed to Health only, compared to those who continued. No differences were observed in WL between motivation groups in either sex. No correlation was found between WL goals and WL attained. Only weak correlations between treatment time and WL were observed across most motivation groups. Despite small differences in treatment time and WL goals, motivations for attempting WL were not significantly associated with differences in the WL achieved.

Real-world evidence on the utilization, clinical and comparative effectiveness, and adverse effects of newer GLP-1RA-based weight-loss therapies

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as key agents for weight management, based on their marked efficacy as observed in randomized controlled trials. While still limited, real-world studies on GLP-1RA use in populations with obesity are increasingly available. This narrative review discusses contemporary real-world evidence demonstrating the utilization, clinical and comparative effectiveness, and adverse effects of the currently approved GLP-1RA-based weight-loss therapies, that is, liraglutide, semaglutide and tirzepatide. The observed weight reduction in clinical practice overall tends to be lower than in randomized controlled trials; however, outcomes approach those seen in trials when focusing on highly adherent patients. Real-world studies demonstrate high discontinuation rates of GLP-1RAs (20%-50%) within the first year, and the use of much lower doses than those evaluated in clinical trials. Evidence from observational studies within type 2 diabetes or obesity populations suggests frequent gastrointestinal disturbances in GLP-1RA users, as also observed in trials, but no clear increase in risks of severe events like pancreatitis or pancreatic cancer, thyroid disorders, or depression and self-harm. Further evidence is needed to understand possible real-world associations of GLP-1RAs with eye disease and other rare outcomes. We provide 10 areas of particular importance for further research on GLP-1RA within the real-world space, including improved understanding of the exact drivers of early discontinuation and suboptimal dosing, studies of the effects of stopping GLP-1RA treatment, and investigations of clinical and cost-effectiveness for hard clinical outcomes in real-world settings, including not only cardio-reno-metabolic outcomes but also obesity-induced diseases like neuropsychiatric disease, cancer, musculoskeletal disease, and infections. PLAIN LANGUAGE SUMMARY: Recent advancements in weight-loss medications have sparked a lot of interest. The so-called GLP-1 receptor agonist medications (GLP-1RAs) have gained a lot of attention, because they have shown to be very effective, leading to significant weight loss in patients participating in clinical trials. GLP-1RAs, like liraglutide, semaglutide, and tirzepatide, help manage weight by mimicking hormones that control blood sugar and appetite. However, how these medications perform in real life can be different from the controlled settings of clinical trials, in which patients are carefully selected and their treatment plans closely followed. This literature review looks at how these medications are used and their effectiveness and safety in real-world settings. In real-life practice, GLP-1RAs are often less effective than in clinical trial conditions. This is usually because patients don't follow their medication plans as strictly as in trials. Real-world data shows that many patients use lower doses and do not stick to their treatment as strictly as participants in a controlled trial might, leading to less weight loss. However, those who do follow their plans closely can achieve results similar to those in trials. A major issue with GLP-1RAs is that many patients stop using them within the first year due to side effects or high costs of the medications, especially if not covered by insurance. Common side effects include nausea and digestive problems, which are the main reasons patients stop taking these treatments. These side effects are often manageable and decrease over time, and this reviews found no strong real-world evidence that GLP-1RAs cause severe side effects in many users. Despite these challenges, when GLP-1RAs are used effectively and consistently, they show substantial benefits in weight loss, most so the newest medications semaglutide and tirzepatide. These medications are also likely to help manage and prevent weight-related health conditions like type 2 diabetes and cardiovascular disease, but evidence for these beneficial outcomes is still scarce in real-world settings. The review emphasizes the need for more research to understand why many patients stop using these medications and how to improve dosing. It also calls for studies on the long-term effects of these therapies on various health outcomes, including mental health, cardiometabolic health, cancer, and rare conditions like eye diseases. Overall, while GLP-1RAs are a valuable tool for weight management, their real-world use requires careful consideration of individual patient factors, such as the ability to stick to treatment plans, manage side effects, and afford the medications. Further research will help make these treatments more effective for a wider range of people that need them.

Effect of interdisciplinary obesity care on metabolic markers and body weight in people with type 2 diabetes in a rural setting: A randomised controlled trial

Management of type 2 diabetes includes medications that can unintentionally increase obesity and insulin resistance. This unblinded, single-centre, randomised controlled trial focused on rural Australian adults with type 2 diabetes (aged 18-75 and body mass index [BMI] >30 kg/m2), measuring the effectiveness of a tailored interdisciplinary obesity care approach compared with usual diabetes care. Led by a nurse practitioner with allied health support (dietitian ± psychologist and physiotherapist), the bariatric treatment involved reducing weight-gaining medications, a 500-calories/day deficit, an unsupervised exercise program emphasising movement/strength and psychotherapy, 3-monthly to 24-months with support phone calls at weeks 2, 4, 8 and 10. Outcomes from the 224 (113 intervention/111 control) participants were differences in biomedical and physical markers within- and between-groups estimated using multivariate mixed-effects linear regression between recruitment and 6-monthly follow-ups. Greater change occurred in intervention compared with control groups at 12 and 24 months in mean: body weight (-5.9 kg [95% confidence interval, CI: -8.53, -3.23] and -9.0 kg [95% CI: -13.2, -4.77]); BMI (-2.03 kg/m2 [95% CI: -2.92, -1.15] and -3.51 kg/m2 [95% CI: -4.93, -2.08]); and glycated haemoglobin (-0.26% [95% CI: -0.69%, 0.18%] and -0.63% [95% CI: -1.17%, 0.08%]). The control group showed a significant increase in mean leptin level, resulting in a between-group difference (-27.1 [95% CI: -42.7, -11.5]). Lipids and blood pressure differences were inconclusive, while exploratory analysis showed greater decline in estimated glomerular filtration rate in the control group. The interdisciplinary obesity approach, compared with usual diabetes care, resulted in sustained weight loss and improved diabetes control over 2 years. Trial registration number: ACTRN12622000240741.

Women's Improvements in Cardiorespiratory Fitness Following Cardiac Rehabilitation Differ by Body Mass Index Category

Background

Improving women's cardiovascular outcomes requires optimizing cardiorespiratory fitness (CRF), as higher CRF predicts improved mortality in people with cardiovascular disease (CVD). As such, increasing CRF is a key goal of cardiac rehabilitation (CR). This study assesses the potential influence of body habitus, assessed by body mass index (BMI), on improvements in CRF in women with CVD.

Methods

Women (18+ years) diagnosed with CVD who completed a 12-week exercise-based CR program between 1996 and 2016 were included in this retrospective analysis. Women completed a symptom-limited graded exercise test before CR and at CR completion to determine CRF via peak metabolic equivalents (METs). Women were categorized by baseline BMI: normal = 18.5 to 24.9 kg/m2, overweight = 25.0 to 29.9 kg/m2, and obese ≥ 30 kg/m2. Mixed analysis of covariance (ANCOVA) was performed to evaluate the impact of BMI classification on ΔMETs at 12 weeks.

Results

Data from 1313 women (mean age = 62 ± 11 years) were analyzed. Results from mixed ANCOVA indicated a significant time (pre-CR, 12 weeks) by BMI category interaction (F [2,1307] = 3.20, P = 0.041, ƞp2 = 0.005). Follow-up analyses of variance (ANOVAs) showed significant improvements in ΔMETs in women with normal and overweight BMI categories (standard mean difference =1.03, n = 454 and 0.92, n = 461, respectively, P < 0.001). However, ΔMETs among women classified as obese was nonsignificant using a Bonferroni-adjusted alpha of 0.017 (standardized mean difference [SMD] = 0.79, P = 0.028; n = 398).

Conclusions

A 12-week exercise-based CR program increased CRF in women classified as normal or overweight by BMI, whereas those with obesity did not realize similar improvements. Women with obesity may need tailored strategies to increase their improvements in CRF in CR.

Clinical Trial Registration

REB18-0083.

Gastrointestinal tolerability and weight reduction associated with tirzepatide in adults with obesity or overweight with and without type 2 diabetes in the SURMOUNT-1 to -4 trials

AIMS

This analysis evaluated whether gastrointestinal (GI) adverse events (AEs) including nausea, vomiting, diarrhoea (N/V/D) and dyspepsia were associated with weight reduction with tirzepatide across the SURMOUNT-1 to -4 trials.

MATERIALS AND METHODS

SURMOUNT-1 to -4 were global Phase 3 clinical trials evaluating the safety and efficacy of tirzepatide among participants with obesity or overweight with or without type 2 diabetes (T2D). Participants were randomly assigned to receive once weekly subcutaneous tirzepatide or placebo. This post hoc analysis investigated weight change at the primary endpoint from baseline among participants who self-reported no N/V/D, any N/V/D or nausea alone. Mediation analyses evaluated the contribution of N/V/D and dyspepsia on weight reduction. Time to first use of antidiarrheal and antiemetic usage was reported by time intervals.

RESULTS

Baseline characteristics were similar between participants who reported N/V/D and those who did not. More participants reported GI AEs in the tirzepatide treatment arms (27.8%-72.8%) than with placebo (12.2%-32.5%). Most GI AEs were non-serious and occurred during dose escalation. Between 1.0% and 10.5% of tirzepatide-treated participants discontinued treatment due to GI AEs. Weight reduction with tirzepatide was similar among participants reporting no nausea, nausea alone, or any N/V/D. Mediation analyses suggested that N/V/D and dyspepsia were associated with up to 3.1% of total weight reduction. When required, first use of antidiarrheal and antiemetic medication was most commonly reported during dose escalation.

CONCLUSIONS

In this post hoc analysis, GI AEs appeared to contribute slightly to the weight reduction seen with tirzepatide in participants with obesity or overweight with or without T2D.

Tackling the complexity of obesity in the US through adaptation of public health strategies

Obesity prevalence continues to rise in the US despite more than two decades of recommendations and guidelines for its prevention and management. The encouragement of individuals to adopt a healthy diet and lifestyle has remained the focus of clinical interventions and recommendations despite these efforts alone proving ineffective for long-term weight management. There are many recognized barriers to obesity prevention and management in community and clinical settings including political factors, social determinants of health, weight bias and stigma, and inequities in access to treatment and insurance coverage. We discuss these barriers in more detail and attempt to identify areas where public health and healthcare approaches can be better aligned, allowing for better advocating by public health officials to enable a more meaningful and population-level change in obesity prevention and management in the US.

Exploring dietitians' experiences caring for patients living with obesity in acute care: a qualitative study

BACKGROUND

Obesity is a modifiable risk factor associated with hospital-associated complications. Recent studies show there is a high prevalence of patients with obesity presenting to hospital and evidence indicates that people living with obesity should receive diet advice from a dietitian; however, patients often do not receive this care in acute settings.

AIM

The primary aim of this study was to explore the experiences of dietitians caring for patients living with obesity in acute hospital settings.

METHODS

A multi-site qualitative study was conducted from October 2021 to November 2023 in Melbourne, Australia. Constructivist grounded theory methodology informed sampling and data collection. Semi-structured interviews were undertaken with dietitians working in acute care. Data were analysed using open coding and constant comparison underpinned by Charmaz's framework.

RESULTS

Interviews were conducted with 25 dietitians working across four hospitals. The theory developed from the data describes an enculturated decision-making process whereby acute clinical dietitians are limiting acute nutrition care for people living with obesity in hospital. The theory includes five interdependent categories that influence clinical decision-making and practice: (1) culture of professional practice, (2) science and evidence, (3) acknowledgement of weight bias and stigma, (4) dietitian-led care and (5) hospital systems and environment.

CONCLUSION

The findings from this study provide new insights as to why dietitians may not be providing acute nutrition care for people living with obesity. Strategic leadership from clinical leaders and education providers together with the lived experience perspectives of people with obesity is needed to shift the culture of dietetic professional practice to consider all nutrition care needs of patients living with obesity who are accessing acute hospitals for health care.

An overview of obesity-related complications: The epidemiological evidence linking body weight and other markers of obesity to adverse health outcomes

Obesity is a highly prevalent chronic multisystem disease associated with shortened life expectancy due to a number of adverse health outcomes. Epidemiological data link body weight and parameters of central fat distribution to an increasing risk for type 2 diabetes, hypertension, fatty liver diseases, cardiovascular diseases including myocardial infarction, heart failure, atrial fibrillation, stroke, obstructive sleep apnoea, osteoarthritis, mental disorders and some types of cancer. However, the individual risk to develop cardiometabolic and other obesity-related diseases cannot entirely be explained by increased fat mass. Rather than excess fat accumulation, dysfunction of adipose tissue may represent the mechanistic link between obesity and adverse health outcomes. There are people living with obesity who seem to be protected against the premature development of cardiometabolic diseases. On the other hand, people with normal weight may develop typical obesity diseases upon dysfunction of adipose tissue and predominantly visceral fat distribution. The mechanisms linking impaired function of adipose tissue in people with obesity include adipocyte hypertrophy, altered cellular composition, limited expandability of safe subcutaneous fat stores, ectopic fat deposition in visceral depots, the liver and other organs, hypoxia, a variety of stresses, inflammatory processes, and the release of pro-inflammatory, diabetogenic and atherogenic signals. Genetic and environmental factors might contribute either alone or via interaction with intrinsic biological factors to variation in adipose tissue function. There are still many open questions regarding the mechanisms of how increased body weight causes obesity-related disorders and whether these pathologies could be reversed. Evidence-based weight loss interventions using behaviour change, pharmacological or surgical approaches have clarified the beneficial effects of realistic and sustained weight loss on obesity-related complications as hard outcomes. This review focusses on recent advances in understanding epidemiological trends and mechanisms of obesity-related diseases. PLAIN LANGUAGE SUMMARY: Obesity is a chronic complex and progressive disease characterized by excessive fat deposition that may impair health and quality of life. Worldwide, the number of adults living with obesity has more than doubled since 1990. Obesity may lead to reduced life expectancy, because it increases the risk for type 2 diabetes, cardiovascular diseases (e.g., myocardial infarction, high blood pressure, stroke), fatty liver diseases, musculoskeletal diseases, chronic respiratory diseases, depression and certain types of cancer. However, not every person with obesity develops these diseases. For better prevention and treatment, it is important to understand the mechanisms linking high fat mass to obesity related diseases. It has become clear that fat mass alone cannot explain the higher risk of obesity complications. People with obesity can have either high or low risk of developing complications. Compared to people with a low risk for obesity complications those with a high risk to develop obesity related diseases are characterized by higher central fat deposition in the abdominal region, on average bigger fat cells, higher number of immune cells in adipose tissue and altered signals released from adipose tissue that may directly affect the brain, liver, vasculature and other organs. Both inherited and environment factors may cause these abnormalities of adipose tissue function. However, weight loss through behaviour changes (e.g., lower calorie intake, higher physical activity), medications or obesity surgery can improve health, quality of life and reduce the risk for obesity related diseases.

Development and Evaluation of a Bariatric Mannequin Simulation System

Physical assessment of obese patients is an essential clinical skill for identifying the numerous health problems of obese patients and monitoring treatment effectiveness. Use of simulation mannequins facilitates teaching and learning of physical assessment. Available bariatric simulation mannequins have poor functional design, unrealistic appearance, and limited assessment functions. We developed a bariatric mannequin simulation system and an associated education curriculum of seven case scenario and debriefing exercises focused on health problems experienced by individuals who are obese. An innovation of our mannequin is inclusion of programmable electronics that can be used with clinical tools that receive the electronic signals; together they provide ability to assess normal and abnormal signs of a wide variety of health problems. Ten nursing faculty and 51 nursing and medical students at a Midwestern university evaluated the features and satisfaction of a prototype bariatric mannequin in separate simulation sessions using Likert-scale questionnaires. Results showed that the majority of faculty (60%) and student participants (70%+) agreed/highly agreed that the bariatric mannequin was innovative, engaging, user-friendly, useful, and likely effective for teaching or learning. Satisfaction ratings of both groups were similar. Feedback from participants was incorporated into a final refined product that improved its realistic appearance.

Treating obesity in patients with depression: a narrative review and treatment recommendation

The high morbidity of obesity and depression pose significant public health concerns, with the prevalence of obesity doubling in the US between 1990 and 2022 and patients frequently presenting with both. Untreated obesity and depression can greatly impact patient health and well-being, as both obesity and depression are associated with a number of comorbidities including sleep apnea, type 2 diabetes mellitus, metabolic syndrome, metabolic dysfunction-associated steatotic liver disease, and cardiovascular disease. This narrative review aims to provide a comprehensive and current overview of the overlapping etiologies between obesity and depression as well as the available treatment options that may be recommended by primary care professionals to treat these patients with concomitant obesity and depression. With the considerable overlap in the population of patients with obesity and depression, as well as the overlap in the neurobiological, hormonal, and inflammatory pathways underlying both diseases, primary care professionals should consider screening patients presenting with obesity for depression. Holistic treatment options, including lifestyle and behavioral modifications, and pharmacotherapy for both depression and obesity and bariatric surgery for obesity are critical to manage both conditions simultaneously. Therefore, due to the overlapping neurobiological pathways and mechanisms responsible for the incidence and progression of both obesity and depression, a holistic treatment plan including strategies with efficacy for both conditions and any additional comorbidities may improve the clinical approach for patients with concomitant obesity and depression.