ABSTRACTFeeding is regulated by energy homeostatic and pleasure-induced rewarding signals. Palatable food intake modifies serotonergic (5-HT) and dopaminergic (DA) pathways in nucleus accumbens, inducing neuronal maladaptations that favor hyperphagia for high-energy dense food and consequent obesity. Chronic stress is an environmental condition that increases the preference for palatable food by modulating brain DA and 5-HT metabolism. Objective: To evaluate the association between changes in accumbal 5-HT and DA metabolism and the effects of chronic stress, palatable food intake and their interaction with satiety/hunger condition. Methods: Wistar rats were housed in pairs (non-stressed) or individually (stressed), fed with chow or chocolate milk plus chow (Ch) for 2 weeks (4 groups); then 6 animals/group were 48 h fasted or maintained ad libitum; the rest were fasted and re-fed for 2 h either with chow or Ch. Results: Rats with prolonged high-energy density food intake and re-fed with chow showed reduced 5-HT metabolism, although there was no association with animals' feeding behavior. In contrast, after re-fed with palatable food, stressed chow-fed rats had increased 5-HT turnover, which decreased in Ch re-fed rats, supporting that palatable food might induce positive mood changes related to high extracellular 5-HT in limbic regions. Discussion: Rats with prolonged palatable food intake exhibited high accumbal DA turnover independently of stress exposure, supporting its relation with the development of high-energy dense food hyperphagia. As accumbal 5-HT and DA metabolism changed due to fasting or re-feeding, alterations could represent the interaction of energy homeostatic and hedonic feeding signaling in animals.

Background: Obesity significantly impacts disease burden, with waist-to-hip ratio (WHR) as a key obesity indicator, but the genetic and biological pathways underlying WHR, particularly its sex-specific differences, remain poorly understood. Methods: This study explored WHR's sexual dimorphism and its links to complex traits using cross-sectional surveys and genetic data from Giant and UK Biobank (UKB). We analyzed WHR heritability, performed tissue-specific transcriptome-wide association studies (TWAS) using FUSION, and conducted genetic correlation analyses with linkage disequilibrium score regression (LDSC) and Local Analysis of [co]Variant Association (LAVA). Polygenic scores (PGS) for WHR were constructed using the clumping and thresholding method (CT), and associations with complex traits were assessed via logistic or linear models. Results: The genetic analysis showed sex-specific heritability for WHR, with TWAS identifying female-specific (e.g., CCDC92) and male-specific (e.g., UQCC1) genes. Global genetic correlation analysis revealed sex-specific associations between WHR and 23 traits, while local analysis identified eight sex-specific loci across five diseases. Regression analysis highlighted sex-specific associations for 70 traits with WHR and 45 traits with WHR PGS, with stronger effects in females. Predictive models also performed better in females. Conclusions: This study underscores WHR's sexual dimorphism and its distinct associations with complex traits, offering insights into sex-specific biological differences, health management, and clinical advancements.

Background: Obesity is a chronic and complex disease; by its nature, it represents an enormous challenge to be solved and managed. For that matter, several guidelines have been published, but there is still a long way to go until concrete scaled results can be presented. Adults with obesity, and especially severe obesity, need to have access to treatment programs, but they are not available for the vast majority of the population. Objective: The aim of this study is to evaluate the effectiveness of a multidisciplinary treatment program for obesity (MTPO) offered to adults (ages 18 to 50 years old) with a BMI over 30 kg/m2. Methods: Participants were invited through media ads, resulting in 404 participants for the first phase of that study, from whom the risk profile was assessed. After that, 180 participants (82.8% with severe obesity) concluded the MTPO, which consisted of 48 sessions of exercises and the same number of professional orientations about a healthy lifestyle, including the importance of being physically active, how to improve their eating habits, and how to control their emotions. Results: For the analysis of results, participants were grouped according to their weight loss in terciles, with the first, tercile presenting an average weight loss of 7.6%, which is considered clinically significant. In the same way, the average percental variations were even higher in this group for body fat (12.7%) and the lean mass to fat mass ratio (LM/FM), which increased by 14.3%. The homeostatic model assessment for insulin resistance, HOMA-IR, was around 3 times the variation of body mass, whereas the triglycerides (TG) and the hemoglobin A1C (H1Ac) were around twice that rate. Conclusions: These results made clear the effectiveness of the MTPO, which needs to be tested in public health services.

Obesity and sleep disorders are highly prevalent conditions with profound implications for public health. Emerging evidence highlights a bidirectional relationship between these two conditions, with each exacerbating the other in a complex interplay of behavioral, physiological, and hormonal mechanisms. Sleep deprivation and poor sleep quality contribute to energy imbalance through dysregulation of appetite hormones (e.g., leptin and ghrelin), increased caloric intake, and reduced physical activity. Conversely, sleep disorders such as obstructive sleep apnea syndrome (OSAS), insomnia, and restless leg syndrome (RLS) are significantly more common in individuals with obesity.

This review explores the pathophysiological mechanisms underlying this relationship, including the roles of inflammation, autonomic dysregulation, and neuroendocrine pathways. Sleep loss exacerbates metabolic syndrome components, including insulin resistance and dyslipidemia, further perpetuating weight gain. Similarly, obesity-induced sleep disorders lead to pro-inflammatory states, vascular dysfunction, and sympathetic overactivation, compounding cardiometabolic risks. Specific conditions like OSA and RLS are examined as models of this interdependence, emphasizing their shared pathways and clinical implications.

The bidirectional link between obesity and sleep disorders underscores the importance of integrating sleep assessment and management into obesity treatment strategies. Addressing this relationship could mitigate the progression of cardiometabolic comorbidities and improve overall health outcomes. Moreover, the intertwined dynamics between obesity, sleep disorders, and mental health-mediated by inflammatory pathways, hormonal dysregulation, and neurobehavioral factors-highlight the critical need for integrated treatment approaches targeting physical, psychological, and sleep-related dimensions to enhance health and quality of life.

To estimate the impact of semaglutide 2.4 mg treatment on the risk of major adverse cardiovascular events (MACE) in adults with overweight/obesity in the United States based on the SELECT trial of patients with atherosclerotic cardiovascular disease.

Using 2023 census projections and National Health and Nutrition Examination Survey data, we developed Markov population-based predictive models for US adults meeting SELECT inclusion criteria and, separately, for adults eligible for semaglutide 2.4 mg for its MACE risk reduction indication. The 10-year rate of recurrent MACE and deaths was estimated based on the Secondary Manifestations of ARTerial disease 2 risk calculator and estimated semaglutide 2.4 mg treatment effect as per the SELECT MACE hazard ratio.

Of 6 164 019 US adults meeting the SELECT criteria, 2 523 218 (40.9%) are estimated to have ≥1 new MACE in the next 10 years with no additional intervention. Semaglutide 2.4 mg may prevent 496 400 events, a 16% relative reduction. An estimated 2 103 630 deaths are predicted over the next 10 years, of which 332 597 deaths (any cause, 16% relative reduction) could be avoided with semaglutide 2.4 mg. Among the estimated 22 653 158 meeting the MACE risk reduction FDA label criteria, 42.7% could experience ≥1 new MACE; treatment could prevent 1 934 493 MACE and 1 231 295 deaths (16% relative reduction for both).

Four in 10 individuals in the United States meeting the SELECT criteria are estimated to experience a recurrent CV event without additional intervention. Semaglutide 2.4 mg can potentially prevent between half a million and up to 2 million MACE over the next 10 years in the population meeting SELECT and MACE risk reduction eligibility.

What is the context and purpose of this research study? More than 7 in 10 US adults have overweight or obesity, which increases the risk of heart disease. Semaglutide is a medication used to treat type 2 diabetes and obesity. A clinical study called SELECT found that semaglutide reduces the risk of heart attack, stroke, or death by 20% in adults with overweight or obesity and heart disease. What was done? Our research estimated how many people in the United States would meet the criteria for participation in SELECT, how many heart disease events they might have with regular medical care over the next 10 years, and how many could be avoided with semaglutide 2.4 mg treatment in addition to regular medical care. We also estimated how many people would still be alive if they were treated with semaglutide. We estimated the same information for all people eligible for treatment with semaglutide based on the US Food and Drug Administration (FDA) indication of semaglutide 2.4 mg in patients with heart disease. These estimations were based on a large survey of US adults. What were the main results? We found that over 6 million people would meet the SELECT study criteria. Of these, 41% are estimated to have at least 1 new heart disease event in the next 10 years. If treated with semaglutide 2.4 mg, nearly 500 000 heart disease events and more than 300 000 deaths could be avoided. More than 22 million adults would qualify for semaglutide 2.4 mg, according to the FDA indication. If all of these people were treated with semaglutide 2.4 mg, nearly 2 million heart disease events and more than 1 million deaths might be prevented. What is the originality and relevance of this study? Treatment with semaglutide 2.4 mg can reduce the risk of new heart disease events and death in patients with existing heart disease, showing a substantial impact of semaglutide treatment in a real-world setting in the United States. Our study used different analyses to add to the existing research about reducing the risk of heart disease in people with overweight or obesity.

Diabesotension, an overlapping triad of diabetes, hypertension, and obesity, remains a diagnostic challenge due to its complex underlying molecular mechanisms. Individuals with diabesotension face twice the risk of microvascular and macrovascular complications compared to those with either condition alone. However, the complexity of diabesotension poses significant diagnostic challenges due to limited knowledge of this disease trifecta.

The protein network was constructed, and the DPClusOST algorithm was applied to determine the protein clusters with a density ranging from 0.1 to 1.0 and those relevant to the pathophysiology of diabesotension. The significance score (SScore) was computed using the p-value from Fisher's exact test to evaluate each cluster, and the clusters containing proteins associated with diabesotension were classified using receiver operating characteristic (ROC) analysis. The significant density of the cluster, as indicated by the AUC, was determined and subsequently subjected to pathway enrichment analysis using ShinyGO.

At densities of 0.6 and 0.8, 14 proteins (STX3, VAMP2, STX4, SYT1, DNAJC5, HSD17B10, DLD, AIFM1, PDHA1, PDHB, DLAT, PDHX, OGDH, and STAT5A) from clusters 13 and 53 were significantly identified as potential diabesotension-related proteins. Key pathways associated with the tripartite interplay of the three pathologies were found to involve amino acid metabolism, glycolysis/gluconeogenesis, SNARE-mediated vesicle transport, insulin and salivary secretion, and the glucagon and HIF-1 signaling pathways, thus identifying novel candidates for diabesotension biomarkers and therapeutic targets.

This study highlights the use of graph clustering to identify potential biomarkers for the comorbid triad, which could enhance personalized future treatment strategies.

This real-world study compared clinical outcomes between tirzepatide treatment and bariatric metabolic surgery (BMS) in adults with obesity.

This retrospective cohort study used the TriNetX network to identify adults with a body mass index (BMI) ≥ 30 kg/m2. Patients initiating tirzepatide treatment were compared with those undergoing BMS. The primary outcome was all-cause mortality, while secondary outcomes included major adverse cardiovascular events (MACEs) and major adverse kidney events (MAKEs). Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and stratified analyses were performed based on age, sex and BMI categories.

After exclusions and 1:1 propensity score matching (PSM), 84 884 matched pairs were analysed. The incidence of all-cause mortality was 0.19 per 100 person-years in the tirzepatide group compared with 0.57 in the BMS group. Tirzepatide was associated with a significantly lower risk of all-cause mortality compared with BMS (HR, 0.311; 95% CI, 0.257-0.375; p < 0.0001). The mortality benefits were consistent across age groups, genders and BMI categories. Tirzepatide also reduced the risk of MACEs (HR, 0.743; 95% CI, 0.673-0.821; p < 0.0001) and MAKEs (HR, 0.375; 95% CI, 0.336-0.419; p < 0.0001). Stratified analyses demonstrated significant reductions in primary and secondary outcomes across most categories.

Tirzepatide demonstrated superior clinical outcomes compared with BMS in adults with obesity, including significant reductions in all-cause mortality, MACEs and MAKEs. These findings suggest that tirzepatide may serve as an effective non-surgical alternative to BMS, with broad applicability across diverse patient populations.

To understand real-world tirzepatide use among individuals without type 2 diabetes (T2D) diagnoses in a US electronic health record (EHR) database.

This retrospective, descriptive, cohort study used Veradigm's® Network EHR database linked with administrative claims. Adults (≥18 years) included had ≥1 tirzepatide prescription (index period: 13 May 2022-31 August 2023); continuous medical and pharmacy enrolment for ≥12 months pre-index; and no T2D diagnosis or baseline T2D medications except metformin (overall cohort). 'Anti-obesity medication (AOM)-eligible cohort' included individuals with body mass index (BMI) ≥30 or ≥27 kg/m2 and ≥1 obesity-related complication (ORC) and ≥6 months of continuous post-index enrollment.

The overall cohort included 10,193 individuals (mean age: 45.0 years; female: 77.1%). Among 6623 individuals with BMI data, 5931 were AOM-eligible. Of these, 3470 had 6-month follow-up data (AOM-eligible cohort; ≥1 ORC: 76.5%; ≥2 ORCs: 51.8%). Treatment patterns at 6 months were assessed among 755 individuals with complete claims data in the AOM-eligible cohort. Most individuals (95.6%) were initiated on a tirzepatide dose of ≤5 mg. At the fifth prescription refill (n = 448), 91.1% were receiving tirzepatide doses of ≤10 mg. At 6 months, tirzepatide adherence was 55.5% and persistence was 54.2%. Among discontinued individuals (n = 346), 10.1% switched to an alternate AOM.

Majority of individuals in the AOM-eligible cohort had ≥1 ORC, and half had ≥2 ORCs, indicating that in this study cohort tirzepatide was being used in people with multimorbidity. Tirzepatide dose escalation in this real-world cohort was slower than in clinical trials, which may have implications for its real-world effectiveness.

Obesity, a global epidemic, significantly increases cardiovascular disease (CVD) risk. Conventional treatments often lack long-term efficacy, emphasizing the need for integrative, sustainable approaches.

This review assesses the role of yoga as a complementary intervention in obesity management and its effectiveness in reducing cardiovascular risk.

We systematically reviewed literature up to March 2024 from Medline/PubMed, Scopus, Embase and the Cochrane Central Library. The focus was on randomized controlled trials (RCTs), observational studies, systematic reviews and meta-analyses evaluating the impact of yoga on obesity-related outcomes and cardiovascular risk factors. Studies were reviewed for quality, outcomes, and both physiological and psychological effects of yoga on obese individuals.

Yoga interventions consistently yielded positive results in reducing body mass index (BMI), waist circumference, and body fat. These physical changes correlate with significant improvements in cardiovascular markers, including blood-pressure, cholesterol levels, endothelial and autonomic functions. Yoga also enhances stress management and psychological well-being, addressing both mental and physical facets of obesity. The benefits extend beyond mere weight reduction, affecting systemic inflammation and metabolic health, crucial for mitigating CVD risks.

Yoga represents a promising, non-pharmacological approach to obesity management and CVD risk reduction. Its holistic impact on physical and psychological health makes it a viable adjunct therapy in comprehensive obesity management, fostering sustainable lifestyle changes and long-term health benefits.

Incorporating yoga into standard obesity management protocols could enhance therapeutic outcomes. Future research should standardize yoga interventions to better integrate them into modern healthcare and explore their long-term cardiovascular effects.

Across the spectrum of weight regain, ranging from cachexia rehabilitation and catch-up growth to obesity relapse, the recovery rate of body fat is often disproportionate relative to lean tissue recovery. Such preferential 'catch-up fat' is in part attributed to an increase in metabolic efficiency and embodied in the concept that 'metabolic adaptation' or 'adaptive thermogenesis' in response to large weight deficits can persist during weight regain to accelerate fat stores recovery. This paper reviews the evidence in humans for the existence of this thrifty metabolism driving catch-up fat within the framework of a feedback loop between fat stores depletion and suppressed thermogenesis. The search for its effector mechanisms suggests that whereas adaptive thermogenesis during weight loss results primarily from central suppression of sympathetic nervous system and hypothalamic-pituitary-thyroid axis, its persistence during weight regain for accelerating fat recovery is primarily mediated through peripheral tissue resistance to the actions of this systemic neurohormonal network. Emerging evidence linking it to an upregulation of skeletal muscle type 3 deiodinase (D3), the main thyroid hormone inactivating enzyme, along with slowed muscle metabolism and altered contractile properties, suggest that D3-induced muscle hypothyroidism is a key feature of such peripheral resistance. These findings underlying a role of skeletal muscle hypothyroidism in adaptive thermogenesis driving catch-up fat, but which can also concomitantly compromise muscle functionality, have been integrated into a mechanistic framework to explain how weight cycling and large weight fluctuations across the lifespan can predispose to sarcopenic obesity.

Addressing obesity and overweight is crucial for cancer prevention. However, ensuring that such efforts do not harm individuals with obesity requires careful consideration to avoid reinforcing the widespread stigmatisation of individuals with obesity. This study aims to explore how individuals who have overweight or obesity perceive cancer risk information addressing obesity as a cancer risk factor.

Semi-structured interviews were conducted during autumn 2023 and spring 2024, with 11 Swedish men and women, aged 24 to 70 years, who self-assessed as having overweight or obesity. The collected data were analysed using reflexive thematic analysis as described by Braun and Clarke.

The first theme, Reflecting on personal risk, included the subthemes: It is about me and my body and Awareness can be a burden. The second theme, Healthcare encounters: building trust and providing support, included the subthemes: Past encounters influence how risk information is perceived, Need to act and succeed, and Consider receptivity and power imbalances. The third theme, Distribution of responsibility and blameworthiness, included subthemes: Being personally blamed and fearing increased discrimination and A need for shared responsibility.

Participants experienced that risk information, when presented as simplified associations between obesity and cancer, felt personally relevant but difficult to act upon, and therefore burdensome to bear. Consequently, the information risks failing to prevent cancer and may instead cause harm to the people it purports to benefit. Participants suggested several ways to improve the provision and benefit of such information, including introducing multiple ways to act to reduce cancer risk that goes beyond weight reduction, and raising public awareness of the causes of obesity. Efforts to communicate risk, both to the public and to patients, require better ethical considerations of their benefits and harms. Furthermore, risk communicators should act with compassion and responsibility.

Current clinical practice in bariatric surgery follow-up care is highly heterogeneous, and patients have reported needing more and extended personalised support. Especially, they want more support on how to self-manage and cope with the changes and challenges of living with the chronic aspects of obesity and a changing body following surgery. The overall aim of this study protocol is to develop and validate a digital self-management support checklist in bariatric surgery aftercare.

We propose a protocol for a modified, electronic Delphi study design using qualitative and quantitative methods to develop and validate the content of the checklist. The study is divided into two phases: (1) generation of candidate checklist attributes and (2) validation of candidate checklist attributes. In Phase 1, two qualitative studies involving individual interviews with patients and focus groups with healthcare professionals will be conducted to derive context-specific knowledge. This knowledge will be combined with best-practice evidence and stakeholder input to generate candidate checklist attributes, that is, principles, items and features. In Phase 2, a two-round electronic Delphi survey with an expert panel will be conducted to assess the relevance, comprehensibility and comprehensiveness of candidate checklist attributes and to determine the final checklist attributes based on content validity results from the Delphi process. Reflexive thematic analysis will be used on qualitative data and descriptive statistics on quantitative data.

The study has been approved by the Regional Committee for Medical and Health Research Ethics, Region West (2023/676367). The Data Protection Officer at Førde Hospital Trust and collaborating hospital trusts have approved the project (4386-4386). The results will be presented at scientific conferences, published and open-accessed in international peer-reviewed journals.

Obesity poses serious health risks and is trending younger, developing effective strategies to prevent obesity is crucial. Calcium intake is a potential strategy to reduce weight/fat, as it generally enhances the body's energy metabolism. However, calcium's effects on appetite and its specific mechanisms remain unclear. To investigate these questions, we administered calcium orally to fasted mice and found that calcium inhibited food intake during the first 3 h. Long-term calcium supplementation in water decreased HFD intake, weight gain, and fat deposition while increasing energy metabolism in young mice. Mechanistically, calcium activated the vagal afferent nerves and inhibited ARCAgRP neurons-key appetite regulation neuron. What's more, these effects are blunted by chemogenetic inhibition of gastrointestinal intestinal vagal afferent nerves or activation of ARCAgRP neuronal activity. Overall, we showed that ingested calcium activates vagal afferent nerves, inhibiting the activity of ARCAgRP neurons, thereby reducing food intake. This study supports calcium's role in obesity dietary therapy.

To summarize the results of China's five national monitoring reports (CFNMR) on physical fitness (PF) for adults. The Government of China has taken a systematic administrative approach to a creative environment building, and has conducted five national physical fitness monitoring, with a sixth already started in 2024.

CFNMR included indices, rates, test indicators, and questionnaire indicators collected between 2000 and September 2024. Data were collected (every 5 years), analyzed (every 3 years) and published (government announcements and reports) by the Monitoring Center of the General Administration of Sport of China. Adults' data were divided into Group A (20-39 years) and Group B (40-59 years). In this study, once the database was established using government reports as the standard, the indicators were categorized, counted, and descriptively analyzed using EXCEL.

Group A: Indices fluctuated up 2.98 (2010 highest 102.98), and rates fluctuated up 2.40% (2005 highest 89.3%). Group B: Indices continued to decline 0.23 (2014 lowest 99.77), and rates fluctuated up 3.00% (2019 highest 90.6%). Test and questionnaire indicators show different structural characteristics, but obesity (7.33%) and overweight rates (5.88%) continue to increase.

Adult physical fitness is improving, but physical activity is decreasing. The results of the overall growth shown by the tested indicators do not, however, represent the formation of well-functioning mechanisms. Obesity is an ongoing and growing problem that requires constant attention. It should consider adding a physical literacy monitoring component, utilizing public goods attributes, to promote sustainable change and reach more adults.

Obesity is a chronic, relapsing, and progressive disease requiring long-term, interprofessional treatment strategies to improve health outcomes. With over 40% of US adults and nearly 20% of children affected, obesity remains a significant public health concern. Despite the American Medical Association's recognition of obesity as a chronic disease, gaps persist in education, training, and access to effective treatments. These gaps contribute to inadequate obesity management and reinforce stigma and weight bias in healthcare settings.The Standards of Care in Overweight and Obesity-2025, developed by The Obesity AssociationTM, a division of the American Diabetes Association(R), (ADA's Obesity Association), will provide evidence-based recommendations for screening, diagnosis, and management of obesity and related complications. These guidelines will emphasize a complication-centric, risk-reduction approach rather than solely focusing on weight loss. The recommendations will be intended for healthcare professionals, including but not limited to primary care physicians, endocrinologists, obesity medicine physicians, dietitians, and behavioral health specialists, as well as policymakers and insurers.The guideline development will follow a rigorous methodology, incorporating evidence from systematic literature reviews, expert consensus, and public feedback. Recommendations will be graded based on the quality and certainity of supporting evidence, with the goal of annual updates to ensure alignment with the latest research. A stringent conflict-of-interest policy will be maintained to uphold guideline integrity.By promoting personalized and equitable obesity care, these guidelines will aim to bridge existing gaps in clinical practice, enhance treatment accessibility, and improve long-term health outcomes for individuals with overweight or obesity.

The growing prevalence of overweight and obesity (OB) poses a considerable economic burden worldwide. However, nationally representative, detailed analyses estimating the total burden of OB are few. We characterized direct, indirect, and total costs of overweight and obesity in a population-based cohort of Finnish adult individuals and evaluated the additional total costs attributed to overweight and obesity.

The study cohort included 5,587 randomly-selected individuals (≥18 years of age) who participated in the national FinHealth 2017 health examination survey. The main study group consisted of working-age individuals (18-64 years of age; n = 3,914). Individual-level data were collected from the nationwide registers by the Finnish Institute for Health and Welfare (healthcare resource utilization), Social Insurance Institution of Finland (prescription medications, sick leaves, disability pensions, rehabilitation periods), and Statistics Finland (deaths). Indirect costs were calculated using the Human Capital Approach, and direct costs were based on the medication purchases and healthcare resource use.

The mean annual indirect costs were €1,683 (SD, €6,395) per person for the working-age individuals with normal-weight (NW), €2,957 (€8,797) for individuals with overweight (OW), €4,488 (€11,607) for individuals with class I obesity (OBI), and €4,654 (€11,383) for individuals with class II-III obesity (OBII-III). The mean annual total (direct + indirect) costs were €3,314 (SD, €8,358) per person in the NW, €4,902 (€10,747) in the OW, €7,129 (€14,313) in the OBI, and €7,372 (€14,423) in the OBII-III groups. Compared with individuals with NW, OW was associated with 31% (rate ratio, RR, 1.31; 95% CI, 1.09-1.58; p = 0.005), OBI with 83% (RR, 1.83; 95% CI, 1.46-2.28; p < 0.001), and OBII-III with 95% (RR, 1.95; 95% CI, 1.48-2.55; p < 0.001) higher total costs in working-age individuals. When adjusted for age and sex, the predicted total annual cost difference per person was €1,124 for OW, €3,002 for OBI, and €3,443 for OBII-III compared with a person with NW.

Indirect costs constitute a major part of the total costs of obesity in the working-age population. Compared with NW, the total costs are significantly higher not only for severe obesity, but also for OW and OBI.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely associated with insulin resistance (IR). However, the prognostic value of different alternative IR surrogates in patients with MASLD remains unclear. This study aimed to evaluate the association between various IR indices and all-cause mortality and cardiovascular mortality in MASLD patients.

A total of 8,753 adults aged ≥ 20 years with MASLD from the National Health and Nutrition Examination Survey (NHANES, 2003-2018) were included, and their mortality data were obtained from the National Death Index (NDI). Insulin resistance surrogates [including the triglyceride-glucose (TyG) index, TyG-body mass index (TyG-BMI), TyG-waist circumference index, TyG-waist-to-height ratio index, and Homeostatic Model Assessment for IR] were stratified into quartiles. Cox proportional hazards models, receiver operating characteristic (ROC) curve analysis, restricted cubic spline (RCS), mediation analyses, and subgroup analyses were used to explore the associations between these indices and all-cause mortality as well as cardiovascular mortality in MASLD patients.

During a median follow-up of 98 months, 1,234 deaths were observed, including 409 cardiovascular disease (CVD)-related deaths. In the fully adjusted model, higher quartiles of TyG-related indices were significantly associated with an increased risk of all-cause mortality in MASLD patients. Furthermore, the TyG-BMI index was associated with both all-cause mortality and CVD mortality [all-cause mortality: HR (95% CI) 2.84 (1.73-4.67), P < 0.001; CVD mortality: HR (95% CI) 5.32 (2.26-12.49), P < 0.001]. The RCS analyses indicated a U-shaped relationship between TyG-BMI and mortality, with a threshold value of 270.49. Subgroup analyses demonstrated that TyG-related indices had stronger associations with mortality in elderly MASLD patients.

Our findings highlight the prognostic value of IR indices, particularly TyG-BMI index, in predicting all-cause mortality and CVD mortality in MASLD patients.

Excess weight has been identified as a potential risk factor for post-COVID-19 condition (PCC). This systematic review and meta-analysis aimed to investigate whether excess weight is associated with the development or experience of neurological and neuropsychiatric symptoms in PCC.

We conducted a comprehensive search of eight databases (PubMed, Embase, Scopus, Web of Science, VHL, Google Scholar, ProQuest, and medRxiv) for studies published up to July 2023. Studies were included if they assessed PCC symptoms in relation to nutritional status, specifically the development of neurological and neuropsychiatric symptoms more than 12 weeks post-infection. The analysis compared exposure and controls groups (excess weight vs. normal weight; obesity vs. non-obesity). Data were synthesized using a random-effects model.

Of the 10,122 abstracts screened, 18 studies (n = 139,091 adults) were included. These studies included 79,050 individuals with excess weight vs 57,926 normal-weight individuals and 30,694 individuals with obesity vs 107,612 non-obese individuals. The presence of excess weight in PCC was significantly associated with persistent depression (RR = 1.21; 95% CI: 1.03-1.42), headache (OR = 1.23; 95% CI: 1.10-1.37), memory issues (RR = 1.43; 95% CI: 1.24-1.65), sleep disturbance (RR = 1.31; 95% CI: 1.16-1.48), and vertigo (RR = 1.21; 95% CI: 1.04-1.41). Obesity was significantly associated with persistent headache (OR = 1.45; 95% CI: 1.37-1.53), numbness (RR = 1.61; 95% CI: 1.46-1.78), smell disorder (OR = 1.16; 95% CI: 1.11-1.22), taste disorder (OR = 1.22; 95% CI: 1.08-1.38), and vertigo (RR = 1.44; 95% CI: 1.35-1.53).

Excess weight, including overweight and obesity, is associated with experiencing neuro-symptoms related to PCC. Individuals with these conditions urgently need enhanced personalized care management in current post-pandemic context.

To assess the association of tirzepatide use with a 10-year predicted risk of type 2 diabetes (T2D) among Chinese participants with obesity or overweight from the SURMOUNT-CN trial.

In this post hoc analysis, the QDiabetes-2018 risk engine was used to calculate the 10-year predicted T2D risk at baseline, week 24 and week 52 among SURMOUNT-CN participants randomized to receive tirzepatide 10 mg, 15 mg or placebo. A mixed model for repeated measures was used to compare mean predicted risk changes from baseline to weeks 24 and 52 between tirzepatide and placebo. Subgroup analyses were conducted by baseline body weight mass index (BMI) status and baseline prediabetes status.

Demographic and baseline clinical characteristics were similar among tirzepatide10 mg (n = 59), 15 mg (n = 53) and placebo (n = 57). From baseline to week 52, the least square (LS) mean predicted T2D risk changed from 5.3% to 1.2% for tirzepatide 10 mg, from 4.9% to 1.0% for tirzepatide 15 mg and from 5.8% to 4.5% for placebo. The difference in LS mean risk change from baseline to week 52 was significant between both tirzepatide 10 mg (-3.2%, 95% confidence interval [CI]: -4.2%, -2.2%) and 15 mg (-3.4%, 95% CI: -4.4%, -2.4%) and placebo. Significantly greater predicted risk reductions for tirzepatide than placebo were observed in all subgroups.

Tirzepatide was associated with significantly reduced predicted 10-year risk of T2D among SURMOUNT-CN participants with obesity or overweight, irrespective of baseline BMI and prediabetes status.

The use of corticosteroids (CS) has been associated with higher body mass index (BMI) and waist circumference (WC) in cross-sectional studies. However, longitudinal data are scarce, particularly for locally administered forms.

We analyzed weight and waist circumference changes in 81 361 Lifelines Cohort Study participants (mean age 46.3 years, mean BMI 26.0 kg/m2, 41% male, mean follow-up 3.9 years) via linear regression. Sensitivity analyses included stratification by sex and BMI. Short-term weight changes post-start were assessed in a subset using linear mixed-effect models.

We found 23.8% CS users during the study period. Individuals reporting any new use of CS gained significantly more weight compared to nonusers at follow-up (β .034 kg/year, P = .021), particularly among those initiating local CS use (β .037 kg/year, P = .017). Use of new systemic CS was associated with increased WC (β .200 cm/year, P < .001). Discontinuation of CS led to decreased WC (β -.078 cm/year, P = .028). These effects were particularly observed in female participants and individuals with BMI ≥25 kg/m2, but not in male participants and those with BMI < 25 kg/m2. Short-term weight-inducing effects of CS were not observed in the weeks after initiation of CS use.

This study demonstrates that CS use, including locally administered forms, is associated with long-term increases in weight and WC, notably in female individuals and those with overweight or obesity. Discontinuing CS was linked to reductions in WC. These findings underscore the need to carefully assess chronic systemic and local CS use, as discontinuation could benefit obesity-related outcomes in certain patients.

The global prevalence of obesity has more than tripled since 1975 and represents a substantial public health challenge. Obesity is a chronic disease with a high tendency to recurrence and is associated with numerous comorbidities, such as diabetes mellitus, high blood pressure and cardiovascular diseases. Every year around 2.8 million people die from the sequelae. Obesity is defined as the excessive accumulation of fatty tissue. In routine clinical practice obesity is diagnosed by measuring the body mass index (BMI); however, there are numerous professional associations that recommend the additional determination of another biometric parameter (waist to height ratio or waist circumference). This not only reduces inaccuracies in the BMI but also makes it easier to identify patients with a particularly high risk of cardiovascular and metabolic diseases. Regardless of the definitions and diagnostics of obesity, the aim of treatment for those affected is not just to reduce weight but more to improve the quality of life, overall survival and the improvement or prevention of obesity-related diseases.

Lipid accumulation inhibition is a pivotal focus for anti-obesity drugs. α-Tocopheryl succinate (TS) is a derivative of α-tocopherol (T) that inhibits lipid accumulation, making it a propitious candidate for an anti-obesity agent. However, cytotoxicity of TS limits its application. Reactive oxygen species produced by TS are responsible for the cytotoxicity, which can be mitigated by T. Herein, we evaluated the effect of a liposomal formulation co-encapsulating TS and T (TS/T-lipo) on obesity. We prepared TS/T-lipo and evaluated the resultant cytotoxicity and lipid accumulation inhibition effect in vitro. TS/T-lipo showed a significant inhibitory effect on lipid accumulation without cytotoxicity. The inhibitory effect on lipid accumulation is likely due to upregulation of Uncoupling Protein 1, which causes lipid consumption. Moreover, we evaluated the effect of TS/T-lipo on a high-fat diet-induced obese mouse model and found that body weight significantly decreased in the TS/T-lipo group without elevation of liver toxicity or blood glucose levels. Additionally, increased glycerol serum levels are suggestive of increased lipolysis upon treatment with TS/T-lipo. Histological analysis supports inhibition of lipid accumulation by treatment with TS/T-lipo. Taken together, this evidence demonstrates that co-administration of TS/T can reduce cytotoxicity and may be a promising candidate for an anti-obesity drug.

Obesity is recognised as a chronic, relapsing and progressive disease, and long-term weight maintenance remains one of the greatest challenges in obesity management. When treatment gets interrupted, recurrent weight gain might be expected. Funding structures for MBS in numerous health systems globally do not currently permit metabolic and bariatric surgery (MBS) to prevent recurrent weight gain in patients who are normal weight or overweight. Gastric band removal is frequently required due to long-term complications such as slippage, which raises an important question: should revisional MBS be considered for weight maintenance in patients who have successfully lost weight after gastric banding? With the increasing use of obesity management medications and the associated successful weight loss, we anticipate that more patients will discontinue pharmacological treatment after reaching a normal weight or overweight range. However, many of these patients may still seek MBS for long-term weight maintenance. We question whether weight maintenance should be considered an indication for MBS in patients who are currently normal weight or overweight but have a history of severe obesity and must discontinue their current obesity treatment.

Chronic disease is the leading cause of death in the United States but can be prevented with lifestyle behaviors, such as physical activity and healthy dietary habits. Experts have developed health programs to promote these behaviors, but they have not led to long-term effects or focused on meeting guidelines and recommendations.

To determine the effectiveness of a health program in improving participants' confidence levels, health outcomes, and health behaviors.

Within-subjects analysis was conducted to determine pre-post changes in weight, health, and confidence in achieving step count and fruit and vegetable consumption goals. A between-subjects analysis was conducted to compare program graduates and program dropouts to determine the influence of weight classification, weight, health, and confidence on program completion.

After completing the program, program graduates lost an average of six pounds and reported increases in health and confidence in achieving step count and fruit and vegetable goals. Health and confidence levels were significantly lower among program dropouts compared to program graduates.

The program had a positive effect on confidence levels and health outcomes among program graduates. Materials to enhance confidence should be considered for distribution during the pre-assessment phase of this program.

There is widespread debate about the impact of metabolically healthy obesity (MHO) on cardiovascular outcomes. However, studies have not exclusively examined the impact of MHO on cardiovascular outcomes in the postmenopausal population.

To explore the prevalence of MHO and its relationship with hospitalization outcomes, including major adverse cardiac or cerebrovascular events (MACCE), in postmenopausal women.

We extracted data from the National Inpatient Sample 2020 database using International Classification of Disease, Tenth Revision, Clinical Modification codes for all admissions of postmenopausal women. We excluded patients with diabetes, hypertension, and hyperlipidemia to obtain metabolically healthy patients and then identified patients with obesity to create obese and non-obese cohorts. We used a 1:1 propensity score matching method to match patients with and without MHO based on age, and then we did a multivariable regression analysis for in-hospital MACCE.

In 2020, 1304185 metabolically healthy postmenopausal women were admitted; 148250 (11.4%) had MHO. After propensity score matching for age, a statistically significant difference was observed in overall MACCE [odds ratio (OR): 1.08, 95% confidence interval (CI): 1.01-1.16, P = 0.028] among MHO and non-MHO cohorts, especially in patients of African-American ethnicity (OR: 1.23, 95%CI: 1.01-1.49, P = 0.035) and the lowermost income quartile (OR: 1.24, 95%CI: 1.06-1.44, P = 0.007).

Postmenopausal patients with MHO are at risk of MACCE, especially black patients and those with lower incomes. Larger prospective studies can demystify MHO's impact on cardiovascular outcomes among postmenopausal women.

Over the past few decades, obesity has transitioned from a localized health concern to a pressing global public health crisis affecting over 650 million adults globally, as documented by WHO epidemiological surveys. As a chronic metabolic disorder characterized by pathological adipose tissue expansion, chronic inflammation, and neuroendocrine dysregulation that disrupts systemic homeostasis and impairs physiological functions, obesity is rarely an isolated condition; rather, it is frequently complicated by severe comorbidities that collectively elevate mortality risks. Despite advances in nutritional science and public health initiatives, sustained weight management success rates and prevention in obesity remain limited, underscoring its recognition as a multifactorial disease influenced by genetic, environmental, and behavioral determinants. Notably, the escalating prevalence of obesity and its earlier onset in younger populations have intensified the urgency to develop novel therapeutic agents that simultaneously ensure efficacy and safety. This review aims to elucidate the pathophysiological mechanisms underlying obesity, analyze its major complications-including type 2 diabetes mellitus (T2DM), cardiovascular diseases (CVD), non-alcoholic fatty liver disease (NAFLD), obesity-related respiratory disorders, obesity-related nephropathy (ORN), musculoskeletal impairments, malignancies, and psychological comorbidities-and critically evaluate current anti-obesity strategies. Particular emphasis is placed on emerging pharmacological interventions, exemplified by plant-derived natural compounds such as berberine (BBR), with a focus on their molecular mechanisms, clinical efficacy, and therapeutic advantages. By integrating mechanistic insights with clinical evidence, this review seeks to provide innovative perspectives for developing safe, accessible, and effective obesity treatments.

Despite substantial advancements and extensive funding in obesity research-spanning the development of novel pharmacological and non-pharmacological treatments, as well as numerous public health initiatives-the global prevalence of obesity continues to escalate at an alarming rate [...].

Introduction: the Dietary Inflammatory Index (DII) provides a quantitative means for assessing the role of diet in relation to health outcomes. Objetive: this study aimed to assess the association between the inflammatory potential of diet, as measured by the DII and IL-17A levels in young adults. Methods: a cross-sectional study was conducted on 69 adults between 18-30 y of age in San Luis Potosi, Mexico. Fasting blood samples were collected to analyze lipid profile, glucose homeostasis, and IL-17A. Dietary intake was assessed using a 24-hour recall. DII scores were calculated from 19 available food parameters. Univariate linear regression models were estimated to evaluate the possible dependence of IL-17A levels (dependent variables) on some potential explicative variables such as anthropometric, clinical, biochemical, and dietary variables. Results: there was a high inflammatory potential, with a mean DII score of +1.04 (range: -2.19 to +2.78). The DII was not associated with BMI, IL-17A levels or cardiometabolic risk factors. Conclusion: the study shows that the diets of healthy college-aged Mexican adults had a high inflammatory potential.

Untreated obesity in pregnancy is associated with adverse fetal and neonatal outcomes that influence the long-term offspring health trajectory, propagating obesity and cardiometabolic disease from one generation to the next. The current efforts to reduce the risk of these negative outcomes through preconception weight loss remain largely ineffective. Anti-obesity medications (AOMs) are an understudied option for this indication, likely due to the potential for teratogenicity with accidental exposure during pregnancy. However, the current recommendation to discontinue all AOMs prior to conception fails to frame obesity within the chronic disease paradigm typically used for preconception counseling. Evolving evidence suggests that glucagon-like peptide 1 receptor agonists (GLP-1 RAs), the newest and most effective AOM class, may be safe in early pregnancy. Although further research is needed, counseling about GLP-1 RAs during pregnancy should include the potential for both risk and benefit. This review summarizes the known risks that obesity in pregnancy poses to the offspring and discusses the benefits and limitations of current treatment strategies. While there remain several barriers to optimal preconception and prenatal care for people with obesity, this review aims to arm providers with the knowledge needed for patient-centered counseling prior to and during pregnancy.

Obesity is on the rise, increasing the demand for efficient treatment and delivery of care in the obesity medicine ambulatory care setting.

Clinicians provided redundant information during the client's initial visit, leading to longer than necessary clinic visits.

Iterative plan-do-study-act cycles were used for this quality improvement project.

A 4-minute educational video was sent to clients prior to their initial appointment using automated systems through the electronic health record. Education consisted of the specialty services offered, nutrition, and frequently asked questions.

Visits completed in under 40 minutes increased from 73% to 84%, with average initial visit times decreasing from 44 to 37 minutes. The number of patients providers were able to see increased from 10 to 18 after implementing the educational video.

Clinics may consider using pre-visit video-based education to reduce visit time and improve efficiency in the obesity medicine ambulatory care setting.

The development of long-acting incretin receptor agonists represents a significant advance in the fight against the concurrent epidemics of type 2 diabetes mellitus (T2DM) and obesity. The aim of the present review is to examine the cellular processes underlying the actions of these new, highly significant classes of peptide receptor agonists. We further explore the potential actions of multi-agonist drugs as well as the mechanisms through which gut-brain communication can be used to achieve long-term weight loss without negative side effects.

Several unimolecular dual-receptor agonists have shown promising clinical efficacy studies when used alone or in conjunction with approved glucose-lowering medications. We also describe the development of incretin-based pharmacotherapy, starting with exendin- 4 and ending with the identification of multi-incretin hormone receptor agonists, which appear to be the next major step in the fight against T2DM and obesity. We discuss the multi-agonists currently in clinical trials and how each new generation of these drugs improves their effectiveness. Since most glucose-dependent insulinotropic polypeptide (GIP) receptor: glucagon-like peptide- 1 receptor (GLP- 1) receptor: glucagon receptor triagonists compete in efficacy with bariatric surgery, the success of these agents in preclinical models and clinical trials suggests a bright future for multi-agonists in the treatment of metabolic diseases. To fully understand how these treatments affect body weight, further research is needed.

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.

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.

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.

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.

Obesity and overweight are widespread among individuals in both developed and emerging nations. Obesity is a global health issue, and its prevalence has been increasing in Egypt for several decades. The health belief model (HBM) is a comprehensive framework model that has an important role in preventing disease and promoting health.

This study aims to measure the prevalence of overweight and obesity among medical students in the faculty of medicine at Ain Shams University and to determine the effect of nutritional educational program on body mass index and health belief model scales among them.

This study was conducted in the Faculty of Medicine at Ain Shams University among medical students in 2 phases: phase 1, a descriptive cross-sectional study to calculate the prevalence of the disease; and phase 2, an intervention study that included a sample of 100 medical students whose body mass index was greater than or equal to 25. The study tool is a self-administered questionnaire based on the health belief model for weight control behavior that is tested by the participants before and after the intervention program.

Most participants had a normal BMI, while 40% were overweight or obese. There was a statistically significant difference in the HBM scores before and after the intervention sessions. The mean BMI before the intervention was 29 ± 0.25 and had improved after the intervention session to 29, where there was a highly statistically significant difference (p-value < 0. 001).

Nutritional education sessions based on the health belief model help in improving the knowledge and habits of high-risk medical students for weight gain. There were substantial changes between before and after the nutrition program interventions.

Eating behavior traits (EBTs), defined as personal tendencies determining food intake, can be useful targets for behavioral weight management interventions. Previous reviews have examined the impact of specific intervention types on EBTs, not reflecting the breadth of interventions used in practice. This systematic review and meta-analysis synthesized evidence on the impact of all types of behavioral weight management interventions on EBTs. We searched seven databases and included randomized controlled trials reporting EBT outcomes following behavioral weight management interventions delivered to adults with overweight or obesity. Using random-effects meta-analyses, we synthesized findings from 27 trials at the end of intervention and 12 months (±3 months) post intervention. We found evidence to suggest that interventions improved uncontrolled eating, external eating, susceptibility to hunger, restraint and intuitive eating at intervention end when compared with waitlist, minimal or usual care control. We found no evidence of effects on emotional eating, disinhibition, and hedonic hunger. At follow-up, effects on restraint remained, but we found no evidence of an effect on emotional eating, hedonic hunger and uncontrolled eating. Findings were limited by low numbers of contributing trials. More high-quality trials reporting EBTs are needed to better understand the impact of adult behavioral weight management interventions on EBTs. PROSPERO registration number: CRD42022367505.

Chronic stress, characterized by increased long-term exposure to the glucocorticoid hormone cortisol, is increasingly linked to obesity development. Still, various knowledge gaps persist, including on underlying pathophysiological mechanisms. The aim of the current review is to provide the latest insights on the connection between stress and obesity. We discuss three biological stress systems-the autonomic nervous system, the hypothalamus-pituitary-adrenal (HPA) axis and the immune system-and their link with obesity, with a particular focus on the HPA axis. The role of cortisol and its regulatory variations (including glucocorticoid rhythmicity and altered sensitivity) in adipose tissue biology and obesity development is discussed. Moreover, we highlight the physiological, affective, cognitive and behavioural dimensions of the stress response offering a deeper understanding of how stress contributes to obesity development and vice versa. Finally, stress as a treatment target for obesity is discussed. We conclude that the link between stress and obesity is complex and multifaceted, influenced by physiological, affective, cognitive and behavioural stress response mechanisms, which especially when chronically present, play a key role in the development of obesity and associated cardiometabolic diseases. This necessitates integrated approaches tailored to individual needs, including lifestyle modifications, behavioural interventions, psychosocial support and possible additional pharmacological interventions.

Accumulating evidence supports the effectiveness of moderate-intensity aerobic training on metabolic health, with limited studies investigating change in resting substrate oxidation. The aim of this study was to explore whether 10 weeks of walking-based aerobic training would alter substrate oxidation in postmenopausal women with obesity.

Twenty-four postmenopausal women with obesity who were assigned into the control (n = 12) or exercise groups (n = 12) undertook a 10-week aerobic training program (3 d·week-1) that involved walking exercises at 50-70% of heart rate reserve on a treadmill, with exercise volume increased from 25 to 40 min·day-1. Resting metabolic rate (RMR) and body composition were measured pre- and post-training. Whole-body substrate oxidation was calculated using respiratory data collected during RMR measurement via indirect calorimetry. No significant change was noted (p > 0.05) in resting fat oxidation and carbohydrate oxidation in the exercise group. Resting respiratory exchange ratio and RMR did not alter in response to the training program (p > 0.05).

Our results show that a 10-week of moderate-intensity aerobic training does not modify substrate oxidation in postmenopausal women with obesity.

Metabolic bariatric surgery (MBS) candidates undergo a comprehensive nutritional preparation process by a registered dietitian (RD). The effect of eHealth interventions on the MBS preparation process is unknown.

To assess the impact of adding an application to the nutritional preparation process on pre-surgery nutritional knowledge, physical, and behavioral parameters among MBS candidates.

An open-label randomized controlled trial among MBS candidates. All participants received 3-6 meetings with an RD and the intervention group also received access to an application containing information modules and a communication platform. Data was collected at baseline and end of preparation.

Forty participants were recruited, of them 67.5% women, with a mean age and body mass index of 34 ± 10.1 years and 43.5 ± 6.0 kg/m2, respectively. Nutritional knowledge, anthropometrics, functionality, adherence to most behavioral recommendations, and subjective state of health improved in both groups (P Time ≤ 0.044). Physical activity initiation (i.e., beginning of regular exercise engagement) was higher among the intervention group (40% at baseline and 68% at end of preparation vs 35% at baseline and 32% at end of preparation for interventions and controls, respectively, P Time × Group = 0.026). The application was rated as providing added value (8.2 on a scale of 1 (no added value) to 10 (meaningful added value)).

Nutrition preparation process with an RD improved MBS knowledge, adherence to behavioral recommendations, subjective state of health, and modestly enhanced weight and functionality outcomes among MBS candidates. Although rated as having an added value, incorporating an application had only a minimal impact on these outcomes.

Obesity prevalence continues to rise globally at alarming rates, with adverse health and economic implications. In this state-of-the-art review, we provide an analysis of selected evidence about the current knowledge in the obesity literature, including a synthesis of current challenges in obesity and its determinants. In addition, we review past and current efforts to combat the obesity epidemic, highlighting both successful efforts and areas for further development. Last, we offer insights into the next steps to address the obesity epidemic and advance the field of obesity through both research and practice by (a) adopting a systems perspective, (b) fostering cross-sector and community collaborations, (c) advancing health equity, (d) narrowing the research-to-practice and research-to-policy gaps with multidisciplinary approaches, and (e) embracing complementary approaches for concurrent obesity prevention and treatment.