OBJECTIVE: We compared health care spending and utilization associated with semaglutide relative to bariatric surgery in patients with obesity and type 2 diabetes (T2D). METHODS: Using MarketScan insurance claims of pati...OBJECTIVE: We compared health care spending and utilization associated with semaglutide relative to bariatric surgery in patients with obesity and type 2 diabetes (T2D). METHODS: Using MarketScan insurance claims of patients with BMI ≥ 35 and T2D from 2016 to 2021, we examined associations between choice of semaglutide, sleeve gastrectomy, or gastric bypass; 3-year health care spending (out-of-pocket [OOP] and total); and clinical outcomes (ED visits, hospital admissions, and major adverse cardiovascular events [MACE]). Analyses were adjusted using generalized linear models, inverse probability weighting, and instrumental variables. RESULTS: Among 6748 patients (2797 semaglutide, 2300 sleeve gastrectomy, 1651 gastric bypass), bariatric surgery patients had higher BMI and more comorbidities. In IPTW-adjusted analysis, semaglutide was associated with the highest 3-year OOP costs ($7752 vs. $5980 [sleeve gastrectomy] vs. $6591 [gastric bypass], p < 0.001), but total spending was not statistically different across the groups. Relative to semaglutide, the gastric bypass group showed higher observed ED visits (hazard ratio relative to semaglutide [95% CI]: 1.36 [1.28-1.45]) and inpatient admissions (1.25 [1.13-1.37]) and fewer MACE (0.71 [0.59-0.88]). Sleeve gastrectomy was associated with fewer long-term admissions (0.79 [0.72-0.86]) and MACE (0.79 [0.66-0.93]). CONCLUSIONS: For patients with T2D and obesity, compared with semaglutide, bariatric surgery is associated with lower OOP spending and similar total spending at 3 years, as well as lower long-term MACE rates.
OBJECTIVE: We aimed to examine the effect of obesity on the plasma free fatty acid (FFA) carrier proteome in mice. METHODS: From 6 to 20 weeks of age, male and female C57BL/6J wild-type mice were fed either a low-fat die...OBJECTIVE: We aimed to examine the effect of obesity on the plasma free fatty acid (FFA) carrier proteome in mice. METHODS: From 6 to 20 weeks of age, male and female C57BL/6J wild-type mice were fed either a low-fat diet (10% of kilocalories from fat) or a high-fat diet (60% of kilocalories from fat), and leptin-deficient ob/ob mice were fed a low-fat diet. Plasma FFA carrier proteins were isolated using a fatty acid pulldown assay and detected by proteomics. Plasma proteins and lipoprotein particles were separated by fast protein liquid chromatography (FPLC). Hepatic gene expression was quantified by qPCR. RESULTS: In each sex, 284 FFA carrier proteins were detected, with dozens of differentially abundant proteins between lean and obese groups. We identified eight proteins that exhibited altered abundance in both models of obesity for both sexes, with the majority transcribed in the liver. Interestingly, proteins with lower or higher abundance in the plasma FFA carrier proteome in obesity showed correspondingly altered gene expression in the liver. Furthermore, FFAs coeluted with lipoprotein particles in FPLC fractions, with accentuated FFA levels in the low-density lipoprotein fractions in obesity. CONCLUSIONS: Obesity remodels the spectrum of plasma FFA carriers, potentially via changes in gene expression and lipoprotein abundance.
Staiano AE, Estabrooks PA, Buccini G
… +17 more, Cook SR, Davis AM, Davison K, Fiechtner L, Heerman WJ, Hill JL, Inge TH, Jelalian E, Kelly AS, Martin CK, McLoughlin GM, Redman LM, Ruggiero C, Ryder J, Skinner AC, Sweeney B, Katzmarzyk PT
Obesity (Silver Spring)
· 2026 Jun · PMID 42084557
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OBJECTIVE: Pennington Biomedical Research Center convened a scientific symposium in March-April 2025, which brought together leaders in dissemination and implementation science to identify what is known and what is neede...OBJECTIVE: Pennington Biomedical Research Center convened a scientific symposium in March-April 2025, which brought together leaders in dissemination and implementation science to identify what is known and what is needed to foster the rapid dissemination and implementation of evidence-based, guideline-backed pediatric obesity prevention and treatment interventions. METHODS: The primary aim of the symposium was to identify effective dissemination and implementation strategies, contextual factors related to strategy selection, and mechanisms of successful intervention reach, adoption, implementation, and maintenance. Through this symposium, the overarching goal was to accelerate the rate of translation of evidence-based interventions for the prevention and treatment of pediatric obesity into practice while advancing dissemination and implementation science in settings including health care, schools, and the community. RESULTS AND CONCLUSIONS: This article summarizes the state of the scientific evidence discussed at the symposium, identifies exemplars of implementation-effectiveness trials, and provides recommendations for disseminating and implementing evidence-based pediatric obesity prevention and treatment interventions into typical clinical and community settings.
OBJECTIVE: This study evaluated the association between antiobesity medications (AOM) and incident cardiovascular disease (CVD) among older women, examining this relationship within and across survivors of obesity-relate...OBJECTIVE: This study evaluated the association between antiobesity medications (AOM) and incident cardiovascular disease (CVD) among older women, examining this relationship within and across survivors of obesity-related cancers (ORCa) and age-matched cancer-free populations. METHODS: We conducted a retrospective cohort study using SEER-Medicare data from 2007 to 2015. The study included 46,552 women aged ≥ 65 years: ORCa survivors (n = 23,276) and age- and index-matched cancer-free women (n = 23,276). Prediagnostic AOM prescriptions before CVD onset were examined using intent-to-treat (ITT) and per-protocol approaches. Multivariable Cox proportional hazards models estimated hazard ratios (HR) and 95% CI for incident CVD. RESULTS: In ITT analyses, AOM use was associated with lower CVD incidence in the composite analytic sample (HR = 0.80, 95% CI: 0.71-0.90) and among cancer-free women (HR = 0.70, 95% CI: 0.58-0.85). Among ORCa survivors, estimates suggested a similar direction but were not statistically significant. In per-protocol analyses, AOM use was associated with reduced CVD risk in ORCa survivors (HR = 0.74, 95% CI: 0.57-0.94) and cancer-free women (HR = 0.59, 95% CI: 0.45-0.77). These associations were more pronounced within the first 2 years of follow-up. CONCLUSIONS: AOM use was inversely associated with incident CVD among ORCa survivors and cancer-free women. Further studies of second-generation AOM, particularly glucagon-like peptide-1 receptor agonists, are warranted.
Setmelanotide, a melanocortin 4 receptor (MC4R) agonist, is a promising pharmacological treatment option for people with rare monogenic obesity conditions affecting the leptin-melanocortin signaling pathway, including pr...Setmelanotide, a melanocortin 4 receptor (MC4R) agonist, is a promising pharmacological treatment option for people with rare monogenic obesity conditions affecting the leptin-melanocortin signaling pathway, including proprotein convertase subtilisin/kexin type 1 (PCSK1) gene mutations. It has been studied in people with homozygous mutations causing a complete deficiency of PCSK1. We report the first case of a 40-year-old female with a heterozygous PCSK1 N221D (c.661 A>G) variant mutation leading to severe early-onset treatment-resistant obesity with previous suboptimal response to bariatric surgery and conventional obesity medications, who achieved a total weight loss of 11.8% with setmelanotide treatment over the course of 3 months. Although her mutation confers a loss of 10% to 30% enzymatic function in in vitro studies, setmelanotide was highly effective in treating her obesity. It is also the first reported case of a cutaneous adverse effect of setmelanotide in the form of severe skin hyperpigmentation in a patient with a pathogenic PCSK1 variant. This case underscores the effectiveness and safety of setmelanotide in a heterozygous PCSK1 mutation.
OBJECTIVE: This study examined the effectiveness of behavioral weight management integrated with continuous glucose monitoring (CGM) among adults with overweight or obesity and type 2 diabetes. METHODS: This was a two-ar...OBJECTIVE: This study examined the effectiveness of behavioral weight management integrated with continuous glucose monitoring (CGM) among adults with overweight or obesity and type 2 diabetes. METHODS: This was a two-arm, parallel, randomized clinical trial. Participants (n = 151) were randomly assigned to intervention (INT; n = 75) or usual care (UC; N = 76). INT participants received a behavioral weight management program tailored for type 2 diabetes and CGM. UC participants received a session with a dietitian and educational materials. The primary outcome was 6-month change in HbA1c%. Additional outcomes included changes in weight, waist circumference, blood pressure, CGM metrics, diabetes stress, and treatment satisfaction. RESULTS: INT reduced HbA1c% (-0.87%; 95% CI: -1.17%, -0.57%) more than UC (-0.41%; -0.72%, -0.10%) (difference: -0.46%; -0.89%, -0.03%; p = 0.037). INT had greater reductions in percent body weight compared to UC (difference: -3.2%; -4.9%, -1.5%; p < 0.001). Several CGM metrics improved significantly more in INT than UC, and INT had significantly greater improvements in diabetes treatment satisfaction and regimen-related diabetes stress relative to UC. CONCLUSIONS: Integrating CGM with a digital weight management program produced significantly greater improvements in HbA1c%, body weight, and other glucose metrics compared to UC among adults with overweight or obesity and type 2 diabetes. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05935514.
Wang Z, Berntzen B, Patel N
… +6 more, Zellers S, Aaltonen S, Dick D, Silventoinen K, Lakerveld J, Kaprio J
Obesity (Silver Spring)
· 2026 May · PMID 42043331
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OBJECTIVE: BMI is influenced by both genetic and environmental factors, including features of the obesogenic environment such as walkability. This study investigated the interplay between residential walkability, genetic...OBJECTIVE: BMI is influenced by both genetic and environmental factors, including features of the obesogenic environment such as walkability. This study investigated the interplay between residential walkability, genetics, and BMI among 4312 individuals from two Finnish twin cohorts (mean age: 43). METHODS: Residential walkability was quantified using a composite index including built and natural environmental features. RESULTS: Multiple linear regression, adjusted for sociodemographic factors, showed that higher walkability was associated with lower BMI (coefficient: -0.02, 95% CI: -0.04, -0.01), but pairwise twin analyses indicated that this association was not independent of genetic and early shared environmental influences. Univariate twin modeling revealed that additive genetic effects accounted for 22% of the variation in walkability when participants were middle-aged. Bivariate moderation twin modeling showed that the additive genetic influence on BMI was significantly stronger among individuals living in areas with average or moderately low residential walkability. The unique environmental component played a larger role among those living in areas with either very low or very high residential walkability. CONCLUSIONS: These findings underscored the complex gene-environment interplay between walkability and BMI. While genetic susceptibility cannot be modified, public health strategies that focus on the obesogenic environment, such as improving walkability, may still help mitigate obesity risk.
OBJECTIVE: This study aimed to describe parental communication with children around obesity management medications (OMMs) and child, parent, and family factors associated with communication. METHODS: Parents (N = 211; 80...OBJECTIVE: This study aimed to describe parental communication with children around obesity management medications (OMMs) and child, parent, and family factors associated with communication. METHODS: Parents (N = 211; 80% mothers; 89% White) prescribed OMMs at a medical center participated in a survey about communication with children about OMM use, weight, and health behaviors. Logistic regression models assessed associations between communication about OMMs and child weight, diet, and activity. RESULTS: Among study participants, 50% of parents talked with their child about the decision to take OMMs; 75% talked openly about it. Parents with older children were more likely to have open communication about OMMs (OR = 1.10; p = 0.016). Parents with impaired family functioning were less likely to communicate about OMMs (OR = 0.23; p = 0.002). Children who made comments to parents about their own weight were more likely to notice parents' weight loss (OR = 2.70; p = 0.002), be older in age (OR = 1.13; p = 0.006), and have overweight (OR = 3.58; p < 0.001). Parents who reported their child made comments about his or her own diet were more likely to report that their child noticed parents' diet change (OR = 4.40; p < 0.001), had overweight (OR = 2.03; p = 0.046), and had healthy family functioning (OR = 0.42; 95% p = 0.025). CONCLUSIONS: Parents are talking with their children about their OMMs and behaviors, especially with older children, children with overweight, and in families with healthy functioning.
Boudreau A, Yoo L, Harvey I
… +5 more, Mota de Sà P, Javvadi P, Ghosh S, Richard AJ, Stephens JM
Obesity (Silver Spring)
· 2026 Jun · PMID 42015583
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OBJECTIVE: An Artemisia scoparia extract (SCO) has been shown to enhance adipocyte function, improve insulin sensitivity, and regulate lipolysis. We evaluated the actions of SCO and rosiglitazone (ROSI) in adipocytes, fo...OBJECTIVE: An Artemisia scoparia extract (SCO) has been shown to enhance adipocyte function, improve insulin sensitivity, and regulate lipolysis. We evaluated the actions of SCO and rosiglitazone (ROSI) in adipocytes, focusing on PPARγ's role in their regulation. METHODS: We assessed PPARγ activation by measuring its half-life and the PPAR-dependent transcription of a luciferase reporter. We measured glycerol release from adipocytes with siRNA gene silencing or pharmacological inhibition of PPARγ. Immunoblotting was used to detect adiponectin and protein disulfide isomerase (PDI); transcriptional effects in SCO- and ROSI-treated cells were compared by RNA-seq. RESULTS: ROSI and SCO both enhanced PPARγ degradation, a hallmark of ligand-induced activation. PPARγ transcriptional activity was induced in three cell types by ROSI, but in only one by SCO. PPARγ knockdown reversed the antilipolytic effects of both SCO and ROSI, while pharmacological inhibition only reversed the effect of ROSI. SCO treatment, but not ROSI, produced reduction-resistant adiponectin multimers and high-molecular-weight complexes of PDI. Transcriptional changes were more pronounced with ROSI than SCO, although the affected pathways were largely overlapping. CONCLUSIONS: SCO is a context-dependent PPARγ agonist with unique effects on redox-dependent protein multimerization. Transcriptional profiling indicates that SCO acts as a partial or selective PPARγ agonist.
OBJECTIVE: This study examined the relationship between health-related quality of life (HRQoL) and weight status across the pediatric life course. METHODS: We analyzed data from a cohort of 9745 children from the Longitu...OBJECTIVE: This study examined the relationship between health-related quality of life (HRQoL) and weight status across the pediatric life course. METHODS: We analyzed data from a cohort of 9745 children from the Longitudinal Study of Australian Children, with follow-up over 14 years. HRQoL was measured with the proxy parent-reported Pediatric Quality of Life Inventory (PedsQL). Healthy weight, overweight, obesity, and severe obesity were defined using World Health Organization standards. We investigated the association of child HRQoL and weight status during early childhood (2-5 years), middle childhood (6-11 years), and adolescence (12-17 years), after controlling for continuous age, sex, and socioeconomic position. RESULTS: The negative association between HRQoL and weight status strengthened with increasing age group and higher weight status. Compared to healthy weight, mean (95% CI) differences in total PedsQL score for obesity were -0.9 (-1.7 to -0.2) in early childhood, -3.6 (-4.4 to -2.9) in middle childhood, and -5.5 (-6.4 to -4.6) in adolescence. Weight-associated loss of HRQoL was greatest for adolescents with severe obesity (BMI-z ≥ 3) at -10.5 points (95% CI: -12.9 to -8.1) lower than those in healthy weight. CONCLUSIONS: The study highlights the important contribution of weight status to HRQoL during the child and adolescent life course.
Chaudhary P, Yang S, Waldrop S
… +2 more, Katzmarzyk PT, Staiano AE
Obesity (Silver Spring)
· 2026 Jun · PMID 42002413
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OBJECTIVE: This study aimed to estimate the prevalence of preclinical and clinical obesity among US youth using the Lancet Diabetes & Endocrinology Commission's framework. METHODS: This cross-sectional study examined NHA...OBJECTIVE: This study aimed to estimate the prevalence of preclinical and clinical obesity among US youth using the Lancet Diabetes & Endocrinology Commission's framework. METHODS: This cross-sectional study examined NHANES 2017-2023 data from 5513 youth aged 5-18. Obesity classification included: (i) no obesity (BMI < 95th percentile and/or waist to height ratio (WHtR) < 0.5), (ii) preclinical obesity (BMI ≥ 95th percentile and WHtR ≥ 0.5 without clinical impairment or functional limitations), and (iii) clinical obesity (BMI ≥ 95th percentile and WHtR ≥ 0.5 with one or more clinical impairments or functional limitations). RESULTS: The weighted prevalence was 8.3% for preclinical and 12.5% for clinical obesity; combined prevalence (20.8%) was similar to ~22% using BMI percentile alone. Clinical obesity was more common in older children and racial/ethnic minority groups but similar by sex. Impairments associated with clinical obesity included low HDL cholesterol (60.3%), asthma (24.8%), early menarche in girls (18.0%), elevated blood pressure (16.2%), prediabetes/diabetes (9.1%), and functional limitations related to walking (7.7%) and self-care (4.1%). CONCLUSIONS: Applying the Lancet Diabetes & Endocrinology Commission's new definition criteria revealed substantial physiological dysfunction in US youth. Applying preclinical and clinical obesity definitions is challenging, given the limitations of the routinely collected clinical and epidemiological data that make up NHANES and in standard clinical practice.
OBJECTIVE: This study investigated structural drivers of neighborhood food access to identify possible pathways at a census tract level. METHODS: Data from 9597 census tracts across 201 counties, within 38 states, tested...OBJECTIVE: This study investigated structural drivers of neighborhood food access to identify possible pathways at a census tract level. METHODS: Data from 9597 census tracts across 201 counties, within 38 states, tested potential pathways including the built environment, criminal justice, education, housing, social cohesion, transportation, wealth, and income/poverty. Historic residential redlining was defined using Home Owners' Loan Corporation residential security maps. Food access was defined using the modified retail food environment index. Direct and indirect relationships were investigated using structural equation modeling (SEM) run in Stata v18, controlling for the population of each census tract. Standardized estimates were used with p < 0.05 considered statistically significant. RESULTS: Redlining was directly associated with higher disadvantage across all tested pathways. Higher disadvantage in the built environment (-0.06, p < 0.001), criminal justice (-0.11, p < 0.001), housing (-0.04, p < 0.01), and social cohesion (-0.18, p < 0.001) was associated with lower food access, while higher disadvantage in education was associated with higher food access (0.07, p < 0.001), and transportation, wealth, and income were not significant pathways. CONCLUSIONS: The strongest neighborhood-level drivers were social cohesion, criminal justice, and education. Policies that focus on a holistic approach to the neighborhood environment may be needed to improve access to healthy food options at the neighborhood level.
Herschbach A, Erschens R, Junne F
… +20 more, Ehehalt S, Jacoby J, Martus P, Mack I, Weiland A, Krauß I, Greule C, Zurstiege G, Wels A, Adam SH, Hoell A, Bethge W, Ums M, Sammet T, Reyer M, Schliesing O, Zipfel S, Gawrilow C, Giel KE, Ziser K
Obesity (Silver Spring)
· 2026 May · PMID 41968571
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OBJECTIVE: Pediatric obesity (OB) treatments show small effects and high dropout rates, potentially due to low motivation in participating families. Motivation prior to a weight management program is referred to as "read...OBJECTIVE: Pediatric obesity (OB) treatments show small effects and high dropout rates, potentially due to low motivation in participating families. Motivation prior to a weight management program is referred to as "readiness to change" (RTC). Understanding RTC is key to improving outcomes. Previous studies observed determinants for RTC, but results are heterogenous and data about adolescents' RTC are lacking. METHODS: Baseline data of the STARKIDS trial were used to find determinants of RTC in (a) adolescents (n = 125), (b) their caretakers (n = 185), and (c) caretakers of younger children (n = 325). Potential determinants were sociodemographic variables, weight, general quality of life (QoL), OB-related QoL, self-efficacy, and body image of caretakers and children. Pearson correlations (t-tests and ANOVA) and multiple linear regression analyses were performed. RESULTS: The RTC of adolescents and of both groups of caretakers was determined by adolescents'/children's OB-related QoL. The RTC of caretakers of younger children was also determined by children's BMI-SDS. CONCLUSIONS: OB-related QoL plays a major role in determining adolescents' and caretakers' motivation prior to weight management. In all groups, most significant determinants refer to corresponding family members, showing that the mutual influence is large. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS000228 13 (acknowledged primary register of the World Health Organization).
Polak R, Budd MA, Finkelstein A
… +5 more, Goldsmith R, Goldstein R, Gray BE, Keshet R, Tirosh A
Obesity (Silver Spring)
· 2026 May · PMID 41947527
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INTRODUCTION: Health-related culinary intervention, termed culinary medicine (CM), is an innovative evidence-based strategy in the field of nutrition to improve dietary quality and prevent/manage chronic diseases. Long-t...INTRODUCTION: Health-related culinary intervention, termed culinary medicine (CM), is an innovative evidence-based strategy in the field of nutrition to improve dietary quality and prevent/manage chronic diseases. Long-term effects on dietary intake and obesity using well-designed studies are limited. METHODS: A randomized controlled trial evaluated the impact of a CM intervention on body weight. Participants were age 25-70 with BMI 27.5-35 kg/m. INTERVENTION: Dietary counseling and twelve 30-min CM sessions. CONTROL: Dietary counseling and CM resources. Body weight, nutrition, and health outcomes were measured at 0, 3, 6, and 12 months. RESULTS: Fifty participants are included in a modified intention to treat analysis. Average intervention group weight loss was: at 3 months, -3.23% (3.52%), net difference -2.52% (CI: -0.48% to -4.56%; p = 0.016); at 6 months, -4.2% (5.24%), net difference -2.98% (CI: -0.36% to -5.60%; p = 0.027); and at 12 months, -4.02% (6.24%), net difference -4.30% (CI: -0.69% to -7.92%; p = 0.021). Intervention group had: fat mass loss at 6 months, 1.86% (1.54%), net difference 1.96% (CI: -3.82% to 0.11%, p = 0.039); Mediterranean diet score improvement at 3 months, 2 points, net difference 1.62 (CI: 0.263 to 2.968; p = 0.020); and calorie consumption decrease at 6 months, 452 cal, net difference -390 (CI: -701.1 to -78.13; p = 0.015). CONCLUSIONS: CM can be an effective strategy to promote weight and body fat loss. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT03823469; preregistered on June 30, 2019.