OBJECTIVE: This study aimed to characterize the underdocumentation of obesity by comparing the rates of obesity in databases based on measured BMI, BMI measured while inpatient, and obesity ICD-10 codes input by health p...OBJECTIVE: This study aimed to characterize the underdocumentation of obesity by comparing the rates of obesity in databases based on measured BMI, BMI measured while inpatient, and obesity ICD-10 codes input by health providers for inpatients in the United States. METHODS: We compared three datasets to test the prevalence of obesity in the United States general population and the inpatient hospital in the United States. The 2017-2018 National Health and Nutrition Examination (NHANES) dataset was used to estimate the prevalence in the general population. For the inpatient hospitals, we used data from the 2017 National Inpatient Sample (NIS) and the 2017-2018 American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) datasets. RESULTS: There were 5434 participants in the NHANES, 2,006,047 participants in the NSQIP, and 6,084,184 participants in the NIS databases for analysis. The overall prevalence/diagnosis of obesity was 41.9% for NHANES (nationwide survey), 44.5% for NSQIP (in-hospital measurements), and 15.4% for NIS (ICD codes retrieved from medical charts). CONCLUSIONS: The prevalence of obesity in NIS (based on recorded obesity in medical charts) is significantly lower than NHANES and NSQIP (based on measured BMI) suggesting underrecognition or underdocumentation of obesity in the inpatient setting.
OBJECTIVE: The objective of this study is to use a machine learning approach to identify predictors of BMI percentile among Hispanic/Latino youth in the United States. METHODS: Participants were Hispanic/Latino 8- to 16-...OBJECTIVE: The objective of this study is to use a machine learning approach to identify predictors of BMI percentile among Hispanic/Latino youth in the United States. METHODS: Participants were Hispanic/Latino 8- to 16-year-olds from the cross-sectional Study of Latino Youth (SOL Youth; n = 1466). A supervised machine learning approach, LASSO regression, was used with BMI percentile as the outcome. A total of 102 predictor variables were examined spanning parent and child demographics; health behaviors; and psychological, sociocultural, and environmental measures. RESULTS: Mean age of participants was 12 years, 50% were female, and 44.2% were of Mexican heritage. A 36-variable LASSO model yielded the optimum mean squared error (R = 0.42), but a 10-variable solution was selected for parsimony. Six associations were significant. Dieting 1-4 or ≥ 5 times/year (β = 8.69 [95% CI: 10.25 to 14.52] or 10.86 [95% CI: 13.14 to 18.33], respectively) and having a parent of Dominican heritage (β = 3.48 [95% CI: 4.05 to 9.90]) or with obesity (β = 2.96 [95% CI: 2.99 to 6.85]) were associated with a higher BMI percentile. Perception of being smaller than the "ideal" body size (β = -1.65 [95% CI: -6.84 to -1.35]) and use of the food/activity parenting practice Control (β = -1.17 [95% CI: -3.63 to -1.69]) were associated with a lower BMI percentile. CONCLUSIONS: Family-based approaches and focusing on dieting and body image satisfaction may be important for weight management in Hispanic/Latino youth.
Duh-Leong C, Partida I, Bien-Aime C
… +10 more, Finkel MA, Stockwell MS, Rundle AG, Orjuela-Grimm M, Perrin EM, Cheng ER, Meyer D, Velasquez EE, Goldsmith J, Woo Baidal J
Obesity (Silver Spring)
· 2026 Feb · PMID 41399008
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OBJECTIVE: This study aimed to quantify associations between newborn social risk factors and high infant weight-for-length (WFL) at 6 months. METHODS: We conducted a longitudinal, observational study using electronic hea...OBJECTIVE: This study aimed to quantify associations between newborn social risk factors and high infant weight-for-length (WFL) at 6 months. METHODS: We conducted a longitudinal, observational study using electronic health record data among infants in New York City. We included newborns with a primary care screening questionnaire for social risk factors (food insecurity, housing instability, transportation problems, and utility hardship) measured using the Accountable Health Communities Screening Tool. We conducted regression analyses to assess associations between social risk factors and high WFL, or the 97.7th percentile at 6 months. Secondary analyses included additional single-time-point and longitudinal weight outcomes (continuous and dichotomous). RESULTS: Among 1876 newborns, 77.3% identified as Hispanic/Latino, almost all had Medicaid insurance (96.6%), 355 (23.3%) had food insecurity risk, 149 (7.9%) had housing instability, 132 (7.0%) had transportation problems, and 110 (5.9%) had utility hardship. Newborns with utility hardship had higher odds of high WFL in unadjusted (OR 3.0, 95% CI: 1.8-5.2) and adjusted models (aOR 3.1, 95% CI: 1.7-5.6) accounting for infant, parent, and social risk factors. CONCLUSIONS: Newborn utility hardship was associated with obesity risk at age 6 months. Interventions to address newborn social risk factors should examine the effectiveness of utility shutoff protection to reduce excess infant weight gain.
Obesity (Silver Spring)
· 2026 Feb · PMID 41397701
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OBJECTIVE: We evaluated whether sleep disturbance moderates weight loss in breast cancer survivors. We hypothesized that poor sleep prior to behavioral weight loss (BWL) would be associated with less weight reduction tha...OBJECTIVE: We evaluated whether sleep disturbance moderates weight loss in breast cancer survivors. We hypothesized that poor sleep prior to behavioral weight loss (BWL) would be associated with less weight reduction than better sleep. METHODS: Women with prior stage 0-III breast cancer with BMI ≥ 25 kg/m were randomized to BWL (n = 47) or self-directed approach (n = 46). Weight and self-reported sleep (NIH PROMIS Adult Sleep Disturbance Short Form) were collected at baseline and at 6 and 12 months. In the full sample and cohorts stratified by baseline sleep, multiple regression analyses evaluated associations of study arm, age, baseline sleep, and BMI with weight loss. RESULTS: There was significant interaction between baseline sleep and treatment (BWL vs. self-directed) for weight loss at 6 (p = 0.024) and 12 months (p = 0.019). Weight loss among better sleepers was -6.16% (SE 1.42%) in BWL versus self-directed arms and -7.53% (SE 2.02%) at 6 (p < 0.001) and 12 months (p = 0.001), respectively. Among poor sleepers, weight loss was -3.15% (SE: 1.58%) and -2.44% (SE: 2.40%) at 6 (p = 0.056) and 12 months (p = 0.321), respectively. BWL had a greater effect among better sleepers but minimal effect among poor sleepers. CONCLUSIONS: BWL has greater effects in breast cancer survivors with better versus worse sleep. Studies should evaluate whether sleep disturbance treatment augments weight loss. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01871116.
Obesity (Silver Spring)
· 2026 May · PMID 41392868
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As governments become aware of the increasing prevalence of obesity in their countries, they install taxes for the amount of sugar in sodas. This is leading to reductions in sugar intake and cardiovascular disease, as pr...As governments become aware of the increasing prevalence of obesity in their countries, they install taxes for the amount of sugar in sodas. This is leading to reductions in sugar intake and cardiovascular disease, as predicted, but unintentionally also to considerable increases in the consumption of non-nutritive sweeteners (NNS). Since many studies on the safety of NNS are highly conflicting, it is unclear at present whether NNS are a healthy substitute for sugar.
Obesity is a complex, rapidly escalating global health challenge that demands innovation across biology, clinical care, and public health. This review synthesizes evidence on artificial intelligence (AI) revolutionizing...Obesity is a complex, rapidly escalating global health challenge that demands innovation across biology, clinical care, and public health. This review synthesizes evidence on artificial intelligence (AI) revolutionizing obesity research and management. In mechanistic discovery, AI techniques like deep neural networks and graph architectures integrate multi-omics, microbiome, and wearable-sensor data to elucidate metabolic signatures and gene-environment interactions. Clinically, AI enables predictive modeling of treatment response and supports adaptive trial designs. For pediatric obesity, machine learning facilitates early risk detection and personalized digital therapeutics, enhanced by privacy-preserving methods like federated learning. At the population level, spatial analytics and multi-omics modeling uncover environmental drivers, informing precision public health initiatives. The trustworthy deployment of these technologies hinges on cross-cutting imperatives: explainability, fairness, and data-quality assurance. The review compares key AI methodologies-from classical machine learning to large language models and causal inference frameworks-while addressing associated ethical and infrastructural challenges. It proposes a phased road map for equitable integration, positioning AI as a unifying framework that bridges molecular insights, individualized interventions, and population-wide strategies for more effective and scalable obesity prevention and care.
OBJECTIVE: This study aimed to assess weight and safety outcomes in a large national cohort of patients with overweight and obesity treated with GLP-1 medications via telehealth. METHODS: Data were obtained from deidenti...OBJECTIVE: This study aimed to assess weight and safety outcomes in a large national cohort of patients with overweight and obesity treated with GLP-1 medications via telehealth. METHODS: Data were obtained from deidentified EHRs for a random sample of 4500 patients who initiated semaglutide treatment via telehealth for overweight and obesity between December 1, 2022, and June 1, 2023. Outcomes and predictors of outcomes were analyzed for patients who reported a follow-up weight within ±14 days of week 68. RESULTS: Of 655 patients (n = 445 female, n = 210 male), mean body weight reduction was -16.6% (SD 7.5%, 95% CI: -17.1% to -16.0%). Female sex was the only factor consistently associated with categorical weight loss, with significantly higher odds at ≥ 5% (OR 4.26, p < 0.001), ≥ 10% (OR 5.90, p < 0.001), and ≥ 20% (OR 2.51, p < 0.001). The most common adverse events were nausea/vomiting (37.3%) and constipation (15.6%); no new safety signals were observed. CONCLUSIONS: Findings suggest semaglutide treatment via telehealth can achieve trial-level weight loss with similar safety profiles, supporting telehealth as an evidence-based approach to medical weight management.
Obesity (Silver Spring)
· 2026 Apr · PMID 41326176
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OBJECTIVE: This study compared the efficacy of metabolic/bariatric surgery (MBS) and GLP-1 receptor agonists (GLP-1 RAs), including dual GLP-1/GIP analogues, for weight and metabolic outcomes in adults with obesity. METH...OBJECTIVE: This study compared the efficacy of metabolic/bariatric surgery (MBS) and GLP-1 receptor agonists (GLP-1 RAs), including dual GLP-1/GIP analogues, for weight and metabolic outcomes in adults with obesity. METHODS: A network meta-analysis of randomized controlled trials compared MBS or GLP-1 RAs versus lifestyle intervention in adults with overweight or obesity. Primary outcomes were percent total weight loss (TWL) and BMI; secondary outcomes included body weight, waist circumference, HbA1c, and systolic blood pressure. Random-effects models used lifestyle intervention as the common comparator; all MBS versus GLP-1 RA comparisons were indirect. RESULTS: Thirty randomized controlled trials (n = 20,015) were included. At < 104 weeks, MBS achieved greater reductions than GLP-1 RAs in %TWL (ETD -10.3%; p = 0.001), BMI (-4.5 kg/m; p < 0.001), body weight (-11.7 kg; p < 0.001), waist circumference (-12.6 cm; p < 0.001), and HbA1c (-0.5%; p = 0.033). At ≥ 104 weeks, differences remained for %TWL (-9.1%; p = 0.022) and body weight (-14.6 kg; p = 0.049). In tirzepatide-only analyses, differences versus MBS were not significant. Among participants with type 2 diabetes, MBS produced greater reductions in BMI, weight, waist, and %TWL, with similar HbA1c improvement. CONCLUSIONS: Both MBS and GLP-1 RAs provide substantial metabolic benefits. MBS remains superior, but tirzepatide is a promising nonsurgical option supporting personalized obesity care.
Obesity (Silver Spring)
· 2026 Mar · PMID 41287121
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Since the onset of the COVID-19 pandemic, obesity has been consistently associated with worse clinical outcomes. In 2020, we hypothesized that adipose tissue (AT) might serve as a viral reservoir and amplifier of immune...Since the onset of the COVID-19 pandemic, obesity has been consistently associated with worse clinical outcomes. In 2020, we hypothesized that adipose tissue (AT) might serve as a viral reservoir and amplifier of immune responses in SARS-CoV-2 infection. Five years on, accumulating evidence supports this hypothesis. Recent autopsy and in vitro studies support that SARS-CoV-2 disseminates to and may replicate within human adipocytes. While several studies have detected SARS-CoV-2 RNA and proteins in AT, the recovery of infectious virus from this tissue has not yet been demonstrated. This remains a critical gap in our understanding of SARS-CoV-2 viral tropism and replication within adipocytes. Viral entry is mediated via angiotensin-converting enzyme-2 and neuropilin-1 receptors. Infected AT exhibits immune cell infiltration and cytokine activation, implicating it in systemic inflammation. Persistent viral RNA in AT correlates with prolonged metabolic dysfunction. These findings highlight the dual role of AT as a potential viral reservoir and immunometabolic organ. Understanding these mechanisms is critical to mitigating the long-term impact of COVID-19 and guiding responses to future pandemics involving metabolically active tissues.
Najam W, Kpormegbey DE, Thapa DK
… +7 more, Rust B, Golzarri-Arroyo L, Baumgard LH, Fan LW, Ibrahim JG, Mayorga EJ, Allison DB
Obesity (Silver Spring)
· 2026 Feb · PMID 41286579
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OBJECTIVE: Pair-feeding is a study design element where one group's food intake is provided to another group to assess whether a treatment effect is independent of food intake. Investigators often assume equivalent food...OBJECTIVE: Pair-feeding is a study design element where one group's food intake is provided to another group to assess whether a treatment effect is independent of food intake. Investigators often assume equivalent food intake across experimental conditions and exclude it from the statistical analysis. However, the impact of this practice on type I error (T1Er) rates has not been quantified. METHODS: We conducted a Monte Carlo simulation in which animals were assigned baseline weights and food intakes, then randomized to non-pair-fed or pair-fed groups. Daily food intake for both groups was initially drawn from the baseline food intake distribution. For pair-fed animals, food intake was truncated if it exceeded the previous day's intake of the matched non-pair-fed animal (individual pair-feeding) or the group's average (group pair-feeding). Weight changes were calculated as a function of food intake, and final weight change was analyzed with and without adjusting for mean food intake. RESULTS: Both individual and group pair-feeding inflated T1Er rates ranging from 0.12 to 0.71 in unadjusted models. However, adjustment for food intake reduced error rates to around 0.05. CONCLUSIONS: Under some circumstances, pair-feeding designs can inflate T1Er rates. Investigators can mitigate this inflation by adjusting the analyses for food intake.
Haltia H, Muniandy M, Heinonen S
… +10 more, Saari S, Alvarez M, Hakkarainen A, Lundbom J, Kuula J, Groop PH, Kaprio J, Pajukanta P, Pietiläinen KH, van der Kolk BW
Obesity (Silver Spring)
· 2026 Feb · PMID 41276278
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OBJECTIVE: We investigated the impact of sex on the subcutaneous adipose tissue (AT) transcriptome and its obesity-related adaptations. METHODS: We studied rare BMI-discordant monozygotic twin pairs (ΔBMI > 2.5 kg/m; 21...OBJECTIVE: We investigated the impact of sex on the subcutaneous adipose tissue (AT) transcriptome and its obesity-related adaptations. METHODS: We studied rare BMI-discordant monozygotic twin pairs (ΔBMI > 2.5 kg/m; 21 female, 16 male pairs) to assess how sex affects AT and whole-body metabolism. AT RNA sequencing was analyzed using linear mixed modeling and pathway enrichment for: (1) sex differences in individual twins, adjusted for BMI, (2) sex-stratified effects of acquired obesity (ΔBMI between co-twins separately in females and males), (3) sex-specific effects of obesity (differences in the ΔBMI effect between sexes). RESULTS: (1) AT transcriptional profiles differed between sexes, associating with insulin sensitivity. (2) Sex-stratified obesity effects within pairs were stronger in females, with upregulated inflammation and downregulated mitochondrial oxidative phosphorylation; males showed increased inflammation and decreased histone modification. (3) The response to obesity was sex-specific: lower expression of genes in unsaturated fatty acid metabolism in obesity was seen in females only. Sex-specific obesity AT gene expression was associated with metabolic health, with a negative association between unsaturated fatty acid metabolism and insulin sensitivity in males only. CONCLUSIONS: Biological sex influences the AT transcriptome and its response to obesity, highlighting distinct molecular mechanisms that may contribute to sex-specific metabolic health.
OBJECTIVE: This study aimed to quantify the effect of glucagon-like peptide-1 receptor agonists (GLP-1s) on weight loss and weight gain following GLP-1 discontinuation. METHODS: This retrospective cohort study using elec...OBJECTIVE: This study aimed to quantify the effect of glucagon-like peptide-1 receptor agonists (GLP-1s) on weight loss and weight gain following GLP-1 discontinuation. METHODS: This retrospective cohort study using electronic health records from TriNetX included individuals age 18 years or older with various lengths of continuous GLP-1 use between September 2014 and November 2023. Applying an intention-to-treat framework, we used linear mixed effects models and propensity score adjustment to model changes in BMI after GLP-1 discontinuation while accounting for correlated within-person observations and potential confounders. RESULTS: A total of 78,076 (19.7%) individuals used GLP-1s continuously for 3 months, 23,861 (6.0%) for 6 months, and 12,642 (3.2%) for 9 months. The median BMI prior to initiation was 36.38 (IQR 36.30-36.46), which declined by 2.15% (IQR 2.10%-2.21%) to 35.81 (IQR 35.7-35.92) among individuals with 3 months of continuous GLP-1 use. Median BMI declines were greater among individuals with 6 months (4.38%, IQR 4.27%-4.48%) and 9 months (5.56%, IQR 5.34%-5.78%) of continuous use. On average, weight loss among discontinuers at months 3, 6, and 9 slowed in comparison to their counterparts. CONCLUSIONS: Among this real-world sample, GLP-1 use was associated with more modest weight loss than has been demonstrated in randomized controlled trials.
OBJECTIVE: We aimed to compare the effectiveness and safety of semaglutide 1.0 mg versus dulaglutide 1.5 mg and liraglutide 1.8 mg in patients with type 2 diabetes mellitus (T2DM) under routine clinical care. METHODS: Th...OBJECTIVE: We aimed to compare the effectiveness and safety of semaglutide 1.0 mg versus dulaglutide 1.5 mg and liraglutide 1.8 mg in patients with type 2 diabetes mellitus (T2DM) under routine clinical care. METHODS: This multicenter, retrospective, real-world study enrolled Chinese adults with T2DM who initiated GLP-1 receptor agonist therapy in endocrinology clinics between January 1, 2022, and August 31, 2024. We compared the effectiveness of these agents on HbA1c and weight loss, with safety as a key exploratory endpoint. Additionally, the UK Prospective Diabetes Study Outcomes Model 2.1 was utilized to project long-term health outcomes. RESULTS: This multicenter retrospective study included 111, 74, and 107 patients treated with semaglutide 1.0 mg, dulaglutide 1.5 mg, and liraglutide 1.8 mg, respectively. After 1:1 propensity score matching, semaglutide demonstrated significantly greater HbA1c reduction compared to both dulaglutide (-0.27% ± 0.70%, p = 0.008) and liraglutide (-0.39% ± 0.87%, p < 0.001), along with higher glycemic target achievement rates. Semaglutide was associated with improved outcomes in all death, cardiovascular death, and other death endpoints. No significant differences in safety profiles were observed among the three treatment groups. CONCLUSIONS: Semaglutide demonstrated superior glycemic control and weight loss compared to both dulaglutide and liraglutide, whereas dulaglutide and liraglutide exhibited comparable clinical efficacy.
Maskarinec G, Klapp R, Nöthlings U
… +45 more, Schulze MB, Bamberg F, Machann J, Schlesinger S, Leitzmann M, Sedlmeier A, Bohmann P, Rospleszcz S, Nattenmüller J, Haueise T, Steindorf K, Niendorf T, Schlett CL, Greiser KH, Panreck L, Linseisen J, Conzen CA, Gastell S, Schikowski T, Völzke H, Bülow R, Peters A, Niedermayer F, Kaaks R, Becher H, Karch A, Berger K, Keil T, Krist L, Hoffmeister M, Mons U, Schmidt B, Stang A, Mikolajczyk R, Kluttig A, Lieb W, Övermöhle C, Hebestreit A, Günther K, Harth V, Obi N, Castell S, Kettlitz R, Nimptsch K, Pischon T
Obesity (Silver Spring)
· 2026 Jan · PMID 41261047
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OBJECTIVE: This cross-sectional study examined a Lifestyle Risk Factor Index (LSRI) in relation to adiposity measures including visceral adipose tissue (VAT) in the German National Cohort (NAKO). METHODS: Based on self-r...OBJECTIVE: This cross-sectional study examined a Lifestyle Risk Factor Index (LSRI) in relation to adiposity measures including visceral adipose tissue (VAT) in the German National Cohort (NAKO). METHODS: Based on self-reports at baseline among 30,920 of > 205,000 NAKO eligible participants with magnetic resonance imaging (MRI) scans, one point each for not smoking, adhering to ≥ 3/7 diet recommendations, consuming ≤ 1 (women)/≤ 2 (men) alcoholic drinks/day, and ≥ 150 min/week physical activity was assigned. VAT volume, obtained from whole-body MRI at 3T, was analyzed by deep learning-based image segmentation. General linear models estimated adjusted geometric mean adiposity measures by LSRI and stratified analyses by sex and BMI. RESULTS: Of 18,508 participants aged 48.2 ± 12.2 years, the respective proportions for 0/1, 2, 3, and 4 LSRI points were 7%, 24%, 51%, and 18%. Participants with LSRI scores of 4 versus 0/1 had lower adjusted geometric mean volumes of VAT (2.3; 95% CI 2.2, 2.3 vs. 3.0; 95% CI 2.9, 3.1 L). These differences were slightly attenuated after adding BMI. This association was weaker for individuals with obesity than normal/overweight. CONCLUSION: A combination of lifestyle factors appears to be associated with lower VAT volume, but an elevated BMI may have a greater influence on VAT accumulation than lifestyle behaviors alone.