Importance: Glucagon like peptide 1 receptor agonists (GLP 1 RAs) and dual glucose dependent insulinotropic polypeptide/glucagon like peptide 1 receptor agonists have demonstrated what may be considered transformative efficacy in recent randomized clinical trials for the treatment of obesity, yielding substantial weight loss in a majority of participants. However, the extent to which these trial results translate into routine clinical practice particularly within the rapidly expanding direct to consumer (DTC) telehealth sector serving self pay populations remains insufficiently characterized. As access to and affordability of these therapies broaden beyond traditional insurance based care models, evaluating real world effectiveness, safety, and patient engagement among individuals shouldering the full financial cost of treatment is essential for informing future models of obesity care delivery. Objective:To assess long term medication specific weight loss outcomes, including gender specific responses and discrepancies, and explore usage trends in a real world, self pay telehealth cohort receiving GLP 1 RA therapy, using an Observational study design (Retrospective data analysis). Setting and Participants:Retrospective data of patients enrolled in electronic health records (EHR) from Carevalidate, a national US telehealth platform provider for Online TeleHealth companies. The data collected ranged for a total of 703 days from January 12, 2024, to December 15, 2025. The analysis included 572 adults with overweight or obesity diagnosis who initiated treatment with semaglutide or tirzepatide and completed a minimum of 9 months of active follow up. Patients with insufficient follow up or those utilizing insurance coverage were excluded to isolate the self pay phenotype. Exposures: Prescription of semaglutide or tirzepatide (injectable or oral formulations) via synchronous or asynchronous telehealth consultations, titrated according to standard clinical protocols adapted for patient tolerance and financial sustainability. Main Outcomes and Measures: The primary outcome was percentage total body weight loss (%TBWL) from baseline to the last recorded encounter. Secondary outcomes included categorical responder rates (5%, 10%, 15%, >20% weight loss), weight loss velocity analysis, and telehealth utilization metrics (frequency of encounters and visit intervals) including gender differences in approaching the telehealth program. Results: The final analytical cohort included 572 patients (79.2% female; 20.8% male). Overall, 95.8% (548/572) achieved weight loss, while 3.7% experienced weight gain. At 12 months, the mean %TBWL was 13.8% for the semaglutide cohort (n=450) and 12.5% for the tirzepatide cohort (n=122), with no statistically significant difference between the two medications (P >.05), contrary to standard clinical trial data suggesting tirzepatide superiority. A significant gender difference was observed: females were significantly more in number comprising 80% of the cohort and were likely to be "major responders" (>20% weight loss) compared to males (29.8% vs 5.9%; P <.001). Conversely, males demonstrated significantly higher utilisation rates, attending more frequent encounters (mean 13.5 vs 12.7; P =.028) with shorter intervals between visits (35.6 vs 44.1 days; P =.009) compared to females. Weight loss velocity for both medications peaked during months 1 to 3 (~1.07 lbs/week) and declined substantially by months 12 to 15, indicating a plateau effect independent of the specific agent used. Conclusions and Relevance: Telehealth-managed GLP 1 treatment in a self pay population demonstrates high efficacy comparable to clinical trials for semaglutide. However, tirzepatide outcomes fell short of trial benchmarks, likely due to economic barriers preventing optimal dose titration and lower sample size. The study identifies a discrepancy where females approach the telehealth based self pay system more but males engage more frequently with the digital platform which could be due to inferior physiological outcomes ( less weight loss and more non responders) compared to females.This suggests that while telehealth is a viable model for long term obesity care, the "one size fits all" approach may be insufficient for under responders, who may require distinct titration strategies or tailored behavioral interventions to overcome baseline genetic and biological resistance. ### Competing Interest Statement Dr. Shailaja Patil received compensation from CareValidate. Suraj Patel works for CareValidate. ### Funding Statement The study was funded by CareValidate ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Sterling IRB reviewed the application and granted the exempt/ waiver status. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors
The increasing prevalence of cardiovascular diseases (CVD) and type 2 diabetes, particularly among younger populations, highlights the urgent need for early, cost-effective risk assessment tools. The Triglyceride-Glucose (TyG) index, derived from routine triglyceride and glucose levels, has emerged as a reliable predictor of insulin resistance and is gaining recognition for its role in forecasting cardiovascular risk, including Major Adverse Cardiac and Cerebrovascular Events (MACCE). Unlike more complex and costly insulin resistance tests, the TyG index offers a simpler approach to early detection, particularly in individuals without obvious clinical signs of metabolic disease. This narrative review synthesizes evidence on the association between the TyG index and various cardiovascular outcomes, focusing on early-onset conditions such as atherosclerotic cardiovascular disease (ASCVD), myocardial infarction (MI), coronary artery disease (CAD), stroke, heart failure, and all-cause mortality. Notably, the TyG index has shown predictive value across diverse patient populations, including those free from diabetes or dyslipidemia.
The increasing incidence of mental illness at work has highlighted the need for global action on workplace mental health and organizational well-being. This chapter looks at an integrative model of workplace mental health and organizational well-being, focusing on prevention, promotion, and responsive care. It emphasizes how burnout, stress, and negative organizational culture influence psychological as well as physical health, and how mindfulness and yoga practices improve resilience, concentration, and emotional stability. The biopsychosocial model and yoga leadership are offered as potent tools for building inclusive, ethical, and effective workplaces. The chapter also covers obstacles like stigma and resource deficits while providing techniques for sustainable, culturally responsive mental health promotion in diverse workplaces.
Background The teenage years (ages 13–19) are crucial for development. In India, 253 million teenagers shaping the nation's future, but rising cardiovascular disease (CVD) is a concern. Risk factors like poor diet, inactivity, and obesity begin in adolescence, leading to future heart issues. Although CVD manifests in adulthood, its roots often start young. In India, CVD causes over 28% of annual deaths, with a DALY rate 1.3 times the global average, highlighting need for early intervention. Objectives Identify prevalent cardiovascular risk factors & investigate socio-economic, environmental, and lifestyle factors influencing it among teenagers in rural setting. Methods A cross-sectional study was conducted among 106 teenagers (13–19 years) in rural areas. Data were collected through interviews using structured questionnaires to gather socio-demographic profiles and assess cardiovascular risk factors such as physical activity, dietary habits, and family history. Diet Diversity Score (DDS) evaluated the variety in food consumption, while Standardized Physical Activity Questionnaire (PAQ) assessed physical-activity levels among participants. Results The mean age was 15.41 ± 1.98years (51.9% boys, 48.1% girls). Half belonged to Class IV or V of the modified BG Prasad socio-economic scale. Mean cardiovascular knowledge score was poor (34.91%) to fair (65.09%). The mean IDDS was 5.53 ± 1.25, with 56.6% showing low dietary-diversity. Physical activity was inadequate, with minimal hours spent fitness activities. Conclusion Inadequate physical activity, high salt intake, high animal food consumption, and moderate intake of legumes, fruits, and vegetables can independently increase CVD, regardless of BMI. Most teenagers had poor to fair knowledge of CVD risk factors. Effective interventions are needed to improve cardiovascular health knowledge and promote diverse, healthy diets among rural adolescents.
