BACKGROUND:Australian public-private bariatric surgery comparisons have largely focused on access, safety and clinical outcomes, with less evidence describing provider-specific engagement across the perioperative pathway. OBJECTIVES:To compare pre-operative engagement, provider-specific follow-up, attrition and weight outcomes between public and private bariatric surgery pathways in Australia. METHODS:This prospective multi-site observational study included adults undergoing bariatric surgery across two public and two private services in New South Wales (2021-2024). Appointment attendance across the perioperative period (12 months pre- to 24 months post-surgery) was analysed. Engagement, attrition and weight outcomes were compared using non-parametric tests, regression analyses and Kaplan-Meier and Cox proportional hazards models. RESULTS:Of 240 participants, 176 (73.3%) underwent private and 64 (26.7%) public surgery. Public patients had higher baseline weight, BMI, multimorbidity and greater socioeconomic disadvantage (all p < 0.001). They engaged longer pre-operatively (21.6 vs 2.7 months) and attended more MDT appointments (14 vs 2; both p < 0.001), with greater exposure to non-surgical doctors, dietitians, nurses, psychologists, and exercise professionals. Post-operatively, public patients attended a median of 12 (IQR 9-18) appointments compared to 7 (IQR 5-10) in the private services (p < 0.001) and remained engaged longer (18.2 vs 14.5 months). Attrition occurred later in public patients but was similar by 24 months. No statistically significant differences in relative weight loss were detected beyond 6 months. Surgical setting (B =4.344, p < 0.001) and anticipated support need (B =2.194, p = 0.035) were independently associated with post-operative attendance. CONCLUSION:Follow-up engagement appeared to be associated with surgical setting and anticipated support need, while observed weight loss outcomes were broadly similar between sectors. However, baseline differences and observational design preclude conclusions about the comparative effectiveness of the care pathways.
Introduction Physical exercise has been reported positive effects on both bones and muscles simultaneously. The underlying mechanisms remain unclear. This study investigated whether treadmill training can inhabit bone loss and muscle atrophy in ovariectomized (OVX) rats by activating Wnt/β-Catenin pathway. Materials and methods 8-week-old female Sprague-Dawley (SD) rats were randomly divided into three groups (n = 12 per group): Sham group with sham operation, OVX group with bilateral ovariectomy and sham treadmill training, and ET groups with bilateral ovariectomy and 12 weeks treadmill training. Bone mineral density/microarchitecture, level of serum biochemical markers, osteogenesis-related and muscle atrophy markers, and Wnt/β-catenin signaling genes in rat were then analyzed. Results The 12-week treadmill training intervention showed a significant effect on inhibition of ovariectomy-induced bone loss and muscle atrophy. Further analysis revealed that treadmill training enhanced bone mineral density of the proximal femoral metaphysis, improved the proximal tibia microarchitecture, inhabiting bone marrow adipogenesis, decreased serum TRACP-5b, CTX-I, CK, LDH and MDA levels, and elevated the serum BALP, Irisin, CAT and SOD levels. Furthermore, treadmill training upregulated RUNX2, BMP2 and Osterix, but downregulated PPAR-γ in the bone marrow of OVX rats; it downregulated atrogin1 and MuRF1, but upregulated PAX7, in their skeletal muscle; additionally, it markedly upregulated Wnt3a, LRP5 and β-catenin, but downregulated DKK1 and GSK3β, in both their bone marrow and skeletal muscle tissues. Conclusion Treadmill training mitigates bone loss and muscle damage associated with estrogen deficiency. The Wnt/β-catenin signaling pathway potentially serves as a common mechanism.
BACKGROUND:Rare and deleterious variants in the leptin-melanocortin pathway can underlie severe childhood obesity, but data from East Asian populations remain limited. METHODS:We conducted a single-center prospective observational cohort study of 188 Taiwanese children (4-18 years) with nonsyndromic obesity recruited between Jan 2017 and Dec 2024 for targeted sequencing of 12 leptin-melanocortin genes and compared them with two cohorts from the Taiwan Biobank: 527 normal‑weight adults presumed to have normal weight in childhood and 213 obese adults. We compared carrier proportions and mean variant counts and applied the Optimal Sequence Kernel Association Test (SKAT-O) across groups at the pathway and gene levels for three variant sets: all exonic variants, rare variants, and potentially influential variants (PIVs, defined as rare protein-truncating variants or missense variants with high deleteriousness scores). We also analyzed questionnaire-derived eating behavior scores using SKAT-O within the childhood obesity cohort. RESULTS:Children with obesity carried a higher PIV burden than both normal-weight adults (41.0% vs. 24.1%; p < 0.0001) and obese adults (41.0% vs. 25.8%; p = 0.001); mean PIV counts were also higher. Pathway-level SKAT-O supported enrichment driven by rare variants and PIVs. Gene-level enrichment for LEPR and MAGEL2, and variant-level enrichment for two missense variants, MAGEL2 p.Gly285Arg and LEPR p.Asn128Lys, were observed in the childhood obesity group. Analyses of eating‑behavior scores showed nominal signals for exonic variants in MAGEL2 and PIVs in SIM1, but neither met the Bonferroni‑corrected threshold. CONCLUSIONS:Rare, putatively deleterious leptin-melanocortin variants, particularly in LEPR and MAGEL2, are enriched in Taiwanese children with nonsyndromic obesity, underscoring the value of pathway-focused genetic evaluation in pediatric obesity.
INTRODUCTION:Post-partum haemorrhage (PPH) is a leading cause of maternal morbidity and mortality, yet its relationship with body mass index (BMI) remains unclear. AIM:To examine the association between BMI and PPH among primiparous women in Australia. METHODS:A population-based retrospective cohort study was conducted using Victorian Perinatal Data Collection registry (2010─2019). BMI data were available for 311,266 primiparous women. Post-partum haemorrhage was defined using two blood loss thresholds: ≥ 500 mL and ≥ 1000 mL. Logistic regression models were used. RESULTS:The prevalence of overweight and obesity increased from 24.9% to 26.4% and 16.5-18.6%, respectively, while PPH rates rose from 25.5% to 31.5% (≥500 mL) and 2.6-6.4% (≥1000 mL). Women with overweight and obesity had higher odds of PPH compared to women with normal BMI: adjusted odds ratios (AORs) for PPH ≥ 500 mL were 1.11 (95% CI: 1.07-1.13) for overweight and 1.32 (95% CI: 1.29-1.36) for obesity. For PPH ≥ 1000 mL, AORs were 1.10 (95% CI: 1.05-1.15) and 1.30 (95% CI: 1.24-1.37), respectively. Subgroup analysis of vaginal births showed a stronger association between obese BMI and PPH ≥ 1000 mL. For caesarean births, BMI was not significantly associated with PPH ≥ 1000 mL. CONCLUSION:Higher maternal BMI is significantly associated with PPH, particularly in vaginal births. Rising PPH rates over time align with increasing overweight and obesity prevalence, but cannot be fully explained by BMI alone. Enhanced focus on pre-pregnancy weight management and tailored maternity care could contribute to mitigating these risks and improving maternal health outcomes.
We tested for an asymmetric effect of food positional nudge biased towards the unhealthy for individuals with different BMI and fasted states. Data from 141 Indonesian participants were analysed. Participants completed the single-person Fake Food buffet twice, which offered healthy (e.g., roasted chicken) and unhealthy (e.g., fried chicken) options. Ramadan fasting was incorporated as a natural experimental condition by having participants complete the buffet during non-Ramadan and Ramadan periods. In addition, participants were randomly assigned to one of three positional nudge experimental conditions: control, healthy, and unhealthy. Control positional nudge had a balanced 2-to-2 healthy-unhealthy food placement in the buffet. In contrast, the healthy positional nudge had a starting 3-to-1 ratio, biased towards healthier food options, placed at the start of the buffet. The unhealthy positional nudge had a 3-to-1 starting ratio, biased towards more unhealthy options. The main results revealed an asymmetric effect that is biased towards an unhealthy positional nudge for fasted participants with high BMI. This bias was not reversed with a healthy positional nudge. The present findings raise questions about whether healthy positional nudges alone are sufficient in contexts involving high hunger and individuals with higher BMI, although further research with larger samples and more precise designs is needed before drawing policy conclusions.
OBJECTIVE:To evaluate how individuals with different BMI (Body Mass Index) levels respond to the statement "obesity is a disease" in terms of agreement, emotional reactions, and motivation for weight loss. METHODS:A cross-sectional online survey was conducted in January 2024 among 597 Israeli adults (43.3+16.7 years old), stratified by weight status (normal weight (n = 200), overweight (n = 200), obesity (n = 197)) and gender (females (50.1%), males (49.9%)). Participants reported their level of agreement with the statement "obesity is a disease" their emotional reactions to this statement, and weight-related motivation. Multivariate analyses examined demographic and psychological predictors of agreement. RESULTS:Overall, 47.6% of participants agreed with the disease framing. Agreement was significantly associated with higher BMI, lower religiosity, and poorer self-rated mental health. However, agreement was not associated with greater motivation to lose weight or perceived control over weight. Participants with obesity endorsed more negative emotional responses, to the statement including worry, frustration, helplessness, and pressure versus those with lower weight-status. Positive emotions such as optimism or confidence were not significantly associated with weight status. CONCLUSIONS:Framing obesity as a disease is common and more frequently endorsed by individuals with obesity (versus those with lower weight status), yet it does not appear to enhance motivation for weight loss. This framing is also associated with emotional distress, suggesting that such messaging may unintentionally reinforce internalized stigma. Public health communications should consider these nuanced responses and strive to promote messages that are empathetic, non-stigmatizing, and behaviorally supportive.
Olanzapine is an atypical antipsychotic medication utilized for the management of schizophrenia and bipolar disorder. Obesity is a negative consequence of olanzapine. Fish Oil (FO) and Evening Primrose Oil (EPO), are proposed to possess anti-obesity properties. The present study sought to examine the impacts of these oils on olanzapine-induced obesity and its associated abnormalities in female albino rats. The animals were categorized into four groups designated Normal, Oanzapine, Olanzapine + FO (200 mg/kg, oral) and Olanzapine + EPO (200 mg/kg, oral) groups. All animals, except the normal control group, were orally given olanzapine at a dosage of 4 mg/kg/day for 8 weeks and the treated groups started during the last 4 weeks. Body weight variations were observed on a weekly basis during the investigation. Upon the end of the trial, serum samples were obtained for detection of various biochemical and physiological parameters and pancreas and omental adipose tissues were dissected out for histological analysis. The data of the study indicated a substantial increase in serum concentrations of all mentioned biochemical parameters except serum levels insulin and C-peptide, which exhibited a significant decrease in olanzapine-induced obese rats in comparison with the normal control. After treatments on olanzapine-administered rats with these oils, body weight gains and adipose tissue absolute and relative weights were significantly improved. Serum fasting and postprandial glucose levels, insulin, lipid profile, and enzymes related to liver function were also significantly ameliorated. Thereby, these findings indicated the potential of FO and EPO to control obesity and reduce obesity-related olanzapine complications.
Maternal obesity is strongly associated with adverse pregnancy outcomes. However, the extent to which adolescent weight status can predict pre-pregnancy obesity and severe obesity among future first-time mothers has not been well explored. This cohort study utilized adolescent body mass index (BMI) assessments linked to birth records for women 20-30 years old to examine this relationship. The population-based study cohort included 27,370 first-time mothers who had a 10th-grade BMI measurement; among this cohort, 18,881 had BMI assessments in 10th, 8th, and 6th grade. Most women who had severe obesity in 10th grade still had severe obesity prior to their first pregnancy (78.2%). Predictive characteristics using 10th-grade weight categories for predicting pre-pregnancy obesity and severe obesity combined achieved an area under the curve (AUC) of 84.2%, with 79.1% accuracy, 74.3% sensitivity, and 81.4% specificity. For pre-pregnancy severe obesity alone, the approach yielded an AUC of 88.1%, accuracy of 86.9%, sensitivity of 65.7%, and specificity of 91.0%. Predictive accuracy declined minimally in earlier grades (8th and 6th). Adolescent weight status demonstrates predictive capacity for pre-pregnancy obesity and severe obesity, even as early as 6th grade. Early risk identification may enable interventions to reduce maternal obesity and improve pregnancy outcomes.
INTRODUCTION:Body mass index (BMI) is commonly used to estimate obesity-related risk, but it does not reflect fat distribution. A Body Shape Index (ABSI), which captures central adiposity independently of BMI, may offer better prognostic value. We compared ABSI and BMI as predictors of all-cause and cardiovascular (CV) mortality in a general rural population. METHODS:This prospective analysis included 820 participants from the ENAH (Endemic Nephropathy in Croatia - Epidemiology, Diagnostics and Etiopathogenesis) cohort with complete baseline anthropometric data. BMI and ABSI were calculated at baseline and expressed as z-scores. Participants were followed for a median of 9.7 years. Associations with all-cause mortality, CV mortality, and a composite non-fatal outcome were examined using multivariable Cox regression. Discriminative ability was assessed by receiver operating characteristic analysis. RESULTS:Higher ABSI was independently associated with increased all-cause mortality (hazard ratio per 1-SD increase 1.15, 95% confidence interval 1.01-1.32) and CV mortality (1.27, 1.04-1.55), whereas BMI showed no significant association with either outcome. Mortality risk increased across ABSI tertiles but not BMI tertiles. ABSI demonstrated better discrimination for all-cause and CV mortality than BMI, while neither index predicted non-fatal outcomes. CONCLUSION:ABSI outperformed BMI in predicting all-cause and CV mortality. Measures of central adiposity such as ABSI may improve mortality risk stratification beyond BMI alone.
Obesity is associated with risk for chronic health problems and increased mortality. Weight stigma, which entails negative attitudes and behaviors directed at people based solely on their body size, is psychologically harmful and contributes to obesity and obesity-related health problems. Yet, weight stigma is pervasive in society and commonly experienced by patients in healthcare settings, which lowers the quality of patients' healthcare experiences. Healthcare providers and trainees report feeling underprepared to treat obesity, which may lead to overreliance on weight-management strategies that are not evidence-based and are susceptible to weight stigma, such as fad diets emphasizing unrealistic dietary restriction. In the current manuscript, we discuss current weight stigma interventions with other populations and the rationale for integrating training in evidence-based approaches to treat obesity with weight stigma interventions, specifically cognitive dissonance-based interventions. Current learning theories emphasize empathic perspective-taking, and current methods to reduce weight stigma use social-cognitive theories to raise awareness of stereotypes. However, current methods are insufficient because they create discomfort but fail to alter internalized bias nor advise providers on how to deliver non-stigmatizing, evidence-based obesity interventions. Cognitive dissonance theory posits that resolving tension between beliefs and behaviors will change future behaviors. Cognitive dissonance-based interventions have effectively reduced personal weight stigma and are promising to be similarly effective in reducing weight stigma among healthcare providers. In this manuscript, we highlight how cognitive dissonance theory can help improve interventions to reduce bias and support providers' efforts treating obesity.
Obesity is a chronic disease characterized by persistent low-grade inflammation, oxidative stress, and profound metabolic dysregulation, representing a major global health challenge. Among the key molecular players implicated in these processes is nuclear factor erythroid 2-related factor 2 (Nrf2), a master regulator of cellular redox homeostasis and cytoprotective responses. In recent years, growing evidence has identified Nrf2 as a central node linking inflammation, oxidative stress, adipogenesis, and lipid metabolism in the development and progression of obesity. This review provides an integrated overview of current insights into the mechanistic roles of Nrf2 in these processes, incorporating findings from genetic and pharmacological models and discussing its dual, context-dependent effects on obesity-related pathways. Special emphasis is placed on highlighting both protective and adverse outcomes of Nrf2 modulation. Furthermore, the review presents a comprehensive summary of bioactive compounds, both synthetic and natural, that may activate Nrf2 and exert anti-obesity effects. Some of these compounds have undergone clinical trials and represent promising leads for the development of Nrf2-targeted interventions in obesity. However, current clinical evidence remains limited and is derived mainly from studies on metabolic syndrome, type 2 diabetes, and fatty liver disease rather than obesity-focused trials. The review also identifies limitations and gaps that must be addressed before preclinical findings can be effectively translated into clinical applications. Collectively, the review underscores both the therapeutic potential and the complexity of Nrf2 signaling modulation in obesity, while emphasizing the need for further mechanistic and clinical studies to better define safe and effective Nrf2-targeted strategies.
OBJECTIVE:To investigate comorbid correlation and prognostic value of triglyceride-glucose (TyG) and its obesity-related derivatives for all-cause and cardiovascular mortality in the obesity with metabolic dysfunction-associated fatty liver disease (MASLD), and develop incremental predictive model using machine learning and SHapley Additive exPlanations (SHAP) analysis. METHODS:4807 adults with obesity and MASLD enrolled from National Health and Nutrition Examination Survey 1999-2018. Kaplan-Meier, Cox regression, and restricted cubic splines (RCS) were used to examine associations. Machine learning and incremental prognostic model were developed to predict mortality, with SHAP interpreting feature importance. RESULTS:Both TyG and TyG-WHtR were associated with all-cause mortality after full adjustment, whereas TyG-WHtR showed a more robust association with cardiovascular mortality. TyG-WHtR showed the strongest association: each 1-unit increase linked to 31.7% and 46.7% higher risk of all-cause and cardiovascular mortality respectively in the fully adjusted model, with RCS showing an S-shaped relationship. Time-varying hazard ratio patterns suggested that the associations of TyG and TyG-WHtR with mortality were stronger in the early follow-up period and attenuated over time. XGBoost performed best with SHAP analysis identified age, fasting plasma glucose (FPG), male as primary factors. The incorporation of TyG and TyG-WHtR into predictive models modestly improved the prediction performance for mortality outcomes. CONCLUSIONS:TyG-WHtR showed a stronger time-dependent association with mortality in obesity-MASLD comorbidity, while TyG mainly associated with all-cause mortality. S-shaped curve for TyG-WHtR indicates the critical need for early intervention. Integrating TyG-WHtR into XGBoost prognostic models enhances risk identification, while SHAP values clarify age, FPG, male as key drivers.
BACKGROUND/OBJECTIVES:Sciatica from sciatic nerve pathology remains a major public health concern. Individual components of metabolic syndrome (MetS) have been associated with nonspecific lower back pain. Accordingly, this study investigated the association between MetS and sciatica, evaluated the cumulative association according to the number of MetS traits, and identified key contributing factors in a large Taiwanese population. METHODS:This cross-sectional analysis included 121,673 adults aged 30-70 years from the Taiwan Biobank. MetS was defined using the modified National Cholesterol Education Program Adult Treatment Panel III criteria for Asian populations. Sciatica was assessed through a standardized self-reported questionnaire. Multivariate logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for sciatica in relation to MetS and its individual components. RESULTS:MetS was associated with a higher prevalence of sciatica after multivariable adjustment (adjusted OR, 1.19; 95% CI, 1.06-1.34). A graded association was observed between the number of MetS components and the prevalence of sciatica, with a significant trend across increasing component burden (adjusted p for trend = 0.001). Among the individual components, abdominal obesity remained significantly associated with sciatica (adjusted OR, 1.42; 95% CI, 1.28-1.57). These findings were consistent across sex-stratified and standardized analyses. CONCLUSIONS:MetS, particularly abdominal obesity, was associated with a higher prevalence of sciatica. A trend toward increasing prevalence was observed with a higher number of MetS components. Given the cross-sectional design, causal relationships cannot be inferred. These findings suggest that metabolic health may be related to sciatica burden in the general population.
INTRODUCTION:This study compared the discriminatory performance of seven obesity indices for metabolic diseases by sex and age. METHODS:We analyzed data from 8900 Korean adults aged ≥ 20 years using the 2022-2023 Korea National Health and Nutrition Examination Survey. Seven obesity indices (body mass index, waist circumference, waist-to-height ratio, a body shape index, body roundness index, fat mass index, and body fat percentage) were evaluated in relation to hypertension, diabetes, dyslipidemia, and metabolic syndrome. Associations and discriminatory ability were assessed using logistic regression and receiver operating characteristic analyses stratified by sex and age. RESULTS:Central obesity indices, particularly waist-to-height ratio and body roundness index, showed the strongest associations with all metabolic outcomes in both sexes. A body shape index exhibited weaker associations after age adjusted. Discriminatory performance declined with age across all indices, especially after 50 years. CONCLUSIONS:Waist-to-height ratio, body roundness index, and waist circumference were superior to body mass index and comparable to fat mass index and body fat percentage in identifying metabolic risk, particularly in younger and middle-aged adults. The reduced discriminatory power in older adults underscores the need for age-sensitive obesity metrics and complementary functional assessments.
AIM:To evaluate metabolic and dialysis parameters following bariatric surgery in prospective kidney transplant candidates. BACKGROUND:Bariatric surgery has been associated with improved survival among patients receiving dialysis. However, the mechanism to explain this observation remains unclear, especially considering higher body mass index (BMI) has been associated with improved survival on dialysis ("Obesity Paradox") Clarifying how surgery impacts interdialytic weight gain (IDWG), and cardiovascular risk factors, such as systolic blood pressure (SBP) and diabetes is essential. METHODS:All adult patients receiving dialysis who underwent bariatric surgery were identified via the Queensland Statewide Bariatric Service. Demographics, co-morbidities, weight, height, and dialysis parameters (pre-dialysis SBP, intradialytic weight gain (IDWG), and calculated ultrafiltration volume) were collected over a three-month pre-surgery and six-month post-surgery from the medical records. Paired T-Tests and Wilcoxon Signed Rank Tests were used as appropriate. RESULTS:Thirteen patients (mean age 50.3 years; 61.5% female; all on haemodialysis) were identified. Most had type 2 diabetes mellitus (61.5%) and no one had coronary artery disease. Preoperative mean weight and BMI were 129.2 kg and 44.2 kg/m², respectively. Post-operatively, patients lost an average of 29.6 kg (22.9% reduction,95%CI 19.09-40.05) and reduced BMI by 10.4 kg/m² (23.5% reduction,95%CI 6.46-14.32) SBP decreased by 14.2 mmHg (10.3% reduction) (p < 0.001), and IDWG dropped by 1.16 kg (55.5% reduction) (p < 0.001). Calculated ultrafiltration requirements declined by 47.7% (p < 0.001). No significant changes were observed in HbA1c, antihypertensive use, or admissions for fluid overload. CONCLUSION:Bariatric surgery was associated with significant improvements in fluid management and blood pressure control in this small cohort. Larger studies are needed to confirm the consistency and generalisability of these findings.
Background In Denmark, achieving ≥ 8% preoperative weight loss within 6 months is a requirement for bariatric surgery (BS). This weight loss is difficult for many patients, postponing their surgery. Objectives This study aimed to optimize pre-surgical weight loss strategies for patients referred to BS. Setting Aarhus University Hospital, Denmark. Methods In a prospective study, we evaluated the proportion of patients who underwent BS within 6 months after referral as a marker of successful preoperative weight loss. Furthermore, a randomized controlled trial (RCT) with complete follow-up was performed, comparing very low calorie diet (VLCD) to conventional energy-restricted diet regarding the proportion of patients achieving the mandatory weight loss and undergoing BS within 6 months. Results Our prospective study revealed that 67% underwent BS during the entire study period (median time to surgery 8 months), while only 16% underwent BS within 6 months. In the RCT, 65 patients were assigned to either VLCD or conventional diet. The proportion of patients achieving the target weight loss was 94% in the VLCD group vs. 62% in the control group (p < 0.01), and the proportion that underwent BS within 6 months was 86% vs. 38% (p < 0.01), in the VLCD and control group, respectively. VLCD was well tolerated with no adverse effects on surgery time or postoperative complications. Conclusion These findings support VLCD as an effective and feasible preoperative intervention to optimize weight loss goals and thereby BS outcomes.
Introduction Individuals with obesity often face challenges related to mental health, including variations in mood state. However, evidence on how physical exercise within weight loss programs influences these outcomes remains limited. Objectives To examine the mood state of individuals with obesity enrolled in weight loss programs with physical exercise. Methods A Systematic review was conducted following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The searches were carried out in the databases Cochrane Library, Embase, PsycINFO, PubMed, Scopus, and Web of Science. Studies that addressed the population with obesity, applied physical exercise as the main intervention or as a complement to diet and/or behavioral intervention, and examined mood states before and after exercise were included. Results Seven studies were included, all using the Profile of Mood States scale. Most interventions combined physical exercise with dietary strategies, and some also included behavioral support. Improvements were more consistently observed in vigor and fatigue, whereas other mood domains showed variable results across studies. Interventions combining exercise with dietary and behavioral components tended to demonstrate more consistent improvements compared to exercise-only approaches. However, the evidence was limited by heterogeneity in intervention protocols and a high risk of bias, particularly in outcome measurement and randomization. Conclusion Weight loss programs incorporating physical exercise may be associated with improvements in certain mood states in individuals with obesity, particularly when combined with dietary and behavioral strategies. However, the evidence is heterogeneous and limited by methodological concerns, and findings should be interpreted with caution.
INTRODUCTION:The use of anti-obesity medications, particularly including glucagon-like peptide-1 receptor agonists (GLP1-RA), is expanding and increasingly combined with bariatric surgery (BS). However, evidence on their use preoperative and impact on body composition remains limited. PURPOSE:To compare weight loss and body composition changes in patients undergoing BS with or without prior GLP1-RA treatment. PATIENTS AND METHODS:Retrospective observational study of adults who underwent BS at Clínica Universidad de Navarra (Madrid) between 2017 and 2023. RESULTS:Overall, 86 patients (mean age, 46.6 ± 12 years; 66% women) were included; 80.2% and 19.8% underwent sleeve gastrectomy and gastric bypass, respectively. Preoperative GLP1-RA therapy (63.4% liraglutide and 36.6% semaglutide) was prescribed in 34.8% of patients for a mean of 21.7 ± 15.9 weeks. Adverse events were mild and mostly gastrointestinal symptoms. Patients treated with GLP1-RA achieved greater weight loss preoperatively (5.1% ± 4.9% vs. 2.4% ± 3.7%; p = 0.005) and at 1 month postoperatively (15.4% ± 5.2% vs. 13.0% ± 3.8%; p = 0.03), but not at 6 months. Prior to BS, fat mass was lower in the GLP1-RA group (53.3 kg [95% CI 50.7-56.0] vs. 58.6 kg [95% CI 56.6-60.5]; p = 0.01), whereas no differences in lean mass or body composition were observed at 6 months between the two groups. CONCLUSIONS:Preoperative GLP1-RA therapy resulted in greater preoperative weight and fat mass reduction without additional lean mass loss. Larger prospective studies are warranted to define the long-term role of GLP1-RA therapy before BS.
OBJECTIVE:Advanced cardiovascular-kidney-metabolic (CKM) syndrome carries substantial mortality risk, yet the independent and joint prognostic roles of insulin resistance-related markers-estimated glucose disposal rate (eGDR) and triglyceride-glucose (TyG) index-remain insufficiently characterized in advanced CKM. METHODS:We analyzed 6527 adults with advanced CKM (AHA stages 3-4) from NHANES 1999-2018 with mortality follow-up through 2019. Survey-weighted Cox models with restricted cubic splines and segmented regression evaluated associations and thresholds. Joint-exposure models quantified additive interaction (RERI/AP/SI). Survival-based machine learning was performed to account for follow-up time and censoring, with XGBoost-Cox interpreted using SHAP. RESULTS:Higher eGDR was linearly associated with lower mortality (per 1-unit increase: all-cause HR 0.80; cardiovascular HR 0.73). TyG showed threshold effects: risk increased steeply above 9.13 (all-cause) and 9.09 (cardiovascular) (above-threshold per 1-unit increase: HR 3.85 and 5.50, respectively). Joint analyses showed the highest risk in the TyG-high/eGDR-low group (all-cause HR 2.20; cardiovascular HR 2.80 vs TyG-low/eGDR Q1), while additive interaction was antagonistic for higher eGDR categories (SI <1), indicating attenuation of TyG-associated excess risk at higher eGDR. The combined eGDR-TyG model improved discrimination (C-index 0.883). XGBoost-Cox showed the best discrimination, and SHAP analysis supported the prognostic importance of age, eGDR, and TyG. CONCLUSION:In advanced CKM, eGDR is consistently protective, whereas TyG confers additional risks; higher eGDR mitigates TyG-associated risk. Combined eGDR-TyG assessment may improve mortality risk stratification.
Intracranial aneurysms are a prevalent cerebrovascular condition and a leading cause of aneurysmal subarachnoid hemorrhage (aSAH). Beyond established risk factors, increasing attention has been focused on metabolic conditions that may modulate vascular inflammation and endothelial function. In this context, obesity has been proposed as potential modifiers of intracranial aneurysm vulnerability. However, clinical evidence remains inconsistent and, in some cases, counterintuitive. Most studies rely on body mass index (BMI) as a proxy for adiposity. Across population-based cohorts and clinical series, BMI has not consistently emerged as an independent risk factor for aneurysm formation or rupture after adjustment for major confounders. Conversely, several studies have reported inverse associations between higher BMI and the risk of aSAH or post-hemorrhagic mortality, findings that have contributed to the concept of an "obesity paradox." Nevertheless, these associations vary widely by study design, population characteristics, and clinical endpoints, and do not show a consistent linear response pattern. Interpretation of these findings is limited by substantial methodological constraints. BMI does not reflect body composition, fat distribution, or the biological activity of adipose tissue, and may instead capture overall health status or nutritional reserve. Overall, current clinical evidence does not support a consistent or independent role of BMI-defined obesity in intracranial aneurysm risk or prognosis. Reported inverse associations should be interpreted with caution, as they may reflect methodological constraints rather than true biological effects. Future research should incorporate direct and biologically meaningful measures of adiposity to better clarify the relationship between metabolic factors and aneurysm disease.
