Background Awareness is growing that body mass index (BMI) alone does not capture the behavioral, psychological and physiological heterogeneity of obesity. We investigate the recognition and alignment of four existing obesity phenotype descriptor domains (emotional hunger, hungry brain, hungry gut, and slow burn) among people with obesity (PwO) and physicians. Methods This was a real-world, cross-sectional survey study, which included elements of retrospective data collection. Data were collected from physicians and PwO in the United States between October 2023 and April 2024 as part of the Adelphi Real World Obesity Disease Specific Programme™. Physicians provided clinical data and PwO demographic information; both reported on predefined obesity phenotype descriptors. Agreement between PwO and physician reports was evaluated using Cohen’s κ; PwO characteristics were compared using bivariate analyses. Results PwO (n=215) mean age was 48.8 ± 13.9 years, and 69.3% were female. Significant differences between comorbidity prevalence were observed across phenotype descriptors; depression, stress and hypothyroidism being notably common in PwO reporting emotional hunger or hungry brain descriptors. Physicians (n=151) most commonly reported hungry brain descriptor (52.6%), whereas PwO most commonly reported emotional hunger (45.1%). Patient-physician agreement was slight for hungry brain (κ=0.176) and hungry gut (κ=0.113), fair for emotional hunger (κ=0.207) moderate for slow burn (κ=0.410). There was significantly greater weight loss among PwO where physicians aligned on the presence of the hungry brain descriptor compared with those who did not align. Conclusions Obesity phenotype descriptors relating to emotional hunger, hungry brain, hungry gut and slow burn may provide a useful framework for characterizing behavioral, psychological and physiological aspects of obesity that are not reflected by BMI. However, PwO-physician recognition and agreement were limited and varied across descriptor domains. Greater concordance on selected descriptors was associated with improved weight-loss outcomes, suggesting value in supporting shared understanding of obesity presentation and management.
Background Bariatric surgery is widely used for severe obesity and may influence neurological outcomes through metabolic alterations, nutritional deficiencies, and changes in Antiepileptic Drug (AED) absorption. Despite increasing reports of neurological complications, seizure patterns before and after bariatric surgery have not been comprehensively summarized. Methods This was a systematic review conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search of PubMed, Scopus, Web of Science, and Embase was conducted through April 20, 2025. Eighty-three studies reporting seizures before and/or after bariatric surgery were included. Data on patient demographics, surgery type, seizure timing, etiology, AED adjustments, and clinical outcomes were narratively synthesized. Results Across the included studies, patients were mostly middle-aged women undergoing sleeve gastrectomy or Roux-en-Y gastric bypass. Three outcome patterns emerged. Some patients with pre-existing epilepsy remained seizure-free postoperatively with stable AED regimens. Others experienced persistent or recurrent seizures, commonly associated with reduced postoperative absorption of valproate or phenytoin, requiring dose escalation or drug substitution. New-onset postoperative seizures occurred across both surgery types and were predominantly secondary to metabolic disturbances especially hypoglycemia, hyperammonemia, electrolyte abnormalities, or cardiac arrhythmia and typically resolved after addressing the underlying cause. AED adjustments were more frequently required after gastric bypass due to greater pharmacokinetic changes. Conclusion Seizure outcomes after bariatric surgery are variable and influenced by altered drug absorption and postoperative metabolic complications. Most patients maintain seizure control, but a subset develops breakthrough or new-onset seizures, highlighting the need for AED monitoring and careful evaluation of metabolic causes.
Background Real-world evidence describing the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for adolescent obesity in Saudi Arabia remains limited. This study aimed to characterize current GLP-1 RA use, evaluate specialty-based variation in prescribing practices, and explore healthcare professionals’ perspectives on barriers to prescribing, training needs, and clinical guidance. Methods This was a national cross-sectional survey study conducted among physicians and clinical nutritionists practicing in Saudi Arabia between December 2024 and July 2025. The survey assessed prescribing practices, clinical perspectives, perceived barriers, and educational needs related to the use of GLP-1 receptor agonists for adolescent obesity. Comparisons across healthcare specialties were performed using chi-square and Fisher’s exact tests, and reflexive thematic analysis was applied to responses to an optional open-ended question. Results A total of 140 healthcare professionals completed the survey, of whom 30% reported prescribing GLP-1 RAs for adolescent obesity. Pharmacological treatment was reported more frequently by endocrinologists and bariatric surgeons than by family medicine physicians, general pediatricians, and clinical nutritionists (p < 0.001). Among the 42 GLP-1 RA prescribers, reported treatment duration differed significantly across specialties (p = 0.017). Nausea was the most frequently reported adverse effect among prescribers (95%). Treatment cost, safety concerns, limited training, and the need for clearer national guidance were identified as major barriers. Qualitative findings reinforced the need for standardized prescribing criteria, monitoring recommendations, and multidisciplinary care. Conclusions Considerable specialty-based variation exists in GLP-1 RA prescribing practices for adolescent obesity in Saudi Arabia. These findings support the development of standardized national guidance, targeted professional education, and multidisciplinary care pathways to promote consistent, safe, and evidence-based prescribing.
Background Rare genetic forms of obesity are characterized by severe, early-onset obesity and hyperphagia, often involving the leptin–melanocortin pathway. Although advances in genetic testing have improved the recognition of monogenic obesity, data from Southern European populations remain limited. We investigated the genetic landscape and associated clinical characteristics of Greek patients with severe early-onset obesity and hyperphagia. Methods This retrospective, single-center, observational study included 67 children and adults with severe obesity and hyperphagia, consecutively recruited at the University Hospital of Patras, Greece, between September 2019 and November 2020. Targeted next-generation sequencing, supplemented by Sanger sequencing, evaluated 101 genes associated with monogenic obesity. Variants were classified according to the American College of Medical Genetics and Genomics (ACMG) criteria. Results Among 67 participants, 37 (55.2%) carried obesity-associated variants, with 51 variant findings identified across 24 genes, predominantly involving PCSK1, ALMS1, and BBS20. Several variants occurred in more than one participant. Variant classification identified one benign, five likely benign, two variants of uncertain significance (VUS)-favoring benign, 37 VUS, one likely pathogenic, and five pathogenic variants. Nearly half of variant-positive participants (45.9%) carried variants in more than one obesity-associated gene, suggesting potentially oligogenic contributions. Conclusion Genetic variants affecting the leptin–melanocortin pathway were frequently identified in this cohort of patients, highlighting the marked genetic heterogeneity of rare obesity. From a clinical perspective, these findings support phenotype-driven genetic evaluation in patients with severe early-onset obesity and marked hyperphagia, particularly when syndromic, endocrine, developmental, or behavioral features are present. Genetic results may help establish an etiologic diagnosis, inform genetic counselling and family evaluation, and identify selected patients who may be candidates for mechanism-based therapies. Because most detected variants were VUS, results should be interpreted by clinicians with expertise in obesity and genetics and should not be used to guide treatment on the basis of a VUS alone.
Background Overweight and obesity affect an estimated 2.5 billion adults worldwide. Reviews of single treatment modalities are abundant, but clinicians lack one appraised comparison of nutrition therapy, physical activity, and behavioural modification across outcomes and treatment durations. Methods This was an umbrella review and meta-analysis of systematic reviews and meta-analyses of randomized controlled trials in adults aged 18 years or older with overweight or obesity PubMed was searched (2015–2025) with backward and forward citation tracking. Quality was appraised with AMSTAR 2 and certainty of evidence with GRADE. Primary outcomes were mean change in weight and body mass index (BMI) by intervention type and follow-up duration (<3, 3–6, 6–12, and >12 mo.); secondary outcomes were glycaemic, lipid, and blood pressure parameters. Estimates were pooled using random-effects models. Results Of 1,725 records, 112 reviews (424 comparisons; 2,332 unique randomized trials) were included. All intervention types produced significant but modest weight reduction. Combined diet and physical activity yielded the largest weight reduction beyond 12 mo. (mean difference −3.68 kg; 95% CI: −5.47, −1.89; single contributing review), the largest BMI reduction at <3 mo. (−1.22 kg/m2; 95% CI: −2.31, −0.13), and the greatest improvements in fasting glucose and insulin resistance. Pooled fasting glucose and lipid estimates combine effects reported on differing scales and are exploratory and descriptive only, not absolute mg/dL values. Physical activity produced the largest systolic blood pressure reduction (6–12 mo.: −6.10 mm Hg; 95% CI: −8.07, −4.13). Lipid effects were inconsistent, heterogeneity was high (I2 commonly 70%–99%), and AMSTAR 2 confidence was low or critically low in 69% of reviews. Conclusion Most non-pharmacological approach reduced weight and BMI, and multicomponent programs combining diet, physical activity, and behavioural support gave the greatest cardiometabolic benefit. Because this benefit was partly independent of the weight lost, such programs remain worthwhile for patients who do not reach conventional 5%–10% weight-loss targets. Registration PROSPERO CRD420251245029 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=1245029 )
Background and aims: Central obesity, commonly assessed using waist circumference (WC), is strongly associated with cardiometabolic risk. While lifestyle interventions and glucagon-like peptide-1 receptor agonist-based therapies (GLP-1RA-based therapies) reduce body weight, their effects on WC and factors influencing response remain incompletely characterised. This systematic review and meta-analysis evaluated the effects of these interventions on WC in randomised controlled trials (RCTs). Methods: Following PRISMA 2020 guidelines, we searched PubMed for RCTs published between 2010 and 2025 that reported outcomes related to WC or visceral adipose tissue in adults. Eligible interventions included diet, exercise, diet plus exercise, and GLP-1RA-based therapies. Data from 27 intervention-comparator study arms (21 RCTs; n = 3196) were pooled using random-effects models to estimate between-group mean differences in WC change. Meta-regression explored associations between baseline characteristics and WC response. Publication bias was assessed using funnel plots and Egger's test. Results: Interventions were associated with significant reductions in WC (MD: −4.36 cm; 95% CI: −4.97 to −3.74; prediction interval: −6.98 to −1.73). Subgroup analyses demonstrated significant reductions for GLP-1RATs (MD -5.93 cm; 95% CI -7.88 to −3.98) and diet-alone interventions (MD -3.46 cm; 95% CI -5.91 to −1.00). Exercise-only and diet-plus-exercise interventions showed more variable effects, and subgroup differences were not statistically significant. Exploratory meta-regression suggested potential associations between baseline anthropometric measures, age, and WC reduction, although these findings should be interpreted cautiously. WC change was positively associated with visceral adipose tissue change at the study-arm level. Funnel plots suggested possible small-study effects (Egger's p = 0.0025). Conclusions: GLP-1RA-based therapies and dietary interventions were associated with reductions in WC in adults. WC may serve as a practical anthropometric marker of intervention response, although observed associations with visceral adipose tissue were derived from study-arm-level analyses. Further studies are needed to better define predictors of treatment response.
Background: Obesity is highly prevalent among U.S. adults and is associated with substantial morbidity and mortality. Primary care clinicians are well positioned to identify patients with overweight or obesity and address related health risks. Prior studies suggest that obesity is often underdiagnosed, but less is known about how frequently overweight or obesity diagnosis codes are documented during routine primary care encounters. Methods: This was a retrospective observational study of 49,279 adult family medicine and internal medicine encounters at Mayo Clinic in Jacksonville, Florida, from July 1, 2021, through June 30, 2022. Encounters included adults ≥18 years of age with a recorded body mass index (BMI) ≥25 kg/m2. The primary outcome was documentation of an overweight or obesity diagnosis code (OODC) during the encounter. Logistic regression evaluated associations between patient, clinician, and encounter characteristics and OODC documentation. Results: An OODC was documented in 3658 encounters (7.4%). Documentation increased across BMI categories, from 2.5% of encounters involving patients with overweight to 22.0% of encounters involving patients with class III obesity. In multivariable analysis, class III obesity had the strongest association with OODC documentation compared with overweight (adjusted odds ratio [aOR], 11.22; 95% confidence interval [CI], 10.05, 12.55). Male clinician sex was associated with modestly lower odds of documentation (aOR, 0.88; 95% CI, 0.81, 0.95). Internal medicine encounters had higher odds of documentation than family medicine encounters (aOR, 1.24; 95% CI, 1.14, 1.35), while office visits had lower odds than comprehensive visits (aOR, 0.70; 95% CI, 0.65, 0.75). Conclusion: OODCs were infrequently documented during adult primary care encounters involving patients with BMI ≥25 kg/m2. Documentation increased with BMI severity but remained uncommon overall and varied according to clinician age, clinician sex, department, and encounter type.
Background: The increasing prevalence of obesity is generating demand for chronic pharmacologic treatment, but Latin American evidence on population-level budget implications remains limited. Methods: This was an observational, cross-sectional descriptive study using ENDES (Encuesta Demográfica y de Salud Familiar or Demographic and Family Health Survey) 2022–2024 data, with a deterministic scenario-based budget impact analysis component. Survey-observable candidate populations and gross medication-acquisition requirements were estimated under the complex survey design. Liraglutide, extended-release naltrexone/bupropion, and extended-release phentermine/topiramate were modeled, while semaglutide 2.4 mg served as a supplementary non-governmental retail scenario. Results: The pooled file included 76,819 records. An estimated 7.54 million adults had Body Mass Index-defined obesity, 9.04 million met the broad criterion, and 3.67 million met pragmatic priority. At 100% coverage, broad-criterion annual budgets were S/142.95 billion for liraglutide, S/23.65 billion for the IETSI (Institute for Health Technology Assessment and Research)-reported naltrexone/bupropion scenario, and S/26.83 billion for phentermine/topiramate; corresponding pragmatic-priority budgets were S/57.95 billion, S/9.59 billion, and S/10.88 billion. Semaglutide 2.4 mg cost S/16,804.86 per patient in the first year and S/18,135.52 in a maintenance year. Conclusion: In Peru, a substantial proportion of adults meet survey-observable criteria for treatment with obesity medications. The broad criterion reaches more than nine million adults, whereas pragmatic priority reduces the initial candidate population to nearly four million. Projected budget impact is driven primarily by candidate-population size and annual medication cost. Liraglutide 3.0 mg and semaglutide 2.4 mg represent high-cost non-governmental retail scenarios rather than expected institutional procurement estimates. Extended-release naltrexone/bupropion provides a lower-cost non–GLP-1 comparator,and extended-release phentermine/topiramate was analyzed only as an exploratory supplementary comparator.
Background Updated recommendations for metabolic and bariatric surgery may expand the population requiring further clinical evaluation, but their scope across settings remains unclear. We estimated adults aged 18–69 years meeting a restricted surveillance-based operationalization of the 1991 US National Institutes of Health (NIH) and 2022 American Society for Metabolic and Bariatric Surgery/International Federation for the Surgery of Obesity and Metabolic Disorders (ASMBS/IFSO) thresholds through 2030. Methods This was an observational burden-estimation and population-projection study based on secondary analysis of cross-sectional surveys. We analyzed World Health Organization (WHO) STEPwise Approach to Noncommunicable Disease Risk Factor Surveillance (STEPS) surveys from 37 settings. Estimates incorporated the complex survey design, demographic projections, paired primary-sampling-unit bootstrap resampling, and Shapley decomposition. The 2030 demographic-stability scenario was primary; the epidemiological-trend scenario was exploratory. Results We analyzed 138,695 participants, representing 468.2 million adults in 2030. In the common classifiable universe, 17.1 million (3.6%) met the operationalized NIH threshold and 48.5 million (10.4%) met the ASMBS/IFSO threshold, a paired ratio of 2.84. The additional 31.5 million comprised 26.5 million with body mass index (BMI) 30.0–34.9 kg/m2 and metabolic disease and 4.9 million with BMI 35.0–39.9 kg/m2 outside the NIH threshold stratum. Threshold prevalence was higher among women and older adults and varied across settings. In the high/exploratory scenario, 64.2 million met the ASMBS/IFSO threshold, and epidemiological change accounted for 51.7% of the projected increase. Conclusion The restricted surveillance-based operationalization of the ASMBS/IFSO thresholds identified a population nearly three times larger than the NIH threshold stratum. These estimates quantify a population requiring further clinical evaluation and capacity planning; they do not establish individual candidacy, indication, or expected utilization.
Background:Psychosocial and behavioural interventions are a core pillar of obesity care alongside metabolic and bariatric surgery and pharmacotherapy. However, research priorities to advance psychosocial obesity care have not yet been systematically identified in Canada. Objective:To identify national research priorities for psychosocial and behavioural interventions in obesity care from Canadian knowledge users. Methods:This was a Canadian research priority-setting consultation conducted through the virtual National Obesity Psychosocial Research Summit in September 2024. Participants included researchers, clinicians, administrators, and people with lived experience (PWLE) across Canada (N = 48). Summit attendees discussed current research priorities in psychosocial obesity care in breakout discussions followed by plenary report-backs. Facilitator notes and transcripts were analyzed using thematic analysis to generate priority areas. Participants subsequently ranked priorities in an online survey. Results:Six research priority areas were identified for psychosocial interventions in obesity care: (1) establishing systems that improve the quality and rigor of behavioural research; (2) addressing weight stigma and environmental determinants of outcomes; (3) developing consensus around research measures that evaluate the impact of behavioural treatments on outcomes other than weight (e.g., quality of life, pain reduction); (4) advancing precision-based and culturally responsive care approaches; (5) improving public, patient, and provider education regarding psychosocial care; and (6) expanding study designs and delivery modalities to enhance accessibility and scalability. Conclusions:These six priorities provide a roadmap to guide collaboration, funding, and implementation efforts to strengthen psychosocial care in obesity management.
Background:Weight-loss outcomes after bariatric surgery (BS) show interindividual variability that is not fully explained by clinical factors. In the OBEGEN study we previously developed a clinical-genetic score combining three clinical variables with nine single nucleotide polymorphisms to predict weight-loss success at 12-18 months after BS. In the present study we evaluated the usefulness of this clinical-genetic score to predict longitudinal weight-loss trajectories up to five years after BS. Methods:Multicenter retrospective cohort study including 342 adults who underwent Roux-en-Y gastric bypass or sleeve gastrectomy (2018-2020) with available genetic data. Patients were classified as into higher or lower predicted response groups using the OBEGEN cut-off (0.662). The primary outcome was percentage total weight loss (%TWL) assessed from 6 months to 5 years. Longitudinal trajectories were analyzed using linear mixed-effects models adjusted for baseline BMI, sex, type 2 diabetes, and center. Secondary outcomes included the proportion achieving >20% TWL and recurrent weight gain. Results:Patients in the higher predicted response group achieved greater %TWL throughout follow-up than those in the lower predicted response group (adjusted β = 2.60%, p = 0.009). Differences emerged early after surgery and remained stable over time without progressive divergence. At 5 years, a higher proportion of patients in the higher predicted response group maintained >20% TWL (78.7% vs. 60.0%, p = 0.001). Discriminatory performance of response to BS was moderate but consistent (area under the receiver operating characteristic curve 0.674 at 1 year; 0.608 at 5 years). Conclusion:The OBEGEN clinical-genetic score stratifies patients into distinct medium-term weight-loss trajectories after bariatric surgery, supporting its utility as a preoperative tool for risk stratification and personalized management in obesity.
Introduction:Adolescent bariatric surgery is rising, but comparative outcome data for sleeve gastrectomy in adolescents and young adults remain limited. Pre-surgical glucagon-like peptide-1 receptor agonist use in younger patients represents an unaddressed confounder. We therefor compared 1-year weight loss, metabolic comorbidity, nutritional and surgical outcomes of laparoscopic SG between adolescents (13-17 years) and young adults (18-21years) with severe obesity, using propensity score matching (PSM). Methods:This retrospective comparative cohort study used the TriNetX US Collaborative Network,a fedrated electronic health record platform spanning 66 health care organizations and approximately 113 million patients. Patients who underwent laparoscopic SG with morbid obesity were identified and stratified by age group. After exclusion of prior or concurrent alternative bariatric procedures, adolescents (n = 327) and young adults (n = 1056) were matched 1:1 using 25 pre-surgical characteristics, including GLP-1 RA medications. Outcomes were assessed at 1 year. Results:After PSM, 318 matched pairs were analyzed. Pre-surgical semaglutide use was markedly higher among adolescents (29.4% vs 14.6%; SMD 0.363 before matching) and was balanced after matching (27.4% vs 26.1%; SMD 0.028). At 1-year, post-operative Body Mass Index (BMI) was equivalent (38.6 ± 8.7 vs 39.1 ± 8.8 kg/m2; p = 0.534). No significant differences were observed in type 2 diabetes persistence, hypertension persistence, dyslipidemia, NAFLD, or new-onset GERD. No reoperations or conversions to RYGB occurred at 1 year. Approximately 49% of patients in both cohorts had pre-existing vitamin D insufficiency. Sex-stratified analyses were concordant with primary findings. Conclusions:Adolescents achieve equivalent 1-year weight loss and metabolic outcomes following SG compared with young adults. Pre-surgical GLP-1 RA exposure is substantially higher in adolescents and must be controlled for in comparative bariatric research. The high prevalence of pre-existing vitamin D insufficiency in this population warrants routine pre-operative assessment and supplementation.
Introduction The prevalence and associated factors of overweight and obesity among patients with type 2 diabetes mellitus (T2DM) were inconsistent in Ethiopia. Therefore, we aimed to pool the prevalence and associated factors of overweight and obesity among patients with T2DM using a systematic review and meta-analysis. Methods This was a systematic review and meta-analysis of studies reporting overweight and obesity among patients with T2DM in Ethiopia. PubMed, MEDLINE, Scopus, Web of Science, Google and Google Scholar, and Cochrane Library databases were systematically searched for relevant studies from January 2015 to December 2025. In addition, a manual search was conducted using published articles’ reference lists. This review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guideline. A narrative synthesis was provided by indicating the Adjusted Odds Ratio (AOR) with its corresponding 95% Confidence Interval (CI) of individual studies. All analyses were performed using STATA Version 17 software. Results A total of 52 studies met the inclusion criteria. Of these, 47 studies contributed to the meta-analysis of prevalence, while six studies contributed to the narrative synthesis of associated factors. The pooled prevalence of overweight, obesity, and both overweight and obesity were 33.8% (95% CI: 30.7–37.0), 17.1% (95% CI: 13.6–20.6) and 51.1% (95% CI: 45.9–56.3), respectively. A significant heterogeneity was found across the included studies. Study region explained part of the observed heterogeneity. A narrative synthesis identified fifteen significant factors associated with overweight and obesity among patients with type 2 diabetes in Ethiopia. These factors were grouped into three categories: socio-demographic factors (age, sex, place of residence, educational level, monthly income and family history of overweight/obesity); behavioral factors (physical activity/exercise, dietary practice, alcohol consumption, walking status, walking level and vigorous physical activity); and clinical factors (comorbid hypertension, duration of diabetes, central obesity and triglyceride level). Conclusion This study found that approximately half of patients with T2DM in Ethiopian studies were affected by overweight and obesity; there was a considerable difference across regions, with a higher prevalence observed in Addis Ababa. These findings highlight the importance of educating patients with T2DM on managing weight.
Background Lipedema is a chronic medical condition primarily affecting women, characterized by bilateral, symmetrical, disproportionate fat deposition in the lower limbs, and sometimes arms and lower trunk. Pharmacological interventions remain limited, but glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists (GLP-1/GIP RAs) could provide potential therapeutic benefit due to their effects on weight, metabolism, pain, and inflammation. Methods This was a cross-sectional, patient-reported online survey study comparing self-reported lipedema symptom severity, medication use history, and physical and mental health outcomes across three groups of women with lipedema stratified by GLP-1/GIP receptor agonist medication use status (current users, discontinued users, and never-users). The survey captured demographics, lipedema characteristics, medication use history, and intensity of lipedema symptoms. Additionally, the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health-10 (PROMIS-10) instrument was used to assess physical and mental health. Analyses compared current users, discontinued users, and never-users of GLP-1/GIP RA medications. Results Of 2852 respondents, 2719 met inclusion criteria for analysis. Most participants (99.7%) identified as female, with a mean age of 52.4 years. Approximately 55% were current GLP-1/GIP RA users, most commonly taking tirzepatide. The primary reported reason for medication use was weight management (67.2%), followed by lipedema symptom management (19.3%). PROMIS-10 scores demonstrated higher physical and mental health ratings among current users compared with never-users (median Global Physical Health (GPH): 42.3 vs. 39.1; Global Mental Health (GMH): 44.9 vs. 40.8). Participants recalled improvements in both general health and lipedema symptoms after starting medication. Symptom severity scores for pain, swelling, and functional limitation were consistently lower among current users. Conclusions Self-reported participant responses indicated improved health and symptom severity while using GLP-1/GIP RA medication. These findings support further investigation of GLP-1/GIP RA medications as potential therapeutic options for lipedema.
Background Obesity prevalence among females in the United States continues to rise across the lifespan, imposing a substantial burden on individuals and the health care system through an increasing number of preventable, excess weight-attributable disabling diseases and mortality. A clearer understanding of the impact of obesity and treatment interventions on outcomes for reproduction, cardiometabolic risk, musculoskeletal health, and mental health at various life stages is critical to optimizing management strategies for women with obesity. Methods This narrative clinical review synthesizes published literature and expert perspectives regarding obesity-related risk factors, health outcomes, and treatment considerations related to obesity in women, including the impact of obesity medications across the lifespan. Results Adiposity influences reproductive, cardiometabolic, musculoskeletal, and mental health outcomes across the female lifespan. During adolescence, early pubertal onset and metabolic dysfunction are common. In reproductive years, infertility, polyendocrine metabolic ovarian syndrome, and pregnancy complications are prominent. Perimenopause is associated with vasomotor symptoms, sleep disruption, and increased cardiovascular risk. In older age, risks for cancer, functional decline, and frailty increase. Pharmacologic therapies, including incretin-based agents, demonstrate efficacy in weight reduction and cardiometabolic improvement, although life stage-specific safety and outcome data remain limited. Conclusion Obesity management in women requires individualized, life stage-specific approaches integrating lifestyle interventions and pharmacotherapy. Additional research is needed to clarify long-term outcomes and optimize treatment strategies across the lifespan.
Background Insight into how obesity medication (OM) is prescribed, accessed, and experienced in daily practice remains limited. This study explored prescribing practices, patient experiences and perceived barriers and facilitators regarding OM use in the Netherlands. Methods This was an exploratory sequential mixed-methods study consisting of qualitative interviews followed by a cross-sectional questionnaire survey. Semi-structured interviews were performed with healthcare professionals and individuals using or considering OM (n = 14). Findings informed the development of a questionnaire completed by healthcare professionals (n = 102) and individuals using OM (n = 96). Results The qualitative analysis generated five themes: (1) navigating access and reimbursement pathways, (2) negotiating professional roles and expertise, (3) balancing medication and lifestyle support, (4) living with OM: relief, stigma and legitimacy, and (5) uncertainty and future perspectives. Quantitative findings largely supported these themes. Overall, OM care was experienced as supportive and accessible. However, important challenges were identified, including: strict reimbursement criteria, a mandatory combined lifestyle intervention perceived as insufficiently tailored to individual needs, high out-of-pocket costs, uncertainty regarding tapering strategies, and differences between regular and private care pathways. Conclusion OM is generally experienced positively within Dutch obesity care, but structural barriers remain. Improving access, reimbursement policies, professional education, and guidance regarding long-term treatment and tapering may contribute to more equitable and sustainable obesity care.
Background Obesity is highly prevalent among U.S. adults and is associated with substantial morbidity and mortality. Primary care clinicians are well positioned to identify patients with overweight or obesity and address related health risks. Prior studies suggest that obesity is often underdiagnosed, but less is known about how frequently overweight or obesity diagnosis codes are documented during routine primary care encounters. Methods This was a retrospective observational study of 49,279 adult family medicine and internal medicine encounters at Mayo Clinic in Jacksonville, Florida, from July 1, 2021, through June 30, 2022. Encounters included adults ≥18 years of age with a recorded body mass index (BMI) ≥25 kg/m2. The primary outcome was documentation of an overweight or obesity diagnosis code (OODC) during the encounter. Logistic regression evaluated associations between patient, clinician, and encounter characteristics and OODC documentation. Results An OODC was documented in 3658 encounters (7.4%). Documentation increased across BMI categories, from 2.5% of encounters involving patients with overweight to 22.0% of encounters involving patients with class III obesity. In multivariable analysis, class III obesity had the strongest association with OODC documentation compared with overweight (adjusted odds ratio [aOR], 11.22; 95% confidence interval [CI], 10.05, 12.55). Male clinician sex was associated with modestly lower odds of documentation (aOR, 0.88; 95% CI, 0.81, 0.95). Internal medicine encounters had higher odds of documentation than family medicine encounters (aOR, 1.24; 95% CI, 1.14, 1.35), while office visits had lower odds than comprehensive visits (aOR, 0.70; 95% CI, 0.65, 0.75). Conclusion OODCs were infrequently documented during adult primary care encounters involving patients with BMI ≥25 kg/m2. Documentation increased with BMI severity but remained uncommon overall and varied according to clinician age, clinician sex, department, and encounter type.
Background Obstructive sleep apnea (OSA) disproportionately affects individuals with obesity and is associated with significant morbidity. The objective of this study was to estimate the cost of care and healthcare resource utilization among adults with OSA and obesity by OSA treatment status. Methods This retrospective, longitudinal study used Optum’s de-identified Market Clarity Data (Optum® Market Clarity) from Oct 2015 to Mar 2024. Adults (≥18 years old) with an OSA diagnosis, body mass index (BMI) ≥30 kg/m2 and apnea-hypopnea index (AHI) score ≥5 during the index period (Oct 2016–Dec 2022) were included. Individuals were also required to have continuous medical and pharmacy enrollment and no prior OSA treatment. Healthcare costs (excluding OSA-related treatment costs) and acute care events were evaluated during the 12-month follow-up period using generalized linear models, stratified by OSA treatment status. Results The final sample included 10,116 individuals in the OSA-treated cohort and 3,881 individuals in the OSA-untreated cohort. In fully adjusted models, treated individuals had significantly lower least squares mean costs ($34,248 vs. $37,295, p=0.0003) and had fewer acute care events, including emergency department (ED) visits and hospitalization days (0.87 vs. 1.09, p<0.0001), compared to untreated individuals. They also had an 18% lower likelihood of ≥1 ED visit or day of hospitalization (odds ratio=0.82; 95% confidence interval: 0.75, 0.89). Results were consistent across subgroups, including those with moderate-to-severe OSA and individuals with Medicare or commercial insurance. Conclusion These findings suggest that receiving treatment for OSA significantly reduces overall healthcare utilization among individuals with OSA and obesity.
