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The 2024 European Association for the Study of Obesity (EASO) framework redefines obesity by incorporating central adiposity and morbidity. However, the phenotypic characterization of risk heterogeneity across the full BMI spectrum under this framework-and its prognostic implications for mortality and cardiovascular outcomes-remain to be elucidated. Therefore, we aimed to evaluate the ability of this new framework to improve phenotypic stratification and describe risk heterogeneity across BMI categories. In 451,615 UK Biobank participants (median follow-up, 15.1 years), obesity was defined using (1) the EASO framework (which reclassifies individuals with BMI 25-<30 kg/m² into 'EASO overweight' [WHtR <0.5 and/or absence of morbidity] and 'EASO new obesity' [WHtR ≥0.5 and the presence of at least one morbidity]), and (2) an extended EASO framework incorporating morbidity stratification across all BMI categories. Cox proportional hazards models estimated hazard ratios (HRs) for all-cause mortality and major adverse cardiovascular events (MACE). Applying the EASO framework reclassified 15.62% of individuals previously categorized as having overweight into the category of people with obesity. Consequently, the prevalence of obesity increased from 24.50% to 40.12%. Two distinct risk patterns emerged: all-cause mortality showed a V-shaped association across adiposity categories, whereas MACE risk increased linearly with higher adiposity. Compared with normal weight, EASO overweight had the lowest mortality (HR 0.82 [95% CI, 0.80-0.84]), while EASO new obesity showed a comparable risk (0.96 [0.94-0.99]). The highest mortality risk was observed in BMI obesity (1.05 [1.02-1.08]). For MACE, EASO overweight had no excess risk (1.04 [0.99-1.09]), whereas both EASO new obesity and BMI obesity faced the highest and most substantial risks, with HRs of 1.35 (1.29-1.42) and 1.38 (1.32-1.45), respectively. When stratified by morbidity, the V-shaped mortality association was preserved and MACE risk remained linear. Individuals with morbidity consistently exhibited higher risks across all adiposity categories, indicating a vertical shift in risk rather than a change in association shape. The EASO framework substantially increases obesity prevalence and better identifies individuals with adverse metabolic and cardiovascular profiles. Morbidity does not alter the overall pattern of mortality and cardiovascular risk across adiposity levels but consistently amplifies absolute risk, supporting a morbidity-integrated approach to obesity phenotyping and risk assessment.
<p>Introduction: Despite clinical obesity guidelines recommending evidence-based treatment, people with obesity have limited access to these treatments due to restrictions in the healthcare system. At present, little is known how individuals with obesity experience healthcare and what are their opinions on current treatment options. To collect data on the attitude and acceptance of current obesity treatment options, a representative online survey among adults with obesity (body mass index, BMI ≥30.0 kg/m2) living in Germany was performed in October 2024. Questions covered demographics, the subjective burden of obesity, discrimination, weight loss attempts and success, as well as use of specific weight reduction approaches. The data were weighted to represent the adult population in Germany. Data were analyzed descriptively and by using chi-squared tests and multiple logistic regression analysis. In total, 1,004 adults (51.2% women) with obesity participated, with a mean BMI of 35.2 ± 5.2 kg/m2 and a mean age of 50.0 ± 17.1 years. In total, 78.4% of all participants (787/1,004) answered to feel moderately to very much burdened by their body weight, and 37.4% of participants (361/966) reported to have already been disadvantaged or discriminated against because of their body weight. Logistic regression analyses showed statistically significant differences by gender, age-groups, BMI groups, and educational status (most p < 0.05). The majority of participants (89.7%, 865/964) reported to have had at least one weight loss attempt. Regarding evidence-based treatment options, most participants stated to have not yet used weight loss medication (95.3%, 953/1,000) and that it is unlikely that they would take them in the future (88.4%, 791/895). Moreover, most participants stated to have not yet used reimbursable digital behavioral programs (96.7%, 966/999) or surgery (97.3%, 969/996) for weight loss. The findings indicate a gap between obesity treatment guidelines and real-world weight loss practice among adults with obesity. This might be due to stigma and access barriers. Therefore, more and better communication is needed between healthcare providers and people with obesity. </p>.
Within the kidney transplant community, there is growing recognition of the importance of treating obesity to improve access to and outcomes of kidney transplant. We sought to assess kidney transplant professionals' attitudes and practices regarding obesity management. The American Society of Transplantation Kidney Pancreas Community of Practice Obesity Workgroup developed and administered a web-based survey to a broad audience of healthcare professionals working with potential kidney transplant candidates and recipients. With 275 respondents from 113 kidney transplant programs representing >70% of US kidney transplant volume, we found that only 68% of kidney transplant programs with a weight management program reported access to an obesity medicine specialist. Among programs that prescribe anti-obesity medications, the majority prescribe nutrient-stimulated hormones, while few utilize other agents. Most kidney transplant professionals prefer that obesity medicine physicians lead obesity management in their patients; however, 74% reported that access to weight management programs was extremely or somewhat difficult, with 64% citing long wait times for an appointment as the main barrier to care. Kidney transplant professionals believe that obesity medicine physicians are best suited to lead obesity treatment for their patients, though access to this care appears to be a major barrier.
Obesity prevalence is high, requiring effective and scalable treatment options. German guidelines recommend referral to multimodal treatment programmes. However, reimbursement by statutory health insurance remains fragmented. Little is known about how people with overweight and obesity engage with available support in Germany. An online survey was administered to a representative sample of adults living with overweight or obesity in Germany. Participants reported awareness, use, interest, and perceived barriers regarding uptake of (a) primary care consultations, (b) behavioural programmes, and (c) pharmacotherapy for obesity. A total of 2,065 respondents (46.5% women; 53.3% with overweight; 46.7% with obesity) were included. Most had experience with weight management (85.5%), but approaches were predominantly self-directed (75.1%). Engagement with professional obesity care was limited (conversations with general practitioners: 43.1%; participation in structured behavioural weight management programme: 7.8%; use of pharmacotherapy: 6.2%). Awareness and interest varied across treatment modalities, with particularly low awareness (19.6%) but high interest (39.1%) in behavioural programmes. Common barriers included lack of awareness, concerns about long-term effectiveness and side effects, and perception that support was not yet necessary. We identify a substantial evidence-practice gap in German obesity care, characterized by low reported use of professional support despite widespread weight management attempts. Beyond improving access and availability of services, effective obesity care also requires better communication on the effectiveness of evidence-based treatments, in particular behavioural programmes. Additionally, promoting a long-term, chronic-disease model of obesity and weight management may help align expectations, reduce discontinuation, and support sustained engagement with care.
This study investigated associations between weight-related impairment (WrI), degree of overweight/obesity, and health-related quality of life (HrQoL) in children and adolescents with overweight or obesity. Data were collected within the LIFE Child cohort study conducted in Leipzig, Germany. We used a repeated cross-sectional dataset containing 539 data points of 270 10- to 17-year-old children with overweight (n = 83 data points), obesity (n = 276 data points), or severe obesity (n = 180 data points) who had completed questionnaires on WrI (Kindl-R, total score) and HrQoL (Kidscreen-27, scores physical wellbeing, psychological wellbeing, peer relations, family relations, school). Associations between weight status, WrI, and HrQoL were assessed using regression analyses, adjusting for age, sex, and socioeconomic status. Children with obesity or severe obesity showed significantly more WrI than children with overweight. Regarding HrQoL, however, only physical and psychological wellbeing were significantly associated with weight group. Higher WrI was strongly associated with lower HrQoL in all domains (b ranging between -6.07 and -3.16, all p < 0.001). The association between WrI and psychological wellbeing was stronger in children with obesity or severe obesity than in children with overweight. In multivariate models, only WrI, but not the degree of overweight/obesity was associated with the different domains of HrQoL. The findings suggest that WrI and not weight per se impacts HrQoL of children and adolescents with overweight and obesity.
<p>Background: The introduction of incretin mimetics (IMs), including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as liraglutide and semaglutide, as well as dual GLP-1/glucose-dependent insulinotropic polypeptide receptor co-agonists (GLP-1/GIP RAs) like tirzepatide, has revolutionized obesity treatment. These obesity management medications promote significant weight loss with metabolic and cardiovascular improvements. However, pharmacotherapy alone seems insufficient to address the multifactorial nature of obesity. While IMs suppress appetite and reduce caloric intake, they do not prevent potential nutrient deficiencies and possible loss of skeletal muscle mass, nor do they guarantee lasting behavioral changes necessary for long-term weight management, particularly in the absence of other complementary interventions. Summary: In this context, a clear distinction must be made between general lifestyle modification advice (Ls-M) and personalized and structured dietetic and physical exercise interventions (D-PE-Is). Ls-M, including a balanced diet and regular physical activity, is essential for preventing obesity and reducing the risk of weight gain and associated metabolic disorders. However, once obesity is established, D-PE-I becomes necessary. Unlike Ls-M, D-PE-I integrates personalized nutritional strategies with structured exercise to maximize fat loss, preserve skeletal muscle mass and function, and enhance metabolic health. This narrative and concept-driven review aimed to delineate key areas for future clinical trials and meta-analyses. Key Messages: IMs have brought important progress in the management of obesity, contributing meaningfully to current therapeutic approaches. However, pharmacotherapy alone is not sufficient to ensure long-term success. While lifestyle advice may aid in prevention, structured and personalized dietetic and physical exercise interventions are essential once obesity is established. Their integration with IMs is crucial to support long-term weight maintenance and improve overall health and quality of life. </p>.
Obesity is increasingly prevalent among older adults and is a major contributor to cardiometabolic diseases, functional decline, frailty, and loss of independence. The intersection between population ageing and the obesity epidemic poses major public health and clinical challenges. This European Association for the Study of Obesity (EASO) position statement represents an update of the EASO guideline from 2012, and provides a comprehensive overview of the epidemiology, pathophysiology, clinical consequences, and management of obesity in adults aged ≥65 years. It summarizes current evidence and offers practical recommendations for diagnosis and treatment tailored to this age group. To guide clinicians and researchers through this updated framework, the position statement highlights four central concepts that underpin obesity assessment and management in later life: (1) obesity affects up to one-third of older adults globally, with prevalence varying by sex and geography; (2) ageing is associated with changes in body composition, hormonal milieu, and lifestyle factors (diet, physical inactivity, and polypharmacy) that favour fat accumulation and sarcopenic obesity; (3) body mass index alone is insufficient; assessment should include body composition analysis (including fat distribution and muscle mass), psychological status, and functional performance; (4) a multimodal approach is recommended, including moderate energy restriction with adequate protein intake, structured multicomponent exercise, behavioural support, and, where appropriate, obesity management medications and/or metabolic bariatric surgery. The focus should be on preserving muscle mass, functional capacity, and quality of life, rather than weight loss alone. Effective management of obesity in older adults should focus on individualized, multidisciplinary strategies that balance the benefits of weight reduction against the risks of sarcopenia, malnutrition, and loss of independence.
Given the scarce evidence on mortality risks associated with obesity trajectories beyond body mass index (BMI), this study examined the independent associations of changes in anthropometric and dual-energy X-ray absorptiometry (DXA)-measured indicators of general and abdominal obesity with all-cause and cardiovascular mortality in older Chinese adults. A total of 1,495 male and 1,506 female participants, with a mean age of 71.75 years and BMI at 23.75 kg/m2 at baseline in 2001-2003, were followed up on mortality till mid-2020. BMI, waist-to-hip ratio (WHR), and DXA-measured indicators including whole body fat mass (WBFM) and android-to-gynoid ratio (AGR) were assessed at baseline and year 4. Sex-specific multivariable Cox proportional hazards regression and competing risk survival model were employed. A substantial 4-year decline (>10%) in obesity indicators, except WHR, was associated with elevated mortality risks. General obesity indicators, particularly BMI, remained as strong predictors after accounting for abdominal obesity measures. The association of BMI with all-cause mortality was largely attributable to change in whole body muscle mass (WBMM) in men and to both changes in WBFM and WBMM in women, whereas their roles in cardiovascular mortality were less apparent. Despite elevated mortality associated with increases in general obesity measures, lower all-cause mortality was found for increase in AGR in men. Notwithstanding critiques on BMI for obesity assessment, BMI change appears to be a robust indicator of survival in older Chinese adults, as it reflects not only fat mass but also lean muscle mass changes. Moreover, increases in abdominal obesity indicators do not seem to pose mortality risks.
Tirzepatide, a dual glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide receptor agonist, is recently approved for the treatment of type 2 diabetes and obesity in adults. Melanocortin-4-receptor (MC4R) deficiency is the most common monogenic cause of obesity and presents with hyperphagia and early onset obesity. While tirzepatide seems to be effective in inducing weight loss in adults with MC4R deficiency, its effects on hyperphagia and weight loss in pediatric patients are unexplored. A 17-year-old girl was admitted to our specialized obesity clinic because of hyperphagia and severe early onset obesity due to MC4R deficiency. She had an extensive history of lifestyle interventions and psychological support and maintained a high level of physical activity. Despite these efforts, she presented with a BMI of 37 kg/m2 (3.68 SDS) and a substantial psychosocial burden. Vital signs and laboratory evaluations revealed no obesity-related complications. Tirzepatide was initiated at a dose of 2.5 mg weekly and slowly titrated to a maximum dose of 12.5 mg weekly. She initially experienced a substantial reduction in hyperphagia and reported less food noise, a reduction in hunger feelings and prolonged postprandial satiety. However, after 12 weeks hunger scores started to increase again, approaching pre-treatment levels at 28 weeks of follow-up. Metformin was added at 28 weeks in an attempt to better manage of hyperphagia, resulting in a reduction in hyperphagia. Despite these increasing hunger feelings from week 12 to 28, substantial weight loss was achieved, and the patient lost -13.9% of her initial body weight at 28 weeks. After addition of metformin, the patient lost an additional -7% of her weight. Total body weight reduction at week 37 was -20.9%. Tirzepatide was well tolerated, with no adverse effects reported at 41 weeks of follow-up. This case report suggests that tirzepatide is effective in reducing body weight in adolescents with MC4R deficiency. However, the question remains what the effect is on hunger and satiety in the long run and at a higher dose. Cohort studies are needed to assess long-term safety and effectiveness of tirzepatide in the pediatric population and in managing hyperphagia.
Pediatric obesity is a major health issue with a growing worldwide trend since 1990. The present study aims to describe the design, methods, and pilot baseline results of a school-based obesity-prevention intervention implemented in disadvantaged communities. The SEÍSMO study integrates two stages: the first stage includes baseline and follow-up assessments for 11,139 children aged 6-12, evaluated at baseline between 2020 and 2024 in 120 Spanish schools. The second stage is a 6-year cluster randomized controlled trial (RCT) that incorporated the learnings of the first stage to assess from 2024 to 2041 two primary outcomes (z-score body mass index and waist-to-height ratio) and several secondary outcomes (healthy lifestyles, quality of life, academic performance, psychosocial determinants, psychological resilience, and weight stigma) will be evaluated at 12, 24, 36, and 48 months. A sample size of 56 clusters and 4,760 participants is needed, assuming an attrition rate of 35% by 36 months post-baseline, but an oversampling will result in 10,080 participants. In this stage will involve three recruitment editions (2024-2025, 2025-2026, 2026-2027) and will incorporate children aged 3-12 located in Catalonia, Spain. The intervention includes a total of 50 specific action groups. In both study stages, a follow-up will be conducted at 18 years of age, involving a total of 21,219 children. SEÍSMO first-stage participants present prevalences of severe obesity and abdominal obesity of 5.4% and 31.3%, respectively. There is an urgent need to have effective obesity-prevention with the capacity to reduce the current inequalities.
The aim was to identify neurodevelopmental diagnoses and problems and the extent of their overlap in children undergoing obesity treatment. Totally, 139 children (72 girls; mean age 12.7 years, mean BMI SDS 3.1) were recruited from three obesity clinics in Sweden. Motor, executive, perception, memory, language, learning, social, and emotional/behavioural functioning were assessed with an age-normed questionnaire. Scores ≥ the 90th percentile were considered indicative of problems with probable clinical relevance in each domain. Neurodevelopmental diagnoses were subsequently collected from the patients' records. The proportion of children exceeding the clinical threshold in each domain was compared with the expected population frequency (10%) and between participants with and without neurodevelopmental disorders. The proportion exceeding the 90th percentile was significantly higher than the expected 10% in all domains: ranging from 33.6% (memory functioning) to 54.0% (emotional/behavioral functioning) (p < 0.001). Neurodevelopmental disorders were diagnosed in 52.5% (73/139). Diagnosed children had higher rates and greater overlap of neurodevelopmental problems than children without diagnoses (p < 0.001). Recognizing neurodevelopmental problems in children with obesity may improve understanding of their needs in obesity treatment settings.
This study aimed to describe the demographic and clinical characteristics of individuals with obesity (IWO) in Germany and to explore weight loss methods and their effectiveness. Data were drawn from a cross-sectional survey of adults with obesity (≥18 years of age) conducted in Germany between November and December 2022 through an online consumer panel. Data were captured using a self-administered questionnaire and included demographic and clinical characteristics, weight loss methods attempted in the last 12 months, and how successful these attempts were. Logistic regression analysis assessed the effect of variables including age, sex, and weight loss method on the odds of weight reduction. Data were presented as odds ratios, p values and confidence intervals. For descriptive statistics, continuous variables were presented as means and standard deviations (SDs). Categorical variables were presented as frequency counts and percentages. Overall, the 1,000 IWO in this study had a mean age (SD) of 42.8 (10.7) years, 94% were White, 45% were female, and mean (SD) body mass index was 37.6 (8.3) kg/m2. In total, 73% had ≥1 comorbid conditions, the most common being musculoskeletal pain (19%). Just 43% were being managed for a weight condition; however, 95% had attempted to lose weight over the previous 12 months, with 33% utilizing an anti-obesity medication and 26% utilizing a calorie-controlled diet. IWO on a calorie-controlled diet or a digital health application was more likely to lose weight than people using other methods (p < 0.05). Our results highlight gaps in obesity recognition and management in Germany, underscoring the importance of enhancing access to effective interventions and improving support systems for this population.
Cardiovascular-kidney-metabolic (CKM) syndrome refers to a multi-systemic condition with established pathophysiological connections between obesity, diabetes mellitus, chronic kidney disease (CKD), and cardiovascular disease (CVD). Chronic low-grade inflammation has been recognized as a common pathophysiological theme linking metabolic dysfunction to multisystem damage of the heart, kidneys, and vasculature. The aim of this narrative review is to summarize the major pharmacologic strategies that target inflammatory pathways in obesity and across the cardiovascular-kidney-metabolic (CKM) disease spectrum, including metabolic therapies with indirect anti-inflammatory effects and targeted immunomodulatory agents. New therapies have markedly changed the obesity and the CKM treatment paradigm, with evidence that currently available metabolic medications confer cardiovascular and renal benefits in addition to glycemic control or weight improvement. Nutrient-Stimulated Hormone (NuSH) therapies, and sodium-glucose cotransporter-2 inhibitors (SGLT2i), work synergistically to positively modulate systemic inflammation while maintaining cardiovascular health and cardiometabolic function throughout therapy. Additionally, emerging clinical data for direct anti-inflammatory treatments, such as interleukin-1β/interleukin-6 inhibition and low-dose colchicine, have established inflammation as a modifiable cardiovascular risk factor. Furthermore, therapies that target the liver such as resmetirom, fibroblast growth factor-21 (FGF21) analogues, and peroxisome proliferator-activated receptors (pan-PPAR) agonists, have highlighted the role of the liver-adipose axis in metabolic inflammation and CKM progression. Together, both metabolic and direct anti-inflammatory therapies represent the most recent evolution of a combined approach to treating metabolic dysfunction and inflammation. This type of approach has the potential to revolutionize the prevention and treatment of CKM across the spectrum of diseases and usher in personalized medicine for obesity-related cardiometabolic diseases. However, further studies are needed to determine when these therapies should be initiated, which patients are most likely to benefit, and whether combination approaches can alter disease progression beyond the current standard of care.
Dysregulation of the melanocortin-4 receptor (MC4R) pathway can lead to hyperphagia and early-onset obesity. Setmelanotide, an MC4R agonist, is approved for patients age ≥2 years with rare MC4R pathway disease due to Bardet-Biedl syndrome, pro-opiomelanocortin or proprotein convertase subtilisin/kexin type 1 deficiency, or leptin receptor (LEPR) deficiency, but there are limited clinical data on treatment outcomes in very young children. This case report describes the use of setmelanotide in a 2-year-old child with hyperphagia and obesity due to LEPR deficiency. The patient presented with early-onset hyperphagia, rapid weight gain, and obesity-associated delays in motor development. Following a medical assessment in May 2021, he was diagnosed with LEPR deficiency. Setmelanotide treatment via subcutaneous injection was initiated in March 2023 (patient age 2 years 4 months) at a dose of 0.5 mg/day, increased to 2.5 mg/day in 0.5 mg increments, and the patient was followed for 23 months. Following treatment initiation, significant clinical improvements were observed, including reductions in hyperphagia, food intake and cravings, and body mass index (BMI). Motor skill function also improved, with the child achieving milestones such as crawling and kneeling. Significant improvements in caregivers' QoL were also reported. Reported adverse events included skin rash and skin hyperpigmentation. Setmelanotide treatment started in a 2-year-old patient and continued for 23 months led to improvements in hyperphagia, BMI, and blood lipids and led to significant improvements in caregivers' QoL. Improved motor skill function was also seen with as BMI decreased. These findings support the use of setmelanotide in young children with hyperphagia and obesity due to LEPR deficiency.
We investigated how causal attributions-that is, individuals' beliefs about what caused their obesity-are associated with weight loss in a digital lifestyle intervention. Data were collected from Healthy Weight Coaching, a 12-month real-world online intervention. Weight and height were self-reported. Body mass index (BMI) was calculated using interpolated weights at 3, 6, 9, and 12 months. At baseline, participants completed an eight-item questionnaire on causal attributions, rating each as playing no role, some role, or a major role. TwoStep cluster analysis grouped individuals with similar response profiles. Data were available for 1834 participants (1524 83.1% women, median age 52 years, median BMI 39.1 kg/m2). Participants most frequently attributed obesity to unhealthy dietary habits and lack of physical activity, whereas genetics, family lifestyle habits, and medication were least endorsed. Attributing obesity to stress (somewhat, standardized B=0.156 95% CI, 0.051-0.262; very much, B=0.204 95% CI, 0.100-0.307), fatigue (very much, B=0.154 95% CI, 0.073-0.235), adversities in life (somewhat, B=0.112 95% CI, 0.041-0.184; very much, B=0.100 95% CI, 0.024-0.176), or medication (somewhat, B=0.089 95% CI, 0.022-0.155; very much, B=0.108 95% CI, 0.025-0.192) were associated with lower weight loss compared with those not endorsing these attributions. However, only stress ("very much") reached a small effect size according to Cohen's criteria, whereas the remaining associations were negligible in magnitude despite statistical significance. Cluster analysis revealed four clusters. Compared to those Behaviourally focused, particularly endorsing dietary habits and physical activity, all other clusters showed higher endorsement of stress, fatigue, and adversities in life, with a cluster labelled Multifactorial fully endorsing all eight items. Relative to Behaviourally focused, all other clusters had lower odds of 5% weight loss and lost less weight (Broad lifestyle oriented, B=0.104 95% CI, 0.032-0.177, p=0.004; Psychologically burdened, B=0.144 95% CI, 0.063-0.225, p<0.001; Multifactorial, B=0.222 95% CI, 0.136-0.308, p<0.001). Only the Multifactorial cluster reached a small effect size. Strong endorsement of stress as a cause of obesity and membership in the Multifactorial cluster were associated with less favourable weight loss outcomes. However, effect sizes were small, suggesting limited standalone impact but potential relevance within broader behavioural and psychological treatment contexts.
Obesity heterogeneity by sex and age is crucial for precise risk stratification. Limited phenotyping obscures sex-specific risks and contributes to diagnostic and treatment disparities. This is a cross-sectional study of 1,014 adults with obesity (68% women; median age 50) from four Madrid Obesity Centers using a digital pathway (OB-DigiThum) including anthropometry, bioimpedance, biomarkers, and comorbidity screening. Fat mass (FM) and skeletal muscle mass (SMM) were normalized to body surface area (FM/BSA; SMM/BSA). Participants were stratified into four predefined sex and age-groups (female <50, female ≥50, male <50, male ≥50). Multidimensional phenotyping was performed using discriminant analysis and hierarchical clustering applied to standardized group-level mean profiles. Women had higher FM/BSA and lower SMM/BSA than men (p < 0.001), highlighting BMI's limitations. With age, women's BMI fell despite stable/increasing fat due to muscle loss (sarcopenic risk). Men showed more cardiometabolic disease overall, but post-menopausal women experienced sharp rises in type 2 diabetes, hypertension, and dyslipidemia. Psychological distress was more frequent in women; bulimic behaviors appeared in younger men. Physical inactivity was common; Mediterranean diet adherence was relatively strong, especially in participants aged ≥50 years. The four sex- and age-stratified profiles showed distinct patterns in body composition, metabolic risk, and psychological burden, supporting differential risk stratification across groups. Sex and age strongly shape obesity phenotypes. Post-menopausal women face accelerated metabolic deterioration and sarcopenia. FM/BSA and SMM/BSA enhance risk profiling. Sex- and age-tailored metabolic, physical, and mental health screening should guide personalized management.
Adipocyte hypertrophy is an important marker of adipose tissue dysfunction which significantly correlates with cardiometabolic risk factors. Fat cell size increases with adiposity and then plateaus at body mass index (BMI) values higher than 30 kg/m2. It is unknown whether fat cell size still associates with markers of dysmetabolism in severe obesity. Our objectives were to examine the associations between adipocyte diameter and markers of cardiometabolic health in a large sample of participants with severe obesity while adjusting for age, BMI, and waist circumference. Biopsy samples of liver as well as abdominal subcutaneous and omental adipose tissues were obtained from 337 bariatric surgery patients. Evaluation of histological liver characteristics (steatosis, steatohepatitis, portal and lobular inflammation, hepatocellular ballooning, and hepatic fibrosis) was performed by specialized pathologists. Adipocyte diameters were measured automatically using microscopy imaging. Lipid-lipoprotein profile, glucose-insulin homeostasis, and adipokine levels were measured from blood samples. Omental fat cell size was significantly larger with the presence of metabolic dysfunction-associated steatotic liver disease, metabolic dysfunction-associated steatohepatitis, liver fibrosis and lobular inflammation, as well as the presence and severity of portal inflammation. When stratified by sex, omental adipocytes were larger in women with liver injury, but not in men. In participants with severe obesity, associations between adipocyte hypertrophy and cardiometabolic risk factors are mostly seen in the omental fat compartment, and especially in women.
Adolescent obesity requires effective and accessible treatment. Intensive dietary interventions may be used as adjunctive therapy to behavioral interventions, and lead to weight loss. The effects of behavioural interventions on psychosocial outcomes are mixed, and the impact of intensive interventions with shifts away from normal eating habits and social norms is not clear. Adolescents (13-17years) with obesity and ≥1 complication participated in a 52-week RCT, conducted 2018-2023 (ACTRN12617001630303). The intervention compared a 4-week very low energy diet followed by intermittent or continuous energy restriction (48weeks). Anthropometry and psychosocial health were assessed at baseline, weeks-4, -16, and -52 including Dutch Eating Behaviour Questionnaire (DEBQ), Rosenberg Self-Esteem Scale (RSE), Weight Bias Internalization Scale (WBIS), Body Appreciation Scale (BAS), and Depression Anxiety and Stress Scale (DASS). Intention to treat analysis using linear mixed models investigated changes over time between intervention groups. 141 adolescents (70 female) were enrolled and 97 (48 female) completed the intervention. There were significant reductions in external eating (DEBQ, p<0.001), weight bias internalization (WBIS, p<0.001), anxiety (DASS, p<0.001), and stress (DASS, p=0.082), and significant increases in self-esteem (RSE, p<0.001) and body appreciation (BAS, p<0.001) in both groups. There were increases in dietary restraint (DEBQ, p=0.595), and decreases in emotional eating (DEBQ, p=0.645) and depression (DASS, p=0.381) which returned to baseline by the end of intervention. Reductions in BMIz were significantly associated with improvements in emotional eating (r=0.215, p=0.046, n=87) and body appreciation (r=-0.235, p=0.027, n=88). Intensive interventions incorporating dietary and behavioural components were associated with improvements in psychosocial health among adolescents with obesity associated complication.
Introduction Approximately one in five workers in Europe is engaged in shift work. Studies reveal that night shift work leads to an increased risk of overweight, obesity and related diseases. Yet, the biological and behavioural mechanisms underlying these associations are not fully understood. The cross-sectional and mechanistic studies within the European SHIFT2HEALTH project aim to investigate biological, behavioural and psychosocial key risk factors responsible for the association between night work and obesity across five European countries. Methods A multi-centric cross-sectional study is designed to unravel obesogenic risk factors, eating habits and sleep patterns in night shift workers and day workers from the health- and various industrial sectors. Recruitment takes place in Austria, Denmark, Germany, Poland, and the Netherlands, aiming at 500 night shift workers and 500 day workers. Anthropometric measurements, sensory perception and food preference tests are performed, alongside extensive questionnaires. In addition, biological samples (blood, hair, urine, faeces) are collected for biomarker measurements of inflammation, oxidative stress, glycaemic and lipaemic parameters, for microbiome and metabolomics analyses and chronotype assessment. In a nested mechanistic study, night shift workers (N=200) recruited in Austria and in the Netherlands, additionally collect urine samples from all voids over 24 hours during a day shift and a night shift, as well as dried blood spots and tongue swabs at four time points and undergo continuous sleep, activity and light exposure monitoring through actigraphy. The association between night shift work and its metrics with levels of pre-obesity biomarkers will be evaluated in crude and multivariable-adjusted regression models, adjusting for potential confounders. Stratified analyses by age, gender, sector and chronotype will be conducted. Conclusion In the cross-sectional and mechanistic studies of the SHIFT2HEALTH project, biological, behavioural and psychosocial factors of night shift workers will be compared with those of day workers across sectors. The outcomes of these studies will serve as a basis for future intervention studies and, together, will contribute to the development of strategies to prevent and reduce overweight and obesity with the aim to improve the health and wellbeing of night shift workers. Trial registration: clinicaltrials.gov, ID: NCT06288568.
The conflicting impact of obesity on pulmonary function has been observed. Our study aimed at exploring the relationship between body mass index (BMI) and pulmonary function parameters in individuals with obesity. This cross-sectional study included a consecutive cohort of bariatric surgery candidates with pulmonary function tests. BMI, analyzed as both quartile-stratified groups and a continuous variable, was evaluated for associations with pulmonary function parameters and the risk of pulmonary impairment. A total of 1,834 patients with obesity (BMI range: 27.5-76.4 kg/m2) were included in our study. BMI exhibited a significantly positive correlation with forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), total lung capacity, and functional residual capacity (p < 0.001), and a negative correlation with FVC percent predicted (FVC % pred), FEV1 percent predicted (FEV1 % pred), FEV1/FVC%, and residual volume/TLC (p < 0.05). Nonlinear relationships were found between BMI and both FVC % pred and FEV1 % pred (P for nonlinearity <0.01) after adjusting for covariables. Beyond the threshold BMI of 38.2 kg/m2, FVC % pred and FEV1 % pred declined significantly (FVC % pred: β = -0.522, 95% CI: -0.756 to -0.289; FEV1 % pred: β = -0.435, 95% CI: -0.869 to -0.199), and the risk of pulmonary function impairment increased (OR = 1.008, 95% CI: 1.002-1.014). BMI exhibited a nonlinear relationship with pulmonary function parameters. Beyond the critical threshold of 38.2 kg/m2, increasing BMI led to a significant decline in ventilatory capacity, concomitant with an amplified risk of pulmonary function impairment.