Obesity is recognized as a risk factor for several cancer types and is linked with different patient outcomes. However, the extent to which obesity prevalence at treatment initiation differs from lifetime (ever) obesity exposure remains unclear. In this descriptive real-world study, we analysed longitudinal body mass index (BMI) records from the QResearch general practice database linked to the National Health Service England Systemic Anti-Cancer Therapy dataset including patients with a first systemic treatment in 2013-2023. We calculated age-standardised obesity prevalence at first treatment and lifetime obesity prevalence based on BMI ≥30 kg/m2 at treatment initiation and from historic measurements for patients across 13 cancer types. In total, 79 271 patients were included (median age 66.5 years at first treatment, 54.2% female, and 89.0% white ethnicity). Age-standardised obesity prevalence at first treatment was 26.4% [95% confidence interval (CI) 26.0% to 26.9%] for all cancers, ranging from 13.7% (95% CI 11.6% to 15.9%) for pancreatic cancer to 36.3% (95% CI 29.9% to 42.7%) for uterine cancer. Lifetime obesity prevalence was 53.5% (95% CI 53.2% to 53.9%) for all cancers, ranging from 51.1% (95% CI 50.3% to 52.0%) for lung cancer to 63.0% (95% CI 58.8% to 67.2%) for hepatocellular carcinoma. We found that approximately one in four cancer patients in England were living with obesity at the start of systemic treatment, while half had a history of obesity. Reliance on BMI at treatment initiation for cancer prognostication substantially underestimates lifetime exposure to obesity with implications for precision medicine and outcomes research.
Obesity-related metabolic disease is linked to impaired adipose tissue function, but the underlying molecular programs are difficult to assign to specific adipose-resident cell types, to mechanistically connect to inflammation, and to distinguish from alterations that normalize with weight loss. We integrated here a layered design combining untargeted proteomics and lipidomics to define obesity-associated, cell-type-resolved molecular phenotypes across isolated adipocytes and adipose microvascular endothelial cells, explore whether an obesity-like inflammatory milieu reproduces adipose-resident cell dysfunction, and identify molecular features that show evidence of recovery after surgery-induced weight loss. As expected, adipocytes from people with obesity show suppression of mitochondrial energy metabolism together with impaired lipid plasticity, as reflected by triglyceride remodelling. By mimicking an obesity-like inflammatory milieu with macrophage-conditioned media, we reproduced most of these changes in adipocyte cultures. Endothelial cells exhibited yet another, opposite trajectory in obesity, with reduced cell-cycle signalling and increased mitochondrial activation, which were recapitulated in vitro when these cells were exposed, respectively, to the secretions of inflamed macrophages and adipocytes. Bulk adipose tissue proteomes and lipidomes showed evidence of metabolic improvement after weight loss, with broad restoration of mitochondrial and substrate-handling pathways and reciprocal triglyceride remodelling. Alongside the inflammation-responsive adipocyte mitochondrial and lipid-handling dysfunction, our cell-type-informed framework probes macrophage and adipocyte-to-endothelial activation in obesity and delineates cross-context cellular programs that recover with weight loss. Additionally, we identified the elements that exhibit the strongest association with dyslipidaemia, hypertriglyceridemia and hyperglycaemia in individuals with obesity, confirming molecular signatures relevant to metabolic obesity in two cross-sectional samples. Vaishali Chaurasiya, Luyang Li, Aina Lluch participated equally.
Obesity is a growing public health concern and an independent contributor to chronic kidney disease, with obesity-related glomerulopathy (ORG) representing a distinct but insufficiently characterized entity. This study aimed to comprehensively describe the spectrum of kidney histological damage in patients with obesity and overt kidney disease. We reviewed 503 native kidney biopsies performed at Hospices Civils de Lyon between 2019 and 2022, identifying 103 adults with obesity. Glomerular histology was compared to 206 controls matched 2:1 for age, sex, hypertension, and diabetes. In the cohort with obesity, mean body mass index (BMI) was 35.1 kg/m²; 83% had hypertension and 33% had diabetes. Biopsies were performed for active urinary sediment (56%), proteinuria (49%), and acute or chronic kidney failure (31% of cases each). The mean estimated glomerular filtration rate was 47 ml/min/1.73 m², and proteinuria was 3.13 g/day. The post-biopsy complication rate was similar between groups. A wide spectrum of renal lesions was observed: hypertensive nephrosclerosis (34%), acute tubular necrosis (34%), diabetic nephropathy (17%), IgA nephropathy (13%), and other glomerulonephritides. ORG was identified in 25.2% of cases, isolated in 6.8% and associated with other lesions in 18.4%, while 74.8% had alternative diagnoses. Although no significant difference in glomerular size was observed between patients with obesity and controls, glomerular diameter was positively correlated with BMI (P = .049). ORG is not the predominant cause of kidney disease in patients with obesity. Given the wide range of alternative diagnoses and the safety of the procedure, renal biopsy should be considered to guide accurate diagnosis and optimize management.
While obesity is a well-established risk factor for slipped capital femoral epiphysis (SCFE), limited data exist regarding its impact on postoperative complication rates. This study aimed to evaluate the association between obesity and complications following SCFE treatment. We queried a large national database for pediatric patients who underwent treatment for SCFE between June 2005 and June 2025. We divided this cohort into patients with obesity and patients without obesity. We matched the cohorts with a propensity scoring algorithm on a one-to-one basis, resulting in 1,175 patients in each group. We tracked outcomes including infection, pulmonary embolism (PE), chondrolysis, avascular necrosis (AVN), leg length discrepancy (LLD), and hardware complications. We used the relative risk ratio (RR) and 95% confidence intervals (CIs). P values less than 0.05 were considered significant. ≤10 (0.85%) patients developed an infection, and none developed a PE; ≤10 (0.85%) patients in each group developed chondrolysis. Thirty-eight (3.23%) patients in the obese group developed AVN after SCFE treatment, and 34 (2.89%) patients in the nonobese group developed AVN (RR = 1.12, CI: 0.71-1.76, P = .632). Seventy-seven (6.55%) patients in the obese group developed LLD compared to 50 (4.26%) patients in the nonobese group (RR = 1.54, CI: 1.09-2.18, P = .014). Sixty-one (5.19%) patients in the obese group had hardware complications, whereas 35 (2.98%) patients in the nonobese group had hardware complications (RR = 1.74, CI: 1.16-2.62, P = .007). Patients with obesity had increased rates of LLD and hardware complications after treatment for SCFE compared to nonobese patients. Our findings highlight the importance of ongoing follow-up and monitoring of SCFE patients to detect the development of any of these outcomes. (1)Rates of infection, pulmonary embolism, and chondrolysis were low (<1%) and did not differ between obese and nonobese cohorts.(2)The rate of avascular necrosis was similar between groups.(3)In contrast, obese patients had significantly higher rates of leg length discrepancy and hardware complications. III: Retrospective cohort study.
Recent reports have suggested an association between the pathogenesis of systemic lupus erythematosus (SLE) and various adipokines secreted by adipocytes. However, the impact of obesity on the susceptibility to SLE relapses remains unclear. This study investigated the association between obesity and relapse in patients with SLE using a large, multicenter cohort. Patients enrolled in LUNA, a nationwide, multicenter SLE registry in Japan, with a body mass index (BMI) ≥ 18.5 kg/m2 were included in the study. Participants were divided into two groups: the obese group (BMI ≥ 25 kg/m2) and the normal weight group (18.5 kg/m2 ≤ BMI < 25 kg/m2). The one-year relapse rate after LUNA registration was compared between the two groups. Relapses were defined as an increase in glucocorticoid dosage during follow-up. A multivariate analysis was performed using generalized linear models adjusted for age, sex, disease duration, education level, glycated hemoglobin level, disease activity (Systemic Lupus Erythematosus Disease Activity Index), organ damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index), current prednisolone (PSL) dose, past maximum PSL dose, calcineurin inhibitor use, and incretin-related drug use as covariates. Furthermore, a sensitivity analysis was performed using the same statistical model and covariate adjustments to reclassify participants into the overweight (BMI ≥ 25 kg/m2 and < 30 kg/m2) and non-overweight (BMI ≥ 18.5 kg/m2 and < 25 kg/m2 or BMI ≥ 30 kg/m2) groups. Among the 1, 134 patients, 909 were classified as normal weight and 225 as obese. The multivariate analysis showed that obesity significantly reduced relapse rates (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.30-0.90, p = 0.02). The sensitivity analysis revealed that overweight was an independent factor associated with a reduced risk of SLE relapses, with an OR lower than that for obesity in the primary analysis (OR 0.43, 95% CI 0.22-0.82, p = 0.01). Patients with mild obesity had lower relapse rates than those with normal BMI. The findings suggest that metabolic status may influence the disease course of SLE. Appropriate weight management guidance, including avoiding excessive dietary restriction, may help prevent SLE relapses.
Obesity is a chronic disease associated with multiple comorbidities and can affect drug pharmacokinetics. Appropriate dosing in obese patients is essential to ensure therapeutic efficacy and safety. To summarize the impact of obesity and bariatric surgery on drug pharmacokinetics and provide recommendations for individualized dosing. Review of available literature and clinical guidelines addressing changes in drug absorption, distribution, metabo-lism, and excretion in obese patients and after bariatric procedures. Obesity is associated with nonlinear changes in volume of distribution and heterogenous changes in clearance: modification of certain CYP enzyme activity (notably CYP3A4, CYP2C19, CYP2E1), and alteration of renal function. Anatomical and functional chages of gastrointestinal tract (GIT) following bariatric surgery variably modify absorption area, pH, GIT motility and lead to improvement in metabolic comorbidities. Dose adjustments are particularly important for drugs with a narrow therapeutic range, weight-based dosing regimens, and highly lipophilic substances. An individualized approach and therapeutic drug monitoring are recommended in clinical practice. Universal drug dosing regimens for obese patients or those after bariatric surgery are unavailable for most drugs. Body composition and other patient-specific factors, as well as drug pharmacokinetics should be considered. Clinical pharmacists can contribute to optimal pharmacotherapy in this heterogeneous population.
Obesity is a major global health concern, and scalable digital solutions are urgently needed. While digital lifestyle interventions (DLSIs) have shown promise, prior meta-analyses often included hybrid formats with human support, limiting insights into the effectiveness of fully digital interventions. This study aimed to evaluate the independent effects of standalone DLSIs-defined as interventions delivered exclusively via digital platforms without in-person or adjunctive support-on anthropometric and dietary outcomes in adults with overweight or obesity. We searched MEDLINE, Embase, PsycINFO, Web of Science, and the Cochrane Library from inception through March 4, 2026. Eligible studies were randomized controlled trials (RCTs) evaluating stand-alone DLSIs in adults with overweight or obesity. Interventions were included if they targeted diet or physical activity exclusively through digital platforms. We included fully automated, asynchronous, or one-to-many synchronous systems without individualized support. Studies involving hybrid interventions, including one-to-one synchronous human interaction, nonadult populations, or non-RCT designs, were excluded. Two independent reviewers performed study selection and data extraction. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool (Cochrane Bias Methods Group). Meta-analysis used a random-effects model with the Hartung-Knapp-Sidik-Jonkman method, and heterogeneity was assessed using I2 statistics. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation approach. A total of 19 RCTs involving 3556 participants were included. Stand-alone DLSIs significantly improved anthropometric outcomes compared to controls (standardized mean difference 0.26, 95% CI 0.14-0.38; 95% prediction interval [PI] -0.16 to 0.68; P<.001; 19 studies; n=3556; I2=56.1%), corresponding to an additional weight loss ranging from 2.62 kg to 6.55 kg, depending on the baseline body weight. Significant improvements were also found in dietary outcomes (standardized mean difference 0.26, 95% CI 0.04-0.48; 95% PI -0.29 to 0.81; P=.008; 8 studies; n=1365; I2=57.5%). Subgroup analyses for anthropometric outcomes revealed significant differences only by control group type (P<.001), with waitlist controls showing the largest effect. For dietary outcomes, no significant subgroup differences were found (P>.05). While most studies showed a low risk of bias, substantial statistical heterogeneity was observed in some outcomes. Consequently, the certainty of evidence for both outcomes was rated as moderate. This review is innovative as it is the first to isolate the pure efficacy of stand-alone DLSIs by excluding synchronous human support. Our findings provide moderate-certainty evidence that these tools are effective for weight management and dietary improvement without human intervention. While stand-alone DLSIs offer a highly scalable, cost-effective first-step intervention, the PIs included zero, and substantial heterogeneity was observed, suggesting that benefits may vary across settings. Future research should identify user characteristics that maximize engagement with unguided digital tools.
Background Obesity has been increasingly linked to structural alterations in the brain, particularly involving subcortical gray matter regions. This study aimed to investigate whether obesity is associated with measurable volumetric changes in key subcortical structures relative to normal-weight individuals. Methodology In this cross-sectional observational study, 46 healthy volunteers (25.07 ± 5.82 years old) were initially recruited, of whom 38 normal-weight men and eight obese men (body mass index greater than 30 kg/m²) were included. High-resolution T1-weighted MRI scans were acquired and analyzed using both FreeSurfer's automated segmentation and manual segmentation via ITK-SNAP. Statistical comparisons were performed to determine volumetric differences between groups. Results Automated segmentation results revealed significantly larger gray matter volumes in the right amygdala and left thalamus among obese individuals, with near-significant increases observed in the bilateral hippocampus and putamen. Manual segmentation demonstrated significant enlargement of the amygdala and caudate in obese participants. Conclusions Collectively, these findings indicate that obesity is associated with subtle but consistent volumetric expansion in several subcortical regions. Further research is needed to clarify the mechanisms underlying these structural differences and their potential cognitive and behavioral implications.
Diabetes, obesity, and hypertension are common chronic conditions in which the role of lifestyle alteration is central to control. Education materials may accompany these interventions, but will only be helpful if clear and credible. Since the development of large language models (LLMs) like ChatGPT and Google Gemini, the potential of contributing to the production of health education materials should be seriously taken into account. The aim of this study is to conduct a cross-sectional comparison of five LLMs (ChatGPT-4o, Google Gemini 2.5, Claude Sonnet 4, Grok 3, and Perplexity) in generating patient education brochures on diet and exercise for diabetes, hypertension, and obesity, evaluating their readability, originality, and reliability. The primary objective is to compare the readability and reliability of AI-generated patient education materials. The secondary objective is to assess lexical complexity and originality of generated content. This cross-sectional study used standardized questions to generate brochures based on each response provided by the LLMs. Outputs were evaluated for readability (Flesch-Kincaid test), word complexity, novelty (PapersOwl plagiarism software), and consistency (modified DISCERN instrument). Descriptive statistics and one-way ANOVA were used, where p < 0.05 was deemed significant. ChatGPT produced the shortest and most readable content, evidenced by its lowest grade level (5.2 ± 0.8) and highest Flesch Reading Ease rating (70.0 ± 5.1). Gemini and Claude produced longer, more elaborate brochures that received higher reliability ratings (3.0 ± 0.0 and 3.0 ± 1.0, respectively) but were at higher reading levels (≈ 9th grade). Grok obtained medium for all the measures, while Perplexity produced shorter responses (≈ 444 words) but the lowest reliability score (1.3 ± 0.6). There were no major differences in originality scores across the tools. Every model had a strength: ChatGPT in readability, Gemini and Claude in reliability, Grok in balance, and Perplexity in conciseness. Every model demonstrated at least one parameter where it outperformed the others. The results validate LLMs in terms of producing patient-comprehensible leaflets, but human editing, updation with the latest guidelines, and human supervision will be needed before clinical application.
The detrimental cycle of sarcopenic obesity (SO) significantly reduces quality of life in older adults, while the mechanisms are still unclear. We first analyzed the incidence of SO using the CHARLS database. We identified key genes by integrating differentially expressed genes, weighted gene co-expression network analysis, and targets of gut microbiota metabolites, refining the selection through machine learning methods (LASSO, XGBoost, SVM-REF, Random Forest). These genes were validated through single-cell sequencing, receiver operating characteristic analysis, and Muscle immunohistochemistry in a high-fat-diet (HFD) induced mouse model. Further analyses comprised immune infiltration profiling, pathway enrichment, and transcriptional regulation analysis. Additionally, we explored the relationships between key genes and autophagy, ferroptosis, and immunity responses. Finally, we predicted and evaluated potential therapeutic compounds via the CMap database and molecular docking. SO incidence in China increased significantly from 16.1% (2011) to 20.4% (2018). Machine learning identified ALDH1A3, CSF1R, and PHGDH as key genes. These genes were validated in external muscle single-cell datasets, demonstrating robust diagnostic performance with AUC values exceeding 0.72 across four independent GEO cohorts. Following an HFD intervention in mice, ALDH1A3 and CSF1R expression in muscle tissue was significantly upregulated, while PHGDH showed a consistent upward trend that did not reach statistical significance. Immune infiltration analysis revealed a significant increase in resting NK cells in both obesity and sarcopenia states. Functional enrichment analyses using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes linked the genes to transcriptional regulation pathways. The Cisbp_M4923 motif was identified as the most relevant transcription factor binding site. Finally, molecular docking simulations indicated stable binding of the top candidate compound, Birinapant, to the key gene targets. ALDH1A3, CSF1R, and PHGDH serve as potential co-morbid biomarkers for SO.
Microglia, the resident macrophages of the central nervous system, are recognized for their heterogeneity and integral role in brain function and diseases. In the context of high fat diet (HFD) feeding and obesity, microglia become overactive, acquiring a prevailing lipid associated microglial phenotype (also known as LAM). Yet, how microgliosis is induced and regulated remains unclear. Here we report a key role for the Complement 3a Receptor (C3aR), on HFD-induced hypothalamic gliosis and weight gain in mice. HFD consumption leads to elevated microglial expression of C3aR, which parallels widespread accumulation of reactive microglia, selectively in the hypothalamus. Conditional microglial C3aR deletion protects mice from HFD-induced hypothalamic reactive microgliosis. C3aR deletion or pharmacological antagonism opposes HFD-induced weight gain in male but not female mice. Mechanistically, we demonstrated that C3aR is essential for lipid-induced lipid droplet formation, and acquisition of a LAM molecular signature. In summary, we uncovered a previously unknown role for C3aR in the acquisition of a LAM signature driving diet-induced gliosis, identifying this receptor as a new viable therapeutic candidate for conditions associated with hypothalamic neuroinflammation.
Being overweight and obese are major health concerns worldwide, contributing to lifestyle-related diseases such as hypertension, dyslipidemia, type 2 diabetes, and cardiovascular disease. Increasing physical activity is an effective strategy for weight management. However, earlier step count studies have remained limited to small populations, short-term measurements of 1-2 weeks, and mainly cross-sectional comparisons of average step counts. The effects of long-term step count changes on weight loss remain unclear. This study was conducted to assess the effects of long-term patterns of step counts on weight loss using data from the "Asmile" mobile health app in Japan. We hypothesized that participants with continuously increasing step counts over time would have a higher likelihood of significant weight reduction than participants who show steady or fluctuating patterns, even if their average step counts were similar. We analyzed data of 2778 Asmile users aged 40-74 years with BMI ≥25 kg/m² who underwent a specific health checkup during fiscal years 2019-2023 and who had valid step count records for 10-14 months. Step count trajectories, reflecting long-term trends in physical activity, were classified using a latent class mixed model into four patterns: UP (increasing), FLAT (steady), DOWN (decreasing), and UP/DOWN (increasing then decreasing). Logistic regression was applied to estimate odds ratios for achieving ≥3% weight loss, with step trajectory as the explanatory variable and weight loss as the outcome. Among participants, 1601 (57.6%) were men and 1177 (42.4%) were women, with respective mean ages of 65.8 (SD 7.9) and 64 (SD 8.2) years. Step count trajectories were distributed as 28.5% UP, 36.2% FLAT, 20.1% DOWN, and 15.2% UP/DOWN. Compared with the FLAT group, participants in the UP group had a significantly higher likelihood of achieving ≥3% weight loss (adjusted odds ratio 2.45, 95% CI 1.78-3.38). Long-term tracking of step counts using the Asmile app revealed distinct activity patterns. Continuous increases in step counts were associated with the greatest likelihood of weight loss, emphasizing the importance of sustained physical activity. These findings support the use of long-term step monitoring to guide interventions for obesity and lifestyle-related disease prevention.
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This study aims to investigate lifestyle-related factors in patients with psoriatic arthritis (PsA) and their association with disease activity measurements. This multicenter cohort included 938 patients newly diagnosed with PsA, between 2013 and 2023. A composite lifestyle risk score (range 0 to 5) was calculated using five lifestyle-related factors assessed at baseline (BMI outside normal range, abdominal obesity, current smoking, no alcohol consumption, physical inactivity). Higher scores indicate the presence of more lifestyle-related risk factors. One year disease activity outcomes included PsA Disease Activity Score (PASDAS), disease activity in PsA (DAPSA), PASDAS and DAPSA low disease activity (LDA) and remission, and minimal disease activity (MDA). The rate of obesity was 33%, abdominal obesity was 51%, current smoking was 19%, and alcohol consumption was 72% with 3% of patients physically inactive. Using multivariable analyses, a higher lifestyle risk score was associated with higher PASDAS (β 0.15; 95%CI 0.08, 0.23), and lower odds for achieving PASDAS-LDA (OR 0.59; 95%CI 0.45, 0.77), and MDA (OR 0.72; 95%CI 0.57, 0.90) at one year follow-up. Similar associations were observed for DAPSA (βadj 1.18; 95%CI 0.65, 1.71) and DAPSA-LDA (OR 0.74; 95%CI 0.59, 0.92). Analysis of individual factors showed that general obesity, abdominal obesity and smoking, were significantly associated with higher PASDAS and DAPSA, and lower odds for achieving PASDAS-LDA and MDA. Lifestyle-related risk factors were prevalent in patients with PsA. The associations between lifestyle-related factors and PsA disease activity, mainly obesity and smoking, provide foundation to address lifestyle in PsA care.
Atrial fibrillation (AF) and venous thromboembolism (VTE) are common conditions requiring anticoagulation in patients with severe obesity (body mass index ≥40 kg/m2). Comparative safety and efficacy data for direct oral anticoagulants (DOACs) vs warfarin in this population remain limited. To compare the safety and efficacy of DOACs and warfarin in non-valvular atrial fibrillation (NVAF) and VTE in patients with severe obesity in a real-world setting. This single-center, retrospective matched cohort study included adults with severe obesity receiving a DOAC or warfarin for NVAF or VTE from January 1, 2019, to December 31, 2024. Patients were matched by age, sex, and indication. Primary outcomes were composite thrombotic events (recurrent VTE or ischemic stroke occurrence) and composite bleeding events (clinically relevant non-major and major bleed). Secondary outcomes were assessments of predictors for these events. The study included 182 patients, 91 per cohort. Composite bleeding was significantly higher in the warfarin group (39.6% vs 23.1%, P = 0.017), but it was not significantly different after adjustment for time on therapy. Composite thrombotic events were similar between groups (12.1% vs 9.9%, P = 0.89). History of major bleed (hazard ratio [HR] = 2.37, P = 0.022, 95% confidence interval [CI] = [1.13-4.96]) and concomitant antiplatelet use (HR = 3.80, P < 0.001, 95% CI = [1.98-7.26]) were predictors for bleeding. History of cerebrovascular accident (CVA)/transient ischemic attack (TIA) (HR = 3.34, P = 0.014, 95% CI = [1.28-8.74]) was a predictor for thrombosis. DOACs demonstrated comparable safety and efficacy to warfarin in patients with severe obesity with NVAF or VTE.
Obesity and diabetes are well-established risk factors for Alzheimer's disease (AD), implicating metabolic dysfunction in AD pathogenesis. Sleeve gastrectomy (SG) is among the most effective metabolic interventions available, yet its impact on AD progression remains poorly understood. We hypothesized that SG performed early in life would improve metabolic health, attenuate AD pathology, and preserve cognition in a transgenic AD mouse model. Five-week-old female 3xTg-AD mice were preconditioned on a Western diet (WD) to induce obesity and glucose intolerance, then randomized to SG or sham surgery and maintained on either standard chow or continued WD for 12 months. Metabolic phenotyping, body composition, and cognitive assessments (Novel Object Recognition, Barnes Maze, Fear Conditioning) were performed longitudinally, with histological and molecular analysis of brain tissue at endpoint. Under chow-fed conditions, SG reduced adiposity, improved insulin sensitivity, and decreased cortical Aβ plaque burden, accompanied by attenuated gliosis (GFAP, IBA1) and region-specific, insulin pathway-dependent modulation of autophagy. Under persistent WD, SG improved metabolic health, frailty, spatial cognition, and Aβ pathology, again with corresponding perturbations in autophagy pathway activity. Across all groups, food intake did not differ significantly, indicating that these effects were not secondary to caloric restriction. Collectively, these data suggest that SG engages neuroprotective brain insulin signaling pathways, supporting metabolic surgery as a promising disease-modifying intervention for AD prevention in individuals with obesity.
GLP-1 receptor agonists (GLP-1 RAs) are increasingly used for weight management in patients with obesity, yet their safety in those with comorbid type 1 diabetes (T1D) remains uncertain due to concerns about diabetic ketoacidosis (DKA). This targets trial emulation using OneFlorida+ EHR data (2014-2024). After 1:1 time-conditional propensity score matching, the cohort included 651 GLP-1 RA initiators and 651 matched non-initiators with T1D meeting anti-obesity medication criteria. DKA incidence rates were 13.5 vs. 21.8 per 1,000 person-years. GLP-1 RA initiation was not significantly associated with DKA (hazard ratio [HR], 0.62; 95% confidence interval [CI]: 0.33-1.17) or severe hypoglycemia (HR, 0.52; 95% CI: 0.17-1.55) but was associated with fewer hospitalizations (HR, 0.74; 95% CI: 0.62-0.90) and emergency department visits (HR, 0.73; 95% CI: 0.57-0.92). These findings suggest that GLP-1 RAs may be safely prescribed in adults with T1D and obesity without increasing acute diabetes complications, while potentially reducing healthcare utilization.
Background: Obesity is a prevalent condition associated with numerous comorbidities. Weight loss medications reduce comorbidity burden, but barriers hinder access and titration. Clinical pharmacists play a key role in chronic disease management, but limited research exists on pharmacists managing weight loss. Objective: Evaluate the impact of a clinical pharmacist on weight loss medication management for adults without diabetes in an outpatient Internal Medicine primary care resident clinic. Methods: This matched case-control study included adults without diabetes with at least 1 weight management visit with a clinical pharmacist between July 2023 and May 2024. Controls were matched on insurance and baseline body mass index, and included patients prescribed weight loss medications by clinicians and those without pharmacotherapy. Data were collected over 6 months. The primary outcome was percent weight loss. Rate of weight loss was explored as a secondary outcome. Results: 94 patients were included: 35 pharmacist-managed, 24 clinician-managed, and 35 without pharmacotherapy. At 6 months, mean weight change was -11.8%, -8.3%, and +1.3% in the pharmacist, clinician, and nonmedication groups, respectively. Absolute weight loss was greater in the pharmacist group, but not statistically significant compared with the clinician-managed group (P = 0.12). The weekly rate of weight loss was significantly higher in the pharmacist group (-0.29 kg/week; P = 0.04 and P < 0.001 vs controls). Conclusion: Patients prescribed obesity medications experienced significant weight loss, regardless of whether the patients were managed by pharmacists or primary care clinicians. These findings support a collaborative care model in obesity management.
This study assessed weight self-stigma (WSS) levels and associated factors among primary school students. A cross-sectional survey was conducted in five Linhai primary schools (May-July 2023). Among 2678 students (76.6% response rate), WSS was measured using the weight self-stigma questionnaire (WSSQ), with high/low groups divided by median score. Totally, 2619 (97.8%) valid questionnaires was included in the analysis. Mean WSSQ score was 21.5 ± 9.2, varying significantly by weight status: underweight (19.8 ± 8.3), normal (19.9 ± 8.3), overweight (25.5 ± 9.1), obesity (23.6 ± 10.7) (p < 0.001). Logistic regression showed higher odds of high WSS for overweight (OR = 3.00, 95%CI: 2.36-3.80), obesity (OR = 1.68, 95%CI: 1.35, 2.09), rural schooling (OR = 1.22, 95%CI: 1.01, 1.48), lower family socioeconomic status (OR = 1.30, 95% CI: 1.04, 1.61), insufficient sleep (7-8 h vs. 10 h: OR = 1.51, 95% CI: 1.17-1.97; 9 h vs. 10 h: OR = 1.23, 95% CI: 1.03-1.47), and older age (10 yrs. vs. 7-9 yrs.: OR = 1.37, 95% CI: 1.03-1.82). High WSS levels were prevalent among primary school students with overweight/obesity. Insufficient sleep, lower family socioeconomic status, rural schooling, and older age emerged as associated factors.
Airway management in obese adults can be challenging. Obesity causes both anatomical and physiological changes that make a difficult airway more likely and rescue techniques more likely to fail. The final approach to "can't intubate, can't oxygenate" in airway management is acquiring front-of-neck access (FONA) to facilitate oxygenation. Although incredibly rare, it is essential that the quickest and most efficient technique is utilized. Therefore, FONA needs to be taught and performed to the highest standards to maximize the chances of success. However, there is a distinct lack of obese models available for FONA training. Standard training models do not replicate obesity, and obese model designs described in the literature are often bespoke to the authors' facility. To create a model that replicates the obese airway as much as possible, both in size and girth of the neck, thickness of the anterior neck skin folds, tactile feel of the subcutaneous tissue, and the lack of anatomical landmarks. For education and training purposes it should be cheap and easily produced. For research purposes it should be reproducible with little variation between subsequent models using the same materials. We trialed several models, including animal and synthetic products, culminating in a model involving a commercially available task trainer, 3D printed larynx for increased anatomical accuracy, ballistics gel to reproduce subcutaneous adipose tissue and the proprietary skin supplied with the commercial model. A pilot phase involved use of the model in various educational forums, with fine tuning of the model as issues were identified. The final model adequately reproduces the obese airway while being cheap, easily reproducible, standardized for obese airway FONA research, and can be produced en masse for large educational forums.