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This article discusses a pilot study that aimed to assess the use of a portable scanning device to measure body metrics in people with obesity. The study found that the device was capable of accurately identifying maximum body area and circumference, and these measurements strongly correlated with traditional metrics such as BMI and body fat. The participants reported high acceptance of the scanning procedure and found the visual output motivating. The authors suggest that optical scanning could have potential applications in clinical practice and other settings where body metrics are important. However, further research is needed to evaluate the accuracy and effectiveness of this approach. [Extracted from the article]

Aim: To study safety, efficacy and weight loss with ADO09, a co‐formulation of insulin A21G and pramlintide, in type 1 diabetes. Materials and Methods: A randomized, two‐arm ambulatory 16‐week study compared ADO09 with insulin lispro in 80 participants with type 1 diabetes. We compared changes of weight, glycated haemoglobin, glycaemic patterns during continuous glucose monitoring, and insulin doses at baseline and at the end of treatment. Results: A significant and continuing weight loss, the primary endpoint, was observed with ADO09 compared with lispro as prandial insulin. In the whole group, the weight loss with ADO09 relative to lispro was 2.1 kg. Glycaemic control was relatively good (7.7% mean glycated haemoglobin) in both groups and did not change during treatment. Prandial insulin doses were reduced by 21% in the ADO09 group, whereas basal insulin dosage was not modified. Gastrointestinal symptoms were more frequent with ADO09, but no clear difference in hypoglycaemia was observed. Conclusions: These results extend previous observations on the efficacy and safety of this insulin/pramlintide co‐formulation. They show a beneficial effect on weight, using less mealtime insulin and without increased hypoglycaemia. [ABSTRACT FROM AUTHOR]

This article discusses the perceptions, attitudes, and barriers to effective obesity care among people with obesity (PwO) and healthcare professionals (HCPs) in India. The study found that the majority of PwO and HCPs recognized obesity as a disease, but many PwO assumed self-responsibility for weight loss. Lack of exercise and unhealthy eating habits were identified as major barriers to weight loss. The study also highlighted the importance of initiating weight management discussions and addressing weight stigma. The authors suggest the need for a multidisciplinary approach and increasing awareness about obesity. [Extracted from the article]

A study published in the journal Diabetes, Obesity & Metabolism examined the effects of a weight-loss program combined with respiratory muscle training (RMT) on weight and cardiovascular risk in adults with obesity. The study found that participants who followed the program experienced significant improvements in weight management and biomarkers, such as blood pressure and blood glucose levels. Compliance with the program was linked to positive outcomes. The study suggests that a combination of portion control and RMT could be an effective approach for weight loss and improving cardiovascular health in individuals with obesity. However, the study had limitations, including a small sample size and lack of a control group. [Extracted from the article]

Aim: To investigate the associations of the Dietary Approaches to Stop Hypertension (DASH) score with subcutaneous (SAT) and visceral (VAT) adipose tissue volume and hepatic lipid content (HLC) in people with diabetes and to examine whether changes in the DASH diet were associated with changes in these outcomes. Methods: In total, 335 participants with recent‐onset type 1 diabetes (T1D) and type 2 diabetes (T2D) from the German Diabetes Study were included in the cross‐sectional analysis, and 111 participants in the analysis of changes during the 5‐year follow‐up. Associations between the DASH score and VAT, SAT and HLC and their changes were investigated using multivariable linear regression models by diabetes type. The proportion mediated by changes in potential mediators was determined using mediation analysis. Results: A higher baseline DASH score was associated with lower HLC, especially in people with T2D (per 5 points: −1.5% [−2.7%; −0.3%]). Over 5 years, a 5‐point increase in the DASH score was associated with decreased VAT in people with T2D (−514 [−800; −228] cm3). Similar, but imprecise, associations were observed for VAT changes in people with T1D (−403 [−861; 55] cm3) and for HLC in people with T2D (−1.3% [−2.8%; 0.3%]). Body mass index and waist circumference changes explained 8%‐48% of the associations between DASH and VAT changes in both groups. In people with T2D, adipose tissue insulin resistance index (Adipo‐IR) changes explained 47% of the association between DASH and HLC changes. Conclusions: A shift to a DASH‐like diet was associated with favourable VAT and HLC changes, which were partly explained by changes in anthropometric measures and Adipo‐IR. [ABSTRACT FROM AUTHOR]

Tirzepatide, a novel GLP-1/GIP dual receptor agonist, shows significant advantages in glycemic management and weight control. By summarizing the results of the SURMOUNT and SURPASS clinical trials, we evaluate the efficacy and safety of tirzepatide in reducing blood glucose and weight. These trials indicate that tirzepatide significantly lowers HbA1c levels (with a maximum reduction of 2.24%) and promotes weight loss (up to 11.2 kg) with good tolerability. However, there are still some challenges in its clinical application, including high treatment costs and gastrointestinal discomfort. Additionally, the safety and efficacy of tirzepatide in special populations, such as patients with renal impairment, require further investigation. Future large-scale clinical trials, such as SURPASS-CVOT and SUMMIT, are expected to further verify the long-term benefits of tirzepatide in cardiovascular health management, providing stronger evidence for its comprehensive treatment of diabetes and its complications. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus is one of the most prevalent health conditions worldwide, affecting millions of individuals and posing significant public health challenges. Understanding the nature of type 2 diabetes, its causes, symptoms and treatments is crucial for managing and preventing its complications. Many different dietary strategies are used by individuals to treat and manage diabetes. This review provides an overview of popular dietary strategies that have evidence for improving long‐term glycaemic control or achieving diabetes remission, as well as strategies that may be useful to reduce postprandial hyperglycaemia, which may be of use in the prevention of diabetes, but also as strategies for those already diagnosed but trying to manage their condition better. Recent clinical trials have provided evidence that in people living with type 2 diabetes who also live with overweight or obesity, using a total diet replacement weight loss programme results in significant and substantial weight loss, and as a result, many people can achieve remission from their diabetes. There has been considerable interest in whether similar effects can be achieved without reliance on formula foods, using real diet approaches. Reduced or low‐carbohydrate diet approaches hold some promise, with observational or preliminary findings suggesting beneficial effects, but evidence from robust trials or systematic reviews of randomized controlled trials is still lacking. The Mediterranean dietary pattern, low in saturated fat and high in monounsaturated fat, also has some potential, with evidence to suggest some people can lose weight and achieve remission using this approach, which may be easier to adhere to longer term than more intensive total diet replacement and low‐carbohydrate strategies. Plant‐based diets that advocate for the elimination of animal‐based and/or animal‐derived foods have increased in popularity. There is evidence from epidemiological studies that people who follow these diets have a lower risk of developing type 2 diabetes, and evidence from trials and systematic reviews of trials that changing to a dietary pattern lower in animal‐based and animal‐derived foods has benefits on glycaemic control and other markers of cardiovascular disease. While these approaches all provide food or nutrient prescriptions, approaches that incorporate periods of fasting do not provide rules on the types of foods that can or cannot be consumed, but rather provide time windows of when to eat. Evidence suggests that these approaches can be as effective in achieving energy restriction and weight loss as approaches that advocate continuous energy restriction, and there is evidence for benefits on glycaemic control independent of weight loss. Finally, popular dietary strategies that may be useful to use or combine to help prevent postprandial hyperglycaemia include reducing the glycaemic index or glycaemic load of the diet, high‐fibre diets, eating foods in a meal in the order vegetables > protein > carbohydrates, preloading or combining acids such as vinegar or lemon juice with meals and engaging in low‐intensity aerobic exercise immediately after meals. [ABSTRACT FROM AUTHOR]

Obesity is a chronic multi‐system disease and major driver of type 2 diabetes and cardiometabolic disease. Nutritional interventions form the cornerstone of obesity and type 2 diabetes management. Some interventions such as Mediterranean diet can reduce incident cardiovascular disease, probably independently of weight loss. Weight loss of 5% or greater can improve many adiposity‐related comorbidities. Although this can be achieved with lifestyle intervention, it is often difficult to sustain in the longer term due to adaptive endocrine changes. In recent years glucagon‐like‐peptide‐1 receptor agonists (GLP‐1RAs) have emerged as effective treatments for both type 2 diabetes and obesity. Newer GLP‐1RAs can achieve average weight loss of 15% or greater and improve cardiometabolic health. There is heterogeneity in the weight loss response to GLP‐1RAs, with a substantial number of patients unable to achieve 5% or greater weight. Weight loss, on average, is lower in older adults, male patients and people with type 2 diabetes. Mechanistic studies are needed to understand the aetiology of this variable response. Gastrointestinal side effects leading to medication discontinuation are a concern with GLP‐1RA treatment, based on real‐world data. With weight loss of 20% or higher with newer GLP‐1RAs, nutritional deficiency and sarcopenia are also potential concerns. Lifestyle interventions that may potentially mitigate the side effects of GLP‐1RA treatment and enhance weight loss are discussed here. The efficacy of such interventions awaits confirmation with well‐designed randomized controlled trials. [ABSTRACT FROM AUTHOR]

Obesity is a complex chronic disease with increasing prevalence across the globe. Medical nutrition therapy (MNT) is an important component of obesity treatment, and low‐calorie diets (LCDs) and very‐low‐calorie diets (VLCDs) are part of the MNT toolbox. This narrative review focuses on the latest evidence and clinical guidelines regarding the use and impact of meal replacements (MRs) as part of LCDs/VLCDs for the treatment of obesity and some associated complications. MRs can be used in conjunction with food as partial diet replacement (PDR) or can be used exclusively to serve as the sole source of dietary energy (total diet replacement [TDR]). Use of MR may be associated with better control of cravings and hunger typically observed during reduced calorie intake through effects of ketosis or stimuli narrowing, although the exact mechanisms for these effects remain unclear. Several clinical guidelines have endorsed the use of MRs as a part of MNT for obesity, primarily based on evidence that shows an average weight reduction of ~10 kg or more with TDR over at least 12 months in large, randomized controlled trials. When compared to usual care controls, these effects are 6–8 kg greater, and when compared to food‐based diets, the effects are nearly twice the effect of a food‐based diet. MR‐based diets have been found to be safe and associated with improvements in quality of life. These diets are also effective for improving key cardiometabolic health outcomes, including dysglycaemia, blood pressure, lipids, and metabolic associated fatty liver. The effectiveness, safety, and associated health improvement makes MRs use a valuable strategy for several higher risk clinical scenarios where weight reduction is indicated. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (OA) is a leading cause of disability among the elderly and is often exacerbated by obesity. Research supports weight loss and exercise therapy as key strategies for managing knee OA‐related disability. Concurrently, telemedicine is becoming a popular healthcare approach. This study aimed to develop and evaluate an 8‐week tele‐education programme's impact on weight control and knee OA outcomes. Methods/Design: Participants with knee OA and obesity were included. Baseline data on pain (VAS index), physical activity (GPAQ questionnaire), and quality of life (EQ5D and KOOS questionnaires) were collected. Performance tests, including the 30‐second Chair Stand test (30CST) and the Timed Up‐and‐Go test (TUG), were recorded. Participants were randomly divided into two groups: a control group receiving oral advice on diet and exercise, and an intervention group receiving educational videos on nutrition, lifestyle changes, physical activity, individualised exercises, and psychosocial support. Evaluations were repeated after 8 weeks. Results: Data from 25 of 30 participants were analysed. In the intervention group, body composition, waist, and abdominal circumference decreased significantly (p < 0.05). The KOOS questionnaire showed significant improvements in pain, activity, and daily tasks (p = 0.00). The EQ5D questionnaire and health satisfaction also showed positive results within the intervention group (p = 0.00) and between groups (p = 0.008). The pain index improved significantly within (p = 0.00) and between groups (p = 0.02). Functional test results were significant within the intervention group (p = 0.00) and between groups (p = 0.017 for 30CST and p = 0.004 for TUG). Conclusion: An 8‐week tele‐education programme for weight control and exercise therapy in knee OA patients significantly improved body composition, quality of life, and functional performance. Given the costs of obesity and knee OA on both people and the health system, tele‐education can be a cost‐effective treatment strategy. [ABSTRACT FROM AUTHOR]

Aim: To examine the associations between visceral adipose tissue (VAT) and brain structural measures at midlife and explore how these associations may be affected by age, sex and cardiometabolic factors. Methods: We used abdominal and brain magnetic resonance imaging data from a population‐based cohort of people at midlife in the UK Biobank. Regression modelling was applied to study associations of VAT volume with total brain volume (TBV), grey matter volume (GMV), white matter volume, white matter hyperintensity volume (WMHV) and total hippocampal volume (THV), and whether these associations were altered by age, sex or cardiometabolic factors. Results: Complete data were available for 17 377 participants (mean age 63 years, standard deviation = 12, 53% female). Greater VAT was associated with lower TBV, GMV and THV (P <.001). We found an interaction between VAT and sex on TBV (P <.001), such that the negative association of VAT with TBV was greater in men (β = −2.89, 95% confidence interval [CI] −2.32 to −10.15) than in women (β = −1.32, 95% CI −0.49 to −3.14), with similar findings for GMV. We also found an interaction between VAT and age (but not sex) on WMHV (P <.001). The addition of other cardiometabolic factors or measures of physical activity resulted in little change to the models. Conclusions: VAT volume is associated with poorer brain health in midlife and this relationship is greatest in men and those at younger ages. [ABSTRACT FROM AUTHOR]

Aims: To assess the relationship of longitudinal changes in fat mass (FM), lean mass (LM) and waist circumference (WC) with incident kidney outcomes in people with overweight/obesity and type 2 diabetes mellitus (T2DM). Materials and Methods: A total of 3927 participants with baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 from the Look AHEAD (Action for Health in Diabetes) trial were included. The primary outcome was kidney outcomes, defined as a decrease in eGFR of at least 40% from baseline at follow‐up visit, or end‐stage kidney disease. Results: During a median follow‐up of 8.0 years, 450 kidney outcomes were documented after the first 1 year. In the intensive lifestyle intervention (ILI) group, reductions in FM (per 10% decrease, adjusted hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.69–0.94) and WC (per 10% decrease, adjusted HR 0.72, 95% CI 0.59–0.88) from baseline to 1‐year follow‐up were significantly associated with a lower risk of kidney outcomes. The change in LM was not significantly associated with risk of kidney outcomes (per 10% decrease, adjusted HR 0.78, 95% CI 0.58–1.06). In the diabetes support and education group (control group), no significant association was found between changes in body composition and kidney outcomes. Similar results were observed for the 4‐year changes in body composition. Conclusions: In this post hoc analysis of the Look AHEAD trial, longitudinal declines in FM and WC were associated with a lower risk of kidney outcomes in the ILI group in participants with overweight/obesity and T2DM. [ABSTRACT FROM AUTHOR]

Obesity is an abnormal and potentially dangerous condition caused by excess body fat accumulation. The number of people with obesity is increasing worldwide. Obesity is the primary cause of various diseases; therefore, it is crucial to make efforts to control body weight. Identifying the factors that influence men with obesity to attempt to control and not control their weight is essential. The objective of this study was to create a prediction model for weight control experience among Korean men in their 30 s and 40 s. We analyzed data from the 2022 Community Health Survey and included 12,311 men who were overweight or obese. The men were divided into two groups based on their weight control experience: (1) Yes group (n = 9405) and (2) No group (n = 2906). Chi-square and independent t-tests were used to compare general and health-related characteristics between the groups. Decision tree analysis was used to build a prediction model for weight control experience. A split-sample test was conducted to validate the model. From the results of this study, various models predicting weight control experience were derived. From the decision tree model without setting the first node, those who weighed below average, had a high school diploma or less, and did not know their blood sugar levels had the highest probability of not controlling their weight at 55.3%. In the prediction model where the first node was set to age, those in their 40 s who thought their weight was below average and were unaware of their blood sugar levels had the highest rate of not trying to control their weight at 50.1%. In the prediction model where the first node was set to BMI, those who were overweight but thought their weight was below average and had a high school diploma or less had the highest rate of not trying to control their weight at 51.5%. There is an urgent need to provide obesity prevention and management education to those who have no weight control experience, particularly those at high risk, as identified in this study. [ABSTRACT FROM AUTHOR]

Metformin (dimethyl‐biguanide) can claim its origins in the use of Galega officinalis as a plant treatment for symptoms ascribed to diabetes. Since the first clinical use of metformin as a glucose‐lowering agent in 1957, this medicine has emerged as a first‐line pharmacological option to support lifestyle interventions in the management of type 2 diabetes (T2D). It acts through multiple cellular pathways, principally in the gut, liver and muscle, to counter insulin resistance and lower blood glucose without weight gain or risk of overt hypoglycaemia. Other effects include improvements in lipid metabolism, decreased inflammation and lower long‐term cardiovascular risk. Metformin is conveniently combined with other diabetes medications, can be prescribed in prediabetes to reduce the risk of progression to T2D, and is used in some regions to assist glycaemic control in pregnancy. Consistent with its diversity of actions, established safety profile and cost‐effectiveness, metformin is being assessed for further possible clinical applications. The use of metformin requires adequate renal function for drug elimination, and may cause initial gastrointestinal side effects, which can be moderated by taking with meals or using an extended‐release formulation. Thus, metformin serves as a valuable therapeutic resource for use throughout the natural history of T2D. [ABSTRACT FROM AUTHOR]

Metformin (dimethyl‐biguanide) can claim its origins in the use of Galega officinalis as a plant treatment for symptoms ascribed to diabetes. Since the first clinical use of metformin as a glucose‐lowering agent in 1957, this medicine has emerged as a first‐line pharmacological option to support lifestyle interventions in the management of type 2 diabetes (T2D). It acts through multiple cellular pathways, principally in the gut, liver and muscle, to counter insulin resistance and lower blood glucose without weight gain or risk of overt hypoglycaemia. Other effects include improvements in lipid metabolism, decreased inflammation and lower long‐term cardiovascular risk. Metformin is conveniently combined with other diabetes medications, can be prescribed in prediabetes to reduce the risk of progression to T2D, and is used in some regions to assist glycaemic control in pregnancy. Consistent with its diversity of actions, established safety profile and cost‐effectiveness, metformin is being assessed for further possible clinical applications. The use of metformin requires adequate renal function for drug elimination, and may cause initial gastrointestinal side effects, which can be moderated by taking with meals or using an extended‐release formulation. Thus, metformin serves as a valuable therapeutic resource for use throughout the natural history of T2D. [ABSTRACT FROM AUTHOR]

Aims: To investigate the associations of conicity index (C‐index) and relative fat mass (RFM) with incident type 2 diabetes mellitus (T2DM) among adults in China. Materials and Methods: A total of 10 813 participants aged over 18 years in Shenzhen Longhua district were enrolled in a follow‐up study conducted from 2018 to 2022. The participants were categorized based on quartiles (Q) of C‐index and RFM. The Cox proportional hazards model was performed to examine the relationships between C‐index, RFM and the risk of T2DM. Results: After adjusting for potential confounding factors, including age, sex, occupation, marital status, education level, smoking status, alcohol consumption, physical exercise, hypertension status, fasting blood glucose (FBG) and total cholesterol (TC), both C‐index and RFM showed positive and independent associations with risk of T2DM. The multivariable‐adjusted hazard ratios (95% confidence intervals) for T2DM risk in participants in C‐index Q3 and Q4 compared with those in C‐index Q1 were 1.50 (1.12, 2.02) and 1.73 (1.29, 2.30), and 1.94 (1.44, 2.63), 3.18 (1.79, 5.64), 4.91 (2.68, 9.00) for participants in RFM Q2, Q3 and Q4 compared with RFM Q1. These differences were statistically significant (all p < 0.05). Conclusion: C‐index and RFM are strongly associated with new‐onset T2DM and could be used to identify the risk of diabetes in large‐scale epidemiological studies. [ABSTRACT FROM AUTHOR]

Aims: To summarize the effects of semaglutide 2.4 mg on weight‐related quality of life (WRQOL) and health‐related quality of life (HRQOL), focusing on the confirmatory secondary endpoint of physical functioning. Materials and Methods: The STEP 1–4 Phase 3a, 68‐week, double‐blind, randomized controlled trials assessed the efficacy and safety of semaglutide 2.4 mg versus placebo in individuals with overweight/obesity. WRQOL and HRQOL were assessed by change from baseline to Week 68 in two different but complementary measures, the Impact of Weight on Quality of Life‐Lite Clinical Trials Version (IWQOL‐Lite‐CT; STEP 1 and 2) and the SF‐36v2 Health Survey Acute (SF‐36v2; STEP 1–4). Results: Superiority for semaglutide 2.4 mg over placebo based on IWQOL‐Lite‐CT and SF‐36v2 physical functioning scores was confirmed in STEP 1 and 2 and in STEP 1, 2 and 4, respectively. At Week 68, a greater proportion of participants treated with semaglutide 2.4 mg than with placebo reached meaningful within‐person change (MWPC) thresholds for IWQOL‐Lite‐CT Physical Function scores in STEP 1 (51.8% vs. 28.3%; p < 0.0001) and STEP 2 (39.6% vs. 29.5%; p = 0.0083) and the MWPC threshold for SF‐36v2 Physical Functioning in STEP 1 (39.8% vs. 24.1%; p < 0.0001), STEP 2 (41.0% vs. 27.3%; p = 0.0001) and STEP 4 (18.0% vs. 6.6%; p < 0.0001). All other IWQOL‐Lite‐CT and SF‐36v2 scale scores in STEP 1–4 were numerically improved with semaglutide 2.4 mg versus placebo, except for SF‐36v2 Role Emotional in STEP 2. Conclusions: Semaglutide 2.4 mg significantly improved physical functioning, with greater proportions of participants achieving MWPC compared with placebo, and showed beneficial effects on WRQOL and HRQOL beyond physical functioning. [ABSTRACT FROM AUTHOR]

Aims: To establish which components of energy balance mediate the clinically significant weight loss demonstrated with use of cotadutide, a glucagon‐like peptide‐1 (GLP‐1)/glucagon receptor dual agonist, in early‐phase studies. Materials and Methods: We conducted a phase 2a, single‐centre, randomized, placebo‐controlled trial in overweight and obese adults with type 2 diabetes. Following a 16‐day single‐blind placebo run‐in, participants were randomized 2:1 to double‐blind 42‐day subcutaneous treatment with cotadutide (100–300 μg daily) or placebo. The primary outcome was percentage weight change. Secondary outcomes included change in energy intake (EI) and energy expenditure (EE). Results: A total of 12 participants (63%) in the cotadutide group and seven (78%) in the placebo group completed the study. The mean (90% confidence interval [CI]) weight change was −4.0% (−4.9%, −3.1%) and −1.4% (−2.7%, −0.1%) for the cotadutide and placebo groups, respectively (p = 0.011). EI was lower with cotadutide versus placebo (−41.3% [−66.7, −15.9]; p = 0.011). Difference in EE (per kJ/kg lean body mass) for cotadutide versus placebo was 1.0% (90% CI −8.4, 10.4; p = 0.784), assessed by doubly labelled water, and −6.5% (90% CI −9.3, −3.7; p < 0.001), assessed by indirect calorimetry. Conclusion: Weight loss with cotadutide is primarily driven by reduced EI, with relatively small compensatory changes in EE. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the efficacy and cardiovascular outcomes of combination pioglitazone with either a glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) or a sodium‐glucose cotransporter‐2 (SGLT2) inhibitor in individuals with type 2 diabetes (T2D) by conducting a systematic review, meta‐analysis, and analysis of a large international real‐world database. Methods: We searched MEDLINE, SCOPUS and Web of Science to identify relevant articles for inclusion (PROSPERO [CRD: 42023483126]). Nineteen studies assessing pioglitazone + SGLT2 inhibitors or GLP‐1RAs versus controls were identified, 16 of which were randomized controlled trials. Risk of bias was assessed using Cochrane‐endorsed tools and quality of evidence was assessed using GRADE. We additionally performed a retrospective cohort study of all individuals aged 18 years or over with T2D, using the TriNetX platform. We included propensity‐score‐matched individuals who were treated for at least 1 year with pioglitazone and a GLP‐1RA or pioglitazone and an SGLT2 inhibitor, compared against GLP‐1RA and SGLT2 inhibitor monotherapy. Outcomes were all‐cause mortality, heart failure, chronic kidney disease and composite stroke and transient ischaemic attack. Results: The average follow‐up in the included studies ranged from 24 to 52 weeks. Combination of pioglitazone with a GLP‐1RA reduced glycated haemoglobin (HbA1c) and weight greater than in controls: mean differences −1% (95% confidence interval [CI] −1.27, −0.74) and −1.19 kg (95% CI −1.80, −0.58), respectively. There was no statistically significant difference in systolic blood pressure (SBP) or mortality between groups: mean difference − 1.56 mmHg (95% CI −4.48, 1.35; p = 0.30) and relative risk (RR) 0.29 (95% CI 0.07–1.15; p = 0.08), respectively. Combination of pioglitazone with SGLT2 inhibitors reduced HbA1c, weight and SBP to a greater extent than control treatment: mean differences −0.48% (95% CI −0.67, −0.28), −2.3 kg (95% CI −2.72, −1.88) and −2.4 mmHg (95% CI −4.1, −0.7; p = 0.01), respectively. There was no statistically significant difference in mortality between groups (RR 1.81, 95% CI 0.30–10.97; p = 0.52). The included trials demonstrated a reduction in risk of heart failure with combination treatment. Similarly, from the real‐world database (n = 25 230 identified), pioglitazone and SGLT2 inhibitor combination therapy was associated with reduced risk of heart failure compared to monotherapy alone (hazard ratio 0.50, 95% CI 0.38–0.65; p < 0.001). Conclusion: Both our systematic review/meta‐analysis and the real‐world dataset show that combination of pioglitazone with either GLP‐1RAs or SGLT2 inhibitors is associated with increased weight loss and reduced risk of heart failure compared with monotherapy. [ABSTRACT FROM AUTHOR]

Background: Limited real-world data on the benefits and risks associated with 3 and 4.5 mg doses of dulaglutide currently exists, making it difficult to determine the impact of dose titration for patients currently managed with dulaglutide 1.5 mg weekly. Objective: To determine the impact of dulaglutide 3 and 4.5 mg doses on weight and hemoglobin A1c (HbA1c) in patients with type 2 diabetes mellitus (T2DM), in clinical practice. Methods: Retrospective, observational study of adult T2DM patients receiving dulaglutide 3 or 4.5 mg weekly within a large, university-affiliated, primary care network. The primary outcome was change in weight and HbA1c from baseline to 24 weeks. Secondary outcomes included incremental changes in weight and HbA1c, and describing trends related to dose reductions. Results: Ninety-five patients were included, 62 in the dulaglutide 3 mg group and 33 in the dulaglutide 4.5 mg group. After 24 weeks, the mean changes in weight and HbA1c from baseline were −1.8 kg (P < 0.01) and −0.4% (P < 0.01) in the 3 mg group, and −4.2 kg (P < 0.01) and −0.4% (P = 0.119) in the 4.5 mg group. Incremental change in weight and HbA1c among patients who were titrated from dulaglutide 3 to 4.5 mg weekly were −2.6 kg (P < 0.01) and −0.2% (P = 0.04), respectively. Conclusion and Relevance: Titration from dulaglutide 1.5 to 3 mg resulted in significant reductions in weight and HbA1c after 24 weeks. Additional, statistically significant, reductions in weight and HbA1c were seen when patients were further titrated to dulaglutide 4.5 mg weekly. [ABSTRACT FROM AUTHOR]

Aim: To investigate the real‐world utilization and comparative clinical outcomes of injectable and oral semaglutide in individuals with type 2 diabetes (T2D) with the aim of enhancing understanding of the practical implications associated with choosing between these formulations. Methods: New users of oral or injectable semaglutide were selected from a cohort of 14 079 initiators of glucagon‐like peptide‐1 receptor agonists. Propensity‐score matching (PSM) was employed to create balanced groups, ensuring comparability. The analysis encompassed dose exposure, drug persistence, and clinical outcomes, including changes in glycated haemoglobin (HbA1c) and body weight, with up to 18 months' follow‐up. Results: We analysed two matched groups of 107 participants each, who comprised on average 63.6% men, aged 64 years, with diabetes duration of approximately 10 years, body mass index of 29 kg/m2 and HbA1c level of 7.7–7.8% (61‐62 mmol/mol). The proportion of low, intermediate and high doses were similar with the oral and the injectable formulation. The change in HbA1c was similar between groups (−0.9% / ‐10 mmol/mol at 18 months) as was the proportion of individuals reaching HbA1c <6.5% (48 mmol/mol). The average change in body weight was similar in the two groups (−3.7 kg with injectable and −3.3 kg with oral at 18 months) but more new users of injectable semaglutide lost ≥5% body weight. Persistence on drug was longer with injectable than with oral semaglutide. Conclusion: In a real‐world setting, improvements in HbA1c and body weight were similar after initiation of oral or injectable semaglutide. These results may be specific to the features of the matched cohorts under investigation, with limited generalizability to populations with different characteristics. [ABSTRACT FROM AUTHOR]

Aim: To provide an updated estimate of the association between body mass index (BMI) and health‐related quality of life (HRQoL) among the general population in England and to identify population subgroups with the highest potential utility gains from obesity interventions. Materials and Methods: The sample included 12 158 adults with valid HRQoL and BMI data from the 2017 and 2018 Health Survey for England. Robust standard error linear regression, controlling for demographic and socioeconomic characteristics, lifestyle behaviours and obesity‐related comorbidities, was used for the baseline analysis. Robustness checks assessed the impact of (a) estimator selection; (b) model specifications; (c) statistical outliers at high BMI; (d) potential BMI measurement error; and (e) data pooling. Results: The study found a significant association between HRQoL and BMI, which exhibited an inverted U‐shaped relationship. The mean HRQoL peaked at 25.7 kg/m2 in men and 22.6 kg/m2 in women and was reduced in the underweight, overweight and obesity BMI ranges. Sensitivity analyses reported similar coefficients, suggesting a robust model specification. Conclusions: Reduced HRQoL beyond optimal BMI underlines the importance of maintaining a normal BMI range for overall health. The rising prevalence of class III obesity is a major public health concern given its disproportionate impact on health, health care utilization and costs. Obesity management is key to preventing the reduction in HRQoL associated with obesity‐related comorbidities, and this analysis supports the development of targeted policies and population health initiatives for people with class III obesity. [ABSTRACT FROM AUTHOR]

Aims: To examine the effects of a home‐based exergame training over 6 weeks on cardio‐metabolic and cognitive health, as well as training adherence, in physically inactive individuals. Materials and Methods: Twenty participants were equipped with an exergame system specifically designed for use at home. Each participant performed at least three weekly exercise sessions at ≥80% of their individual maximum heart rate, over 6 weeks. Exercise duration increased biweekly until 75 min of vigorous exercise were performed in Weeks 5 and 6. Maximum oxygen uptake (VO2max), cardio‐metabolic profiling, and neuro‐cognitive tests were performed at baseline and study end. Additionally, training adherence was assessed via training diaries. Results: After 6 weeks of home‐based exergaming, VO2max increased significantly, while there was a significant decrease in heart rate (resting and maximum), blood pressure (systolic, diastolic and mean), and low‐density lipoprotein cholesterol. Dynamic balance and reaction time improved after 6 weeks of exergaming. Training adherence was 88.4%. Conclusions: Home‐based exergaming induced a clinically relevant increase in VO2max, a determinant of cardiovascular health, accompanied by further improvements in cardiovascular, metabolic and neuro‐cognitive parameters. Exergaming may, therefore, offer an innovative approach to increasing regular physical activity, improving metabolic risk profile, and preventing chronic diseases. [ABSTRACT FROM AUTHOR]

A personal norms intervention strategy is an effective way to reduce food waste behavior. However, the mechanism controlling how personal norms affect food waste behavior needs to be further investigated. In addition, previous studies have reported that weight control is part of this mechanism, but few studies have focused on how internal (personal norms) and external beauty (weight control) act simultaneously on individuals. This study constructed an analytical framework with personal norms as the independent variable, emotions as the mediating variable, and weight control as the moderating variable from a cognitive perspective. A stratified regression approach was used to analyze 835 validated questionnaires on food waste at the consumption level (outside the home) that were collected from across China. The results showed that (1) Chinese consumer personal norms about eating at restaurants and outside the home exacerbated food waste behavior; (2) consumer emotions mediated the effect of personal norms on food waste behavior; and (3) weight control moderated both paths associated with the mediating effect of emotions, and its cubic term had a more significant moderating effect. Policy recommendations are proposed based on the conclusions of this study that will effectively reduce food waste behavior. [ABSTRACT FROM AUTHOR]

Background: Electronic cigarettes or vapes are battery-operated devices that heat a liquid, often containing nicotine and flavouring substances, to produce an inhalable aerosol. Despite being used as an alternative to traditional smoking, many studies have reported their health risks and ineffectiveness in smoking cessation. The impact of e-cigarettes on weight control behaviours, a known effect of traditional cigarette smoking, is unclear. Herein, a systematic review was conducted to explore the relationship between e-cigarette use and body weight changes in adolescents and young adults. Methods: The existing literature from databases such as PubMed, Cochrane Library, Embase, Science Direct, Web of Science, Scopus, and Google Scholar until October 2023 was searched and included in the review. The methodological quality of all selected studies was assessed using the Joanna Briggs Institute's (JBI) Critical Appraisal Checklists for Studies. Results: Out of 5117 citations, 20 publications featuring cross-sectional studies with adolescent participants were qualitatively analysed. The high rates of e-cigarette usage seemed to correlate with increased weight concerns, particularly among females. Regular e-cigarette users who reported being overweight and used calorie restriction for weight reduction were more likely to view vaping as a weight loss or control strategy. Young adults (<24 years) may consume more flavoured e-cigarettes than older users (>25 years). Conclusions: This study revealed a significant use of e-cigarettes among high school students, driven by taste preferences, weight management, and perceived harm reduction. Particularly among girls facing body image pressures, vaping serves as a weight control method. This highlights the need to assess cardiovascular risks and advocate for further research, including longitudinal studies, to inform public health strategies effectively. [ABSTRACT FROM AUTHOR]

Background: Combining smoking with poor eating habits significantly elevates the risk of chronic illnesses and early death. Understanding of how dietary quality shifts post-smoking cessation remains limited. The objective of this study is to examine dietary quality – using Healthy Eating Index (HEI – 2020) and its 13 components, among current, former, and never smokers, and particularly the impact of quitting and the duration of cessation on dietary habits. Methods: A cross-sectional analysis of 31,569 adults from the National Health and Nutrition Examination Survey (NHANES) 2005–2018 was conducted. Dietary quality was assessed using HEI-2020 scores, which were determined by NIH developed - simple HEI scoring algorithm per person. Smoking status was categorized into current, former, and never smokers, with further subdivisions for current (heavy/light smokers) and former smokers (duration post-cessation). Descriptive analysis and multiple regression models weighted to represent the US population were performed. Results: The current smoking rate was 19.4%, with a higher prevalence in males (22.5%) than females (17.5%). Current smokers reported statistically significantly lower HEI total score than both former and never smokers. Former smokers exhibited HEI scores similar to those of never smokers. The adjusted HEI total scores for current, former, and never smokers were 49.2, 54.0, and 53.3, respectively, with a statistically significant difference (p < 0.001). Moreover, light smokers had better total HEI score than heavy smokers (46.8 vs. 50.8, p < 0.001, respectively), but former and never smokers scored even higher. Quitting smoking immediately improved dietary quality, with former smokers reaching the dietary levels of never smokers within 5–10 years (53.8 vs. 53.3, p > 0.05, respectively). Compared to current smokers, former smokers tended to consume more beneficial foods (e.g., fruits, vegetables, greens and beans, whole grains, proteins, and fatty acids), while also consuming more sodium and less added sugar. Conclusions: Current smokers, particularly heavy smokers, exhibit poorer dietary habits than former and never smokers. The dietary quality of former smokers aligns with never smokers over time, highlighting the positive impact of smoking cessation on diet. This has implications for reducing chronic disease risks associated with poor diet and smoking. [ABSTRACT FROM AUTHOR]

Bardet‐Biedl syndrome (BBS) is a rare, monogenic, multisystem disorder characterized by retinal dystrophy, renal abnormalities, polydactyly, learning disabilities, as well as metabolic dysfunction, including obesity and an increased risk of type 2 diabetes. It is a primary ciliopathy, and causative mutations in more than 25 different genes have been described. Multiple cellular mechanisms contribute to the development of the metabolic phenotype associated with BBS, including hyperphagia as a consequence of altered hypothalamic appetite signalling as well as alterations in adipocyte biology promoting adipocyte proliferation and adipogenesis. Within this review, we describe in detail the metabolic phenotype associated with BBS and discuss the mechanisms that drive its evolution. In addition, we review current approaches to the metabolic management of patients with BBS, including the use of weight loss medications and bariatric surgery. Finally, we evaluate the potential of targeting hypothalamic appetite signalling to limit hyperphagia and induce clinically significant weight loss. [ABSTRACT FROM AUTHOR]

Background: Hypothalamic centres have been recognized to play a central role in body weight regulation for nearly 70 years. Aims: In this review, we will explore the current undersanding of the role the hypothalamus plays in controlling food intake behaviours. Materials and Methods: Review of relevant literature from PubMed searches and review article citations. Results: Beginning with autopsy studies showing destructive hypothalamic lesions in patients manifesting hyperphagia and rapid weight gain, followed by animal lesioning studies pinpointing adjacent hypothalamic sites as the 'satiety' centre and the 'feeding' centre of the brain, the neurocircuitry that governs our body weight is now understood to consist of a complex, interconnected network, including the hypothalamus and extending to cortical sites, reward centres and brainstem. Neurons in these sites receive afferent signals from the gastrointestinal tract and adipose tissue indicating food availability, calorie content, as well as body fat mass. Discussion: Integration of these complex signals leads to modulation of the two prime effector systems that defend a body fat mass set point: food intake and energy expenditure. Conclusion: Understanding the hypothalamic control of food intake forms the foundation for understanding and managing obesity as a chronic disease. [ABSTRACT FROM AUTHOR]

Aim: To test the feasibility and acceptability of a reduced‐carbohydrate dietary program, intended to reduce the risk of gestational diabetes. Materials and Methods: Fifty‐one pregnant women at <20 weeks' gestation, with body mass index ≥30 kg/m2, and a normal baseline oral glucose tolerance test (OGTT), were randomized 2:1 to an intervention or control group and followed‐up until delivery. The dietary intervention aimed at providing 130–150 g carbohydrate/day. Feasibility outcomes assessed at 24–28 weeks' gestation, included adoption of the reduced‐carbohydrate diet by the intervention group, and retention of all participants, assessed by completion of a second OGTT. Changes in glycemia, weight gain and dietary intake, and the maternal and neonatal outcomes were also assessed. Participants were interviewed about their experience of the intervention and the study. Results: Forty‐nine of 51 participants attended the follow‐up OGTT, a retention rate of 96% (95% confidence interval [CI] 86.8%–98.9%). In the intervention group, carbohydrate intake at follow‐up was 190.4 (95% CI 162.5–215.6) g/day, a reduction of −24.6 (95% CI −51.5–2.4) g/day from baseline. Potentially favourable effects of the intervention on glucose control, weight gain and blood pressure were observed, but the study was not powered to detect significant differences in these. Participants found the intervention acceptable, and were content with the study processes, but some reported barriers to sustained adherence, mainly pertaining to competing priorities. Conclusions: Retention was high, suggesting the study processes are feasible, but the carbohydrate reduction in the intervention group was small, and did not meet progression criteria, limiting the likelihood of achieving the desired goal to prevent gestational diabetes. Trial registration number: ISRCTN16235884. [ABSTRACT FROM AUTHOR]

Aim: This trial assessed the efficacy and safety of 2.24 g intragastric expandable capsules twice per day versus placebo for weight management in adults with overweight or obesity. Methods: This double‐blind, placebo‐controlled study included adults with a body mass index of at least 24 kg/m2 and no more than 40 kg/m2. In total, 280 participants were recruited from six hospitals in China and were assigned in a 1:1 ratio to receive 2.24 g oral intragastric expandable capsules or placebo for 24 weeks. Coprimary endpoints were the percentage change in body weight from baseline and the rate of weight reduction of ≥5%, assessed using both the full analysis set and per protocol set. Results: At baseline, the mean body weight was 81.8 kg, and the mean body mass index was 29.4 kg/m2. The mean body weight change at week 24 was −4.9% with intragastric expandable capsules versus −1.9% with placebo [estimated treatment difference (ETD) −3.0%, 95% confidence interval (CI) −4.1 to −1.9; p <.001] using the full analysis set and −6.1% versus −2.5% (ETD −3.6%, 95% CI −5.0 to −2.3; p <.001), respectively, using the per protocol set. The percentage of participants who had weight loss exceeding 5% was 45.0% in the intragastric expandable capsule group versus 19.7% in the placebo group (ETD 25.3%, 95% CI 14.7‐35.9; p <.001) in the full analysis set and 55.9% versus 26.2% (ETD 29.6%, 95% CI 17.1‐42.2; p <.001), respectively, in the per protocol set. Waist circumference significantly decreased at week 24 (intragastric expandable capsules vs. placebo: −5.6 ± 8.3 cm vs. −2.9 ± 4.8 cm; p =.003). The most common adverse events associated with the use of intragastric expandable capsules were gastrointestinal disorders (intragastric expandable capsule vs. placebo, 25.0% vs. 21.9%), and most were mild and transient. Conclusions: In this 24‐week trial including participants with overweight or obesity, 2.24 g of intragastric expandable capsules twice daily led to a clinically meaningful reduction in body weight compared with placebo. [ABSTRACT FROM AUTHOR]

Amidst the obesity and type II diabetes mellitus (T2DM) epidemics, glucagon-like peptide-1 receptor agonists (GLP-1RAs) stand out as a promising therapeutic ally, achieving notable success in glycemic control and weight management. While GLP-1RAs' positive clinical outcomes are commendable, they introduce significant gastrointestinal (GI) challenges, emphasizing the pivotal role of gastroenterologists in understanding and managing these implications. Physicians should be vigilant of potential complications if endoscopy is indicated and considered. A protocol coined "The Three E's: Education, Escalation, and Effective Management" is essential as the first defense against GLP-1RA-induced dyspepsia, necessitating routine GI consultations. Awareness and intervention of potential aspiration due to GLP-1RA-induced gastroparesis are vital in clinical management. Furthermore, the evolving recognition of GLP-1RAs' beneficial effects on non-alcoholic steatohepatitis (NASH) suggests gastroenterologists will increasingly prescribe them. Thus, a comprehensive understanding of pharmacological properties and potential GI complications, including the undetermined cancer risk landscape, becomes paramount. This review accentuates the nuances of GLP-1RA therapy from a gastroenterological lens, juxtaposing the therapeutic potential, manageable side effects, and circumstantial challenges, ensuring that GI specialists remain at the forefront of holistic care in obesity and T2DM management. [ABSTRACT FROM AUTHOR]

Aim: To assess weight loss associated with liraglutide 3.0 mg treatment in individuals with obesity (body mass index [BMI] ≥30 kg/m2) or overweight (BMI > 27 to <30 kg/m2) in a reimbursed, real‐world setting in Switzerland. Materials and Methods: ADDRESS was a non‐comparative, multicentre, retrospective exposure cohort study in Switzerland, examining weight loss in individuals with obesity or overweight whose treatment was reimbursed (divided into BMI subgroups) or non‐reimbursed. The primary outcomes were proportions of participants in the reimbursed cohort achieving predefined weight loss targets with liraglutide 3.0 mg at Week 16 (≥5% and ≥7% for the lower BMI [28 to <35 kg/m2 with weight‐related comorbidities] and higher BMI [≥35 kg/m2] subgroups, respectively) and Month 10 (additional ≥5% from Week 16; per Swiss reimbursement criteria). Results: The full analysis set comprised 258 individuals (195 reimbursed; 63 non‐reimbursed). In the reimbursed cohort, 139 individuals (71.3%) achieved their weight loss targets at Week 16. Of individuals who met the Week‐16 criteria, 43.2% attained an additional 5% weight loss at Month 10. In 162 individuals for whom data were recorded at Month 10, the mean (standard deviation) relative weight loss from baseline to Month 10 was −12.4% (6.4%). Conclusions: Although reimbursement criteria may be difficult to achieve, particularly the additional weight loss of 5% from Week 16 to Month 10, a clinically relevant overall weight loss from baseline to Month 10 was shown in most individuals with obesity or overweight who received liraglutide 3.0 mg. [ABSTRACT FROM AUTHOR]

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Background: Cardiovascular disease (CVD) is a significant contributor to morbidity and mortality worldwide, with CVD and post-acute COVID-19 associated CVD increasing. It remains unknown whether COVID-19 patients with weight gain are at a high risk for CVD events. Therefore, the primary objective of this study is to investigate the association between weight control and the risk of CVD following COVID-19. Methods: The study included 2,024,728 adults who participated in two rounds of health screening between 2017 and 2020. The final cohort, which included 70,996 participants in the COVID-19 group and 212,869 participants in the control group. The adjusted hazard ratio of BMI change to CVD risk was calculated using Cox proportional hazards regression. Results: We identified a total of 2869 cases of CVD (861 events for COVID-19 group and 2,008 events for the control group). Compared to individuals with a stable BMI, COVID-19 patients without obesity had an increased risk of CVD (adjusted hazard ratio [aHR] = 2.28; 95% confidence interval [CI], 1.15–4.53; p-value = 0.018). Additionally, non-COVID-19 patients with obesity also exhibited a higher risk of CVD (aHR = 1.58; 95% CI, 1.01–2.47; p-value = 0.046). Conclusion: In conclusion, people who gained weight during the pandemic, regardless of their weight category, had a significantly higher risk of CVD associated with COVID-19 compared to those who maintained their weight before the pandemic. [ABSTRACT FROM AUTHOR]

Purpose: Orthorexia nervosa involves restricting diet based on quality rather than quantity. Although orthorexia is well reported in many at-risk populations, limited data addresses its presence in individuals with eating disorder history (EDs) or athletes. We aimed to identify the presence and potential drivers of orthorexia in adults with EDs and endurance athletes, compared to control subjects. Methods: Participants ≥ 18y included: people with a diagnosed eating disorder (ED as per DSM-5); endurance athletes (training/competing ≥ 5 h/week); or control subjects. Participants (n = 197) completed an online survey assessing orthorexia (eating habits questionnaire, EHQ), eating motivations (TEMS-B) and compulsive exercise (CET). Results: ED had the highest orthorexia symptom severity (92.0 ± 3.02, n = 32), followed by athletes (76.2 ± 2.74, n = 54) and controls (71.0 ± 1.80, n = 111) (F (2) = 18.2, p < 0.001). A strong positive correlation existed between weight control motives and higher orthorexia symptom severity (r = 0.54, 95% CI [1.35, 2.36], p < 0.001), while a weak negative association existed between Hunger and Pleasure motives and higher orthorexia symptom severity (r = 0.23, 95% CI [− 2.24, − 0.34], p = 0.008; r = 0.26, 95% CI [− 2.11, − 0.47], p = 0.002, respectively). A moderate positive relationship was found between CET and orthorexia symptom severity (95% CI [1.52, 3.12], p < 0.001). Conclusion: Adults with ED history and endurance athletes have greater orthorexia symptom severity compared to control. Clinicians working with at-risk populations should screen patients and be aware of red-flags of orthorexic traits, desire to control weight, and compulsive exercise behavior. Level of evidence: III: Evidence obtained from cohort studies. [ABSTRACT FROM AUTHOR]

Aims: We investigated the impact of intentional weight loss on health care resource utilization (HCRU) and costs among people with obesity. Materials and Methods: This retrospective, observational cohort study used data from the Clinical Practice Research Datalink (CPRD) GOLD database. Adults >18 years at index date [first recorded body mass index (BMI) of 30‐50 kg/m2 between 2006 and 2015 with a further BMI record 4 years later] were assigned to an intentional weight loss cohort (−25% to −10% BMI change) or a stable weight cohort (−3% to +3%), based on their BMI change during a 4‐year baseline period from index date. Evidence of intention to lose weight during the baseline period was required. Linked Hospital Episode Statistics datasets captured HCRU and costs over an 8‐year follow‐up period. Mixed effects models adjusted for demographics, total costs during baseline and baseline comorbidities were used. Results: Baseline characteristics were similar between cohorts with weight loss (n = 8676) and stable weight (n = 44 519). Over follow‐up, the weight loss cohort experienced a significantly lower mean annual increase in total costs [2.1% (95% confidence interval: 1.3‐2.8)] than the stable weight cohort [4.3% (95% confidence interval: 4.0‐4.6); p <.0001]. Weight loss was associated with a lower mean annual increase in multiple HCRU and cost components compared with maintaining a stable high weight. Conclusions: Our findings suggest that intentional weight loss of 10‐25% is associated with lower HCRU and costs in the long term among individuals living with obesity, relative to stable weight. [ABSTRACT FROM AUTHOR]

Obesity is a debilitating disease of global proportions that necessitates refined, concept‐driven therapeutic approaches. Policy makers, the public and even health care professionals, but also individuals with obesity harbour many misconceptions regarding this disease, which leads to prejudice, negative attitudes, stigmatization, discrimination, self‐blame, and failure to provide and finance adequate medical care. Decades of intensive, successful scientific research on obesity have only had a very limited effect on this predicament. We propose a science‐based, easy‐to‐understand conceptual model that synthesizes the complex pathogenesis of obesity including biological, psychological, social, economic and environmental aspects with the aim to explain and communicate better the nature of obesity and currently available therapeutic modalities. According to our integrative 'Behavioral Balance Model', 'top‐down cognitive control' strategies are implemented (often with limited success) to counterbalance the increased 'bottom‐up drive' to gain weight, which is triggered by biological, psycho‐social and environmental mechanisms in people with obesity. Besides offering a deeper understanding of obesity, the model also highlights why there is a strong need for multimodal therapeutic approaches that may not only increase top‐down control but also reduce a pathologically increased bottom‐up drive. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to assess overweight and obese pregnant women's beliefs related to weight control behaviors. Material: A descriptive study design was conducted from July 2nd 2022 to November 7th 2022. A random sample of (532) pregnant women was chosen. The study was conducted at randomly selected Primary Health Care Centers on right & left side of Mosul city. Results: The study finding showed the mean age of the participants was 27.2 ± 2.75 years, (84.02%) of them live in the city, (68.80%) are housewives, results also indicated that the mean score of participants’ beliefs related to weight control behaviors was low (25.5) for all subscales of health beliefs. Conclusions: The study showed that most of the overweight and obese pregnant women's beliefs related to weight control in general were low for all subscales of the Health Belief Model. [ABSTRACT FROM AUTHOR]

Roselle calyces (Hibiscus sabdariffa L.) were evaluated through a critical study of existing research works on health benefits, mineral compositions, bioactive compositions, mechanisms, and possible research gaps. The use of roselle calyces as an alternative to synthetic food dyes, addressing growing global challenges of overweight, obesity, and cardiovascular diseases, was evaluated and encouraged. Studies indicate the attenuation of obesity by chlorogenic acid (the predominant phenolic compound in roselle calyx) via mechanisms associated with the UCP-1 and PGC-1α pathways, resulting in reduced blood lipid levels, reduced fat accumulation in the liver, and increased thermogenesis through fat metabolism. Minimum inhibitory concentration (MIC) of known bacteria and fungi, such as Listeria monocytogenes, Escherichia coli, Bacillus cereus, Salmonella typhimurium, Candida tropicalis, and Candida krusei, were studied. More research, however, needs to be conducted on organic acids present in roselle calyces to look into their possible applications and maximize their possible benefits. [ABSTRACT FROM AUTHOR]

Objective: To identify the value of head rotation in the supine position and oral appliance (OA) use in drug‐induced sleep endoscopy (DISE). Study Design: Eighty‐three sleep apnea adults undergoing target‐controlled infusion‐DISE (TCI‐DISE) were recruited from a tertiary academic medical center. Setting: During DISE, 4 positions were utilized: supine position (position 1), head rotation (position 2), mandibular advancement using an OA (position 3), and head rotation with an OA (position 4). Methods: Polysomnography (PSG) data and anthropometric variables during DISE were analyzed. Results: Eighty‐three patients (65 men and 18 women; mean [standard deviation, SD], 48.5 [11.0] years) who underwent PSG and TCI‐DISE were included. The mean (SD) apnea–hypopnea index (AHI) was 35.5 (22.4) events/h. Twenty‐three patients had persistent complete concentric velopharyngeal collapse in the supine position, even with concurrent head rotation and OA (position 4). Their mean (SD) AHI was 54.7 (24.6) events/h, significantly higher than that of the 60 patients without such collapse in position 4 (p <.001). Their mean (SD) body mass index (BMI) was 29.0 (4.1) kg/m2, also significantly higher (p =.005). After adjustment for age, BMI, tonsil size, and tongue position, the degree of velum and tongue base obstruction was significantly associated with sleep apnea severity in positions 2, 3, and 4. Conclusion: We showed the feasibility, safety, and usefulness of using simple edge‐to‐edge, reusable OA in DISE. Patients who are not responsive to head rotation and OA during TCI‐DISE may need upper airway surgery and/or weight control. [ABSTRACT FROM AUTHOR]

Aim: To develop and investigate an imbalanced dual gastric inhibitory polypeptide receptor (GIPR)/glucagon‐like peptide‐1 receptor (GLP‐1 R) agonist with Fc fusion protein structure. Methods: We designed and constructed an Fc fusion protein that is a dual agonist (HEC‐CG115) with an empirically optimized potency ratio for GLP‐1R and GIPR. The long‐term effects of HEC‐CG115 on body weight and glycaemic control were evaluated in diet‐induced obese mice and diabetic db/db mice. Repeat dose toxicity assays were performed to investigate the safety profile of HEC‐CG115 in Sprague‐Dawley rats. Results: HEC‐CG115 displayed high potency for GIPR and relatively low potency for GLP‐1R, and we labelled it 'imbalanced'. In animal models, HEC‐CG115 (3 nmol/kg) led to more weight loss than semaglutide at a higher dose (10 nmol/kg) in diet‐induced obese model mice. HEC‐CG115 (one dose every 3 days) reduced fasting blood glucose and glycated haemoglobin levels similar to those after semaglutide (once daily) at the same dose. In a 4‐week subcutaneous toxicity study conducted to assess the biosafety of HEC‐CG115, the no observed adverse effect level was determined to be 3 mg/kg. Conclusion: HEC‐CG115 is a novel Fc fusion protein with imbalanced dual agonism that shows superior weight loss, glycaemic control and metabolic improvement in animal models, and has an optimal safety profile according to a repeat‐dose toxicity study. Therefore, the use of HEC‐CG115 appears to be safe and effective for the treatment of obesity and type 2 diabetes. [ABSTRACT FROM AUTHOR]

Steady growth in beer production is increasing the number of by-products named brewers' spent grain. Such by-products are a source of several components, where cellulose is usually present in high amounts. The aim of this study was to develop a protocol to obtain a mix of cellulose microfibers with an average diameter of 8–12 µm and cellulose nanoplatelets with an average thickness of 100 nm, which has several applications in the food industry. The process comprised one alkaline treatment followed by acid hydrolysis, giving a new mix of micro and nanocellulose. This mix was characterized by Fourier transform infrared spectroscopy, scanning electron microscopy, and laser scanning microscopy corroborating the presence and measurements of the cellulose nanostructure, showing an aspect ratio of up to 500. Finally, we demonstrated that the administration of this new type of nanocellulose allowed us to control the weight of mice (feed intake), showing a significant percentage of weight reduction (4.96%) after 15 days compared with their initial weight, indicating the possibility of using this material as a dietary fiber. [ABSTRACT FROM AUTHOR]

Dietary intake of medium-chain triacylglycerols (MCTs) is known to alleviate obesity. MCTs have also been suggested to beneficially influence protein metabolism. This study evaluated the effects of dietary intake of MCTs on energy restriction-induced weight control and loss of skeletal muscle. Rats were divided into the following groups: 1) AL-LCT group that received the AIN-93G-based control diet containing longchain triacylglycerols (LCTs) ad libitum, 2) ER-LCT group fed the control diet with 30% energy restriction, and 3) ER-MCT group fed a diet containing MCTs with 30% energy restriction. After the 4-wk dietary treatment, both energy-restricted groups had significantly lower body weight than the AL-LCT group and rats in the ER-MCT group were significantly lighter than those in the ER-LCT group. In contrast, the extent of energy restriction-induced loss of skeletal muscle was not significantly different between the two energy-restricted groups, resulting in an increase in muscle mass relative to body weight in the ER-MCT group. Despite maintaining the lower body weight, dietary intake of MCTs did not further influence signaling pathways involved in protein synthesis or breakdown. These results suggest that intake of MCTs could be a valuable dietary intervention to maintain a lower body weight and increase relative muscle mass without negative effects on skeletal muscle protein metabolism. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the safety, tolerability, pharmacokinetics and pharmacodynamics of single and multiple doses of orforglipron (LY3502970), an oral, non‐peptide glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) in healthy participants. Materials and Methods: This was a double‐blind, placebo‐controlled, Phase 1 study. Overtly healthy adults aged 18 to 65 years with body mass index of 20 to 40 kg/m2 and glycated haemoglobin concentration of 47.5 mmol/mol (<6.5%) were eligible. In Part A, participants received single‐dose orforglipron, with four cohorts receiving escalating doses (0.3‐6 mg). In Part B, participants received 4 weeks of daily repeated oral orforglipron with doses escalating weekly to four different final target doses (2‐24 mg). Results: Ninety‐two participants enrolled and received at least one study drug dose (32 in Part A [mean age 43.4 years] and 60 in Part B [mean age 42.5 years]). The most common adverse events were gastrointestinal tract‐related. Pharmacokinetics were approximately dose proportional, and the mean t1/2 was 24.6 to 35.3 hours after a single dose (0.3‐6 mg). On Day 28, the mean t1/2 was 48.1 to 67.5 hours across the dose range (2‐24 mg). Substantial reductions in body weight of up to 5.4 kg were observed after 4 weeks in orforglipron‐treated participants, compared to a reduction of 2.4 kg with placebo (P < 0.05). Orforglipron decreased fasting glucose levels across Days 1 to 28, and gastric emptying was delayed on Day 28. Conclusions: Orforglipron's long half‐life (25‐68 hours) allows once‐daily oral dosing, without water and food restrictions. Orforglipron had a pharmacodynamic and safety profile similar to that of injectable GLP‐1RAs, which supports continued clinical development. [ABSTRACT FROM AUTHOR]

The novel GIP, GLP-1 and glucagon receptor agonist retatrutide delays gastric emptying Keywords: GIP; GLP-1; glucagon; type 2 diabetes; weight control EN GIP GLP-1 glucagon type 2 diabetes weight control 2784 2788 5 08/03/23 20230901 NES 230901 INTRODUCTION Delayed gastric emptying (GE) is a well-known effect of glucagon-like peptide-1 (GLP-1).[[1]] Similarly, glucagon (GCG) has been shown to slow GE in rodents and humans,[[3]] while glucose-dependent insulinotropic polypeptide (GIP) does not appear to impact GE.[[1]] Retatrutide (LY3437943) is a novel GIP/GLP-1/GCG receptor agonist (RA) under investigation for chronic weight management and its complications. LY3437943, a novel triple GIP, GLP-1, and glucagon receptor agonist in people with type 2 diabetes: a phase 1b, multicentre, double-blind, placebo-controlled, randomised, multiple-ascending dose trial. The maximum extent of GE delay observed with retatrutide was similar to that previously noted with tirzepatide.[12] The magnitude of GE inhibition was lower following subsequent retatrutide doses and appeared to be diminishing at Days 30 and 79, despite ongoing dose escalation in the two highest dose retatrutide groups. [Extracted from the article]

Aim: To report the results of a Phase 1b trial evaluating the safety, pharmacokinetics and pharmacodynamics of orforglipron (LY3502970), an oral, non‐peptide glucagon‐like peptide‐1 receptor agonist (GLP‐1RA), in patients with type 2 diabetes (T2D). Materials and Methods: This was a double‐blind, placebo‐controlled Phase 1 study evaluating five different dosing regimens. The first group established that weekly dose escalation of the daily doses of orforglipron was generally well tolerated. This enabled a parallel‐arm design for the four groups following. Participants were randomized 3:1 to daily doses of orforglipron or placebo for 12 weeks. Eligible participants with T2D were aged 18 to 70 years and had glycated haemoglobin (HbA1c) levels ≥53.0 mmol/mol (7.0%) and ≤91.3 mmol/mol (10.5%). Results: A total of 51 participants received orforglipron and 17 received placebo. In the placebo and orforglipron groups, respectively, baseline HbA1c was 8.1% and 8.0%, and baseline body weight was 90.3 and 88.4 kg. The most common adverse events were gastrointestinal‐related, and occurred early in treatment, similar to findings with other GLP‐1RAs. At Week 12, mean t1/2 ranged from 29 to 49 hours. Mean HbA1c change ranged from −1.5% to −1.8% across orforglipron doses, versus −0.4% with placebo, and body weight change was −0.24 to −5.8 kg across orforglipron doses, versus 0.5 kg with placebo. Conclusions: Orforglipron treatment resulted in meaningful reductions in HbA1c and body weight, with an adverse event profile consistent with that of other GLP‐1RAs. Orforglipron may provide a safe and effective once‐daily oral treatment alternative to injectable GLP‐1RAs or peptide oral formulations without water and food restrictions. [ABSTRACT FROM AUTHOR]

Aims: To examine associations between weight loss/gain and risk of developing 13 obesity‐related complications (ORCs), stratified by baseline body mass index (BMI). Materials and Methods: In this retrospective cohort study, we included adults with obesity (>30 kg/m2) from the UK Clinical Practice Research Datalink GOLD database with weight change (−50% to +50%) between Years 1 and 4 (N = 418 774 [median follow‐up: 7 years]). Associations between weight change, baseline BMI and risk of developing ORCs during follow‐up were assessed using Cox proportional hazard models. Results: The impact of weight change on ORCs was generally dependent on baseline BMI. Four clear patterns were seen across the 13 outcomes. Pattern 1 showed greatest weight loss benefit for people with low baseline BMI (type 2 diabetes, sleep apnoea, hypertension and dyslipidaemia); Pattern 2 showed most weight loss benefit at lower baseline BMI but no significant weight loss effect at higher baseline BMI (asthma, hip/knee osteoarthritis and polycystic ovary syndrome); Pattern 3 showed benefit in most cardiovascular diseases with weight loss (chronic kidney disease, heart failure, atrial fibrillation and venous thromboembolism), but no additional benefit with >10% weight loss; Pattern 4 showed no clear relationship between weight change and unstable angina/myocardial infarction and depression. We found similar but opposite patterns for weight gain. Conclusions: Weight loss benefit is dependent on weight loss magnitude and initial BMI, and weight gain is associated with a similar risk increase. Four patterns of association were identified between degree of weight change, baseline BMI and 13 ORCs. [ABSTRACT FROM AUTHOR]

Aim: Weight bias, stigma and discrimination are pervasive in the health care system and society and may result in biased treatment of people living with obesity (PwO). We aimed to identify perceptions, attitudes and potential barriers that exist between people with obesity and health care professionals (HCPs) in Denmark. Methods: The ACTION‐DK survey was a cross‐sectional, non‐interventional, descriptive study conducted in Denmark. The cohort included 879 PwO (body mass index ≥30.0 kg/m2) based on self‐reported height and body weight, and 100 HCPs from the primary and secondary sectors who frequently encountered PwO. Results: Several discrepancies between PwO and HCPs were identified, including recognition of obesity as a chronic disease (PwO: 49% vs. HCPs: 84%) and whether PwO were responsible for their weight loss (PwO: 81% vs. HCPs: 17%). Among PwO, 46% were motivated to lose weight, but only 28% of HCPs shared this perception. Untimely initiation of obesity care consultations was also identified as a potential barrier to proper obesity care, as PwO waited 7 years, on average, from their initial decision to lose weight before having their first obesity care consultation. In addition, only 24% of PwO had a follow‐up consultation after the initial obesity care discussion. Almost half of HCPs (46%) considered weight loss medication effective, but only 10% brought up this possibility during an obesity care discussion. Conclusions: Our findings suggest that it is pivotal to improve obesity care in Denmark by ensuring a better follow‐up and alignment of the perceptions and attitudes toward obesity between PwO and HCPs. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to assess overweight and obese pregnant women's beliefs related to weight control behaviors. Material: A descriptive study design was conducted from July 2nd 2022 to November 7th 2022. A random sample of (532) pregnant women was chosen. The study was conducted at randomly selected Primary Health Care Centers on right & left side of Mosul city. Results: The study finding showed the mean age of the participants was 27.2 ± 2.75 years, (84.02%) of them live in the city, (68.80%) are housewives, results also indicated that the mean score of participants' beliefs related to weight control behaviors was low (25.5) for all subscales of health beliefs. Conclusions: The study showed that most of the overweight and obese pregnant women's beliefs related to weight control in general were low for all subscales of the Health Belief Model. [ABSTRACT FROM AUTHOR]

Background: Lack of adherence is a primary reason people fail to maintain a healthy diet or lose weight. Multiple environmental factors, including aggressive marketing and convenience of nutrient‐poor food, undermine people's best intentions. The aim was to assess the feasibility, acceptability and impact of food prescriptions in which participants' exposure to commercial food outlets is reduced, because the groceries are delivered with weekly menu plans and recipes. Methods: This is a series of pre‐post pilot proof‐of‐concept studies. We recruited 37 members of Kaiser Permanente interested in improving their diet or losing weight. Weekly meal plans meeting more than 90% of recommended dietary allowances were designed to be low cost, in line with Supplemental Nutrition Assistance Program (SNAP) allowances. Five separate pilots targeted different populations. Participants were required to provide 24‐h dietary recalls (ASA24) before and during the interventions. Weight management pilot participants had height, weight and blood pressure measured before and after 4‐week pilots and followed sustainability guidelines, limiting meat and dairy. Results: Across pilots, the healthy eating index improved (+21.1 points; 95% CI [confidence interval] 15.9, 26.3). For the weight management pilots, most participants lost weight (average 10.3 lbs for men, 5.7 lbs for women; 95% CI −10.2, −5.4). The majority of participants liked the programme and considered it the easiest weight loss programme they ever tried. Conclusions: These pilots suggest that meal planning and grocery delivery can be affordable and acceptable and could ultimately have a major impact on diet‐related chronic diseases. Longer‐term studies are needed to confirm how long compliance will endure. Key points: Healthy groceries meeting recommended dietary allowances and sustainability guidelines are affordable and fall within Supplemental Nutrition Assistance Program maximum allotments for <2000 calories per person per day.Menu planning and grocery delivery resulted in significant improvements in the healthy eating index.For overweight/obese individuals, 1500‐calorie meal plans/groceries resulted in significant weight loss among most participants. [ABSTRACT FROM AUTHOR]