Pub Date : 2025-07-22DOI: 10.1016/j.obpill.2025.100198
Roohi Y. Kharofa , Sanita L. Ley , Kristin M. Stackpole , Jessica A. Lin , Carolina M. Bejarano , Katelyn Gordon , Shelley Kirk , Melissa Burbrink , Robert M. Siegel
Background
Adolescents with obesity are at increased risk for disordered eating behaviors (DEBs). Despite screening being recommended, identification of DEBs in pediatric weight management (PWM) remains inadequate.
Methods
The aim of this quality improvement project was to increase provider documentation of screening for DEBs from 44 % to 80 % for new patients, age ≥12, seen at a PWM program over a 10-month period. Interventions were grouped into four PDSA cycles: 1. Provider education, 2. Screening tool implementation, 3. Systematic use of screening tool, and 4. Implementation of an electronic screener. The primary outcome was the percent of patients with documentation of DEB screening. Data was plotted on a p-chart. Standard statistical process control methods were used.
Results
Mean documentation rates for DEBs increased from a baseline of 44 %–85 %, with special cause analysis demonstrating improvement. Referrals for DEBs increased from 13 % at baseline to 19 %.
Conclusion
Consistently screening for disordered eating behaviors in pediatric weight management is feasible. Quality improvement methodology can be utilized to help identify and act on facilitators and barriers to screening. Improved screening may lead to earlier identification of high-risk patients and prompt referral to mental health practitioners.
{"title":"Improving screening for disordered eating behaviors in pediatric weight management using quality improvement methodology","authors":"Roohi Y. Kharofa , Sanita L. Ley , Kristin M. Stackpole , Jessica A. Lin , Carolina M. Bejarano , Katelyn Gordon , Shelley Kirk , Melissa Burbrink , Robert M. Siegel","doi":"10.1016/j.obpill.2025.100198","DOIUrl":"10.1016/j.obpill.2025.100198","url":null,"abstract":"<div><h3>Background</h3><div>Adolescents with obesity are at increased risk for disordered eating behaviors (DEBs). Despite screening being recommended, identification of DEBs in pediatric weight management (PWM) remains inadequate.</div></div><div><h3>Methods</h3><div>The aim of this quality improvement project was to increase provider documentation of screening for DEBs from 44 % to 80 % for new patients, age ≥12, seen at a PWM program over a 10-month period. Interventions were grouped into four PDSA cycles: 1. Provider education, 2. Screening tool implementation, 3. Systematic use of screening tool, and 4. Implementation of an electronic screener. The primary outcome was the percent of patients with documentation of DEB screening. Data was plotted on a p-chart. Standard statistical process control methods were used.</div></div><div><h3>Results</h3><div>Mean documentation rates for DEBs increased from a baseline of 44 %–85 %, with special cause analysis demonstrating improvement. Referrals for DEBs increased from 13 % at baseline to 19 %.</div></div><div><h3>Conclusion</h3><div>Consistently screening for disordered eating behaviors in pediatric weight management is feasible. Quality improvement methodology can be utilized to help identify and act on facilitators and barriers to screening. Improved screening may lead to earlier identification of high-risk patients and prompt referral to mental health practitioners.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100198"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-19DOI: 10.1016/j.obpill.2025.100197
Fábio de Freitas , Mariana R. Zago , Maria Ângela Antônio , António Videira-Silva , Maria Ângela Bellomo Brandão
Background
Motivation is essential in turning the intention to engage in physical activity (PA) into consistent action, promoting healthier and more sustainable habits. This study aimed to identify the motivational factors associated with engagement in a PA program and examine the relationship between motivation and body composition in adolescents with obesity.
Methods
Fifty adolescents (60.0 % boys); Median age of 13.6 years (IQR: 2.4); Median BMI z-score of 3.42 (IQR: 1.55) recruited for a PA program were included in this cross-sectional study. All participants completed standardized body composition assessments and an online questionnaire assessing five motivational domains: enjoyment and competence (intrinsic), and appearance, fitness, and social (extrinsic domains).
Results
Fitness emerged as the main reason for engaging in the PA program (6.41 ± 0.81), followed by appearance (5.64 ± 1.43), enjoyment (4.98 ± 1.47), competence (4.55 ± 1.99), and social (3.79 ± 1.85). Enjoyment and competence showed significant negative associations with body weight. (rp = −0.29, p = 0.045; rp = −0.32, p = 0.027). Regression analysis identified fitness as a significant predictor for BMI z-score (β = 0.4, p = 0.027).
Conclusion
Extrinsic motives, such as fitness and appearance may drive PA engagement in treatment-seeking adolescents with obesity. However, intrinsic motives, such as enjoyment and competence, may be inversely associated with BMI z-score. Thus, targeting both extrinsic and intrinsic motivation may help to improve adherence and weight outcomes in obesity care. More studies with larger samples are needed to confirm these findings.
{"title":"Cross-sectional associations between intrinsic and extrinsic motivation for physical activity and body composition in adolescents with obesity","authors":"Fábio de Freitas , Mariana R. Zago , Maria Ângela Antônio , António Videira-Silva , Maria Ângela Bellomo Brandão","doi":"10.1016/j.obpill.2025.100197","DOIUrl":"10.1016/j.obpill.2025.100197","url":null,"abstract":"<div><h3>Background</h3><div>Motivation is essential in turning the intention to engage in physical activity (PA) into consistent action, promoting healthier and more sustainable habits. This study aimed to identify the motivational factors associated with engagement in a PA program and examine the relationship between motivation and body composition in adolescents with obesity.</div></div><div><h3>Methods</h3><div>Fifty adolescents (60.0 % boys); Median age of 13.6 years (IQR: 2.4); Median BMI z-score of 3.42 (IQR: 1.55) recruited for a PA program were included in this cross-sectional study. All participants completed standardized body composition assessments and an online questionnaire assessing five motivational domains: enjoyment and competence (intrinsic), and appearance, fitness, and social (extrinsic domains).</div></div><div><h3>Results</h3><div>Fitness emerged as the main reason for engaging in the PA program (6.41 ± 0.81), followed by appearance (5.64 ± 1.43), enjoyment (4.98 ± 1.47), competence (4.55 ± 1.99), and social (3.79 ± 1.85). Enjoyment and competence showed significant negative associations with body weight. (<em>r</em><sub><em>p</em></sub> = −0.29, p = 0.045; <em>r</em><sub><em>p</em></sub> = −0.32, p = 0.027). Regression analysis identified fitness as a significant predictor for BMI z-score (β = 0.4, p = 0.027).</div></div><div><h3>Conclusion</h3><div>Extrinsic motives, such as fitness and appearance may drive PA engagement in treatment-seeking adolescents with obesity. However, intrinsic motives, such as enjoyment and competence, may be inversely associated with BMI z-score. Thus, targeting both extrinsic and intrinsic motivation may help to improve adherence and weight outcomes in obesity care. More studies with larger samples are needed to confirm these findings.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100197"},"PeriodicalIF":0.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144686543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-08DOI: 10.1016/j.obpill.2025.100195
Brittany V.B. Johnson, Mary Milstead, Lauren Green, Rachel Kreider, Rachel Jones
Background
With the rise of glucagon-like-peptide-1 receptor agonist medications (GLP-1RA) for obesity treatment, understanding diet quality can be a valuable tool for providing evidence-based nutrition guidance. However, there is limited data on dietary intake during GLP-1RA treatment. Thus, we analyzed diet quality and nutrient timing while using GLP-1RA.
Methods
This was a secondary analysis from a previous cross-sectional online survey questionnaire study involving adults currently using GLP-1RA for weight reduction (N = 69, 49.6 ± 12.3 years old, 35.9 ± 9.1 kg/m2). Three-day food records were analyzed using the Healthy Eating Index (HEI), a validated score that indicates overall diet quality. The 13 HEI components were scored from average 3-day food records and calculated using 95 % confidence intervals (CI). A Bonferroni correction applied significance accepted at p = 0.0038. Additionally, 95 % CI were calculated for calories, macronutrients, and fiber intake reported for breakfast, lunch, dinner, and snacks.
Results
A 95 % CI revealed a total HEI score of 54 ± 12 (51.4, 57.3), significantly below the HEI goal (p < 0.0038). All components, except added sugars, were significantly under the max score. There was no significant difference for HEI scores based on duration of GLP-1RA use. The largest number of calories were consumed at dinner, averaging 649 compared to 538, 392, and 391 calories at lunch, breakfast, and snacks, respectively. Further, 40 % of the total daily protein intake occurred at dinnertime.
Conclusion
Within the sample of patients using GLP-1RAs, dietary quality was suboptimal for fruits, vegetables, whole grains, seafood and plant proteins, dairy and fatty acids. Future research is needed to determine if HEI scores change before, during, and after GLP-1RA treatments and nutrient timing.
{"title":"Diet quality and nutrient distribution while using glucagon-like-peptide-1 receptor agonist: A secondary cross-sectional analysis","authors":"Brittany V.B. Johnson, Mary Milstead, Lauren Green, Rachel Kreider, Rachel Jones","doi":"10.1016/j.obpill.2025.100195","DOIUrl":"10.1016/j.obpill.2025.100195","url":null,"abstract":"<div><h3>Background</h3><div>With the rise of glucagon-like-peptide-1 receptor agonist medications (GLP-1RA) for obesity treatment, understanding diet quality can be a valuable tool for providing evidence-based nutrition guidance. However, there is limited data on dietary intake during GLP-1RA treatment. Thus, we analyzed diet quality and nutrient timing while using GLP-1RA.</div></div><div><h3>Methods</h3><div>This was a secondary analysis from a previous cross-sectional online survey questionnaire study involving adults currently using GLP-1RA for weight reduction (N = 69, 49.6 ± 12.3 years old, 35.9 ± 9.1 kg/m2). Three-day food records were analyzed using the Healthy Eating Index (HEI), a validated score that indicates overall diet quality. The 13 HEI components were scored from average 3-day food records and calculated using 95 % confidence intervals (CI). A Bonferroni correction applied significance accepted at p = 0.0038. Additionally, 95 % CI were calculated for calories, macronutrients, and fiber intake reported for breakfast, lunch, dinner, and snacks.</div></div><div><h3>Results</h3><div>A 95 % CI revealed a total HEI score of 54 ± 12 (51.4, 57.3), significantly below the HEI goal (p < 0.0038). All components, except added sugars, were significantly under the max score. There was no significant difference for HEI scores based on duration of GLP-1RA use. The largest number of calories were consumed at dinner, averaging 649 compared to 538, 392, and 391 calories at lunch, breakfast, and snacks, respectively. Further, 40 % of the total daily protein intake occurred at dinnertime.</div></div><div><h3>Conclusion</h3><div>Within the sample of patients using GLP-1RAs, dietary quality was suboptimal for fruits, vegetables, whole grains, seafood and plant proteins, dairy and fatty acids. Future research is needed to determine if HEI scores change before, during, and after GLP-1RA treatments and nutrient timing.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100195"},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-03DOI: 10.1016/j.obpill.2025.100194
Jennifer L. Warnick , Katherine E. Darling , Smriti Maskey , Lisa Swartz Topor , Katelyn Fox , KayLoni Olson , Elissa Jelalian
Background
The prevalence of obesity among youth with type 1 diabetes (T1D) has significantly increased over the past few decades, leading to increased risks for morbidity and early mortality. Despite this growing need, there is a dearth of evidence-based intensive health behavior and lifestyle treatments (IHBLT) for youth with T1D. This study collected qualitative data from adolescents with T1D and with comorbid overweight/obesity and their caregivers to inform the refinement of an IHBLT specific to adolescents with T1D.
Methods
This is an original clinical research study. Participants completed individual semi-structured interviews to provide feedback on planned session topics, handouts, and activities for a modified IHBLT for T1D. A deductive framework matrix analysis approach was used to analyze data. All data were analyzed by two independent coders who met to discuss divergence in coding and came to 100 % agreement. Codes were iteratively reduced and organized into themes.
Results
Sixteen participants (n = 8 adolescents, n = 8 caregivers) completed qualitative interviews. Three main themes emerged from the data: (1) satisfaction with the proposed program, (2) program structure preferences, and (3) suggested adaptations.
Conclusions
The adapted IHBLT for adolescents with T1D seems to be initially acceptable to the target population. Results provide suggestions for the continued refinement of an IHBLT specific to adolescents with T1D.
{"title":"Creating an adolescent intensive health behavior and lifestyle treatment for type 1 diabetes: Feedback from the target population","authors":"Jennifer L. Warnick , Katherine E. Darling , Smriti Maskey , Lisa Swartz Topor , Katelyn Fox , KayLoni Olson , Elissa Jelalian","doi":"10.1016/j.obpill.2025.100194","DOIUrl":"10.1016/j.obpill.2025.100194","url":null,"abstract":"<div><h3>Background</h3><div>The prevalence of obesity among youth with type 1 diabetes (T1D) has significantly increased over the past few decades, leading to increased risks for morbidity and early mortality. Despite this growing need, there is a dearth of evidence-based intensive health behavior and lifestyle treatments (IHBLT) for youth with T1D. This study collected qualitative data from adolescents with T1D and with comorbid overweight/obesity and their caregivers to inform the refinement of an IHBLT specific to adolescents with T1D.</div></div><div><h3>Methods</h3><div>This is an original clinical research study. Participants completed individual semi-structured interviews to provide feedback on planned session topics, handouts, and activities for a modified IHBLT for T1D. A deductive framework matrix analysis approach was used to analyze data. All data were analyzed by two independent coders who met to discuss divergence in coding and came to 100 % agreement. Codes were iteratively reduced and organized into themes.</div></div><div><h3>Results</h3><div>Sixteen participants (<em>n</em> = 8 adolescents, <em>n</em> = 8 caregivers) completed qualitative interviews. Three main themes emerged from the data: (1) satisfaction with the proposed program, (2) program structure preferences, and (3) suggested adaptations.</div></div><div><h3>Conclusions</h3><div>The adapted IHBLT for adolescents with T1D seems to be initially acceptable to the target population. Results provide suggestions for the continued refinement of an IHBLT specific to adolescents with T1D.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100194"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.obpill.2025.100191
Jessica Stockham , Shannon Harris , William Berard
Background
Obesity is a complex, chronic disease requiring time-intensive, multifaceted management strategies that are often difficult to implement in primary care. This quality improvement project aimed to evaluate whether the integration of an online motivational support group via Facebook, in addition to routine monthly office visits, could enhance obesity treatment outcomes and patient motivation in a primary care setting. As a nurse practitioner driven project, nurse practitioners have the training to make significant improvements in the area of obesity treatment. Nurse practitioners are key in providing patients with education and tools to help patients lose weight and maintain successful weight loss (Fruh, 2017) [1].
Methods
This was a quality improvement project using a pre-post design conducted at a private outpatient internal medicine clinic. Adult patients (n = 68) with a BMI ≥30 or ≥25 with comorbidities were enrolled. Participants joined a Facebook-based support group and received standardized education and monthly in-person follow-up for 12 weeks. Outcomes measured before and after the intervention included weight, BMI, waist circumference, and responses to the Weight Efficacy Lifestyle Questionnaire-Short Form (WEL-SF). Paired t-tests were used for statistical analysis.
Results
Statistically significant improvements were observed in weight (−9.46 lbs, p < 0.0001), BMI (−1.91, p < 0.0001), and waist circumference (−1.87 inches, p < 0.0001). WEL-SF scores improved significantly in 7 of 8 domains, with an average increase of 11.8 %, indicating enhanced self-efficacy and motivation for healthy eating behaviors.
Conclusion
The integration of an online motivational support platform with monthly in-office visits significantly improved physiologic outcomes and patient self-efficacy in managing obesity. These findings support the feasibility and potential benefit of low-cost digital support tools in augmenting outpatient obesity care, particularly in settings with limited resources. Further research should explore the impact of engagement level and long-term outcomes.
{"title":"Improving obesity treatment through online motivational support in primary care","authors":"Jessica Stockham , Shannon Harris , William Berard","doi":"10.1016/j.obpill.2025.100191","DOIUrl":"10.1016/j.obpill.2025.100191","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is a complex, chronic disease requiring time-intensive, multifaceted management strategies that are often difficult to implement in primary care. This quality improvement project aimed to evaluate whether the integration of an online motivational support group via Facebook, in addition to routine monthly office visits, could enhance obesity treatment outcomes and patient motivation in a primary care setting. As a nurse practitioner driven project, nurse practitioners have the training to make significant improvements in the area of obesity treatment. Nurse practitioners are key in providing patients with education and tools to help patients lose weight and maintain successful weight loss (Fruh, 2017) [1].</div></div><div><h3>Methods</h3><div>This was a quality improvement project using a pre-post design conducted at a private outpatient internal medicine clinic. Adult patients (n = 68) with a BMI ≥30 or ≥25 with comorbidities were enrolled. Participants joined a Facebook-based support group and received standardized education and monthly in-person follow-up for 12 weeks. Outcomes measured before and after the intervention included weight, BMI, waist circumference, and responses to the Weight Efficacy Lifestyle Questionnaire-Short Form (WEL-SF). Paired t-tests were used for statistical analysis.</div></div><div><h3>Results</h3><div>Statistically significant improvements were observed in weight (−9.46 lbs, <em>p</em> < 0.0001), BMI (−1.91, <em>p</em> < 0.0001), and waist circumference (−1.87 inches, <em>p</em> < 0.0001). WEL-SF scores improved significantly in 7 of 8 domains, with an average increase of 11.8 %, indicating enhanced self-efficacy and motivation for healthy eating behaviors.</div></div><div><h3>Conclusion</h3><div>The integration of an online motivational support platform with monthly in-office visits significantly improved physiologic outcomes and patient self-efficacy in managing obesity. These findings support the feasibility and potential benefit of low-cost digital support tools in augmenting outpatient obesity care, particularly in settings with limited resources. Further research should explore the impact of engagement level and long-term outcomes.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100191"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144721829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pediatric obesity presents complex challenges in children with underlying endocrine disorders. In patients with optic nerve hypoplasia (ONH) and hypothalamic-pituitary dysfunction, lifestyle changes alone are often ineffective for obesity treatment. This case report describes targeted pharmacologic interventions for severe early-onset obesity in a child with ONH and multiple pituitary hormone deficiencies.
Case presentation
A Hispanic female was diagnosed at 45 days of life with ONH and central arginine vasopressin deficiency, central hypothyroidism, secondary adrenal insufficiency, and growth hormone deficiency. Despite early interventions, her weight-for-length percentile rose from the 65th to >97th by nine months, with continued acceleration to body mass index (BMI) of 52 kg/m2 by age 5. Topiramate 100 mg nightly was initiated, with some associated appetite suppression and weight deceleration appreciated. Weight continued to increase during the COVID-19 pandemic, and at age 6, the dose of topiramate was increased (200 mg nightly) and phentermine 15 mg daily was added. An 11 % BMI reduction was observed over the subsequent 12 months, leading to BMI of 47 kg/m2 at age 7. Due to persistent and worsening obstructive sleep apnea (OSA) despite BMI reduction, semaglutide was then initiated, with ramp-up to 2.4 mg weekly, resulting in BMI reduction of 30 % over 24 months with triple-agent therapy, and associated resolution of OSA, elevated liver enzymes, and hypertriglyceridemia.
Discussion
This case highlights the potential role and therapeutic benefit of early, targeted pharmacologic intervention in managing severe obesity in pediatric patients with hypothalamic dysfunction and ONH. In a setting where lifestyle modifications alone are insufficient, the use of combination obesity medications resulted in substantial and sustained BMI reduction, alongside resolution of obesity-related comorbidities. These findings underscore the need for proactive, individualized treatment strategies in complex pediatric obesity.
{"title":"Use of obesity medications in a young pediatric patient with optic nerve hypoplasia and severe early-onset obesity: A case report","authors":"Armine Simonian , Emily Sousa , Kamran Samakar , Alaina P. Vidmar","doi":"10.1016/j.obpill.2025.100192","DOIUrl":"10.1016/j.obpill.2025.100192","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric obesity presents complex challenges in children with underlying endocrine disorders. In patients with optic nerve hypoplasia (ONH) and hypothalamic-pituitary dysfunction, lifestyle changes alone are often ineffective for obesity treatment. This case report describes targeted pharmacologic interventions for severe early-onset obesity in a child with ONH and multiple pituitary hormone deficiencies.</div></div><div><h3>Case presentation</h3><div>A Hispanic female was diagnosed at 45 days of life with ONH and central arginine vasopressin deficiency, central hypothyroidism, secondary adrenal insufficiency, and growth hormone deficiency. Despite early interventions, her weight-for-length percentile rose from the 65th to >97th by nine months, with continued acceleration to body mass index (BMI) of 52 kg/m<sup>2</sup> by age 5. Topiramate 100 mg nightly was initiated, with some associated appetite suppression and weight deceleration appreciated. Weight continued to increase during the COVID-19 pandemic, and at age 6, the dose of topiramate was increased (200 mg nightly) and phentermine 15 mg daily was added. An 11 % BMI reduction was observed over the subsequent 12 months, leading to BMI of 47 kg/m<sup>2</sup> at age 7. Due to persistent and worsening obstructive sleep apnea (OSA) despite BMI reduction, semaglutide was then initiated, with ramp-up to 2.4 mg weekly, resulting in BMI reduction of 30 % over 24 months with triple-agent therapy, and associated resolution of OSA, elevated liver enzymes, and hypertriglyceridemia.</div></div><div><h3>Discussion</h3><div>This case highlights the potential role and therapeutic benefit of early, targeted pharmacologic intervention in managing severe obesity in pediatric patients with hypothalamic dysfunction and ONH. In a setting where lifestyle modifications alone are insufficient, the use of combination obesity medications resulted in substantial and sustained BMI reduction, alongside resolution of obesity-related comorbidities. These findings underscore the need for proactive, individualized treatment strategies in complex pediatric obesity.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100192"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-30DOI: 10.1016/j.obpill.2025.100188
Jessica Duncan, Patrick Lee Stevens, Emily Bigby, Courtney Floyd, Josh Malina, Jennifer Nickens, Amber Lambert, Taylor Kantor
Background
Here we show results of 1,131 patients on therapy with semaglutide who underwent a comprehensive clinical protocol utilizing the Individualized Virtual Integrative Medicine (IVIM) approach, evaluating the protocol as a comprehensive clinical care model for patients utilizing GLP-1 medications.
Methods
This is a retrospective analysis of patients who completed at least 365 days of the protocol while on GLP-1 therapy with semaglutide. Patients with a body-mass index (BMI) of 30 or greater were included. Patients were prescribed personalized therapy with semaglutide based on their weight reduction goals, insurance coverage, accessibility during the GLP-1 shortages of branded semaglutide, and socioeconomic factors.
Results
The cohort size was 1,131 patients who were prescribed semaglutide while on the IVIM protocol. A Linear Mixed Effects Model was used to test the relationship between time spent on the IVIM protocol and weight reduction. This model estimated a weight reduction coefficient of -0.739 lbs/week, providing a large z-statistic of -74.02 and a p value < 0.0001. Mean change in weight at 12-weeks for all patients was 14.9 lbs (6.5 %), 24-weeks: 28.6 lbs (12.6 %), 36-weeks: 36.8 lbs (16.4 %), 52-weeks: 45.95 lbs (19.5 %), and those who extended to 68-weeks lost: 46.9 lbs (21.8 %). The percentage of patients who lost at least 5 % of their body weight at 52 weeks was: 99.2 %, 10 % or more: 93.9 %, 15 % or more: 73.5 %, and 20 % or more: 47.8 %.
Conclusion
Patients with obesity completing 52 weeks of the IVIM clinical protocol on semaglutide lost 19.5 % of total body weight with 47.8 % of patients losing 20 % or more. The results of this study indicate the protocol is a novel method to enhance therapeutic medical weight reduction results via a structured, telehealth-based approach for obesity management.
{"title":"Individualized virtual integrative medicine (IVIM): A clinical model for enhanced GLP-1 therapeutic outcomes","authors":"Jessica Duncan, Patrick Lee Stevens, Emily Bigby, Courtney Floyd, Josh Malina, Jennifer Nickens, Amber Lambert, Taylor Kantor","doi":"10.1016/j.obpill.2025.100188","DOIUrl":"10.1016/j.obpill.2025.100188","url":null,"abstract":"<div><h3>Background</h3><div>Here we show results of 1,131 patients on therapy with semaglutide who underwent a comprehensive clinical protocol utilizing the Individualized Virtual Integrative Medicine (IVIM) approach, evaluating the protocol as a comprehensive clinical care model for patients utilizing GLP-1 medications.</div></div><div><h3>Methods</h3><div>This is a retrospective analysis of patients who completed at least 365 days of the protocol while on GLP-1 therapy with semaglutide. Patients with a body-mass index (BMI) of 30 or greater were included. Patients were prescribed personalized therapy with semaglutide based on their weight reduction goals, insurance coverage, accessibility during the GLP-1 shortages of branded semaglutide, and socioeconomic factors.</div></div><div><h3>Results</h3><div>The cohort size was 1,131 patients who were prescribed semaglutide while on the IVIM protocol. A Linear Mixed Effects Model was used to test the relationship between time spent on the IVIM protocol and weight reduction. This model estimated a weight reduction coefficient of -0.739 lbs/week, providing a large z-statistic of -74.02 and a p value < 0.0001. Mean change in weight at 12-weeks for all patients was 14.9 lbs (6.5 %), 24-weeks: 28.6 lbs (12.6 %), 36-weeks: 36.8 lbs (16.4 %), 52-weeks: 45.95 lbs (19.5 %), and those who extended to 68-weeks lost: 46.9 lbs (21.8 %). The percentage of patients who lost at least 5 % of their body weight at 52 weeks was: 99.2 %, 10 % or more: 93.9 %, 15 % or more: 73.5 %, and 20 % or more: 47.8 %.</div></div><div><h3>Conclusion</h3><div>Patients with obesity completing 52 weeks of the IVIM clinical protocol on semaglutide lost 19.5 % of total body weight with 47.8 % of patients losing 20 % or more. The results of this study indicate the protocol is a novel method to enhance therapeutic medical weight reduction results via a structured, telehealth-based approach for obesity management.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"15 ","pages":"Article 100188"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144534459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-26DOI: 10.1016/j.obpill.2025.100189
Vittoria Frattolillo, Alessia Massa , Dalila Capone , Noemi Monaco, Gianmario Forcina, Pierluigi Di Filippo, Pierluigi Marzuillo, Emanuele Miraglia del Giudice, Anna Di Sessa
Background
Childhood obesity is a growing global health concern with significant cardiometabolic consequences. While conventional treatment approaches often fail to achieve sustained outcomes, emerging digital health interventions (DHIs)—including mobile applications, educational video games, wearable devices, telemedicine, and social media—offer innovative tools to support lifestyle modifications and enhance therapeutic adherence.
Methods
In this narrative review, we focus on the main evidence regarding the effectiveness of DHIs for pediatric obesity treatment according to target (children vs. children with families) and duration (short- and long-term interventions). We also review their impact on clinical (e.g. body mass index, body composition, etc.), behavioral (physical activity, nutrition, adherence) and psychosocial (motivation, engagement) outcomes. In addition, future trends in the field are also discussed.
Results
DHIs demonstrate short-term effectiveness, especially when they incorporate personalization, interactivity, and family involvement. Mobile applications and educational video games boost nutritional literacy and promote healthy behaviours. Wearable devices encourage physical activity awareness, though adherence often varies. Long-term, family-based interventions help reduce dropout rates and reinforce lasting healthy habits. Guided use of social media can facilitate health education but also exposes users to risks such as misinformation and unhealthy food marketing. Despite these advancements, DHIs still face major challenges, including unequal access, data privacy concerns, and a lack of long-term outcome evaluations.
Conclusion
The increasing prevalence of pediatric obesity underscores the urgent need for effective and sustainable treatment strategies. DHIs represent a promising, scalable approach for managing childhood obesity, but their long-term sustainability and effectiveness remain to be fully established. Ongoing technological advancements—and their thoughtful integration into existing healthcare frameworks—present significant opportunities to develop innovative, patient-centered therapeutic solutions that can improve engagement, adherence, and long-term health outcomes in children and adolescents with obesity.
{"title":"Integrating digital health into pediatric obesity management: Current practices and future perspectives","authors":"Vittoria Frattolillo, Alessia Massa , Dalila Capone , Noemi Monaco, Gianmario Forcina, Pierluigi Di Filippo, Pierluigi Marzuillo, Emanuele Miraglia del Giudice, Anna Di Sessa","doi":"10.1016/j.obpill.2025.100189","DOIUrl":"10.1016/j.obpill.2025.100189","url":null,"abstract":"<div><h3>Background</h3><div>Childhood obesity is a growing global health concern with significant cardiometabolic consequences. While conventional treatment approaches often fail to achieve sustained outcomes, emerging digital health interventions (DHIs)—including mobile applications, educational video games, wearable devices, telemedicine, and social media—offer innovative tools to support lifestyle modifications and enhance therapeutic adherence.</div></div><div><h3>Methods</h3><div>In this narrative review, we focus on the main evidence regarding the effectiveness of DHIs for pediatric obesity treatment according to target (children vs. children with families) and duration (short- and long-term interventions). We also review their impact on clinical (e.g. body mass index, body composition, etc.), behavioral (physical activity, nutrition, adherence) and psychosocial (motivation, engagement) outcomes. In addition, future trends in the field are also discussed.</div></div><div><h3>Results</h3><div>DHIs demonstrate short-term effectiveness, especially when they incorporate personalization, interactivity, and family involvement. Mobile applications and educational video games boost nutritional literacy and promote healthy behaviours. Wearable devices encourage physical activity awareness, though adherence often varies. Long-term, family-based interventions help reduce dropout rates and reinforce lasting healthy habits. Guided use of social media can facilitate health education but also exposes users to risks such as misinformation and unhealthy food marketing. Despite these advancements, DHIs still face major challenges, including unequal access, data privacy concerns, and a lack of long-term outcome evaluations.</div></div><div><h3>Conclusion</h3><div>The increasing prevalence of pediatric obesity underscores the urgent need for effective and sustainable treatment strategies. DHIs represent a promising, scalable approach for managing childhood obesity, but their long-term sustainability and effectiveness remain to be fully established. Ongoing technological advancements—and their thoughtful integration into existing healthcare frameworks—present significant opportunities to develop innovative, patient-centered therapeutic solutions that can improve engagement, adherence, and long-term health outcomes in children and adolescents with obesity.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100189"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144580402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-26DOI: 10.1016/j.obpill.2025.100190
Antonio Videira-Silva , Fábio de Freitas , Luis B. Sardinha , Helena Fonseca
Background
Severe obesity (SOb) treatment in adolescents has been focused on surgery and pharmacological treatment, in part due to difficulty in implementing lifestyle behavioral changes, such as physical exercise. However, the potential long-term consequences and costs of these options prompt new effective and sustainable treatment options. This study aimed to investigate the effect and safety of a 6-month high-intensity physical exercise-based intervention on body composition and cardiometabolic health in adolescents with SOb (BMI z-score ≥3), compared to those without SOb and SOb controls (without intervention).
Methods
Data from 46 adolescents (50 % girls), including 20 with SOb (43.5 %), exposed to two exercise sessions/week for 6 months, and 16 controls were analyzed.
Results
Adolescents with SOb showed a higher decrease and increase in central fat mass (β=-2.3, 95 %CI: 4.8, 0.1) and fat-and-bone-free mass (β = 1.70, 95 %CI: 3.25, 0.15) and a higher rate of insulin resistance normalization (58.3 vs. 12.5 %) after the intervention, compared to those without SOb, with no differences in adverse effects. Adolescents with SOb exposed to intervention also showed improvements in BMI, compared to an impairment in controls (95 %CI: 2.64, 0.16).
Conclusion
High-intensity physical exercise-based interventions should be considered as an obesity treatment option in adolescents with SOb. Higher exercise volume and/or frequency may further improve health-related outcomes and should become a first-line strategy alongside other lifestyle changes.
{"title":"Effect and safety of a physical exercise-based intervention on body composition and cardiometabolic health of adolescents with severe obesity. Secondary analysis from the PAC-MAnO trial","authors":"Antonio Videira-Silva , Fábio de Freitas , Luis B. Sardinha , Helena Fonseca","doi":"10.1016/j.obpill.2025.100190","DOIUrl":"10.1016/j.obpill.2025.100190","url":null,"abstract":"<div><h3>Background</h3><div>Severe obesity (SOb) treatment in adolescents has been focused on surgery and pharmacological treatment, in part due to difficulty in implementing lifestyle behavioral changes, such as physical exercise. However, the potential long-term consequences and costs of these options prompt new effective and sustainable treatment options. This study aimed to investigate the effect and safety of a 6-month high-intensity physical exercise-based intervention on body composition and cardiometabolic health in adolescents with SOb (BMI z-score ≥3), compared to those without SOb and SOb controls (without intervention).</div></div><div><h3>Methods</h3><div>Data from 46 adolescents (50 % girls), including 20 with SOb (43.5 %), exposed to two exercise sessions/week for 6 months, and 16 controls were analyzed.</div></div><div><h3>Results</h3><div>Adolescents with SOb showed a higher decrease and increase in central fat mass (<em>β=</em>-2.3, 95 %CI: 4.8, 0.1) and fat-and-bone-free mass (<em>β</em> = 1.70, 95 %CI: 3.25, 0.15) and a higher rate of insulin resistance normalization (58.3 vs. 12.5 %) after the intervention, compared to those without SOb, with no differences in adverse effects. Adolescents with SOb exposed to intervention also showed improvements in BMI, compared to an impairment in controls (95 %CI: 2.64, 0.16).</div></div><div><h3>Conclusion</h3><div>High-intensity physical exercise-based interventions should be considered as an obesity treatment option in adolescents with SOb. Higher exercise volume and/or frequency may further improve health-related outcomes and should become a first-line strategy alongside other lifestyle changes.</div></div><div><h3>Trail registration</h3><div>Clinicaltrials.gov NCT02941770.</div></div>","PeriodicalId":100977,"journal":{"name":"Obesity Pillars","volume":"16 ","pages":"Article 100190"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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