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Diet quality and nutrient distribution while using glucagon-like-peptide-1 receptor agonist: A secondary cross-sectional analysis 使用胰高血糖素样肽-1受体激动剂时的饮食质量和营养分布:二次横断面分析
Pub Date : 2025-07-08 DOI: 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.
随着胰高血糖素样肽-1受体激动剂(GLP-1RA)药物用于肥胖治疗的兴起,了解饮食质量可能是提供循证营养指导的宝贵工具。然而,关于GLP-1RA治疗期间饮食摄入的数据有限。因此,我们在使用GLP-1RA时分析了饮食质量和营养时机。方法:这是先前一项横断面在线调查问卷研究的二次分析,该研究涉及目前使用GLP-1RA减肥的成年人(N = 69, 49.6±12.3岁,35.9±9.1 kg/m2)。三天的饮食记录分析使用健康饮食指数(HEI),一个有效的分数,表明整体饮食质量。13种HEI成分根据平均3天的食物记录进行评分,并使用95%置信区间(CI)计算。Bonferroni校正应用显著性接受p = 0.0038。此外,计算了早餐、午餐、晚餐和零食的卡路里、常量营养素和纤维摄入量的95%置信区间。结果95% CI显示HEI总分为54±12(51.4,57.3),明显低于HEI目标(p <;0.0038)。除添加糖外,其余组分均显著低于最高分数。基于GLP-1RA使用时间的HEI评分无显著差异。晚餐消耗的卡路里最多,平均为649卡路里,而午餐、早餐和零食分别为538、392和391卡路里。此外,每日总蛋白质摄入量的40%发生在晚餐时间。结论在使用GLP-1RAs的患者样本中,水果、蔬菜、全谷物、海鲜和植物蛋白、乳制品和脂肪酸的膳食质量较差。未来的研究需要确定HEI评分是否在GLP-1RA治疗和营养时机之前,期间和之后发生变化。
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引用次数: 0
Creating an adolescent intensive health behavior and lifestyle treatment for type 1 diabetes: Feedback from the target population 创建青少年强化健康行为和生活方式治疗1型糖尿病:来自目标人群的反馈
Pub Date : 2025-07-03 DOI: 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.
在过去的几十年里,青少年1型糖尿病(T1D)的肥胖患病率显著增加,导致发病和早期死亡的风险增加。尽管这种需求不断增长,但缺乏针对青年T1D患者的循证强化健康行为和生活方式治疗(IHBLT)。本研究收集了T1D青少年和共病超重/肥胖青少年及其护理人员的定性数据,以完善针对T1D青少年的IHBLT。方法本研究为原创性临床研究。参与者完成了单独的半结构化访谈,以提供对计划的会议主题、讲义和针对T1D的改进IHBLT的活动的反馈。采用演绎框架矩阵分析方法对数据进行分析。所有数据都由两名独立的程序员进行分析,他们开会讨论编码分歧,并达成100%的一致。代码被反复简化并组织成主题。结果16名参与者(n = 8名青少年,n = 8名照顾者)完成了定性访谈。数据中出现了三个主要主题:(1)对拟议计划的满意度;(2)对计划结构的偏好;(3)建议的适应性。结论针对青少年T1D患者的适应性IHBLT初步可为目标人群所接受。结果为继续完善针对青少年T1D的IHBLT提供了建议。
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引用次数: 0
Erratum regarding missing clinical trial registration numbers in previously published articles 关于先前发表的文章中缺少临床试验注册号的勘误表
Pub Date : 2025-07-03 DOI: 10.1016/j.obpill.2025.100193
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引用次数: 0
Improving obesity treatment through online motivational support in primary care 在初级保健中通过在线激励支持改善肥胖治疗
Pub Date : 2025-07-01 DOI: 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.
背景:肥胖是一种复杂的慢性疾病,需要耗时、多方面的管理策略,往往难以在初级保健中实施。本质量改进项目旨在评估通过Facebook整合在线激励支持小组,除了常规的每月办公室访问外,是否可以提高初级保健环境中的肥胖治疗结果和患者动机。作为一个由执业护士驱动的项目,执业护士接受了培训,在肥胖治疗领域取得了重大进展。执业护士是为患者提供教育和工具以帮助患者减肥并保持成功减肥的关键(Fruh, 2017)。方法采用岗前设计,在某私立内科门诊进行质量改进项目。纳入BMI≥30或≥25并伴有合并症的成年患者(n = 68)。参与者加入了一个基于facebook的支持小组,并接受了标准化的教育和为期12周的每月面对面随访。干预前后测量的结果包括体重、BMI、腰围和对体重功效生活方式问卷(well - sf)的回答。采用配对t检验进行统计分析。结果:在体重方面有统计学上的显著改善(- 9.46磅,p <;0.0001), BMI (- 1.91, p <;0.0001),腰围(- 1.87英寸,p <;0.0001)。well - sf得分在8个领域中的7个领域显著提高,平均提高11.8%,表明自我效能感和健康饮食行为动机增强。结论将在线激励支持平台与每月就诊相结合,可显著改善肥胖患者的生理结局和自我效能感。这些发现支持了低成本数字支持工具在增加门诊肥胖护理方面的可行性和潜在效益,特别是在资源有限的情况下。进一步的研究应探讨参与水平和长期结果的影响。
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引用次数: 0
Use of obesity medications in a young pediatric patient with optic nerve hypoplasia and severe early-onset obesity: A case report 在视神经发育不全和严重早发性肥胖的年轻儿童患者中使用减肥药:1例报告
Pub Date : 2025-07-01 DOI: 10.1016/j.obpill.2025.100192
Armine Simonian , Emily Sousa , Kamran Samakar , Alaina P. Vidmar

Introduction

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.
儿童肥胖对伴有潜在内分泌紊乱的儿童提出了复杂的挑战。对于视神经发育不全(ONH)和下丘脑-垂体功能障碍的患者,仅仅改变生活方式往往对肥胖治疗无效。本病例报告描述了针对患有ONH和多种垂体激素缺乏的儿童的严重早发性肥胖的靶向药物干预。病例介绍:一名西班牙裔女性在出生45天时被诊断为ONH和中枢性精氨酸抗利尿激素缺乏、中枢性甲状腺功能减退、继发性肾上腺功能不全和生长激素缺乏。尽管早期干预,她的身高体重百分位数在9个月时从第65位上升到第97位,到5岁时体重指数(BMI)继续加速到52 kg/m2。托吡酯100mg每晚开始,有一些相关的食欲抑制和体重减轻。在COVID-19大流行期间,体重继续增加,在6岁时,托吡酯剂量增加(每晚200 mg),芬特明每天添加15 mg。在随后的12个月里,观察到BMI下降了11%,导致7岁时BMI为47 kg/m2。尽管BMI降低,但由于阻塞性睡眠呼吸暂停(OSA)持续恶化,随后开始使用西马鲁肽,每周增加2.4 mg,导致在三药治疗的24个月内BMI降低30%,并相关解决OSA,肝酶升高和高甘油三酯血症。本病例强调了早期、有针对性的药物干预在治疗伴有下丘脑功能障碍和ONH的儿童严重肥胖患者中的潜在作用和治疗益处。在仅仅改变生活方式是不够的情况下,联合使用减肥药可以显著和持续地降低BMI,同时解决与肥胖相关的合并症。这些发现强调了在复杂的儿童肥胖中需要积极的、个性化的治疗策略。
{"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 ,&nbsp;Emily Sousa ,&nbsp;Kamran Samakar ,&nbsp;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 &gt;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}
引用次数: 0
Individualized virtual integrative medicine (IVIM): A clinical model for enhanced GLP-1 therapeutic outcomes 个性化虚拟结合医学(IVIM):提高GLP-1治疗效果的临床模型
Pub Date : 2025-06-30 DOI: 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.
在这里,我们展示了1131名接受西马鲁肽治疗的患者的结果,他们使用个性化虚拟综合医学(IVIM)方法进行了综合临床方案,评估了该方案作为使用GLP-1药物的患者的综合临床护理模型。方法:这是一项对完成至少365天GLP-1治疗的患者进行回顾性分析,同时使用semaglutide。包括身体质量指数(BMI)为30或更高的患者。根据患者的减肥目标、保险覆盖范围、品牌西马鲁肽GLP-1短缺期间的可及性以及社会经济因素,为患者开了个性化的西马鲁肽治疗。结果队列大小为1131例在IVIM方案中使用西马鲁肽的患者。采用线性混合效应模型检验在IVIM方案上花费的时间与体重减轻之间的关系。该模型估计减重系数为-0.739磅/周,提供了-74.02的大z统计量和p值<;0.0001. 所有患者在12周时体重的平均变化为14.9磅(6.5%),24周:28.6磅(12.6%),36周:36.8磅(16.4%),52周:45.95磅(19.5%),延长至68周的患者体重减轻:46.9磅(21.8%)。52周时体重减轻至少5%的患者比例为:99.2%,10%或以上:93.9%,15%或以上:73.5%,20%或以上:47.8%。结论完成52周西马鲁肽IVIM临床方案治疗的肥胖患者体重减轻19.5%,其中47.8%的患者体重减轻20%或以上。本研究结果表明,该方案是一种通过结构化的、基于远程医疗的肥胖管理方法来增强治疗性医学减肥效果的新方法。
{"title":"Individualized virtual integrative medicine (IVIM): A clinical model for enhanced GLP-1 therapeutic outcomes","authors":"Jessica Duncan,&nbsp;Patrick Lee Stevens,&nbsp;Emily Bigby,&nbsp;Courtney Floyd,&nbsp;Josh Malina,&nbsp;Jennifer Nickens,&nbsp;Amber Lambert,&nbsp;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 &lt; 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}
引用次数: 0
Integrating digital health into pediatric obesity management: Current practices and future perspectives 将数字健康整合到儿童肥胖管理中:当前实践和未来展望
Pub Date : 2025-06-26 DOI: 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.
儿童肥胖是一个日益严重的全球健康问题,具有显著的心脏代谢后果。虽然传统治疗方法往往无法取得持续的效果,但新兴的数字健康干预措施(DHIs)——包括移动应用程序、教育视频游戏、可穿戴设备、远程医疗和社交媒体——提供了支持改变生活方式和增强治疗依从性的创新工具。方法在这篇叙述性综述中,我们根据目标(儿童与有家庭的儿童)和持续时间(短期和长期干预)关注DHIs治疗儿童肥胖的有效性的主要证据。我们还回顾了它们对临床(如体重指数、身体成分等)、行为(身体活动、营养、依从性)和心理社会(动机、参与)结果的影响。此外,还讨论了该领域的未来发展趋势。结果dhis显示出短期的有效性,特别是当它们结合个性化、互动性和家庭参与时。移动应用程序和教育视频游戏提高了营养素养,促进了健康行为。可穿戴设备鼓励人们意识到体育锻炼的重要性,但坚持与否往往各不相同。以家庭为基础的长期干预措施有助于降低辍学率和加强持久的健康习惯。有指导地使用社交媒体可以促进健康教育,但也使用户面临错误信息和不健康食品营销等风险。尽管取得了这些进步,但DHIs仍然面临着重大挑战,包括不平等获取、数据隐私问题以及缺乏长期结果评估。结论儿童肥胖症患病率的不断上升,迫切需要有效和可持续的治疗策略。DHIs是一种很有前途的、可扩展的儿童肥胖管理方法,但其长期可持续性和有效性仍有待充分确定。持续的技术进步及其与现有医疗保健框架的周到整合为开发创新的、以患者为中心的治疗解决方案提供了重要机会,这些解决方案可以提高儿童和青少年肥胖患者的参与度、依从性和长期健康结果。
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引用次数: 0
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 以体育锻炼为基础的干预对严重肥胖青少年身体成分和心脏代谢健康的影响和安全性PAC-MAnO试验的二次分析
Pub Date : 2025-06-26 DOI: 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.

Trail registration

Clinicaltrials.gov NCT02941770.
青少年严重肥胖(SOb)的治疗一直集中在手术和药物治疗上,部分原因是难以实施生活方式行为改变,如体育锻炼。然而,这些选择的潜在长期后果和成本促使人们选择新的有效和可持续的治疗方案。本研究旨在探讨为期6个月的高强度体育锻炼干预对SOb青少年(BMI z-score≥3)的身体成分和心脏代谢健康的影响和安全性,并与没有SOb和SOb对照组(没有干预)进行比较。方法对连续6个月每周进行两次锻炼的46名青少年(50%为女孩)和16名对照组的数据进行分析,其中20名为SOb(43.5%)。结果与无SOb组相比,SOb组在干预后中枢脂肪量(β=-2.3, 95% CI: 4.8, 0.1)和无脂无骨量(β= 1.70, 95% CI: 3.25, 0.15)和胰岛素抵抗正常化率(58.3比12.5%)的下降和增加更高,不良反应无差异。与对照组相比,接受干预的SOb青少年的BMI也有所改善(95% CI: 2.64, 0.16)。结论以高强度体育锻炼为基础的干预措施可作为青少年SOb肥胖治疗的一种选择。更高的运动量和/或频率可能会进一步改善与健康相关的结果,应该与其他生活方式的改变一起成为一线策略。临床试验注册:clinicaltrials .gov NCT02941770。
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引用次数: 0
How do patients choose between obesity medications: A thematic analysis 患者如何选择减肥药:专题分析
Pub Date : 2025-06-16 DOI: 10.1016/j.obpill.2025.100187
Alvin Mondoh , Hilary Craig , Michael Crotty , Francisca Contreras , Carel W. le Roux

Introduction

The rising prevalence of obesity is of particular concern due to its association with a range of serious complications, including type 2 diabetes mellitus, cardiovascular diseases, and certain types of cancer. Obesity medications can control the disease but it is unclear how patients choose which medication to use.

Methods

A qualitative thematic analysis was conducted to investigate how patients select between obesity medications. Fifteen treatment naive adults with a body mass index ≥27 kg/m2 with at least one weight-related complications were recruited.

Results

The 5 major themes depicting how patients make selections included 1) Effectiveness of medication, 2) Information to make decisions, 3) Safety of medications, 4) Practicality and 5) Individual Strategies and Community Supports in Obesity Management. Safety concerns of side effects and long-term risks were perceived major barriers to initiating or adhering to pharmacotherapy.

Conclusion

In a situation where the medications are described as being free and readily available, patient preferences for obesity medications are shaped by treatment efficacy, safety, information provided by healthcare providers. To enhance adherence and improve patient outcomes, healthcare providers should focus on delivering clear, comprehensive information and fostering strong support systems for patients.
由于肥胖与一系列严重的并发症(包括2型糖尿病、心血管疾病和某些类型的癌症)有关,肥胖的流行率不断上升值得特别关注。减肥药物可以控制这种疾病,但目前尚不清楚患者如何选择使用哪种药物。方法采用定性专题分析的方法,调查患者对减肥药的选择情况。招募了15名体重指数≥27 kg/m2且至少有一种体重相关并发症的未接受治疗的成年人。结果描述患者如何选择的5个主要主题包括1)药物有效性,2)信息决策,3)药物安全性,4)实用性和5)肥胖管理中的个人策略和社区支持。副作用和长期风险的安全问题被认为是开始或坚持药物治疗的主要障碍。结论在药物被描述为免费和容易获得的情况下,患者对肥胖药物的偏好受治疗疗效、安全性和医疗保健提供者提供的信息的影响。为了加强依从性和改善患者的治疗结果,医疗保健提供者应专注于提供清晰、全面的信息,并为患者建立强有力的支持系统。
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引用次数: 0
Nutritional deficiencies and muscle loss in adults with type 2 diabetes using GLP-1 receptor agonists: A retrospective observational study GLP-1受体激动剂对成人2型糖尿病患者营养缺乏和肌肉损失的影响:一项回顾性观察研究
Pub Date : 2025-06-10 DOI: 10.1016/j.obpill.2025.100186
W. Scott Butsch , Suela Sulo , Andrew T. Chang , Jeeyun A. Kim , Kirk W. Kerr , Dominique R. Williams , Refaat Hegazi , Thadchaigeni Panchalingam , Scott Goates , Steven B. Heymsfield

Background

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) drug-induced weight loss is associated with fat mass reduction but can also lead to nutritional deficiencies and loss of muscle. We quantified nutritional deficiencies in adults who had undergone GLP-1RA treatment.

Methods

This was an observational, retrospective analysis of de-identified patient-level claims data from 461,382 adults newly prescribed GLP-1RAs between 7/2017 and 12/2021 with no prior diagnoses of nutritional deficiencies. While most patients had type 2 diabetes (T2DM), the population also included individuals with type 1 diabetes (T1DM), prediabetes, or no recorded diabetes diagnosis. A secondary propensity-matched analysis compared GLP-1RA users with non-users. The matched comparator cohort consisted of adults with type 2 diabetes treated with metformin but not prescribed GLP-1RAs, whereas GLP-1RA users were treated with both metformin and GLP-1RA. Nutritional deficiencies were assessed at 6 and 12 months after GLP-1RA initiation. Nutritional deficiency diagnoses or complications were compared between patients with or without a dietitian visit within a 6-months of treatment initiation.

Results

Patients were mainly female (56.3 %), mean age (±SD) 52.9 (±11.7) years, with obesity (44.9 %) or overweight (5.6 %); type 2 diabetes (80.5 %) and hypertension (66.3 %) were the most common comorbidities. Nutritional deficiencies were diagnosed in 12.7 % of the patients within 6 months after GLP-1RA initiation and in 22.4 % within 12 months. Vitamin D deficiency was most common, having an incidence of 7.5 % and 13.6 % within 6 and 12 months, respectively. Recorded nutrient deficiencies or deficiency-related complications were more likely among patients with a dietitian visit within the first 6 months of GLP-1RA initiation compared to patients without a dietitian visit.

Conclusion

Over 20 % had nutritional deficiencies diagnosed within one-year of starting GLP-1RA treatment. These findings highlight the importance of nutritional screening and diagnosis of deficiencies and inclusion of physician nutrition specialists, dietitians, and other nutrition care specialists in patient care.
胰高血糖素样肽-1受体激动剂(GLP-1RAs)药物诱导的体重减轻与脂肪减少有关,但也可能导致营养缺乏和肌肉损失。我们量化了接受GLP-1RA治疗的成年人的营养缺乏症。这是一项观察性、回顾性分析,对2017年7月至2021年12月期间新开GLP-1RAs的461,382名未确诊营养缺乏症的成年人的患者水平索赔数据进行了分析。虽然大多数患者患有2型糖尿病(T2DM),但人群中也包括患有1型糖尿病(T1DM)、糖尿病前期或无糖尿病诊断记录的个体。二级倾向匹配分析比较了GLP-1RA使用者和非使用者。匹配的比较组包括接受二甲双胍治疗但未开GLP-1RA处方的成人2型糖尿病患者,而GLP-1RA使用者同时接受二甲双胍和GLP-1RA治疗。在GLP-1RA启动后6个月和12个月评估营养缺乏症。在治疗开始的6个月内,比较有或没有营养师访问的患者的营养缺乏症诊断或并发症。结果患者以女性为主(56.3%),平均年龄(±SD) 52.9(±11.7)岁,肥胖(44.9%)或超重(5.6%);2型糖尿病(80.5%)和高血压(66.3%)是最常见的合并症。12.7%的患者在GLP-1RA开始治疗后6个月内诊断出营养缺乏,22.4%的患者在12个月内诊断出营养缺乏。维生素D缺乏症最为常见,在6个月和12个月内的发病率分别为7.5%和13.6%。与未接受GLP-1RA治疗的患者相比,在GLP-1RA开始治疗的前6个月内接受营养师访问的患者更容易出现营养缺乏或营养不足相关并发症。结论超过20%的患者在开始GLP-1RA治疗的一年内被诊断为营养缺乏。这些发现强调了营养筛查和缺陷诊断的重要性,以及医生营养专家、营养师和其他营养护理专家参与患者护理的重要性。
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引用次数: 0
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Obesity Pillars
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