Current Obesity Reports最新文献

Purpose of review: Myosteatosis, defined as the pathological accumulation of fat within skeletal muscle, has emerged as a critical yet underrecognized feature of muscle aging and metabolic dysregulation. Despite its growing clinical relevance, the field remains constrained by fragmented definitions, heterogeneous diagnostic criteria, and limited mechanistic understanding, all of which hamper effective detection and intervention. This review synthesizes current evidence to delineate the epidemiological landscape and clinical ramifications of myosteatosis across organ systems, and to highlight emerging myokine-driven endocrine signaling, biomarker candidates, and diagnostic strategies.

Recent findings: Population-level studies increasingly implicate myosteatosis in impaired mobility, heightened morbidity, and poor survival in chronic disease contexts. Susceptibility is influenced by age, sex, ethnicity, and genetic background, while pathological integration with sarcopenia, cardiometabolic dysfunction, malignancy, and systemic frailty is becoming evident. Additionally, dysregulated myokine-mediated endocrine signaling and altered muscle-adipose crosstalk are increasingly recognized as adjunct pathological signatures of myosteatosis, with potential relevance to its progression and metabolic complications. Advances in diagnostic strategies, including quantitative imaging modalities and circulating biomarkers, alongside ongoing progress toward laboratory determinants and assay standardization, have begun to refine disease characterization and translational potential, though consensus remains limited. Myosteatosis is a modifiable disease trait that bridges muscle quality decline with systemic metabolic risk. By outlining unresolved challenges and future research priorities, this review aims to reframe myosteatosis as a targetable axis in precision medicine, with implications for risk stratification, therapeutic development, and improved clinical outcomes.

Background: Obesity represents a significant public health challenge, particularly in the context of coexisting chronic diseases and multi-morbidity. In Spain, and specifically in Catalonia, primary care plays a central role in prevention and management, yet barriers such as weight-related stigma can compromise care delivery.

Aim: To evaluate the current state of obesity prevention and management within the health system, with a focus on implications for primary care in Catalonia, including prevalence, stigma, and integration of chronic disease care.

Methods: A narrative literature review was conducted, including studies, government reports, and policy documents relevant to obesity prevalence, psychosocial factors, and healthcare system strategies.

Results: Persistent weight bias among healthcare professionals can delay diagnosis, reduce treatment adherence, and negatively affect patient experience. Integrated, patient-centered care models that consider physical, psychological, and social health have gained traction. Holistic assessment-including behavioral context, mental health, and social determinants alongside cardiorenal metabolic diseases-is central to these approaches.

Conclusions: Effective obesity management requires integrated chronic disease management frameworks. Collaborative care models, community-based resources, and equitable health policies are essential. Incorporating patient experience helps identify unmet needs and improve care quality. A system-wide, holistic approach is critical to reducing the burden of obesity and related chronic diseases in Catalonia.

Purpose of review: This review explores the intricate and bidirectional relationship between mood disorders and obesity, focusing on the psychiatric implications of metabolic bariatric surgery and weight-loss pharmacotherapy. In particular, the review examines how these interventions impact psychiatric outcomes, identifying both benefits and risks.

Recent findings: While metabolic bariatric surgery and incretin-based therapies improve metabolic health and, in some cases, mental well-being, they may also lead to psychiatric complications. Studies indicate increased risks of mood episodes, self-harm, and altered psychotropic drug metabolism post-surgery. Concerns have also emerged regarding glucagon like peptide-1 (GLP-1) receptor agonists and their potential link to depression and suicidality. Weight-loss interventions require thorough psychiatric assessment prior to treatment, as well as long-term psychiatric monitoring thereafter. Future research should prioritize longitudinal studies with standardized psychiatric assessments to refine risk stratification and optimize clinical outcomes. A multidisciplinary approach integrating endocrinology, psychiatry, and behavioral sciences is essential for improving both physical and mental health outcomes.

Purpose of review: Obesity-related metabolic disorders such as metabolic dysfunction-associated fatty liver disease (MAFLD), metabolic syndrome (MetS), and type 2 diabetes mellitus (T2DM) have traditionally been treated as separate conditions. This review aims to present a unified conceptual framework in which these disorders are viewed as progressive stages within a continuous and dynamic process of metabolic dysfunction. The goal is to clarify the shared mechanisms underlying this progression and to explore the clinical value of approaching them as a continuum.

Recent findings: Insulin resistance, chronic low-grade inflammation, adipokine imbalance, and ectopic fat accumulation are common drivers across all stages of metabolic deterioration. These processes are reinforced by coordinated dysfunction in adipose tissue, liver, skeletal muscle, pancreas, and the gut microbiota. Longitudinal and genetic studies support a typical progression from individuals with obesity to MAFLD, then to MetS and T2DM, although individual trajectories vary. Certain phenotypes such as metabolically healthy individuals with obesity and normal-weight individuals with visceral adiposity illustrate the spectrum's heterogeneity. Early dysfunction is often reversible through lifestyle or pharmacologic intervention, underscoring the importance of timely detection. Reframing obesity-associated metabolic disorders as a continuous disease process enables more accurate risk assessment, earlier intervention, and coordinated care strategies. This integrated perspective supports a shift toward mechanism-based and individualized treatment, with the potential to reduce risk and delay progression to advanced metabolic disease and its complications.

Purpose of review: This review comprehensively highlights the molecular and cellular pathways that link insulin resistance (IR) to muscle atrophy.

Recent findings: Skeletal muscle IR is a key driver of muscle atrophy in obesity. It disrupts metabolic homeostasis, leading to impaired glucose uptake and utilization. Crucially, IR shifts the balance in skeletal muscle from anabolic to catabolic processes by simultaneously inhibiting protein synthesis and promoting proteolysis, resulting in a progressive decline of muscle mass and function. This review summarizes how defective insulin signaling activates a cascade of intracellular events that accelerate muscle wasting in obese individuals. The nexus between IR and muscle atrophy in obesity involves multiple interconnected mechanisms, including mitochondrial dysfunction, elevated inflammation and oxidative stress, and compromised satellite cell function-essential for muscle repair and regeneration. The prevalence of IR, which rises with age and is exacerbated by sedentary behavior and poor nutrition, underscores the importance of understanding these signaling pathways. Elucidating these mechanisms is critical for developing effective interventions to combat muscle loss and enhance metabolic health in the obese population.

Purpose of review: This review examines recent literature on grazing and its two subtypes - compulsive (CG) and non-compulsive (NCG) - utilizing a consistent definition and psychometrically sound instruments.

Recent findings: Grazing is a distinct problematic eating behavior, prevalent across various weight, age, and sexes groups, with higher rates observed in younger adults and older children/adolescents. Grazing has associations with socioeconomic status, and scores differ between countries, suggesting cultural differences. Grazing is consistently linked to higher body mass index, poor weight loss and metabolic control outcomes after metabolic-bariatric surgery. CG, particularly, has been consistently associated with greater psychological distress, eating disorder psychopathology, affective dysregulation, impulsivity and addictive behaviors, and poorer quality of life. Grazing is a problematic eating behavior associated with loss of control eating, and within the spectrum of disordered eating. Assessing and addressing grazing may be a crucial strategy to mitigate obesity and its associated medical risks.

Purpose of review: Climate change and obesity are two converging global crises with complex and interrelated pathways. This review aims to synthesize recent evidence linking climate-related exposures, including rising ambient temperatures, air pollution, and urbanization to the pathogenesis of obesity. It also explores how obesity itself increases vulnerability to heat injury and environmental stress, highlighting the bidirectional nature of this syndemic.

Recent findings: Epidemiologic evidence has supported associations between air pollution and increased body mass index, central adiposity, and metabolic dysfunction across the lifespan. Mechanistic research implicates impaired thermogenesis, chronic inflammation and oxidative stress, endocrine disruption, hypothalamic inflammation, and microbiome dysbiosis as key pathways linking environmental exposures to adiposity. Obesity further amplifies the physiological burden of climate-related stressors, such as heatwaves, due to reduced heat dissipation and altered hormonal responses. Anti-obesity medications may exacerbate heat-related risks via dehydration and gastrointestinal side effects. Urban greenness appears to offer a partial protective effect, modulating the obesogenic impact of air pollution and heat, particularly in low-income settings. Obesity and climate change share common socioeconomic, behavioral, and environmental drivers. Addressing this dual burden requires integrated strategies that promote environmental sustainability and metabolic health. These include green infrastructure, active transportation, climate-adapted clinical care, and public health strategies that reflect planetary health principles. Recognizing obesity not only as a medical condition but also as an environmentally influenced disorder is essential for effective, future-oriented prevention and intervention efforts.

Purpose of review: Insulin resistance is a key component of the metabolic syndrome, type 2 diabetes mellitus (T2DM), and related cardiovascular complications. However, despite its clinical relevance, a simple and reliable surrogate marker of insulin resistance is lacking. The body muscle-to-fat ratio (BMFR) is a novel anthropometric index, and particularly in treatment-naïve patients with T2DM, BMFR correlates more closely with insulin sensitivity, assessed using the hyperinsulinemic-euglycemic clamp, than conventional indices, such as the Matsuda Index and the Quantitative Insulin Sensitivity Check Index. In this review, we critically evaluate the current evidence regarding the BMFR as an index of insulin resistance and metabolic disease risk, highlight its strengths and limitations versus conventional measures, and discuss future directions.

Recent findings: Several recent studies have demonstrated the importance of body composition metrics for the evaluation of metabolic health, including those by Guan et al. (Adv Nutr), Oliver et al. (J Cachexia Sarcopenia Muscle), and Vieira et al. (Rev Endocr Metab Disord). The findings have resulted in a growing recognition of the need for reliable, accessible markers of muscle quality and metabolic risk. BMFR offers advantages over the fat-to-muscle ratio and conventional anthropometric indices as an intuitive and clinically relevant marker of insulin resistance. It represents a promising method of screening for obesity-related complications, evaluating treatment responses, and guiding personalized care, including in patients with high-risk phenotypes, such as sarcopenic obesity. With further validation, BMFR could become a standard tool for the evaluation of metabolic health and risk in clinical practice.

Purpose of review: To summarize the available knowledge on the effect of eating frequency and intermittent fasting to prevent and manage obesity.

Recent findings: Eating schedule variability is associated with excess weight. Increasing eating frequency in those who eat three times a day or less does not lead to weight reduction. Intermittent fasting diets may enhance lipolysis, insulin sensitivity, adipose remodeling, and restore gut microbial diversity. Intermittent fasting diets appeared more effective than unrestricted diets and non-inferior to continuous energy restriction in producing weight loss. Intermittent fasting diets appeared more effective than unrestricted diets and non-inferior to continuous energy restriction in producing weight loss. Intermittent fasting may provide some additional benefits for lipid profiles, glucose control, and liver steatosis, but not for blood pressure. Possible benefits on gingival inflammation and detrimental effects on hair growth should warrant further investigation. Reduced eating frequency and intermittent fasting diets are effective lifestyle interventions for weight loss. The preference for intermittent fasting over continuous energy restriction should depend on the patient to maximize adherence.

Purpose of review: In this review, current evidence on the levels of chemerin and asprosin, which are promising adipokines in metabolic syndrome, their mechanisms of action, and their relationship with inflammation, diet and lifestyle in metabolic syndrome, and their effects on metabolic syndrome are reviewed.

Recent findings: Metabolic syndrome is a pro-inflammatory condition characterized by the coexistence of risk factors such as atherogenic dyslipidemia, high blood pressure, abdominal obesity, insulin resistance and higher blood glucose levels, cardiovascular diseases and type 2 diabetes etc. related with increased risk of developing chronic diseases. In recent years, chemerin and asprosin, the new players of metabolic syndrome, whose incidence has been increasing with the changing world, have attracted attention as predictive biomarkers in metabolic syndrome. These two adipokines seem to mediate the systemic pro-inflammatory state of individuals with metabolic syndrome. There is information that chemerin and asprosin levels are mostly increased in individuals with metabolic syndrome and that their levels can be altered or unaffected by dietary and lifestyle factors. However, conflicting results in the literature indicate that more studies are needed. With the adoption of healthy lifestyle habits through healthy diet and exercise interventions, chemerin and asprosin hold promise for early detection, prevention and treatment strategies of metabolic syndrome.