Obesity Facts最新文献

Introduction: Given the scarce evidence on mortality risks associated with obesity trajectories beyond body mass index (BMI), this study examined the independent associations of changes in anthropometric and dual-energy X-ray absorptiometry (DXA)-measured indicators of general and abdominal obesity with all-cause and cardiovascular mortality in older Chinese adults.

Methods: A total of 1,495 male and 1,506 female participants, with a mean age of 71.75 years and BMI at 23.75 kg/m2 at baseline in 2001-2003, were followed up on mortality till mid-2020. BMI, waist-to-hip ratio (WHR), and DXA-measured indicators including whole body fat mass (WBFM) and android-to-gynoid ratio (AGR) were assessed at baseline and year 4. Sex-specific multivariable Cox proportional hazards regression and competing risk survival model were employed.

Results: A substantial 4-year decline (>10%) in obesity indicators, except WHR, was associated with elevated mortality risks. General obesity indicators, particularly BMI, remained as strong predictors after accounting for abdominal obesity measures. The association of BMI with all-cause mortality was largely attributable to change in whole body muscle mass (WBMM) in men and to both changes in WBFM and WBMM in women, whereas their roles in cardiovascular mortality were less apparent. Despite elevated mortality associated with increases in general obesity measures, lower all-cause mortality was found for increase in AGR in men.

Conclusion: Notwithstanding critiques on BMI for obesity assessment, BMI change appears to be a robust indicator of survival in older Chinese adults, as it reflects not only fat mass but also lean muscle mass changes. Moreover, increases in abdominal obesity indicators do not seem to pose mortality risks.

Introduction: Despite clinical obesity guidelines recommending evidence-based treatment, people with obesity have limited access to these treatments due to restrictions in the healthcare system. At present, little is known how individuals with obesity experience healthcare and what are their opinions on current treatment options.

Methods: To collect data on the attitude and acceptance of current obesity treatment options, a representative online survey among adults with obesity (body mass index, BMI ≥30.0 kg/m2) living in Germany was performed in October 2024. Questions covered demographics, the subjective burden of obesity, discrimination, weight loss attempts and success, as well as use of specific weight reduction approaches. The data were weighted to represent the adult population in Germany. Data were analyzed descriptively and by using chi-squared tests and multiple logistic regression analysis.

Results: In total, 1,004 adults (51.2% women) with obesity participated, with a mean BMI of 35.2 ± 5.2 kg/m2 and a mean age of 50.0 ± 17.1 years. In total, 78.4% of all participants (787/1,004) answered to feel moderately to very much burdened by their body weight, and 37.4% of participants (361/966) reported to have already been disadvantaged or discriminated against because of their body weight. Logistic regression analyses showed statistically significant differences by gender, age-groups, BMI groups, and educational status (most p < 0.05). The majority of participants (89.7%, 865/964) reported to have had at least one weight loss attempt. Regarding evidence-based treatment options, most participants stated to have not yet used weight loss medication (95.3%, 953/1,000) and that it is unlikely that they would take them in the future (88.4%, 791/895). Moreover, most participants stated to have not yet used reimbursable digital behavioral programs (96.7%, 966/999) or surgery (97.3%, 969/996) for weight loss.

Conclusion: The findings indicate a gap between obesity treatment guidelines and real-world weight loss practice among adults with obesity. This might be due to stigma and access barriers. Therefore, more and better communication is needed between healthcare providers and people with obesity.

Background: The introduction of incretin mimetics (IMs), including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as liraglutide and semaglutide, as well as dual GLP-1/glucose-dependent insulinotropic polypeptide receptor co-agonists (GLP-1/GIP RAs) like tirzepatide, has revolutionized obesity treatment. These obesity management medications promote significant weight loss with metabolic and cardiovascular improvements. However, pharmacotherapy alone seems insufficient to address the multifactorial nature of obesity. While IMs suppress appetite and reduce caloric intake, they do not prevent potential nutrient deficiencies and possible loss of skeletal muscle mass, nor do they guarantee lasting behavioral changes necessary for long-term weight management, particularly in the absence of other complementary interventions.

Summary: In this context, a clear distinction must be made between general lifestyle modification advice (Ls-M) and personalized and structured dietetic and physical exercise interventions (D-PE-Is). Ls-M, including a balanced diet and regular physical activity, is essential for preventing obesity and reducing the risk of weight gain and associated metabolic disorders. However, once obesity is established, D-PE-I becomes necessary. Unlike Ls-M, D-PE-I integrates personalized nutritional strategies with structured exercise to maximize fat loss, preserve skeletal muscle mass and function, and enhance metabolic health. This narrative and concept-driven review aimed to delineate key areas for future clinical trials and meta-analyses.

Key messages: IMs have brought important progress in the management of obesity, contributing meaningfully to current therapeutic approaches. However, pharmacotherapy alone is not sufficient to ensure long-term success. While lifestyle advice may aid in prevention, structured and personalized dietetic and physical exercise interventions are essential once obesity is established. Their integration with IMs is crucial to support long-term weight maintenance and improve overall health and quality of life.

Introduction: Early-onset obesity increases the risk of developing comorbidities and decreases life expectancy with many variables such as age of onset, severity, and duration of obesity each having an individual influence. Here, we present findings from a model that aims to assess the impact of early-onset obesity.

Methods: The Early-Onset Obesity Model (EOObesity Model) was built by integrating data from clinical studies with demographic information. It categorizes information into four primary groups: prevalence, morbidity risk, mortality risk, and impact of obesity duration. Type 2 diabetes, cardiovascular events (fatal and nonfatal events, cardiovascular disease, and coronary heart disease), metabolic dysfunction-associated steatotic liver disease, asthma, obstructive sleep apnea, and cancer were evaluated over a range of age and body mass index (BMI) z-scores.

Results: The EOObesity Model provides a systematic approach for estimating the impact of early-onset obesity on risk of comorbidities and on life expectancy by considering individual patient weight trajectories. We test different scenarios to illustrate the potential impact of age of onset and severity of obesity on the risk of various comorbidities, on life expectancy, and on disability-adjusted life years. The model indicates that severe early-onset obesity has a high impact on life expectancy with, for example, up to 42 years of life lost if a patient has a BMI z-score of 4 by the age of 4 years.

Discussion: The model and these scenarios underscore the predicted substantially detrimental effects of early-onset and prolonged obesity on life expectancy, and the increased risks of obesity-related comorbidities. They suggest that morbidity and mortality risks increase with obesity duration and severity in a nonlinear manner, thereby supporting the view that early weight-loss intervention and obesity prevention strategies may reduce long-term health risks substantially.

Introduction: Monitoring childhood obesity at a national scale is essential for planning health policies. This study analyzes the 2 decades secular trends of pediatric weight status in Spain.

Methods: Comparison of two nationwide representative cross-sectional studies: EnKid, conducted from 1998 to 2000, and PASOS from 2019 to 2020. Healthy weight, overweight, obesity, excess weight, severe obesity, and abdominal obesity were estimated. Analyses were stratified by developmental stage, gender, and mother educational level.

Results: From 2000 to 2019, the prevalence of abdominal obesity significantly increased from 16.0% to 22.6% (p < 0.05). Girls experienced a significant rise in the prevalence of obesity: from 3.16% to 7.20% (p < 0.05). The logistic regression analysis revealed a significantly higher odd ratio of excess weight (1.17, 95% CI: 1.01-1.36; p = 0.043), obesity (1.43, 95% CI: 1.08-1.90; p < 0.001), and abdominal obesity (1.57, 95% CI: 1.31-1.88; p < 0.05) in 2019 than in 2000. Moreover, we found a strong significant increase in the likelihood of obesity (2.40; 95% CI: 1.44-3.97; p < 0.01), severe obesity (4.56; 95% CI: 1.07-19.4; p = 0.04), and abdominal obesity (2.48; 95% CI: 1.82-3.37; p < 0.001) among girls. Finally, in 2019, lower socioeconomic status participants were also more likely to present excess weight (1.25; 95% CI: 1.05-1.48; p < 0.05), obesity (1.45; 95% CI: 1.07-1.97; p < 0.05), and abdominal obesity (1.65; 95% CI: 1.35-2.02; p < 0.001).

Conclusion: Pediatric obesity has increased in Spain over 2 decades. Effective health policies are urgent.

Introduction: Bariatric surgery (BS) is an effective intervention for severe obesity, but long-term weight regain (WR) can occur and may impact comorbidity outcomes.

Methods: In this retrospective study, we analyzed patients who underwent BS with a 10-year follow-up. WR was calculated as the percentage of maximum weight loss (%MWL) that had been regained from the nadir weight. Patients were categorized as "Maintainers" (WR ≤20% of %MWL) or "Regainers" (WR >20%).

Results: Among the 353 included patients, 317 underwent Roux-en-Y gastric bypass (RYGB) and 36 underwent sleeve gastrectomy (SG), 90.4% were female, with a mean age of 42 ± 11 years and a mean body mass index of 44.6 kg/m2. Mean WR at 10 years was 28% (±25), higher in SG vs. RYGB (41.37% vs. 26.17%, p = 0.03). Overall, 56.7% were Regainers. Baseline type 2 diabetes mellitus (T2D) was associated with an approximately 40% reduced risk of WR >20% (OR = 0.59; 95% CI: 0.38-0.93; p = 0.023). WR was not significantly associated with the recurrence or remission of T2D, hypertension, or dyslipidemia.

Conclusion: WR is common a decade after BS, particularly following SG. While WR does not appear to significantly impact comorbidity recurrence, its clinical relevance warrants further study. Standardized definitions are urgently needed to guide long-term management.

Introduction: Adolescence and early adulthood represent a critical phase for management of chronic diseases, including obesity. To improve transition of care in adolescents and young adults with obesity (AYALwO), the main goal was to summarize the current evidence on transition of care interventions (T-interventions) for obesity management. Anticipating a lack of evidence on T-interventions for AYALwO, we expanded the patient population to include individuals with other chronic diseases that can be appropriately transferred, such as diabetes.

Methods: We searched three databases and one trial registry from 01/2013-07/2025 onwards and screened reference lists of included trials, i.e. randomized-controlled trials (RCTs) and non-randomized-controlled studies of interventions (NRSI) enrolling AYALwO, type 1 (T1D)/ 2 diabetes and RCTs only for inflammatory bowel disease (IBD), arthritis or asthma (effects for these populations were considered transferable in case of lack of trials in AYALwO). We evaluated outcomes of T-interventions, e.g. HbA1c, quality of life, self-management or transition readiness. The review process was completed by two reviewers, independently. Results were summarized via random-effects meta-analysis or descriptively.

Results: We included 14 RCTs (n=9 T1D, n=2 mixed population, n=1 IBD, n=1 arthritis, n=1 asthma) and four NRSI (n=2 T1D, n=2 mixed population). Prespecified outcomes were mostly reported infrequently and/or heterogeneously. Effect measures were mostly inconclusive or not meaningful. No effect was shown for HbA1c in seven RCTs (mean difference 0.12% [95%-confidence interval -0.59; 0.83]) or in two NRSI. A higher transfer rate by appointment reminders (one RCT) or consultation at the same physician for pediatric and adult care (one RCT) and an improvement of transition readiness for transition-oriented patient education programs (one RCT, one NSRI) was found. Certainty of evidence (CoE) was very low for all outcomes, mainly due to a high risk of bias, indirectness and imprecision.

Conclusion: We found no trial for AYALwO. Evidence on other chronic diseases was limited, showing that T-interventions lead to improvements in transfer rate or transition readiness (very low CoE). This highlights the need for future research regarding T-interventions in AYALwO.

Prospero-id: CRD42024513411.

Introduction: To improve pediatric obesity treatment, this study aimed to identify predictors of body weight loss (BWL) and its maintenance (BWLM) in children and adolescents.

Methods: Data from 59 hospitalized children and adolescents with obesity (aged 9-17, mean 13.4 ± 1.9 years; mean length of stay: 38 ± 9.1 days) were collected at admission (T1), at discharge (T2), and up to 24 months thereafter (T5). Predictors of BWL (ΔT1-T2) (mean 0.33 ± 0.14 BMI z-score) and BWLM (ΔT2-T5) were categorized into demographic, psychometric, and sociometric data, physical condition, autonomic nervous system functions, and eating behavior. Secondary outcomes included changes in body composition and motor performance. Predictors were analyzed using LASSO [Journal of the Royal Statistical Society. 1996;58(1):267-288] and hierarchical regression.

Results: Energy density and food intake consistently predicted BWL and BWLM. Body dissatisfaction (p = 0.016), better anger management (less anger-related emotion regulation in the Stress and Stress Coping Questionnaire) (p = 0.031), smell identification skills, higher initial motor performance and strength, and lower initial endurance predicted BWL. A positive attitude toward healthy eating (p < 0.001), its improvement over time (p = 0.027), lower parasympathetic withdrawal - indicated by a smaller relative change in Root Mean Square of Successive Differences (RMSSDs) from baseline to stress (%RMSSD change, p = 0.022) - and high salt sensitivity (p < 0.001) significantly predicted BWLM.

Conclusion: This study provides initial indications that energy intake, in interaction with psychological and physiological factors, may be relevant to understanding BWL and BWLM in pediatric obesity, warranting further investigation.

Introduction: Obesity is a chronic, progressive, and recurring disease that contributes significantly to multi-morbidity across Europe. Despite the publication of numerous clinical practice guidelines (CPGs) for obesity, many chronic disease guidelines for obesity-related diseases such as diabetes, MASLD, heart disease, and obstructive sleep apnoea do not integrate contemporary understandings of obesity as an adiposity-based disease requiring direct management in its own right. The objective of this qualitative content analysis was to evaluate the extent to which recent chronic disease CPGs align with current evidence-based obesity guidance.

Methods: A working group convened by the European Association for the Study of Obesity reviewed 13 chronic disease CPGs published since 2019. Guidelines were assessed using nine predefined criteria based on leading obesity CPGs. Data were extracted, and content analysis was used to identify gaps and opportunities across the chronic disease CPGs.

Results: Three key themes were identified: (1) inconsistent scientific/medical conceptualization of obesity, (2) limited integration of evidence-based obesity management guidance, and (3) minimal inclusion of person-centred care principles. Most guidelines treated obesity as a risk factor, not a disease, and lacked reference to contemporary obesity frameworks or person-first language.

Conclusion: Greater alignment across CPGs is essential to improve obesity care within multi-morbidity management. Collaborative, cross-speciality approaches are recommended to harmonize clinical guidance and promote integrated, stigma-free care.