VAT volume is a critical determinant of cardiometabolic risk, yet population-specific thresholds and accessible predictive tools remain undefined.
Methods
Using US National Health and Nutrition Examination Survey (NHANES) data, we analyzed dual-energy x-ray absorptiometry (DXA)-derived VAT volume. Threshold effects and sex/ethnicity interactions were evaluated via multivariable regression, while LASSO regularization and ROC analyses identified a simplified predictive model.
Results
A VAT volume threshold of 327.0 cm3 stratified CVD risk, distinguishing compensatory from pathological adiposity. The high-VAT group exhibited elevated CVD prevalence (2.41% vs. 1.12%, p = 0.016), metabolic dysregulation, and socioeconomic disparities. Males showed higher risk thresholds than females (387.5 vs. 312.0 cm3, p-interaction = 0.029). Non-Hispanic White participants and multiracial groups exhibited abrupt risk escalation above 399.5 and 270.0 cm3 (aOR = 1.08–1.12, p < 0.001), absent in non-Hispanic Black individuals and Hispanic individuals. A tri-biomarker model (waist circumference + triglycerides + apolipoprotein B) achieved near-equivalent accuracy to DXA-based VAT quantification (AUC = 0.821 vs. 0.819, p = 0.66), with high sensitivity (80.95% vs. 69.05%) and cost-effectiveness.
Conclusions
This study establishes the first sex-specific and ethnicity-specific VAT thresholds for CVD risk stratification and provides a clinically actionable tool for visceral adiposity screening.
目的：VAT体积是心脏代谢风险的关键决定因素，但特定人群的阈值和可获得的预测工具仍未定义。方法：使用美国国家健康与营养检查调查（NHANES）数据，我们分析了双能x线吸收仪（DXA）衍生的VAT体积。阈值效应和性别/种族相互作用通过多变量回归进行评估，而LASSO正则化和ROC分析确定了简化的预测模型。结果：VAT容积阈值为327.0 cm3分层CVD风险，将代偿性肥胖与病理性肥胖区分开来。高增值组表现出心血管疾病患病率升高（2.41% vs. 1.12%, p = 0.016）、代谢失调和社会经济差异。男性的危险阈值高于女性（387.5 vs. 312.0 cm3， p交互作用= 0.029）。非西班牙裔白人参与者和多种族组的风险突然上升至399.5和270.0 cm3以上（aOR = 1.08-1.12, p）。结论：本研究首次建立了CVD风险分层的性别特异性和种族特异性VAT阈值，并为内脏脂肪筛查提供了临床可操作的工具。
{"title":"Visceral Adiposity Thresholds for Cardiovascular Risk Stratification: A Simplified Biomarker-Driven Model","authors":"Tangmeng Guo, Ping He, Weilin Lu, Lili Huang, Chengyun Liu, Bei Cheng, Yuanyuan Zhang, Qi Zhang, Yanxu Chen, Minghao Liu, Peien Zhou, Junxi Liu, Xinchun Gu, Zhengyang Sun, Qiang Zhang, Sihao Xiao","doi":"10.1002/oby.24367","DOIUrl":"10.1002/oby.24367","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>VAT volume is a critical determinant of cardiometabolic risk, yet population-specific thresholds and accessible predictive tools remain undefined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using US National Health and Nutrition Examination Survey (NHANES) data, we analyzed dual-energy x-ray absorptiometry (DXA)-derived VAT volume. Threshold effects and sex/ethnicity interactions were evaluated via multivariable regression, while LASSO regularization and ROC analyses identified a simplified predictive model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A VAT volume threshold of 327.0 cm<sup>3</sup> stratified CVD risk, distinguishing compensatory from pathological adiposity. The high-VAT group exhibited elevated CVD prevalence (2.41% vs. 1.12%, <i>p</i> = 0.016), metabolic dysregulation, and socioeconomic disparities. Males showed higher risk thresholds than females (387.5 vs. 312.0 cm<sup>3</sup>, <i>p</i>-interaction = 0.029). Non-Hispanic White participants and multiracial groups exhibited abrupt risk escalation above 399.5 and 270.0 cm<sup>3</sup> (aOR = 1.08–1.12, <i>p</i> < 0.001), absent in non-Hispanic Black individuals and Hispanic individuals. A tri-biomarker model (waist circumference + triglycerides + apolipoprotein B) achieved near-equivalent accuracy to DXA-based VAT quantification (AUC = 0.821 vs. 0.819, <i>p</i> = 0.66), with high sensitivity (80.95% vs. 69.05%) and cost-effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study establishes the first sex-specific and ethnicity-specific VAT thresholds for CVD risk stratification and provides a clinically actionable tool for visceral adiposity screening.</p>\u0000 </section>\u0000 </div>","PeriodicalId":215,"journal":{"name":"Obesity","volume":"33 10","pages":"2005-2013"},"PeriodicalIF":4.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.24367","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Casey Tak, Paige Thompson, Jessica L. Morse, Meaghan McCallum
Objective
The objective of this study was to compare health care resource utilization (HRU), health care costs, and glucagon-like peptide-1 (GLP-1) agonist use among working US adults who engaged in Noom Weight, a smartphone-based lifestyle intervention for weight management, to individuals offered Noom who did not enroll.
Methods
Insurance claims data were used to conduct retrospective analyses of 723 Noom participants matched via propensity scores and compared to 723 non-Noom participants at 6 months post index.
Results
Compared to nonparticipants, Noom participants had significantly lower HRU, medical and pharmacy costs, and GLP-1 agonist use in the 6-month post-index period. On average, Noom participants had 3.2 fewer outpatient visits, 0.34 fewer emergency department visits, 0.25 fewer inpatient visits, and 0.012 fewer surgeries than non-Noom participants (all p values <0.001). Noom participants’ health care costs were $831 lower than non-Noom participants. Relative to non-Noom users, Noom participants also had 42% fewer claims for GLP-1 agonists (p = 0.02).
Conclusions
Compared to matched nonparticipants, Noom participation was associated with lower HRU, health care costs, and GLP-1 agonist use at 6 months post index. Results of this study support Noom as a cost-effective and HRU-lowering digital weight-management program for working adults in the United States.
{"title":"Health care resource utilization and health care costs among digital weight-loss intervention participants and nonparticipants","authors":"Casey Tak, Paige Thompson, Jessica L. Morse, Meaghan McCallum","doi":"10.1002/oby.24337","DOIUrl":"10.1002/oby.24337","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The objective of this study was to compare health care resource utilization (HRU), health care costs, and glucagon-like peptide-1 (GLP-1) agonist use among working US adults who engaged in Noom Weight, a smartphone-based lifestyle intervention for weight management, to individuals offered Noom who did not enroll.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Insurance claims data were used to conduct retrospective analyses of 723 Noom participants matched via propensity scores and compared to 723 non-Noom participants at 6 months post index.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to nonparticipants, Noom participants had significantly lower HRU, medical and pharmacy costs, and GLP-1 agonist use in the 6-month post-index period. On average, Noom participants had 3.2 fewer outpatient visits, 0.34 fewer emergency department visits, 0.25 fewer inpatient visits, and 0.012 fewer surgeries than non-Noom participants (all <i>p</i> values <0.001). Noom participants’ health care costs were $831 lower than non-Noom participants. Relative to non-Noom users, Noom participants also had 42% fewer claims for GLP-1 agonists (<i>p</i> = 0.02).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Compared to matched nonparticipants, Noom participation was associated with lower HRU, health care costs, and GLP-1 agonist use at 6 months post index. Results of this study support Noom as a cost-effective and HRU-lowering digital weight-management program for working adults in the United States.</p>\u0000 </section>\u0000 </div>","PeriodicalId":215,"journal":{"name":"Obesity","volume":"33 9","pages":"1637-1644"},"PeriodicalIF":4.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.24337","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Brittney O. Baumert, Elizabeth Costello, Zhenjiang Li, Justin R. Ryder, Thomas Inge, Todd Jenkins, Stephanie Sisley, Stavra A. Xanthakos, Douglas I. Walker, Nikos Stratakis, Damaskini Valvi, Scott M. Bartell, Angela L. Slitt, Rohit Kohli, Sarah Rock, Michele A. La Merrill, Sandrah P. Eckel, Max T. Aung, Rob McConnell, David V. Conti, Lida Chatzi
Objective
Weight regain following bariatric surgery remains a clinical challenge, with limited understanding of contributing environmental factors. Per- and polyfluoroalkyl substances (PFAS), persistent chemicals linked to metabolic dysfunction, may influence long-term weight trajectories. This study aimed to evaluate associations between PFAS exposure and changes in BMI, percent weight loss, and waist circumference among adolescents after bariatric surgery.
Methods
We included 186 adolescents (mean age: 17.1 years; 76.3% female; 72.0% White) from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) cohort who underwent surgery between 2007 and 2012. Anthropometric measurements were collected at baseline and 6, 12, 36, and 60 months post surgery. Presurgical plasma concentrations of seven PFAS were measured using liquid chromatography–tandem mass spectrometry. Associations were estimated using linear mixed-effects models and quantile g-computation.
Results
Higher concentrations of PFOS, PFHxS, and PFHpS were associated with greater BMI regain, reduced percent weight loss, and increased waist circumference from 1 to 5 years post surgery. At PFOS concentrations of 1.45 to 2.94 log2 ng/mL, annual BMI regain increased from 1.34 to 1.84 kg/m2 (p = 0.0497). Mixture analyses confirmed cumulative PFAS effects, with sulfonic acids showing the strongest associations.
Conclusions
PFAS exposure was associated with weight regain after bariatric surgery in adolescents, potentially undermining long-term metabolic benefits.
{"title":"PFAS Exposure and Postoperative Weight Regain in Adolescents After Bariatric Surgery: Findings From the Teen-LABS Study","authors":"Brittney O. Baumert, Elizabeth Costello, Zhenjiang Li, Justin R. Ryder, Thomas Inge, Todd Jenkins, Stephanie Sisley, Stavra A. Xanthakos, Douglas I. Walker, Nikos Stratakis, Damaskini Valvi, Scott M. Bartell, Angela L. Slitt, Rohit Kohli, Sarah Rock, Michele A. La Merrill, Sandrah P. Eckel, Max T. Aung, Rob McConnell, David V. Conti, Lida Chatzi","doi":"10.1002/oby.70009","DOIUrl":"10.1002/oby.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Weight regain following bariatric surgery remains a clinical challenge, with limited understanding of contributing environmental factors. Per- and polyfluoroalkyl substances (PFAS), persistent chemicals linked to metabolic dysfunction, may influence long-term weight trajectories. This study aimed to evaluate associations between PFAS exposure and changes in BMI, percent weight loss, and waist circumference among adolescents after bariatric surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 186 adolescents (mean age: 17.1 years; 76.3% female; 72.0% White) from the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) cohort who underwent surgery between 2007 and 2012. Anthropometric measurements were collected at baseline and 6, 12, 36, and 60 months post surgery. Presurgical plasma concentrations of seven PFAS were measured using liquid chromatography–tandem mass spectrometry. Associations were estimated using linear mixed-effects models and quantile g-computation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Higher concentrations of PFOS, PFHxS, and PFHpS were associated with greater BMI regain, reduced percent weight loss, and increased waist circumference from 1 to 5 years post surgery. At PFOS concentrations of 1.45 to 2.94 log<sub>2</sub> ng/mL, annual BMI regain increased from 1.34 to 1.84 kg/m<sup>2</sup> (<i>p</i> = 0.0497). Mixture analyses confirmed cumulative PFAS effects, with sulfonic acids showing the strongest associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PFAS exposure was associated with weight regain after bariatric surgery in adolescents, potentially undermining long-term metabolic benefits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>\u0000 ClinicalTrials.gov identifier NCT00474318</p>\u0000 \u0000 <div>\u0000 \u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure>\u0000 </div>\u0000 </section>\u0000 </div>","PeriodicalId":215,"journal":{"name":"Obesity","volume":"33 10","pages":"1930-1954"},"PeriodicalIF":4.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12424438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although associations of adiposity with metabolic, cardiovascular, and liver diseases are known, the genetic links, causal effects, and polygenic risk score (PRS) predictions for these health conditions in East Asian individuals remain unclear.
Methods
We conducted genome-wide association studies of BMI (n = 95,488) and body fat percentage (BFP; n = 83,448) in Taiwanese individuals from Taiwan Biobank data, followed by cross-trait genetic correlation and bidirectional Mendelian randomization in four East Asian biobanks. BMI and BFP PRS were constructed and validated in the China Medical University Hospital and Biobank Japan databases.
Results
We identified 41 BMI and 22 BFP loci, including novel loci. Genetically predicted higher adiposity correlated with increased risk of metabolic syndrome, cardiovascular disease, hypertension, and elevated liver enzymes. Bidirectional Mendelian randomization revealed a causal effect of adiposity on glycosylated hemoglobin, systolic blood pressure, liver enzymes, and cholelithiasis, with no reverse causality. After adjusting for type 2 diabetes, the effect on glycemic traits diminished, suggesting a strong influence of diabetes-related loci. BMI and BFP PRS robustly predicted higher risk and earlier onset of type 2 diabetes, hypertension, cholelithiasis, and liver dysfunction in East Asian individuals.
Conclusions
These findings reveal novel adiposity loci and underscore the clinical utility of adiposity-related genetics for personalized health.
{"title":"Unraveling the genetic link: causal effects and PRS predictions of adiposity-related health conditions in East Asian individuals","authors":"Ying-Ju Lin, Ju-Pi Li, Ting-Yuan Liu, Jian-Shiun Chiou, Hsing-Fang Lu, Kuyuri Ariyoshi, Shunsuke Uchiyama, Chikashi Terao, Jai-Sing Yang, Chen-Hsing Chou, Wen-Miin Liang, I-Ching Chou, Cheng-Wen Lin, Ting-Hsu Lin, Chiu-Chu Liao, Shao-Mei Huang, Fuu-Jen Tsai","doi":"10.1002/oby.24335","DOIUrl":"10.1002/oby.24335","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Although associations of adiposity with metabolic, cardiovascular, and liver diseases are known, the genetic links, causal effects, and polygenic risk score (PRS) predictions for these health conditions in East Asian individuals remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted genome-wide association studies of BMI (<i>n</i> = 95,488) and body fat percentage (BFP; <i>n</i> = 83,448) in Taiwanese individuals from Taiwan Biobank data, followed by cross-trait genetic correlation and bidirectional Mendelian randomization in four East Asian biobanks. BMI and BFP PRS were constructed and validated in the China Medical University Hospital and Biobank Japan databases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 41 BMI and 22 BFP loci, including novel loci. Genetically predicted higher adiposity correlated with increased risk of metabolic syndrome, cardiovascular disease, hypertension, and elevated liver enzymes. Bidirectional Mendelian randomization revealed a causal effect of adiposity on glycosylated hemoglobin, systolic blood pressure, liver enzymes, and cholelithiasis, with no reverse causality. After adjusting for type 2 diabetes, the effect on glycemic traits diminished, suggesting a strong influence of diabetes-related loci. BMI and BFP PRS robustly predicted higher risk and earlier onset of type 2 diabetes, hypertension, cholelithiasis, and liver dysfunction in East Asian individuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings reveal novel adiposity loci and underscore the clinical utility of adiposity-related genetics for personalized health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":215,"journal":{"name":"Obesity","volume":"33 9","pages":"1765-1778"},"PeriodicalIF":4.7,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144850231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The study aimed to compare the cost-effectiveness of various strategies for screening for MASLD-related advanced hepatic fibrosis (fibrosis stage > 2) using the fibrosis-4 index (FIB-4) and liver stiffness measurement (LSM) by transient elastography (TE) in persons with obesity.
Methods
We created a decision-analytic model comparing three screening strategies: no screening, TE, and FIB-4 followed by TE. We used a Markov transition model to track liver state, with prevalence and transition probabilities specific to the population with obesity. If MASLD was detected, patients were treated with resmetirom.
Results
We found an incremental cost-effectiveness ratio (ICER) of $234,781 (95% CI: $232,581, $235,608) when comparing TE to no screening with a 10-year interval. We note the ICER of $234,673 (95% CI: $234,033, $235,072) when comparing TE to FIB-4+TE. In multivariate simulations, we found no screening was most likely to be cost-effective for willingness-to-pay for QALY below approximately $250,000.
Conclusions
Our results suggest routine screening for MASLD in obesity clinics is not cost-effective with resmetirom as the available treatment. A prescreening with FIB-4 before TE did not increase economic efficiency.
{"title":"Screening for MASLD and Advanced Fibrosis Among Patients With Obesity: A Cost-Effectiveness Analysis","authors":"Arpan Mohanty, Yin Wang, Charles Stoecker","doi":"10.1002/oby.70005","DOIUrl":"10.1002/oby.70005","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The study aimed to compare the cost-effectiveness of various strategies for screening for MASLD-related advanced hepatic fibrosis (fibrosis stage > 2) using the fibrosis-4 index (FIB-4) and liver stiffness measurement (LSM) by transient elastography (TE) in persons with obesity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We created a decision-analytic model comparing three screening strategies: no screening, TE, and FIB-4 followed by TE. We used a Markov transition model to track liver state, with prevalence and transition probabilities specific to the population with obesity. If MASLD was detected, patients were treated with resmetirom.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We found an incremental cost-effectiveness ratio (ICER) of $234,781 (95% CI: $232,581, $235,608) when comparing TE to no screening with a 10-year interval. We note the ICER of $234,673 (95% CI: $234,033, $235,072) when comparing TE to FIB-4+TE. In multivariate simulations, we found no screening was most likely to be cost-effective for willingness-to-pay for QALY below approximately $250,000.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our results suggest routine screening for MASLD in obesity clinics is not cost-effective with resmetirom as the available treatment. A prescreening with FIB-4 before TE did not increase economic efficiency.</p>\u0000 </section>\u0000 </div>","PeriodicalId":215,"journal":{"name":"Obesity","volume":"33 10","pages":"1845-1848"},"PeriodicalIF":4.7,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144984070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hanyue Zhang, Aikaterina Vasileiou, Dominique Searle, Sofus C. Larsen, Alistair M. Senior, Faidon Magkos, Leigh C. Ward, Graham Horgan, Inês Santos, António L. Palmeira, Stephen J. Simpson, David Raubenheimer, R. James Stubbs, Berit L. Heitmann
Objective
To examine the association between dietary macronutrient composition and 12-month weight loss maintenance (WLM) in adults who achieved initial weight loss (≥ 5%).
Methods
This prospective cohort analysis used 12-month follow-up data from the Navigating to a Healthy Weight trial. Macronutrient composition (%) was assessed using a 4-day, 24-h dietary recall. Food sources were categorized as discretionary foods, lean meat, vegetables, fruit, grains, and dairy. Primary outcomes included 12-month changes in body weight, fat mass index (FMI), waist-to-height ratio (WHtR), and hip-to-height ratio (HHtR). A nutritional geometry approach was used to examine individual and interactive associations of macronutrient intake, visualizing as response surfaces.
Results
Among 1518 participants (69.8% women; mean age 45 ± 12 years), mean macronutrient composition was 20.6% protein, 33.8% fat, and 43.1% carbohydrate. Protein energy percentage was inversely associated with energy intake (β: −0.33; 95% CI: −0.39, −0.27). Response surfaces revealed that lower proportional energy from protein, diluted by high fat and/or carbohydrate, was associated with higher total energy intake and greater 12-month increases in body weight, WHtR, and HHtR, but not FMI. Consumption of discretionary food, not other food sources, increased energy intake by reducing proportional energy from protein.
Conclusions
Maintaining dietary proportional energy from protein, particularly by limiting discretionary food consumption, was associated with reduced energy intake and improved WLM.
{"title":"Dietary Macronutrient Composition and Protein Concentration for Weight Loss Maintenance","authors":"Hanyue Zhang, Aikaterina Vasileiou, Dominique Searle, Sofus C. Larsen, Alistair M. Senior, Faidon Magkos, Leigh C. Ward, Graham Horgan, Inês Santos, António L. Palmeira, Stephen J. Simpson, David Raubenheimer, R. James Stubbs, Berit L. Heitmann","doi":"10.1002/oby.24370","DOIUrl":"10.1002/oby.24370","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the association between dietary macronutrient composition and 12-month weight loss maintenance (WLM) in adults who achieved initial weight loss (≥ 5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective cohort analysis used 12-month follow-up data from the Navigating to a Healthy Weight trial. Macronutrient composition (%) was assessed using a 4-day, 24-h dietary recall. Food sources were categorized as discretionary foods, lean meat, vegetables, fruit, grains, and dairy. Primary outcomes included 12-month changes in body weight, fat mass index (FMI), waist-to-height ratio (WHtR), and hip-to-height ratio (HHtR). A nutritional geometry approach was used to examine individual and interactive associations of macronutrient intake, visualizing as response surfaces.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1518 participants (69.8% women; mean age 45 ± 12 years), mean macronutrient composition was 20.6% protein, 33.8% fat, and 43.1% carbohydrate. Protein energy percentage was inversely associated with energy intake (β: −0.33; 95% CI: −0.39, −0.27). Response surfaces revealed that lower proportional energy from protein, diluted by high fat and/or carbohydrate, was associated with higher total energy intake and greater 12-month increases in body weight, WHtR, and HHtR, but not FMI. Consumption of discretionary food, not other food sources, increased energy intake by reducing proportional energy from protein.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Maintaining dietary proportional energy from protein, particularly by limiting discretionary food consumption, was associated with reduced energy intake and improved WLM.</p>\u0000 </section>\u0000 </div>","PeriodicalId":215,"journal":{"name":"Obesity","volume":"33 10","pages":"1995-2004"},"PeriodicalIF":4.7,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.24370","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ulf Holmbäck, Stefan Grudén, Sandra Kuusk, Helena Litorp, Joakim Englund, Arvid Söderhäll, Göran Alderborn, Anders Forslund
Objective
This study aimed to evaluate the added effect of acarbose to orlistat on relative weight loss in the novel antiobesity medication EMP16.
Methods
In this 6-month double-blind trial, 240 individuals with obesity or overweight and comorbidities were randomized equally into three groups: (1) EMP16 (120 mg modified release orlistat/40 mg modified release acarbose), (2) MR-O (120 mg modified release orlistat), and (3) Conv-O (120 mg conventional orlistat). The primary outcomes were relative and categorical weight loss after 6 months.
Results
Mean relative weight loss was −7.73% for the EMP16 group as compared to −5.78% for the MR-O group and −5.13% for the Conv-O group (p < 0.01). Proportion achieving ≥ 5% or ≥ 10% weight reduction was 61%/32% in EMP16 group, compared to 51%/20% in the MR-O and 48%/12% in the Conv-O group (p > 0.05 for ≥ 10%). All groups showed small improvements in glucose and lipid markers, with EMP16 demonstrating greater improvement in fatty liver index and quality of life compared to Conv-O (p < 0.01). No serious adverse events occurred; most AEs were mild and transient.
Conclusions
Acarbose enhances the weight loss efficacy of EMP16, supporting its potential as a safe and effective treatment for long-term obesity management.
Trial Registration
EU Clinical Trials Register: EudraCT-nr. 2022-003320-40
{"title":"The Supportive Effect of Acarbose to Orlistat in Weight Management—A Randomized, Double-Blind, Multiarm Phase 2 Trial","authors":"Ulf Holmbäck, Stefan Grudén, Sandra Kuusk, Helena Litorp, Joakim Englund, Arvid Söderhäll, Göran Alderborn, Anders Forslund","doi":"10.1002/oby.24369","DOIUrl":"10.1002/oby.24369","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to evaluate the added effect of acarbose to orlistat on relative weight loss in the novel antiobesity medication EMP16.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this 6-month double-blind trial, 240 individuals with obesity or overweight and comorbidities were randomized equally into three groups: (1) EMP16 (120 mg modified release orlistat/40 mg modified release acarbose), (2) MR-O (120 mg modified release orlistat), and (3) Conv-O (120 mg conventional orlistat). The primary outcomes were relative and categorical weight loss after 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Mean relative weight loss was −7.73% for the EMP16 group as compared to −5.78% for the MR-O group and −5.13% for the Conv-O group (<i>p</i> < 0.01). Proportion achieving ≥ 5% or ≥ 10% weight reduction was 61%/32% in EMP16 group, compared to 51%/20% in the MR-O and 48%/12% in the Conv-O group (<i>p</i> > 0.05 for ≥ 10%). All groups showed small improvements in glucose and lipid markers, with EMP16 demonstrating greater improvement in fatty liver index and quality of life compared to Conv-O (<i>p</i> < 0.01). No serious adverse events occurred; most AEs were mild and transient.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Acarbose enhances the weight loss efficacy of EMP16, supporting its potential as a safe and effective treatment for long-term obesity management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>EU Clinical Trials Register: EudraCT-nr. 2022-003320-40</p>\u0000 </section>\u0000 </div>","PeriodicalId":215,"journal":{"name":"Obesity","volume":"33 10","pages":"1855-1864"},"PeriodicalIF":4.7,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.24369","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144796580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samantha Lange Pierce, Emily M. Kraus, Renee Porter, Mona Sharifi, Lyudmyla Kompaniyets, Alyson B. Goodman
Objective
The 2023 American Academy of Pediatrics clinical practice guideline (CPG) recommends testing children aged ≥ 10 years with obesity for abnormalities in lipids, glucose metabolism, and liver function. We aimed to assess laboratory screening and test results for three obesity-related chronic conditions in a large cohort of US patients 10–18 years with obesity.
Methods
We used electronic health record data to estimate (1) prevalence of screening for diabetes, dyslipidemia, and nonalcoholic fatty liver disease (NAFLD), individually and in combination, and (2) prevalence of abnormal test results, by obesity severity and demographics.
Results
Among 333,110 patients with obesity, only one-quarter (26%) were screened for diabetes, dyslipidemia, or NAFLD during 2020–2022. Among those screened, complete screening (all three conditions) occurred half of the time. Screening rates were significantly higher in those with more severe obesity, yet 64% of children with class 3 obesity remained unscreened. When screening occurred, results revealed a high proportion of abnormal lipid (56%), NAFLD (44% elevated or borderline), and diabetes markers (14% prediabetes or diabetes).
Conclusions
Most youth with obesity were not screened for chronic conditions. Many who were screened had abnormal results. These findings establish baseline estimates and highlight opportunities for improvement in uptake of CPG recommendations to support evidence-based obesity pediatric care.
{"title":"Assessment of Guideline-Recommended Laboratory Screening for Obesity-Related Chronic Conditions in US Youth 10–18 Years","authors":"Samantha Lange Pierce, Emily M. Kraus, Renee Porter, Mona Sharifi, Lyudmyla Kompaniyets, Alyson B. Goodman","doi":"10.1002/oby.24365","DOIUrl":"10.1002/oby.24365","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The 2023 American Academy of Pediatrics clinical practice guideline (CPG) recommends testing children aged ≥ 10 years with obesity for abnormalities in lipids, glucose metabolism, and liver function. We aimed to assess laboratory screening and test results for three obesity-related chronic conditions in a large cohort of US patients 10–18 years with obesity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used electronic health record data to estimate (1) prevalence of screening for diabetes, dyslipidemia, and nonalcoholic fatty liver disease (NAFLD), individually and in combination, and (2) prevalence of abnormal test results, by obesity severity and demographics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 333,110 patients with obesity, only one-quarter (26%) were screened for diabetes, dyslipidemia, or NAFLD during 2020–2022. Among those screened, complete screening (all three conditions) occurred half of the time. Screening rates were significantly higher in those with more severe obesity, yet 64% of children with class 3 obesity remained unscreened. When screening occurred, results revealed a high proportion of abnormal lipid (56%), NAFLD (44% elevated or borderline), and diabetes markers (14% prediabetes or diabetes).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Most youth with obesity were not screened for chronic conditions. Many who were screened had abnormal results. These findings establish baseline estimates and highlight opportunities for improvement in uptake of CPG recommendations to support evidence-based obesity pediatric care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":215,"journal":{"name":"Obesity","volume":"33 10","pages":"1921-1929"},"PeriodicalIF":4.7,"publicationDate":"2025-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144777471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Currently approved incretin-based therapies for weight loss, specifically semaglutide and tirzepatide, can induce 10% to 25% reductions in body weight. These “chemical shields” against the obesogenic environment not only facilitate satiety at lower caloric intake but also reduce the pervasive “food noise” described by many users, making it potentially easier to engage in other healthy lifestyle changes. These are important medicines coming at a time when obesogenic environments show little signs of being meaningfully reversed.</p><p>Importantly, the clinical effects of these weight loss therapies extend beyond weight reduction. Semaglutide has been shown to reduce cardiovascular events in people without diabetes, as demonstrated in the landmark SELECT trial [<span>1</span>]. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 receptor agonist (GLP-1RA), appears to offer even greater average weight loss and potentially additional metabolic benefits, though its cardiovascular impact remains to be confirmed.</p><p>The ongoing SURMOUNT-MMO trial described in this issue of <i>Obesity</i> [<span>2</span>] is designed to evaluate this question and much more. It is the pivotal placebo-controlled cardiovascular outcomes trial for tirzepatide in individuals without type 2 diabetes (T2D), following on from the soon to be reported SUPRASS CVOT (https://clinicaltrials.gov/study/NCT04255433) which tests the cardiovascular outcomes of tirzepatide versus an active comparator, dulaglutide, in people with T2D. SURMOUNT-MMO compares tirzepatide to placebo for a composite primary endpoint that includes a range of cardiovascular events, notably including heart failure—a cardiovascular condition more strongly associated with obesity than atherosclerotic outcomes.</p><p>Critically, however, in addition to the primary endpoint, SURMOUNT-MMO is also examining a series of important secondary outcomes [<span>2</span>]. These include the incidence of T2D, changes in kidney function via estimated glomerular filtration rate, and physical functioning, each representing somewhat different pathways through which obesity causes harm: metabolic, hemodynamic, and mechanical. Other secondary and tertiary outcomes include heart failure hospitalization, obesity-related liver outcomes, cancers linked to obesity, and all-cause hospitalization [<span>2</span>]. Consequently, this trial will offer an opportunity to assess both the broad direct and weight loss effects of tirzepatide in a controlled setting (Figure 1). Placebo-controlled randomized trials remain the gold standard for assessing both benefits and safety and are especially valuable for detecting outcomes that are relatively common. Even the best designed observational studies cannot provide this level of causal evidence.</p><p>Beyond clinical outcomes, health systems and policy makers are paying close attention to trials like SURMOUNT MMO due to economic implications. The curre
{"title":"From Weight Loss to Multimorbidity Prevention: Framing the Anticipated Contributions of SURMOUNT-MMO","authors":"Naveed Sattar","doi":"10.1002/oby.70017","DOIUrl":"10.1002/oby.70017","url":null,"abstract":"<p>Currently approved incretin-based therapies for weight loss, specifically semaglutide and tirzepatide, can induce 10% to 25% reductions in body weight. These “chemical shields” against the obesogenic environment not only facilitate satiety at lower caloric intake but also reduce the pervasive “food noise” described by many users, making it potentially easier to engage in other healthy lifestyle changes. These are important medicines coming at a time when obesogenic environments show little signs of being meaningfully reversed.</p><p>Importantly, the clinical effects of these weight loss therapies extend beyond weight reduction. Semaglutide has been shown to reduce cardiovascular events in people without diabetes, as demonstrated in the landmark SELECT trial [<span>1</span>]. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 receptor agonist (GLP-1RA), appears to offer even greater average weight loss and potentially additional metabolic benefits, though its cardiovascular impact remains to be confirmed.</p><p>The ongoing SURMOUNT-MMO trial described in this issue of <i>Obesity</i> [<span>2</span>] is designed to evaluate this question and much more. It is the pivotal placebo-controlled cardiovascular outcomes trial for tirzepatide in individuals without type 2 diabetes (T2D), following on from the soon to be reported SUPRASS CVOT (https://clinicaltrials.gov/study/NCT04255433) which tests the cardiovascular outcomes of tirzepatide versus an active comparator, dulaglutide, in people with T2D. SURMOUNT-MMO compares tirzepatide to placebo for a composite primary endpoint that includes a range of cardiovascular events, notably including heart failure—a cardiovascular condition more strongly associated with obesity than atherosclerotic outcomes.</p><p>Critically, however, in addition to the primary endpoint, SURMOUNT-MMO is also examining a series of important secondary outcomes [<span>2</span>]. These include the incidence of T2D, changes in kidney function via estimated glomerular filtration rate, and physical functioning, each representing somewhat different pathways through which obesity causes harm: metabolic, hemodynamic, and mechanical. Other secondary and tertiary outcomes include heart failure hospitalization, obesity-related liver outcomes, cancers linked to obesity, and all-cause hospitalization [<span>2</span>]. Consequently, this trial will offer an opportunity to assess both the broad direct and weight loss effects of tirzepatide in a controlled setting (Figure 1). Placebo-controlled randomized trials remain the gold standard for assessing both benefits and safety and are especially valuable for detecting outcomes that are relatively common. Even the best designed observational studies cannot provide this level of causal evidence.</p><p>Beyond clinical outcomes, health systems and policy makers are paying close attention to trials like SURMOUNT MMO due to economic implications. The curre","PeriodicalId":215,"journal":{"name":"Obesity","volume":"33 9","pages":"1622-1624"},"PeriodicalIF":4.7,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vy T. Nguyen, Ashley A. Donovan, Kathryn M. Taylor, Katelyn Guerriere Aaron, Leila A. Walker, Vincent P. Pecorelli, David J. Zeppetelli, Colleen M. Castellani, Susan P. Proctor, Julie M. Hughes, Stephen A. Foulis
Objective
To investigate the association between weight loss before joining the U.S. Army and rates of musculoskeletal injury (MSKI) during physically demanding Basic Combat Training (BCT).
Methods
Self-reported weight loss was collected on 3168 Army trainees who were followed through electronic medical records for diagnosis of any and region-specific MSKI. Cox regression models were stratified by sex and COVID-19 pandemic and adjusted for age, height, maximum-ever BMI, race/ethnicity, smoking history, prior physical activity, and history of injury.
Results
A total of 829 trainees (26.16%) reported losing weight to enter the Army with mean (SD) weight loss of 9.06 (8.62) kg, most commonly through exercise (83.72%). Trainees who lost weight to enter the Army had lower rates of any (HR: 0.86; 95% CI: 0.74, 0.99) and lower extremity (HR: 0.84; 95% CI: 0.72, 0.98) MSKI during BCT compared to trainees who did not lose weight. Rate of weight loss (mean [SD]: 1.27 [1.06] kg/week) was not associated with any or region-specific MSKI.
Conclusions
Results indicate that losing excess weight before military training may minimize injuries during training and the relatively gradual rate of weight loss in these trainees did not pose a higher risk of injury.
{"title":"Weight Loss Before Basic Combat Training and Musculoskeletal Injuries Among U.S. Army Trainees: The ARMI Study","authors":"Vy T. Nguyen, Ashley A. Donovan, Kathryn M. Taylor, Katelyn Guerriere Aaron, Leila A. Walker, Vincent P. Pecorelli, David J. Zeppetelli, Colleen M. Castellani, Susan P. Proctor, Julie M. Hughes, Stephen A. Foulis","doi":"10.1002/oby.24364","DOIUrl":"10.1002/oby.24364","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the association between weight loss before joining the U.S. Army and rates of musculoskeletal injury (MSKI) during physically demanding Basic Combat Training (BCT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Self-reported weight loss was collected on 3168 Army trainees who were followed through electronic medical records for diagnosis of any and region-specific MSKI. Cox regression models were stratified by sex and COVID-19 pandemic and adjusted for age, height, maximum-ever BMI, race/ethnicity, smoking history, prior physical activity, and history of injury.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 829 trainees (26.16%) reported losing weight to enter the Army with mean (SD) weight loss of 9.06 (8.62) kg, most commonly through exercise (83.72%). Trainees who lost weight to enter the Army had lower rates of any (HR: 0.86; 95% CI: 0.74, 0.99) and lower extremity (HR: 0.84; 95% CI: 0.72, 0.98) MSKI during BCT compared to trainees who did not lose weight. Rate of weight loss (mean [SD]: 1.27 [1.06] kg/week) was not associated with any or region-specific MSKI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Results indicate that losing excess weight before military training may minimize injuries during training and the relatively gradual rate of weight loss in these trainees did not pose a higher risk of injury.</p>\u0000 </section>\u0000 </div>","PeriodicalId":215,"journal":{"name":"Obesity","volume":"33 10","pages":"1977-1983"},"PeriodicalIF":4.7,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/oby.24364","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144755528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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