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Challenges in accessing NHS prescribed Wegovy highlight gaps in the UK’s weight management services
In the UK, the rollout of the weight-loss drug Wegovy by the National Health Service (NHS) has been significantly less widespread than anticipated. Since its introduction, Wegovy has been prescribed approximately 3,300 times, a figure starkly lower than the 13,500 prescriptions projected by the National Institute of Health and Care Excellence (Nice) for the drug’s first year. This shortfall is attributed to a combination of factors, including an international shortage of the drug and a domestic scarcity of specialised weight management clinics required for its distribution.
The Financial Times, analysing NHS England data, notes that this slow uptake occurs amidst escalating demand, especially after recent endorsements from the Medicines and Healthcare products Regulatory Agency (MHRA). The MHRA has expanded Wegovy’s use not only for weight reduction but also as a preventative treatment against severe heart conditions and strokes in adults with overweight and obesity.
Compounding the issue, the NHS faces a shortage of the drug due to global supply constraints, which has led to a prioritisation of Ozempic—another drug by the same manufacturer, Novo Nordisk, intended for type-2 diabetes but containing the same active ingredient, semaglutide. This decision reflects the broader challenges in managing pharmaceutical supplies amidst varying clinical demands.
The limited availability of “tier 3” specialist weight management services, which provide comprehensive support including counselling, physiotherapy, and dietary advice, further hinders access. These services are crucial as they replicate the conditions of the clinical trials conducted by Novo Nordisk, yet there are barely over 20 such clinics across the UK, some with extensive waiting lists.
Nerys Astbury, a professor at Oxford University specialising in diet and obesity, highlighted the inconsistency in the availability of these services. “The provision of tier 3 weight management services is very patchy across the country. Some areas are well-serviced, whilst others lack these services entirely, or face significant delays,” she explained. This disparity has led some individuals to pursue private treatment, which is not a viable option for everyone due to the high costs—up to £299 for a month’s supply at commercial pharmacies like Boots.
Despite these obstacles, NHS prescriptions of Wegovy have been on a gradual rise, reaching about 770 by April from its UK approval in September of the previous year. Looking forward, projections indicate that by 2027, nearly 4 million Britons could qualify for semaglutide treatment under NHS guidelines, with expectations that almost 50,000 will receive it annually.
However, the Department of Health and Social Care has warned that drugs in the GLP-1 category, which includes Wegovy, may continue to face shortages until at least the end of 2024. In response, Novo Nordisk has prioritised maintaining a stable supply of Ozempic for diabetes patients over Wegovy, reflecting a strategic decision to meet critical healthcare needs first.
Despite these prioritisation efforts, the future of weight management drugs like Wegovy and the newly mentioned Mounjaro from Eli Lilly, which might soon be prescribed without the need for tier 3 services, points towards a potential shift in how obesity treatments are administered in the UK. Professor Astbury remains cautiously optimistic about these developments, yet she underscores the necessity for readiness in service provision: “It’s promising that access might improve, but we must ensure that the healthcare settings are prepared to support patients effectively.”
In summary, while Wegovy offers significant potential in combating obesity and related health issues, its effective deployment within the NHS is hampered by systemic issues in drug supply and specialised service availability. These challenges highlight the need for strategic improvements in healthcare logistics and infrastructure to better serve the population’s needs.
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Britain’s drug regulator approves Novo Nordisk’s weight loss drug Wegovy to cut heart disease risk in patients with obesity
On Tuesday, the 23rd of July, 2024, the United Kingdom’s Medicines and Healthcare products Regulatory Agency (MHRA) granted approval for an additional use of Novo Nordisk drug, semaglutide (marketed as Wegovy), targeting the reduction of cardiovascular risks in adults with overweight and obesity.
Originally sanctioned for obesity treatment and weight management in conjunction with dietary, physical, and behavioural interventions, semaglutide, a GLP-1 receptor agonist, has now emerged as the pioneering prescription weight loss medication to thwart cardiovascular incidents. This includes the prevention of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke in individuals possessing a Body Mass Index (BMI) of at least 27 kg/m2 who already suffer from established cardiovascular disorders.
The endorsement by MHRA is supported by recent data derived from a post-approval clinical trial, indicating that a weekly subcutaneous injection of semaglutide (2.4 mg) over a span of up to five years considerably diminishes the occurrence of major adverse cardiovascular events (MACE) when compared to a placebo.
In a significant international study, which randomly allocated more than 17,600 participants to either receive Wegovy or a placebo, the treatment with Wegovy was observed to reduce the risk of major adverse cardiovascular events by 20%. These events transpired in only 6.5% of the Wegovy group, as opposed to 8% among those who received the placebo.
Recent research underscores the efficacy of semaglutide in augmenting the life quality of individuals with cardiovascular diseases by substantially lowering the risk of severe cardiac episodes.
Furthermore, in a strategic expansion move, Novo Nordisk procured a 200-acre plot earlier this month in Odense, Denmark’s third-largest city. The company has initiated preliminary excavation activities at this site, potentially setting the stage for a new manufacturing facility.
The surge in demand has propelled the pharmaceutical giant to invest billions in amplifying its production capacities in both Denmark and the United States. While the specific purpose of the new site in Odense remains to be officially confirmed, a report by Reuters in January highlighted that the site might accommodate facilities crucial for the fill-finish process involved in injection pen manufacturing.
A company statement released to Reuters mentioned, “With the political processes and approvals in place, we are pleased to announce that Novo Nordisk is now the owner of the site in Tietgenbyen in Odense.”
The company further indicated that the decision-making process regarding the precise use of the new site would conclude by the end of the year, post-internal approvals. The environmental report sheds light on future plans, which include establishing a packaging facility by 2026 and a factory for moulding plastic components necessary for pen and possibly tablet production by 2030.
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Ireland’s new legislation to revolutionise digital health records
In a significant move to enhance healthcare management, Ireland’s Department of Health has introduced the Health Information Bill 2024, poised to revolutionise the management of digital health records across the nation. This pivotal legislation follows the approval of the Irish Government and is specifically crafted to create a comprehensive legal framework facilitating the efficient sharing of patient data necessary for care and treatment.
This legislative initiative aligns with Ireland’s obligations under the impending European Health Data Space (EHDS) Regulation, set for implementation within the year. The Health Information Bill 2024 aims to establish a robust national health information system, designed to significantly improve the quality of patient care as well as the planning and delivery of healthcare services.
A cornerstone of this initiative, as outlined by the Department of Health, is the bill’s crucial role in the successful implementation of the ‘Digital for Care: A Digital Health Framework for Ireland 2024 – 2030’. This framework, launched in June, 2024, outlines a strategy for integrating digital technology into healthcare systems over the next several years.
Upon enactment, the bill will empower the Health Service Executive (HSE) to amalgamate health information across diverse care settings—encompassing private, public, and voluntary sectors. This comprehensive consolidation is intended to facilitate the development and deployment of digital health records accessible to all patients across Ireland.
Moreover, the bill proposes enhanced accessibility of health information for both patients and healthcare providers, which is anticipated to lead to improved health outcomes. It also focuses on augmenting patient safety by refining patient identification processes, incorporating tools like Eircode and the Personal Public Service Number (PPSN) to seamlessly integrate patient data with Ireland’s national digital strategy.
Ireland’s Health Minister, Stephen Donnelly, emphasised the importance of integrated care, as envisioned in the Sláintecare reform. He stated, “Integrated care as envisioned in Sláintecare, needs the right information, in the right place, at the right time. The Health Information Bill gives patients greater access to their own information so they can make informed decisions about their health and care options. It also enables health professionals to have a more complete, holistic view of the patients they are treating.”
Minister Donnelly also noted that the bill is slated to progress through the Houses of the Oireachtas during the upcoming autumn legislative session. Furthermore, additional legislative measures are planned for the forthcoming months and years to fully realise the policy intent of the approved General Scheme of the Bill and to ensure compliance with the EHDS implementation deadlines set for 2026 to 2030. This series of legislative updates underscores Ireland’s commitment to a fully integrated and digitally enhanced healthcare system.
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Alarming surge in severe obesity among adolescents in Ireland
Since 2018, Ireland has witnessed a tenfold increase in referrals of adolescents to specialised obesity clinics, highlighting a critical and worsening health issue among young people. Dr. Órla Walsh, a paediatric specialist at Children’s Health Ireland in Temple Street, has expressed deep concern over the rising number of young patients exhibiting severe symptoms of obesity. Over the past six years, the situation has escalated, with Dr. Walsh noting the overwhelming demand for treatment at her medically-led complex obesity clinic. “I’m running a clinic that is merely the tip of the iceberg. It is a tertiary clinic, which means we only see cases of severe complex obesity that also present with at least two other complications. Since its inception last year, our waiting list has grown to include 419 children,” Dr. Walsh explains.
The pervasive influence of obesity on both the physical and psychological well-being of children is profound. Dr. Walsh stresses that neither the child nor their family is at fault, pointing to genetic factors and an environment that promotes obesity. “The relentless marketing by food and beverage companies significantly contributes to the problem. Our children are inundated with advertisements daily, pushing fast food, processed items, and oversized portions,” she remarks.
A study presented in Dublin last year offered a glimmer of hope, showing promising results from weekly weight loss injections of semaglutide, a medication under the brand names Wegovy and Ozempic. Nearly half of the children treated no longer met the criteria for clinical obesity following the treatment. However, access to such medications is restricted; adolescents can only use these drugs if they are diabetic or if they can afford private treatment, costing approximately £200 a month.
Dr. Walsh highlights the inequality in access to treatment, especially among socioeconomically disadvantaged adolescents. She contrasts the situation in Ireland with international standards where adolescents have access to weight loss medications and bariatric surgery, which are not readily available in Ireland. Efforts have been made to urge the Health Service Executive (HSE) to provide weight loss medication freely to children suffering from complex obesity. “Treating these adolescents can prevent complications later in life. Investing in adolescent health yields a triple benefit: improving their current and future health, and potentially the health of their future children,” Dr. Walsh advocates.
The paediatrician also runs a general adolescent clinic and sees a troubling trend of obesity-related medical complications such as hypertension, pre-diabetes, and obstructive sleep apnoea, along with significant psychiatric comorbidities. “The stigma, shame, and bullying associated with obesity severely affect their mental health, leading to anxiety, depression, and often undiagnosed eating disorders,” she reveals.
Further stressing the urgency, a 2022 international report indicated that Ireland had the highest rate of risk factors for non-communicable diseases in European adolescents. The study surveyed nearly 500,000 children aged between 11 and 17, revealing that 63% of Irish adolescents exhibited four or more risk factors such as physical inactivity, poor diet, and substance use, compared to just 13% of their Swedish counterparts.
Dr. Walsh reflects on her recent observations in Sweden, where a healthier environment for children starkly contrasts with the situation in Ireland. “Sweden offers extensive support for child health, including widespread access to playgrounds, pools, and government-supported child care, which contributes to a healthier societal setup,” she notes.
The article concludes with the HSE’s response on the current status of obesity treatments under consideration for reimbursement, including medications like Saxenda and Wegovy, which are aimed at adults and potentially extendable to adolescents.
Dr. Walsh’s observations and the data presented underscore a dire need for systemic change to combat adolescent obesity in Ireland, a public health challenge that has only intensified in the wake of the global pandemic.
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New study finds financial rewards enhance obesity interventions for teens
A recent study has demonstrated that adolescents suffering from severe obesity achieve a more significant reduction in body mass index (BMI) when meal-replacement therapy is supplemented with financial incentives, as opposed to meal-replacement therapy alone. These findings have been documented in an article published by JAMA Pediatrics.
Justin Ryder, PhD, an associate professor involved in both the Surgery Division of Pediatric Surgery and Pediatrics, collaborated on this research. Ryder highlighted the importance of developing more effective treatments for severe obesity, which currently impacts approximately 20% of children and adolescents in the U.S. The Centers for Disease Control and Prevention defines severe obesity as having a BMI at or above the 95th percentile for one’s age and gender. This condition predisposes individuals to a host of future health issues including adult obesity, cardiovascular diseases, and type two diabetes.
Previous studies have shown that meal replacement therapy (MRT), which replaces regular meals with controlled, pre-portioned meals totalling 1,200 calories per day, tends to be more effective than traditional lifestyle changes for reducing BMI in young people with severe obesity. In light of these findings, the recent study aimed to assess whether the addition of financial incentives would enhance the effectiveness of MRT.
“There’s literature for adults that supports that tying in financial incentives to weight loss or physical activity programs increases adherence, and so we wanted to see whether or not adding financial incentives to a behavioural/nutrition weight loss program using meal replacement therapy would increase adherence and through adherence, increase the efficacy of the treatment,” explained Ryder.
The research involved 126 adolescents, divided into two groups of 63 participants each. For one year, one group received MRT along with financial incentives based on their weight reduction from baseline, while the other group received only the MRT. At the end of the 52-week period, the group that received both MRT and financial incentives exhibited a greater decrease in BMI—by 6 percentage points—and a higher reduction in total body fat mass—4.8 kilograms compared to their counterparts who only received MRT.
Ryder added, “Using a cost-effectiveness analysis, we looked at mean fat mass lost between the two treatments and found that despite providing the additional meal replacements for per pound lost, it was cost-effective to do so.”
The study’s authors also noted the need for the development of interventions that maintain effectiveness beyond a one-year timeframe. “While financial incentives plus MRT appears to be a longer-term strategy than MRT alone, treatment withdrawal will likely result in BMI increase. As such, research is needed to identify strategies that are scalable and feasible in the long term given the chronic nature of obesity,” they mentioned.
This pivotal research was funded by multiple grants from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institutes of Health National Center for Advancing Translational Sciences. Financial support for the meal programs was provided by Healthy For Life Meals, contributing to the resources necessary for this comprehensive study.
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Significant weight loss improves metabolism, mood, and decision-making in individuals with obesity
Severe obesity not only predisposes individuals to a variety of health risks but also significantly alters their metabolic functions and psychological states. Historically, it was believed that individuals with severe obesity tended to display heightened impulsivity and a greater propensity for risk-taking. However, recent research conducted by scientists at the DZD partner German Institute of Human Nutrition Potsdam-Rehbrücke (DIfE) has explored whether substantial weight loss could reverse these effects, enhancing both metabolic and psychological conditions and thereby improving decision-making processes. These findings have been elucidated in the publication ‘Clinical Nutrition‘.
Human behaviour is influenced by a myriad of factors including personality traits and internal physiological signals like glucose metabolism and mood states. In individuals with obesity, these internal signals are often disrupted, leading to unreliable decision-making foundations. Beatrix Keweloh, a doctoral researcher in the Department of Neuroscience of Decision and Nutrition, spearheaded an intervention study to investigate if these impairments could be reversed through significant weight loss. The study involved 62 participants, aged 18 to 75, all with severe obesity (BMI > 35 kg/m2). They underwent a rigorous 10-week diet limiting their daily caloric intake to 800 kilocalories.
Measurements of participants’ weight, body fat, mood (via a questionnaire), and risk-taking tendencies (using a computer-based test) were taken at both the start and conclusion of the diet. Results demonstrated a considerable decrease in BMI and HbA1c levels—markers of glucose metabolism—and notable improvements in mood. Additionally, there was a shift towards more risk-averse behaviours, suggesting a direct correlation between BMI and risk behaviour in individuals with obesity. “Our findings also indicated that the metabolic factor HbA1c becomes a predominant predictor of risk-taking behaviours post-weight loss,” commented Beatrix Keweloh.
The study further noted that post-weight loss, mood had a diminished impact on decision-making, with metabolic signals becoming the primary influencers of risk behaviour. “Weight loss positively impacts glucose metabolism and mood, and importantly, restores the regulatory function of glucose metabolism in decision-making processes,” Keweloh summarised.
The interplay between weight loss and the metabolic and psychological factors influencing risk-taking is intricate, with BMI playing a pivotal role. A reduced propensity for risk-taking correlates with a healthier lifestyle, crucial for both achieving and maintaining a healthy body weight. Consequently, interventions aimed at managing weight should incorporate both metabolic and psychological considerations to prevent relapses and foster metabolically driven decisions.
“This study is pioneering as it considers both metabolic and psychological aspects in overweight individuals,” stated Prof. Soyoung Q Park, head of the Department of Neuroscience of Decision and Nutrition. “It marks a significant contribution to the field, although it also highlights the necessity for further research to fully comprehend how energy balance and psychological factors influence our choices.”
Globally, the prevalence of obesity is escalating rapidly. According to a report in the British journal ‘Lancet’, over one billion individuals are affected worldwide, out of a global population of approximately eight billion. Data from the Federal Statistical Office reveal that in Germany alone, around 42 percent of women and 62 percent of men are considered to have either overweight or obesity. The World Health Organization (WHO) classifies individuals with a BMI over 25 as having overweight and over 30 as having obesity.
In studies assessing risk-taking tendencies, various methodologies are employed, such as computerised lottery tasks. In this particular study, a conventional lottery task was utilised where participants made choices between a guaranteed monetary amount and a variable amount, with a 50 percent chance of winning in each scenario.
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Roche highlights promising results from early obesity drug trial
Swiss pharmaceutical giant Roche has announced encouraging outcomes from an early-stage trial for its new obesity drug candidate, CT-996. This development emerges from its acquisition of Carmot Therapeutics. On Wednesday, 17th of July, 2024, Roche revealed that CT-996, a once-daily oral medication, demonstrated a significant placebo-adjusted average weight loss of 6.1% over a span of four weeks among patients with obesity who do not have diabetes.
The positive trial results, reported during a Phase I study, have notably propelled Roche’s stock up by 6.1% to a one-year peak at 1025 GMT. This surge mirrors the market’s response to earlier favourable results from another Carmot drug, underlining Roche’s burgeoning presence in the competitive obesity treatment landscape.
Currently, Roche is positioning itself against established players like Novo Nordisk and Eli Lilly, whose injectable weight-loss therapies are witnessing soaring demand. Forecasts for the market of such obesity treatments are expected to potentially reach $150 billion by the early 2030s.
Roche’s CT-996, appealing particularly to those who prefer pills over injections, has been well-received with primarily mild or moderate gastrointestinal side effects, comparable to those associated with other drugs in the weight-loss category.
Despite the promising data, Roche is navigating a rapidly evolving and crowded sector, aiming to develop oral formulations that effectively match the efficacy of the more prevalent weekly injections. Other companies, including Structure Therapeutics and Pfizer, are also making significant headway in this space. Structure Therapeutics reported a 6.2% weight loss after 12 weeks in a Phase II trial, while Pfizer recently outlined plans for trials of its revamped daily pill. Additionally, Viking Therapeutics showed a 3.3% weight loss at the four-week mark with its pill.
Manu Chakravarthy, Head of Metabolic Drug Development at Roche, commented on the challenges and potentials within the industry, noting the inherent unpredictability of side effects with small-molecule chemical compounds compared to the established peptide-based obesity drugs. “Having worked with many small molecules for most of my life, I can say it’s never over until it’s over. It’s a very different beast from an injectable formulation,” Chakravarthy stated.
Looking forward, Roche plans to advance CT-996 into Phase II clinical trials next year. Meanwhile, another Carmot-derived drug, CT-388, which is a self-administered once-weekly injection similar to the leading products from Novo and Lilly, also showed success in its Phase I trial in May.
In a strategic move to strengthen its position in the market, Roche acquired Carmot Therapeutics in December for $2.7 billion, signalling its commitment to expanding its portfolio in the obesity drug arena and challenging the dominance of Novo and Lilly in this field.
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New clinic for childhood obesity to open in Surrey, UK
Surrey is set to benefit from a pioneering initiative aimed at combating childhood obesity, as revealed by the BBC. The newly established Complications from Excess Weight (CEW) clinic, a part of Ashford and St Peter’s Hospitals NHS Foundation Trust, is preparing to welcome its first referrals in early autumn, 2024.
This service forms part of a broader national strategy, initiated by NHS England in 2022, to open 30 dedicated clinics across the country. These clinics are designed to offer comprehensive support services, including mental health care and nutritional guidance, to children grappling with obesity.
The teams at these clinics will consist of multidisciplinary professionals such as consultant paediatricians, dietitians, and psychologists, who are committed to a holistic treatment approach for the affected children and their families.
Vicky Williams, the Associate Director of Women and Children’s Services at Surrey Heartlands Integrated Care System, highlighted the urgent need for such services: “Obesity affects one in four children in the UK and it can increase the likelihood of a child developing serious health issues.” She emphasised the importance of early intervention and continuous support to prevent future complications. Williams expressed optimism about the local availability of the service, stating, “It means that, in future, children and young people will be referred to a specialist service in Surrey, closer to home, instead of having to travel further away – so it’s good news for families in Surrey.”
Furthermore, the NHS Frimley Integrated Care Board mentioned that currently, children eligible for the CEW clinic’s services in its area are receiving care from consultants based in Southampton. Plans are underway to establish a similar clinic closer to home for patients from Surrey Heath and Farnham, North East Hampshire, and East Berkshire.
The urgent need for such clinics is underscored by alarming statistics; NHS leaders have noted that obesity impacts one in four children in the UK, potentially leading to severe health problems such as Type 2 diabetes, liver disorders, and early onset heart disease. Data from the latest child measurement programme in schools indicates that nearly 13% of children assessed in Surrey during the 2022/23 school year were living with obesity by the time they reached year six of primary school.
Previous governmental measures include the 2018 imposition of a tax on high-sugar soft drinks and limitations on the promotion of unhealthy products in supermarkets across England.
The new Labour government has expressed a firm commitment to addressing this health crisis. A Department for Health and Social Care spokesperson detailed forthcoming measures: “We will introduce tight restrictions on advertising junk food, alongside banning children from being able to purchase sugary, high caffeine energy drinks. By building a healthier society, we will help to build a healthy economy.” This statement underscores the government’s proactive stance on cultivating a healthier future for the next generation.
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Examining the impact of excess weight on semen quality
A recent systematic review and meta-analysis published in the International Journal of Obesity, conducted by researchers in China, has revealed the profound impacts of obesity and overweight on male fertility. This study delves into the association between Body Mass Index (BMI) and semen quality, indicating significant adverse effects, particularly in men with more severe levels of obesity.
Approximately 15% of couples of reproductive age worldwide face infertility issues, with male factors, notably poor semen quality, contributing to 20–70% of these cases. Over recent decades, a marked decline in semen quality has been noted globally. For instance, significant decreases in total sperm count and sperm concentration were observed from 1973 to 2011 in Western nations, and from 1981 to 2019 in China. This decline is influenced by various factors including age, lifestyle, and environmental conditions. An increase in abnormal BMI has been pinpointed as a potential risk factor amidst these changes. Previous studies have linked obesity to reductions in semen quality, but results have varied due to differences in BMI classifications and other methodological limitations.
To address these inconsistencies and provide clearer insights, the researchers included data from 50 human studies, involving a total of 71,337 men aged between 26 and 44 years. These studies were sourced from Embase, PubMed, and Web of Science and categorised men based on their BMI: under 25.0 kg/m² as the reference group, 25.0–29.9 kg/m² as overweight, and over 30.0 kg/m² as having obesity. The studies examined various semen parameters such as volume, sperm concentration, motility, total sperm count, and morphology. Men were also categorised based on their fertility status into general, infertile or sub-fertile, and suspiciously sub-fertile groups.
The analysis, employing statistical tools like the random effects model, Cochran’s Q tests, and I² statistics, demonstrated that obesity was associated with significant reductions in several key semen parameters. Men with obesity, for instance, showed reductions of 0.24 ml in semen volume, 19.56 × 10⁶ in total sperm number, and decreases in both total and progressive motility. Men with overweight experienced milder declines, which were not as widespread across different semen parameters.
The study also highlighted that the detrimental effects of obesity on semen quality varied across different global regions, including America, Asia, and Europe, suggesting regional differences in lifestyle and environmental factors could influence the degree of impact. Furthermore, the findings were consistent across different methods of semen assessment, reinforcing the robustness of the results.
Despite its strengths, such as a large sample size and unified BMI classifications, the study faced limitations related to potential inaccuracies in aggregated data and the BMI’s inability to distinguish between muscle and fat mass. Additionally, the traditional semen parameters used might not fully reflect the functional capacity of sperm.
In conclusion, the analysis confirmed a significant association between higher BMI and poorer semen quality, with more severe impacts observed in men with higher obesity classes. These findings emphasise the importance of maintaining a healthy weight to support male reproductive health and suggest that future studies should explore broader reproductive implications of obesity using more comprehensive indicators of sperm health and function.
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Nutritional studies highlight pulses as key to lowering diabetes and cholesterol risks
Research consistently highlights pulses—such as beans, peas, lentils, and chickpeas—as crucial allies in the fight against diabetes and elevated cholesterol levels. This insight comes at a critical time, as projections from a study published in The Lancet last year forecast that diabetes could affect over 1.31 billion people globally by 2050. Concurrently, elevated cholesterol levels remain a significant health issue, with nearly half of adults in the UK exceeding national guidelines.
A detailed review in the journal Nutrients has shown that regular consumption of pulses can significantly improve these concerning health trends. The review meticulously examined thirty studies that looked at various types of pulses, including lentils, chickpeas, and several common beans like pinto, black, and kidney beans. The studies covered a wide array of health outcomes, from lipid profiles and blood pressure to risks of cardiovascular diseases and diabetes management.
The findings from these studies are telling. They specifically note improvements in low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, systolic and diastolic blood pressure, fasting blood sugar, haemoglobin A1c levels, waist circumference, and markers of inflammation and sensitivity such as C-reactive protein. These outcomes particularly underscore the potential of pulses to enhance lipid profiles and manage blood pressure.
The review emphasised that interventional studies, which typically have larger sample sizes and provide robust data, consistently confirm the health benefits of pulses. These studies often involved dietary adjustments where pulses replaced red meat or were added to diets as fixed servings. The results repeatedly demonstrated improvements in dietary quality and beneficial health outcomes.
Pulses’ potential to prevent heart disease is particularly noteworthy, largely due to their ability to lower total and LDL cholesterol levels. The authors of the review highlight that pulses are low in fat and rich in healthy mono- and polyunsaturated fats, essential micronutrients, and bioactive compounds with antioxidant properties, making them a true “nutritional powerhouse.”
Longitudinal studies also link higher pulse consumption with reduced risks of developing type 2 diabetes. This association is bolstered by interventional studies that document notable improvements in fasting glucose levels and insulin sensitivity with increased pulse intake. Consequently, pulses are not only pivotal in preventing diabetes but also in managing blood glucose levels effectively.
Tim McGreevy, CEO of USA Pulses, commented on the research, stating, “This research accentuates the fact that pulses are beneficial for health in so many ways, underscoring dietary guidelines that endorse plant-based eating patterns,” even though he was not directly involved in the study.
Additionally, awareness about type 2 diabetes is critical as many individuals may be unknowingly afflicted. Symptoms to watch for include increased urination, persistent thirst, excessive tiredness, unexplained weight loss, genital itching or recurrent thrush, delayed healing of wounds, and blurred vision. Recognising these signs can prompt earlier intervention and management of the condition, further reducing long-term health risks.
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Lifestyle changes in mothers with obesity could mitigate heart risks in offspring
Researchers at King’s College London have discovered that lifestyle modifications could potentially reduce the risk of children developing certain cardiovascular diseases, which are believed to stem from maternal obesity and related foetal heart abnormalities.
Globally, obesity rates among pregnant women are on the rise, with more than half of the women attending antenatal clinics in England and Wales either having overweight (28.5%) or obesity (22.7%). Studies have increasingly shown that obesity during pregnancy can precipitate cardiovascular complications and disrupt normal cardiac development in the offspring.
The findings were detailed in a recent publication in the International Journal of Obesity, led by Dr Samuel Burden. The research team conducted a systematic review of existing studies to explore whether interventions targeting obesity in pregnant women—through diet, exercise, and other physical activities—can foster cardiac health in their children.
The selection criteria for the studies included randomised trials focusing on lifestyle changes among pregnant women diagnosed with obesity. The evidence reviewed indicated that such interventions could avert atypical cardiac development in children, highlighting several benefits commonly associated with improved heart health, such as decreased thickening of the heart walls, maintaining normal heart weight, and reducing the likelihood of increased heart rates.
Dr Samuel Burden commented, “We and others have demonstrated that maternal obesity correlates with signs of poor heart development in children. Our review of existing literature on dietary and exercise interventions in women with obesity, either before or during pregnancy, revealed that these measures indeed offer a protective shield against the extent of this unhealthy heart development in children. Should these results hold into adulthood, these interventions could shield against the detrimental cardiovascular conditions seen in adult children of mothers with obesity, thus guiding public health strategies to enhance cardiovascular health for future generations.”
Although the data supports the premise that lifestyle adjustments in pregnant women with obesity may safeguard infant cardiovascular health, further comprehensive studies are necessary. These should involve larger cohorts and extend into later childhood to affirm the findings and assess if the benefits continue into adulthood.
Should future research corroborate these findings, the implications could be significant, potentially shaping public health initiatives aimed at improving heart health across generations.
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Beyond BMI: A new framework for diagnosing obesity with a focus on overall health
The traditional method of diagnosing and managing obesity, which heavily relies on body mass index (BMI), is increasingly seen as inadequate. Acknowledging this, the European Association for the Study of Obesity (EASO) has introduced a comprehensive new framework for diagnosing, staging, and managing adult obesity. Detailed in a recent publication in Nature Medicine, this framework aims to incorporate the latest scientific insights and advancements, including novel obesity medications, to ensure more effective and inclusive treatment strategies.
Obesity is widely recognised as a multifactorial, chronic, relapsing, non-communicable disease characterised by an abnormal and/or excessive accumulation of body fat. Traditionally, the diagnosis has been predominantly based on BMI cut-off values. This method fails to consider critical factors such as the distribution and functional roles of adipose tissue in the disease’s severity.
The EASO Steering Group, comprising current and former association presidents among other experts, has crafted a series of statements that update the obesity management approach to reflect the latest scientific knowledge. A key update in this new framework is the revised approach to the anthropometric component of obesity diagnosis. The authors explain, “An important novelty of our framework regards the anthropometric component of the diagnosis. The basis for this change is the recognition that BMI alone is insufficient as a diagnostic criterion, and that body fat distribution has a substantial effect on health.” They specifically highlight the health risks associated with the accumulation of abdominal fat, noting its association with an increased risk of cardiometabolic complications and its significance as a determinant of disease, even in individuals with a BMI below traditional obesity thresholds.
The new framework underscores the importance of considering abdominal (visceral) fat accumulation as a critical health risk factor, even in individuals with lower BMI (≥25–30 kg/m^2) who exhibit significant abdominal fat but may lack overt clinical symptoms. This broader definition aims to reduce the risk of undertreating these individuals compared to the current BMI-based criteria.
Treatment recommendations within the framework align with existing guidelines but emphasise behavioural changes such as dietary adjustments, increased physical activity, stress management, and improved sleep quality. Psychological therapy, obesity medications, and metabolic or bariatric procedures are also considered crucial, depending on individual needs.
The steering committee has pointed out that the traditional reliance on BMI cut-offs in clinical trials and guidelines often excludes individuals who, despite having a lower BMI, carry a significant obesity-related health burden. The committee suggests a shift towards including patients with a BMI of at least 25 kg/m^2 and a waist-to-height ratio above 0.5, who also exhibit medical, functional, or psychological impairments, in obesity medication and treatment programmes.
The authors make a call to action to pharmaceutical companies and regulatory bodies: “This statement may also be seen as a call to pharmacological companies and regulatory authorities to use inclusion criteria that are more adherent to the clinical staging of obesity and less to traditional BMI cut-offs when designing future clinical trials with obesity medications.”
In conclusion, the authors advocate for a paradigm shift in obesity management, likening it to the management of other chronic non-communicable diseases. They emphasise the importance of defining long-term, personalised therapeutic goals from the outset of treatment, considering the disease’s stage and severity, therapeutic options, side effects, patient preferences, and individual challenges. They stress the necessity for a comprehensive, life-long treatment plan over mere short-term weight reduction, stating, “Emphasis on the need for a long-term or life-long comprehensive treatment plan rather than short-term body weight reduction is warranted.”
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