Obesity Care

Large-scale study finds children with obesity face markedly higher risk of limb fractures

Key Takeaways: 

• Children with obesity at the age of starting school have nearly a five-fold higher risk of bone fractures during childhood compared with children of a healthy weight.
• Analysis of almost 467,000 children in Catalonia showed obesity at age four was associated with a 70% higher risk of lower limb fractures and a 20% higher risk of upper limb fractures.
• Findings highlight the long-term health implications of obesity in the preschool years, reinforcing the need for early intervention and further research.
  

Growing concern over childhood obesity

The rising prevalence of childhood obesity is a major global public health challenge. It has already been linked to a wide range of conditions in later life, including cardiorespiratory disease, type 2 diabetes, and mental health disorders. Much of the research in this field has focused on obesity in older children and its consequences for adult health. Less is known about how excess weight in the preschool years influences immediate health outcomes during childhood and adolescence.

A new study, published in the Journal of Bone & Mineral Research and supported by the NIHR Oxford Biomedical Research Centre, sought to address this gap by examining whether obesity at the age of school entry is associated with an increased risk of fractures in later childhood.

Study aims and design

“The primary aim of the study was to determine if elevated body mass index (BMI) just before starting school at age 4 years was associated with an increased incidence of fracture in childhood,” explained Jennifer Lane, Versus Arthritis Clinical Research Fellow in Orthopaedic Surgery at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences and lead author of the paper. “We found that elevated body weight at the age of starting school increased the risk of breaking a bone later in childhood.”

To investigate this, the research team – consisting of scientists and doctors from the United Kingdom and Spain – analysed the anonymised health records of 466,997 children living in Catalonia. As part of routine healthcare check-ups before starting school, each child was weighed and measured, and their BMI calculated. The researchers then followed the health of these children until they reached 15 years of age, or until data were no longer available due to other reasons such as moving away.

Key findings

At baseline, 5.7% of the children were classified as overweight and 2.0% as having obesity according to their BMI. The results showed a clear link between higher BMI at preschool age and later fracture risk:

• Children with obesity at age four faced a 70% higher risk of lower limb fractures and a 20% higher risk of upper limb fractures compared with peers of a healthy weight.
• Children with overweight had a 40% higher risk of lower limb fractures and a 10% higher risk of upper limb fractures.
  

These findings underscore that excess body weight at the point of starting school is not only a predictor of long-term health risks but also increases vulnerability to fractures during the remainder of childhood.

Next steps and research implications

Jennifer Lane highlighted the importance of building on this work to understand the underlying biological and mechanical mechanisms: “More research is needed to further understand the mechanisms underlying this correlation. Our study adds to a body of work that supports further research into the role that pre-school obesity has in health problems in childhood and beyond.”

While the precise pathways are not yet fully understood, potential factors may include greater force exerted on bones during falls, differences in bone structure or density, or changes in physical activity patterns among children with overweight or obesity.

Broader significance

The study is one of the largest of its kind to investigate fracture risk in relation to BMI measured at preschool age. Its findings highlight the importance of early monitoring of weight and growth, as well as timely interventions that support healthy development before children enter formal education.

The evidence reinforces that obesity in the early years is not only a future risk factor for adult disease but also has immediate and tangible consequences for musculoskeletal health during childhood.

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Obesity drives high rates of chronic disease in US adolescents and young adults

 Key Takeaways: 

• A new JAMA Pediatrics study found obesity is linked to a substantial proportion of chronic health conditions in US adolescents and young adults, with the highest impact seen in liver steatosis and type 2 diabetes.
• Among young adults with obesity, nearly 79% of type 2 diabetes cases were attributable to excess weight, while almost half of adolescent liver steatosis cases were linked to obesity.
• Researchers emphasise the need for early prevention and treatment strategies, including behavioural, surgical, and pharmacological interventions, to mitigate long-term health and economic consequences.
  

Rising prevalence of obesity and chronic disease

The prevalence of obesity among adolescents and young adults in the United States continues to rise and is closely linked with a growing burden of obesity-related conditions (ORCs). A study recently published in JAMA Pediatrics has provided one of the most comprehensive analyses to date, showing that obesity accounts for a substantial share of several chronic health conditions in this population.

Researchers conducted a cross-sectional analysis using pooled data from the National Health and Nutrition Examination Survey (NHANES) between 2013 and 2023. The study population included 4199 adolescents aged 12–17 years and 3200 young adults aged 18–25 years. These participants represented approximately 56 million people nationwide. Individuals who were pregnant or underweight were excluded.

How the study was conducted

Body mass index (BMI) was classified into three categories: normal weight, overweight, and obesity, according to standard clinical definitions. Investigators identified obesity-related conditions using consensus definitions and the data available from NHANES. Conditions examined included:

• Prediabetes and type 2 diabetes
• Hypertension
• Dyslipidaemia
• Asthma
• Stress urinary incontinence
• Liver steatosis
• Kidney hyperfiltration
• Probable obstructive sleep apnoea
  

Relative risks for each condition were calculated by comparing individuals with obesity or overweight to those with normal BMI, while adjusting for factors such as age, sex, insurance status, access to health care, and survey cycle. The researchers then estimated population attributable fractions (PAFs), which indicate the proportion of each condition that could be attributed to overweight or obesity.

Study findings

Among adolescents, 18.7% had overweight and 22.3% had obesity. Among young adults, 25.8% had overweight and 29.7% had obesity. Prevalence of obesity-related conditions varied widely — from 0.3% for type 2 diabetes in adolescents to 36.4% for liver steatosis in young adults.

The analysis showed that obesity made a striking contribution to the overall disease burden:

• Adolescents – Six of seven measured conditions showed significant PAFs due to obesity, ranging from 10.2% for asthma to 49.6% for liver steatosis.
• Young adults – Eight of nine conditions showed significant obesity-attributable fractions, ranging from 10.4% for asthma to 78.9% for type 2 diabetes.
  

Overweight status also contributed to disease burden, though to a lesser extent. For adolescents, PAFs due to overweight ranged from 6.2% for asthma to 13.1% for liver steatosis. In young adults, overweight contributed to 10.0% of hypertension cases and 21.0% of liver steatosis cases.

The study authors concluded: “Large portions of ORCs in US adolescents and young adults may be attributable to obesity and, to a lesser extent, overweight.”

Implications for prevention and treatment

The findings underscore the critical role of obesity in the early development of chronic disease. The researchers highlighted that obesity-related conditions arising in adolescence or young adulthood increase the risk of more severe disease later in life.

They noted: “These PAFs can inform estimates of the potential impact of expanding access to behavioural, surgical, and pharmacotherapeutic interventions, including glucagon-like peptide-1 receptor agonists, on reducing ORCs in US youth.”

Limitations

The study acknowledged several limitations. Its cross-sectional design assumed causality between obesity and obesity-related conditions, which cannot be proven definitively. Reliance on self-reported data introduced the risk of recall bias, and there was a possibility of misclassifying diabetes subtypes. The researchers also noted the potential for confounding factors, such as independent precursors that may contribute to both obesity and associated conditions.

Conclusion

Obesity remains a major driver of chronic disease among adolescents and young adults in the United States. While overweight status contributes to some extent, obesity accounts for much larger proportions of conditions such as liver steatosis, hypertension, and type 2 diabetes.

The authors emphasised that intervening early in life — through prevention and treatment strategies — may reduce both the long-term health impact and the associated economic burden of these conditions.

CCH Insight:

The findings of this study are, in a way, quite shocking – the fact that large numbers of young people have liver disease, prediabetes and hypertension, conditions that were once associated with the later stages of life. However, the rising prevalence of child and adolescent obesity over recent decades means this has been sadly predictable, and it is a ticking time-bomb in terms of chronic diseases, disability, premature mortality and health and social care costs. As the authors stated, it is vital that obesity is addressed from the earliest opportunity, including access to GLP-1 medications.

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Childhood obesity associated with structural changes in foot shape

Key Takeaways:

• A large international study published in BMC Pediatrics has identified a significant link between childhood obesity and changes in foot morphology.
• Using advanced photogrammetry techniques, researchers found that children with higher BMI were more likely to present wider and flatter feet, with potential consequences for mobility and musculoskeletal health.
• The findings highlight the importance of considering foot structure in obesity management and suggest the need for tailored footwear, early interventions, and holistic public health strategies.
  

Rising childhood obesity and its overlooked consequences

Childhood obesity continues to rise at concerning rates worldwide, prompting extensive research into its impact on health and development. While much of the scientific focus has traditionally been on metabolic or cardiovascular complications, a new international study has turned attention towards a less-examined area – foot morphology. The research provides new insights into how excess body weight may affect the structure of children’s feet and the implications this has for mobility and long-term musculoskeletal health.

Understanding foot morphology

Foot morphology refers to the anatomical shape and structure of the foot, including features such as arch height, width, and length. In children, whose bones and musculoskeletal systems are still developing, these structures are particularly sensitive to external pressures such as excess weight. While previous studies have linked obesity to chronic conditions such as diabetes or hypertension, few have explored how it alters the structural integrity of the body during growth.

The team of researchers – Hakan Büyükçelebi, Mahmut Açak, Özgür Eken, Adem Doğaner, Gökmen Özen, and Luca Paolo Ardigò – set out to address this gap by analysing how obesity correlates with variations in foot structure.

Advanced use of photogrammetry

To capture precise data, the researchers used state-of-the-art photogrammetry. This imaging technique builds detailed three-dimensional models from photographs, allowing highly accurate measurement of anatomical features. Unlike traditional measuring methods, photogrammetry is non-invasive and child-friendly, reducing discomfort during assessment.

Each participant’s foot was digitally scanned, producing accurate records of structural features such as arch height, foot length, and width. These digital models enabled the team to identify subtle but consistent differences in foot shape across groups of children categorised by Body Mass Index (BMI).

Large and diverse study sample

The cross-sectional study engaged children from a wide range of backgrounds and geographical locations, improving the reliability and generalisability of the results. Participants were grouped according to BMI, and their foot morphology was carefully compared.

The data revealed clear patterns. Children with higher BMI tended to have feet that were wider and flatter than those of children in a healthy weight range. Conversely, children with BMI within standard limits displayed foot shapes more typically associated with healthy biomechanics.

Findings and implications for children’s health

The study suggests that children living with obesity may be more susceptible to structural changes in the foot that affect overall mobility. “Wider and flatter foot shapes were prevalent among obese children,” the researchers noted, raising concerns about increased risk of pain, discomfort, and potential musculoskeletal injuries.

These structural changes can alter gait and movement patterns, potentially leading to joint strain or other biomechanical problems as children grow. The implications extend beyond immediate discomfort. Altered foot morphology may increase vulnerability to long-term mobility limitations, impacting physical activity and overall health.

The role of footwear and early interventions

One practical consideration arising from the study is footwear. Children with altered foot morphology may require specially designed shoes that provide adequate support and prevent further complications. Standard footwear may not meet the needs of children with wider, flatter feet, potentially exacerbating problems.

The researchers highlight the importance of recognising these needs early and encouraging parents, educators, and healthcare professionals to consider foot health as part of obesity management. Promoting healthy weight, encouraging physical activity, and ensuring supportive footwear could together help safeguard mobility and comfort in growing children.

Broader public health significance

The findings also reinforce the urgent need for comprehensive strategies to address childhood obesity. As the researchers note, excess weight has “multifaceted consequences,” with foot morphology being one aspect of a much wider issue. The study underscores that obesity does not only affect internal systems but also the very structures that underpin daily movement.

Public health initiatives that encourage balanced nutrition, regular activity, and healthy environments for children may reduce not only metabolic risks but also structural complications such as those observed in foot shape.

Future directions for research

The study paves the way for future investigations into related areas. Longitudinal studies could help determine how these morphological changes evolve over time and whether early interventions can reverse or mitigate their effects. Researchers may also examine whether obesity influences other structural aspects of the musculoskeletal system, such as the spine or lower limb joints.

Additionally, there is scope for exploring the effectiveness of footwear specifically designed for children with altered foot structures, assessing whether targeted design can improve mobility outcomes and reduce injury risk.

Conclusion

This large-scale study provides compelling evidence of a link between childhood obesity and changes in foot morphology. The use of advanced photogrammetry offered detailed insights into how excess weight may alter the developing foot, with potential implications for gait, mobility, and injury risk.

By drawing attention to foot structure, the research underscores the importance of addressing childhood obesity in a holistic manner. As Hakan Büyükçelebi and colleagues highlight, the medical community should consider foot health as an integral part of assessment and management.

In doing so, society can take one step closer to ensuring that children receive comprehensive support for healthier, more active futures.

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Study highlights ways to improve primary care visits for people living with obesity

Key Takeaways:

• A new study led by Drexel University shows that people living with obesity strongly prefer primary care visits that emphasise empathy, respect, and freedom from stigma.
• Surveyed participants rated an “ideal” visit scenario at 9.4 out of 10, citing the importance of attentive listening, respectful communication, and not attributing all health concerns solely to weight.
• Researchers recommend that clinician training, office practices, and referral systems should explicitly address weight stigma, with a greater focus on patient-centred, respectful care.
  

Understanding barriers in primary care

Accessing health care can be difficult under any circumstances, but systemic barriers make the experience particularly challenging for some groups. For people living with obesity, weight-related stigma and inequities in health care often negatively influence their experiences when visiting primary care physicians. Such encounters can lead to frustration, mistrust, and in some cases, avoidance of care altogether.

Redesigning the “ideal” primary care visit

To address these challenges, researchers at Drexel University’s College of Nursing and Health Professions worked with people living with obesity to explore what an “ideal” primary care visit might look like. Their findings, recently published in Patient Education and Counseling, provide an evidence-based model for improving everyday interactions between clinicians and patients.

The project was conducted in two phases.

In the first phase, the Obesity Action Coalition (OAC) partnered with Thoughtform, an experience design studio, to work directly with people who have obesity. Participants shared their personal experiences, highlighting both barriers and possible solutions within primary care. Concerns included a limited sense of rapport with clinicians and the lack of appropriate physical resources such as larger blood pressure cuffs or gowns that fit comfortably.

From these discussions, OAC and Thoughtform developed a story-based narrative that illustrated a more positive primary care experience. The scenario depicted a setting where patients were listened to, treated kindly, and not judged for their weight. Illustrations were included to help visualise these improvements.

Validating the “ideal” model with patient input

In the second phase, the research team surveyed 250 American adults living with obesity, asking them to compare the “ideal” scenario with their most recent real-life doctor’s visit. The results were clear: participants overwhelmingly preferred the redesigned model, giving it an average rating of 9.4 out of 10.

Respondents highlighted several aspects that made the “ideal” scenario preferable. These included clinicians who:

• listened attentively,
• showed respect,
• avoided attributing every health issue to weight, and
• referred patients to specialists who treated them with empathy and professionalism.
  

“The survey results showed that people living with obesity want empathetic, respectful health care,” explained Kristal Lyn Brown, PhD, assistant professor in the College and lead author of the study. “We hope these results encourage providers and their staff to make their spaces more inclusive and free of weight bias and stigma.”

The value of empathy and common sense in care

Brown emphasised that the findings underscore the importance of recognising patients’ humanity.

“People with obesity are asking for basic, every day, human interactions — not resource-intensive changes but literally common-sense practices, of which our primary care offices often fall short,” she said.

The study suggests that simple changes in tone, communication, and approach can make a significant difference. By fostering empathy and respect, health care teams may help patients feel more comfortable attending primary care appointments, reducing the risk of avoidance. Over time, these practices could also build greater trust between providers and patients.

Recommendations for practice and training

Based on the findings, the research team outlined several key recommendations:

• Clinician training should explicitly address weight stigma and promote patient-centred, respectful communication.
• Front office staff should be trained to recognise and address bias, as the patient experience often begins at reception.
• Referral practices should prioritise specialists known for respectful and empathetic care.
• Patient-centred dialogue should allow individuals to tell their story without assumptions that every concern is weight-related.
  

Including patient voices in systemic change

Brown stressed that beyond individual practice, the study highlights the value of including patient voices in the design of health systems and research projects. Actively partnering with people living with obesity ensures that proposed solutions address real-world needs, and helps create care environments that are inclusive, respectful, and free from stigma.

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Responsive parenting may help reduce behaviours tied to childhood obesity

Key Takeaways: 

• Infants whose mothers received responsive parenting guidance showed fewer behaviours associated with later childhood obesity risk.
• The intervention was especially effective in reducing risk behaviours during the first two months of infancy.
• Coordinated care between paediatricians and nutritionists supported mothers in better recognising and responding to their babies’ cues.
  

Early weight gain and obesity risk

One in five children in the United States is living with obesity, a condition strongly associated with long-term health complications. Infants who gain excessive weight before their second birthday face an elevated risk of developing obesity later in childhood. This risk is particularly high among infants encouraged to continue eating after expressing signs of fullness, according to researchers from the Penn State Department of Nutritional Sciences and Geisinger College of Health Sciences.

A recent study demonstrated that mothers who were guided in responsive parenting were better able to identify and respond appropriately to their babies’ cues. These mothers also reported fewer behaviours in their infants that could contribute to obesity risk.

Details of the study

The study was led by Yining Ma, a doctoral student in nutritional sciences, together with Professor Jennifer Savage Williams, professor of nutritional sciences and director of the Centre for Childhood Obesity Research, and Professor Lisa Bailey-Davis, professor of population health sciences and director of the Centre for Women’s & Children’s Research at Geisinger College of Health Sciences. The findings were published in Pediatric Obesity.

“Responsive parenting helps mums and caregivers to be in tune with their baby and correctly identify their baby’s needs to respond in a supportive and nurturing way,” Ma explained. “For new parents, recognising signs of hunger or tiredness in their baby can be challenging. When these cues are missed or misread, it can sometimes lead to overfeeding, which may contribute to excessive weight gain.”

The WEE Baby Care intervention

The researchers analysed data from 288 mother–infant pairs from low-income households who participated in the Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care study. This clinical trial, led by Savage Williams and Bailey-Davis, tested whether coordinated care between paediatricians and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) nutritionists could improve maternal education in responsive parenting.

Over a six-month period, participating mothers were divided into two groups. One group received a responsive parenting intervention involving integrated care from paediatricians and WIC nutritionists. The other group received standard care during routine well-child visits.

The responsive parenting intervention offered guidance on infant feeding, soothing strategies, sleep, and interactive play. All mothers completed a lifestyle risk assessment during their babies’ two-month and six-month wellness visits. These assessments included questions on feeding practices, behaviours associated with obesity risk, infant sleep, appetite traits, interactive parent–child play, and caregiver relationships. The results were recorded in electronic health records to support tailored counselling.

Outcomes and findings

According to Bailey-Davis, “The Early Healthy Lifestyles (EHL) Screening tool used to assess lifestyle risk allowed us to target a combination of obesity risk behaviours at developmentally relevant times to better help mothers with their unique needs rather than focusing on a single behaviour.”

Key findings included:

• Mothers in the intervention group were less likely to pressure their infants to finish bottles.
• They were less likely to put their babies to bed after 8 p.m.
• They were less likely to use devices such as smartphones or televisions during feeding or play.
• They reported fewer nighttime feedings.
  

The researchers developed an overall obesity risk behaviour score. Infants whose mothers received the responsive parenting intervention had significantly lower scores at two months compared with the standard care group, though this difference was not evident at six months.

“Our main finding demonstrated the effectiveness of responsive parenting behaviours for reducing the obesity-promoting risk for children during the first two months of infancy,” Savage Williams stated. “The education that WEE Baby Care’s intervention provided helped mothers better understand their baby’s cues and needs and how to respond appropriately to them.”

Broader significance

The study also demonstrated the value of coordinated healthcare approaches for addressing obesity risk during infancy. The research team intends to further explore how the EHL screening tool may be used by practitioners to identify risk behaviours and track their relationship to infant weight patterns.

“For many families, especially those with limited access to educational resources, programmes like WEE Baby Care and WIC provide vital support in helping caregivers learn babies’ behaviour cues and building confidence in caring for a new baby,” Ma noted.

Amy Moore, assistant professor of nutritional sciences, also contributed to the study.

Funding

This research was supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services, the Maternal and Child Health Field-initiated Innovative Research Studies Programme, and the National Center for Advancing Translational Sciences of the National Institutes of Health.

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UK government launches £85m programme to expand obesity care through pharmacies and community services

Key Takeaways:

• The Government has announced an £85 million initiative to expand obesity support services, delivered through pharmacies, digital platforms, and community-based models.
• The pharmaceutical company Lilly will contribute £35 million in grant funding, though the firm insists its involvement is not linked to its obesity medicines.
• Pharmacy leaders welcome the programme but stress that funding must adequately cover the costs of providing wraparound care.
  

Government unveils new obesity programme

The Government has launched an £85 million programme designed to expand access to obesity care across the United Kingdom. The initiative will allow people living with obesity to seek support through community pharmacies as well as via digital platforms and local community-based services.

Labour has invited integrated care boards and technology providers to submit bids to pilot the programme, which it describes as offering “comprehensive holistic weight management support including a range of wraparound services.”

The Department of Health and Social Care (DHSC) confirmed that patient eligibility will be determined locally by clinicians, with all services required to follow national guidelines, NHS governance, and clinical standards. The department emphasised that this approach is intended to ensure care remains patient-centred and responsive to local needs.

Funding breakdown

The Government will contribute around £50 million to the programme, with an additional £35 million coming from pharmaceutical company Lilly in the form of grant funding. At least £10 million has been set aside to support bids in Scotland, Wales, and Northern Ireland.

While pharmacies already provide weight management services such as lifestyle advice, the details of their role under the new programme remain unclear. According to the DHSC, the initiative will focus on “innovative models of care for people living with obesity, outside of existing specialist weight management services,” with the aim of increasing capacity and reducing pressure on current services.

The DHSC also noted that treatments for obesity could “potentially” be included as part of the wraparound services offered, although specifics were not confirmed.

Questions over medicines provision

Independent Community Pharmacist (ICP) sought clarification from the DHSC on several points, including:

• Whether participating pharmacies will provide weight loss injections such as Mounjaro, Ozempic, and Wegovy once the programme launches in summer 2026, or only Mounjaro given Lilly’s financial involvement.
• Whether pharmacies will supply Lilly’s investigational daily obesity pill orforglipron, which is currently in trials and not yet licensed but may become available next year.
• How much funding each pharmacy will receive to deliver services under the programme.
  

When asked whether it was effectively paying the Government to promote its obesity medicines through pharmacies, Lilly stated the programme is “completely unrelated” to its pharmaceutical products and that its grants “will not fund purchasing or prescribing of specific medicines.”

A Lilly spokesperson explained:

“The aim of the programme is to facilitate the development of innovative models of care for obesity across the UK, to enhance the support available to individuals living with obesity.

The programme could make it easier for patients to access holistic obesity care, which could include access to medicines and other treatments for eligible patients, as deemed clinically appropriate by their healthcare professional. This is agnostic of which treatment and there is no link to Lilly’s medicines.”

Pharmacy leaders respond

Numark: Community pharmacies ‘uniquely placed’

Harry McQuillan, chair of Numark, said the programme is “ideally suited for community pharmacy involvement” and represents “an important step in expanding access to weight management support across our communities.”

He emphasised the value of pharmacists in this role:

“Pharmacists and their teams are uniquely placed to deliver this service. As highly accessible healthcare professionals, they already provide trusted advice, regular health interventions, and continuity of care to millions of people every year.

This service recognises their critical role in supporting healthier lifestyles and tackling one of the most pressing public health issues we face.”

NPA: Ensure funding covers costs

Henry Gregg, chief executive of the National Pharmacy Association (NPA), also welcomed the announcement but underlined the importance of adequate funding:

“Any funding made available is sufficient to cover the costs involved for pharmacies to provide wraparound care and support.

Obesity is the single biggest health challenge facing our country, and if we are serious about tackling it, pharmacies must be empowered to play a central role in the solution. With the right funding, pharmacies can scale up delivery quickly, ensuring more people get the help they need, when and where they need it.”

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Maternal obesity before pregnancy linked to autism-like behaviours in offspring, University of Hawai‘i mice study finds

Key Takeaways:

• University of Hawai‘i researchers have shown that maternal obesity prior to conception can cause epigenetic changes in eggs that affect offspring brain development.
• Male offspring of obese mothers displayed autism-like traits, including altered social behaviour and increased repetitive actions, linked to changes in the Homer1 gene.
• The findings, obtained using an in vitro fertilisation model, may inform early interventions aimed at reducing neurodevelopmental risk before pregnancy.
  

Maternal health before conception found to have long-term impact on brain development

A study conducted at the University of Hawai‘i at Mānoa’s John A. Burns School of Medicine (JABSOM) has revealed a direct link between a mother’s weight before pregnancy and autism-like behaviours in her offspring.

Published in the journal Cell, the research offers new insight into how maternal health in the period before conception can influence a child’s brain development. The team, led by Professors Alika K. Maunakea and Monika Ward from JABSOM’s Department of Anatomy, Biochemistry & Physiology and the Yanagimachi Institute for Biogenesis Research (YIBR), found that maternal obesity can trigger metabolic changes which cause lasting epigenetic modifications in eggs.

These modifications are transmitted to the developing embryo, altering the expression of genes involved in brain development, including Homer1, a protein that regulates synaptic signalling, learning, memory, and responses to neural activity.

Gene changes linked to autism-like behaviours in male offspring

The researchers discovered that male offspring of obese mothers exhibited increased levels of a specific Homer1 gene isoform. This variant is known to disrupt neural connections and has been associated with behaviours linked to autism spectrum disorder (ASD).

“This work highlights how a mother’s health prior to pregnancy, not just during gestation, can shape her child’s brain development in profound ways,” said Professor Maunakea. “We were surprised to find that even without direct maternal contact after conception, these epigenetic imprints from the egg carried enough weight to alter behaviour.”

IVF and embryo transfer model used to isolate effects

To separate the effects of obesity before pregnancy from those during gestation, the team used an in vitro fertilisation (IVF) and embryo transfer model. This allowed them to examine the influence of early epigenetic programming without confounding maternal factors during pregnancy.

When the adolescent male mice were tested, behavioural assessments showed reduced social interactions and increased repetitive behaviours — characteristics that parallel features of ASD. These changes were traced to altered regulation of brain-related genes.

“This discovery exemplifies the core mission of the YIBR,” said Professor Ward. “By leveraging our institute’s expertise in developmental biology, reproductive science and epigenetics, we are beginning to understand how early-life programming can ripple through generations.”

Potential for early intervention before conception

Both obesity and ASD have been increasing worldwide, underscoring the public health importance of these findings. The researchers suggest that interventions — potentially nutritional or pharmacological — could be developed to reverse or reduce the impact of pre-pregnancy obesity on brain development.

The study highlights the importance of maternal health not only during pregnancy but also in the months and years before conception, signalling that preventive measures could have lasting benefits for the next generation.

CCH Insight:

We have to interpret this study with caution, because it was conducted with mice, so we cannot extrapolate directly to humans. However, it serves as a reminder that obesity reduces fertility, and obesity during pregnancy carries risks to mother and baby, so pre-conception should be a priority for pro-active obesity care interventions.

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Landmark UK study finds ultra-processed foods may undermine the benefits of healthy eating

Key Takeaways: 

• Ultra-processed foods (UPFs) significantly reduce weight loss effectiveness, even when nutritional content aligns with national healthy-eating guidelines.
• Participants lost more than twice as much weight on a minimally processed food (MPF) diet compared to a UPF-based diet, despite identical macronutrient targets.
• The findings underscore the urgent need for UK dietary policy reform, highlighting food processing as an independent factor influencing diet quality and public health.
  

Introduction: Ultra-Processed Foods Under Scrutiny

New research has revealed that diets high in ultra-processed foods (UPFs) may hinder weight loss efforts, even when they comply with national dietary recommendations. The study, published on 4 August in Nature Medicine, was conducted in the United Kingdom and led by Samuel Dicken, an obesity and behaviour researcher at University College London (UCL). According to the researchers, the study provides some of the clearest evidence to date that the way food is processed — not just its nutritional composition — plays a critical role in weight management and overall health.

Defining Ultra-Processed Foods

Ultra-processed foods are industrially manufactured products that combine food extracts with additives, preservatives, and other synthetic ingredients. These products are typically designed for cost efficiency, long shelf-life, and mass appeal, making them highly profitable and widely available. Examples include packaged snacks, soft drinks, instant meals, and many supermarket-ready items.

While their high salt, sugar, and fat content has long been known to contribute to poor health outcomes, this new study suggests that the processing itself — including textural changes, heating methods, and additives — may also play a significant role in how the body responds to these foods.

Study Design: Real-World Eating in a Controlled Trial

This eight-month randomised crossover trial involved 55 adult participants and was designed to reflect real-world conditions as closely as possible. Each participant completed two distinct 8-week diet phases: one based on minimally processed foods (MPFs) and the other on ultra-processed foods (UPFs). The two phases were separated by a 4-week washout period, during which participants returned to their usual diet.

Both diets were constructed in accordance with the UK government’s Eatwell Guide, which provides recommendations on the proportions of food groups and macronutrients (carbohydrates, fats, proteins). Participants received all meals, snacks, and beverages directly to their homes, allowing them full flexibility in terms of portion size and meal timing.

“The motivation behind this study was to address a gap in national dietary recommendations, and to do so in the participants’ everyday environment,” said lead author Samuel Dicken. “It will be the longest-ever trial of a UPF diet to date. It’s the first one to do it in the real world to try and apply all those behavioural influences.”

Findings: Same Nutrients, Very Different Results

The study found that while participants lost weight during both dietary phases, weight loss was significantly greater during the MPF phase. On average, participants lost 1.84 kilograms while consuming minimally processed foods — more than double the 0.88 kilograms lost on the UPF-based diet.

In addition to greater weight loss, the MPF phase led to measurable improvements in body composition, including:

• Reduction in total fat mass
• Decrease in body-fat percentage
• Lower visceral-fat rating
  

Such changes were not observed during the UPF phase.
Participants also reported fewer food cravings while on the MPF diet.

Why the Difference? The Role of Processing

Although the exact mechanism remains uncertain, several hypotheses were proposed by the researchers:

• Texture and structure: UPFs are often softer and easier to chew, which may lead to faster consumption and delayed feelings of fullness.
• Gut microbiome: Additives and heat treatments used in processing could negatively impact gut health and promote inflammation.
• Behavioural cues: Attractive packaging and misleading nutritional claims may encourage overconsumption.
  

“UPFs are engineered to be overconsumed,” noted Carlos Monteiro, an epidemiologist at the University of São Paulo, Brazil, who coined the term ultra-processed food. “These foods are more ‘addictive-like’, energy-dense and tasty, which can lead to higher intake when compared with MPFs.”

Public Health Implications: Beyond Nutrients

The findings challenge existing dietary policies that focus predominantly on macronutrients while paying little attention to how food is processed.

“This trial supports the importance of considering food processing as a distinct and policy-relevant dimension of diet quality,” said Tera Fazzino, a psychologist at the University of Kansas. “Policies that focus solely on reformulating UPFs to meet nutritional standards may overlook the behavioural and physiological effects of how those foods are engineered.”

Fazzino added, “This study strengthens the evidence base needed to inform policy and public-health messaging. By showing that processing matters even when nutritional quality is controlled, it challenges the current focus on nutrients alone and may help catalyse broader discussion and reform.”

A Socio-Economic Dimension

In the UK, over 50% of the average person’s daily energy intake comes from ultra-processed foods — a figure echoed across much of Europe and North America. Dicken warned that the ubiquity and affordability of UPFs pose a particular risk for individuals from low-income communities, where access to fresh, minimally processed foods is limited.

“Issues around diet and obesity related to these [UPFs] are very much related to socio-economic inequalities,” he said. “People might have unhealthy diets not because they aren’t trying to eat healthily, but because our food environment is just setting us up to fail.”

Conclusion: A Call to Re-Evaluate National Guidelines

This landmark trial provides compelling evidence that ultra-processed foods can substantially blunt the effects of otherwise healthy diets. It also highlights a pressing need to broaden the scope of national dietary guidelines to include food processing as a factor in health outcomes.

According to Dicken, “This isn’t just about calories or nutrients — it’s about the way our food is made, marketed, and made available to us. If we want meaningful change, we need policy that reflects that complexity.”

CCH Insight:

This is an excellent study and the results provide confirmation of what many of us have suspected for a long time; that these foods have health implications beyond just their nutrient content – the food has been altered in a way which has a wider impact on health. But the challenge is how to reverse the increasing levels of consumption of these foods, especially amongst deprived communities who are most vulnerable to obesity and associated chronic health issues. One option is taxation, in the hope this will not drive up prices, but will motivate the food industry to re-formulate foods (as they re-formulated sugary drinks) to reduce the degree of processing.

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Prolonged obesity in early life linked to accelerated biological ageing, study finds

Key Takeaways:

• Individuals with persistent obesity from early childhood or adolescence show signs of biological ageing years ahead of their chronological age.
• Researchers observed increases of over 4.5 years in biological age and up to 48% acceleration in some individuals, alongside molecular markers of physiological decline.
• Findings challenge the long-standing belief that calorie restriction is the key modulator of ageing, suggesting instead that obesity itself may drive premature ageing.
  

Introduction: Obesity and Ageing – Rethinking the Relationship

New research from the Santiago Longitudinal Study has found that individuals with long-term obesity exhibit signs of accelerated biological ageing as early as their late twenties. The findings, published in JAMA Network Open, provide compelling evidence that sustained obesity from childhood or adolescence may hasten physiological decline at a molecular level – in some cases by nearly five years compared to chronological age. 

The results pose a significant challenge to traditional models of ageing, which have focused heavily on the benefits of caloric restriction. Instead, the authors argue that excess calorie intake and the associated hormonal and metabolic changes of obesity may directly contribute to the ageing process.

Study Overview: A Longitudinal View of Lifespan Health

The research team, led by Dr Paulina Correa-Burrows of the Universidad de Chile, drew on data from over 1,000 participants in the Santiago Longitudinal Study, a project tracking individuals from birth through to young adulthood. For this analysis, the focus was narrowed to 205 participants with complete data sets:

• 89 individuals with a normal body mass index (BMI)
• 43 individuals with obesity beginning in adolescence
• 73 individuals with obesity starting in early childhood
  

Participants were followed until they reached the ages of 28 to 31 years, at which point a range of biological ageing markers were assessed.

Biological Ageing Measured by Epigenetic Clocks

To estimate biological age, researchers used multiple advanced methods, including:

• DNA methylation-based epigenetic clocks
• Estimation of leukocyte telomere length
• Circulating biomarkers such as cytokines, adipokines, myokines, and growth factors
  

The findings were stark. In participants with long-term obesity, epigenetic age exceeded chronological age by:

• 2.23 to 4.68 years, depending on the method used
• 15.2% to 16.4% increase on average
• Up to 48% in some individuals
  

These results suggest that long-term obesity may induce molecular signatures typically associated with ageing, including telomere shortening, mitochondrial stress, chronic inflammation, and disrupted intercellular signalling.

Rethinking the Role of Calories in Ageing

In an editorial accompanying the study, Dr Antonello Lorenzini reflects on the broader implications of these findings. Historically, the biology of ageing has centred on the notion that caloric restriction slows ageing. However, Dr Lorenzini proposes a paradigm shift:

“The average level of biological age is clearly elevated in the two groups experiencing lasting obesity,” he wrote.

“This elevation strongly suggests that it is time to doubt the classical interpretation that has dominated the field of biology of aging for a long time: caloric restriction slows down the aging process.”

He suggests that the presence of excess calories, the hormonal imbalance of obesity, or both, may serve as active drivers of ageing.

Implications for Public Health and Ageing Research

Dr Lorenzini also highlights the public health implications of these findings, particularly given the scale of the global obesity epidemic:

“A new awareness of the effect of obesity in accelerating the aging process represents an additional element for educational campaigns that aim to address the globesity epidemic,” he wrote.

Rather than advocating for restrictive diets or prolonged hunger, Dr Lorenzini suggests a more balanced approach to healthy ageing:

“The recipe for a long and healthy life, therefore, does not seem to require experiencing hunger, but rather simply avoiding mental and physical stress, getting an appropriate amount of physical activity, and modifying the diet to increase foods that prevent obesity while reducing those that promote it.”

Conclusion

This study adds to a growing body of evidence linking long-term obesity with premature biological ageing. While more research is needed to establish causal mechanisms and explore potential interventions, the findings underscore the importance of early-life obesity prevention and raise critical questions about how we understand and modulate the ageing process.

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Obesity-linked cancer deaths triple across the United States over two decades, study finds

Key Takeaways:

• Cancer deaths associated with obesity have tripled in the United States from 1999 to 2020, with the sharpest rises seen among women, older adults, Black people, Native Americans and those living in rural communities.
• Obesity is linked to a higher risk of developing 13 types of cancer, which collectively account for 40% of all cancers diagnosed in the United States each year.
• Researchers highlight the urgent need for tailored public health initiatives to enhance early screening and expand access to care, particularly in underserved and high-risk areas.
  

Alarming rise in obesity-related cancer deaths

Cancer deaths linked to obesity have tripled in the United States over the past two decades, according to new research being presented at ENDO 2025, the Endocrine Society’s annual meeting in San Francisco, California.

The study investigated more than 33,000 deaths from cancers known to be associated with obesity. It revealed striking increases in mortality, particularly among women, older adults, Native Americans and Black Americans.

“Obesity is a significant risk factor for multiple cancers, contributing to significant mortality. This research underscores the need for targeted public health strategies such as early screening and improved access to care, especially in high-risk rural and underserved areas,” said Dr Faizan Ahmed, lead researcher from Hackensack Meridian Jersey Shore University Medical Center in Neptune City, New Jersey.

Obesity’s far-reaching impact on health

Obesity is a widespread condition. According to the U.S. Centers for Disease Control and Prevention (CDC), 40.3% of adults in the country have obesity. It is a complex disease, influenced by an interplay of genetic, physiological, hormonal, environmental and developmental factors.

In addition to increasing the risk of certain cancers, obesity raises the likelihood of developing serious long-term conditions, including:

• high blood pressure
• high cholesterol
• prediabetes and type 2 diabetes
• heart disease
• chronic and end-stage kidney disease
  

The 13 cancers linked to obesity

Data from the CDC show that obesity is associated with a higher risk of developing 13 types of cancer. These cancers together make up 40% of all cancers diagnosed each year in the United States. They include:

• Adenocarcinoma of the oesophagus
• Breast cancer (in women who have gone through menopause)
• Colon and rectal cancer
• Cancer of the uterus
• Gallbladder cancer
• Upper stomach (gastric cardia) cancer
• Kidney cancer
• Liver cancer
• Ovarian cancer
• Pancreatic cancer
• Thyroid cancer
• Meningioma (a type of brain tumour)
• Multiple myeloma
  

What the study found

Dr Ahmed’s research used mortality data from the CDC to analyse 33,572 deaths in the United States from cancers linked to obesity between 1999 and 2020. The findings showed that age-adjusted mortality rates rose markedly over this period, increasing from 3.73 to 13.52 per million people.

Certain groups experienced especially steep rises in these death rates. These included:

• women
• older adults
• Black people
• Native Americans
• people living in rural areas
  

Regional differences across the United States

The study also uncovered notable geographic patterns. The Midwest recorded the highest rate of obesity-related cancer deaths, whereas the Northeast had the lowest. When analysed by state, Vermont, Minnesota and Oklahoma had the highest rates of deaths linked to obesity-associated cancers. In contrast, Utah, Alabama and Virginia reported the lowest rates.

Calls for stronger public health action

Experts stress that these findings highlight the critical importance of targeted public health interventions. Strategies could include expanding early cancer screening programmes and improving access to healthcare services, with a particular focus on communities that are rural, socioeconomically disadvantaged or have a high prevalence of obesity.

As Dr Ahmed emphasised: “This research underscores the need for targeted public health strategies such as early screening and improved access to care, especially in high-risk rural and underserved areas.”

CCH Insight:

Sadly, the rapid rise in cancer cases across the US is not really surprising, in that it follows the increase in obesity over recent decades. While CCH agrees there is an urgent need for targeted public health strategies, such as early cancer screening and improved access to cancer care, we would also say “treat obesity first.” If you treat obesity successfully, you will significantly reduce the prevalence of obesity-related conditions such as type 2 diabetes, heart disease and a number of common cancers.

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Intermittent fasting shown to be effective for weight loss in new large-scale study

Key Takeaways:

• A comprehensive analysis of 99 clinical trials found alternate-day fasting to be the most effective form of intermittent fasting for weight loss and improving key health markers.
• Participants practising alternate-day fasting lost an average of 1.3 kg more than those following standard calorie-restricted diets, alongside improvements in waist size, cholesterol, and inflammation.
• However, the differences fell below the threshold considered clinically meaningful for people living with obesity, highlighting the need for longer studies to assess long-term impacts.
  

Intermittent fasting gains further attention as a weight-loss approach

Intermittent fasting has become an increasingly popular method for managing weight, with growing evidence suggesting it may rival or even outperform traditional calorie-reduction diets in some respects. This dietary pattern restricts the window during which food is consumed each day, prompting the body to draw on fat reserves for energy once its immediate glucose supply is depleted.

Prominent institutions such as Johns Hopkins Medicine have long acknowledged the potential health benefits of intermittent fasting, which may extend beyond weight control to broader metabolic health.

Obesity’s continuing burden on public health

Obesity remains a critical public health challenge, affecting approximately two in five adults in the United States. It imposes an estimated annual cost of $173 billion on the American healthcare system. Carrying excess body weight is well established as a major risk factor for chronic diseases, including cardiovascular disease and type 2 diabetes.

Against this backdrop, researchers continue to explore diverse dietary strategies that might help reduce obesity prevalence and mitigate its health impacts.

Large-scale study identifies alternate-day fasting as particularly beneficial

In a recent high-quality analysis published in The BMJ, researchers from the Harvard T.H. Chan School of Public Health, working alongside colleagues from international institutions, sought to evaluate the effectiveness of different intermittent fasting methods. Their investigation pooled data from more than 6,500 adults enrolled in 99 clinical trials worldwide. Most participants were living with obesity and had additional health conditions.

Their findings pointed to alternate-day fasting — a regime where individuals eat normally one day and completely abstain from caloric intake the next — as the most effective intermittent fasting strategy compared to both standard calorie restriction and other time-restricted eating patterns.

As the Harvard team summarised:

“Among all intermittent fasting methods studied, alternate-day fasting – where a person eats normally one day and completely abstains from food the next – was shown to be the most effective.”

Measurable improvements in weight and cardiovascular risk factors

Participants who adopted alternate-day fasting achieved greater weight reduction, losing on average 2.8 pounds (approximately 1.3 kg) more than those adhering to traditional calorie-controlled diets. Beyond weight loss, this approach was linked with notable improvements in several key markers associated with cardiovascular disease and type 2 diabetes risk.

These included significant reductions in waist circumference, total cholesterol, low-density lipoprotein (LDL or “bad”) cholesterol, triglycerides, and C-reactive protein — a marker of systemic inflammation. Collectively, these changes suggest potential benefits for heart health and metabolic disease prevention.

Caution warranted: differences below clinical thresholds

Despite these encouraging outcomes, the researchers highlighted that the differences in weight loss did not meet the commonly accepted threshold of clinical significance, typically defined as a minimum of 4.4 pounds (2 kg) in individuals with obesity. This means that while alternate-day fasting demonstrated statistically meaningful results, the average benefits may not translate into substantial clinical improvements without further supportive evidence.

Zhila Semnani-Azad, who led the study, underscored the need for a cautious and personalised approach:

“Intermittent fasting, despite its promising results, may not be suitable for everyone. Before making significant dietary changes, it is essential to consult healthcare professionals and consider personal medical history, lifestyle, social circumstances, and potential for sustained adherence.”

Looking ahead: need for longer trials

The researchers called for extended studies to explore whether intermittent fasting — and alternate-day fasting in particular — can deliver lasting weight management and cardiovascular benefits over time. Such evidence would be crucial to inform clinical guidelines and support people living with obesity in choosing the most appropriate dietary strategies.

This new analysis offers valuable insights into how intermittent fasting might contribute to tackling obesity and its related health risks, while reinforcing the importance of individualised medical advice and long-term research.

CCH Insight:

There are undoubted benefits to be gained from intermittent fasting, including weight loss. However, the practicalities of some of these diets, such as alternate day fasting, may be very challenging for people living with obesity. Eating next to nothing one day and then normal meals the next can be difficult, especially for people who have cravings or experience ‘food noise’, for example. Time- restricted eating, where the same eating pattern is adhered to every day, may therefore be a more practical form of intermittent fasting for people with obesity, rather than alternate day fasting.

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Study shows training cuts weight bias and improves clinical practice in obesity care

Key Takeaways:

• A four-hour continuing medical education (CME) intervention significantly reduced healthcare professionals’ negative stereotypes towards people living with obesity, while increasing empathy and confidence – effects that persisted up to 12 months.
• The intervention led to tangible changes in clinical practice, including higher rates of obesity diagnosis and referrals to lifestyle programmes, obesity medicine, and bariatric surgery.
• Experts argue more such training is urgently needed, given widespread weight bias in healthcare and the chronic, complex nature of obesity.
  

Introduction: Confronting bias in healthcare

Many healthcare professionals (HCPs) hold negative attitudes towards people living with excess weight or obesity. This weight bias is not merely a social issue – it can significantly undermine patient care. Now, new research demonstrates that clinicians’ views and behaviours can be reshaped through targeted education.

In a study published in the Journal of General Internal Medicine, researchers led by Dr Amanda Velazquez of the Centre for Weight Management and Metabolic Health and the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai Medical Center in Los Angeles found that a structured four-hour CME programme could meaningfully shift both attitudes and practice.

The educational intervention

In April 2021, a single-site symposium was held within the Kaiser Permanente Southern California healthcare system. It invited a broad cross-section of 472 eligible HCPs across specialties – from plastic surgeons and obstetricians to nurses and emergency medical technicians.

Dr Velazquez highlighted the rationale:

“There is a considerable gap in the education of healthcare professionals about obesity,” she told Medscape Medical News.
“Our study was unique in that it had a broad target group and invited professionals across all specialties… Our goal was to move the needle toward greater comfort in referring their patients to appropriate obesity management.”

She noted that many health conditions treated outside obesity medicine – including psoriasis, cardiometabolic disease and impaired fertility – are worsened by excess weight.

Measuring and shifting attitudes

Participants completed a 16-item questionnaire originally developed by Robert F. Kushner and colleagues to assess three aspects of weight bias:

• Negative stereotypes, such as “Individuals with obesity have themselves to blame”
• Empathy, such as recognising that “People with obesity feel stigmatized by the medical profession”
• Confidence, such as feeling comfortable discussing weight.
  

Immediately after the programme, results showed statistically significant improvements:

• Negative stereotypes dropped from 2.81 ± 0.47 to 2.50 ± 0.46 (P < .001).
• Empathy increased from 3.33 ± 0.64 to 3.47 ± 0.63 (P = .006).
• Confidence rose from 3.10 ± 0.86 to 3.85 ± 0.79 (P < .001).
  

These positive shifts persisted at both four- and twelve-month follow-up.

Tangible changes in clinical practice

Beyond self-reported attitudes, the researchers examined real-world clinical behaviour by comparing electronic medical record data for 218 participants and 89 non-participants over the following year.

After adjusting for factors such as years in practice, race/ethnicity, gender, profession type, practice type, and patient panel size, those who attended the CME were significantly more likely to:

• Diagnose obesity (OR, 1.60; 95% CI, 1.54–1.66),
• Refer to healthy lifestyle programmes (OR, 1.27; 95% CI, 1.19–1.36),
• Refer to obesity medicine specialists (OR, 1.87; 95% CI, 1.63–2.14),
• And, for patients with a BMI ≥ 35, refer for bariatric surgery (OR, 2.12; 95% CI, 1.70–2.67).
  

In contrast, the comparison group’s rates largely remained unchanged or decreased.

Dr Velazquez admitted she was not prepared for the scale of change.

“The increase in the number of referrals to obesity care was so overwhelming, we had to change the BMI eligibility criterion to handle the influx,” she explained.
With referrals to the obesity clinic doubling, they raised the threshold for new referrals from BMI ≥ 30 to BMI ≥ 35.

Broader expert views

Leslie Heinberg, PhD, professor of medicine and vice chair for psychology at the Cleveland Clinic, praised the work:

“It’s an interesting and comprehensive study that goes beyond previous work in attitudinal change to look at change in actual practice behaviour around obesity.”

While she was unsurprised by the immediate shift in attitudes – noting, “We all know the right answers to give” – she found it notable that the change persisted.

“In my practice, patients often report experiencing weight stigma during interaction with their HCPs. But healthcare should be sensitive to patients across the entire weight spectrum.”

Heinberg added that most HCPs receive little or no training on obesity.

“They might get one lecture during training, but 40% of the patients they treat will have obesity.”
At her institution, all new clinical staff undergo onboarding in obesity bias, with annual refreshers.

Dr Carolynn Francavilla, an obesity medicine specialist in Colorado, also applauded the findings.

“As someone who dedicates a significant amount of my time to developing CME and educating clinicians, I find it very encouraging that this study was able to demonstrate both reduced weight bias and improved referrals for care,” she told Medscape Medical News.
“While most physicians are now aware of treatment options, many do not understand the chronic nature of the disease and many still believe that willpower is enough to treat obesity.”

Next steps for research and practice

The authors concluded that carefully designed CME can reduce HCPs’ weight bias and encourage better use of the full spectrum of obesity treatments.

“We’re hoping to apply the intervention in other groups to see if it has the same positive impact on practice,” said Dr Velazquez.
However, she noted that since the original study was run before the rise of GLP-1 therapies, future programmes will need updating.

The researchers called for additional trials to explore long-term changes beyond one year and to incorporate pharmacotherapy into the educational content.

Funding and disclosures

This work was funded by the Southern California Permanente Medical Group, with open access support from the Statewide California Electronic Library Consortium.

Dr Velazquez serves on advisory boards for WW, Eli Lilly, and Intellihealth and consults for Novo Nordisk. Coauthor A. Janet Tomiyama’s work was supported by the NIH and NSF. Dr Kushner consults for Altimmune, Pfizer, Eli Lilly and serves on advisory boards for Novo Nordisk and WW. Joseph Nadglowski is employed by the Obesity Action Coalition. Dr Francavilla is a speaker and adviser for Eli Lilly and holds personal investments in Eli Lilly and Novo Nordisk. Dr Heinberg declared no relevant conflicts.

CCH Insight:

This is an impressive study, which shows what impact even a short training course in obesity care can achieve. Around the globe there is a general lack of training of health professionals in obesity care, and the lack of understanding of obesity as a complex, chronic condition manifests as not just a lack of confidence and self-efficacy to treat obesity, but also a continuation of long-held stereotypes and stigmatisation of people living with obesity. High quality obesity care training for health professionals is essential if we are to improve access to care and outcomes for people with obesity.

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