Obesity Care

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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Greater fruit intake linked to lower abdominal fat in US children, study finds

Key Takeaways: 

• A nationally representative study of over 1,700 children in the United States found that higher fruit consumption is significantly associated with lower levels of abdominal adiposity.
• Children who consumed moderate to high amounts of fruit had smaller waist circumferences and reduced abdominal height, especially among boys and those with healthier lifestyle habits.
• The findings suggest fruit’s low energy density and high fibre content may be key contributors to improved weight outcomes, although causality cannot be established due to the study’s cross-sectional design.
  

Introduction

A new study led by Professor Larry A. Tucker of Brigham Young University, published in Frontiers in Nutrition, has identified a significant association between fruit intake and abdominal adiposity among children in the United States. The research highlights the potential role of fruit consumption in addressing paediatric obesity, particularly abdominal fat accumulation, which is a known risk factor for numerous metabolic diseases.

Context: The Obesity Crisis in Children

Childhood overweight and obesity remain a pressing public health concern in the United States, currently affecting over 40% of children. The prevalence of these conditions has increased nearly fivefold in the past half-century among children and adolescents.

Excess body weight during childhood increases the risk of a wide range of physical and psychological health problems, including:

• Insulin resistance and type 2 diabetes
• High blood pressure and cholesterol levels
• Cardiovascular disease
• Depression and anxiety

Although Body Mass Index (BMI) is commonly used to assess weight status, it does not distinguish between fat and lean mass, nor does it indicate where fat is distributed. This is a critical limitation, as abdominal adiposity – excess fat around the midsection – has been shown to be more predictive of cardiometabolic risk than BMI alone.

According to the Lancet Diabetes & Endocrinology Commission, waist circumference and other measures of central adiposity should be prioritised in research and clinical assessments. The accumulation of abdominal fat is especially influenced by dietary patterns, including the consumption of high-energy-dense foods, which are typically high in fat and low in water and fibre.

Why Fruit Matters

Fruits are among the lowest energy-dense food groups, thanks to their high water and fibre content and minimal fat. Numerous studies have indicated that diets rich in fruits and other low-energy-dense foods are effective in supporting healthy body weight.

Given these properties, this study sought to examine whether there is a measurable association between fruit intake and abdominal fat among a nationally representative sample of children aged 8 to 11 years in the United States.

Study Design and Methodology

The research analysed data from 1,707 children enrolled in the National Health and Nutrition Examination Survey (NHANES), a population-based study conducted by the US National Center for Health Statistics (NCHS) and the Centers for Disease Control and Prevention (CDC).

Key measurements and parameters included:

• Fruit intake: Assessed using two 24-hour dietary recall interviews. Fruit juices were excluded. Intake was calculated as the percentage of total daily energy derived from fruit.
• Abdominal adiposity: Measured using waist circumference and sagittal abdominal diameter (also known as abdominal height).
• Confounding variables: Adjusted for age, sex, race, household size, survey year, physical activity, recreational computer use, total energy intake, and consumption of macronutrients (carbohydrates, protein, fat), sugar, saturated fat, and fibre.

Results and Observations

Fruit Consumption Patterns

• 27% of children reported consuming no fruit at all.
• 36% consumed a low amount of fruit.
• 37% consumed a moderate-to-high amount of fruit.
• On average, fruit made up 10% of total energy intake.

Association with Abdominal Fat

After accounting for confounding factors, the study found that:

• Children who consumed more fruit had significantly smaller waist circumferences and lower sagittal abdominal diameters.
• The association was stronger and statistically significant for sagittal abdominal diameter.
• For waist circumference, the association was marginally significant in the fully adjusted model.
  

Lifestyle Factors Matter

Subgroup analyses revealed that the benefits of fruit intake were more pronounced among children who:

• Engaged in at least one hour of physical activity on four or more days per week.
• Spent two hours or less per day on recreational computer use.
  

Among children who were less active or had higher screen time (three hours or more per day), the association between fruit intake and abdominal adiposity was not significant.

Nutritional Insights

Children with higher fruit intake were found to consume:

• Greater amounts of dietary fibre, natural sugars, and carbohydrates.
• Lower levels of saturated fat.
  

These dietary patterns are consistent with the properties of fruit as a low-energy-dense food. Fibre, in particular, may help explain the association with lower abdominal fat, as it contributes to satiety, regulates gut microbiota, and has been shown to support metabolic health.

Fruits are also rich in micronutrients and bioactive compounds, including:

• Vitamins
• Antioxidants
• Flavonoids
• Phytochemicals

These compounds are known to reduce inflammation, improve insulin sensitivity, and regulate hunger-related hormones such as leptin and ghrelin – all of which may support healthy weight management.

Public Health Implications

Despite the benefits highlighted in this study, approximately 80% of the US population fails to meet the recommended daily fruit intake outlined in the 2020–2025 Dietary Guidelines for Americans. Professor Tucker commented:

“Fruit intake is widely underconsumed in the United States. These findings support the view that fruit can play a crucial role in the prevention of abdominal obesity in children.”

He urged healthcare professionals, parents, and educators to encourage fruit consumption as part of broader efforts to combat paediatric obesity and its associated health complications.

Limitations and Future Research

While the study presents compelling evidence of an association between fruit intake and reduced abdominal fat, its cross-sectional design limits the ability to establish causality. Longitudinal or experimental studies would be necessary to confirm whether increasing fruit consumption directly leads to reduced abdominal adiposity.

Additionally, the NHANES methodology involves oversampling certain ethnic groups, such as Mexican Americans, which may have influenced the racial distribution of the study population.

Conclusion

This study contributes to a growing body of evidence suggesting that fruit consumption supports healthier body composition in children. With paediatric obesity continuing to rise, particularly in the United States, promoting higher fruit intake may offer a simple, evidence-informed strategy for reducing central fat accumulation and associated health risks in young people.

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Global study provides practical guidance on antibiotic dosing for people with obesity

Key Takeaways: 

• A major systematic review has revealed how obesity alters the distribution and efficacy of antibiotics, with significant implications for dosing and therapeutic outcomes.
• While certain antibiotics such as β-lactams may not require routine adjustments, classes like aminoglycosides and glycopeptides require close monitoring and individualised dosing.
• The research team calls for global data sharing and improved pharmacokinetic studies to inform evidence-based dosing guidelines.
  

Introduction: A Call for Precision in Dosing

A large international team of researchers has published the most comprehensive analysis to date on antibiotic dosing in people living with obesity. Led by Dr Anne-Grete Märtson of Leiden University and Dr Thomas Tängdén of Uppsala University, the review brings together findings from 128 studies and proposes practical recommendations for clinical dosing adjustments. The work, published in The Lancet Infectious Diseases on 15 May, represents a significant step towards individualised antibiotic therapy in a population often overlooked in clinical pharmacology.

“It’s high time researchers started sharing more data,” said Märtson, underscoring the pressing need for greater collaboration to close longstanding gaps in clinical guidance.

Clinical Foundations and Rising Challenges

Märtson’s interest in the topic was informed by her early career as a clinical pharmacist in Estonia, where she participated in hospital ward rounds and focused on drug safety and dosing. “As a clinical pharmacist, I focused on the medication: was a certain combination of drugs safe, what was the optimal dose?”

Today, with rising obesity rates globally, clinicians are increasingly encountering challenges in treating infections effectively. “We’re increasingly seeing limited responses to administered medicines – in some patients the infection even worsens,” she noted. Complicating matters, most drug labels do not include dosing guidance for people with obesity, leaving clinicians without clear direction.

How Obesity Affects Antibiotic Pharmacokinetics

The review explains that obesity can significantly influence how antibiotics are absorbed, distributed, and cleared from the body. Changes in body composition, such as increased fat and muscle mass, and potential organ dysfunction, especially of the liver or kidneys, can affect the volume of distribution and drug metabolism.

“Substantial changes can occur in the volume of distribution due to increased fat and muscle mass, and tissue drug concentrations might be lowered,” the authors write.

Mahyar Etminan, a drug safety epidemiologist with EpiLytics Consulting who was not involved in the study, commented that “you need more of the drug to get into the tissue and that usually means higher doses than what we usually use in non-obese patients.” He also advised choosing antibiotics with higher tissue penetration.

128 Studies Analysed Across Multiple Drug Classes

Märtson and her colleagues systematically reviewed over 6,000 studies, narrowing their analysis to 128 that met strict inclusion criteria. Of these, 57 focused on β-lactam antibiotics, while 45 examined glycopeptides, lipoglycopeptides, and oxazolidinones. The analysis covered individuals aged 18 years and older with a Body Mass Index (BMI) over 30.

The findings showed that commonly prescribed antibiotics for pneumonia, urinary tract infections, and other bacterial conditions behave differently in people with obesity. “They distribute differently across the body’s tissues. Sometimes too little reaches the lungs, even though you’re trying to treat a lung infection,” Märtson explained.

Recommendations by Antibiotic Class

The review provides tailored guidance for specific classes of antibiotics:

β-lactams

This broad class, which includes penicillins and cephalosporins, is widely used for acute infections. Although obesity modestly alters their pharmacokinetics, the review concludes:

“Obesity modestly alters the pharmacokinetics of β-lactam antibiotics, but evidence does not support routine dose adjustments.”

However, it cautions against overly aggressive dosing due to the risk of toxic concentrations and side effects.

Aminoglycosides and Glycopeptides

These antibiotics are used for severe infections and require careful dose management.

“Therapeutic drug monitoring and the monitoring of creatinine clearance are highly recommended to guide maintenance dosing,” the authors state.

For aminoglycosides in particular, standard practice already includes therapeutic drug monitoring due to risks of nephrotoxicity and irreversible hearing damage. Dosing based on adjusted body weight is recommended to avoid under- or overdosing.

Other Antibiotic Classes

The study found that not all antibiotics require specific adjustments. In some cases, the pharmacological properties of the drug mean standard doses may remain appropriate, though further studies are needed to confirm this across more antibiotic types.

Optimising Dosing in Critical Care Settings

Märtson highlighted practical clinical strategies such as modifying infusion duration. “In critically ill patients, it can be helpful to administer the dose over two to four hours instead of half an hour via infusion,” she noted, emphasising the need to maintain appropriate plasma concentrations for effective treatment.

Gaps in the Data and the Need for Shared Research

Despite these insights, the researchers emphasise that much of the existing evidence remains limited. Many included studies were small-scale, and more robust pharmacokinetic data are needed. “There are excellent methods available to conduct high-quality research into this issue,” said Märtson, referencing tools like CT imaging to assess body composition and predictive modelling using large datasets.

The authors stress that:

“In the absence of robust pharmacokinetic data to inform dose adjustments, therapeutic drug monitoring can be useful to guide individualised dosing.”

They also call on future research to account for variables such as infection site, severity of illness, pathogen susceptibility, and potential drug toxicity when considering dosage in people with obesity.

Conclusion: Towards Evidence-Based Personalised Antibiotic Dosing

Märtson, Tängdén, and their multinational team – including contributors from the United States, Belgium, Austria, Germany, and Australia – have laid a critical foundation for improving antibiotic treatment in people with obesity. Their systematic review offers both immediate clinical value and a roadmap for future research.

As Märtson concluded, “I hope researchers will start sharing more data, so we can ultimately establish proper guidelines for all antibiotics.”

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Low-calorie diets linked to increased risk of depression, especially in men and people living with obesity

Key Takeaways: 

• Low-calorie diets may increase the risk of depressive symptoms, particularly among men and people living with overweight or obesity, according to a large population study.
• Nutritional deficiencies linked to unsupervised calorie restriction may negatively affect mental wellbeing, highlighting the importance of dietary quality.
• The findings challenge previous clinical studies suggesting mood benefits from calorie restriction, calling attention to the gap between controlled interventions and real-world dieting behaviour.
  

Introduction

Restrictive dieting is a common approach to weight management, but emerging evidence suggests that cutting calories—especially without professional guidance—may have unintended consequences for mental health. A new Canadian study published in BMJ Nutrition, Prevention & Health has found a link between low-calorie diets and an increased risk of depressive symptoms, particularly among men and individuals living with overweight or obesity.

Study Overview

Researchers analysed data from 28,525 adults who took part in the US National Health and Nutrition Examination Survey (NHANES). Participants completed a standardised mental health questionnaire, which assessed symptoms such as persistent low mood, fatigue, and disturbed sleep.

The study revealed that individuals who were actively restricting their calorie intake scored higher for depressive symptoms than those who were not dieting. The association was especially pronounced among:

• Men
• People classified as having overweight or obesity

Overall, around 8% of participants reported symptoms of depression, while over 70% were living with overweight or obesity—a demographic more likely to engage in calorie-restrictive dieting.

The Role of Nutritional Deficiency

While the study could not prove causation, the researchers proposed that self-imposed dietary restrictions may lead to insufficient intake of essential nutrients—particularly protein, vitamins, and minerals. Such deficiencies can place the body under physiological stress, potentially exacerbating or triggering symptoms of poor mental health.

This stands in contrast to earlier clinical trials where calorie-restricted diets appeared to improve mood. However, the authors of the current study point out that these prior interventions were typically nutritionally balanced and closely monitored, unlike the unsupervised and potentially imbalanced dieting patterns seen in the general population.

Diet Quality Matters

The study draws a distinction between restrictive dieting and overall dietary quality. Diets that are rich in whole foods—including fruits, vegetables, whole grains, nuts, and lean protein—have consistently been associated with lower rates of depression. In contrast, those high in ultra-processed foods and refined carbohydrates are linked to higher depression risk.

Expert Commentary

Professor Sumantra Ray, Executive Director of the NNEdPro Global Institute for Food, Nutrition and Health, underscored the wider implications of the findings:

“This adds to the growing body of evidence linking diet and mental health.

Restrictive diets low in nutrients important for cognitive function, such as omega-3 and vitamin B12, may contribute to depressive symptoms. However, further well-designed studies are needed to better understand these relationships.”

Implications for Healthcare Practice

While the study is observational and cannot confirm a causal relationship, it offers a timely reminder for healthcare professionals. When supporting individuals who wish to lose weight, especially those with existing vulnerabilities to depression or anxiety, it is crucial to:

• Emphasise nutritional adequacy, not just calorie reduction
• Support patients in choosing sustainable, balanced dietary patterns
• Consider mental health screening as part of weight management strategies

In summary, the findings call for a more nuanced approach to dietary advice—one that respects the complex interplay between physical and mental health, and avoids simplistic calorie-cutting recommendations that may do more harm than good.

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Shedding excess weight in midlife may protect against chronic illness and early death, study finds

Key Takeaways:

• Adults who reduced their weight from overweight to a healthy range in midlife—without medication or surgery—experienced significantly lower risks of chronic disease and death.
• These health benefits extended beyond the reduced risk of type 2 diabetes and were evident even decades later.
• Sustained, intentional weight loss through lifestyle changes may offer long-term protective effects, especially when initiated between the ages of 40 and 50.

Introduction

A new study published in JAMA Network Open has provided compelling evidence that sustained weight loss during midlife can significantly reduce the long-term risk of chronic illness and premature death. While pharmacological treatments such as GLP-1 receptor agonists and bariatric surgery are effective in promoting weight loss, they carry inherent risks. This research focuses on the long-term outcomes of weight loss achieved without these medical or surgical interventions.

Obesity is a well-established risk factor for several chronic conditions, particularly type 2 diabetes. However, the long-term health outcomes associated with lifestyle-induced weight loss—outside of diabetes risk—remain less well understood. This study aimed to clarify these outcomes by examining the health trajectories of individuals aged 40 to 50 who achieved and maintained weight loss over multiple decades.

Study Overview

The analysis drew upon data from 23,149 adults enrolled in three long-running cohort studies:

• Whitehall II Study (WHII) (1985–1988, United Kingdom)
• Helsinki Businessmen Study (HBS) (1964–1973, Finland)
• Finnish Public Sector Study (FPS) (2000, Finland)

Participants’ body mass index (BMI) was measured repeatedly over periods ranging from 12 to 35 years. Individuals were then categorised into four groups based on their BMI trajectories:

1. Persistent healthy weight (BMI consistently <25)
2. Weight loss (BMI reduced from ≥25 to <25)
3. Weight gain (BMI increased from <25 to ≥25)
4. Persistent overweight (BMI consistently ≥25)

The study excluded individuals who used medications or underwent surgery for weight loss, focusing solely on lifestyle-driven changes. Furthermore, participants were initially free from diagnosed chronic disease, limiting the likelihood of confounding due to weight loss caused by illness.

Key Findings

Risk of Chronic Disease

Participants who moved from an overweight to a healthy weight category and sustained this reduction experienced significantly lower risks of chronic disease. Notably:

• In the WHII cohort, individuals who lost weight or maintained a healthy BMI were 50% less likely to develop one or more chronic conditions over a median follow-up of 23 years, compared to those who remained overweight.
• After adjusting for the effects of reduced type 2 diabetes risk, the chronic disease risk remained 40% lower, suggesting additional health benefits.
• In the FPS cohort, weight loss was associated with a 60% reduction in chronic disease risk over a 12-year median follow-up.

These reductions were accompanied by healthier clinical profiles, such as lower mean blood pressure and total cholesterol levels among those who lost weight.

Mortality Risk

In the HBS cohort, participants who achieved a healthy weight had a 20% lower risk of death over 35 years. The median age at death in this cohort was 91, highlighting the extended timeline over which benefits may be realised.

Weight Gain and Health Risk

Individuals who moved from a healthy BMI into the overweight category had a higher risk of developing chronic disease than those who maintained a healthy weight. However, their risk was still lower than those who were persistently overweight.

Methodological Strengths and Considerations

A key strength of this study is its ability to exclude confounding by unintentional weight loss—a marker often associated with disease, frailty, or undiagnosed cancer—by selecting relatively young, healthy participants. This helps to isolate the effects of deliberate, lifestyle-induced weight loss.

The findings also contrast with previous studies that assessed weight loss through medication or surgery. While such treatments result in more dramatic weight changes, the long-term benefits—especially on cardiovascular health or mortality—have remained inconsistent. This may partly reflect the concurrent use of medications such as statins in control groups or short follow-up periods.

Importantly, the study did not specifically verify whether the observed weight loss was intentional. However, the researchers argued that, given the health status and age of the participants, it was reasonable to assume the changes were deliberate and achieved through modifications in diet, physical activity, or other lifestyle factors.

The FPS cohort relied on self-reported weight and height, which introduces a potential for reporting bias. In contrast, the WHII and HBS cohorts used measured BMI values, lending stronger credibility to their findings.

Implications for Practice and Public Health

This study provides robust evidence that moderate, sustained weight loss during midlife can have enduring health benefits, even when achieved without pharmacological support. Importantly, these benefits extend beyond the well-documented reductions in type 2 diabetes risk to include decreased risks of other chronic diseases and premature mortality.

Furthermore, the results reinforce the value of early intervention. Reducing weight in one’s 40s or early 50s appears to change the trajectory of long-term health outcomes, with positive effects that may take decades to fully manifest.

The findings also highlight a public health challenge: while people living with severe obesity may require pharmacotherapy or surgery, many individuals with moderate overweight status may significantly benefit from supported lifestyle changes. These results suggest that weight management efforts should be actively promoted and supported at midlife to yield maximum long-term impact.

Conclusion

The study found that individuals who transitioned from an overweight BMI to a healthy range during midlife—without the aid of weight loss medications or surgery—experienced a significantly lower risk of chronic disease and, in some cases, reduced all-cause mortality. These findings underscore the potential of midlife lifestyle changes to yield meaningful and sustained health benefits well into older age.

As the global burden of overweight and obesity continues to rise, these insights serve as a call to action for healthcare providers and public health authorities to support early, intentional weight management through non-pharmacological means whenever possible.

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