Age and Sex Shape Obesity’s Impact on Major Diseases, Large Genetic Study Finds
Key Takeaways:
- A time-resolved genetic analysis of over 360,000 UK Biobank participants shows that obesity’s health risks vary substantially across age and between men and women.
- Higher BMI was causally linked to greater risk of type 2 diabetes, coronary artery disease, atrial fibrillation, and osteoarthritis, but the timing and intensity of these effects differed by condition.
- The study’s novel genetic approach revealed that preventive interventions such as statin or blood pressure treatment may temporarily dampen obesity-related cardiovascular risk in midlife.
Understanding obesity’s changing health risks
Nearly one billion adults globally live with obesity, making it a key driver of type 2 diabetes (T2DM), coronary artery disease (CAD), atrial fibrillation (AF), and osteoarthritis (OA). Yet researchers have long struggled to pinpoint when in life excess body weight does the most harm.
Most studies average risk across all adults, masking crucial age-specific patterns. Body mass index (BMI) remains the standard measure of obesity, but its health impact may shift as metabolism, hormones, behaviour, and medical care evolve through life. Moreover, traditional epidemiological studies cannot always distinguish correlation from causation.
Genetic studies using Mendelian randomisation (MR) can infer causal effects, but conventional MR assumes that risks remain constant over time. In a new paper published in Science Advances, researchers introduced a time-resolved MR framework that tracks how obesity’s effects on major diseases change with age and differ between sexes.
Study design and methods
The researchers analysed data from 361,906 unrelated adults of European ancestry within the UK Biobank, a large population-based health resource. Participants had linked genetic and medical record data, and follow-up continued until a median age of around 70 years, capped at 76 to avoid sparse data at older ages.
BMI at study entry was standardised within sex-by-age groups. The primary outcomes were first occurrences of T2DM, CAD, AF, and OA, identified using International Classification of Diseases (ICD-10) codes.
To establish causal relationships, the team employed MR using polygenic scores (PGS) as instruments. They performed genome-wide association studies (GWAS) for BMI in two independent subsamples (each ~180,953 participants) to identify genome-wide significant genetic variants.
To minimise reverse causation, disease-specific BMI PGS were filtered using the Steiger method, which excluded variants that explained more variation in disease outcomes than in BMI itself. The researchers then modelled time-to-event data using Aalen’s additive hazard model, estimating both cumulative (“life-course”) and age-specific (“momentary”) effects.
Sensitivity analyses accounted for potential biases, including lipid-lowering treatment among CAD-free participants, blood pressure (SBP) as an alternative exposure, and cohort selection effects.
Distinct patterns across diseases
Across adulthood, higher BMI was causally associated with increased rates of all four conditions, but with striking differences in timing and trajectory.
- Osteoarthritis (OA): BMI-related risk rose early in life, becoming significant over 20 years before risk for AF increased. This suggests that musculoskeletal strain and inflammatory pathways linked to obesity manifest relatively early.
- Atrial Fibrillation (AF): The risk associated with BMI intensified later in adulthood, suggesting that atrial and metabolic factors accumulate over time.
- Type 2 Diabetes (T2DM): The effect of BMI increased steadily from midlife but plateaued between ages 60 and 70, indicating that preventive measures or clinical interventions may mitigate risk during this period.
- Coronary Artery Disease (CAD): The most distinctive pattern emerged here – a U-shaped curve. Risk decreased markedly around ages 50 to 70 before rising again in older age. This midlife dip was not explained by study participation patterns but appeared more pronounced among individuals on lipid-lowering medication such as statins, suggesting that treatment may blunt BMI-related cardiovascular risk during this window.
When the researchers replaced BMI with systolic blood pressure (SBP) as the exposure, AF risk displayed a similar midlife trough, consistent with the effect of antihypertensive therapy. However, no comparable trough appeared for CAD, reinforcing the role of statins rather than blood pressure control in midlife coronary risk reduction.
Sex differences in risk
Sex-stratified analyses revealed generally stronger BMI effects in men for T2DM, CAD, and AF. Osteoarthritis was an exception: both sexes exhibited similar BMI-related risk until about age 60, after which the association appeared to decline slightly in women, although the results carried uncertainty due to diverging confidence intervals.
A particularly notable finding concerned T2DM. Women displayed a distinct, temporary reduction in BMI-related diabetes risk beginning around age 60 and lasting roughly a decade, whereas men’s risk continued to rise. This “female trough” was not accounted for by menopause timing or the use of hormone therapy, suggesting that behavioural or clinical factors – such as greater engagement with weight management or preventive health care – could play a role.
Genetic and methodological insights
Clustering of BMI-associated genetic variants revealed multiple mechanistic pathways underlying obesity’s effects. Different genetic clusters contributed distinct temporal risk patterns for CAD and T2DM. For instance, “high-risk” clusters largely accounted for the CAD trough and the sex differences seen in T2DM.
Importantly, the researchers verified that the strength of genetic effects on BMI declines with age, underscoring the need for age-sensitive models. Simulation studies confirmed that their time-resolved MR method accurately captured dynamic effects even when the genetic influence on BMI varied over time.
Adjustments for potential selection bias slightly reduced the overall magnitude of effects but preserved key age-related patterns, including the midlife risk reductions.
Clinical implications
The findings emphasise that the timing of prevention matters as much as the magnitude of obesity itself. Sustained high BMI elevates the risk for several major diseases, but the most effective period for intervention differs by condition and by sex.
For example:
- Lipid-lowering treatment in midlife may attenuate BMI-related CAD risk.
- Blood pressure control could moderate AF risk later in life.
- Women may experience a unique window in their 60s when obesity-related diabetes risk temporarily subsides.
The authors conclude that prevention strategies should be tailored to life stage and sex, targeting the periods when intervention can avert the greatest number of disease events.
They also note limitations, including the assumption of an immediate biological response to BMI changes and the reduced precision of genetic instruments for early-life BMI. Nonetheless, their time-resolved MR framework offers a powerful new approach for uncovering dynamic, age-specific health risks that static analyses may obscure.
Read More
Semaglutide’s Cardioprotective Effects Extend Beyond Weight Loss, SELECT Trial Confirms
Key Takeaways:
- Semaglutide significantly reduced major adverse cardiovascular events (MACE) in adults with overweight or obesity and established cardiovascular disease, regardless of baseline body weight.
- Reductions in waist circumference contributed partly – but not fully – to the observed cardioprotective benefits, suggesting mechanisms beyond weight loss.
- Early divergence in cardiovascular outcomes between the semaglutide and placebo groups indicates that benefits emerge rapidly after treatment initiation.
Semaglutide’s impact on heart health goes beyond weight loss
A landmark study published in The Lancet has revealed that semaglutide, a Glucagon-Like Peptide 1 Receptor Agonist (GLP-1RA), offers cardiovascular protection in people with overweight and obesity that cannot be explained by weight loss alone. The findings come from the large-scale SELECT trial, which explored the drug’s effect on major adverse cardiovascular events (MACE) in individuals without diabetes but with established cardiovascular disease.
GLP-1 receptor agonists were originally developed for glycaemic control in type 2 diabetes but have since demonstrated additional benefits, including weight reduction and decreased cardiovascular risk. Obesity itself increases cardiovascular mortality and morbidity through metabolic, inflammatory, and haemodynamic pathways. However, simple measures such as body weight fail to differentiate between fat and lean mass or between subcutaneous and visceral fat – the latter being more strongly associated with cardiovascular disease.
Until now, the relationship between changes in adiposity induced by GLP-1RAs and subsequent cardiovascular outcomes has remained unclear.
About the SELECT trial
The SELECT trial was a randomised, double-blind, placebo-controlled, phase 3 study evaluating whether semaglutide, used alongside standard care, could reduce cardiovascular events in adults with overweight or obesity. The trial enrolled 17,604 participants aged 45 years or older with a body mass index (BMI) of at least 27 kg/m² and established cardiovascular disease (defined as a history of myocardial infarction, stroke, or symptomatic peripheral artery disease).
Participants were randomly assigned to receive either once-weekly semaglutide injections or a placebo, with a gradual 16-week dose escalation to a target of 2.4 mg from week 17 onwards. The primary endpoint was MACE – a composite measure including non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death.
Researchers analysed both baseline measures of adiposity (including waist circumference and body weight) and treatment-induced changes over time. Associations between these factors and MACE were assessed using a Cox proportional hazards model, with additional analyses distinguishing early (week 20) and long-term (week 104) effects.
Key findings
The mean follow-up period was nearly 40 months, with participants exposed to semaglutide for an average of 33.3 months and placebo for 35.1 months. Across all baseline body habitus measures, semaglutide reduced MACE incidence compared with placebo.
Higher baseline BMI was associated with female sex, younger age, non-Asian nationality, higher blood pressure, prediabetes, and greater inflammatory burden. Within both study arms, individuals with lower baseline adiposity had a lower MACE risk. In the semaglutide group, MACE risk fell by approximately 4% for every 5 kg reduction in baseline weight, although this trend was not significant in the placebo group. For waist circumference, both groups showed a 4% lower risk per 5 cm smaller baseline measurement.
By week 20, the rate of first MACE events had already diverged between the groups (hazard ratio [HR] 0.58), demonstrating an early cardioprotective effect.
At this point, mean changes in body weight and waist circumference were −6.4% and −5.0 cm in the semaglutide group, compared with −0.8% and −1.1 cm in the placebo group. These early changes accounted for about 70% of the total reductions seen at week 104. Importantly, 11% of all MACE events occurred within the first 20 weeks of treatment.
In the semaglutide group, greater reductions in waist circumference were associated with a lower subsequent MACE risk (HR 0.91; 95% CI 0.84–0.98; p = 0.02), while weight loss alone was not linearly linked to reduced risk. Among placebo recipients, those who lost at least 5% of their weight experienced higher MACE incidence and all-cause mortality, possibly reflecting unintentional or illness-related weight loss.
At week 104, semaglutide recipients who achieved the greatest weight loss had the lowest MACE incidence, whereas placebo recipients with comparable weight loss had the highest.
Waist circumference emerged as a stronger predictor
Analyses indicated that waist circumference reduction was a partial mediator of semaglutide’s cardiovascular benefits. Accounting for early changes in waist circumference reduced the treatment hazard ratio from 0.80 to 0.86 – suggesting that about one-third (33%) of the cardioprotective effect could be attributed to reduced abdominal fat, while the remainder likely involves other physiological mechanisms.
Crucially, time-varying changes in overall weight did not mediate the observed cardiovascular outcomes, underscoring that semaglutide’s heart-protective properties extend beyond simple weight loss.
Implications and limitations
The authors concluded that semaglutide was superior to placebo in reducing cardiovascular risk across all baseline weight and waist circumference levels, and that its benefits became evident early in treatment. They emphasised that early body weight reductions did not independently explain these benefits.
They cautioned, however, that analyses performed after randomisation were exploratory and not causal. The predominantly White, male study population also limits generalisability to broader groups, including women and ethnically diverse populations.
Despite these caveats, the findings strengthen the evidence that semaglutide’s cardioprotective effects go beyond adiposity reduction, pointing to additional metabolic, vascular, or anti-inflammatory mechanisms.
The SELECT trial was funded by Novo Nordisk, and is registered under ClinicalTrials.gov identifier NCT03574597.
Read More
Obesity-Linked Lipids Drive Aggressive Breast Cancer Growth in Mouse Models
Key Takeaways:
- New research from the University of Utah reveals that lipids – fat molecules elevated in people living with obesity – can accelerate tumour growth in aggressive forms of breast cancer.
- The findings suggest that lipid-lowering therapies may slow cancer progression and that high-fat diets such as ketogenic regimens may worsen outcomes in some patients.
- Researchers caution that weight loss without addressing lipid levels is insufficient protection against obesity-associated cancers like triple-negative breast cancer.
Lipids identified as key driver in obesity-related breast cancer
A new study from the University of Utah’s Huntsman Cancer Institute (HCI) has found that lipids, a hallmark of obesity, play a significant role in fuelling tumour growth in an aggressive form of breast cancer. The research, funded by the National Cancer Institute and conducted using preclinical mouse models, highlights how lipid metabolism may be a crucial therapeutic target for individuals living with obesity who have or have survived breast cancer.
The findings suggest that breast cancer patients and survivors with obesity could benefit from therapies that lower lipid levels. Conversely, high-fat dietary approaches, such as the ketogenic diet, may have unintended adverse effects by increasing lipid availability to cancer cells.
“The key here is that people have underestimated the importance of fats and lipids in the all-encompassing term that is obesity,” explained Dr Keren Hilgendorf, assistant professor of biochemistry and investigator at HCI. “But our study shows that breast cancer cells are really addicted to lipids, and the abundance of lipids in patients with obesity is one of the reasons that breast cancer is more prevalent and more aggressive in these patients.”
Focus on triple-negative breast cancer
The study focused on triple-negative breast cancer (TNBC) – a fast-growing and difficult-to-treat subtype that lacks receptors for oestrogen, progesterone, and HER2. TNBC is more common in women under 40 and in Black women, and it accounts for approximately 10 to 15 per cent of all breast cancer cases. This form of cancer is particularly prone to recurrence and metastasis.
A high level of lipids in the blood, known as hyperlipidaemia, is a frequent feature of obesity. Dr Hilgendorf and her colleagues, Dr Amandine Chaix and Dr Greg Ducker, both from HCI, examined how lipid levels influence tumour growth using specialised mouse models.
Lipid levels alone drive tumour growth
The researchers used two sets of models: one group of mice was fed high-fat diets, while another was genetically engineered to develop hyperlipidaemia without other typical markers of obesity, such as elevated blood glucose or insulin levels. In both cases, tumours grew faster when lipid levels were high.
“The idea is that lipids, which form the surface membrane of the cell, are like building blocks,” explained Dr Chaix, assistant professor of nutrition and integrative physiology. “If a cell receives the signal to proliferate and more building blocks are available, the tumour is going to grow more easily. We see that a high amount of lipids enables this proliferation.”
Importantly, when lipid levels were lowered – even in the presence of high glucose and insulin – breast cancer cell growth slowed down.
Potential implications for treatment and prevention
While the research was conducted in mice, the results point to potential therapeutic strategies for people with obesity and breast cancer.
“We think this has therapeutic implications, because if you could just lower the lipids – which we already know how to do in patients, for example, with lipid-lowering medication – that could be a way to decelerate breast cancer growth,” said Dr Hilgendorf. “If we can target these high levels of fat in the blood, the cancer sufferers, because the lipids are no longer feeding the cancer. But while our results in mice were striking, there are clear limitations in directly projecting these findings onto human patients. More research using human samples and patients will be necessary to confirm our hypotheses.”
Rethinking weight management in cancer care
These findings may also influence how clinicians guide people with obesity and breast cancer in managing their weight. While weight loss is commonly recommended to reduce recurrence risk, there is limited guidance on the best dietary approaches.
Some individuals turn to ketogenic diets, which are high in fat and low in carbohydrates, to induce ketosis – a state where the body uses fat rather than carbohydrates for energy. However, the new findings raise concerns about such diets in this patient group.
“For patients who are diagnosed with breast cancer and have an elevated BMI [body mass index], we would advise them to consult their physician and develop a weight-loss plan as part of their treatment,” said Dr Ducker, assistant professor of biochemistry. “If you have high cholesterol levels to start with, think about a weight-loss plan or potential pharmaceuticals that could lower your lipid levels. As our study shows, diets like keto that are very high in fat can have serious unintended side effects – even causing the tumour to grow.”
Beyond breast cancer: Broader implications
The research team believes that lipid-driven tumour growth may not be limited to breast cancer alone. Elevated lipid levels could also contribute to tumour progression in other cancers linked to obesity, such as ovarian or colorectal cancers.
The next stage of the research will investigate how anti-lipid drugs could improve the effectiveness of chemotherapy and explore the mechanisms through which lipids feed cancer cells.
Dr Chaix, Dr Ducker and Dr Hilgendorf emphasised that their results apply specifically to triple-negative breast cancer, and that ketogenic diets might still hold benefits for other forms of cancer. Nevertheless, their findings underscore the need for careful, evidence-based dietary guidance for people with obesity affected by cancer.
Read More
AI Model Could One Day Help Prevent Childhood Obesity by Counting Bites
Key Takeaways:
- Researchers at Penn State have developed an artificial intelligence (AI) system capable of counting how many bites a child takes during a meal, achieving around 70% accuracy compared to human observers.
- Eating too quickly increases the risk of obesity in children because the body has less time to register fullness, leading to overeating.
- The AI system, named ByteTrack, may in future help parents, clinicians, and researchers monitor and guide children’s eating habits in real-world environments.
AI and eating behaviours: A new frontier in obesity prevention
The faster a child eats, the greater their risk of developing obesity, according to researchers from the Penn State Department of Nutritional Sciences. However, accurately measuring bite rate—the number of bites taken during a meal—has long posed a challenge. Traditionally, this requires a researcher to watch and manually record each bite from hours of video footage, limiting most studies to small, controlled laboratory environments.
In a collaborative effort between Penn State’s Departments of Nutritional Sciences and Human Development and Family Studies, researchers have created an AI model designed to automate this process. Their pilot study, published in Frontiers in Nutrition, shows that the system is currently around 70% as effective as a human observer in counting bites. Although still under development, the researchers believe the technology could eventually help identify when a child needs to slow their eating rate or adjust their eating behaviour.
The link between eating speed and obesity
“When we eat quickly, we do not give our digestive tract time to sense the calories,” explained Professor Kathleen Keller, the Helen A. Guthrie Chair of Nutritional Sciences at Penn State and co-author of the study. “The faster you eat, the faster it goes through your stomach, and the body cannot release hormones in time to let you know you are full. Later, you may feel like you have overeaten, but when this behaviour repeats, faster eaters are at greater risk for developing obesity.”
Keller’s research group has previously demonstrated that a faster bite rate, especially when combined with larger bite size, correlates with a higher likelihood of obesity in children. Other studies have also linked larger bite size to an increased risk of choking.
“Bite rate is often the target behaviour for interventions aimed at slowing eating rate,” noted Dr Alaina Pearce, research data management librarian at Penn State and co-author of the study. “This is because bite rate is a stable characteristic of children’s eating style that can be targeted to reduce their eating rate, intake, and ultimately risk for obesity.”
Manually recording bite rate, however, is both labour-intensive and costly. As Keller pointed out, “Measuring bite rate is tedious, labour-intensive work, meaning it is expensive, which often limits the amount of data considered in bite rate studies.”
Using AI to support healthier habits
To overcome these limitations, Yashaswini Bhat, a doctoral candidate in nutritional sciences and lead author of the study, set out to develop the first AI-powered bite counter designed specifically for studying children’s eating behaviours.
“I have an interest in AI and data science, but I had never developed a system like this one,” Bhat explained.
She partnered with Associate Professor Timothy Brick, from Penn State’s Department of Human Development and Family Studies, to create a system capable of detecting children’s faces within videos and identifying when a child takes a bite.
“An experienced and knowledgeable collaborator like Dr Brick was invaluable to this project,” Bhat added.
The team trained the system using 1,440 minutes of video footage from Keller’s Food and Brain Study, funded by the National Institute of Diabetes and Digestive and Kidney Diseases. The footage featured 94 children aged seven to nine, each consuming four meals with identical foods on different occasions.
Researchers manually identified bites in 242 videos to train the AI. Once the system had been trained to recognise what a bite looks like, it was tested on an additional 51 videos. The AI’s results were then compared to those of human researchers.
Promising early results
“The system we developed was very successful at identifying the children’s faces,” Bhat said. “It also did an excellent job identifying bites when it had a clear, unobstructed view of a child’s face.”
While the AI was 97% as effective as a human observer at recognising faces, it achieved about 70% accuracy in counting bites. Bhat noted that challenges arose when children were partially obscured, turned away from the camera, or engaged in behaviours such as chewing on their spoons or playing with their food—actions common among younger participants.
“The system was less accurate when a child’s face was not in full view of the camera or when a child chewed on their spoon or played with their food, as often happens toward the end of a meal,” Bhat said. “Chewing on a utensil sometimes appeared to be a bite, and this complicated the task for the AI model.”
Next steps for the ByteTrack system
Although still in its early stages, the researchers view the pilot as an important step toward automating bite rate analysis. The system, called ByteTrack, will continue to be refined so it can distinguish between bites and similar movements such as sipping a drink.
“The eventual goal is to develop a robust system that can function in the real world,” Bhat said. “One day, we might be able to offer a smartphone app that warns children when they need to slow their eating so they can develop healthy habits that last a lifetime.”
The research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute of General Medical Sciences, the Penn State Institute for Computational and Data Sciences, and the Penn State Clinical and Translational Science Institute.
Read More
Italy Officially Recognises Obesity as a Chronic Disease under New Law
Key Takeaways:
- Italy becomes the first country to officially recognise obesity as a chronic, progressive, and relapsing disease under national law.
- The new legislation ensures access to prevention, early diagnosis, and treatment through the National Health Service, supported by dedicated funding and professional training.
- The law marks a cultural and clinical milestone, combating stigma and embedding obesity care into multidisciplinary health and social policies.
A landmark in public health policy
Italy has taken a historic step forward in the recognition and treatment of obesity. Following final approval in the Senate, a new law formally recognises obesity as a chronic, progressive, and relapsing disease, fully incorporated within the National Health Service (Servizio Sanitario Nazionale, SSN). This recognition places obesity among the conditions requiring prevention, early diagnosis, and integrated care, marking a fundamental shift in how the nation addresses one of its most pervasive health challenges.
Until now, obesity—despite its well-documented health, social, and economic burden—was often perceived as an “individual problem” tied to lifestyle choices and personal responsibility. This new law redefines that narrative. It positions obesity as a medical condition requiring structured clinical and social support, thereby recognising the biological, psychological, and environmental factors that contribute to it.
Leadership and legislative consensus
The legislation was spearheaded by Hon. Roberto Pella, President of the Interparliamentary Group on Obesity, Diabetes and Non-Communicable Diseases (NCDs), who has long advocated for stronger prevention policies, enhanced patient rights, and healthier urban environments.
The final version of the bill approved by the Senate mirrors that previously passed by the Chamber of Deputies, reflecting broad cross-party agreement on the urgent need to address obesity as a national health priority.
Key provisions of the law
The new law introduces a comprehensive framework of measures that address obesity through prevention, treatment, research, and social inclusion.
- Access to Essential Levels of Care (LEA): People living with obesity will now have guaranteed access to diagnostic and therapeutic services under the National Health Service, ensuring equitable treatment and continuity of care.
- National Programme for Prevention and Care: Dedicated funding will progressively increase from €700,000 in 2025, to €800,000 in 2026, and €1.2 million annually from 2027 onwards. These resources will support prevention campaigns, public awareness efforts, anti-stigma initiatives, and projects promoting social inclusion.
- Health Promotion: The law prioritises preventive health measures, including nutrition education in schools, support for breastfeeding, and programmes encouraging regular physical activity across all age groups.
- Social Inclusion: New provisions promote the full participation of people living with obesity in society—whether in the workplace, education, or recreation—by addressing structural barriers and discrimination.
- Training for Health Professionals: From 2025, €400,000 annually will be invested in training doctors, paediatricians, psychologists, and other healthcare professionals to improve clinical understanding of obesity and strengthen multidisciplinary care.
- National Observatory for the Study of Obesity (OSO): A new Observatory will be established within the Ministry of Health to oversee the implementation of the law. It will monitor outcomes, coordinate research, and present an annual report to Parliament, ensuring transparency and accountability.
- Awareness Campaigns: A permanent fund of €100,000 per year will support public initiatives promoting balanced nutrition and physical activity. Schools, pharmacies, physicians, and local authorities will play key roles in these campaigns.
Cultural and clinical significance
The adoption of this law represents a dual victory—both cultural and medical. Culturally, it challenges the long-standing stereotypes and stigma that have surrounded obesity, reframing it as a health condition rather than a personal failing. It acknowledges the dignity and rights of people living with obesity and underscores the need for inclusion and respect in both healthcare and everyday life.
Clinically, the law ensures equal access to prevention and treatment and formally integrates obesity into structured healthcare pathways. This institutional recognition paves the way for better coordination between medical professionals, community services, and social care systems.
A multidisciplinary and cross-sectoral approach
The reform promotes a multidisciplinary model of care, encompassing prevention, education, inclusion, and research. It also aligns obesity management with broader public health objectives, connecting healthcare policy with urban planning, education, and sport.
By mandating ongoing monitoring through the National Observatory and annual parliamentary reporting, the law ensures a strong framework for governance and sustained progress.
Towards broader change
As Hon. Roberto Pella’s leadership demonstrates, this legislation is not merely a symbolic step—it establishes a concrete foundation for long-term change. The next phase will involve implementing its provisions effectively, strengthening local prevention programmes, supporting patient associations, and fostering partnerships between healthcare providers, schools, and community organisations.
Obesity is not only a disease but also a reflection of how societies live, eat, and structure their environments. Italy’s new law acknowledges this complexity. It is a decisive move toward compassion, inclusion, and evidence-based care, ensuring that people living with obesity receive the attention, respect, and medical support they deserve.
Read More
Precision Medicine Poised to Redefine Obesity Prevention and Treatment
Key Takeaways:
- Researchers at the Pennington Biomedical Research Center highlight how precision medicine could revolutionise the prevention, diagnosis, and treatment of obesity by tailoring interventions to an individual’s biology and environment.
- Significant barriers remain, including limited large-scale clinical trials, underrepresentation of diverse populations, and challenges in integrating personalised tools into clinical practice.
- Experts call for robust biomarkers, inclusive research, and policy support to make precision obesity care accessible and evidence-based.
A blueprint for personalised obesity care
A new report led by researchers at the Pennington Biomedical Research Center underscores the rapidly growing potential of precision medicine to transform how obesity is prevented, diagnosed, and treated. Published in Obesity in September, the paper titled “Precision Prevention, Diagnostics and Treatment of Obesity” brings together insights from the recent Pennington–Louisiana Nutrition Obesity Research Center (NORC) scientific workshop.
The workshop, held in April 2024, convened experts to review evidence on tailoring obesity interventions to a person’s unique biological, behavioural, environmental, and social characteristics. The resulting report presents both the opportunities and obstacles in implementing precision-based strategies in obesity care.
Understanding the multifactorial nature of obesity
The authors emphasise that obesity is not a one-size-fits-all condition. Instead, it is shaped by a complex interplay of factors including genetics, epigenetics, metabolic phenotypes, microbiome composition, and environmental exposures. These elements influence why individuals gain or lose weight differently and why some respond better to certain interventions than others.
The review highlights how understanding these factors could enable clinicians to identify subgroups of people with obesity who would benefit from specific preventive or therapeutic strategies. This approach marks a shift from broad public health recommendations towards tailored, data-driven care.
Diagnostic innovation: Towards greater precision
The report calls for improved diagnostic tools—including the development of reliable biomarkers, imaging technologies, and phenotypic classifications—to better characterise the different subtypes of obesity and related risk profiles.
By accurately identifying an individual’s obesity phenotype, clinicians may be able to predict treatment response more effectively and target interventions that align with a person’s unique biology and lifestyle. Such advances could help move beyond the current trial-and-error approach in weight management.
Treatment personalisation and the path ahead
Emerging research indicates that personalising diet, physical activity, pharmacotherapy, and behavioural interventions according to an individual’s biological and psychosocial characteristics may improve both efficacy and long-term sustainability of outcomes.
However, the authors caution that while enthusiasm for precision-based treatment is growing, more robust clinical evidence is essential before these approaches can be fully integrated into standard care.
“Despite tremendous interest in precision-based treatment, the field is still relatively young,” said Dr Corby Martin, Co-Chair of the symposium and Director of the NORC Human Phenotyping Core. “We need rigorous clinical trials to empirically determine if precision treatment is indeed better than current practices. Unfortunately, few such trials exist, and those that do are not always supportive.”
Persistent gaps and barriers
The report identifies several key challenges hindering progress in precision obesity medicine:
- Limited large-scale clinical trials validating precision approaches.
- Insufficient diversity in study populations, leading to reduced generalisability of findings.
- Inadequate cost-effectiveness data, making implementation difficult within healthcare systems.
- Integration challenges when introducing precision tools into routine clinical settings.
Addressing these barriers will be essential for translating the promise of precision medicine into meaningful clinical and public health outcomes.
Recommendations for future research and policy
To advance the field, the authors recommend:
- Conducting diverse and inclusive research to ensure results are representative across ethnicities, genders, and socioeconomic groups.
- Developing and validating robust biomarkers and imaging tools for more accurate diagnosis and monitoring.
- Running comparative effectiveness trials to determine whether precision interventions outperform current standard treatments.
- Implementing programmes and policies that make precision obesity care both accessible and affordable.
The report suggests that precision-based approaches could enhance obesity prevention by identifying people at risk earlier and tailoring lifestyle or environmental interventions to reduce progression. Moreover, by customising treatment to a person’s biological and behavioural profile, clinicians could minimise side effects, avoid ineffective treatments, and improve outcomes.
A continuing commitment to obesity research
For more than 25 years, the Pennington–Louisiana Nutrition Obesity Research Center (NORC) has convened over 100 scientists annually to explore emerging topics in obesity and nutrition science.
“Supporting 1.5-day workshops such as the ‘Precision Prevention, Diagnostics, and Treatment of Obesity’ brings top scientists and clinicians from around the world to Pennington Biomedical,” said Dr Leanne Redman, NORC Director, LPFA Endowed Chair in Nutrition, and Associate Executive Director for Scientific Education. “These reports provide a blueprint for the current state of the science and avenues for future research.”
Building a collaborative future
Dr John Kirwan, Executive Director of Pennington Biomedical, commended the team’s contribution:
“This team’s efforts in advancing precision medicine to diagnose, prevent, and treat obesity are truly commendable. At Pennington Biomedical, our work is built on strong partnerships across Louisiana and throughout the United States, strengthened through centres and institutes like the Pennington–Louisiana NORC. We are proud to collaborate with leading research institutions, universities, and healthcare systems nationwide to advance obesity research.”
As the science of precision medicine matures, the report provides a clear framework for how personalised approaches may one day redefine obesity prevention and treatment, improving outcomes for individuals and populations alike.
CCH insight:
Precision approaches to obesity prevention and treatments could massively improve outcomes for people with, or at risk of, obesity. The complex nature of the condition, with its broad range of biological, behavioural, psychological, social and environmental determinants and risk factors, means every patient is unique and requires a personalised intervention. However, this complexity of obesity also makes it difficult to characterise an individual’s obesity phenotype and predict responses to interventions – so there is still a long way to go, a lot more research is needed.
Read More
Exercise Shown to Reduce Artery Hardening After Weight Loss in Adults With Obesity
Key Takeaways:
- Regular exercise after weight loss significantly reduces inflammation and improves blood vessel health in adults living with obesity.
- The GLP-1 receptor agonist liraglutide helped participants maintain weight but did not show the same protective effects against artery hardening.
- Researchers emphasise exercise as an essential factor for maintaining cardiovascular health after weight reduction.
Exercise and heart health after weight loss
Maintaining weight loss through regular exercise, rather than relying solely on the glucagon-like peptide-1 receptor agonist (GLP-1RA) liraglutide, appears to protect against atherosclerosis in adults living with obesity, according to new research from the University of Copenhagen. Atherosclerosis—hardening and narrowing of the arteries due to inflammation and fat deposits—is a major underlying cause of cardiovascular disease (CVD).
The findings were presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) 2025 in Vienna (15–19 September).
“Our findings reveal that regular exercise is crucial to helping people living with obesity get the full cardiovascular benefits after a substantial weight loss,” said Dr Rasmus Sandsdal, lead author of the study from the University of Copenhagen, Denmark.
Understanding the risk
Cardiovascular disease remains the leading cause of death globally. It often begins with atherosclerosis, in which chronic inflammation and lipid accumulation cause the arteries to stiffen and narrow. If left unchecked, these plaques can rupture and trigger life-threatening events such as heart attacks and strokes.
Obesity contributes to chronic low-grade inflammation and endothelial dysfunction—a condition in which blood vessels lose their ability to contract and relax properly—both of which accelerate atherosclerosis.
While both exercise and GLP-1RAs are known to lower cardiovascular event risk in people with obesity, their specific effects on the development of atherosclerosis during weight loss maintenance have remained unclear—until now.
The study design
The Danish research team conducted a randomised placebo-controlled trial involving 215 adults aged 18–65 years (63% female) living with obesity (BMI 32–43 kg/m²) but without diabetes or other serious chronic conditions.
All participants began an eight-week low-calorie diet (800 kcal per day) using the Cambridge Weight Plan. Of these, 195 participants who achieved at least a 5% reduction in body weight (average loss of 12% or 13.1 kg) entered a one-year maintenance phase. They were randomly assigned to one of four groups:
- Exercise (150 minutes/week of moderate-to-vigorous activity) plus placebo
- Liraglutide treatment (3.0 mg per day)
- Exercise combined with liraglutide
- Placebo only
Researchers measured several key biomarkers at three points—before dieting, at the start of weight maintenance, and after one year. These included inflammatory markers (interleukin-6 [IL-6] and interferon-γ [IFN-γ]), endothelial function markers (intercellular adhesion molecule [ICAM-1], vascular adhesion molecule [VCAM-1], and tissue plasminogen activator [tPA]), and carotid artery intima-media thickness [cIMT], an indicator of arterial wall health measured by ultrasound.
Exercise reduced inflammation and improved arterial health
After one year, participants in both the exercise and liraglutide groups successfully maintained their weight loss. However, significant differences emerged in their cardiovascular health profiles.
Those who exercised—whether or not they also received liraglutide—had notably lower levels of inflammatory biomarkers compared with non-exercising participants. On average, IL-6 levels were 21% lower, and IFN-γ levels were 27% lower.
Exercise also had a favourable effect on endothelial function, reflected in a 6% reduction in VCAM-1, 8% reduction in ICAM-1, and 12% reduction in tPA compared to those who did not exercise. Moreover, carotid artery thickness decreased by an average of 0.024 mm, indicating reduced arterial hardening.
In contrast, treatment with liraglutide alone did not yield any measurable improvements in inflammatory or endothelial biomarkers, nor did it affect carotid artery thickness.
“Regular exercise seems to confer a protective effect against the development of atherosclerosis in people trying to maintain weight loss,” said Dr Sandsdal. “Since both exercise and GLP-1RA treatment were successful at keeping weight off, it seems that exercise plays an important role in mitigating cardiovascular risk factors in a weight-independent manner.”
Implications for long-term health
Exercise offers multiple benefits beyond weight control, including improvements in body composition, cardiorespiratory fitness, and metabolic health. Together, these contribute to better long-term cardiovascular outcomes.
“The most important message from our findings is that, for those trying to maintain weight loss, exercise is crucial in improving long-term health,” said Professor Signe Sørensen Torekov, corresponding author from the University of Copenhagen. “Given the substantial societal and economic costs of obesity-related cardiovascular disease, these findings underscore regular exercise as a critical component of weight management and heart health.”
Study limitations and future research
The authors acknowledged several limitations. The study’s sample size was relatively small, and adherence to structured exercise in real-world conditions may be lower than in a supervised trial setting.
Future studies, they suggested, should explore longer-term interventions and evaluate newer GLP-1 receptor agonists—potentially more potent than liraglutide—in combination with consistent exercise to assess whether similar or enhanced cardiovascular benefits can be achieved.
CCH insight:
We have long known that exercise is important for cardiovascular health, so the results of this study should not be a surprise – exercise provides cardiovascular benefits whether or not you are taking a GLP-1 medication. It is also important to remember that GLP-1 receptor agonists are meant to be taken as an adjunct to a healthy diet and lifestyle, including exercise. This is not just about weight management, but also about maximising health benefits and minimising the risk of developing diseases associated with obesity – such as cardiovascular disease.
Read More
Severe Obesity Accelerates Lung Ageing by Altering Tissue Structure, Study Finds
Key Takeaways:
- Researchers at the University of Bonn have shown that severe obesity causes structural and molecular changes in lung tissue that mimic those of natural ageing.
- Obesity leads to the accumulation of fat within lung connective tissue cells, disrupting their normal function and reducing lung elasticity.
- These findings help explain why people living with obesity often experience breathing difficulties and may face a higher risk of lung-related complications.
Obesity found to accelerate ageing in the lungs
A research team led by Professor Dr Veronika Lukacs-Kornek from the ImmunoSensation2 Cluster of Excellence at the University of Bonn and the Institute for Molecular Medicine and Experimental Immunology (IMMEI) at the University Hospital Bonn (UKB) has discovered that severe obesity causes the lungs to age prematurely. The findings, published in Cell Reports, shed new light on how excessive body weight affects lung function and structure at the molecular level.
The study explored how the lungs respond to nutritional challenges associated with obesity, revealing that excess body fat significantly remodels the extracellular matrix (ECM) – the protein-based “scaffolding” that provides the lungs with their shape, strength, and stability. These alterations in lung architecture closely resemble those typically observed during the natural ageing process, suggesting that obesity accelerates the biological ageing of lung tissue.
Multi-omics analysis reveals profound structural changes
To investigate these effects, the researchers employed state-of-the-art multi-omics techniques – a set of advanced tools that allow for the simultaneous study of proteins, lipids, and genes. This integrative approach enabled the team to map how obesity influences the lungs at multiple biological levels.
By combining molecular analyses with microscopic imaging and functional experiments that tested how lungs perform, the team was able to capture a comprehensive picture of obesity’s impact. They compared the lungs of obese and lean mice, examined human lung fibroblasts (connective tissue cells), and studied the overall composition of lung tissue to identify both molecular and functional differences.
Fat accumulation and loss of elasticity in lung tissue
The results showed that in obesity, lung fibroblasts – the cells responsible for maintaining the connective tissue – begin to accumulate fat, becoming more mobile and displaying early signs of premature ageing. At the same time, the matrisome, which refers to the entire collection of ECM proteins, undergoes significant changes.
These changes disturb the delicate balance of protease inhibitors, enzymes that regulate tissue maintenance and repair. As a consequence, the lungs become less elastic and more prone to stiffness. This reduced elasticity helps explain why people living with obesity often experience shortness of breath and other respiratory difficulties.
“Interestingly, these changes are similar to those normally seen in older people – pointing to obesity as a driver of accelerated lung ageing,” the authors noted.
Overcoming complex research challenges
Studying the lung’s connective tissue presented major technical challenges. The fibroblastic stroma – the supportive framework of the lungs – comprises numerous cell types with highly specialised roles, making it difficult to isolate and analyse. Furthermore, the extracellular matrix itself is notoriously complex: many of its proteins are insoluble and possess intricate structures that resist standard laboratory analysis.
To address this, the team had to develop novel analytical methods that could overcome these limitations and enable the simultaneous study of multiple molecular components within the tissue. This innovative approach has allowed researchers to better understand how obesity-induced changes at the cellular level translate into functional impairments in lung performance.
Implications for understanding obesity-related lung disease
The study provides compelling evidence that obesity accelerates biological ageing processes in the lungs, underscoring the broader systemic impact of excess body weight beyond metabolic and cardiovascular complications.
By demonstrating that obesity alters both the composition and function of lung tissue, the findings open new avenues for exploring how weight management and metabolic interventions might help preserve lung health and mitigate premature ageing in people living with obesity.
CCH insight:
This is an interesting study. It shows that shortness of breath in people with obesity is not simply a case of poor cardiorespiratory fitness or due to mechanical difficulties due to accumulation of adipose tissue in the chest – it actually involves structural changes to lung tissue, similar to biological aging. It would be interesting to compare the lung tissue of people with obesity who have a sedentary inactive lifestyle with that of people with obesity who are active and physically fit, to see if exercise and better cardiorespiratory fitness can prevent these tissue changes and premature aging of the lungs.
Read More
Many People with Severe Obesity Face Medical Discrimination, Study Finds
Key Takeaways:
- A new study reveals that over 40% of clinics in the United States refused to schedule an appointment for a hypothetical patient with severe obesity.
- More than half of practices surveyed lacked the basic facilities or equipment required to provide appropriate care to patients with a body mass index (BMI) of 60 or greater.
- Researchers warn that discrimination and inadequate resources may contribute to poorer health outcomes, including delayed cancer detection, among people living with severe obesity.
Widespread discrimination in clinical settings
People living with severe obesity frequently encounter discrimination and barriers when seeking medical care, according to a new study published in the Annals of Internal Medicine. Researchers reported that about 2 in 5 (41%) clinics refused to schedule an appointment for a hypothetical patient weighing 465 pounds.
One receptionist at an orthopaedic surgeon’s office stated: “We’ve reached our limit for bariatric patients at this site,” without offering further explanation.
The study highlights a critical issue in access to care: beyond outright refusals, more than half of clinics (52%) did not have the equipment or facilities necessary to provide basic medical care for patients with very high body weights. Severe obesity is defined as a BMI of 40 or higher, with extremely severe obesity considered a BMI of 60 or greater.
Lack of facilities and equipment
Many clinics lacked essential infrastructure, including examination tables or chairs that could safely support higher weights, wide enough doorways and hallways for patient mobility, and appropriately sized medical gowns.
Dr Tara Lagu, senior author of the study and adjunct lecturer of medicine and medical social sciences at Northwestern University Feinberg School of Medicine in Chicago, emphasised the harmful impact of such deficiencies:
“Patients living with severe obesity are likely already struggling with shame and difficulty navigating the world. To tell a patient that they can’t be examined on a table, or can’t wear a gown, or need to stand during an appointment makes what should be a safe place and the experience of seeing a doctor humiliating and degrading. We need to acknowledge, as a profession, that all people deserve better than this.”
Affected population and health risks
According to the researchers, approximately 1 in every 270 Americans – close to 1 million adults – lives with extremely severe obesity (BMI ≥ 60). These individuals are two to three times more likely to experience significant health problems compared with the general population.
Despite this increased risk, previous studies have shown that people with obesity are less likely to receive preventive health services such as cancer screenings. Dr Lagu explained:
“Obesity affects cancer screenings, and failure to screen can result in later cancer detection. We’re always attributing worse outcomes in higher-weight patients to weight itself, but more and more studies are now pointing to worse care, lack of care or being care avoidant as possible reasons for these delays.”
Study design and findings
To investigate barriers to care, researchers used a “secret shopper” approach, in which callers attempted to schedule an appointment for a hypothetical patient weighing 465 pounds. They contacted 300 clinics across four metropolitan areas – Boston, Cleveland, Houston, and Portland, Oregon. The study covered five specialties: dermatology, endocrinology, obstetrics and gynaecology, orthopaedic surgery, and ear, nose, and throat (ENT).
Lead researcher Dr Molly Hales, a physician at University of Chicago Medicine, noted that the caller questions were intentionally designed to suggest possible urgent medical needs:
“We designed some of the questions our callers asked to be red flags for a receptionist to think, ‘I should really schedule this person,’ because the questions suggested the patient might have cancer and need an urgent workup.”
Despite this, only 59% of clinics overall were willing to schedule the appointment. ENT specialists were least likely to agree, with only 48% offering an appointment, while endocrinologists were most likely to accept and to have suitable facilities.
Humiliating workarounds
Even among clinics that agreed to see the hypothetical patient, around 1 in 6 (16%) suggested workarounds that could be humiliating, such as requiring the patient to stand during the exam or to use a sheet instead of a gown.
Dr Hales observed:
“Our numbers likely underestimate the magnitude of the problem. Likely, very few high-weight patients who are scheduling appointments know to even ask if they can be accommodated based on their weight, and they might be hesitant to ask these questions or advocate for themselves because of the social stigma.”
Potential solutions
The researchers highlighted that a Clinical Environment Checklist has been developed to guide outpatient clinics in ensuring they can provide appropriate care for patients with obesity. However, it has not been widely adopted.
Dr Hales noted:
“They designed the checklist to be used by general outpatient clinics and tested it in both primary care and subspecialty settings, so it’s a good resource for clinics in determining where there are opportunities for improvement.”
Read More
New Study Finds Wearables May Reshape Obesity Care
Key Takeaways:
- A new study from Northwestern University demonstrates how wearable devices can identify five distinct overeating patterns in people living with obesity, paving the way for more personalised interventions.
- The HabitSense body camera and NeckSense necklace provide unprecedented yet privacy-conscious insights into real-world eating behaviour.
- Researchers emphasise that overeating is not simply a matter of willpower but is shaped by complex emotional, environmental and behavioural factors.
Rethinking obesity treatment through technology
What if a smartwatch, necklace or discreet camera could sense when someone is about to overeat, and instead gently encourage healthier decisions?
Northwestern University scientists are exploring this idea through a pioneering lifestyle medicine programme that combines wearable technology with behavioural analysis. The approach uses three different devices – a necklace, a wristband and a body-mounted camera – to capture eating habits in natural settings, with privacy firmly safeguarded.
“Overeating is a major contributor to obesity, yet most treatments overlook the unconscious habits that drive it,” explained corresponding author Nabil Alshurafa, Associate Professor of Behavioural Medicine at Northwestern University Feinberg School of Medicine and, by courtesy, of Computer Science and Electrical and Computer Engineering at Northwestern’s McCormick School of Engineering.
Five distinct overeating patterns identified
In the study, published in npj Digital Medicine (part of the Nature Portfolio), 60 adults living with obesity wore the three sensors and logged contextual information – such as mood, activity and social setting – using a smartphone app over a two-week period. The project generated thousands of hours of data, revealing that overeating typically followed one of five recurring patterns:
- Take-out feasting – heavy consumption of delivered or takeaway meals.
- Evening restaurant revelry – social dining leading to excessive intake.
- Evening craving – compulsive late-night snacking.
- Uncontrolled pleasure eating – spontaneous binges driven by enjoyment.
- Stress-driven evening nibbling – grazing triggered by anxiety.
“These patterns reflect the complex dance between environment, emotion and habit,” said Alshurafa. “What’s amazing is now we have a roadmap for personalised interventions.”
A step towards personalised interventions
The findings create a foundation for future clinical practice, in which individuals may be profiled according to their dominant overeating pattern and then matched with tailored interventions.
Lead author Farzad Shahabi, a PhD student in Computer Science and member of Alshurafa’s laboratory, highlighted the significance:
“What struck me most was how overeating isn’t just about willpower. Using passive sensing, we were able to uncover hidden consumption patterns in people’s real-world behaviour that are emotional, behavioural and contextual. Seeing the patterns emerge from the data felt like turning on a light in a room we’ve all been stumbling through for decades. Our long-term vision is to move beyond one-size-fits-all solutions and toward a world in which health technology feels less like a prescription and more like a partnership.”
HabitSense – A body camera with built-in privacy
The project’s roots date back to when Alshurafa borrowed a police body camera from Northwestern’s campus police. He modified it to record only food-related actions, creating what is now called HabitSense.
HabitSense is the first patented Activity-Oriented Camera (AOC), which uses thermal sensors to activate recording solely when food enters the field of view. Unlike conventional egocentric cameras that capture everything from the wearer’s perspective, AOCs record actions rather than scenes. This innovation preserves bystander privacy while still collecting critical behavioural data.
NeckSense – Recording eating behaviours in real time
Participants also wore NeckSense, a necklace designed by Alshurafa and his team. NeckSense is the first technology able to passively and precisely monitor multiple eating behaviours. It can detect when someone is eating, how many bites they take, their chewing rate and the frequency with which their hand moves to their mouth. This provides researchers with highly detailed insight into real-world eating events.
A wrist-worn activity tracker – similar to a Fitbit or Apple Watch – completed the three-sensor system.
From personal struggles to scientific mission
Alshurafa’s scientific interest in obesity stems from his own personal journey. Throughout his younger life, his weight fluctuated by 40 to 50 pounds, with repeated attempts at dieting often undermined by late-night binge eating in front of the television.
“I tried to turn my personal struggle into a scientific mission that promises to reshape obesity treatment,” he reflected. “By merging computer science, behavioural medicine and a dash of Jane Goodall–style curiosity, we’re working to lead the way toward truly personalised, habit-based health care. This study marks only the beginning of a journey toward smarter and more compassionate interventions for millions grappling with overeating.”
Study team and support
The research team behind this project brought together a wide range of expertise from Northwestern and beyond. Contributors included PhD student in computer science Boyang Wei, HABits Lab research study coordinator Chris Romano, and undergraduate student Rowan McCloskey. They were joined by adjunct faculty members Annie Lin of the University of Minnesota and Mahdi Pedram of the University of North Texas, as well as former Northwestern faculty member Tammy Stump, now at the University of Utah. Jacob Schauer, Assistant Professor of Preventive Medicine, also played a role, alongside computer science PhD student Glenn Fernandes and senior engineer Tanmeet Butani (MS ’23).
The study was funded by the US National Institutes of Health through the National Institute of Diabetes and Digestive and Kidney Diseases.
CCH insight:
This is a fascinating study, which shows how new technologies may be able to provide innovative digital solutions to health issues, in this case identifying behavioural patterns underpinning overeating. These results need to be verified in larger studies, and then interventions trialled to address the different eating patterns, so we are a long way from viable new interventions, but this is an intriguing addition to the development of precision treatments for obesity.
Read More
Vanderbilt Researchers Use AI to Address Gaps in Long-Term Obesity Care
Key Takeaways:
- A $1 million Eli Lilly grant will fund a two-year Vanderbilt University Medical Center (VUMC) project using artificial intelligence (AI) to address gaps in obesity care.
- The initiative will analyse electronic health records (EHRs), survey patients and clinicians, and build a multi-agent AI system to develop evidence-based strategies for improving long-term engagement.
- A patient-facing mobile application will be designed and piloted in VUMC obesity clinics to support shared decision-making and sustained weight management.
Major investment in addressing gaps in care
Vanderbilt University Medical Center (VUMC) has secured a $1 million grant from Eli Lilly and Company to fund a two-year research project aimed at improving continuity of care for people living with obesity. The initiative seeks to understand why many individuals discontinue treatment and to create scalable solutions to help them stay engaged in long-term care.
“Obesity is a chronic, relapsing condition that requires ongoing management, yet too often it is treated episodically because of barriers like delayed medication access,” explained You Chen, PhD, Associate Professor of Biomedical Informatics and the project’s Principal Investigator for informatics and technology. “We’re combining data-driven insights, stakeholder input and multi-agent AI to understand where continuity breaks down and to design evidence-based interventions that keep patients engaged.”
Data-driven insights and stakeholder engagement
In its first year, the research team will analyse VUMC’s electronic health records to identify patterns distinguishing people who remain in continuous follow-up from those who disengage. Patient and clinician surveys will be conducted to capture real-world barriers to care, including logistical, financial and psychological challenges.
The findings will be integrated into a multi-agent AI system, featuring simulated physician, nurse and dietitian agents. This system will generate and prioritise strategies for maintaining engagement, which will then be reviewed by panels of clinicians, informaticians and patient representatives.
Patient-facing app to support engagement
The second year of the project will focus on designing and piloting a mobile application to be used in VUMC obesity clinics. This app is intended to help patients view and interpret their own health data, complete pre-visit tasks, and communicate more effectively with their care teams.
“By helping patients view and interpret their own data, complete previsit tasks, and communicate more effectively with care teams, the app will aim to strengthen shared decision-making and sustain engagement over time,” said Chen.
Clinical leadership and broader impact
The project’s clinical lead is Gitanjali Srivastava, MD, Professor of Medicine in the Division of Diabetes, Endocrinology and Metabolism.
“Medicine has evolved, and we need to adapt to new technological advances while catering to patient needs,” Srivastava stated. “It’s about designing practical tools and processes that fit naturally into patients’ lives and clinicians’ workflows, ultimately supporting healthier weight management over time.”
Chen emphasised that the project is intended to be scalable across health systems. The researchers believe that the human–AI collaborative approach developed through this project could serve as a reproducible framework for improving continuity of care for other chronic conditions that require long-term management.
Read More