Obesity Care Tag

GLP-1 Prescribing in Under-12s Has Risen 310-Fold Since 2019

Key Takeaways:

• GLP-1 prescribing for US children aged 8 to 11 living with obesity rose 310-fold between 2019 and 2026, though overall numbers remain low.
  
• Most of those prescribed the medicines had severe obesity (93.7 per cent) and 65.2 per cent already had an obesity-related condition.
  
• Children in higher-income communities were 55 per cent more likely to receive a prescription, pointing to a widening access gap.
  
  
  

A first national picture of GLP-1 use in younger children

New research from NYU Langone Health has produced what its authors describe as the first national overview of how glucagon-like peptide-1 (GLP-1) receptor agonists are being prescribed to children under the age of 12 who are living with obesity in the United States.

The headline finding is one of rapid acceleration from a very low base. The number of US children under 12 living with obesity who were prescribed the weight loss medicines Saxenda, Wegovy and Zepbound remained low in June 2026 – but it was 310 times higher than in 2019, the year the medicines first began to be prescribed in this group.

The study was published online in the journal Pediatrics on 4 September.

What the researchers found

Among children aged 8 to 11 who were living with obesity and did not have diabetes, the proportion prescribed a GLP-1 receptor agonist increased from 0.03 per cent in 2019 to 9.3 per cent in 2026 – a 310-fold rise across a period of seven and a half years. Over that timeframe, 20,282 children aged 8 to 11 were prescribed a GLP-1 medicine.

The researchers also compared prescribing across age groups. GLP-1 medicines were less commonly prescribed to younger children living with obesity, aged 8 to 11, than to adolescents living with obesity, aged 12 to 17, at 0.6 per cent and 0.9 per cent respectively.

That age gradient persists even though clinical guidelines permit the use of these medicines for obesity in children from the age of 8. Girls were more likely than boys to receive a prescription.

An estimated 20 per cent of children in the US are living with obesity, defined as a body mass index (BMI) above the 95th percentile for children of the same age and sex, in the absence of diabetes – a well-recognised complication of the condition.

Who is being prescribed these medicines

The clinical profile of the children receiving GLP-1 medicines suggests that prescribers are, for the most part, reserving them for those with the greatest clinical need.

Most children prescribed a GLP-1 medicine had severe obesity (93.7 per cent), meaning their BMI was substantially higher than that of almost all other children of the same age and gender. Most (65.2 per cent) were also living with at least one illness linked to obesity, such as raised cholesterol, high blood pressure or sleep apnoea.

A further quarter of the younger children living with obesity who were prescribed GLP-1s had prediabetes, placing them at high risk of developing the condition most commonly associated with obesity.

Why the researchers see this as a valuable tool

Lead investigator and obesity medicine specialist Babak J. Orandi, MD, PhD, an associate professor in the Departments of Surgery and Medicine at NYU Grossman School of Medicine, framed the findings as both a snapshot and a signal.

“Our study offers the first national overview in young children of the use of GLP-1 drugs to fight the obesity epidemic in the United States and shows that while the absolute numbers of children under the age of 12 receiving GLP-1 treatment is still low, GLP-1 use is accelerating rapidly,” said Dr Orandi. “The careful use of GLP-1s remains a valuable tool in confronting the obesity epidemic among young Americans.”

Dr Orandi noted that GLP-1 medicines can be highly effective in treating obesity and improving its metabolic complications, supporting weight loss, better blood sugar regulation and appetite suppression.

Weighing the risks of treating and of not treating

The study team was explicit that the decision facing families is not a simple choice between risk and safety.

While parents may hesitate at the prospect of their child being prescribed one of these medicines, there are also long-term risks attached to withholding treatment from young children living with obesity. Those risks include the development of chronic conditions such as diabetes, high blood pressure and liver disease in early adulthood and middle age.

For clinicians supporting families through exactly this kind of conversation, the College of Contemporary Health’s CPD short course GLP-1RAs in Practice (Prescribing and Supporting) addresses the practical side of initiating and monitoring GLP-1 therapy, including how to discuss benefits, risks and expectations with patients and their families.

An emerging gap in access

Alongside the prescribing trend itself, the study surfaced a socioeconomic pattern that the authors treat as a warning sign.

Many young children living with obesity in upper-income communities were 55 per cent more likely to be prescribed GLP-1 medicines than those who were not.

Study co-senior author Allan B. Massie, PhD, an associate professor in the Departments of Surgery and Population Health at NYU Grossman School of Medicine, said that current prescribing patterns already show the beginnings of a growing divergence between those who do and those who do not have access to the medicines.

“Physicians and health policymakers alike have a responsibility to ensure, as use of GLP-1 medications continues to rise, that all young children with obesity who need these drugs have access to them and that these valuable and sometimes costly treatments become available to more than those who have access to health insurance and can afford to visit pediatric clinics,” said Dr Massie.

The case for long-term monitoring

Dr Orandi said that long-term monitoring of children prescribed GLP-1 medicines is needed to confirm that the drugs remain both safe and effective in this age group.

Clinical trials are already under way in children living with obesity from as young as 6 years of age. Dr Orandi said these will inform and offer guidance to physicians, policymakers and parents as the use of anti-obesity medicines continues to grow.

How the study was carried out

The team drew on Epic Cosmos, a national dataset built from the electronic health records of more than 300 million American patients. The dataset covers 2,067 hospitals and 47,100 health clinics that use Epic, the largest electronic health record vendor in the US. Epic had no role in conducting the study.

Funding, authorship and disclosures

Funding support for the study was provided by NYU Langone.

Alongside Dr Orandi and Dr Massie, the NYU Langone researchers involved as co-investigators were Suhani S. Patel, MPH; Mary Jo Messito, MD; Michal A. Mankowski, PhD; and Dorry L. Segev, MD, PhD.

Dr Orandi has served on an advisory board for the pharmaceutical company Boehringer Ingelheim. Dr Segev has received consulting and speaking honoraria from Sanofi, CareDx, Moderna, AstraZeneca, Roche, Optum, OrganOx, Hansa Biopharma and Biosidus, and is a journal editor for Springer. None of these activities relate to the current Pediatrics study. NYU Langone is managing the terms and conditions of these relationships in line with its policies and procedures.

What this means for practice

The picture emerging from this study is of a treatment moving quickly from the margins towards the mainstream in a younger age group than many clinicians and families may expect – and doing so unevenly. Prescribing appears to be concentrated among children with the highest clinical need, but also among those with the greatest access to care.

For healthcare professionals, that combination raises practical questions about assessment, shared decision-making with families, monitoring over long periods, and equity of access within their own services.

CCH insight

This study was carried out in the US, where GLP-1 medications are licensed for the treatment of children with obesity from the age of 8 upwards. The picture in the UK is somewhat different, with just liraglutide and semaglutide, as Victoza and Wegovy, licensed for the treatment of obesity in under-18s, and only from the age of 12. For many people, there is an instinct to object to the use of drugs to treat obesity in children, but with severe obesity rates growing in under-18s, and children presenting with obesity-related diseases and prediabetes, it is hard to argue against the careful use of GLP-1RAs in those with greatest need, to prevent further harm to their health.

Supporting children and families through GLP-1 therapy calls for confidence in both the pharmacology and the conversation. The College of Contemporary Health’s CPD short course GLP-1RA Therapy: The Complete Programme is designed for healthcare professionals who want a structured, evidence-based grounding in initiating, monitoring and supporting GLP-1 receptor agonist treatment – including how to set realistic expectations and manage long-term follow-up.

Explore GLP-1RA Therapy: The Complete Programme → 

Source: NYU Langone Health

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Do GLP-1s Slow Ageing Itself? A New Mouse Study Says They Might

Key Takeaways: 

• In an NIH-funded study, semaglutide given to healthy 20-month-old mice improved muscle and cognitive function and reduced several molecular hallmarks of ageing.
  
• Mice treated until the end of life recorded a median lifespan almost 100 days longer than untreated mice.
  
• Against a 24% calorie-restricted diet, semaglutide matched most benefits, exceeded baseline in spatial memory and blood-sugar maintenance, and left metabolic rate largely unchanged.
  
  
  

A study that asks whether GLP-1s slow ageing itself

Research funded by the National Institutes of Health (NIH) has found that the GLP-1 receptor agonist semaglutide extended lifespan in older, healthy mice by tempering the detrimental effects of ageing. Investigators at the University of California, Berkeley went a step further than most work in this field by comparing the drug directly against reduced food intake. Semaglutide mimicked the anti-ageing benefits of calorie restriction and, in several respects, conferred even greater benefits.

The distinction matters. GLP-1 medicines have already been shown to delay the onset of a long list of age-related diseases in animals, and the clinical picture in people has broadened well beyond glycaemic control and weight. What this study adds is evidence gathered in healthy older animals, where no single disease is being treated. If the drug still produces benefit in that setting, the target may be ageing itself rather than any one condition downstream of it – a notion that could tie the widespread benefits of GLP-1s to a common source.

That framing is what makes the finding interesting to gerontologists as well as to those working in metabolic medicine.

“Most chronic diseases are deeply rooted in the aging process. If GLP-1 agonists do indeed slow it down, then a wide range of clinical benefits is exactly what you’d expect to see,” said Rafael de Cabo, Ph.D., a senior investigator at the NIH’s National Institute on Aging (NIA), and author of a commentary on the new study.

Treating late, when ageing is most pronounced

Many longevity experiments begin an intervention early and follow animals across most of their lives. The authors of this study, led by Danica Chen, Ph.D., took the opposite approach and started late, at the point where the effects of ageing are most pronounced. Semaglutide was administered to 20-month-old female mice for three months.

Set against a control group, the treated mice showed improved muscle function and improved cognitive function. Gene expression analysis pointed in the same direction at a molecular level: several hallmarks of natural ageing, including increased inflammation and reduced regenerative capacity, were reduced in the treated animals. In other words, the functional gains were accompanied by changes in the underlying biology rather than appearing in isolation.

A separate group of mice was treated until the end of life. Their median lifespan was nearly 100 days longer than that of untreated mice.

Separating the drug from the diet

Any intervention that reduces appetite invites an obvious question: is the benefit the drug, or simply the smaller portion? Because semaglutide reliably reduces food intake, the authors designed a head-to-head comparison to test whether its effects could be explained by eating less alone.

Over five months, one group of 20-month-old female mice received semaglutide, while another was placed on a 24% calorie-restricted diet matched to the feeding pattern of the treated animals. Matching the pattern, and not only the total, is what allows the two arms to be compared fairly.

The results drew numerous parallels between the two groups, with most physiological measurements remaining stable in both. Calorie restriction is a long-established intervention in ageing research, so this degree of overlap is itself a meaningful result for a pharmacological agent.

Where the two approaches diverged

Two differences stand out.

First, the semaglutide-treated mice surpassed baseline levels in exploratory behaviour, spatial memory and blood-sugar maintenance. These were not simply preserved measures, but measures that improved beyond where the animals started.

Second, the two groups differed in metabolic rate. It was reduced in the calorie-restricted animals, as would be expected when energy intake falls, but largely unchanged in the semaglutide-treated mice. A drug that delivers comparable benefits without the accompanying drop in metabolic rate is behaving differently from calorie restriction, not merely imitating it.

“These differences point to the possibility that GLP-1 drugs tap into a biological pathway independent of calorie restriction. Uncovering this potential route and the benefits that may specifically stem from it is an important direction for future research into the development of longevity-enhancing interventions,” said Chen, corresponding author of the study and professor of metabolic biology and nutrition at UC Berkeley.

What this does and does not mean for people

These findings may guide future research, but they do not imply that similar results could be achieved immediately in people. Mouse lifespan studies establish plausibility and direction, not clinical practice.

Additional clinical studies will be necessary to determine the clinical efficacy of GLP-1s on longevity in people, including work such as the recent post-hoc analysis of the SLIM LIVER trial. Chen also noted that future clinical investigations may explore benefits in healthy older individuals, which would greatly broaden the application of GLP-1s.

That last point is the one clinicians may want to watch. Prescribing at present is anchored to people living with obesity or type 2 diabetes and to defined clinical indications. A longevity indication in otherwise healthy older people would represent a different proposition altogether, with its own questions about risk, monitoring, muscle mass and long-term adherence.

Keeping pace with a fast-moving evidence base

For practitioners supporting people on GLP-1 therapies, the practical challenge is less about mouse longevity than about interpreting a rapidly expanding literature and explaining it accurately in consultations. Work of this kind is often reported as a longevity breakthrough, and people who have read those headlines may well raise it during appointments. The College of Contemporary Health’s CPD short course GLP-1RAs in Focus is designed for exactly that purpose, covering how GLP-1 receptor agonists work, what the current evidence does and does not support, and how to discuss benefits, limitations and expectations with the people in your care.

CCH insight

Although this study was conducted in mice, so cannot be directly extrapolated to humans, it clearly shows the GLP-1RAs must be acting through pathways other than those by which they induce weight loss. Considering the strong safety record of GLP-1RAs, it is surely now time to carry out trials on healthy, normal weight individuals to see if low-moderate doses can offer long-term benefits without negatively effecting body composition or other aspects of health.

Semaglutide’s effects in older mice sit at the edge of the current evidence base, but the questions they raise – about mechanism, about muscle and cognitive function, about how far the benefits of GLP-1s extend – are already reaching clinical conversations.

GLP-1RAs in Focus is a flexible, fully online CPD short course from The College of Contemporary Health, built for healthcare professionals who want a confident grounding in GLP-1 receptor agonists and the evolving research behind them.

Explore GLP-1RAs in Focus → 

Source: National Institutes of Health (NIH)

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Blueberry Compound Helps Muscle Cells Burn Stored Fat by Protecting a Key Protein

Key Takeaways:

• Researchers in Japan have identified pterostilbene, a polyphenol found in blueberries, grapes and other berries, as a dietary compound that reduces abnormal fat accumulation inside cultured skeletal muscle cells.
  
• The compound works through an unexpected route: rather than switching on the fat-burning receptor PPARδ directly, it protects the PPARδ protein from being broken down, leaving more of it available inside the cell.
  
• The findings are currently limited to molecular experiments in cultured mouse muscle cells, so they do not yet show that pterostilbene can prevent or treat metabolic conditions in animals or in people.
  
  
  

Why fat inside muscle matters

Excess fat stored inside skeletal muscle has become an important metabolic health concern. This type of fat buildup can be encouraged by high-fat diets, physical inactivity and ageing – three factors that are widespread in contemporary populations and that often occur together.

Crucially, fat held within muscle behaves differently from fat stored under the skin. Lipid droplets that accumulate inside muscle cells can interfere with normal muscle function and make it harder for the body to use glucose and fatty acids efficiently. Over time, this reduced metabolic flexibility can contribute to insulin resistance.

That connection is what makes fat inside muscle, known clinically as myosteatosis, more than a question of body composition. Finding ways to limit excess fat inside skeletal muscle could be important for supporting healthy ageing and reducing the risk of lifestyle-related disease.

One pathway plays a particularly important role in this process: peroxisome proliferator-activated receptor δ, usually shortened to PPARδ. When PPARδ signalling is active, it promotes fatty acid oxidation and helps limit the accumulation of lipids inside cells. In other words, an active PPARδ pathway pushes muscle cells towards using fat as fuel rather than storing it.

That has made PPARδ an attractive target. Researchers have become increasingly interested in food-derived bioactive compounds that may influence this pathway, but exactly how these substances affect PPARδ has remained unclear – a gap that limits how confidently any such compound can be developed into a practical intervention.

A berry compound targets muscle fat metabolism

A research team in Japan led by Associate Professor Takakazu Mitani of Shinshu University has now identified pterostilbene as a natural dietary compound that can stabilise PPARδ and influence fat metabolism inside muscle cells.

Pterostilbene is a naturally occurring polyphenol found in blueberries, grapes and other berries. Previous research has linked the compound to beneficial metabolic effects in the liver and in adipose tissue, but scientists knew much less about how it might affect skeletal muscle. The new findings were published in Volume 83 of the journal Food Bioscience on 1 September 2026.

The team’s starting point was a therapeutic gap rather than a specific molecule.

“We currently lack approved treatments specifically targeting myosteatosis,” says Dr Mitani. “This critical gap led our team to screen food-derived compounds for natural, dietary interventions. During the screening, we identified pterostilbene and focused our investigation on uncovering its precise mechanism of action.”

Screening food compounds for fat reduction

To investigate potential natural approaches, the researchers tested a collection of food-derived phytochemicals using cultured C2C12 mouse skeletal muscle cells – a well-established laboratory model for studying how muscle cells develop and handle fuel.

The screen was designed around two requirements rather than one. The researchers examined whether the compounds could reduce abnormal fat accumulation inside the cells, and whether they could do so without interfering with normal muscle development. A compound that stripped fat from muscle cells at the cost of impairing the muscle itself would be of little practical value.

Among the compounds tested, pterostilbene produced the strongest reduction in intracellular lipid accumulation. Importantly, the treated muscle cells continued to grow and differentiate normally.

The next question was how the reduction was being achieved. Broadly, a compound could lower fat inside a cell either by blocking fat from getting in or by increasing the rate at which stored fat is broken down. Further experiments showed that pterostilbene did not work by preventing fatty acids from entering the muscle cells. Instead, the researchers detected increased release of glycerol outside the cells, which is an important sign that stored fat is being broken down.

The treated cells also showed greater expression of genes involved in fatty acid oxidation – the process by which fatty acids are actually consumed for energy. Together, these results suggest that pterostilbene encourages muscle cells to break down stored lipids and process them for energy, rather than simply keeping fat out.

Protecting a key fat metabolism protein

The researchers then investigated the molecular mechanism behind these effects and found that pterostilbene significantly increased PPARδ signalling.

The way it accomplished this was unexpected. Many experimental compounds designed to stimulate PPARδ work by binding directly to the receptor and activating it, in the manner of a conventional drug acting on its target. Pterostilbene appeared to operate differently.

Instead of directly activating PPARδ, the compound increased the amount of PPARδ protein present inside the cells. It did this by preventing the protein from being broken down through the ubiquitin-proteasome pathway, the cell’s main route for tagging proteins for disposal and recycling them.

By slowing the degradation of PPARδ, pterostilbene allowed more of the protein to remain available inside the cell. This stabilisation increased PPARδ transcriptional activity and boosted the activity of genes involved in lipid metabolism.

Why the mechanism matters

Identifying the mechanism does more than explain a single result. It sets out a route that other researchers can follow, and Dr Mitani frames the work in exactly those terms.

“Our findings establish a scientific framework for developing functional foods and nutritional supplements that target muscle fat metabolism. However, beyond the potential of pterostilbene itself, this work provides an experimental framework for identifying other natural compounds that can stabilize the PPARδ protein,” mentioned Dr Mitani.

For healthcare professionals, questions about the role of specific dietary components in metabolic health arrive regularly in consultations, often well ahead of the evidence needed to answer them. Interpreting that evidence and translating it into practical dietary conversations is covered in CCH’s CPD short course Nutrition & Weight Management Essentials.

Potential implications for metabolic health

With metabolic diseases becoming increasingly common worldwide, the findings provide a starting point for studying dietary approaches that could eventually contribute to strategies for obesity, type 2 diabetes and age-related metabolic decline.

However, the results are still limited to molecular experiments in cultured mouse muscle cells. They do not yet demonstrate that pterostilbene can prevent or treat these conditions in animals or in people.

Even so, the researchers say the compound could serve as a promising candidate bio-ingredient for the food and healthcare industries as they explore new functional products aimed at muscle fat metabolism.

What still needs to be established

Additional in vivo research will be necessary to determine whether the effects translate beyond cultured cells. Future studies will also need to evaluate effectiveness, safety, and how selectively pterostilbene acts on its intended biological targets before the findings can be developed into practical nutritional or pharmaceutical applications.

Until that work is done, the most accurate description of pterostilbene is a well-characterised laboratory finding with a clearly mapped mechanism – valuable as a foundation for further research, but not yet a basis for dietary or clinical recommendations.

CCH insight

Conversations about diet, body composition and metabolic health are a routine part of practice, and people living with obesity or type 2 diabetes often ask about specific foods and supplements long before the research is settled. The Nutrition & Weight Management Essentials CPD short course from The College of Contemporary Health equips healthcare professionals to appraise nutritional evidence and apply it in everyday practice.

Explore Nutrition & Weight Management Essentials →

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GLP-1 Receptor Agonists: The Emerging Case for Microdosing

Key Takeaways: 

• A narrative review in Cureus finds that the benefits of GLP-1 receptor agonists (GLP-1RAs) extend beyond weight reduction to cardiovascular, renal, metabolic and other outcomes.
  
• Its authors propose microdosing – smaller, fractional doses – as a tolerability-first approach for people who respond strongly to standard doses or who struggle with gastrointestinal side effects.
  
• Direct evidence is extremely limited, and microdosing remains off-label, so the authors advise caution and clinician guidance.
  
  
  

Why a tolerability-first conversation is gaining ground

In a recent non-systematic narrative review published in the journal Cureus, researchers summarised the current evidence on the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and discussed the possible benefits of microdosing these agents. Their central question is a practical one that clinicians increasingly face in consultation rooms: if the multisystem benefits of this drug class are real, can smaller doses preserve enough of them to keep people in treatment?

Obesity remains a substantial health concern

Obesity continues to represent a significant health concern worldwide. In the United States (US), the prevalence of generalised obesity among adults, defined as a body mass index (BMI) above 30 kg/m², and of extreme obesity, defined as a BMI above 40 kg/m², has been increasing. Childhood obesity, by contrast, is defined using age- and sex-specific BMI thresholds rather than a single fixed cut-off.

Data from a survey conducted between 2021 and 2023 indicate that 21% of children and adolescents and 40% of adults in the US were living with obesity. Those figures give a sense of the scale of the population for whom pharmacological options are now being considered, and of the pressure placed on services that support people with obesity and related conditions.

From exenatide to semaglutide: a rapidly expanding drug class

The development of GLP-1RAs has been a remarkable advancement in the treatment of obesity and diabetes. Exenatide was the first GLP-1RA approved for type 2 diabetes in 2005, and the class has since expanded to include liraglutide, dulaglutide and semaglutide.

Success, however, has brought its own difficulties. Demand for GLP-1RAs far exceeds supply, and this imbalance has contributed to high costs and significant gaps in care. The authors suggest that these pressures have encouraged greater use of medication microdosing, as people and their clinicians look for ways to stretch limited or expensive supplies of medication further.

What microdosing means in this context

The term microdosing has a specific technical origin. It originally referred to sub-pharmacologically active doses used in drug-development studies, where the intention was never therapeutic effect. The review deliberately uses the term in a different, clinical sense: smaller, fractional doses of a medication that may allow people to receive some therapeutic benefit while extending their use of the medication.

That distinction matters when interpreting the literature, because the pharmacokinetic and the clinical uses of the word describe quite different practices. It is the second, clinical meaning that the review sets out to examine.

Clinical benefits of GLP-1 receptor agonists

GLP-1RAs modulate energy intake and promote satiety through agonism of the GLP-1 receptor. They also improve glycaemic control by suppressing glucagon and stimulating insulin secretion. These two mechanisms account for much of the drug class’s original appeal in both diabetes and obesity care.

A recent umbrella review noted trends towards improvements in respiratory, renal, metabolic, endocrine and cardiovascular outcomes, as well as cognitive function, with GLP-1RAs. Taken together, these findings suggest that the benefits of the drug class may extend beyond weight reduction across multiple organ systems, which is precisely why the question of preserving those benefits at lower doses has become interesting.

Cardiovascular and renal outcomes

A meta-analysis reported that GLP-1RAs led to significant reductions in major adverse cardiovascular events (MACE) and mortality. A further meta-analysis showed that long-acting GLP-1RAs reduced MACE and improved a composite kidney outcome among people with type 2 diabetes.

An umbrella review similarly reported that GLP-1RAs were associated with improvements in body weight, glycaemic control and various renal and cardiovascular outcomes. Importantly, the certainty of evidence was lower for some of the cardiovascular and kidney outcomes, so these associations should not all be read with equal confidence.

Emerging and early-stage evidence

Beyond the established indications, the review points to areas where evidence is still at a very early stage. A case report described a 34-year-old woman with type 2, stage III lipoedema who showed improvements after 30 days of treatment with low-dose tirzepatide, a dual GIP and GLP-1 receptor agonist. A single case, however, cannot establish treatment efficacy.

A systematic review indicated that GLP-1RAs significantly improved one measure of motor function among people with Parkinson’s disease. Other motor outcomes did not improve significantly, and adverse events were more frequent. This is a useful reminder that a positive signal on one outcome measure does not amount to a demonstrated clinical benefit overall.

Current dosing regimens of GLP-1RAs

Gradual dose titration is recommended for GLP-1RAs such as liraglutide and semaglutide in order to reduce the risk of adverse gastrointestinal (GI) effects.

For obesity, semaglutide is initiated at 0.25 mg once weekly for four weeks, then increased to 0.5 mg, 1 mg and 1.7 mg once weekly for four weeks each, until reaching 2.4 mg after 16 weeks. Liraglutide, by contrast, is initiated at 0.6 mg daily for the first week, then 1.2 mg daily, 1.8 mg daily and 2.4 mg daily for one week each, reaching 3 mg daily after four weeks.

For diabetes treatment, semaglutide and liraglutide can be dosed up to 2 mg and 1.8 mg respectively, as weekly and daily subcutaneous injections. Tirzepatide has identical dosing for both type 2 diabetes and obesity: treatment starts at 2.5 mg once weekly, increases to 5 mg once weekly four weeks later, and then rises in further 2.5 mg increments every four weeks to a maximum of 15 mg weekly.

The logic of these schedules is worth noting. Titration exists because tolerability, rather than efficacy alone, governs how quickly a person can reach a therapeutic dose. Fractional dosing takes that same logic and extends it further down the dose range. Understanding titration, tolerability and shared decision-making in enough depth to have these conversations well is now core to obesity and diabetes practice, and it forms the focus of the College of Contemporary Health’s CPD short course GLP-1RA Therapy: The Complete Programme.

Tolerability and the case for microdosing

The primary limitation of long-term GLP-1RA use is adverse GI effects, including nausea, diarrhoea, constipation and vomiting. These are also among the leading causes of treatment discontinuation, which means that tolerability is not a secondary concern but a direct determinant of whether anyone benefits from treatment at all.

More severe adverse effects, including intestinal obstruction, delayed gastric emptying and biliary disease, have been variably reported, with inconsistent evidence regarding these complications. Notably, tolerability has often been found to improve over time, which suggests that fractional or lower dosing may support treatment continuity.

Microdosing as a tolerability-first framework

The authors propose microdosing as a tolerability-first framework, enabling clinicians to personalise dosing to the individual and potentially reduce barriers to treatment. They suggest it could be a valuable option for people who have exaggerated pharmacological responses to a standard dose, and for those who are highly sensitive to adverse effects.

Two important caveats accompany the proposal. First, studies on the effects of microdosing GLP-1RAs are extremely limited. Second, the established benefits of standard GLP-1RA doses cannot be assumed to persist with fractional dosing. Dose-escalation trials do suggest a strong therapeutic response in some people at submaximal doses, which is part of what makes the idea plausible, but plausibility is not proof.

What the evidence on lower doses currently shows

A prospective observational study found improvements in body weight, BMI, triglycerides, glycated haemoglobin and low-density lipoprotein cholesterol with low-dose tirzepatide among non-diabetic adults with obesity.

In addition, a pooled analysis of phase III trials assessing once-weekly semaglutide doses of 0.5 mg and 1 mg indicated improved tolerability over time and reduced sensitivity to adverse GI events with long-term exposure.

Both findings are encouraging, but the review is clear about their status: these studies provide indirect support rather than direct evidence from trials specifically designed to test a microdosing strategy.

Practical and safety considerations

The review also notes two constraints that clinicians need to weigh before considering this approach. Microdosing is an off-label approach, and fractional dosing using existing injection devices may raise sterility and safety considerations. The authors therefore recommend caution and clinician guidance before anyone begins a microdosing regimen.

Concluding remarks

Collectively, although microdosing emerged as a pharmacokinetic tool in drug development, the authors describe it as an emerging pragmatic approach in clinical practice. Alongside other treatment modalities, it may better support people in reaching their health goals and improve their quality of life.

The honest conclusion, however, is that there is limited direct evidence on microdosing GLP-1RAs. Further research is warranted to confirm whether fractional dosing helps maintain the long-term benefits that have been demonstrated at standard doses. For now, the concept is best understood as a personalised, tolerability-led hypothesis worth studying rather than a settled standard of care.

CCH insight

This paper highlights a number of questions that are being raised about the potential for microdosing of GLP-1RAs. However, it doesn’t present any new evidence or present a proposed framework or strategy for microdosing because, as it states, there is currently very little evidence. The aim of GLP-1 therapy should always be to achieve the best health outcomes for the patient, using a dose they can tolerate, and then finding the minimum dose to maintain those health benefits. The recent introduction of oral daily GLP-1RA pills should make it much easier to vary the dose, both in terms of amount and frequency, and give clinicians and patients better opportunities to find the best dose for each individual.

Conversations about titration, tolerability and dose personalisation are becoming a routine part of obesity and diabetes care, and they demand a confident grasp of both the pharmacology and the person in front of you.

The College of Contemporary Health’s CPD short course GLP-1RA Therapy: The Complete Programme is designed for healthcare professionals who want to build exactly that confidence, covering how these medicines work, how they are dosed and titrated, how adverse effects are anticipated and managed, and how to support people effectively throughout treatment.

Explore GLP-1RA Therapy: The Complete Programme →

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Immune Cells May Keep a Biological Memory of Obesity

Key Takeaways: 

• Mice lacking a protein called CWC22 in their fat tissue immune cells struggled to lose weight on a reduced-fat diet.
  
• Over half of the obesity-related genetic changes in these cells persisted after weight loss, suggesting a biological “memory” of obesity.
  
• Correcting one of those changes restored normal cell function and helped the mice shed fat again.
  
  
  

Why weight loss can become harder after obesity

According to the World Health Organization, one in eight people worldwide lives with obesity. Yet despite the volume of health education programmes, books, articles and treatments available, many people continue to find weight loss extremely difficult once obesity has developed. Precisely why the body resists losing weight, and why lost weight is so often regained, remains a complex puzzle for researchers.

A new study published in the journal Science Translational Medicine may offer part of the answer. The research points to changes in a particular type of immune cell known as an adipose tissue macrophage (ATM). In mice, these changes appeared to make weight loss harder, because the cells seem to carry a biological “memory” of obesity that outlasts the obesity itself.

What the researchers did

Researchers from several institutions across Japan set out to study ATMs directly. These immune cells help regulate fat tissue health in a number of ways, one of the most important being the safe removal of dying cells from the tissue.

The team fed laboratory mice a high-fat diet for 12 weeks until the animals developed obesity, then switched them to a low-fat diet for a further six weeks. When they compared the animals, they noticed a pattern: the mice that lost the least weight after the dietary switch had lower levels of a protein called CWC22 in the nucleus of their ATM cells. This suggested that CWC22 might play a role in helping the body shed weight.

To test that idea, the researchers genetically modified a group of mice so that they lacked the CWC22 gene in a group of immune cells that includes macrophages. Under normal circumstances, CWC22 helps cells splice messenger RNA, the editing process that RNA undergoes before it is used as a template to make proteins.

A clean-up failure in fat tissue

When the modified mice were placed on a weight-loss diet, they struggled to shed fat. Their ATMs could not clear away dead cells effectively, and as a result dead cells accumulated in the fat tissue.

Closer analysis of these immune cells revealed the mechanism. The absence of the Cwc22 gene caused a splicing error involving a gene called Scarb1. Because of that error, the macrophages destroyed their own clean-up receptors before those receptors could reach the cell surface, leaving the cells without the tools they needed to do their job.

The knock-on effect involved a chemical messenger. Because the macrophages were less able to clear dead cells, they released less inosine. Inosine normally acts as a signal instructing fat cells to break down their stored fat, so with less of it available, fat breakdown was impaired.

A memory that persists after weight loss

Perhaps the most striking finding concerned how long these changes lasted. The research team found that 51.9% of the genes showing obesity-induced RNA splicing changes in these immune cells remained altered even after the animals had lost weight.

In other words, the immune cells retained a biological record of the period of obesity, including alterations that continued to impair their normal clean-up duties long after the diet had changed.

“These findings reveal that aberrant alternative splicing in macrophages underlies resistance to postobesity weight loss,” commented the study authors in their paper.

Rewriting the memory

Encouragingly, at least one component of that memory appears to be reversible. When the scientists corrected the Scarb1 splicing error using a synthetic genetic patch, the clean-up receptors were restored. This in turn increased the amount of inosine available and helped the mice to lose fat once again.

“Our study suggests that specific alternative splicing events can shape macrophage phenotypes under defined environmental conditions.”

What this could mean for people living with obesity

The findings may eventually help inform treatments for people who struggle to lose weight after developing obesity. When the team analysed human tissue samples, they found abundant CWC22 in the nuclei of immune cells taken from people who were lean, but reduced levels in samples from people living with obesity. That parallel between the mouse and human findings is what makes the work potentially translatable.

It is worth keeping the limitations in view. The functional experiments were carried out in mice, and the human element of the study was limited to tissue analysis rather than any test of treatment. No synthetic genetic patch has been trialled in people, and there is a considerable distance between correcting a splicing error in a mouse model and offering a therapy in clinical practice.

Even so, the study adds to a growing body of evidence that weight regain is not simply a matter of behaviour or willpower. Biological adaptations in fat tissue, appetite regulation and now immune cell function all appear to work against sustained weight loss. Clinicians who want to explore these mechanisms and their practical implications in more depth may find it useful to look at structured CPD, such as the College of Contemporary Health’s Obesity Essentials short course, which covers the biological, clinical and behavioural drivers of obesity and weight management.

For people living with obesity, findings like these carry a useful message: the difficulty of maintaining weight loss has measurable biological underpinnings, and understanding them may in time lead to better-targeted support.

CCH insight

Understanding why the body resists weight loss is central to supporting people living with obesity well. Our Obesity Essentials CPD short course explores the physiology, clinical management and behavioural dimensions of obesity, giving healthcare professionals a grounded, evidence-informed basis for the conversations they have every day.

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Ketogenic Diet Cut Liver Fat by 67% in a Randomised Trial

Key Takeaways:

• People with obesity who followed a ketogenic diet reduced their liver fat by an average of 67%, compared with an average reduction of 45% in both the Mediterranean and low-fat plant-forward groups – even though all three groups lost a comparable amount of weight.
  
• Around half of the participants following the ketogenic diet no longer met the criteria for prediabetes by the end of the study, compared with 29% in the Mediterranean group and 7% in the plant-forward group.
  
• Despite obtaining 73% of their calories from fat, participants in the ketogenic group showed no increase in blood fat or cholesterol levels, alongside the largest rise in glucagon and the steepest fall in blood insulin of the three groups.
  
  
  

Carbohydrate restriction appeared to add benefits beyond weight loss

A very low-carbohydrate, high-fat diet may deliver stronger metabolic benefits for people with obesity than either a Mediterranean diet or a low-fat diet, according to a clinical trial published on 27 August in the Cell Press journal Cell Metabolism. After four to five months on a ketogenic (or “keto”) diet, about half of the participants with obesity and prediabetes no longer met the criteria for prediabetes.

“We know weight loss can improve metabolic health in people who are obese,” says Samuel Klein, the study’s corresponding author at Washington University School of Medicine in St. Louis, Missouri. “Our data suggest that if you have high liver fat content and prediabetes, reducing carbohydrate intake can have important therapeutic effects on metabolism beyond just weight loss alone.”

The distinction matters clinically. Weight loss itself is known to improve metabolic markers, so the open question has been whether the composition of a diet contributes anything further once the amount of weight lost is held constant. This trial was designed to test exactly that.

Comparing three widely used weight loss diets

An estimated 40% of adults in the United States have obesity. Doctors often recommend low-fat, low-carbohydrate or Mediterranean diets for weight loss, but researchers have not known whether one approach provides extra metabolic advantages beyond the effects of losing weight.

The three diets differ sharply in how much carbohydrate and fat they provide:

• A low-carbohydrate diet, also known as the Atkins or ketogenic diet, greatly restricts carbohydrates. A ketogenic diet can include foods rich in saturated fat, including animal products.
  
• A low-fat diet, by contrast, can obtain as much as 70% of its energy from carbohydrates.
  
• A Mediterranean diet emphasises plant-based foods such as vegetables, olive oil and nuts, along with moderate amounts of fish and dairy.
  
  
  

To compare their effects, Klein and his colleagues enrolled 42 people with obesity, prediabetes and fatty liver disease in a clinical trial. Participants were randomly assigned to follow a ketogenic diet, a Mediterranean diet, or a low-fat, plant-forward diet. The research team supplied all of their food, and participants met with a dietitian every week to help them stay on their assigned eating plan.

That level of support is worth noting. Providing every meal and offering weekly dietetic contact removes much of the adherence variability that undermines free-living diet studies, which strengthens confidence that the differences observed between groups reflect the diets themselves rather than differences in how closely people managed to follow them.

Matching weight loss across the three groups

The ketogenic diet supplied just 4% of calories from carbohydrates and 73% from fat. In the Mediterranean group, 50% of calories came from carbohydrates and 35% from fat. The plant-forward diet provided 70% of calories from carbohydrates and 15% from fat.

Researchers adjusted calorie intake for each person so that participants in all three groups would lose about 10% of their body weight. Reaching that target took roughly four to five months.

By the end of the study, participants in every diet group had significantly reduced their body fat. Insulin sensitivity also improved across all three groups, helping the body control blood sugar more effectively. In other words, all three approaches worked – the question was whether any of them worked better than the others once weight loss was equalised.

The ketogenic diet produced the largest fall in liver fat

Despite similar weight loss, the ketogenic diet produced the strongest changes across several measures of liver and metabolic health. Liver fat fell by an average of 67% among people following keto, compared with an average reduction of 45% in both the Mediterranean and plant-forward groups.

The researchers also tracked participants’ metabolism over a 24-hour period by repeatedly analysing their blood. People in the ketogenic group showed the largest rise in glucagon, a hormone that helps reduce fat stored in the liver. They also had the greatest decline in blood insulin levels, another change that can help lower liver fat, compared with participants following the other two diets.

Together, the hormonal findings offer a plausible mechanism for the liver fat result: lower circulating insulin and higher glucagon both shift the liver away from storing fat, and both are the expected consequence of sharply restricting carbohydrate intake.

Blood fats did not rise on the highest-fat diet

One of the more counter-intuitive results concerned the lipid profile of the ketogenic group, whose diet contained by far the most fat and could include saturated fat from animal products.

“The most surprising finding was that participants in the ketogenic diet group didn’t experience an increase in blood fat or cholesterol levels despite consuming the most fat,” says Max Petersen, the study’s first author at Washington University School of Medicine.

Prediabetes improved most in the ketogenic group

After the weight loss intervention, about 50% of participants following the ketogenic diet no longer met the criteria for prediabetes. That compared with 29% of those on the Mediterranean diet and 7% of those following the plant-forward diet.

The researchers were careful to position dietary composition alongside, rather than against, current pharmacological options for people living with obesity.

“GLP-1-based medications have revolutionized the therapy of obesity. We now have a very effective pharmacotherapy for achieving significant weight loss,” Petersen says. “But in addition, our study shows that the specific composition of the diet can give you added benefits.”

What the findings mean for everyday practice

For healthcare professionals supporting people with obesity, prediabetes or fatty liver disease, the practical implication is that the content of a weight loss plan may deserve as much consultation time as the calorie target attached to it. Two people can lose the same 10% of their body weight and still arrive at meaningfully different liver fat and glycaemic outcomes.

This is the kind of nuance that clinicians increasingly need to be able to explain confidently in a short appointment, and it is a core focus of continuing professional development in nutrition. The College of Contemporary Health’s Nutrition & Weight Management Essentials CPD short course is designed for practitioners who want to strengthen their grounding in evidence-based nutrition and weight management before applying it in conversations with patients.

It is also worth keeping the study’s limits in view. This was a small trial of 42 people, conducted under closely controlled feeding conditions with weekly dietetic support and all food provided. Whether the ketogenic advantage persists in free-living conditions, over longer periods, and across broader populations remains to be established.

The research was supported by the National Institutes of Health and the Foundation for Barnes-Jewish Hospital.

CCH insight

Findings like these are only useful at the point where a clinician can translate them into a realistic, personalised plan with a patient. Nutrition & Weight Management Essentials is a CPD-accredited short course from The College of Contemporary Health, developed for healthcare professionals who want a practical, evidence-informed foundation in nutrition and weight management.

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GLP-1 Medications May Reshape Obesity Care, but Clinicians Still Have Questions

Key Takeaways: 

• Staff saw injectable GLP-1 medications as a valuable middle option between behavioural support and bariatric surgery.
  
• Their strongest concerns centred on what happens after treatment stops, particularly weight regain and masked behavioural patterns.
  
• Most had learned about these medications from patients rather than through formal training.
  
  
  

A service preparing for a change it had not yet made

A qualitative study published in Obesity Science & Practice set out to capture something rarely documented: what healthcare professionals think about injectable GLP-1 medications before their service begins prescribing them. The researchers interviewed staff at a United Kingdom Tier 3 weight management service that had applications for approval in place but was not yet prescribing, giving an unusually clean view of expectations, hopes and anxieties uncoloured by direct prescribing experience.

The timing matters because these medications are moving quickly into routine obesity care. One in eight people worldwide lives with obesity, a scale that demands sustained attention from health authorities. In England, weight management is organised across four tiers, running from population-level prevention and lifestyle services through to specialist multidisciplinary care and bariatric surgery. Injectable GLP-1 medications, including semaglutide and tirzepatide (a dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist), are increasingly built into these pathways. Semaglutide is recommended for eligible patients within specialist services, while tirzepatide can also be prescribed in NHS primary care.

How the study was carried out

Participants were recruited from a Tier 3 service in England providing interpersonal nutritional advice and behavioural support to people with a body mass index above 40 kg/m², or between 35 and 39.9 kg/m² alongside a weight-related comorbidity.

Interviews took place between 20 June and 19 July 2024. Eligible participants were behavioural change advisors or nutrition advisors, and importantly, none of them held prescribing privileges. Staff were invited by email and completed an information sheet, an electronic consent form, a demographic questionnaire and an interview-date selection.

The research team developed a semi-structured interview schedule, refining it after a pilot interview. Questions covered knowledge of semaglutide, perceived benefits, concerns, possible psychological consequences, long-term outcomes, service integration and information needs. Interviews were audio-recorded and transcribed verbatim, then analysed using Braun and Clarke’s six-stage reflexive thematic analysis. Transcripts were read repeatedly and coded in NVivo 14, with preliminary themes developed, discussed, revised, mapped, defined and named. Analysis was predominantly inductive, with a deductive element used to group themes according to the research questions, and the dataset was interpreted through a constructivist lens.

The recruitment email reached 17 healthcare professionals. Thirteen expressed interest and 11 completed interviews, comprising six nutrition advisors and five behavioural change advisors. Interviews ran from 34 to 62 minutes, with a mean of 46 minutes. Sample size was guided by information power rather than a fixed target. Thirteen themes emerged, organised into four clusters: knowledge and information needs, perceived benefits, concerns, and service provision considerations.

Learning from patients rather than from training

One of the more striking findings concerns where knowledge was coming from. Participants had mainly learned about injectable GLP-1 medications through patients who had purchased them privately. Most did not feel confident in their current understanding, reported little formal training, and often sought out information independently, though lack of time limited how far they could go.

That said, the baseline was not zero. All participants knew the medications could facilitate weight loss, and most recognised appetite suppression as an important mechanism, although understanding of how the drugs work varied considerably. A few had deeper knowledge of semaglutide’s physiological effects. Gastrointestinal effects were widely mentioned, including nausea, constipation and diarrhoea.

It is a gap that structured continuing professional development is well placed to close. CCH’s GLP-1RAs in Focus short course was built for professionals in exactly this position, including non-prescribers supporting people on GLP-1RA pathways who want a working grasp of the underlying physiology and pharmacology rather than a patchwork assembled from patient conversations.

Seen as a middle path, not a shortcut

Most participants held positive views and regarded injectable GLP-1 medications as a useful weight-loss tool. Several felt that early weight loss could boost patients’ confidence in their own ability to lose weight, and in turn encourage greater engagement with behavioural support.

Many framed the medications as a valuable middle ground between behavioural support and bariatric surgery, particularly for people with complex needs or those who did not want surgery. At the same time, participants were clear that the drugs were not a substitute for a patient’s own efforts. Where lifestyle change alone was achievable, it was generally the preferred route, partly because it could help people feel more in control of their own progress.

Concerns clustered around what happens next

The dominant concern was not the treatment period itself but what follows it. Most participants worried about weight regain after discontinuation, particularly where behavioural changes had not become established during treatment.

Closely linked to this was a worry about masking. Participants feared that appetite suppression could obscure emotional eating, stress eating, unhelpful habits and other behavioural patterns, making it harder to tell which changes were driven by the medication and which by behavioural support. There was also concern that successful weight loss could create a false sense of security, reduce engagement with lifestyle advice, or foster reliance on medication.

Some participants raised possible mental health risks, including disordered eating or worsening difficulties among people with eating disorders, psychological trauma or a history of self-harm. It is worth being precise here: these were concerns held by participants rather than harms they had observed, and the authors noted that current evidence does not support a causal relationship between GLP-1 medications and suicidal or self-injurious thoughts or actions.

Where behavioural support should sit in the pathway

Many participants favoured offering behavioural and lifestyle support before prescribing begins, giving time to understand individual needs and to manage expectations about what the medication can and cannot do. Almost all supported providing that help alongside treatment, though views differed on how often and for how long.

Some also argued for support during dose reduction and for a few months after treatment ends, precisely because of the regain risk they had identified. The introduction of GLP-1 prescribing into their own service was viewed by some as experimental and as a learning process, and participants anticipated that their professional roles and responsibilities would shift as a result.

What this study cannot tell us

The authors were candid about the limits. The study included 11 professionals from a single Tier 3 service that had not yet started prescribing injectable GLP-1 medications, so the findings may not generalise to other services or to professionals with direct prescribing experience. The interviewer also worked within the same service, which may have shaped how freely participants expressed their views.

What it means for practice

Taken together, the picture is of a workforce that is broadly positive about injectable GLP-1 medications and sees a clear clinical niche for them, but that is thinking hard about continuity of care. The concerns raised, weight regain after discontinuation, reduced engagement with behavioural support, masked behavioural patterns and possible mental health risks, are perceived rather than demonstrated harms, but they point to real design questions for services.

The authors conclude that further research is needed on combining injectable GLP-1 medications with interpersonal behavioural support, and on how that integration can best sustain patients over time. In the meantime, the most actionable finding may be the simplest one: the staff closest to patients wanted better information and had few structured routes to get it.

CCH insight

Tier 3 specialist weight management services provide care for patients with obesity with the greatest need, so it is vital that staff are well informed about GLP-1 medications. Although this study was published earlier this year, the interviews it is describing took place in June/July 2024, when the NHS was still in the early stages of rolling out its Wegovy treatment programme for Tier 3 weight management, and at a time the drug was still in short supply. Therefore it is understandable there was a lack of knowledge of GLP-1RAs amongst staff at that time. Unfortunately, despite the huge amount of evidence for the safety and benefits of these drugs, there still seems to be scepticism amongst many health professionals today about providing pharmacotherapy for obesity.

This study lands on something many services will recognise: the staff supporting people on GLP-1RA pathways are often the least formally trained in how these medications work, and the anxiety sits not in the prescription itself but in the months that follow it.

GLP-1RA Therapy: The Complete Programme (Ozempic, Wegovy & Mounjaro) is built around that full sequence, covering the science, safe prescribing and the long-term care that protects the result, from nutrition and lean mass through to plateaus and when to refer. Seven CPD hours, three Certificates of Completion, and the CCH Advanced Certificate in GLP-1RA Therapy on passing the capstone. Open to prescribers and non-prescribers alike.

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Novo Nordisk Launches Late-Stage Trial to Find the Lowest Effective Dose of Oral Wegovy

Key Takeaways: 

• Novo Nordisk has begun OASIS-5, a 60-week late-stage trial testing lower maintenance doses of the oral Wegovy pill.
  
• The trial will enrol 450 adults with a BMI of 30 or above, or 27 with a weight-related health condition.
  
• Interest in lower dosing reflects real-world practice, where cost and side effects already drive some people to take reduced doses.
  
  
  

A trial built around dose flexibility

Danish drugmaker Novo Nordisk has started testing smaller doses of its Wegovy pill in a new late-stage study designed to identify the lowest dose that still supports weight loss, according to a listing on a US clinical trials database.

The study, known as OASIS-5, began on 12 August and is scheduled to run until 2028. It will examine lower strengths of the daily maintenance dose – the dose used to sustain weight loss once it has been achieved, rather than the escalating doses used at the start of treatment. At present, the approved long-term dose of the Wegovy pill is 25 milligrams.

“Having a broader range of maintenance doses could provide greater flexibility in treatment and optimising the patient experience,” Novo said in an emailed statement to Reuters.

Novo has not specified which new dose strengths are being tested. The Wegovy pill is also approved in doses of 1.5 mg, 4 mg and 9 mg.

What OASIS-5 will measure

The 60-week trial will recruit 450 adult participants who have previously struggled to lose weight, with a Body Mass Index of 30 or above, or 27 in combination with a weight-related health issue.

The primary objective is to establish whether lower doses of oral semaglutide – the active ingredient in Wegovy – produce greater weight loss than placebo over the 60-week period. Secondary objectives include changes in waist circumference, other health benefits and the side effect profile at these reduced strengths.

The study will exclude people living with diabetes, those who have experienced recent major weight changes, and anyone currently being treated with GLP-1 medications.

Seeking health benefits beyond weight loss

The trial arrives against a backdrop of dosing behaviour that is already happening outside clinical protocols. Some people taking GLP-1 medicines, including Wegovy and Lilly’s Zepbound injections, are microdosing or otherwise taking lower-than-approved doses. The practice has become popular largely because of the high cost of the medicines and the side effects associated with them.

“People are using low dosages of these products… they just decide on their own,” Novo CEO Mike Doustdar told Reuters in an interview last week, noting that patients often seek health benefits beyond weight loss.

That observation points to a broader question facing prescribers: what people hope to gain from GLP-1 therapy is not always confined to the number on the scales. Understanding the pharmacology behind dose escalation and maintenance, and being able to discuss the trade-offs between efficacy, tolerability and cost, is increasingly central to safe prescribing. It is a theme covered directly in the College of Contemporary Health’s CPD short course GLP-1RAs in Practice: Prescribing, which examines dose titration, monitoring and shared decision-making in day-to-day clinical settings.

Competitive pressure in a growing market

Novo is under pressure after losing ground to US rival Eli Lilly in an obesity drug market projected to exceed $100 billion by 2030. Investors are watching the Wegovy pill closely; it generated second-quarter sales of 3.22 billion Danish kroner ($499.89 million).

Doustdar expects market segmentation to prevent a winner-take-all contest with Lilly – a view consistent with a future in which different doses, formulations and treatment goals serve different groups of people rather than a single product dominating.

Lilly did not immediately respond to a Reuters request for comment on whether it plans to test smaller doses of its oral drug Foundayo, which has lowest approved doses of 0.8 mg and 2.5 mg.

What this could mean for practice

If OASIS-5 demonstrates that lower maintenance doses deliver meaningful weight loss, it would give clinicians a wider set of options for people who cannot tolerate higher strengths, who are managing the cost of long-term therapy, or who have reached a weight they wish to maintain rather than continue reducing. It would also bring an existing real-world practice within the evidence base, replacing self-directed dose reduction with an approved, monitored alternative.

Results are not expected until 2028, so any change to prescribing practice remains some way off. In the meantime, conversations about dosing, expectations and adherence will continue to sit with the healthcare professionals supporting people through treatment.

CCH insight

Dose selection, titration and tolerability are among the most common practical challenges in GLP-1 prescribing. The College of Contemporary Health’s CPD short course GLP-1RAs in Practice: Prescribing covers dose escalation and maintenance, managing side effects, patient selection and monitoring – equipping healthcare professionals to make confident, evidence-based decisions as the treatment landscape evolves. 

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Source: Reuters

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Higher Coffee Intake Linked to Lower Visceral Fat and Greater Muscle Mass

Key Takeaways: 

• Higher habitual coffee intake was associated with lower total and visceral fat and greater skeletal muscle mass, despite a similar BMI.
  
• Coffee intake was linked to lower branched-chain amino acids in both sexes, and to sex-specific differences in testosterone and SHBG.
  
• The study was observational, so it cannot show that drinking coffee caused any of the differences identified. 
  
  
  

A familiar drink with poorly understood biology

Coffee is consumed around the world every day, and earlier research has associated coffee drinking with a reduced risk of conditions including type 2 diabetes and cardiovascular disease. What has remained unclear is why. Scientists still do not fully understand the biological processes that might explain those connections, which has made it difficult to interpret the epidemiological signal.

New research from Finland now suggests that regular coffee consumption is associated with healthier body composition, favourable metabolic markers, and distinct patterns involving sex hormones in men and women.

What the researchers examined

Researchers at the University of Oulu analysed information from 2,264 people who were 46 years old and taking part in the Northern Finland Birth Cohort 1966. The team investigated how participants’ usual coffee intake related to circulating metabolites, indicators of cardiometabolic risk, and sex hormone levels.

Studying a single birth cohort at a single age has a particular advantage: it removes age itself as a source of variation, allowing differences between people with higher and lower coffee intake to stand out more clearly.

Lower body fat and greater muscle mass

People who consumed more coffee tended to have lower levels of both total body fat and visceral fat, along with greater skeletal muscle mass.

Notably, these differences appeared even though participants with higher and lower coffee intake had a similar body mass index (BMI). That detail matters clinically. BMI cannot distinguish fat mass from lean mass, or subcutaneous fat from the visceral fat that sits around the abdominal organs and carries the stronger association with cardiometabolic risk. Two people with an identical BMI may therefore have meaningfully different metabolic profiles, and in this cohort coffee intake tracked with that hidden difference rather than with weight itself.

A metabolic marker associated with diabetes risk

Higher coffee consumption was also associated with lower circulating concentrations of branched-chain amino acids in both men and women. When chronically elevated, these biomarkers have previously been associated with insulin resistance and a greater risk of developing type 2 diabetes.

This finding sits alongside the body composition results rather than separately from them, since visceral fat and insulin resistance are themselves closely linked.

Different hormonal patterns in men and women

Some of the clearest differences appeared among men. Greater coffee consumption was associated with a more favourable glucose-insulin profile, higher levels of total and bioavailable testosterone, and greater concentrations of sex hormone-binding globulin (SHBG). However, free testosterone and the free androgen index were modestly lower.

The hormonal associations were less extensive in women. Higher coffee consumption was mainly associated with increased SHBG and lower measures of free androgens.

The common thread across both groups was SHBG, the carrier protein that binds circulating sex hormones and influences how much is biologically available to tissues. Higher SHBG has itself been studied in relation to metabolic health, which makes it a plausible point of connection between the hormonal and cardiometabolic findings.

“Coffee is consumed by millions of people every day, yet we still know surprisingly little about how it relates to our metabolism and hormones. What stood out in our findings was a distinct hormonal signature that didn’t disappear even after we took into account BMI and lifestyle factors, with several of these associations differing between men and women,” says Luca Verroest, lead author of the study and Doctoral Researcher at the University of Oulu.

Why the hormonal findings could matter

The findings raise the possibility that hormonal pathways could help explain some of the previously observed relationship between coffee consumption and metabolic health.

Because the research was observational, however, it cannot establish that drinking coffee directly caused any of the biological differences identified in the study. People who drink more coffee may differ from those who drink less in ways the analysis could not fully capture, and the direction of any relationship cannot be determined from data collected at a single point in time.

For clinicians, the more immediately useful message concerns interpretation rather than advice. Findings of this kind reinforce how much a single anthropometric measure can conceal, and how dietary patterns, body composition, and endocrine markers interact when assessing cardiometabolic risk. Practitioners who want to strengthen that interpretive skill set often look to structured CPD such as the College of Contemporary Health’s Nutrition & Weight Management Essentials short course, which examines how dietary intake relates to body composition and metabolic health in everyday practice.

Finland as a study setting

The setting also makes the research especially relevant. Finland ranks among the world’s highest coffee-consuming countries, with average annual consumption of approximately 11.8 kilograms (26 pounds) per person. A population with high and widely varying intake offers greater statistical range than one in which most people drink little coffee at all.

What happens next

Researchers say the results offer a starting point for studies designed to determine whether coffee itself produces these biological changes and, if so, which compounds may be responsible. Scientists are currently investigating these questions using animal models, with the longer-term aim of moving towards human intervention studies.

Additional research will be necessary before the findings can be used to shape dietary recommendations. For now, the study contributes a mechanistic hypothesis rather than a change in practice.

The study, “Associations of habitual coffee intake with testosterone and cardiometabolic markers: the Northern Finland Birth Cohort 1966 study,” was published in the European Journal of Nutrition.

CCH insight

Body composition, dietary patterns, and metabolic markers rarely tell a complete story in isolation, and BMI alone can mask clinically important differences. The College of Contemporary Health’s Nutrition & Weight Management Essentials short course helps healthcare professionals interpret these measures together and apply nutritional evidence confidently in patient-facing practice.

Explore Nutrition & Weight Management Essentials → 

Source: University of Oulu, Finland

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Scientists Identify a Possible Biological Link Between Obesity and Alzheimer’s

Key Takeaways: 

• Researchers at Houston Methodist have identified phosphatidylethanolamines (PEs) – a class of fat molecule found in cell membranes – as a possible biological link between obesity and Alzheimer’s disease.
  
• Obesity appears to increase levels of these molecules in body tissue, after which they are packaged into tiny particles that travel to the brain, disrupting communication between brain cells, weakening immune protection and encouraging amyloid proteins to accumulate.
  
• Restoring a healthier balance of PEs reduced disruption in lipid regulation and improved brain function and cognitive performance in models of Alzheimer’s disease, pointing to a possible target for future treatments.
  
  
  

Why researchers are looking beyond the brain

Alzheimer’s disease has long been studied as a condition of the brain itself, defined by the amyloid plaques and tangles found in brain tissue. A growing body of research, however, suggests that the disease may be influenced by biological changes taking place far beyond the skull. Metabolic health – and obesity in particular – is now emerging as a possible contributor to the processes that worsen the disease.

New findings from Houston Methodist add weight to that idea. The study examined how changes in body fat associated with obesity may send damaging signals to the brain, where they appear to interfere with the brain’s immune system and contribute to the biological damage linked to Alzheimer’s disease.

The team behind the study

The research was co-led by Stephen Wong, Ph.D., the John S. Dunn Presidential Distinguished Chair in Biomedical Engineering, and Li Yang, Ph.D., a research associate in the Chao Center for BRAIN at Houston Methodist. The findings were published in the journal Molecular Neurodegeneration.

Fat molecules may connect obesity and Alzheimer’s disease

At the centre of the work is a class of lipid, or fat molecule, called phosphatidylethanolamines, abbreviated to PEs. These molecules are found in cell membranes throughout the body, where they form part of the basic structure of every cell.

According to the study, obesity raises the amount of these molecules in body tissue. The PEs are then loaded into tiny particles that are capable of travelling through the body and reaching the brain – effectively carrying a metabolic signal from fat tissue to the central nervous system.

What happens once these particles reach the brain

Once inside the brain, these particles appear to do three things at once. They can interfere with communication between brain cells, they can weaken immune protection, and they can encourage amyloid proteins to accumulate. Amyloid buildup is one of the major biological features associated with Alzheimer’s disease.

That combination matters, because it suggests obesity is not simply sitting alongside Alzheimer’s risk as a separate problem, but may be actively feeding into the mechanisms that drive the disease.

“Obesity can change how signals travel to the brain,” Wong said. “The good news is that this may be something we can treat. Instead of looking at Alzheimer’s risk tied to obesity as just a metabolic problem, this research suggests we may be able to target the process that connects those changes to the brain.”

Restoring lipid balance improved brain function

The findings also suggest a possible direction for future treatments. When the researchers restored a healthier balance of PEs, they observed less disruption in lipid regulation.

Correcting the imbalance also improved brain function and cognitive performance in models of Alzheimer’s disease. Cognitive performance refers to abilities such as learning, memory, attention and problem solving – the domains most visibly affected as Alzheimer’s progresses.

Taken together, these results suggest that targeting the fat molecules themselves, or the pathway that carries them to the brain, could potentially reduce some of the damage associated with obesity and Alzheimer’s disease.

A growing public health challenge

The stakes are considerable. According to the Centers for Disease Control and Prevention, more than 6.5 million Americans are living with Alzheimer’s disease. That total is expected to rise to nearly 14 million by 2060.

Yang emphasised that a good deal more research will be required before treatments aimed at PEs can be tested as prevention or therapy in people. Even so, the findings introduce a possible strategy for intervening earlier in individuals whose metabolic health may place them at greater risk of Alzheimer’s disease.

What this may mean for practice

For healthcare professionals, work of this kind reinforces a message that has been building across obesity research for some years: excess weight is bound up with a wide range of downstream conditions through complex biological pathways, rather than existing in isolation. Understanding those pathways – and being able to discuss them sensitively with patients – is increasingly part of everyday clinical conversation. CCH’s Obesity Essentials CPD short course is designed with exactly that in mind, introducing the many factors that cause and contribute to obesity alongside the practical skills needed to assess and support people living with overweight and obesity.

It is worth being clear about the limits of the current evidence. The results described here come from laboratory models rather than clinical trials in people, and no PE-targeted treatment is close to being available. What the study offers is a plausible mechanism and a candidate target – both of which are needed before prevention strategies aimed at metabolic risk can be tested properly.

Study collaborators and funding

Other collaborators on the study include Li Yang, Jianting Sheng, Shaohua Qi, Zheng Yin, Michael Chan, Yuliang Cao, Hong Zhao, Zhihao Wan, Bill Chan, Ju Ahn, Xiaohui Yu, Matthew Vasquez and Shan Xu from Houston Methodist; Xianlin Han from the University of Texas, San Antonio; Weiming Xia from Boston University; and Willa Hsueh from Ohio State University.

The study was funded by grants from the Cure Alzheimer’s Fund, the T.T. and W.F. Chao Foundation, and the John S. Dunn Research Foundation.

CCH insight

Research linking obesity to conditions well beyond metabolic health is reshaping how clinicians talk to patients about weight. CCH’s Obesity Essentials online CPD short course gives healthcare professionals the knowledge and confidence to assess and manage overweight and obesity effectively, and to hold those conversations with compassion and clarity. The course takes 8–10 hours, is completed entirely online at your own pace, and carries 10 CPD hours plus a certificate of completion.

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Weight Bias at Work: What New GLP-1 Research Reveals About Women’s Employment Prospects

Key Takeaways: 

• Women who were unemployed when they started GLP-1 medications saw their employment rate rise by nearly 27 percentage points over 18 months, according to a 2026 NBER working paper.
  
• The gains appeared only among women entering the workforce – those already employed saw no rise in pay or promotion, pointing to perception rather than capability.
  
• The findings echo long-standing evidence on the financial cost of weight bias, from documented pay gaps to hiring professionals’ judgements based on photographs alone.
  
  
  

A new way to measure an old problem

For years, economists have documented what they call the “obesity penalty” – the social and financial disadvantages people can face because of their weight. It has been a difficult phenomenon to measure cleanly, because the factors that shape someone’s body weight also tend to shape their income, health and opportunities.

The rapid uptake of GLP-1 medications has given researchers something closer to a natural experiment. When large numbers of people begin treatment within a short window, and others who want the same treatment have not yet been able to start, it becomes possible to compare two otherwise similar groups and observe what changes.

That is the approach taken in a 2026 working paper published by the National Bureau of Economic Research, in which Harvard economist Rebecca Diamond examined what happened to women’s employment after they began taking GLP-1 medications.

What the researchers did

Diamond looked at survey data from around 15,000 people. She compared women who had started taking GLP-1 medications with similar women who wanted to take them but had not yet started. The two groups were matched on factors including income, race, body mass index and overall health, so that the comparison was not simply between people in very different circumstances to begin with.

The design matters. Because the comparison group consisted of women who also wanted the medications, the study is less vulnerable to the criticism that people who seek treatment are systematically different in motivation from those who do not.

The result that stands out

Among women who were unemployed at the point they began treatment, the employment rate rose by nearly 27 percentage points over the following 18 months, compared with the matched group who had not yet started.

To put that figure in context, it is a larger gap than the difference in employment between American women with a high school diploma and those holding a university degree. In other words, an 18-month change in body weight was associated with a bigger shift in employment than several years of formal education.

The research does not suggest that losing weight made these women more intelligent, more capable or better qualified for work. Nothing about their skills, experience or credentials changed. What the study raises is a different and more uncomfortable question: whether a change in appearance alters how women are perceived by employers.

Changes beyond the workplace

The effects were not confined to employment. The study also found that single women taking GLP-1 medications were nearly 29 percentage points more likely to get married or move in with a partner than similar women who had not started treatment.

Taken together, the employment and partnership findings describe something broader than a labour market effect. They describe a shift in social response.

The financial cost of weight bias

GLP-1 medications have moved quickly into the mainstream. In 2026, 11% of US adults said they were currently taking one to lose weight, up from just 3% in 2024, according to Gallup.

But the question of how weight shapes women’s working lives long predates the current wave of prescribing. Research was already pointing in this direction well before GLP-1 medications entered the cultural conversation.

What hiring professionals saw

A report from Fairygodboss, an employer review site for women, offered a particularly troubling look at how appearance can shape hiring decisions. In one study, hiring professionals were shown images of women with different body types and asked to evaluate them.

The woman pictured at the highest body weight was judged far more harshly than the others. Twenty percent of respondents described her as “lazy”, a label applied less frequently to every other woman pictured. Just 18% said she appeared to have leadership potential, while 21% described her as “unprofessional”.

These are judgements made on the basis of a photograph alone, with no information about experience, qualifications or performance.

Earnings gaps documented long before GLP-1 medications arrived

The pay data tells a similar story. In 2011, the Federal Reserve Bank of St Louis cited research finding that white women living with overweight earned about 4.5% less than white women whose BMI fell within what researchers classified as the normal range. White women living with obesity earned nearly 12% less.

Two caveats are important here. Those figures were specific to white women and do not apply to everyone. They also say nothing about anyone’s value, ability or contribution. What they suggest is that weight-related bias was already showing up in some women’s pay long before GLP-1 medications became widely available.

When appearance pays

The argument that appearance carries an economic premium is not new, and it is sometimes made bluntly. Codie Sanchez, CEO and founder of Contrarian Thinking, has said that women who wear makeup to work earn about 30% more on average than women who do not.

“Pretty privilege is very real,” she said on an episode of The Burnouts Podcast. “And you can either say ‘That’s not fair, so I’m not doing it.’ or you can win.”

Sanchez acknowledged that the advantage is unfair, but argued that women should use it rather than ignore it. “If it’s going to make me more money to paint my face, clown me up,” she said.

Diamond’s findings suggest weight bias may operate along similar lines. The women who benefited most were those seeking to enter the workforce, where first impressions carry disproportionate weight and where an employer’s judgement is formed quickly and on limited information. For women already in a job, whose managers had direct evidence of their performance, the effect disappeared.

Why this matters in clinical practice

For healthcare professionals, findings like these complicate the consultation room. People starting GLP-1 medications may be motivated by clinical goals, social goals, economic goals, or some mixture of all three, and those motivations shape expectations, adherence and how someone responds if treatment is paused or stopped.

Understanding the pharmacology well enough to have that conversation credibly is increasingly part of everyday practice rather than a specialist concern. Building that grounding is the focus of professional training such as the College of Contemporary Health’s GLP-1RAs in Focus – Why Drugs Like Ozempic Work, a CPD-accredited online short course covering GLP-1 physiology and pharmacology for prescribers and non-prescribers alike.

An uncomfortable conclusion

Losing weight does not make a person more intelligent, more capable, harder working or better qualified for a job. But it may change how other people perceive them.

That is precisely what makes Diamond’s findings difficult to sit with. If some women gain access to more opportunities after losing weight while their underlying abilities remain exactly the same, then the economic benefit is not really a benefit at all. It is a measure of how heavily appearance still shapes the way women are perceived and treated – and of how much value has been withheld from them beforehand.

The medication changed the response. It did not change the woman.

CCH insight 

Findings like these are a reminder that GLP-1 medications carry social and economic weight as well as clinical effect – and that patients arrive at the consultation with motivations shaped by far more than a treatment target. CCH’s GLP-1RAs in Focus – Why Drugs Like Ozempic Work CPD short course (2 CPD hours, fully online, CPD-accredited) builds the foundation in GLP-1 physiology and pharmacology that healthcare professionals need to explain the science clearly, set realistic expectations and contribute confidently to treatment discussions, whether or not they prescribe. 

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Daily Tomato Intake May Lower Liver Fat in People With MASLD, New Study Suggests

Key Takeaways: 

• In a six-week randomised study of 79 adults with metabolic dysfunction-associated liver disease (MASLD), people who ate 200 grams of raw tomatoes and 50 grams of tomato sauce each day showed a greater reduction in hepatic steatosis than people following a tomato-free control diet.
  
• Liver fat fell in both groups, and researchers found no meaningful differences between the groups in liver stiffness, liver enzymes, lipids or body mass index after the intervention period.
  
• Independent specialists described the findings as exploratory rather than practice-changing, noting the short duration, the narrow participant profile and the absence of improvement in clinically relevant markers.
  
  
  

What the research set out to examine

Metabolic dysfunction-associated liver disease (MASLD) covers a spectrum of liver problems, but its defining feature is hepatic steatosis – the accumulation of fat within the liver. A diagnosis also requires the presence of at least one cardiometabolic risk factor, such as obesity or high blood pressure.

Diet and lifestyle changes are a mainstay of support for people living with MASLD, and researchers are increasingly interested in whether particular foods offer measurable advantages over others. A study published in Nutrients set out to test one such food: the tomato, a staple of the Mediterranean diet.

The research team wanted to establish whether regular tomato consumption would influence liver steatosis in people who already had a MASLD diagnosis.

How the study was designed

The study enrolled 79 adults with MASLD. Researchers applied a number of exclusion criteria, ruling out people who consumed above a set threshold of alcohol and those with a body mass index above 30, the point at which obesity is classified.

Participants were divided into two groups. One group followed a tomato-free control diet. The other consumed 200 grams of raw tomatoes and 50 grams of tomato sauce daily. All tomato products were supplied by the same producer to keep the intervention consistent, and participants were asked to carry on with their usual lifestyle in every other respect.

The intervention ran for six weeks. Across that period, researchers tracked a range of health indicators, including body composition, hepatic steatosis, liver stiffness and cholesterol levels.

What the researchers found

Hepatic steatosis declined in both groups over the six weeks. The decrease was greater, however, among people in the tomato group.

Further analysis showed that hepatic steatosis had been broadly similar between the two groups at baseline, which strengthens the comparison. Other measures told a quieter story. Researchers identified no major changes in liver stiffness, and no significant differences between the groups in lipids, liver enzymes or body mass index at the end of the six-week period.

Summarising the result, the authors suggested that “tomato consumption may reduce hepatic fat accumulation independently of major changes in body weight, total and abdominal adiposity.”

Because liver fat shifted while weight and body composition did not, the study raises a familiar practical question for clinicians: how far can dietary composition alone move metabolic outcomes when overall energy intake stays broadly the same? It is the kind of question CCH explores in its CPD short course Nutrition & Weight Management Essentials, which examines the relationship between modern nutrition and weight, and how evidence-based dietary advice translates into everyday clinical conversations.

Study limitations and continued research

The six-week window is short, so the study cannot speak to whether any benefit persists over the longer term. The research also recruited only adults aged 65 and under, leaving it unclear how the findings might apply to older adults.

Most participants were men, so more balanced recruitment would strengthen future work. The decision to exclude people with a body mass index above 30 also narrows how widely the results can be applied.

Endocrinologist and obesity specialist Randa Abdelmasih MD, DipABOM, from the University of Texas Medical Branch (UTMB), who was not involved in this study, told Medical News Today:

“The study demonstrates a modest reduction in hepatic steatosis over only six weeks in a highly selected population of adults with MASLD and BMI [body mass index] of 30 kg/m² [kilograms per square meter] or more. Most patients we see in clinical practice have obesity (BMI over 30 kg/m²), type 2 diabetes, or more advanced metabolic disease, so the generalizability of these findings is limited.”

Jonathan Jennings, MS, MD, a board-certified internist with Medical Offices of Manhattan, who was likewise not involved in the research, raised a related concern about how participants were selected.

“The inclusion criteria required only one cardiometabolic risk factor, and it could be any risk factor. I am concerned that not all risks are equal, and people with multiple factors are at higher risk than those with a single risk factor,” Jennings said.

“Type 2 diabetes is more likely to lead to MASLD than high blood pressure but the study evaluates them as equal risk factors,” he pointed out.

The researchers themselves note that the reduction in liver fat may have been influenced by other factors, including the effect that taking part in a dietary intervention study can have on participants’ behaviour. The team was also reliant on dietary counselling and on participants’ own reports of how closely they followed the intervention.

Abdelmasih added that because the intervention combined raw tomatoes with tomato sauce, it is “difficult to determine which component or combination was responsible for the observed effect.”

A further gap is that researchers did not measure circulating levels of lycopene and carotenoids, the compounds most often proposed as the mechanism behind any effect tomatoes might have on liver health.

Limited clinical application at this stage

The authors describe their study as exploratory, intended primarily to inform future research. They call for confirmation through larger and longer studies, and encourage readers to treat the findings as hypothesis-generating rather than conclusive.

The clinical value is also uncertain because so much else stayed the same. As Abdelmasih put it:

“The study showed improvement in liver fat but no significant improvements in liver stiffness, fibrosis scores, liver enzymes, insulin resistance, inflammatory markers, lipid profile, or body composition. Therefore, while the imaging findings are interesting, we cannot conclude that tomato consumption meaningfully alters disease progression or improves clinically relevant outcomes.”

What this means for people living with MASLD

Within its limits, the study does point to a possible benefit of tomato consumption for people with MASLD, and to a low-cost dietary strategy that may help with fat accumulation in the liver.

Tomatoes may carry other advantages too, with existing research pointing towards cardiovascular benefits and potential anti-cancer properties.

Even so, the sensible route is for people to work with their doctor and wider healthcare team on a dietary plan that addresses their overall health, rather than concentrating on any single food.

Jennings underlined that point, and flagged two practical cautions:

“The study’s conclusions are hopeful but careful discussion with a healthcare provider is still needed before engaging in any radical dietary adjustments. Tomatoes and tomato-based products may be problematic for individuals with gastroesophageal reflux disease (GERD). Many tomato-based foods are also calorically dense and may worsen insulin resistance in certain individuals.”

The broader treatment context matters as well. According to Abdelmasih: “Dietary interventions should be viewed within the broader context of treating the underlying metabolic disease. For patients with obesity, sustained weight loss of approximately 10% or more remains the intervention with the strongest evidence for improving steatohepatitis and fibrosis.”

“While tomatoes can certainly be part of a healthy Mediterranean diet, they should not distract from therapies that have demonstrated meaningful improvements in liver and cardiometabolic outcomes,” she concluded.

CCH insight

Conversations about diet sit at the centre of metabolic and liver care, and single-food headlines can make those conversations harder rather than easier. CCH’s CPD short course Nutrition & Weight Management Essentials gives healthcare professionals a grounding in the fundamentals of nutrition, the factors driving weight gain, and what effective weight management looks like in practice – so you can place findings like these in proportion for the people you support.

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Expert commentary in this article was provided to Medical News Today. Read the original report here.

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