Obesity Care Tag

Walking 8,500 Steps a Day May Help Prevent Weight Regain, Study Finds

Key Takeaways:

• New research presented at ECO 2026 suggests that walking around 8,500 steps a day may help people maintain weight loss and reduce the risk of weight regain after dieting.
  
• Researchers found that people who increased and sustained their daily step count were more successful at keeping weight off over the long term.
  
• The study highlights walking as a simple, affordable, and accessible strategy that could support long-term obesity management.
  
  
  

Study explores the role of walking in long-term weight management

New research being presented at the European Congress on Obesity (ECO 2026) in Istanbul, Turkey, taking place from May 12–15, suggests that walking approximately 8,500 steps per day could help people avoid regaining weight after dieting.

The findings, which will also be published in the International Journal of Environmental Research and Public Health, address one of the biggest challenges in obesity care – maintaining weight loss over time.

Although many weight loss programmes encourage people to increase their daily physical activity, including walking, researchers say there has been relatively limited evidence examining whether higher step counts genuinely help people lose weight during dieting or maintain that weight loss afterwards.

The new study aimed to clarify whether walking more each day could reduce the likelihood of weight regain and identify what level of daily activity may be most beneficial.

Preventing weight regain remains a major challenge

Professor Marwan El Ghoch, from the Department of Biomedical, Metabolic and Neural Sciences at the University of Modena and Reggio Emilia in Italy, highlighted the importance of addressing weight regain in obesity treatment.

“The most important – and greatest – challenge when treating obesity is preventing weight regain,” explained Professor El Ghoch.

“Around 80% of people with overweight or obesity who initially lose weight tend to put some or all of it back on again within three to five years.

“The identification of a strategy that would solve this problem and help people maintain their new weight would be of huge clinical value.”

Long-term weight maintenance is widely recognised as one of the most difficult aspects of obesity management. While many people can initially lose weight through dietary changes, sustaining those results often proves far more challenging due to complex biological, behavioural, and environmental factors.

Researchers conducted a large systematic review and meta-analysis

To explore the relationship between walking and long-term weight management, Professor El Ghoch and colleagues from Italy and Lebanon carried out a systematic review and meta-analysis of existing research.

The researchers analysed 18 randomised controlled trials investigating walking and weight management strategies. Fourteen of those studies, involving a total of 3,758 adults, were included in the final meta-analysis.

Participants had an average age of 53 years and an average body mass index (BMI) of 31 kg/m², placing the average participant in the obesity category. The studies included participants from a range of countries, including the United Kingdom, United States, Australia, and Japan.

The trials compared two groups:

• 1,987 participants enrolled in lifestyle modification (LSM) programmes
• 1,771 participants assigned to control groups

The control groups either followed dieting programmes without additional support or received no treatment intervention.

Lifestyle programmes combined diet and increased walking

The lifestyle modification programmes combined dietary guidance with recommendations to increase walking and monitor daily step counts.

These interventions generally included two distinct phases:

1. An initial weight loss phase
2. A longer-term maintenance phase designed to help participants sustain weight loss

Researchers assessed participants’ daily step counts at multiple time points throughout the studies, including:

• At baseline
• After the weight loss phase
• After the maintenance phase

The average duration of the weight loss phase was 7.9 months, while the maintenance phase lasted an average of 10.3 months.

At the start of the studies, physical activity levels were similar in both groups. Participants in the lifestyle modification programmes averaged 7,280 steps per day, while participants in the control groups averaged 7,180 daily steps.

Higher step counts were associated with less weight regain

The researchers found that participants in the control groups did not significantly increase their daily walking levels and did not experience meaningful weight loss during the studies.

In contrast, participants enrolled in the lifestyle modification programmes increased their average daily step count to 8,454 steps by the end of the weight loss phase.

During this period, participants lost an average of 4.39% of their body weight, equivalent to approximately 4 kg.

Importantly, participants were largely able to maintain their higher levels of daily activity throughout the maintenance phase. By the end of the studies, they were still averaging 8,241 steps per day.

They also maintained most of their weight loss over the longer term, with an average sustained weight reduction of 3.28%, or roughly 3 kg.

Further analysis demonstrated a clear association between higher daily step counts and lower levels of weight regain.

Researchers found that people who increased their walking during the weight loss phase and sustained those higher activity levels afterwards were more successful at maintaining weight loss over time.

Walking appeared more important for weight maintenance than initial weight loss

Interestingly, the study found that walking more was not associated with greater weight loss during the initial dieting period itself.

Researchers suggested this may be because calorie reduction and dietary changes tend to have a stronger influence on short-term weight loss than physical activity alone.

However, physical activity appeared to play a more significant role in helping people sustain weight loss once it had been achieved.

This distinction is important because many obesity interventions focus heavily on initial weight reduction, despite evidence showing that long-term maintenance is often the more difficult challenge.

A simple and affordable intervention

Professor El Ghoch said the findings demonstrate that lifestyle modification programmes incorporating walking can support clinically meaningful long-term weight management.

He added:

“Participants should be always encouraged to increase their step count to approximately 8,500 a day during the weight loss phase and sustain this level of physical activity during the maintenance phase to help prevent them from regaining weight.

“Increasing the number of steps walked to 8,500 each day is a simple and affordable strategy to prevent weight regain.”

The researchers suggest that walking may represent a practical and accessible intervention that could be incorporated into obesity treatment programmes without the need for expensive equipment or specialist facilities.

As obesity rates continue to rise globally, strategies that are sustainable, low-cost, and easy to implement may become increasingly important in supporting long-term health outcomes.

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Obesity Identified as Key Driver of Rising Cancer Rates in Younger Adults

Key Takeaways: 

• A major new study has found that overweight and obesity are likely to be significant contributors to rising cancer rates among younger adults in England.
  
• Researchers found that many traditional behavioural cancer risk factors – including smoking, alcohol consumption and physical inactivity – have remained stable or improved over the past two decades, making them unlikely to fully explain the increase in early-onset cancers.
  
• Although excess weight appears to play an important role, researchers say it cannot entirely account for the rise in cancers such as bowel cancer, suggesting that additional biological, environmental and early-life factors may also be involved.
  
  
  

Study highlights growing concern over early-onset cancer

Being overweight or living with obesity may be a key driver behind rising cancer rates in younger adults in England, according to a major new study led by researchers at The Institute of Cancer Research, London, and Imperial College London.

The analysis, published in BMJ Oncology, examined trends in cancer incidence alongside changes in known behavioural cancer risk factors over nearly two decades. Researchers found that while rates of several cancers among younger adults have continued to increase, many established lifestyle-related risk factors have either improved or remained stable during the same period.

These findings led researchers to conclude that obesity is likely to be one of the most important contributors to the increase in cancer incidence among younger generations in England.

At the same time, the researchers stressed that rising body mass index (BMI) alone does not fully explain the growing number of cancer cases, indicating that additional factors may also be contributing to the trend.

Researchers analysed cancer trends across England

The research team used national cancer registry data from England covering the years 2001 to 2019. The study was conducted by scientists from the Cancer Epidemiology and Prevention Research Unit (CEPRU) at both The Institute of Cancer Research (ICR) and Imperial College London.

Researchers examined incidence trends across:

• 22 cancer types in women
• 21 cancer types in men

From this analysis, they identified 11 cancers that are increasing among adults aged between 20 and 49 years and are associated with known behavioural risk factors.

All of the cancers identified – except oral cancer – are recognised as being linked to excess weight.

For most cancer types, increases seen in younger adults mirrored trends observed in adults aged over 50, where the overall disease burden remains considerably higher. However, bowel cancer and ovarian cancer stood out as notable exceptions because rates were increasing only among younger age groups.

Most traditional risk factors have improved

The study examined trends in several well-established behavioural cancer risk factors, including:

• Smoking
• Alcohol use
• Overweight and obesity
• Physical inactivity
• Red and processed meat consumption
• Low fibre intake

Together, these risk factors accounted for an estimated 40–50 per cent of bowel, endometrial, oral and liver cancer cases in 2019.

However, researchers found that trends for most of these risk factors have either remained stable or improved over time, making them unlikely to substantially explain the recent rise in cancer incidence among younger adults.

According to the analysis:

• Smoking among younger adults has fallen by approximately two per cent annually over the past two decades.
• Alcohol consumption has largely stabilised or declined.
• Physical inactivity has decreased.
• Consumption of red and processed meat has reduced.
• Fibre intake, while still below recommended levels, has gradually improved.

In contrast, rates of overweight and obesity have steadily increased since 1995.

The largest increases in obesity were observed among younger women, where obesity prevalence rose by approximately 2.6 per cent relative increase per year.

Obesity linked to rising bowel cancer rates

The researchers found evidence linking rising BMI to increasing bowel cancer rates among younger adults.

Among younger women, bowel cancer rates associated with BMI rose from 0.9 to 1.6 cases per 100,000 people. In comparison, bowel cancer rates not attributable to BMI increased from 6.4 to 9.6 cases per 100,000 people.

Similar patterns were also observed in men.

However, the authors emphasised that the total number of BMI-linked bowel cancer cases remained lower than the number of cases not linked to BMI. This suggests that although obesity is an important contributor, it cannot fully explain the scale of the increase in bowel cancer among younger adults.

Additional causes may be contributing

The study points to the likelihood that multiple interacting factors are contributing to rising cancer rates in younger generations.

Several suspected contributors have previously been proposed, including:

• Ultra-processed foods
• Antibiotic use
• Air pollution

However, researchers noted that many of these exposures have also shown relatively stable or declining trends in the UK, complicating efforts to identify the main drivers of early-onset cancers.

The authors also highlighted emerging evidence suggesting that obesity-related mechanisms not fully captured by BMI may influence cancer risk. These include:

• Metabolic dysfunction
• Chronic inflammation
• Alterations in the gut microbiome

Further research is needed to determine whether these mechanisms directly contribute to the development of bowel cancer and other cancers in younger adults.

Experts say more research is urgently needed

The researchers called for large-scale, long-term studies capable of tracking exposures across the entire life course in order to better understand what is driving rising rates of early-onset cancers.

Professor Marc Gunter, Co-Director of the Cancer Epidemiology and Prevention Research Unit at Imperial College London, said:

“The changes we’re seeing in cancer incidence, particularly the rates of some cancers in younger adults, don’t have a single cause or a simple answer. They reflect a complex mix of generational effects, gaps in long-term exposure data, and shifts in diagnosis and detection, and show how much more scientists still need to understand about when and how cancer develops across the life course. While rising rates in younger adults are concerning, it remains crucial not to lose sight of cancer trends in older adults, where the absolute burden of disease is still far greater.”

Professor Montserrat García-Closas, Co-Director of the Cancer Epidemiology and Prevention Research Unit and Group Leader in Integrative Cancer Epidemiology at The Institute of Cancer Research, London, said the findings indicate that behavioural changes alone cannot explain current trends.

She said:

“Our findings show that while cancer rates are rising in younger adults, the trends are unlikely to be explained by changes in most known behavioural risk factors. Smoking, alcohol and other behaviours have been stable or improving for two decades, yet early-onset cancers continue to increase – particularly bowel cancer.

“Excess weight is an important contributor, although it cannot fully account for the scale of the rise in bowel and other cancers. This tells us that multiple factors – including early-life exposures – may be acting together. Understanding these patterns is essential for identifying what is truly driving cancer risk in today’s generations. We now need deeper research, better measurement and continued surveillance to uncover the causes behind these worrying trends.

“However, we cannot wait to act. Tackling obesity across all ages, particularly in children and young people, through stronger public health policies and wider access to effective interventions, could slow the rise in cancer and prevent many cancers – and must become a national priority.”

Calls for stronger prevention and public health action

The findings have prompted renewed calls for stronger public health measures aimed at preventing obesity and improving cancer prevention strategies across all age groups.

Professor Kristian Helin, CEO of The Institute of Cancer Research, London, said the study highlights an urgent public health challenge requiring coordinated action across research, prevention and policy.

He said:

“This work highlights a growing public health challenge and the need for urgent action across research, prevention and policy. Although rising cancer rates in younger adults are concerning, the burden remains overwhelmingly higher in older people, which means prevention efforts must span all ages.

“This study makes clear that traditional lifestyle risks alone cannot explain current trends – pointing to the importance of investigating other exposures such as the potential role of the microbiome, while strengthening strategies to address obesity and other established risks. To protect future generations, we must invest in understanding the causes of cancer at all ages and ensure that early diagnosis, screening and prevention strategies keep pace with a changing population.”

CCH insights:

The outcomes of this study are concerning but not entirely surprising, given that obesity rates in children and young people are still rising and obesity is a significant risk factor for many cancers. It adds further support for the call to treat obesity at the earliest opportunity, regardless of the age of the individual. The longer obesity goes untreated the greater the risk of individuals developing serious chronic diseases such as cancer, type 2 diabetes and heart disease.

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People Judge Weight Loss More Harshly When GLP-1 Drugs Are Used, Study Finds

Key Takeaways:

• People using GLP-1 and other anti-obesity medications were consistently judged more negatively than those losing weight through diet and exercise alone.
  
• Researchers found that anti-obesity medication users were perceived as putting in less effort and were therefore viewed as less moral, competent, warm, and deserving of their success.
  
• The findings suggest that stigma surrounding obesity treatment may discourage people from seeking effective medical care and reinforce harmful misconceptions about obesity and weight loss.
  
  
  

Study explores social attitudes toward weight loss medication

A recent study published in Scientific Reports has found that people who lose weight using anti-obesity medications (AOMs), including glucagon-like peptide-1 (GLP-1) receptor agonists, are often judged more harshly than those who lose weight through diet and exercise alone.

The research examined how the use of anti-obesity medication influences perceptions of effort, morality, competence, warmth, and deservingness. The findings suggest that social attitudes toward obesity treatment remain strongly shaped by beliefs about personal effort and self-control.

With more than one billion people worldwide living with obesity, the researchers noted that how a person loses weight can significantly influence how others perceive them. Although GLP-1 receptor agonists and other anti-obesity medications have demonstrated substantial effectiveness in treating obesity, they are frequently criticised as an “easy way out.”

According to the researchers, this perception reflects a broader psychological phenomenon known as effort moralization – the tendency to associate greater effort with greater moral worth.

The authors explained that such beliefs may reinforce obesity stigma, discourage people from seeking treatment, and negatively affect both physical and mental health outcomes.

While anti-obesity medications can provide important medical support for people living with persistent obesity, the researchers stressed that understanding the social impact of these perceptions is necessary if the full potential of these treatments is to be realised.

Four studies conducted across three countries

The research involved four pre-registered experimental studies conducted between November 2024 and February 2025 in Belgium, the United States, and the United Kingdom.

In total, 1,205 participants took part in the research. Participants were recruited online through university participant pools and the Prolific platform. Researchers applied several quality-control measures, excluding incomplete responses, failed attention checks, overly rapid responses, and participants with insufficient language proficiency.

Across the studies, participants were presented with descriptions of two individuals who shared identical weight-loss goals and similar experiences with diet and exercise. The only difference between the individuals was that one used an anti-obesity medication while the other did not.

Participants then rated both individuals using Likert-type scales assessing:

• Perceived effort
• Moral character
• Warmth
• Competence
• Deservingness of weight-loss success
• Willingness to cooperate with them in future scenarios

The researchers also explored several additional variables across the studies, including:

• General attitudes toward anti-obesity medication
• Personal or social experience with weight-loss medication
• Beliefs that anti-obesity medication represents a “shortcut”
• Personality traits measured using the Big Five Inventory (BFI)

To analyse the data, the researchers used t-tests, correlations, multilevel modelling, and evidence synthesis techniques.

Anti-obesity medication users viewed more negatively

Across all four studies, the findings revealed a consistent pattern of negative social judgement toward individuals using anti-obesity medication.

Compared with people relying solely on diet and exercise, anti-obesity medication users were perceived as putting in less effort into achieving their weight-loss goals.

This perception of lower effort was strongly linked to harsher moral evaluations. Participants consistently rated anti-obesity medication users as less moral than non-users.

In Study 1, for example, significantly lower perceived effort ratings for anti-obesity medication users were accompanied by similarly large reductions in moral character ratings.

The bias extended beyond morality alone.

Participants also viewed anti-obesity medication users as:

• Less competent
• Less warm
• Less deserving of their success

In addition, participants reported lower anticipated satisfaction with future cooperation involving anti-obesity medication users in a hypothetical training-partner scenario.

According to the paper’s evidence synthesis, most of these effects were large, although the effect relating to warmth was more moderate.

Perceived effort was closely tied to moral judgement

One of the most significant findings was the strong relationship between perceived effort and moral judgement.

Across all four studies, larger differences in perceived effort between medication users and non-users were associated with larger differences in moral evaluations.

The researchers concluded that perceptions of effort appear to play a major role in shaping broader social judgement.

The findings support the idea that many people continue to associate moral worth with visible personal struggle and self-discipline, particularly in relation to body weight and weight loss.

“Shortcut” beliefs intensified negative bias

The study also examined factors that influenced the strength of these perceptions.

Participants who held more positive views toward anti-obesity medications, or who had prior personal or social experience with such treatments, tended to judge medication users less harshly.

In contrast, stronger beliefs that anti-obesity medication represents a “shortcut” to weight loss were associated with more negative moral judgements.

In some analyses, these shortcut beliefs also amplified the relationship between perceived effort and bias.

The researchers found that personality traits such as conscientiousness and extraversion had little overall effect on participants’ judgements. This suggests that the bias is driven more by beliefs about effort and treatment legitimacy than by broader personality characteristics.

One exploratory analysis identified a small association with neuroticism, although this effect was limited.

Meta-analytic evidence synthesis across the studies confirmed that most effects were large, particularly for:

• Perceived effort
• Moral judgement
• Competence
• Cooperation satisfaction
• Deservingness

Effects relating to warmth were moderate by comparison.

Findings highlight social challenges surrounding obesity treatment

The researchers concluded that using anti-obesity medication is not simply a medical decision, but also a social one that may expose individuals to stigma and negative judgement.

According to the findings, people using anti-obesity medications are frequently perceived as putting in less effort and are therefore judged as less moral, less competent, and less deserving of success.

Although the studies were based on vignette scenarios rather than real-world interactions, the researchers stated that the findings point toward a widespread bias rooted in effort moralization.

They suggested that these attitudes could influence interpersonal relationships, healthcare experiences, and broader public perceptions of obesity treatment.

The authors argued that addressing these misconceptions is important for improving healthcare quality and reducing obesity-related stigma.

They also suggested that public education and changes in the way weight loss is discussed may help shift attention away from perceived effort and toward health outcomes and overall well-being.

CCH insights:

Unfortunately, this shows that there is still a very poor understanding of obesity amongst the general public, which means that biased, negative attitudes towards people with excess weight persist. Instead of being seen as medical tools to treat a complex chronic condition, GLP-1 medications are seen by many as short-cut for weight loss cheats. Current evidence suggests these attitudes are common even within the health professions. To improve the quality of obesity care, and to encourage those who need help to seek it, these misconceptions must be addressed.

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Carbohydrate-Rich Diets May Promote Weight Gain Even Without Higher Calorie Intake

Key Takeaways: 

• A new mouse study found that carbohydrate-rich foods such as bread, wheat flour, and rice flour promoted weight gain and fat accumulation even when total calorie intake did not significantly increase.
  
• Researchers observed that the weight gain appeared to be linked more closely to reduced energy expenditure and metabolic changes than to overeating.
  
• Scientists say future human studies will explore how factors such as whole grains, fibre content, food processing, meal timing, and combinations with protein and fat influence metabolic responses to carbohydrates.
  
  
  

Bread and carbohydrates under renewed scrutiny

Bread has served as a central part of human diets for centuries and remains a staple food in many cultures around the world. Foods such as bread, rice, noodles, and other carbohydrate-rich staples continue to form the foundation of everyday meals for billions of people.

However, as rates of overweight and obesity continue to increase globally, researchers are re-examining how modern dietary patterns may influence body weight and metabolic health. While high-fat diets have traditionally received much of the attention in obesity research, scientists are now taking a closer look at the role carbohydrates may play in weight regulation.

A new study led by researchers at Osaka Metropolitan University suggests that certain carbohydrate-heavy eating patterns may contribute to weight gain in ways that are not solely explained by consuming more calories.

The findings were published in Molecular Nutrition & Food Research. 

Obesity research has traditionally focused on fat intake

Obesity is associated with a broad range of chronic conditions and lifestyle-related diseases, including type 2 diabetes, cardiovascular disease, and metabolic dysfunction. Because of this, understanding the drivers of weight gain has become an increasingly important area of scientific research.

Historically, many obesity studies have focused primarily on dietary fat as the main contributor to excess weight gain. This is reflected in the widespread use of high-fat diets in animal research investigating obesity and metabolism.

At the same time, carbohydrate-rich foods remain deeply embedded in daily diets across the world. Despite their prominence, the metabolic effects of staple carbohydrates such as bread, rice, and noodles have not always been explored in the same depth.

Public perceptions around carbohydrates also remain widespread. Beliefs such as “bread makes you gain weight” or “carbohydrates should be restricted” are common, yet researchers say it has remained unclear whether such effects are driven by the foods themselves, overall dietary habits, eating behaviour, or broader metabolic responses.

Researchers investigated how carbohydrate-rich foods affect metabolism

To better understand the relationship between carbohydrates and weight gain, researchers led by Professor Shigenobu Matsumura at Osaka Metropolitan University’s Graduate School of Human Life and Ecology conducted a series of experiments in mice.

The study examined whether mice would preferentially select carbohydrate-rich foods over standard laboratory chow and how those dietary choices would affect body weight, metabolism, and energy expenditure.

The mice were separated into several dietary groups, including:

• Chow
• Chow + Bread
• Chow + Wheat Flour
• Chow + Rice Flour
• High-fat diet (HFD) + Chow
• High-fat diet (HFD) + Wheat Flour

Researchers monitored multiple metabolic indicators throughout the study, including:

• Body weight
• Fat mass
• Energy expenditure
• Blood metabolites
• Liver gene activity
  
  
  

Mice preferred carbohydrate-rich foods

The researchers found that mice consistently showed a strong preference for carbohydrate-rich foods. Animals given access to bread, wheat flour, or rice flour largely abandoned their standard chow diet in favour of these carbohydrate sources.

Importantly, the researchers reported that overall calorie intake did not increase substantially despite this dietary shift. Nevertheless, mice consuming the carbohydrate-rich diets still experienced increases in body weight and fat mass.

Rice flour produced similar effects to wheat flour, suggesting the observed metabolic changes were not specific to wheat itself.

Interestingly, mice in the High-fat diet (HFD) + Wheat flour group gained less weight than those in the High-fat diet (HFD) + Chow group, indicating that the interaction between fat and carbohydrate intake may be more complex than previously assumed.

“These findings suggest that weight gain may not be due to wheat-specific effects, but rather to a strong preference for carbohydrates and the associated metabolic changes,” said Professor Matsumura.

Reduced energy expenditure appeared to play a key role

To investigate why the mice gained weight without substantially increasing calorie intake, the researchers carried out further metabolic analysis using indirect calorimetry and respiratory gas measurements.

The findings suggested that the weight gain was not primarily caused by overeating. Instead, the animals appeared to experience reduced energy expenditure, meaning they were burning fewer calories.

Researchers also identified several metabolic changes in the mice consuming the carbohydrate-rich diets.

Blood analysis showed:

• Increased fatty acid levels
• Reduced levels of essential amino acids

Meanwhile, examination of the liver revealed:

• Greater fat accumulation
• Increased activity of genes involved in fatty acid synthesis
• Increased activity of genes associated with lipid transport

Together, these findings suggest that carbohydrate-heavy dietary patterns may alter how the body processes and stores energy.

Metabolic changes improved when carbohydrates were reduced

The researchers also observed that removing wheat flour from the diet rapidly improved both body weight and several metabolic abnormalities.

According to the authors, this finding suggests that moving away from a highly carbohydrate-focused dietary pattern and towards a more balanced eating pattern may help improve metabolic regulation.

However, the researchers emphasised that additional work is needed to determine how these findings translate to human diets and real-world eating behaviour.

Future studies will explore human dietary patterns

The research team says the next phase of investigation will focus on understanding whether similar metabolic effects occur in people.

“Going forward, we plan to shift our research focus to humans to verify the extent to which the metabolic changes identified in this study apply to actual dietary habits,” stated Professor Matsumura.

“We also intend to investigate how factors such as whole grains, unrefined grains, and foods rich in dietary fiber, as well as their combinations with proteins and fats, food processing methods, and timing of consumption, affect metabolic responses to carbohydrate intake. In the future, we hope this will serve as a scientific foundation for achieving a balance between ‘taste’ and ‘health’ in the fields of nutritional guidance, food education, and food development.”

The researchers noted that future studies examining food quality, fibre content, food combinations, and meal timing may help provide a more nuanced understanding of how carbohydrates influence metabolism and body weight.

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Adding Weekly GLP-1 to CBT Further Reduces Heavy Drinking

Key Takeaways:

• A new randomised controlled trial found that weekly semaglutide injections combined with cognitive behavioural therapy significantly reduced heavy drinking days in people living with obesity and alcohol use disorder.
  
• Participants receiving semaglutide experienced a 41.1% reduction in heavy drinking days, which was notably greater than the reduction seen in the placebo group.
  
• Researchers say the findings add to growing evidence that GLP-1 receptor agonists may have therapeutic potential beyond weight management, including in the treatment of substance use disorders.
  
  
  

Study suggests GLP-1 therapy may help address alcohol use disorder

A team of researchers from the National Institutes of Health (NIH), Copenhagen University Hospital, and international collaborators has reported the first evidence from a randomised controlled clinical trial showing that a GLP-1 receptor agonist may help reduce heavy drinking in people living with both obesity and alcohol use disorder.

The findings, led by researchers at Copenhagen University Hospital, contribute to a growing body of research suggesting that GLP-1 receptor agonists such as semaglutide may have applications beyond obesity and type 2 diabetes treatment, including potential use in substance use disorders.

Alcohol use disorder remains significantly undertreated worldwide, despite its substantial impact on physical health, mental health, and mortality. Current pharmacological treatment options are limited and often underused in clinical practice.

“Very few medications are currently approved for alcohol use disorder, and these are vastly underutilized. A new option that is more accessible and more effective could be a gamechanger for closing the treatment gap,” said Director of NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA) George Koob, Ph.D., a study co-author.

Increasing interest in GLP-1s for addiction and substance use disorders

In recent years, researchers have become increasingly interested in the possible role of GLP-1 receptor agonists in addiction medicine.

GLP-1 drugs were originally developed for type 2 diabetes and later became widely used for obesity management due to their effects on appetite regulation, satiety, and weight reduction. However, emerging research has suggested these medications may also influence the brain’s reward pathways and reduce cravings or compulsive behaviours associated with substance use disorders.

Previous studies examining GLP-1 therapies in alcohol use disorder have produced mixed findings. One recent clinical trial found that a GLP-1 receptor agonist did not significantly reduce heavy drinking across the entire study population. However, researchers observed that participants living with obesity appeared to respond particularly well.

The latest study was designed specifically to investigate this subgroup.

Trial focused on people living with both obesity and alcohol use disorder

The research team enrolled 108 treatment-seeking adults living with alcohol use disorder and comorbid obesity.

All participants received standard cognitive behavioural therapy (CBT), which is a commonly used psychological treatment for alcohol use disorder that aims to help people identify and modify harmful thought patterns and behaviours associated with drinking.

Participants were then randomly assigned to receive either:

• Weekly semaglutide injections
• A placebo injection

The intervention lasted for 26 weeks.

Throughout the study period, researchers collected self-reported alcohol consumption data and monitored several quantitative biomarkers associated with alcohol use. These biological measurements were used to support and validate the participants’ reported drinking behaviour.

Semaglutide group experienced larger reduction in heavy drinking

At the end of the study, the researchers found that participants receiving semaglutide experienced a substantial decline in heavy drinking days.

According to the findings:

• The semaglutide group showed a 41.1% reduction in heavy drinking days
• This represented a 13.7% greater reduction compared with the placebo group

Importantly, biomarker data measuring alcohol exposure supported the self-reported reductions in drinking behaviour, strengthening confidence in the results.

Researchers also observed improvements in several cardiometabolic measures among participants receiving semaglutide. As expected based on previous obesity trials, reductions in body weight and blood pressure were more pronounced in the GLP-1 treatment group.

Researchers note mild and temporary side effects

The study authors reported that semaglutide was generally well tolerated.

Some participants experienced adverse effects, primarily gastrointestinal symptoms, which are commonly associated with GLP-1 receptor agonists. However, the researchers noted that these symptoms were generally mild and transient.

No unexpected safety concerns were highlighted in the report.

Potential clinical impact compared with existing medications

The investigators also evaluated the treatment’s number needed to treat (NNT), a standard clinical metric used to estimate how many people need to receive a treatment for one person to benefit.

In this study, semaglutide achieved an NNT of 4.3.

The researchers noted that currently approved medications for alcohol use disorder typically have an NNT of 7 or higher, suggesting semaglutide may potentially produce clinically meaningful benefits more frequently than existing therapies.

While the authors stressed that further research is needed before definitive conclusions can be drawn, the findings are likely to increase interest in GLP-1 therapies as a possible future treatment option for alcohol use disorder.

“We’re beginning to see some of that potential for GLP-1s to treat drug addiction turn into reality. Questions remain but this is nonetheless very encouraging,” said Director of NIH’s National Institute on Drug Abuse (NIDA) and study co-author Nora Volkow, M.D.

Larger and longer studies still needed

Despite the encouraging findings, the researchers emphasised that additional studies will be necessary to confirm the results.

Future research will need to assess:

• Whether the effects persist over longer periods
• How GLP-1 therapies perform in larger and more diverse populations
• Which patient groups are most likely to benefit
• Whether similar effects are seen in people without obesity

The authors stated that they hope to examine the effects of GLP-1 receptor agonists over a longer duration and in larger study populations in future investigations.

The scientific team was led by first author Mette Kruse Klausen, M.D., and corresponding author Anders Fink-Jensen, D.M.Sc., at Copenhagen University Hospital.

CCH insights:

These results are very promising, suggesting GLP-1 medications offer an effective treatment option for some people with obesity and alcohol use disorder (AUD). However, these patients would need careful monitoring in terms of diet and nutrition. People with AUD are susceptible to nutrient deficiencies because they get most of their calories from alcoholic drinks. If they eat less than usual due to appetite suppression induced by GLP-1 therapy, there is a risk of exacerbating these deficiencies. 

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Obesity Leaves a Lasting Imprint on the Immune System, Study Finds

Key Takeaways: 

• Immune cells in people living with obesity can retain a long-term “memory” of excess weight through epigenetic changes
  
• This “obesity memory” may persist for 5–10 years after weight loss and could prolong disease risk
  
• Sustained weight management may gradually reverse these effects, with potential for targeted therapies to accelerate the process
  
  
  

A long-term immune memory of obesity

People living with obesity may carry a lasting biological imprint of excess weight within their immune system, even after successful weight loss. A 10-year study published in EMBO Reports suggests that key immune cells retain a “memory” of obesity, potentially extending the risk of related health conditions for years.

The research, led by Professor Claudio Mauro at the University of Birmingham and supported by the National Institute for Health and Care Research Biomedical Research Centre in Birmingham, focused on helper T cells, also known as CD4+ lymphocytes. These cells play a central role in coordinating immune responses.

The findings indicate that these immune cells undergo lasting changes that continue to influence how the body regulates inflammation and maintains immune balance long after weight has been reduced.

DNA methylation and the “tagging” process

At the centre of this phenomenon is DNA methylation, a biological process in which chemical markers attach to DNA and alter gene activity without changing the underlying genetic code.

In people living with obesity, this “tagging” process appears to leave a durable imprint on helper T cells. These markers can persist for an extended period, with the study suggesting a timeframe of approximately 5–10 years after weight loss.

This sustained epigenetic modification may disrupt normal immune functions, including the removal of cellular waste and the regulation of immune ageing.

As a result, even individuals who return to a clinically healthy weight may continue to experience altered immune function for several years.

Implications for long-term disease risk

The persistence of this immune “memory” may help explain why the risk of certain conditions associated with obesity does not immediately resolve following weight loss.

Professor Claudio Mauro, co-lead author of the study, explained:
“The findings suggest that short-term weight loss may not immediately reduce the risk of some disease conditions associated with obesity, including type 2 diabetes and some cancers.”

He added:
“Instead, ongoing weight management following loss will see the ‘obesity memory’ slowly fade. This may take several years of sustained weight loss maintenance, likely 5–10 years, though this requires further study, to fully reverse the effects of obesity on T cells.”

The study highlights that long-term weight maintenance, rather than short-term weight loss alone, may be critical for reducing risk over time.

Study design and participant groups

To build a comprehensive understanding of how obesity affects immune cells, researchers analysed samples from multiple human cohorts and experimental models.

These included:

• Blood samples from people living with obesity who received weight loss injections
• Individuals with Alström Syndrome, a rare genetic condition characterised by early-onset childhood obesity, alongside matched healthy controls
• Participants undergoing a 10-week exercise intervention, with blood and fat tissue collected
• People with either a healthy weight or obesity undergoing hip or knee replacement surgery due to osteoarthritis

In addition, the team examined:

• Mouse models fed a high-fat diet
• Blood samples from healthy human volunteers

These diverse data sources enabled researchers to investigate both real-world and mechanistic aspects of immune dysregulation in obesity.

Disrupted cellular processes: autophagy and immune ageing

The study identified two key biological pathways affected by obesity-related DNA tagging:

Autophagy

Autophagy is a cellular “clean-up” process in which cells break down and recycle damaged components. The obesity-related epigenetic changes appear to impair this process, potentially leading to an accumulation of cellular waste.

Immune senescence

Immune senescence refers to the ageing of the immune system. The research suggests that obesity-associated changes may accelerate or dysregulate this process, altering how immune cells respond over time.

Together, these disruptions may contribute to prolonged inflammation and impaired immune function.

Potential for targeted therapies

Beyond identifying the problem, the research also points towards potential therapeutic strategies.

Professor Mauro noted:
“Additionally, our study suggests potential therapeutic opportunities to expedite this process, such as repurposing drugs like SGLT2 inhibitors, which have shown promise in reducing inflammation and promoting immune-mediated clearance of senescent cells in obesity.”

Such approaches could complement existing weight loss interventions by addressing the underlying immune alterations that persist after weight reduction.

A molecular record of metabolic history

Dr Belinda Nedjai, senior author from the Wolfson Institute of Population Health at Queen Mary University London, emphasised the broader significance of the findings:
“Our findings show that obesity is associated with durable epigenetic modifications that influence immune cell behaviour. This suggests that the immune system retains a molecular record of past metabolic exposures, which may have implications for long-term disease risk and recovery.”

This concept of a “molecular record” reinforces the idea that the body’s response to obesity is not easily reversed, even when weight is reduced.

Understanding obesity as a chronic disease

Professor Andy Hogan of Maynooth University highlighted how these findings align with the understanding of obesity as a chronic condition:
“We know obesity is a chronic progressive and relapsing disease and our findings provide further understanding of exactly what are the molecular mechanisms potentially driving the risk of relapsing and highlight the challenges facing people living with obesity to successfully manage their weight.”

The research underscores the biological complexity of obesity and the challenges individuals face in achieving and maintaining long-term health improvements.

Looking ahead

Delivered through the NIHR Biomedical Research Centre in Birmingham, this study contributes to a growing body of evidence that obesity leaves lasting effects on the body at a molecular level.

Future research will aim to refine understanding of how these epigenetic changes can be reversed and how targeted treatments might accelerate recovery of normal immune function.

In the meantime, the findings highlight the importance of sustained weight management and long-term support for people living with obesity, rather than a sole focus on short-term weight loss.

CCH insights:

This study provides further support for the characterisation of obesity as a chronic relapsing disease. Clinically significant weight loss is just the first step in obesity treatment – the challenge is to then maintain the weight loss so that health improvements are sustained, despite the biological memory of obesity promoting weight regain. Whether this memory reduces over time will have major implications for long-term obesity care in the future.

Source: University of Birmingham

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Remote Culinary Coaching Shows Sustained Weight Loss Benefits in Adults with Overweight and Obesity

Key Takeaways:

• A fully remote culinary medicine programme combining cooking and health coaching led to sustained weight loss over 12 months
  
• Participants experienced significant fat mass reduction without loss of lean body mass
  
• Improvements in diet quality, calorie intake, and cooking confidence were observed alongside weight changes
  
  
  

Study overview

A recent randomised controlled trial has found that a fully remote culinary medicine intervention can support meaningful and sustained weight loss in people living with overweight and stage I obesity. The programme combined practical cooking education with health coaching, offering a patient-centred approach to improving dietary behaviours and long-term health outcomes.

Conducted across two hospitals between May 2019 and September 2022, the study examined the one-year impact of this combined intervention on weight, body composition, and dietary habits.

Methodology

Participant characteristics

The study included 50 adults with overweight or stage I obesity. Participants had a mean age of 47.5 years, and 70% were female. The average body mass index was 30.7, with a mean total fat mass of 40.37%. All participants reported cooking fewer than five meals at home per week at baseline.

Intervention design

All participants initially received two nutrition education sessions focused on the Mediterranean diet. Following this, they were randomly assigned to one of two groups:

• Intervention group: Participants took part in a structured culinary coaching programme consisting of 12 weekly one-to-one tele-sessions, each lasting 30 minutes. These sessions integrated culinary skills training with health coaching principles and provided access to culinary medicine resources.
• Control group: Participants were given access to the same culinary medicine resources but did not receive coaching sessions
  
  
  

Outcome measures

Researchers assessed a range of clinical and behavioural outcomes at baseline, and again at 3, 6, and 12 months within a hospital clinical research setting:

• Body weight and height were measured by a registered dietitian
• Body composition was analysed using dual-energy X-ray absorptiometry (DEXA)
• Dietary intake was calculated using 4-day food records reviewed by a registered dietitian
• Diet quality was evaluated using a 14-item Mediterranean diet assessment tool
• Culinary attitudes and self-efficacy were measured using a validated questionnaire

The primary outcome was change in body weight at 6 months, with secondary outcomes including dietary intake, body composition, and behavioural measures.

Weight loss outcomes

Participants in the culinary coaching group achieved significantly greater weight loss compared with the control group at all measured time points:

• 3 months: -3.23% vs -0.71% (between-group difference -2.52; P = .016)
• 6 months: -4.2% vs -1.22% (between-group difference -2.98; P = .027)
• 12 months: -4.02% vs a weight gain of 0.28% (between-group difference -4.30; P = .021)

These findings indicate that the intervention not only supported early weight loss but also helped sustain these changes over a full year.

Changes in body composition

At 6 months, participants receiving culinary coaching demonstrated favourable changes in body composition:

• Average fat mass decreased by 1.86% in the intervention group
• In contrast, the control group experienced a slight increase in fat mass of 0.11%
• The between-group difference was 1.96 (P = .039)

Importantly, these reductions in fat mass occurred without any significant changes in lean body mass, suggesting that weight loss was primarily driven by fat reduction rather than muscle loss.

Dietary improvements

The intervention also led to measurable improvements in diet quality and energy intake:

• At 3 months, Mediterranean diet scores increased by 2 points in the intervention group compared with 0.38 points in the control group (net difference 1.62; P = .020)
• At 6 months, daily calorie intake decreased by 452 calories in the intervention group compared with 62.4 calories in the control group (net difference 390 calories; P = .015)

These findings suggest that the programme successfully influenced both food choices and overall energy consumption.

Behavioural and skill-based outcomes

Participants who received culinary coaching reported significant improvements in their confidence and ability to prepare meals:

• Self-efficacy in cooking techniques and meal preparation improved significantly at 12 months in the intervention group compared with the control group (P = .040)

No serious adverse events were reported during the study, indicating that the intervention was safe and well tolerated.

Interpretation and clinical relevance

The study authors highlighted the broader significance of these findings, stating:

“This study is an important step in considering CM [culinary medicine] interventions as an effective patient-centered nutrition strategy for weight loss.”

This suggests that combining practical cooking skills with behavioural coaching may offer a scalable and effective approach to supporting people living with overweight and obesity, particularly in remote or resource-limited settings.

Limitations

The study has several limitations, many of which were influenced by the COVID pandemic:

• High dropout rates after the first visit may have introduced attrition bias
• Some follow-up visits were conducted remotely, requiring participants to self-measure body weight
• Remote assessments limited the ability to collect body composition and other clinical data at certain time points
• Pandemic-related restrictions may have affected participants’ ability to cook at home

These factors should be considered when interpreting the findings.

Funding and disclosures

The study was led by Rani Polak at Harvard Medical School and Spaulding Rehabilitation Hospital in Boston and was published in Obesity.

Funding was provided by the US-Israel Binational Science Foundation and the National Institutes of Health Clinical Center. One author reported receiving royalties from a home cooking book and an honorarium from Wellcoaches.

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GLP-1 Weight Loss Is Mostly Driven by Fat Loss, Not Muscle

Key Takeaways:

• GLP-1 receptor agonists and dual GLP-1/GIP therapies lead to significant weight loss, primarily through reductions in fat mass rather than muscle.
  
• Improvements in body composition, including reductions in visceral fat, occur as early as three months into treatment.
  
• Although some lean body mass loss is observed, it is relatively modest compared with overall weight loss, suggesting a favourable pattern of change.
  
  
  

GLP-1 therapies in the context of obesity care

A recent study published in the International Journal of Obesity examined how glucagon-like peptide 1 receptor agonists and dual GLP-1/glucose-dependent insulinotropic polypeptide agonists affect body weight and composition in adults living with overweight or obesity.

The global prevalence of obesity has risen substantially in recent decades. This condition is closely linked to a range of cardiometabolic complications that can reduce both quality of life and life expectancy. As a result, effective obesity management typically requires a personalised, multidisciplinary approach. This may include behavioural support, dietary changes, physical activity, pharmacological treatments, and, in some cases, surgical intervention.

GLP-1 receptor agonists and related incretin-based therapies have emerged as an important pharmacological option. These treatments are known to support sustained weight loss and improve obesity-related comorbidities. They have also demonstrated cardioprotective effects. However, while these therapies predominantly reduce fat body mass, they may also lead to some loss of lean body mass, which has raised concerns, particularly for older adults and people at risk of frailty.

Study design and methods

To better understand these effects, researchers conducted a comprehensive evaluation of clinical studies assessing GLP-1-based therapies and their impact on body composition.

Databases including Web of Science, PubMed, and Scopus were systematically searched for relevant studies involving adults with overweight or obesity, with or without type 2 diabetes. Following removal of duplicate records, studies were screened based on titles, abstracts, and full texts to determine eligibility.

The methodological quality of the included studies was assessed using established tools. Meta-analyses were then performed on studies that provided numerical data on changes in body composition and anthropometric measures. Statistical analyses used random-effects models, with subgroup analyses based on drug type and treatment duration. Publication bias was evaluated using Egger’s test.

In total, 36 studies were included in the qualitative review, with 24 contributing to the meta-analyses. Most studies were conducted in Europe and Asia, and many reported outcomes at six months. Twenty-four studies included people living with type 2 diabetes. The most frequently studied medications were liraglutide and semaglutide. Body composition was commonly assessed using bioelectrical impedance analysis and dual-energy X-ray absorptiometry.

Changes in weight and body composition

Early effects at three months

After three months of treatment, participants experienced a significant reduction in body mass of approximately 9 percent. This effect was particularly notable among those receiving beinaglutide.

Substantial improvements in body composition were also observed. Visceral adipose tissue area decreased by 29.25 cm², while fat body mass was reduced by 17 percent. Lean body mass showed a smaller but statistically significant reduction of 2 percent.

In addition, body mass index decreased by 2.96 kg/m² and waist circumference by 9.6 cm.

Outcomes at six months

At six months, body mass remained significantly reduced, with an average decrease of 5 percent.

Both fat body mass and lean body mass declined further, by 6 percent and 1 percent respectively. Skeletal muscle mass showed a modest reduction of 3 percent. Visceral adipose tissue continued to decrease, with a reduction of 32.31 cm².

Body mass index fell by 2.40 kg/m², while waist circumference decreased by 2.3 cm.

Longer-term results at twelve months

At twelve months, body mass was reduced by 4 percent, with continued decreases in body mass index of 1.74 kg/m² and waist circumference of 3.2 cm.

Both fat body mass and lean body mass were reduced by 4 percent. The most pronounced reductions were reported in a study involving liraglutide, although the authors noted considerable variability between studies and advised caution when comparing specific agents.

Egger’s test indicated some publication bias in outcomes reported at three months, but no significant bias was observed at later time points.

Interpreting fat loss and muscle preservation

Overall, the findings demonstrate that GLP-1-based therapies produce meaningful improvements in key measures associated with obesity, including body mass, body mass index, and waist circumference, across multiple time points.

The most rapid and substantial changes occurred within the first three months of treatment. Across all timeframes, reductions in fat mass, particularly visceral fat, were more pronounced than reductions in lean mass.

The authors described this pattern as “quality” weight loss, characterised by a predominance of fat mass reduction with relative preservation of lean tissue. Importantly, no single GLP-1 receptor agonist was found to be superior in preserving lean mass.

Implications for clinical practice and future research

These findings have important implications for clinical care. While some degree of lean mass loss occurs with GLP-1-based therapies, the overall pattern of weight loss appears favourable, particularly given the substantial reductions in fat mass and visceral adiposity.

Future research should focus on optimising treatment strategies that combine pharmacotherapy with lifestyle interventions. In particular, there is a need to explore approaches that support the preservation of lean mass, such as targeted nutritional strategies and resistance training programmes.

Such considerations are especially important for people at higher risk of sarcopenia, including older adults and those with existing muscle loss.

CCH insights:

These results are encouraging, but it is important not to become complacent about lean mass loss during weight loss. The studies analysed here involved average weight losses of less than 10% of body weight, but some people can lose 15-20% of body weight on GLP-1 therapy – do they lose similar proportions of body fat and lean tissue? All patients on GLP-1 therapy should receive advice on lifestyle measures to help minimise lean tissue loss.

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New Study Suggests Semaglutide May Reduce Epilepsy Risk in Adults with Type 2 Diabetes

Key Takeaways: 

• Initiating semaglutide was associated with a significantly lower risk of developing epilepsy or seizures compared with other glucose-lowering therapies.
  
• The observed effect does not appear to be primarily driven by improvements in blood glucose or body weight.
  
• Findings are preliminary and should be interpreted as an early signal rather than a basis for changing clinical practice.
  
  
  

Background – seizure risk in type 2 diabetes

People living with type 2 diabetes mellitus face a higher risk of developing seizures and epilepsy. This increased risk is thought to be partly driven by inflammatory processes that affect the central nervous system. While glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are primarily used for glucose regulation, there has been growing scientific interest in their potential neurological effects.

However, until now, the relationship between GLP-1 RAs and seizure risk has remained unclear.

Study design and population

The findings were presented at the American Academy of Neurology Annual Meeting, held in Chicago from April 18 to 22, 2026.

Researchers conducted a retrospective study using a target trial emulation approach, drawing on data from the National Institutes of Health All of Us Controlled Tier Dataset. The analysis focused on adults aged 18 years and older with type 2 diabetes mellitus who initiated one of the following treatments between December 2018 and December 2021:

• Semaglutide
• Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors)
• Other glucose-lowering therapies

Participants were followed through to December 2023.

To ensure comparability between groups, inverse probability of treatment weighting was applied to balance baseline characteristics. Time-to-event analyses were then used to assess the risk of developing epilepsy or seizures.

Cohort characteristics

A total of 393,596 individuals met eligibility criteria. Within this population:

• 8,533 individuals were included in the semaglutide versus other glucose-lowering drug comparison (2,397 vs 6,136)
• 7,455 individuals were included in the semaglutide versus SGLT2 inhibitor comparison (1,650 vs 3,725)
  
  
  

Key findings – reduced risk of seizures

After statistical adjustment, initiation of semaglutide was associated with a lower risk of epilepsy or seizures compared with both comparator groups:

• Compared with other glucose-lowering drugs:
  • Hazard ratio: 0.46
  • 95% confidence interval: 0.25–0.83
  • P = .010
• Compared with SGLT2 inhibitors:
  • Hazard ratio: 0.44
  • 95% confidence interval: 0.22–0.86
  • P = .017

These findings suggest a meaningful reduction in relative risk among those initiating semaglutide.

Absolute risk reduction and clinical interpretation

Further modelling provided estimates of absolute risk reduction:

• Compared with other glucose-lowering therapies:
  • Absolute risk reduction: -0.014
  • Number needed to treat: 69
  • P < .001
• Compared with SGLT2 inhibitors:
  • Absolute risk reduction: -0.008
  • Number needed to treat: 129
  • P < .001

These results indicate that, while the relative risk reduction is notable, the absolute reduction in risk remains modest.

Mechanisms – not driven by glycaemic control alone

To explore potential mechanisms, the researchers conducted mediation analyses. These analyses assessed how much of the observed effect could be explained by changes in glycated haemoglobin or body mass index.

The results showed that:

• Glycated haemoglobin accounted for only 1.1% of the effect compared with other glucose-lowering drugs and 3.6% compared with SGLT2 inhibitors
• Body mass index contributed 0.3% or less in both comparisons

This suggests that the reduced seizure risk may not be primarily driven by improvements in glycaemic control or weight loss, pointing towards other possible mechanisms.

Expert perspective

Yoonhyuk Jang, MD, PhD, Postdoctoral Fellow in the Department of Immunology at Harvard Medical School, commented on the findings:

“This study suggests that semaglutide may be associated with a lower risk of adult-onset seizures or epilepsy in patients with type 2 diabetes, with the signal appearing more pronounced in late-onset cases among adults aged 60 years or older.”

He added:

“Given that age-associated brain insults are major contributors to adult-onset seizures and epilepsy, these findings may have implications beyond seizure risk alone and raise the possibility that semaglutide could also be relevant to broader brain health; however, because this was a retrospective target trial emulation with a relatively small number of events, it is not yet practice-changing and should instead be viewed as a signal that supports further research into the role of GLP-1 receptor agonists in epileptogenesis.”

Limitations and future directions

The authors emphasised that the study design was observational, despite using advanced statistical methods to emulate a clinical trial. As such, causality cannot be definitively established.

Additionally, the relatively small number of seizure events limits the strength of the conclusions. These findings should therefore be interpreted cautiously and seen as hypothesis-generating.

Further prospective and randomised studies will be needed to determine whether GLP-1 receptor agonists such as semaglutide have a direct role in reducing seizure risk or influencing broader neurological health.

Disclosures

One study author reported affiliations with biotechnology, pharmaceutical, or device companies. Full disclosure details are available in the original study source.

Source: Neurology Advisor

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Dual Burden of Alcohol Use and Obesity Linked to Rising Liver Disease Risk

Key Takeaways: 

• Around 1 in 10 U.S. adults report both heavy drinking and obesity, creating a compounded risk for liver disease
  
• This overlap is most common in younger and middle-aged adults, suggesting risk accumulates early in life
  
• Integrated, non-judgemental care targeting both conditions together may improve long-term outcomes and reduce progression to advanced liver disease
  
  
  

A growing overlap with serious implications

Heavy alcohol use and obesity are both increasing in the United States, and they are increasingly affecting the same individuals. A new study published in JAMA Internal Medicine explores how often these two major risk factors coincide among U.S. adults and why this overlap has important implications for clinical care and public health policy.

The research was led by Dr Bryant Shuey, a board-certified general internist at UPMC and a clinician-investigator at the University of Pittsburgh Center for Research on Health Care. His work focuses on substance use, chronic disease, and access to care. Drawing on national survey data, the study highlights a critical, and often overlooked, opportunity to intervene earlier in the disease trajectory before severe liver damage develops.

Why examine alcohol use and obesity together?

Dr Shuey explains that this combined risk is increasingly visible in clinical practice:

“In my clinical work, I’ve been seeing more people in their 30s and 40s coming to the hospital with advanced liver disease linked to both alcohol use and metabolic risk factors. Nationally, heavy drinking and obesity are both becoming more common and there has been greater recognition that alcohol and metabolic disease can combine to accelerate liver disease progression. Treatment of both conditions, especially alcohol use disorder, is also lagging, as evident by research by my colleague and study co-author Dr. Eden Bernstein from the University of Colorado. Together, we sought to understand how often risky alcohol use and obesity overlap and what it might mean for prevention and earlier intervention.”

This convergence of risks reflects a broader shift in how liver disease is understood. Rather than being driven by a single cause, many people now present with multiple interacting factors that amplify disease progression.

A significant and early-emerging risk

The study’s central finding is clear:

“The key finding is that about 1 in 10 U.S. adults reported both heavy drinking and a body mass index of 30 or greater in 2023. That’s a substantial share of the population, especially considering how strongly each of these factors contributes to liver disease risk on its own.”

What is particularly striking is how early this overlap appears.

“What stood out most was how early this overlap appears. Rates were highest among young and middle-aged adults, when risk factors for serious liver disease are just beginning to build. These findings suggest that many people are entering adulthood with multiple, reinforcing risk factors for liver disease long before they ever develop symptoms.”

This suggests that prevention efforts may need to begin far earlier than is currently typical, focusing on identifying and addressing risk factors before clinical disease becomes apparent.

How liver disease presents in clinical practice

People living with alcohol-related and metabolically related liver disease may present at very different stages. Some are identified early through routine primary care assessments, while others present later with advanced complications.

Dr Shuey describes this spectrum:

“Patients can show up at different points along the disease course. Some are identified early by their primary care doctor by discussing risk factors like alcohol use and metabolic health and ordering blood work and liver imaging. Others present later, sometimes to the emergency department, with symptoms of advanced liver disease, or cirrhosis, like jaundice, abdominal swelling or gastrointestinal bleeding. Liver disease can lurk for years with no symptoms, so for some, that’s the first time they’re learning they have liver disease. Whether the illness is driven mainly by metabolic disease, alcohol use or a combination of both, if unchecked, the outcome can be the same: progressive liver damage that can lead to cirrhosis and liver failure. That’s why it’s so important to address these risk factors together, not in isolation.”

The silent progression of liver disease underscores the importance of proactive screening and early intervention.

Rethinking care: addressing both risks together

For clinicians, the findings point to the need for a more integrated approach to care.

“We need to routinely screen for both conditions in an empathetic and non-judgmental way and recognize how strongly they interact when it comes to liver disease risk. Clinicians should offer standard evidence-based options to treat both conditions: dietary counseling, motivational interviewing, medications for alcohol use disorder and therapies for metabolic disease such as GLP-1s and related weight loss drugs. There’s growing interest in these medications because they help people reduce their metabolic risk through weight loss and reversing inflammation in metabolic liver disease. Additionally, a smaller trial last year found that GLP-1s may reduce alcohol use among people with alcohol use disorder. While these results should not be overstated, GLP-1s may emerge as an important dual-therapeutic for patients with risky alcohol use and obesity if these findings hold up in larger trials. Ultimately, addressing both risk factors together may be an important strategy to change long-term outcomes.”

This reflects a shift towards dual-risk management, where treatment strategies are designed to address interconnected drivers of disease rather than isolated conditions.

Supporting people without judgement

A central theme in managing these conditions is the importance of person-centred care.

“The most important thing is creating space to talk about these concerns without judgment. I would want to learn about their goals, explore their understanding of the health impacts of alcohol use and metabolic disease, counsel them on treatment options and support them in their decision. For some people, the priority is avoiding serious illness down the road. Others may want to lose weight, drink less or stop drinking altogether. While addressing both conditions simultaneously may be of interest to some patients, others may feel overwhelmed and want to focus on just one. There isn’t a single right goal.”

This highlights the need for flexibility in care plans and respect for individual priorities and readiness for change.

Barriers to care and policy implications

The study also draws attention to wider structural barriers that influence health outcomes.

“Our social conditions shape our health. Improving access to affordable, healthy foods and safe spaces for exercise and activity can go a long way in helping people attain their highest level of health. Bolstering public health messaging about the lesser-known risk of liver disease as a complication of alcohol use and metabolic disease is also critical to helping people make informed decisions. Furthermore, stigma around both weight and alcohol use can discourage people from seeking care in the first place. Fewer than 10% of people with an alcohol use disorder receive treatment, and just 5% are prescribed evidence-based medications that have been demonstrated to reduce alcohol use. Clinicians can be a part of the solution by ensuring they are offering patients standard treatments for alcohol use disorder.”

Access to care remains a major challenge, particularly for those without adequate insurance or financial resources.

“Health care affordability and access to care are major barriers to timely diagnosis and treatment of alcohol- and metabolic-related health issues, particularly for people who are uninsured. Preventing progression to advanced liver disease isn’t just better for patients, it’s far less expensive than treating cirrhosis and its complications. In the U.S., we spend an estimated $135 billion on liver disease every year. We need prevention-focused approaches and more equitable access to care for the populations at highest risk.”

These findings reinforce the importance of prevention-focused policy and equitable healthcare access.

Priorities for future research

Looking ahead, the study highlights several important areas for further investigation.

“We should figure out how to intervene earlier, when obesity and risky alcohol use first begin to overlap, long before advanced liver disease develops. We also need more data on how existing treatments work in patients with multiple, co-occurring risk factors, since many clinical trials have historically excluded these groups.”

There is also a need to better understand how health systems and policy decisions shape outcomes.

“From a policy standpoint, future research should also look at how insurance coverage and access barriers affect outcomes for people at greatest risk. Better evidence in these areas could help guide more effective and equitable prevention strategies.”

A shift towards earlier, integrated prevention

Taken together, the findings point to a clear conclusion: the intersection of heavy alcohol use and obesity represents a growing and under-recognised driver of liver disease. Identifying and addressing these risks earlier, and in combination, may offer a meaningful opportunity to improve patient outcomes and reduce the long-term burden on healthcare systems.

Source: UPMC Life Changing Medicine

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Automated Weight Loss Programme Shows Promise for People Living with Cancer in Landmark Trial

Key Takeaways: 

• A fully automated, web-based programme delivered clinically meaningful weight loss in people living with and beyond cancer, without any in-person support
  
• More than 43 percent of participants achieved at least 3 percent weight loss, with nearly one in three reaching 5 percent or more
  
• The intervention also improved a range of health outcomes, including diet quality, physical functioning, and cardiometabolic markers
  
  
  

A new model for post-cancer care

A large national randomised clinical trial has demonstrated that a fully automated, web-based weight loss intervention can deliver substantial health benefits for people living with and beyond cancer. The programme, developed by researchers at the University of Alabama at Birmingham, represents a significant shift in how post-cancer care may be delivered in the future.

Published in the Journal of the National Comprehensive Cancer Network, the study reported the highest level of weight loss ever achieved through a fully automated intervention in this population. The programme, known as the AMPLIFY Diet (AiM, PLan and act on LIFestYles), was designed to provide structured, evidence-based lifestyle support without requiring direct clinician involvement.

Addressing a major unmet need

A substantial proportion of people living with and beyond cancer are also living with overweight or obesity. In the United States, this figure is estimated to be around 70 percent. This places individuals at increased risk of cardiovascular disease, type 2 diabetes, functional decline, cancer recurrence, and the development of second primary cancers.

Despite this, access to specialist oncology dietitians remains limited. Traditional weight management programmes often rely on in-person consultations or regular coaching, which can be difficult to scale and may not be accessible to all patients.

The AMPLIFY Diet intervention was developed specifically to address these barriers by delivering personalised nutrition and behavioural support entirely online.

A fully automated intervention

The programme operates without live coaching, counselling calls, or face-to-face appointments. Instead, it uses a structured digital platform that includes weekly interactive sessions, goal-setting tools, progress monitoring, and automated personalised feedback.

Participants engage with the system independently, receiving guidance that is grounded in established behavioural and nutritional science. This approach allows for scalability while maintaining a consistent standard of care.

“This is a game changer for cancer survivorship care,” said Wendy Demark-Wahnefried, Ph.D., R.D., senior author and professor at UAB’s School of Health Professions and O’Neal Comprehensive Cancer Center. “We showed that a completely automated online program grounded in decades of behavioral and nutrition science can safely and effectively help cancer survivors lose weight and improve their health at scale.”

Study design and participant profile

Between 2020 and 2024, the study enrolled 349 participants aged between 50 and 82 years from 31 states across the United States. All participants were living with and beyond cancers associated with obesity.

The cohort included individuals with a range of cancer types, including breast, colorectal, prostate, endometrial, ovarian, thyroid, renal, and haematologic cancers. Participants were randomly assigned to either the AMPLIFY Diet programme or a control group receiving standard survivorship information.

Clinically meaningful weight loss outcomes

After six months, the results showed clear differences between the intervention and control groups.

More than 43 percent of participants in the AMPLIFY Diet group achieved weight loss of at least 3 percent of their body weight. In comparison, only 13 percent of those receiving usual care reached this threshold.

In addition, nearly one in three participants in the intervention group lost at least 5 percent of their body weight. This level of weight loss is widely associated with reductions in cardiovascular risk and improvements in cancer-related outcomes.

On average, weight loss in the intervention group was nearly five times greater than that observed in the control group.

Broader health improvements

The benefits of the programme extended beyond weight loss alone. Participants in the AMPLIFY Diet group experienced improvements across multiple domains of health and wellbeing.

These included reductions in waist circumference and overall caloric intake, as well as improvements in diet quality. Biochemical markers also shifted in a favourable direction, with lower circulating levels of leptin, a hormone associated with cancer progression and cardiometabolic disease.

Further gains were observed in blood pressure, physical functioning, and cognitive performance. Participants also reported improvements in depression and their ability to engage in social roles, suggesting a broader impact on quality of life.

Strong engagement without human support

One notable finding from the study was the level of participant engagement. Individuals completed an average of 60 percent of the weekly sessions, which is considerably higher than engagement rates typically reported in other digital lifestyle interventions.

This suggests that a well-designed automated system can maintain user engagement even in the absence of direct human interaction.

Implications for scalable care

Unlike many conventional weight management programmes, the AMPLIFY Diet intervention does not require ongoing staff involvement. This makes it particularly well suited for integration into healthcare systems, cancer centres, and community-based services.

The ability to deliver consistent, evidence-based care at scale may help address longstanding gaps in survivorship support, particularly in settings where specialist resources are limited.

The role of behavioural and nutritional care

The researchers emphasise that lifestyle-based interventions remain a cornerstone of care for people living with and beyond cancer, particularly as pharmacological approaches continue to evolve.

“Behavioral and nutritional interventions are essential,” Demark-Wahnefried said. “Diet quality, muscle preservation, cognition, and long-term sustainability of a healthful lifestyle and body weight are critical for cancer survivors, and even if weight loss medications eventually receive broadscale endorsement, they alone do not address all of these needs.”

Future directions

The research team is now focusing on expanding the reach of the AMPLIFY Diet programme across both clinical and non-clinical settings. The aim is to improve access to effective survivorship care while also contributing to broader cancer prevention efforts.

The study was funded by the National Institutes of Health and the American Cancer Society.

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Can Less Be More? Reduced GLP-1 Dosing May Sustain – and Even Enhance – Weight Loss

Key Takeaways: 

• Structured reduction in GLP-1 receptor agonist dosing frequency may allow continued weight loss while lowering treatment burden
  
• Cardiometabolic improvements achieved during weekly dosing appear to be maintained with less frequent dosing
  
• Early evidence suggests some individuals may not require high or frequent dosing to sustain weight loss, although larger trials are needed
  
  
  

A new approach to GLP-1 treatment

Emerging evidence suggests that reducing the frequency of glucagon-like peptide-1 receptor agonist (GLP-1 RA) dosing may still deliver sustained benefits for people living with obesity. Data presented at the Obesity Medicine Association’s annual conference indicate that a structured, gradual de-escalation strategy could maintain, and in some cases enhance, weight loss outcomes while reducing the burden of ongoing treatment.

This finding challenges the prevailing assumption that continuous, high-frequency dosing is required to preserve the benefits of these therapies.

Continued weight loss despite reduced dosing

The research, led by Mitch Biermann, MD, PhD, examined outcomes in individuals who transitioned from weekly GLP-1 RA dosing to less frequent schedules. Reflecting on the results, Biermann noted:

“What I found was actually surprising, where in addition to losing weight initially on the weekly regimen, people actually lost further weight on the every-other-week regimen,” Mitch Biermann, MD, PhD, an obesity medicine physician and scientist at Scripps Health, told Healio. “I was just hoping people would break even, not get an additional 2% weight loss.”

This observation suggests that, for some individuals, reduced dosing frequency does not simply preserve prior weight loss but may contribute to further reductions.

Addressing a common patient concern

The study was partly motivated by a frequent question from patients considering GLP-1 therapy. As Biermann explained:

“The No. 1 question patients have when they’re deciding to start one of these medicines is, ‘Do I have to be on this every week for the rest of my life? Do I have to take this forever?’” he said. “Patients ask that about certain medicines and not others. It usually correlates with the stigma around the disease. They always ask about it for weight loss medicine.”

This highlights an important dimension of obesity care – long-term treatment expectations and the role of stigma in shaping patient concerns.

Study design and patient cohort

The analysis was based on a retrospective case series involving 30 adults who had been prescribed either semaglutide (Wegovy or Ozempic) or tirzepatide (Mounjaro). All participants had experienced a plateau in weight loss during standard weekly treatment.

Participants agreed to reduce their dosing frequency while maintaining their effective dose. The adjusted schedules included:

• Every 10 to 14 days (n = 6)
• Every two weeks (n = 17)
• Longer than every two weeks (n = 7)

The mean follow-up period was 36 weeks.

Body composition and weight outcomes

Following the transition to reduced dosing, participants continued to lose weight, with reported reductions of 72.4 ± 2.2 kg (P < .01). In addition to overall weight loss, improvements were observed in body composition:

• Reductions in body fat mass
• Decreases in average percentage body fat
• Lower truncal fat mass

At the same time, skeletal muscle mass increased slightly from 30.33 ± 1.27 to 30.63 ± 1.25, suggesting that weight loss was not associated with disproportionate muscle loss.

Sustained cardiometabolic benefits

Importantly, key metabolic improvements achieved during weekly dosing were maintained after reducing treatment frequency:

• Glycaemic control: HbA1c improved from 5.6% ± 0.13% before treatment to 5.1% ± 0.1% during weekly dosing (P < .001), with no change during reduced dosing
• Triglycerides: Levels decreased from 121 ± 11.3 mg/dL to 84.3 ± 9.6 mg/dL during weekly dosing (P < .001) and remained stable at 74.8 ± 4.1 mg/dL
• Mean arterial pressure: Reduced from 90.5 ± 2 mm Hg to 84.8 ± 2.1 mm Hg (P < .05), remaining stable at 85.1 ± 1.5 mm Hg during maintenance

The proportion of participants meeting criteria for metabolic syndrome also declined, from nearly 83% before treatment to 68% during weekly dosing and 58.6% following dose reduction.

Interpreting the findings

The study authors suggest that lower levels of GLP-1 receptor stimulation may be sufficient to maintain weight loss once it has been achieved. Biermann offered the following interpretation:

“that you don’t need much of these hormones to maintain weight loss, even though you need a lot of them to reduce weight.”

He also drew a parallel with physical activity:

“Exercise doesn’t cause people to lose a ton of weight. It causes people to maintain their weight if they lose it by another method for the most part,” he said. “And that matches this hormone data, because that 30% increase [in hormone levels] you get on GLP-1s from exercise is probably enough to maintain your weight loss.”

Limitations and considerations

The findings should be interpreted cautiously. The study was small, non-randomised, and based on a retrospective case series. In addition, the cohort lacked diversity, with only four participants not identified as white and just two individuals living with class II or III obesity.

These limitations mean that the results may not be generalisable to broader populations.

Implications for clinical practice

Despite its limitations, the study offers a potentially important insight into long-term obesity management. Gradual dose reduction may represent a viable strategy for some individuals seeking to balance efficacy with treatment burden.

As Biermann concluded:

“I think it’s an option that works for many people, [particularly] when we don’t study how to stop medicine in general,” Biermann told Healio.

“I think it’s nice to have some published data on the average effectiveness of this strategy, even though it’s not a randomized controlled trial,” he said.

Looking ahead

Further research, particularly large-scale randomised controlled trials, will be essential to determine whether reduced dosing strategies can be safely and effectively implemented in routine care. For now, these findings provide an early signal that long-term GLP-1 therapy may not need to follow a one-size-fits-all model.

Source: Healio

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