Obesity Care Tag

Obesity-Related Fat Tissue Signals Identified as a Driver of Age-Related Muscle Loss

Key Takeaways: 

• Researchers have identified a biological mechanism linking obesity-related fat tissue to accelerated muscle loss in older adults.
• Tiny particles released by adipose tissue were shown to directly trigger muscle atrophy in ageing human muscle cells.
• Younger muscle appears biologically protected from these effects, highlighting an age-dependent vulnerability that may inform future therapies.
  
  
  

New insight into sarcopenic obesity

Researchers at the University of Birmingham have identified a previously unrecognised biological pathway through which obesity may contribute to muscle loss in older adults. The findings provide important new insight into sarcopenic obesity, a condition in which excess body fat exists alongside reduced muscle mass and strength.

The study, published in the Journal of Cachexia, Sarcopenia and Muscle and conducted through the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre (BRC), demonstrates for the first time that signals released from adipose tissue can directly induce muscle wasting in human cells.

Sarcopenic obesity is becoming increasingly common as populations age and is associated with frailty, impaired mobility and poorer overall health outcomes. The condition is estimated to affect approximately 11% of the population.

Fat tissue communication with muscle

The research focused on extracellular vesicles – microscopic particles released by fat tissue that act as biological messengers between organs and tissues.

Investigators discovered that extracellular vesicles derived specifically from obese adipose tissue, rather than lean tissue, caused significant thinning of muscle fibres obtained from older adults. This thinning represents a hallmark feature of muscle atrophy.

The harmful effects were traced to molecular cargo carried within these vesicles, particularly miR-150-5p, a microRNA known to regulate gene expression pathways involved in maintaining muscle structure and function.

These findings suggest that obesity does not simply increase fat mass but fundamentally alters how adipose tissue behaves and communicates with other organs, including skeletal muscle.

Age-dependent vulnerability of muscle

A notable finding of the study was that muscle cells derived from younger adults showed resistance to these obesity-related signals.

When exposed to extracellular vesicles from obese adipose tissue, younger muscle cells did not undergo the same degree of thinning observed in older muscle cells. This indicates that ageing muscle becomes biologically more susceptible to inflammatory and metabolic signals associated with obesity.

Speaking about the findings, first author Dr Joshua Price, Postdoctoral Researcher, explained:

“It isn’t just having more fat tissue that matters. Obesity changes how fat tissue behaves and how it communicates with muscle. Ageing muscle is far more vulnerable to these altered signals, which helps explain why muscle loss accelerates with obesity later in life.”

Identifying a potential therapeutic target

The identification of miR-150-5p as a key molecular driver presents a potential opportunity for therapeutic intervention. Researchers found that inhibiting this microRNA could partially reduce the muscle-wasting effects observed in laboratory models.

Overall, the results suggest a dual biological reality – younger muscle demonstrates protective resilience, while ageing muscle becomes increasingly vulnerable to obesity-related signalling pathways.

Senior author Professor Simon Jones, Professor in Musculoskeletal Ageing at the University of Birmingham and lead for the NIHR Birmingham BRC’s Sarcopenia and Multimorbidity research theme, said:

“Through this research, we’ve identified a key molecular pathway by which obesity can accelerate muscle loss in older adults. Importantly, we found that younger muscle appears resilient to these harmful signals, whereas ageing muscle becomes more vulnerable. This reinforces the importance of maintaining a healthy weight and muscle health as we age.”

He added:

“Our findings also open two potential therapeutic avenues: either blocking or modifying the harmful extracellular vesicles released from obese tissue, or developing strategies to make older muscle more resilient, mimicking the protective effects seen in younger muscle.”

Implications for ageing and obesity care

The study strengthens understanding of how ageing and obesity interact at a cellular level to influence physical decline. Rather than viewing muscle loss solely as a consequence of ageing or inactivity, the findings highlight obesity-related biological signalling as an active contributor.

By demonstrating that altered communication between fat and muscle tissue can directly drive muscle atrophy, the research provides a clearer mechanistic explanation for why people living with obesity may experience accelerated functional decline later in life.

The work was delivered through the NIHR Birmingham Biomedical Research Centre, with Dr Joshua Price serving as a BRC-funded postdoctoral research associate within the Sarcopenia and Multimorbidity research theme.

Together, these findings may support future strategies aimed at preserving muscle health in ageing populations, particularly among people living with obesity, where preventing muscle loss is critical for maintaining independence, mobility and long-term health outcomes.

Read More

Parental Weight Before Pregnancy Linked to Higher Risk of Fatty Liver Disease in Adult Offspring, UK Study Finds

Key Takeaways: 

• Pre-pregnancy overweight or obesity in either parent is associated with a significantly increased risk of metabolic dysfunction associated steatotic liver disease (MASLD) in their children by early adulthood.
  
• When both parents were living with overweight or obesity prior to conception, the likelihood of MASLD in offspring by age 24 was more than three times higher.
  
• Much of this increased risk appears to be mediated by excess weight accumulated during childhood and adolescence.
  
  
  

Rising concern over MASLD across generations

Parental weight status before pregnancy may play an important role in shaping long-term liver and metabolic health in the next generation, according to new research published online in Gut. The findings suggest that overweight and obesity in both mothers and fathers prior to conception are linked to a heightened risk of metabolic dysfunction associated steatotic liver disease (MASLD) in their children as young adults.

MASLD, previously known as non-alcoholic fatty liver disease, is now recognised as the most common chronic liver condition worldwide. Researchers note that the disease affects approximately 15% of children and more than 30% of adults globally. The condition is characterised by excess fat accumulation in the liver alongside cardiometabolic abnormalities and may progress to cirrhosis or liver failure in some individuals.

While earlier studies have primarily focused on maternal obesity, uncertainty has remained regarding the contribution of paternal weight and the role of childhood weight trajectories in determining future disease risk.

Large UK birth cohort provides long-term insight

To investigate these questions, researchers analysed data from 1,933 participants enrolled in the UK Avon Longitudinal Study of Parents and Children (ALSPAC), a long-running population study tracking health outcomes across generations.

The study examined associations between parental body mass index (BMI) before pregnancy and the likelihood that offspring would develop MASLD by the age of 24.

MASLD was defined as the presence of elevated liver fat together with at least one cardiometabolic risk factor, such as raised cholesterol levels or elevated fasting glucose.

Both parents provided information on height, weight, BMI and waist circumference before pregnancy. They also completed detailed questionnaires during pregnancy and following childbirth covering a wide range of potential influencing factors, including:

• Age at delivery
  
• Smoking during early pregnancy
  
• Weekly alcohol consumption prior to pregnancy
  
• Employment status
  
• Educational attainment
  

Mothers additionally reported physical activity levels and whether they had previously been diagnosed with diabetes or hypertension at study enrolment.

Tracking early life and adolescent risk factors

Extensive information was also collected about the children, allowing researchers to examine developmental influences across childhood and adolescence. Recorded factors included:

• Sex
  
• Mode of delivery
  
• Gestational age and birthweight
  
• Antibiotic exposure during the first six months of life
  
• Duration of breastfeeding
  

Participants underwent repeated measurements of BMI and waist circumference between the ages of 7–9, 10–12 and 13–17 years. Lifestyle factors in early adulthood, including alcohol and tobacco use, were also assessed.

One in ten young adults developed MASLD

By age 24, MASLD was identified in 201 participants, representing approximately one in ten individuals in the cohort. The remaining 1,732 participants had normal liver findings.

Those living with MASLD were more likely to be male and to have a higher BMI compared with peers without the condition.

After adjusting for multiple potential confounding factors, both maternal and paternal overweight or obesity before conception were independently associated with increased odds of MASLD in offspring.

Each additional kilogram per square metre of maternal BMI increased the likelihood of MASLD by 10%, while each equivalent increase in paternal BMI was associated with a 9% rise in risk.

Most notably, offspring whose parents were both living with overweight or obesity prior to pregnancy had more than three times the odds of developing MASLD compared with those whose parents had a normal BMI.

Childhood weight plays a central role

Further analysis suggested that much of this association operates through weight gain during childhood and adolescence. Researchers estimated that 67% of the increased risk linked to parental overweight or obesity was explained by cumulative excess BMI between the ages of 7 and 17.

Additional analyses incorporating maternal and offspring sugar intake, as well as genetic susceptibility to MASLD, produced similar results, strengthening confidence in the observed associations.

Observational findings with important limitations

The authors emphasise that the study was observational and therefore cannot establish direct causation. Several limitations were also acknowledged.

Parental weight data prior to pregnancy were self-reported, and information was unavailable regarding parental MASLD status or certain underlying health conditions before and during pregnancy. In addition, physical activity levels of offspring in early adulthood were not captured, which may have influenced outcomes.

Implications for preconception health

Despite these limitations, the researchers conclude that their findings highlight the potential importance of parental metabolic health before conception in shaping long-term outcomes for future generations.

They state that the results “lend support to an early life influence of biparental obesity on offspring metabolic health, suggesting efforts to mitigate excess adiposity of both mothers and fathers before conceiving may confer longitudinal benefits to the metabolic outcomes of their future offspring.“

The study adds to growing evidence that prevention of metabolic disease may need to begin not only in childhood, but even before pregnancy, with both parents playing a meaningful role in influencing lifelong health trajectories.

Read More

Mice Study Suggests Tirzepatide Enhances Metabolism by Activating Brown Fat in Addition to Reducing Weight

Key Takeaways: 

• A preclinical mouse study indicates that tirzepatide may improve metabolism not only by reducing appetite, but also by activating brown adipose tissue.
  
• The research suggests that this activation increases energy expenditure and supports improvements in blood glucose and lipid levels.
  
• Findings remain preliminary and require confirmation in human studies before clinical conclusions can be drawn.
  
  
  

A closer look at tirzepatide’s metabolic effects

Tirzepatide has transformed the treatment landscape for people living with obesity and for those with poorly controlled type 2 diabetes mellitus. Despite its established clinical benefits, the precise molecular and cellular mechanisms underpinning its effects are not yet fully understood.

A recent study conducted in mice provides new insight into how the drug may influence metabolism beyond its well-recognised impact on body weight. The findings suggest that tirzepatide directly activates brown adipose tissue, a specialised form of fat involved in energy expenditure. According to the researchers, this discovery helps clarify how the drug works and may inform the development of more comprehensive treatments for obesity and related metabolic diseases.

The study was led by Marion Peyrou, Ramón y Cajal researcher at the Faculty of Biology and the Institute of Biomedicine of the University of Barcelona, the Sant Joan de Déu Research Institute and the CIBER in Physiopathology of Obesity and Nutrition.

A dual-action therapy

Tirzepatide, marketed under the name Mounjaro, is approved for weight management in adults living with obesity or with overweight accompanied by comorbidities. It is also indicated for the treatment of inadequately controlled type 2 diabetes.

Unlike earlier anti-obesity medicines, tirzepatide acts simultaneously on two hormonal receptors – glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). This dual mechanism leads to substantial reductions in body weight, primarily through decreased food intake driven by appetite suppression.

However, appetite reduction alone may not explain the full spectrum of its metabolic effects.

Investigating effects on adipose tissue

To better understand how tirzepatide exerts its actions, researchers conducted a detailed analysis of its effects on different fat depots in an experimental mouse model. Such in-depth tissue analysis is not feasible in humans.

In the study, mice were rendered obese through a high-fat diet and then treated with tirzepatide. Their outcomes were compared with a control group of mice that consumed the same quantity of food but did not receive the drug. This design allowed the researchers to distinguish between effects caused directly by the drug and those resulting solely from reduced caloric intake.

The analysis revealed that tirzepatide activates brown adipose tissue. Unlike white adipose tissue, which primarily stores excess energy and accumulates in obesity, brown adipose tissue specialises in burning calories to generate heat.

“This activation is associated with an increased capacity to burn metabolic energy and with the production of batokines by brown adipose tissue, molecules that are beneficial for metabolism,” says Marion Peyrou.

Metabolic benefits beyond appetite suppression

The activation of brown adipose tissue is particularly significant because it indicates that tirzepatide may exert metabolic benefits independent of weight loss due to appetite reduction.

“This drug not only reduces body weight, but also has beneficial effects on metabolism. Active brown adipose tissue ‘burns’ glucose and fat within the body, which would contribute to its positive effect not only in reducing body weight, but also in lowering blood glucose and fat levels, and improving metabolism,” the researcher points out.

By enhancing the body’s ability to utilise both glucose and lipids, activation of brown fat may contribute to improved glycaemic control and lipid profiles in addition to weight reduction.

Implications for obesity treatment strategies

For several years, activation of brown adipose tissue has been viewed as a promising strategy for tackling obesity and metabolic disorders. However, previous pharmacological attempts to stimulate brown fat have frequently been limited by adverse effects, particularly cardiovascular complications.

“Tirzepatide, although it activates brown adipose tissue, does not have these negative effects; on the contrary, it shows cardiovascular benefits. If our findings are confirmed in humans, it would reinforce the importance of developing therapeutic strategies that not only reduce food intake but also increase energy expenditure and brown fat activation,” explains the researcher.

These findings support the broader principle that obesity treatments may be more effective when they target multiple physiological pathways simultaneously. Addressing both energy intake and energy expenditure could offer a more comprehensive approach to weight management and metabolic health.

“This could help improve weight control and reduce associated disorders, such as type 2 diabetes and other metabolic disorders,” she adds.

Towards more personalised prescribing

A deeper understanding of tirzepatide’s mechanisms may also influence how such medicines are prescribed in future.

“Identifying which patient profiles could benefit most, for example those with more compromised energy expenditure, would open the door to more personalized medicine, based not only on appetite or weight control, but also on overall metabolic status,” she emphasizes.

Such an approach could support more tailored treatment strategies for people living with obesity and metabolic disease, taking into account differences in metabolic function rather than focusing solely on body weight.

The need for caution and further research

Despite the promising findings, the researchers emphasise that the results are based on animal data and cannot yet be directly translated into clinical practice.

“As this is a study conducted on mice, we must be cautious, as there may be significant differences between species in terms of metabolism regulation, adipose tissue distribution and response to drugs. Therefore, we need more clinical evidence on the action of these drugs on fat in humans,” concludes Peyrou.

Further human studies will be required to confirm whether the activation of brown adipose tissue observed in mice also occurs in people receiving tirzepatide and whether it meaningfully contributes to its metabolic benefits.

Read More

GPs Offered £3,000 Incentive to Increase Prescribing of NHS Weight Loss Injections

Key Takeaways:

• GP practices in England will be eligible for a £3,000 annual payment for prescribing the maximum number of eligible patients the weight loss drug Mounjaro.
  
• Access to NHS weight loss injections remains tightly restricted, with eligibility based on BMI and specific health conditions.
  
• Professional bodies stress that prescribing decisions are driven by clinical judgement, not financial incentives, and warn that workload pressures may increase.
  
  
  

New financial incentives added to GP contract

GP practices across England are set to receive annual incentive payments of £3,000 for prescribing weight loss medication to the maximum number of patients who meet NHS eligibility criteria.

The payments will be incorporated into the national GP contract from April. In addition, practices will be able to receive approximately £1,000 per year for referring patients to weight loss support programmes.

Ministers have said the objective is to ensure that people who could benefit from structured weight management and pharmacological support are able to access it within primary care.

However, specialists in obesity care have cautioned that the overall impact of the scheme may be modest. They note that eligibility for NHS weight loss injections remains tightly restricted and that the incentive does not expand access to a broader population.

Focus on Mounjaro within primary care

The new incentive applies solely to Mounjaro, a next-generation injectable treatment for weight management.

Mounjaro became available on the NHS in 2025. Despite this, prescribing rates in general practice have reportedly been lower than expected, with some variation in uptake across different areas.

Another injectable weight loss medication, Wegovy, is also available through the NHS. However, it is not prescribed by GPs and is instead provided through specialist NHS weight management services.

More than one million people are estimated to be using weight loss injections in the UK. The majority, around nine in ten, are paying privately rather than receiving the medication through the NHS.

Government position: access based on need

The Health Secretary, Wes Streeting, described the medicines as potentially transformative for people living with obesity.

He said: “Weight loss drugs can be a real game changer for those who need them. I’m determined that access should be based on need, not ability to pay.

“Outside the NHS, we’ve seen those who can spare the cash buying privately, and the proliferation of rogue prescribers peddling dangerous unlicensed drugs that are putting patients at risk.

“Investing in general practice will help bring this modern medicine to the many, not just the few, and help shift the focus of the NHS from treatment to prevention.“

The government argues that embedding prescribing targets within the GP contract is consistent with longstanding practice. Incentive payments have previously been used to improve dementia diagnosis rates, increase vaccination uptake, and encourage the prescription of statins to reduce cardiovascular risk.

This marks the first time that weight loss injections have been formally included in the GP contract framework, with the £3,000 payment linked to prescribing the maximum number of eligible patients Mounjaro.

Strict eligibility criteria remain in place

Although the incentive has been introduced, NHS access to Mounjaro remains limited.

During the current financial year, GPs have only been permitted to prescribe the medication to people with severe obesity defined as a body mass index over 40, alongside certain weight-related health conditions.

From next year, eligibility is expected to expand to include people with a BMI over 35. By 2028, it is anticipated that 220,000 patients will be receiving Mounjaro through the NHS. Lower BMI thresholds apply for some ethnic groups.

Despite these planned expansions, the roll-out to date has been described as uneven, with variation between practices and regions.

Support from obesity advocates – with caveats

Katharine Jenner, Director of the Obesity Health Alliance, welcomed the move but emphasised its limitations.

She said: “This doesn’t mean weight loss drugs will suddenly be available to everyone who wants them.

“NHS access will remain very limited and focused on those with the greatest clinical need, and these treatments are most effective when combined with sustained support.“

She also stressed the importance of prevention alongside treatment:

“If we’re serious about moving from sickness to prevention, expanded treatment must go alongside stronger action to improve the food environment and prevent obesity in the first place.“

Her comments reflect a broader concern within public health that medication alone cannot address the structural drivers of obesity.

Concerns about equity and workload

Dr Katie Bramall, representing the British Medical Association, questioned whether the scheme would meaningfully reduce inequalities in access.

She said: “While the headlines promise much, in reality there will be no change to NHS England’s eligibility criteria for patients to access injectable weight-loss medication on the NHS.

“These proposals will do nothing over the next year to address the divide between those able to pay and those left waiting unable to afford private self-funded treatments“

Similarly, Professor Victoria Tzortziou Brown of the Royal College of GPs emphasised that prescribing decisions are rooted in clinical appropriateness rather than financial drivers.

She said: “GPs do not withhold treatment or prescribe based on financial incentives. Decisions are guided by clinical judgement and what is safest and most appropriate for individual patients.

“Widening the roll-out of these medications in general practice could end up increasing workload in a way that may not be sustainable and risk raising unrealistic expectations among patients who may not be eligible or for whom these medicines are not suitable.“

Her comments highlight the tension between expanding pharmacological options in primary care and managing existing workforce pressures.

A cautious step in a tightly controlled rollout

The introduction of incentive payments signals the government’s intention to embed weight loss pharmacotherapy more firmly within general practice. However, strict eligibility criteria remain in place and access is expected to expand gradually over several years.

While the policy aims to increase NHS provision and reduce reliance on private prescribing, professional bodies and advocacy groups have made clear that the immediate effect will be limited. For now, access continues to be targeted at people with the greatest clinical need, with broader prevention strategies still viewed as essential to addressing obesity at population level.

CCH insight:

It is surprising that GPs need incentivising to prescribe GLP-1 medications like Mounjaro – there is undoubtedly a huge need and demand for these drugs. The reluctance to prescribe them is most likely due to the weight bias that still pervades our society and our health system, the view that people shouldn’t need medication to manage their weight. Referring to these drugs as ‘weight loss jabs’ is not helpful – they are anti-obesity medications. Rather than offer a £3k bonus, GPs should be offered training in understanding obesity as a chronic, relapsing disease, and how GLP-1 medications not only support weight loss but can also improve long-term metabolic and cardiovascular health, and in the long run will save billions of pounds by reducing diabetes and heart disease.

Read More

New Cochrane Review Finds Intermittent Fasting Offers No Clear Weight Loss Advantage

Key Takeaways:

• A major Cochrane review found intermittent fasting did not lead to clinically meaningful weight loss compared with standard dietary advice or no structured diet.
  
• Evidence on safety and long-term outcomes remains limited due to small trials, inconsistent reporting, and short follow-up periods.
  
• Experts caution against overinterpreting social media claims and emphasise the need for individualised, long-term approaches to weight management.
  
  
  

Intermittent fasting under scrutiny

Intermittent fasting has become one of the most widely promoted dietary strategies for weight loss, often presented as a superior alternative to conventional calorie reduction. However, a new Cochrane review suggests that these claims may not be supported by robust evidence.

According to the review, intermittent fasting does not appear to deliver greater weight loss than standard dietary advice or even no specific diet plan. The findings challenge the widespread perception that structured fasting schedules offer a unique or clinically meaningful advantage for people who are overweight or living with obesity.

Obesity remains a global public health challenge

Obesity continues to represent a major public health concern worldwide and is now among the leading causes of death in high-income countries. Data from the World Health Organization show that global adult obesity rates have more than tripled since 1975. By 2022, an estimated 2.5 billion adults were classified as overweight, including around 890 million adults living with obesity.

Against this backdrop, intermittent fasting has gained substantial attention. Eating patterns such as alternate-day fasting, periodic fasting, and time-restricted feeding are widely promoted across social media platforms, often accompanied by claims of rapid weight loss and metabolic benefits.

What the review examined

To assess whether intermittent fasting truly offers an advantage, researchers analysed 22 randomised clinical trials involving 1,995 adults across North America, Europe, China, Australia, and South America. The studies evaluated a range of fasting approaches, including alternate-day fasting, periodic fasting, and time-restricted feeding. Most trials followed participants for up to one year.

When outcomes were compared with those of traditional dietary advice or no dietary intervention, intermittent fasting did not result in a clinically meaningful difference in weight loss. In practical terms, fasting-based approaches did not outperform more conventional strategies.

Limited evidence on safety and long-term outcomes

The review also highlighted substantial limitations in the available evidence. Reporting of side effects varied widely between studies, and many trials were relatively small. Inconsistent data collection made it difficult to draw firm conclusions about safety or potential long-term effects.

As a result, the overall certainty of the evidence was judged to be limited.

“Intermittent fasting just doesn’t seem to work for overweight or obese adults trying to lose weight,” said Luis Garegnani, lead author of the review from the Universidad Hospital Italiano de Buenos Aires Cochrane Associate Centre.

Social media enthusiasm outpaces the evidence

Garegnani also warned against the level of enthusiasm surrounding intermittent fasting online. “Intermittent fasting may be a reasonable option for some people, but the current evidence doesn’t justify the enthusiasm we see on social media.”

A further concern is the lack of long-term research. Few studies have examined outcomes beyond relatively short trial periods. “Obesity is a chronic condition. Short-term trials make it difficult to guide long-term decision-making for patients and clinicians,” Garegnani added.

Generalisability remains uncertain

Most of the studies included in the review primarily involved white participants living in high-income countries. Given that obesity prevalence is rising rapidly in low and middle-income countries, the findings may not fully reflect outcomes in more diverse global populations.

The authors note that responses to intermittent fasting could vary depending on sex, age, ethnic background, underlying health conditions, or existing eating behaviours and eating disorders.

Implications for clinical practice

Given the current state of evidence, the review’s authors advise caution when recommending intermittent fasting as a weight loss strategy.

“With the current evidence available, it’s hard to make a general recommendation,” said Eva Madrid, senior author from the Cochrane Evidence Synthesis Unit Iberoamerica. “Doctors will need to take a case-by-case approach when advising an overweight adult on losing weight.”

Overall, the findings reinforce the need for personalised, sustainable approaches to weight management rather than reliance on highly promoted dietary trends.

Read More

Big Breakfast Study Shows Protein Reduces Appetite While Fibre Supports Gut Microbiome Health

 Key Takeaways: 

• Within a calorie-restricted big-breakfast eating pattern, a higher-protein breakfast improved satiety, while a higher-fibre breakfast produced more favourable gut microbiota and short-chain fatty acid profiles.
  
• Both dietary approaches led to clinically meaningful short-term weight loss and improvements in metabolic markers, but with distinct physiological effects.
  
• Fibre-rich breakfasts were linked to greater abundance of beneficial butyrate-producing bacteria, whereas protein-rich breakfasts may better support appetite control and dietary adherence.
  
  
  

Background and rationale

A recent study published in the British Journal of Nutrition examined how breakfast composition influences appetite regulation, energy balance and markers of gut microbiota health when consumed as part of a calorie-restricted, big-breakfast weight-loss diet.

There is growing evidence that meal timing, in addition to dietary composition, plays an important role in healthy weight management. Previous research has shown that people who eat earlier in the day tend to lose more weight than those who eat later. Morning calorie intake has also been associated with improved blood glucose control and lower hunger levels compared with evening intake.

Larger breakfasts have been shown to improve appetite control, while late eating patterns have been linked to increased hunger and greater fat storage. Despite public health advice emphasising the importance of breakfast for weight management, relatively little is known about what people typically consume in the morning. Moreover, evidence explaining how meal timing, calorie distribution and macronutrient composition interact to influence appetite remains limited.

Study design and dietary interventions

The researchers used a randomised crossover design to compare two calorie-restricted weight-loss diets with identical big-breakfast calorie distribution but differing macronutrient profiles. The primary outcomes were appetite, energy balance and gut microbiota composition and metabolites, rather than clinical gastrointestinal outcomes.

Healthy adults with overweight or obesity, aged 18–75 years, were recruited. The protocol consisted of:

• a four-day ad libitum diet
  
• a four-day maintenance diet
  
• a 28-day high-fibre weight-loss diet or high-protein weight-loss diet
  

These phases were separated by a washout period, with participants acting as their own controls. Resting metabolic rate was measured by indirect calorimetry during screening.

The maintenance diet provided 15% of energy from protein, 55% from carbohydrate and 30% from fat, and was set at 1.5 times resting metabolic rate to maintain body weight. Both weight-loss diets were set at 100% of resting metabolic rate to induce a calorie deficit.

Participants consumed three meals per day, with 45% of daily calories at breakfast, 20% at lunch and 35% in the evening. Lunch intake was allowed ad libitum within the provided calorie allowance.

• High-fibre weight-loss diet – 50% carbohydrate, 15% protein and 35% fat, incorporating both soluble and insoluble fibre sources such as lentils, fava beans, buckwheat and wheat bran.
  
• High-protein weight-loss diet – 30% protein, 35% carbohydrate and 35% fat, using foods including fish, poultry, eggs, red meat and dairy.
  
  
  

Measurements and outcomes assessed

Body density, waist and hip circumference, resting metabolic rate, total body water and blood pressure were measured. The thermic effect of food was assessed every 30 minutes for four hours after breakfast. Subjective appetite was evaluated using visual analogue scales.

Blood samples collected after an overnight fast were used to assess glucose, lipid profile and insulin as metabolic biomarkers rather than clinical disease outcomes. Insulin and glucose values were used to calculate HOMA-IR, HOMA-β and the insulin-to-glucose ratio. Total body water was measured using deuterium dilution, and faecal samples were collected to analyse gut microbiota composition.

Weight loss, energy expenditure and metabolic markers

Nineteen participants completed the study, including two women. The mean age was 57.4 years and the mean body mass index was 33.3 kg/m², indicating a predominantly male cohort and limiting generalisability to broader populations.

Energy intake did not differ significantly between the two weight-loss diets. Average weight loss was 4.87 kg with the high-fibre diet and 3.87 kg with the high-protein diet. Both diets significantly reduced fat mass and fat-free mass compared with the maintenance diet, although loss of fat-free mass was greater with the high-fibre approach.

Total body water was reduced following the high-fibre diet but not after the high-protein diet. Waist and hip circumferences, as well as waist-to-hip ratio, were significantly reduced with both weight-loss diets compared with the maintenance diet.

The high-protein breakfast maintained postprandial satiety, whereas the high-fibre breakfast was associated with reduced satiety after meals. Resting metabolic rate declined significantly after both weight-loss diets. The thermic effect of food was lower following the high-fibre diet than after the high-protein or maintenance meals.

Both weight-loss diets improved lipid profiles relative to baseline, with no significant difference between the two approaches. Fasting and postprandial glucose levels were reduced by around 10% following the high-fibre diet and by 8–7% following the high-protein diet compared with the maintenance diet. Fasting insulin, HOMA-IR and the insulin-to-glucose ratio were significantly lower after both weight-loss diets.

HOMA-β decreased significantly more after the high-protein diet than after the maintenance diet, with no significant change observed after the high-fibre diet.

Gut microbiota composition and short-chain fatty acids

Total bacterial load in faecal samples did not differ significantly between the two weight-loss diets. However, microbial diversity was lower following the high-protein diet compared with the high-fibre diet.

Distinct differences in microbiota composition were observed between the dietary patterns, although individual variation remained a major determinant of microbiota profiles and diet explained only part of the observed variability.

The high-fibre diet was associated with a greater abundance of butyrate-producing bacteria, including Anaerostipes hadrus, Roseburia faecis and Faecalibacterium prausnitzii. At the genus level, Bifidobacterium, Faecalibacterium and Roseburia were linked to the high-fibre diet, while Streptococcus was associated with the high-protein diet.

Total short-chain fatty acids and key faecal short-chain fatty acids, including acetate, butyrate and propionate, were significantly lower with the high-protein diet compared with the high-fibre diet.

Interpretation and clinical implications

Overall, the findings suggest that within a calorie-restricted big-breakfast eating pattern, breakfast composition meaningfully influences short-term weight loss, metabolic health markers and gut microbiota characteristics.

Both dietary approaches led to significant weight reduction and metabolic improvements. The high-protein breakfast produced greater satiation, which may support long-term adherence in some people. In contrast, the high-fibre breakfast promoted a more favourable gut microbiota profile and higher short-chain fatty acid production, which may be beneficial for long-term gut health, although this was inferred from microbial and metabolic markers rather than direct clinical outcomes.

The authors emphasised that longer-term studies are needed to determine whether these differences are sustained over time and how they translate into long-term health outcomes.

Read More

Tirzepatide Not Linked to Increased Depression or Suicidal Ideation in Obesity Trials

Key Takeaways: 

• A post hoc analysis of three SURMOUNT trials found no evidence that tirzepatide increases the risk of depression compared with placebo over 72 weeks.
  
• Rates of suicidal ideation and behaviour were low and similar between tirzepatide and placebo groups, with most reports assessed as low risk.
  
• Experts emphasise the need for routine mental health assessment in people living with obesity, alongside further research in populations with established psychiatric conditions.
  
  
  

Overview of the analysis

Once-weekly subcutaneous tirzepatide was not associated with an increased risk of depression compared with placebo, according to a post hoc analysis of the SURMOUNT clinical trial programme. The findings were published in Obesity and add to the growing body of evidence examining the psychiatric safety of incretin-based therapies used for weight management.

As previously reported by Healio, in January the Food and Drug Administration requested the removal of warnings related to suicidal ideation and behaviours from the labels of several obesity medications, including liraglutide 3 mg (Saxenda), semaglutide 2.4 mg (Wegovy) and tirzepatide (Zepbound).

In the newly published analysis, researchers reported that adults receiving tirzepatide across three SURMOUNT trials did not experience worsening of depression over the course of the studies.

“The low occurrence of these events with tirzepatide is similar to that observed in pooled analyses of semaglutide 2.4 mg and liraglutide 3 mg, both GLP-1 receptor agonists approved for weight management,” said Thomas A. Wadden, PhD, professor of psychology in psychiatry at the Perelman School of Medicine, University of Pennsylvania, in comments to Healio. “The present report provides the first detailed analysis of the risk of these psychiatric events with tirzepatide.”

Study design and assessment methods

The analysis included data from the SURMOUNT-1, SURMOUNT-2 and SURMOUNT-3 studies. Across all three trials, adults living with obesity or with overweight and at least one weight-related comorbidity were randomly assigned to receive once-weekly subcutaneous tirzepatide or placebo for 72 weeks.

Depression symptoms were evaluated using the Patient Health Questionnaire-9 (PHQ-9). Suicidal ideation and behaviour were assessed using the Columbia-Suicide Severity Rating Scale. In addition, investigators recorded neuropsychiatric adverse events during scheduled study visits.

Depression symptoms over time

A total of 4,056 adults were included in the pooled analysis, of whom 63 percent were women and 74 percent were White. Overall, 2,806 participants received tirzepatide and 1,250 received placebo. At baseline, mean PHQ-9 scores were 2.7 in the tirzepatide group and 2.6 in the placebo group, indicating minimal or no depressive symptoms.

By week 72, participants receiving tirzepatide experienced a 0.6-point greater reduction in PHQ-9 score compared with those receiving placebo.

Among participants who had no or minimal depression symptoms at baseline and received tirzepatide, 79.4 percent remained in that category through the end of safety follow-up. During follow-up, 17 percent reported mild symptoms, 2.9 percent reported moderate symptoms, 0.7 percent reported moderately severe symptoms and 0.1 percent reported severe symptoms.

A smaller proportion of participants in the tirzepatide group moved to a more severe depression category compared with the placebo group, 18.2 percent versus 24.3 percent respectively, with this difference reaching statistical significance (P < .001). Conversely, a higher proportion of those receiving tirzepatide moved to a less severe depression category compared with placebo, 52.4 percent versus 41.8 percent (P < .001).

Suicidal ideation and behaviour

At baseline, a history of suicidal ideation or behaviour was reported by 70 participants receiving tirzepatide and 38 participants receiving placebo. Through the end of safety follow-up, 0.6 percent of participants in both the tirzepatide and placebo groups reported suicidal ideation. Most of these events were classified as low risk.

Moderate-risk suicidal ideation was reported by 0.3 percent of participants receiving tirzepatide and 0.1 percent of those receiving placebo. High-risk suicidal ideation occurred in three participants receiving tirzepatide and one participant receiving placebo.

Suicidal behaviour was reported by two participants in the tirzepatide group and by none in the placebo group.

Treatment-emergent nervous system disorder adverse events occurred in 15.8 percent of participants receiving tirzepatide and 13 percent of those receiving placebo. The investigators reported no difference between groups in the occurrence of treatment-emergent psychiatric disorders overall.

Implications for mental health care in obesity

Wadden noted that he and his colleagues supported the FDA decision to remove warnings related to suicidal ideation and behaviour from the labels of incretin-based obesity medications. However, he stressed that mental health assessment remains essential in the care of people living with obesity.

“Persons with obesity, particularly with a BMI of more than 40 kg/m2, are at substantially increased risk of major depression and anxiety disorders,” Wadden said. “It’s critical that they receive the same mental health care that persons of average weight would when presenting with these conditions.”

He also highlighted the need for further research to better understand the effects of incretin-based therapies in people with established psychiatric conditions.

“Randomized trials of the GLP-1 obesity medications largely excluded persons who, in the past 2 years, had experienced major depression, schizophrenia or bipolar disorder, or who had a lifetime history of suicide attempt,” Wadden said. “GLP-1 medications potentially could be beneficial to individuals who suffer from these conditions. Small, carefully controlled studies would appear warranted, as would a close examination of the FDA’s recent retrospective cohort study of more than 2 million individuals. The FDA’s dataset likely included a far greater range of psychiatric status than found in the randomized controlled trials that evaluated tirzepatide and semaglutide for chronic weight management.”

Disclosures

Wadden reports advising for Novo Nordisk and WW and receiving grants on behalf of the University of Pennsylvania from Eli Lilly, Epitomee Medical and Novo Nordisk. All other relevant financial disclosures are reported in the study.

Read More

Obesity Associated With Higher Risk of Severe Infectious Disease, Large Study Finds

Key Takeaways:

• People living with obesity face a substantially higher risk of hospitalisation or death from a wide range of common infections, with risk increasing alongside body weight.
  
• Weight change matters – moving out of obesity is associated with fewer severe infections, while progression into obesity increases risk.
  
• Global estimates suggest that around one in ten infectious disease deaths worldwide may be linked to obesity.
  
  
  

Obesity and severe infection risk across multiple pathogens

A large population-based study has examined the relationship between obesity and the risk of severe infectious diseases, finding that people living with obesity are significantly more likely to be hospitalised or die from common infections. These include influenza, Covid-19, pneumonia, and gastrointestinal and urinary tract infections. For people living with morbid obesity, the risk was approximately three times higher than for people of healthy weight.

“During the pandemic, obesity was widely linked to a higher likelihood of severe Covid-19. We set out to investigate how broadly this link applies across different types of infections and whether any underlying factors contribute to it. Our findings extend beyond any single pathogen, with similar associations observed for bacterial, viral, parasitic and fungal infections,” says one of the article’s lead authors, Solja Nyberg of the University of Helsinki and the Finnish Institute of Occupational Health.

Notably, HIV and tuberculosis were exceptions, with no evidence that obesity increased the risk of severe disease for these infections. The researchers also found that comorbidities, socioeconomic status, and lifestyle factors such as alcohol consumption and physical activity did not explain the increased infection risk associated with obesity.

Weight matters for infection outcomes

Participants were followed for an average of 13–14 years, with body mass index (BMI) measured at baseline. People living with obesity, defined as a BMI of 30 kg/m² or higher, had a 70% greater risk of hospitalisation or death from any infectious disease compared with people of healthy weight, defined as a BMI of 18.5–24.9. The risk increased progressively with higher body weight.

People living with morbid obesity, defined as a BMI of 40 kg/m² or higher, experienced a risk of severe infection three times that of people of healthy weight.

Importantly, changes in body weight over time were also associated with changes in risk. Participants who lost weight and moved from obesity to overweight or healthy weight experienced 20% fewer severe infections compared with those whose obesity persisted. In contrast, weight gain from overweight to obesity was linked to a 30% higher risk of severe infection.

Possible links with immune system dysfunction

“Obesity is a well-known risk factor for diabetes and other chronic diseases. The links now identified indicate that severe infectious diseases should be added to the same list,” says Mika Kivimäki of the University of Helsinki and University College London, who led the study.

“Obesity seems to weaken the immune system’s ability to manage infections, raising the risk of severe disease,” he explains.

Kivimäki also notes that experimental evidence from studies of weight-loss drugs supports a link between obesity and immune function. Reductions in body weight appear to lower the risk of severe infections alongside other health benefits. However, he emphasises that further research is needed to confirm the biological mechanisms underlying these associations.

Obesity and global infectious disease mortality

The researchers analysed data from large Finnish cohorts and the UK Biobank, tracking participants through national health registers. They also incorporated infectious disease mortality data from the Global Burden of Disease study to assess how obesity contributes to infectious disease deaths across countries and regions.

Their analysis suggests that approximately 0.6 million of the 5.4 million infectious disease deaths recorded worldwide in 2023, equivalent to around 11% or one in ten, were associated with obesity.

In the Nordic countries, the estimated proportions of infectious disease deaths linked to obesity were:

• Finland – 19%
  
• Sweden – 13%
  
• Norway – 11%
  
• Denmark – 12%
  

Among high-income countries, the United States recorded the highest proportion in 2023, at 26%.

Importance of vaccination and prevention

The researchers stress that adults living with obesity should ensure their vaccinations are up to date and take up booster doses when offered to groups at higher risk of severe infection.

They also highlight several limitations of the study. As an observational analysis, it cannot establish causality. In addition, participants in the Finnish cohorts and the UK Biobank are not fully representative of the general population, meaning the findings should be generalised with caution.

Read More

Nutrition Gaps Raise Safety Concerns as Use of GLP-1 Weight Loss Drugs Accelerates

Key Takeaways:

• Many people prescribed GLP-1 weight loss medications receive little or no structured nutritional guidance, increasing the risk of preventable vitamin and mineral deficiencies and loss of muscle mass.
  
• New research highlights a lack of high-quality evidence on how diet quality, protein intake, and micronutrient intake are affected during treatment with drugs such as semaglutide and tirzepatide.
  
• Experts warn that without integrated nutritional care, the rapid expansion of GLP-1 drug use could undermine long-term health benefits despite effective weight loss.
  
  
  

Experts from University College London and the University of Cambridge are warning that many people prescribed newer weight loss medications may not be receiving sufficient nutritional guidance to support safe and sustainable weight loss. As a result, some individuals may face avoidable risks, including vitamin and mineral deficiencies and loss of lean body mass, particularly muscle.

The concerns arise from new research published in Obesity Reviews. Led by Dr Marie Spreckley of the University of Cambridge, the review identified limited high-quality evidence on how nutritional advice influences calorie intake, body composition, protein consumption, and patient experiences among people using these medications.

How GLP-1 weight loss drugs work

Drugs such as semaglutide and tirzepatide, sold under brand names including Ozempic, Wegovy, and Mounjaro, work by mimicking the action of glucagon-like peptide-1 (GLP-1). This hormone is released after eating and plays a role in regulating appetite and glucose metabolism. By enhancing feelings of fullness, reducing hunger, and dampening food cravings, these medications can substantially lower energy intake.

Studies suggest that calorie intake may fall by 16–39%, helping to explain why these drugs are highly effective for people living with obesity or overweight. However, the researchers note that there has been very little detailed study of how such reductions affect overall diet quality, protein intake, or micronutrient intake, including vitamins and minerals. Existing evidence indicates that lean body mass, including muscle tissue, can account for as much as 40% of total weight lost during treatment.

Experts warn of risks without nutrition support

Dr Adrian Brown, an NIHR Advanced Fellow at UCL’s Centre of Obesity Research and the study’s corresponding author, described how these medications alter eating behaviour.

“Obesity management medications work by suppressing appetite, increasing feelings of fullness, and altering eating behaviors, which often leads people to eat significantly less. This can be highly beneficial for individuals living with obesity, as it supports substantial weight loss and improves health outcomes.

“However, without appropriate nutritional guidance and support from healthcare professionals, there is a real risk that reduced food intake could compromise dietary quality, meaning people may not get enough protein, fiber, vitamins, and minerals essential for maintaining overall health.”

Without structured support, reduced intake may unintentionally lead to inadequate consumption of nutrients needed to preserve muscle mass, bone health, immune function, and overall physical resilience.

Public guidelines versus private use

Guidance from the National Institute for Health and Care Excellence recommends semaglutide for weight management only for people who meet strict eligibility criteria, such as a body mass index of at least 35.0 kg/m² alongside obesity-related comorbidities including type 2 diabetes or cardiovascular disease. When prescribed through the NHS, the medication is intended to be delivered as part of a comprehensive programme that includes dietary changes and increased physical activity.

In reality, most people currently using GLP-1 drugs in the UK obtain them outside the NHS. An estimated 1.5 million people are now using these medications, with around 95% accessing them through private providers. In these settings, ongoing nutritional advice and follow-up support are not always consistently offered.

Rising use outpaces nutrition guidance

Dr Spreckley, who works at the Medical Research Council Epidemiology Unit at the University of Cambridge, said nutritional care has not kept pace with the rapid uptake of these therapies.

“Use of GLP-1 receptor agonist therapies has increased rapidly in a very short period of time, but the nutritional support available to people using these medications has not kept pace. Many people receive little or no structured guidance on diet quality, protein intake, or micronutrient adequacy while experiencing marked appetite suppression.

“If nutritional care is not integrated alongside treatment, there’s a risk of replacing one set of health problems with another, through preventable nutritional deficiencies and largely avoidable loss of muscle mass. This represents a missed opportunity to support long-term health alongside weight loss.”

Low intakes of essential vitamins and minerals are associated with fatigue, impaired immune function, hair loss, and increased risk of osteoporosis. Loss of lean mass, most commonly muscle, can also raise the likelihood of weakness, injuries, and falls, particularly in older adults.

Limited research leaves major questions unanswered

The review identified only 12 studies that examined diet and nutritional outcomes alongside treatment with semaglutide or tirzepatide. These studies differed widely in how dietary advice was delivered and how nutritional outcomes were measured. Many lacked standardised methods and consistent reporting, making it difficult to draw firm conclusions about best practice.

Despite the rapid expansion of GLP-1 drug use, the researchers found little robust evidence to guide clinicians on how to support people nutritionally during treatment.

Lessons from bariatric nutrition care

Given the urgent need for practical guidance, the researchers suggest that interim lessons could be drawn from nutritional care used after bariatric surgery. Procedures such as gastric banding and gastric bypass lead to similar reductions in appetite and food intake.

Dr Cara Ruggiero, a co-author from the MRC Epidemiology Unit at the University of Cambridge, said established post-surgery principles could help address current gaps.

“While GLP-1 receptor agonists are increasingly used, there remains a clear gap in structured nutritional guidance. In the interim, we can draw on well-established post-bariatric nutrition principles. Our previous work highlights the importance of prioritizing nutrient-dense foods including high-quality protein intake, ideally distributed evenly across meals, to help preserve lean mass during periods of reduced appetite and rapid weight loss.”

The available evidence did not support recommending strict low-fat diets alongside GLP-1 therapies. However, some observational studies reported that people using these medications consumed relatively high amounts of total and saturated fat, suggesting a potential need for personalised guidance that aligns with national dietary recommendations.

Meal timing was rarely examined in clinical trials. Nevertheless, the researchers note that eating smaller meals more frequently may help manage side effects such as nausea and improve tolerability, particularly during the early stages of treatment.

Studying real-world experiences

The research team also emphasised the importance of incorporating the perspectives of people using GLP-1 medications into future studies. Understanding what types of information and support individuals find most helpful could improve real-world care and long-term outcomes.

To address this, the team has launched AMPLIFY – Amplifying Meaningful Perspectives and Lived experiences of Incretin therapy use From diverse communitY voices. The project aims to explore how people experience next-generation weight loss medications in everyday life.

“These medications are transforming obesity care, but we know very little about how they shape people’s daily lives, including changes in appetite, eating patterns, well-being, and quality of life,” Dr Spreckley said. “That’s what we’ll explore, working in particular with people from communities historically under-represented in obesity research, to help shape the future of obesity treatment.”

The research was funded by the National Institute for Health and Care Research, with additional support from the Medical Research Council and the NIHR UCLH Biomedical Research Centre.

CCH insights:

GLP-1 medications are licensed for the treatment of diabetes and obesity and they should be used alongside diet and lifestyle advice to improve cardiometabolic health. However, they are now commonly known as ‘weight loss drugs’, implying their primary aim is for people to lose weight. But this is kind of missing the point – the weight loss outcome is one of the mediating effects of the drugs which leads to improved health. However, if weight loss is not accompanied by a move to a healthy diet, which provides adequate levels of essential nutrients, then health outcomes will be compromised, as highlighted by this study.

Read More

Economic Survey Urges Tougher Action on Ultra-Processed Foods as Obesity and Heart Disease Risks Rise in India

Key Takeaways: 

• India’s Economic Survey links rising consumption of ultra-processed foods with increasing risks of obesity, heart disease, diabetes and mental health conditions.
  
• The survey recommends stronger policy measures, including higher taxes, stricter labelling and limits on advertising, particularly to protect children and young people.
  
• Rapid growth in ultra-processed food sales has coincided with a marked rise in overweight and obesity rates across adults and children in India.
  
  
  

Growing concern over ultra-processed food consumption

India’s latest Economic Survey has flagged the rapid growth in the consumption of ultra-processed foods and its implications for public health, recommending that the government consider increasing taxes on products that exceed defined nutritional thresholds, alongside a broader package of regulatory measures.

Tabled in Parliament, the survey draws attention to mounting evidence linking ultra-processed foods with poorer diet quality and higher risks of obesity, diabetes, heart disease and mental health conditions.

“There is a growing body of evidence on the impact of UPFs on human health, indicating that there should be no delay in implementing public health policies while further research continues to unfold,” the survey said.

What are ultra-processed foods?

Ultra-processed foods are industrially manufactured products that undergo multiple stages of processing and typically contain additives not commonly used in home cooking. These include preservatives, flavour enhancers, emulsifiers, colours and sweeteners.

They are generally high in fat, sugar and salt, while being low in fibre and essential nutrients. Common examples include packaged snacks, instant noodles, sugary drinks, reconstituted meat products and ready-to-eat meals.

Rising obesity across adults and children

The survey highlights concerning trends in overweight and obesity across India’s population. According to the National Family Health Survey 2019–21, 24 percent of women and 23 percent of men are living with overweight or obesity. Among women aged 15–49 years, 6.4 percent are living with obesity, compared with 4 percent of men.

Excess weight among children under five has also increased, rising from 2.1 percent in 2015–16 to 3.4 percent in 2019–21.

Looking ahead, the survey warns that the scale of the problem is likely to grow substantially. It cites estimates that more than 33 million children in India were living with obesity in 2020, with this figure projected to rise to 83 million by 2035.

A rapidly expanding market

India has emerged as one of the fastest-growing markets for ultra-processed foods. The survey notes that sales increased by more than 150 percent between 2009 and 2023, while retail sales rose from around $0.9 billion in 2006 to nearly $38 billion in 2019, representing a forty-fold increase.

“It is during the same period that obesity nearly doubled in both men and women,” the survey said.

Health and economic costs

Drawing on evidence from the Lancet Series on Ultra-Processed Foods and Human Health, the survey reports that high intake of ultra-processed foods is associated with obesity, heart disease, diabetes, respiratory conditions and mental health disorders.

Beyond health impacts, it notes substantial economic consequences, including higher healthcare spending, productivity losses and long-term fiscal pressures on the health system.

Marketing practices under scrutiny

The survey raises concerns about marketing strategies that encourage overconsumption of ultra-processed foods. These include the use of celebrity endorsements and messaging that presents such products as healthy options.

It highlights evidence showing that children and adolescents exposed to this advertising report greater desire and intention to consume ultra-processed foods.

“Policies have so far focused on advocacy to reduce consumption of foods high in added fats, sugar, and sodium, many of which are UPFs. However, improving diets cannot depend solely on consumer behaviour change; it will require coordinated policies across food systems that regulate UPF production, promote healthier and more sustainable diets and marketing,” the survey said.

Existing policies and regulatory gaps

The Economic Survey refers to the National Multi-sectoral Action Plan for non-communicable diseases, which set a target to halt the rise in obesity by 2025. Proposed measures include front-of-pack labelling and restrictions on advertising foods high in fat, sugar and salt.

It also cites the 2024 dietary guidelines issued by the Indian Council of Medical Research-National Institute of Nutrition, which explicitly warn against the consumption of ultra-processed foods.

However, the survey points to gaps in enforcement. While current advertising rules prohibit misleading claims, they do not define such claims using nutrient-based criteria, allowing companies to continue making broad or vague health and energy claims.

“This regulatory ambiguity highlights a critical policy gap that needs reform,” it said.

Proposed measures, including advertising restrictions

Building on recommendations made in last year’s Economic Survey, the latest report outlines a more detailed set of policy options. These include exploring a time-based ban on advertising ultra-processed foods from 6am to 11pm across all media platforms, including digital channels, and restricting sponsorship of school and college events by manufacturers.

On food labelling, the survey refers to a multi-sector statement endorsed by 29 organisations that supports warning labels rather than rating systems such as health stars. “Studies have shown that warning labels are the most effective option for discouraging UPF consumption,” it said.

The survey also suggests a nutrient-based tax approach, including applying the highest GST slab and an additional surcharge on ultra-processed foods that exceed thresholds for sugar, salt or fat. It proposes that revenues from such taxes be earmarked for public health programmes.

Call for a multi-pronged response

In conclusion, the Economic Survey reiterates that “a multi-pronged approach is necessary” to address the growing burden of diet-related disease. It calls on the Food Safety and Standards Authority of India to clearly define ultra-processed foods, set enforceable standards, strengthen labelling requirements and increase public awareness, particularly among young people.

Taken together, the recommendations reflect a shift towards more assertive regulation of ultra-processed foods as part of India’s wider strategy to curb obesity and reduce the long-term burden of non-communicable diseases.

CCH insights:

India has undergone a typical ‘nutrition transition’ over the past 20 years. Rapid economic growth and development, accompanied by globalisation of food manufacturing and mass access to online advertising, have lead to the adoption of many aspects of the western diet and the associated non-communicable diseases. We applaud the government’s plans to introduce a multi-sectoral action plan to reduce UPF consumption, but we know from other countries that these tend to have limited effects, and UPFs are just one part of a very complex puzzle of rising obesity rates.

Read More

Combination of Hormone Therapy and Tirzepatide Linked to Greater Weight Loss After Menopause, Study Finds

Key Takeaways:

• Postmenopausal women using menopausal hormone therapy alongside tirzepatide lost around 35% more weight than those using tirzepatide alone in an observational study.
  
• The findings suggest a potential interaction between hormone therapy and GLP-1-based obesity medications, although causality cannot be confirmed.
  
• Researchers say the results warrant randomised clinical trials to explore mechanisms and broader cardiometabolic effects.
  
  
  

Weight management challenges after menopause

A new study led by researchers at Mayo Clinic suggests that combining menopausal hormone therapy with tirzepatide may be associated with substantially greater weight loss in postmenopausal women. The findings, published in The Lancet Obstetrics, Gynaecology, & Women’s Health, indicate that women receiving hormone therapy lost around 35% more weight while taking tirzepatide compared with those treated with tirzepatide alone.

Tirzepatide is approved by the US Food and Drug Administration for the treatment of overweight and obesity. The study’s authors say the results could expand treatment options for the many women who experience weight gain and related health risks following menopause.

Menopause is associated with accelerated age-related weight gain and a higher likelihood of developing overweight or obesity, both of which are major risk factors for cardiovascular disease, type 2 diabetes, and other long-term conditions. In addition to changes in body weight, the decline in oestrogen levels that occurs during menopause is also linked to physiological changes that may independently increase cardiovascular risk.

“This study provides important insights for developing more effective and personalized strategies for managing cardiometabolic risk in postmenopausal women,” says Regina Castaneda, MD, postdoctoral research fellow at Mayo Clinic and first author of the study.

Hormone therapy and obesity treatments

Menopausal hormone therapy is considered the most effective first-line treatment for common menopausal symptoms, such as hot flashes and night sweats, which affect up to 75% of postmenopausal women. Despite its widespread use, evidence on how hormone therapy may interact with pharmacological obesity treatments remains limited.

Previous research has suggested that postmenopausal women using hormone therapy may experience greater weight loss when treated with semaglutide, another GLP-1-based medication for obesity. However, until now, no studies had specifically examined whether hormone therapy might influence outcomes in people treated with tirzepatide.

To explore this question, Dr Castaneda and colleagues reviewed data from 120 participants with overweight or obesity who had received tirzepatide for weight management for at least 12 months. Outcomes among participants who were also using menopausal hormone therapy were compared with those of participants with similar characteristics who were not receiving hormone therapy.

Findings and limitations

According to the researchers, women using both treatments experienced markedly greater weight loss than those using tirzepatide alone.

“In this observational study, women who used menopausal hormone therapy lost about 35% more weight than women taking tirzepatide alone. Because this was not a randomized trial, we cannot say hormone therapy caused additional weight loss,” says Maria Daniela Hurtado Andrade, MD, PhD, endocrinologist at Mayo Clinic and senior author of the study.

She adds that other factors may partly explain the difference observed between the groups.

“It is possible that women using hormone therapy were already engaged in healthier behaviors, or that menopause symptom relief improved sleep and quality of life, making it easier to stay engaged with dietary and physical activity changes.”

The authors emphasise that, as an observational analysis, the study cannot establish a causal relationship between hormone therapy and enhanced weight loss. Nonetheless, they argue that the size of the observed difference is clinically meaningful.

Possible biological synergy

Dr Castaneda notes that the findings align with emerging preclinical evidence suggesting a biological interaction between oestrogen and GLP-1-based therapies.

“The magnitude of this difference warrants future studies that could help clarify how GLP-1-based obesity medications and menopausal hormone therapy may interact. Interestingly, preclinical data suggest a potential synergy, with estrogen appearing to enhance the appetite-suppressing effects of GLP-1,” she says.

Such a mechanism could help explain why women receiving hormone therapy appeared to derive additional benefit from tirzepatide in this study.

Next steps for research

The research team plans to build on these findings through more rigorous study designs.

“Next, we plan to test these observations in a randomized clinical trial and determine if benefits extend beyond weight loss – specifically, whether hormone therapy also enhances the effects of these medications on cardiometabolic measures,” says Dr Hurtado Andrade. “If confirmed, this work could speed the development and adoption of new, evidence-based strategies to reduce this risk for millions of postmenopausal women navigating this life stage.”

The study was funded by the Mayo Clinic Center for Women’s Health Research. The full publication includes a complete list of authors, disclosures, and funding sources.

CCH insight:

This is an interesting study, but as the authors state, no conclusions can be drawn from the findings. But it does raise many questions about the possible potential synergistic effects of oestrogen and GLP-1 therapy. Establishing whether cardiometabolic benefits of GLP-1 medications are amplified, as well as weight loss, should be a priority.

Read More

Dietary Melatonin Intake Linked to Lower Rates of Obesity and Depression

Key Takeaways: 

• Higher intake of melatonin from foods was associated with lower prevalence of obesity and depression in a large cohort of Brazilian university graduates.
  
• No significant associations were found between dietary melatonin intake and most cardiometabolic outcomes, including hypertension, metabolic syndrome or type 2 diabetes.
  
• The strongest associations were observed at moderate rather than very high levels of dietary melatonin intake, highlighting the complexity of diet–health relationships.
  
  
  

Background and study context

In a study published in the Journal of Human Nutrition and Dietetics, researchers examined the melatonin content of commonly consumed foods and explored how dietary melatonin intake was associated with a range of health outcomes. The analysis used cross-sectional data from a large cohort of Brazilian university graduates.

Melatonin is a hormone best known for regulating circadian rhythms and sleep–wake cycles. Beyond its endogenous production, melatonin is also present in both animal-based and plant-based foods. Experimental, observational and supplementation studies have linked melatonin to sleep regulation, mood, and metabolic health. Although the concentration of melatonin in foods is considerably lower than in supplements, diets rich in melatonin-containing foods have been shown to increase circulating melatonin levels within physiological ranges.

Previous evidence suggests that increasing melatonin intake through food may deliver doses that align more closely with natural circadian rhythms than pharmacological supplementation, potentially avoiding suprapharmacological exposure. On this basis, dietary melatonin has attracted interest as a marker of broader dietary patterns rather than as a direct therapeutic intervention.

Rationale for examining dietary melatonin

Obesity, depression and sleep disorders represent a substantial and growing public health burden. Prior observational and experimental studies have suggested that melatonin may have protective effects against inflammatory, metabolic and neurobehavioural outcomes. In addition, observational research has reported inverse associations between melatonin exposure and outcomes such as liver cancer incidence and all-cause mortality.

Despite this, relatively few studies have investigated habitual dietary melatonin intake or its associations with chronic conditions in adult populations. The present study aimed to address this gap by estimating melatonin intake from the diet and examining its relationship with multiple health outcomes in a large cohort.

Study design and population

The analysis drew on data from the Cohort of Universities of Minas Gerais (CUME+) study. CUME+ is an open, prospective cohort designed to assess the impact of dietary patterns and nutrition transition on noncommunicable diseases.

At baseline, participants completed a questionnaire administered in two parts. The first part collected information on sociodemographic characteristics, clinical history, lifestyle factors, anthropometric measures and self-reported morbidity.

Dietary assessment and estimation of melatonin intake

The second part of the baseline assessment included a food frequency questionnaire (FFQ), alongside questions on dietary habits, supplement use and cooking practices. Nutrient intake was estimated using established food composition tables.

Dietary melatonin content was estimated based on values reported in the scientific literature for individual food items. These estimates were then adjusted for total energy intake to account for differences in overall food consumption between participants.

Health outcomes and definitions

The health outcomes assessed in the study included obesity, obstructive sleep apnoea (OSA), hypertension, metabolic syndrome (MetS), type 2 diabetes (T2D), sleep duration, dyslipidaemia and depression.

Obesity was defined as a body mass index of 30 kg/m² or higher. Depression and OSA were identified based on self-reported medical diagnoses.

Dyslipidaemia was defined as the presence of at least one abnormal lipid parameter, including total cholesterol of 200 mg/dL or higher, triglycerides of 150 mg/dL or higher, high-density lipoprotein cholesterol below 40 mg/dL for males or below 50 mg/dL for females, or low-density lipoprotein cholesterol of 130 mg/dL or higher.

Cardiometabolic criteria

Metabolic syndrome was defined as central obesity plus any two of the following criteria: elevated triglycerides or treatment for hypertriglyceridaemia, reduced high-density lipoprotein cholesterol or treatment, elevated blood pressure or treatment for hypertension, and elevated fasting plasma glucose or a diagnosis of type 2 diabetes.

Hypertension was defined by the use of antihypertensive medication, a physician diagnosis, systolic blood pressure of 140 mmHg or higher, or diastolic blood pressure of 90 mmHg or higher. Type 2 diabetes was defined as a self-reported or physician diagnosis, use of antidiabetic medication, or fasting plasma glucose of 126 mg/dL or higher.

Sleep duration was categorised as short if participants reported sleeping less than seven hours per day, and normal if they reported seven hours or more per day.

Statistical analysis

Associations between dietary melatonin intake and health outcomes were estimated using logistic and Poisson regression models. Analyses were adjusted for a wide range of potential confounders, including age, sex, family income, binge drinking, smoking status, screen time, physical activity, medication use and sleep duration.

Participant characteristics

The final analysis included 8,320 participants with a mean age of 35.9 years. Most participants were female and reported that they did not smoke. Around one third of the cohort reported short sleep duration.

Dyslipidaemia, depression, obesity and hypertension were the most commonly reported health conditions within the study population.

Melatonin content of foods and dietary sources

Melatonin content was estimated for 119 of the 144 food items included in the FFQ. Reported concentrations ranged from 0 to 169.9 ng per gram of food. Mean daily melatonin intake was estimated at 25,554.7 ng and was significantly higher in males than in females.

The main dietary sources of melatonin in this population were coffee, lentils and beans, and rice. Higher melatonin intake was associated with lower intake of protein, cholesterol, and saturated and monounsaturated fats, alongside higher intake of fibre and carbohydrates. These patterns suggest that dietary melatonin intake may reflect broader differences in dietary composition.

Associations with health outcomes

After full adjustment, no significant associations were observed between dietary melatonin intake and obstructive sleep apnoea, hypertension, metabolic syndrome or type 2 diabetes. Initial associations with sleep duration and dyslipidaemia were attenuated after adjustment for age and sex and did not remain statistically significant.

In contrast, dietary melatonin intake showed an inverse association with both obesity and depression. Participants with daily melatonin intakes between approximately 14,900 and 34,400 ng were less likely to have obesity, while intakes between approximately 14,900 and 25,000 ng were associated with a lower likelihood of depression.

Notably, the strongest associations were observed in intermediate intake quintiles rather than among those with the highest melatonin intake, suggesting a non-linear relationship.

Conclusions and implications

In this cohort of Brazilian university graduates, higher dietary melatonin intake was associated with lower prevalence of obesity and depression, while no significant associations were identified for most other cardiometabolic outcomes or sleep duration.

The findings support existing hypotheses that dietary melatonin may play a role in metabolic and neurobehavioural regulation, potentially through anti-inflammatory pathways. However, the cross-sectional design of the study means that causal relationships cannot be established.

Further longitudinal and experimental research is needed to confirm these associations, determine whether dietary melatonin has an independent effect beyond overall dietary patterns, and clarify the biological mechanisms that may underlie the observed relationships.

CCH insights:

This is an interesting study, but it is difficult to see where this research leads to. If a person is suspected of having obesity, depression or some other condition due to a lack of melatonin, the solution is surely likely to be supplementation of melatonin, not an increase in melatonin-rich foods – because dietary changes are notoriously difficult to adhere to and when we are looking at just one nutrient, supplementation is a much easier option.

Read More