Obesity Care Tag

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.

Helping patients hold on to those gains over the long term – and navigate the setbacks a relapsing condition brings – is the focus of professional training such as the College of Contemporary Health’s Behaviour Change Skills: Applying CBT in Practice, a CPD-accredited online short course.

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 will have major implications for long-term obesity care in the future. Because sustaining weight loss is where obesity care so often succeeds or fails, CCH’s Behaviour Change Skills: Applying CBT in Practice CPD short course (2 CPD hours, fully online, CPD-accredited) equips healthcare professionals with cognitive and behavioural techniques to help patients maintain progress, handle setbacks and make change stick.

Explore Behaviour Change Skills: Applying CBT in Practice →

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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Breastfeeding for Three Months or More Linked to Lower Long-Term Weight Gain in Women

Key Takeaways: 

• Women who breastfeed for at least three months may gain significantly less weight later in life, with differences observed decades after childbirth.
  
• The strongest long-term effect is seen in women who had overweight or obesity before pregnancy.
  
• Breastfeeding appears to influence energy balance, although individual responses vary and support remains essential.
  
  
  

Long-term impact of breastfeeding on weight

Breastfeeding has long been associated with short-term postpartum weight changes, but new research suggests its effects may extend much further. A study conducted by researchers at the University of Oslo indicates that women who breastfeed for at least three months may experience lower weight gain even decades later.

According to the findings, women gained up to 6.5 kilograms less on average later in life if they breastfed for a minimum of three months. This extends the understanding of breastfeeding beyond its immediate postpartum benefits, highlighting its potential role in long-term weight trajectories.

Previous research has largely focused on weight changes in the first one to two years after childbirth. In contrast, this study followed women for up to 50 years after they had stopped breastfeeding, offering a rare insight into lifelong health patterns. The findings are expected to inform further research into maternal cardiovascular risk.

Large-scale study provides robust data

The analysis drew on data from the Women and Health Study, which includes more than 170,000 women in Norway. The results were published in the American Journal of Clinical Nutrition. 

This large cohort allowed researchers to examine how breastfeeding duration relates to weight development across different groups of women, while accounting for factors such as education, physical activity, and smoking.

Strongest effect seen in women with overweight

The most pronounced differences were observed among women who had overweight or obesity in early adulthood, prior to pregnancy.

“We compared women in this group who were otherwise similar in terms of education level, physical activity and smoking. We then found that those who breastfed for three to 15 months gained on average up to 6.5 kilos less from young adulthood to middle age, compared with those who breastfed little,” says Thorbjørn Brun Skammelsrud.

Skammelsrud is completing his doctoral research at the Department of Nutrition, Institute of Basic Medical Sciences at the University of Oslo.

More modest differences in women with normal weight

Among women who had a normal weight in early adulthood, the long-term effect of breastfeeding was still present but less pronounced. Those who breastfed for three to 15 months gained up to 3 kilograms less compared with those who breastfed for shorter periods.

For women who had been underweight before pregnancy, breastfeeding appeared to have little influence on long-term weight outcomes.

Biological mechanisms and individual variation

The study also highlights the complex relationship between breastfeeding and energy balance.

“Breastfeeding increases energy expenditure, so in theory breastfeeding should contribute to weight loss. But precisely because energy expenditure increases, some women will also experience increased appetite when they are breastfeeding,” Skammelsrud explains.

This means that while breastfeeding may support weight regulation at a population level, individual experiences can differ significantly.

Implications for public health

The study included women who had children as early as the 1940s, although the association between breastfeeding and lower weight was strongest among those who gave birth after 1980. This group is considered more representative of current maternal behaviours, particularly in terms of diet and breastfeeding practices.

In Norway, national guidance generally recommends partial breastfeeding for one year or longer, provided both mother and infant are comfortable. Breastfeeding rates in Norway are relatively high compared with many other countries.

“This is positive for public health. At the same time, the study shows that some women may need extra follow-up after giving birth, particularly those with overweight or obesity,” Skammelsrud says.

Offering that kind of tailored follow-up draws on a solid grounding in nutrition and weight management – the focus of professional training such as the College of Contemporary Health’s Nutrition & Weight Management Essentials, a CPD-accredited online short course.

Supporting women who choose to breastfeed

The findings reinforce the importance of enabling and supporting breastfeeding where desired.

“In this study, we see that breastfeeding for at least three months has a positive effect on women’s weight later in life. It is therefore important that breastfeeding is facilitated, and that women who wish to breastfeed are offered qualified support,” the researcher says.

Ensuring access to appropriate guidance and support may help maximise both short-term and long-term health outcomes for women.

CCH insight

As this study shows, supporting women’s weight – particularly those with overweight or obesity – calls for a firm grasp of nutrition and energy balance across the life course. CCH’s Nutrition & Weight Management Essentials CPD short course (10 hours, fully online, CPD-accredited) gives healthcare professionals a solid grounding in the fundamentals of nutrition and the practical methods that help patients achieve and sustain a healthier weight.
Explore Nutrition & Weight Management Essentials →

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Whole Milk and Childhood Obesity – New Study Challenges Long-Standing Dietary Advice

Key Takeaways:

• Children who consumed whole-fat milk in early childhood showed lower odds of living with obesity in later childhood compared with those consuming reduced-fat options
  
• The study found no evidence that whole milk increases adiposity, challenging decades of low-fat dietary guidance
  
• Researchers suggest milk fat may influence satiety and overall dietary patterns, although mechanisms remain unclear
  
  
  

Rethinking milk fat and childhood health

New research from the University of Toronto suggests that children who consume whole-fat milk during early childhood may have a lower likelihood of living with obesity in middle childhood than those who drink reduced-fat milk.

These findings contribute to a growing body of evidence indicating that lower-fat milk may not provide the protective effect against childhood obesity that has long been assumed. For several decades, dietary guidelines in many countries have promoted low-fat dairy products. For example, Canada’s Dietary Guidelines in 2019 continued to recommend reduced-fat options, reflecting a broader historical focus on reducing dietary fat intake.

Study overview and design

The study, published in the American Journal of Clinical Nutrition, is described as one of the most comprehensive analyses to date examining the relationship between milk consumption and childhood obesity over time.

Researchers, including former postdoctoral fellow Tara Zeitoun and doctoral student Zheng Hao Chen, analysed data from the CHILD Cohort Study. This large, prospective study tracks health data from thousands of children from before birth through to adolescence.

Caregivers reported the type of milk consumed by children, including skim, one per cent, two per cent, and whole-fat milk. Researchers then assessed a range of outcomes at ages five and eight, including:

• Body mass index (BMI)
• Waist-to-height ratio
• Fat mass
• Preclinical and clinical obesity status
  
  
  

Key findings

Milk consumption was common among participants, with over 90 per cent of children consuming milk before the age of five. Among these:

• 24 per cent consumed whole-fat milk
• Approximately half consumed less than one cup per day
  

Despite relatively modest intake, notable differences emerged. Children who consumed whole milk at age five had significantly lower BMI at age eight. They also had 69 per cent lower odds of living with obesity compared with children who consumed skim milk.

In addition, researchers identified a broader pattern in which higher milk fat content was associated with more favourable adiposity profiles.

Expert insight

Kozeta Miliku, a professor of nutritional sciences at the University of Toronto’s Temerty Faculty of Medicine and a researcher at the Joannah and Brian Lawson Centre for Child Nutrition, emphasised the implications of these findings:

“The most important learning from this study is that whole milk was not associated with higher adiposity or obesity risks risk in children, and may even be linked to healthier growth patterns,”

She also highlighted the limitations of focusing narrowly on fat reduction:

“Switching to lower-fat milk has been about cutting fat in the diet, but that may miss the bigger picture,” says Miliku. “When we think about healthy growth, it’s important to consider the overall nutritional context. Removing fat does not automatically make skim milk a healthier choice for children.”

Implications for public health guidance

The findings raise important questions about long-standing public health recommendations. Prior to 2019, Health Canada advised that children transition from whole milk to reduced-fat milk from the age of two. Similarly, the Dietary Guidelines for Americans 2020–2025 supported reduced-fat dairy intake.

However, recent policy developments suggest a shift in thinking. In the United States, the Whole Milk for Healthy Kids Act has allowed full-fat milk to be reintroduced into school lunches, aligning with updated national guidance that is more permissive of full-fat dairy.

Possible biological mechanisms

While the study did not directly investigate underlying mechanisms, the researchers proposed several hypotheses:

• Milk fat may enhance satiety, potentially reducing the consumption of energy-dense, nutrient-poor foods
• It may influence overall energy balance
• It could play a role in metabolic pathways linked to growth and nutritional status
  

These potential explanations highlight the complexity of dietary patterns and suggest that focusing on single nutrients may overlook broader physiological effects.

The need for further research

Miliku noted that additional research is needed to better understand how milk fat may influence obesity risk and whether any protective effects persist into adolescence and adulthood.

With Canada’s 2019 dietary recommendations offering limited specific guidance on milk consumption for children, the study’s findings may help inform future discussions among parents, clinicians, and policymakers.

A broader view of healthy diets

Miliku concluded by reinforcing the importance of overall dietary quality:

“Whole fat milk can be part of a healthy diet and does not on its own increase obesity risk,” she adds. “And it’s important to think about the overall quality of the diet – the fruits and vegetables, whole grains and protein-rich foods they consume.”

Funding and support

The research was funded by the Canadian Institutes of Health Research and the Joannah & Brian Lawson Centre for Child Nutrition at the University of Toronto, supported through a donation by President’s Choice Children’s Charity.

CCH insights:

This interesting new research will hopefully be the trigger for governments and public health bodies to review and amend their outdated advice to choose low-fat dairy options instead of full-fat. The reductionist approach to nutrition, which considers food just in terms of calories and individual nutrients, is an oversimplification which does not help our understanding of the relationship between food and health. If the best food for children early in life is whole milk, why would it be beneficial for them to suddenly switch to low-fat milk at the age of 2?

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Visual Signals, Healthier Choices – Study Shows Colour-Coded Labels Influence Consumer Decisions

Key Takeaways:

• Colour-coded nutrition labels are more effective than traditional tables in guiding healthier food choices
  
• Red warning signals have a stronger behavioural impact than green positive cues, reflecting a “negative bias” in decision-making
  
• Simple visual labelling systems may support public health efforts to address obesity and poor dietary habits
  
  
  

The growing use of colour-coded nutrition labels

Colour coding on food packaging is becoming increasingly common, particularly as policymakers and manufacturers seek ways to guide consumers towards healthier dietary choices. A recent study conducted by researchers from SWPS University, the University of Wisconsin, and the University of Massachusetts suggests that these visual systems are significantly more effective than traditional nutritional tables.

The findings, published in Current Psychology, indicate that the effectiveness of colour-coded labels lies in how the brain processes signals of benefit and risk. Rather than requiring effortful interpretation, colour cues allow for rapid, intuitive judgements about a product’s healthfulness.

Obesity and the need for clearer nutritional guidance

According to the World Health Organization, overweight and obesity are major contributors to the development of chronic diseases. Over the past three decades, the proportion of children and adolescents in the United States who are overweight or at risk has more than tripled, reaching 37% and 34% respectively.

This trend has been driven largely by reduced physical activity and the increased consumption of foods high in fat and sugar. In response, clearer and more accessible nutritional labelling systems are being explored as tools to help people make more informed food choices.

How traffic light labelling works

One widely adopted approach is the traffic light labelling (TLL) system, originally developed in the United Kingdom. This system uses colours to indicate the levels of key nutrients such as calories, fat, saturated fat, sugar, and salt relative to recommended intake levels.

• Green indicates low levels, typically below 15% of the reference intake
  
• Red signals high levels, typically exceeding 25% of the reference intake

By translating numerical data into easily recognisable visual cues, the system allows consumers to assess a product’s nutritional profile at a glance.

“A picture is worth a thousand words”

The study aimed to explore the psychological mechanisms behind how people interpret these colour-coded labels.

“We decided to investigate the psychological mechanisms behind the reading of color-coded product labels. We drew on theories about verbal and visual information processing, as well as the perception of information in positive and negative contexts. We wanted to bridge a gap. Previous studies focused exclusively on consumer purchasing behavior and analyzed the extent to which color-coded labels influenced the choice of healthy food products,” says Professor Andrzej Falkowski, a business psychologist from the Institute of Psychology at SWPS University and the author of the study.

To examine this, researchers recruited 79 participants in the United States via Amazon Mechanical Turk. Participants were asked to evaluate products such as chicken noodle soup, ranch dressing, and peanut butter. These products were presented either with colour-coded nutrient indicators or with traditional text-based information.

Participants rated each product on a scale from 0 to 10, where 0 indicated “harmful” and 10 indicated “healthy”.

Faster processing, more intuitive decisions

The findings confirmed that visual information is easier for people to process than text. Colour cues are interpreted almost instantly by the brain, requiring minimal cognitive effort.

This enables individuals to make quick, instinctive judgements about whether a product is beneficial, even in time-pressured situations such as shopping. In contrast, traditional nutritional tables require more deliberate analysis, which may reduce their practical usefulness in real-world settings.

The power of red and the role of negative bias

One of the most striking findings was the disproportionately strong influence of the colour red. While green highlights positive attributes, red signals high levels of fat or sugar and prompts caution.

“This result also aligns with existing theories suggesting that negative events exert a stronger influence on behavior than positive ones. It is this ‘negative bias’ that makes color systems so effective. Red causes us to pause and reconsider a purchase,” Professor Falkowski emphasizes.

This asymmetry – where negative signals carry more weight than positive ones – was not observed with traditional labelling formats. Without clear visual cues, participants found it more difficult to distinguish between beneficial and harmful aspects of a product.

Improved consistency in consumer judgements

The study also found that colour-coded labels led to more consistent evaluations across participants. Because the visual system clearly differentiates between risks and benefits, individuals were better able to assess products in a uniform way.

By contrast, traditional descriptors such as “low fat” can be ambiguous and open to interpretation, particularly for those with limited nutritional knowledge. Colour coding, based on universally recognised traffic signals, offers a more accessible and intuitive alternative.

Implications for public health and obesity prevention

The researchers suggest that these findings have important implications for public health policy.

“Given the ongoing global challenges of obesity and poor dietary habits, color-coded labeling represents a simple yet impactful strategy for guiding healthier consumer choices,” Falkowski says.

By enhancing the visibility and clarity of nutritional information, colour-coded systems may encourage people to select healthier options. Over time, such behavioural shifts could contribute to improvements in population health.

The authors conclude that leveraging visual attention mechanisms and simplifying complex nutritional data may be a practical and scalable approach to addressing poor dietary habits and the global rise in obesity.

CCH insights:

The results of this study supports the use colour-coded labelling system as it enables quick health-based decision-making, with minimal time or effort required. And it also revealed that we use the system more to avoid unhealthy ‘red’ foods than to actively choose healthy ‘green’ foods. These outcomes emphasise the complex range of factors that contribute to shopping behaviours and decisions about what people eat. And if we want to encourage people to eat healthily, we need to understand these factors better and consider how best to influence them.

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Weight Loss Drugs May Be Linked to Bone Health Risks, Five-Year Study Shows

Key Takeaways:

• A large observational study suggests a modest increase in osteoporosis and related conditions among people taking GLP-1 receptor agonists over five years
  
• The underlying cause remains unclear, with weight loss itself, rather than the drugs alone, likely contributing to changes in bone health
  
• Despite these findings, the cardiovascular and metabolic benefits of GLP-1 therapies continue to outweigh potential skeletal risks for most people
  
  
  

Growing use of GLP-1 therapies raises new questions

Glucagon-like peptide-1 receptor agonists, commonly referred to as GLP-1 drugs, are widely used to manage type 2 diabetes and support weight loss. These medications are recognised for their ability to reduce body weight, improve glycaemic control, and lower cardiovascular risk.

However, emerging long-term data are beginning to highlight potential concerns relating to bone health. A new study, presented at the 2026 annual meeting of the American Academy of Orthopaedic Surgeons, examined five years of real-world data and suggests that these treatments may be associated with an increased risk of certain skeletal conditions.

The findings are observational and have not yet undergone peer review. They demonstrate association rather than causation. Nevertheless, given the rapid uptake of GLP-1 receptor agonists, researchers emphasise the need for careful, ongoing evaluation.

Study findings – signals of increased skeletal risk

Researchers analysed medical records from more than 146,000 adults living with obesity and type 2 diabetes over a five-year period.

Among those taking GLP-1 therapies, approximately 4 percent developed osteoporosis, compared with just over 3 percent of those not taking these medications.

Additional findings included:

• Osteomalacia, or bone softening, occurred in around 0.2 percent of people using GLP-1 drugs, compared with 0.1 percent in the control group
  
• Gout was slightly more common, affecting 7.4 percent of people taking GLP-1 therapies compared with 6.6 percent in those not taking them
  

Lead researcher Muaaz Wajahath, a medical student at Michigan State University College of Human Medicine, highlighted the importance of emerging long-term data:

“We are just now reaching the precipice where five- and 10-year follow-up data are becoming available for patients taking GLP-1 medications,” Wajahath said. “Any medication that sees this rapid adoption warrants close examination, particularly in orthopedics, where obesity and surgical intervention often overlap.”

Dr Giles Scuderi, an orthopaedic surgeon and vice president of Northwell Orthopedics, commented on the findings:

“The study findings contradict recent assertions of musculoskeletal protection and suggest that GLP-1 RA exposure may confer increased long-term skeletal risk.”

Is the risk driven by the drug or by weight loss?

A key question remains whether the observed risks are directly caused by GLP-1 medications or are instead related to weight loss itself.

People living with obesity and type 2 diabetes already have elevated risks of inflammation and bone fragility. In addition, weight loss – particularly when rapid or substantial – can affect bone metabolism.

Dr James J. Chao explained:

“As with any weight loss, bone remodeling can occur if patients lose weight on these medications.”

Bone remodelling is the continuous process of breaking down old bone and replacing it with new tissue. During periods of calorie deficit, this balance can shift, resulting in net bone loss.

“If patients lose lean mass on these medications, bone health can be affected due to less strain being placed on bones,” he added.

Dr Fernando Ovalle Jr. reinforced that this is not unique to GLP-1 therapies:

“We’ve seen it with bariatric surgery for many years and even with aggressive caloric restriction. That’s not unique to GLP-1s.”

Balancing risks and benefits

Despite these findings, experts continue to support the use of GLP-1 receptor agonists in appropriate patients.

These medications have demonstrated strong benefits, including:

• Improved glycaemic control
• Reductions in blood pressure and lipid levels
• Lower risk of heart attack and stroke
  

“In high-risk patients, those benefits are substantial and often life-saving,” Ovalle said.

As a result, the overall benefit–risk balance remains favourable in most cases. While there may be a modest increase in fracture or gout risk, these risks can typically be monitored and managed.

Scuderi echoed this perspective:

“Since heart disease is a leading cause of death, the potential risk of muscle and bone problems might be less important.”

He also emphasised the importance of active clinical management rather than passive prescribing.

Practical steps to protect bone health

Healthcare professionals can take a proactive role in supporting people receiving GLP-1 therapies.

Recommended strategies include:

• Ensuring adequate protein intake to support muscle mass
• Maintaining sufficient calcium and vitamin D levels
• Engaging in regular resistance and weight-bearing exercise
• Avoiding excessively rapid or unsupported weight loss

“Strength training, in particular, is critical,” Ovalle said. “Preserving muscle mass protects bone. If a patient loses weight but also loses significant muscle, fracture risk can increase regardless of the medication used.”

Certain groups may require closer monitoring:

• Postmenopausal women
• Older adults
• Individuals with a history of fractures
  

Gout risk may also increase temporarily during periods of rapid weight loss.

“Regarding gout, rapid weight loss and changes in uric acid metabolism can transiently increase flares,” Ovalle said. “That’s something we’ve seen even outside of GLP-1 therapy.”

Building the nutritional knowledge to guide patients through these supportive measures – adequate protein, key micronutrients and protecting lean mass during weight loss – is the focus of professional training such as the College of Contemporary Health’s Nutrition & Weight Management Essentials, a CPD-accredited online short course.

For individuals concerned about bone health, targeted supplementation may be considered. Scuderi noted that healthcare professionals may recommend therapeutic doses of dietary supplements to support lean mass retention and reduce inflammation.

A signal worth monitoring, not a cause for alarm

While early long-term data suggest a potential association between GLP-1 therapies and bone-related risks, these findings should be interpreted with caution.

The study does not establish causation, and multiple factors – including weight loss, underlying conditions, and changes in body composition – are likely to contribute.

At present, GLP-1 receptor agonists remain a valuable and often transformative option for people living with obesity and type 2 diabetes, provided their use is accompanied by appropriate clinical oversight and supportive lifestyle measures.

CCH insight

With so many people taking GLP-1 medications, it is important to keep researching the long-term effects, and this study sheds important light on potential risks with regard to bone health. The most important message here, however, is that this reminds us how it is vital that patients on GLP-1 therapy need to be carefully monitored and supported, particularly during the first year or so when weight loss is relatively rapid. If bone health is affected, this can be managed and treated. If bone health is affected, this can be managed and treated. Much of that support is nutritional: CCH’s Nutrition & Weight Management Essentials CPD short course (10 CPD hours, fully online, CPD-accredited) gives healthcare professionals a solid grounding in nutrition and weight management, including how to help patients meet their protein, calcium and vitamin D needs and preserve lean muscle during periods of rapid weight loss.

Explore Nutrition & Weight Management Essentials →

Source: The Epoch Times  

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