Obesity Care Tag

Almost a Quarter of UK GPs Report Obesity in Children Aged Four and Under

Key Takeaways:

• Nearly one in four UK GPs report seeing children aged four and under where obesity is a clinical concern, with cases identified even in infancy.
• Most GPs find conversations about weight with children and parents difficult, citing fear of distress, stigma and complaints.
• The survey also raises concerns about inappropriate private access to GLP-1 weight loss medicines among adults who do not meet eligibility criteria.
  
  
  

Growing concern among family doctors

Almost a quarter of UK general practitioners report seeing children aged four or under who are living with obesity, according to a new survey of family doctors. The findings point to what respondents described as an “alarming” escalation of childhood obesity presenting at ever younger ages.

The research found that almost half of GPs, 49 per cent, have seen boys and girls up to the age of seven with obesity, including a small number of children younger than one year old. These early presentations raise concerns about long-term health consequences and the pressures faced by primary care clinicians in addressing weight sensitively and effectively.

Survey scope and headline findings

The survey, conducted by MDDUS, asked 540 family doctors about their experiences of managing obesity, the rapid growth in the use of weight loss medications, and the implications of widespread overweight and obesity for the NHS.

Almost one in four respondents, 23 per cent, said they had seen children aged zero to four where obesity was a clinical concern. Across childhood more broadly, 81 per cent of doctors reported seeing obesity in children between the age of 12 months and 11 years.

Dr John Holden, chief medical officer at MDDUS, said:
“These findings are an alarming confirmation of the growing crisis of childhood obesity across the country and the very real difficulties this creates in everyday GP consultations.”

Challenges of discussing weight with families

Despite the scale of the issue, most GPs reported significant difficulty in raising concerns about weight with children and their families. Four in five doctors, 80 per cent, said they find it somewhat or very challenging to talk to the parents of a child under 16 living with obesity about their weight and health. Only 10 per cent said they found such conversations easy.

Nearly two thirds of respondents, 65 per cent, also reported difficulty speaking directly with young people themselves about weight, with just 20 per cent describing those discussions as easy.

Doctors cited multiple reasons for this hesitation. Conversations with parents are often constrained by concerns that parents may become upset, reported by 72 per cent, angry, reported by 47 per cent, or may make a complaint, reported by 24 per cent. A further 74 per cent worried that such discussions could cause shame or stigma. Similar concerns were reported when speaking with children, including fears that conversations about weight could contribute to disordered eating behaviours.

The wider determinants of childhood obesity

Respondents highlighted that obesity is shaped by complex and interrelated factors, including poverty, limited access to nutritious food, and fewer safe or affordable opportunities for children to be physically active. These realities, the survey suggests, shape how GPs approach discussions about weight.

Dr Holden said GPs therefore approach these conversations “with care and empathy for families under pressure”. He added:
“When parents feel judged or blamed, conversations can quickly become emotionally charged and, as our members tell us, can lead to complaints from distressed or angry parents.”

Calls for stronger prevention measures

Katharine Jenner, executive director of the Obesity Health Alliance, said the findings underline a failure to protect children early in life.

She said that the high numbers of GPs seeing infants and very young children with obesity “is another sign we’re letting children down before they even start school. If we’re serious about prevention, it has to begin in the earliest years, otherwise the damage follow them through life.”

Jenner called for a stronger focus on prevention, including reformulation of food and drink products to improve their nutritional quality, tighter restrictions on the marketing of products high in fat, salt and sugar, and better support for families facing structural and financial barriers to healthy eating.

Concerns over private access to weight loss drugs

Alongside childhood obesity, the survey also explored GP experiences of adult patients using weight loss medications inappropriately. Doctors reported that some adults who should not be using GLP-1 weight loss drugs are obtaining them through deception from private pharmacies.

These include people with eating disorders, such as anorexia or bulimia, and people already taking other medications that could interact adversely with so-called “fat jabs” and pose risks to their health.

It is estimated that around 1.5 million people in Britain are using GLP-1 medicines for weight loss, the majority having obtained them privately rather than through the NHS, where eligibility criteria are strict.

One GP told the survey that GLP-1s are being “accessed privately pretty indiscriminately by many people whose body mass index is not in the obese category”. Another described a patient with a history of anorexia nervosa who had also obtained the drugs privately. Overall, 67 per cent of family doctors said they had seen patients using GLP-1s despite not meeting eligibility rules.

These findings raise questions about how rigorously private pharmacies are carrying out appropriate checks, including assessments of medical history and potential drug interactions, before supplying weight loss medications.

Implications for the NHS and future care

The vast majority of GPs surveyed said obesity is likely to be a defining public health challenge during their careers, with 92 per cent agreeing with that statement. An even higher proportion, 95 per cent, believe obesity will significantly affect the NHS’s ability to deliver care.

However, views on weight loss injections were more mixed. While 59 per cent of respondents believe such medications will ultimately save the NHS money, 22 per cent disagreed.

Government response

The Department of Health and Social Care did not comment directly on the survey findings. A spokesperson said:
“Every child deserves the best possible start in life, which is why this government is taking decisive action to tackle childhood obesity.

“We are restricting junk food advertising on television before 9pm and online, a move expected to remove up to 7.2bn calories per year from children’s diets; while giving local authorities new powers to stop fast food shops opening outside schools.

“Through our ten-year health plan, we’re shifting the focus from sickness to prevention to create a healthier nation.”

CCH insight:

This study highlights the considerable challenges that primary care practitioners face in addressing obesity in young children. It is a very sensitive issue, and there may also be cultural attitudes that see overweight children as beautiful or healthy. Unfortunately, healthcare professionals in the UK are not trained to deal with obesity and the unique challenges it presents. It requires a very sensitive approach, communicating with parents in a non-judgemental way, highlighting the role of the obesogenic environment and finding ways to support behaviour change at a family level. On the positive side, if this can be achieved, an entire family can benefit from these interventions, not just the child with excess weight.

Read More

Genetic Study Establishes Causal Link Between Obesity and Dementia

Key Takeaways: 

• New genetic evidence suggests that higher body weight and elevated blood pressure play a direct causal role in the development of dementia.
  
• The findings indicate that addressing obesity and high blood pressure earlier in life may offer an important opportunity for dementia prevention.
  
• Much of the increased dementia risk associated with higher body weight appears to be driven by high blood pressure, highlighting a potentially modifiable pathway.
  
  
  

Obesity, blood pressure and dementia risk

People living with obesity and high blood pressure may face a higher risk of developing dementia, according to a new study published in The Journal of Clinical Endocrinology & Metabolism. The research adds to a growing body of evidence linking cardiovascular and metabolic health to long-term brain health.

Dementia represents a major and escalating global public health challenge. There is currently no cure, and people living with dementia experience a progressive decline in mental abilities, including memory, thinking and reasoning. Over time, this decline can significantly impair daily functioning and independence.

The most common forms of dementia include Alzheimer’s disease, vascular dementia and mixed dementia. Although these conditions vary in their underlying pathology, all involve progressive damage to nerve cells in the brain, leading to worsening problems with memory, language, problem-solving and behaviour.

Study identifies a causal relationship

The study was led by Ruth Frikke-Schmidt, M.D., Ph.D., Professor and Chief Physician at Copenhagen University Hospital – Rigshospitalet and the University of Copenhagen.

“In this study, we found high body mass index (BMI) and high blood pressure are direct causes of dementia,” said Frikke-Schmidt. “The treatment and prevention of elevated BMI and high blood pressure represent an unexploited opportunity for dementia prevention.”

Researchers analysed genetic and health data from participants in Copenhagen and the UK. Their analysis revealed a clear causal link between higher body weight and an increased risk of dementia.

How Mendelian randomisation strengthened the findings

The researchers were able to establish a direct causal relationship by using a Mendelian randomisation study design, which closely mimics the structure of a randomised controlled trial.

In Mendelian randomisation, naturally occurring genetic variants associated with higher BMI are used as proxies for lifelong exposure to higher body weight. Because these genetic variants are randomly inherited from parents to offspring, their distribution is not influenced by lifestyle, socioeconomic status or other confounding factors.

This process mirrors the random assignment of participants to treatment or placebo groups in drug trials. As a result, any differences in dementia outcomes between individuals with BMI-increasing genetic variants and those without can be more confidently attributed to body weight itself, rather than to external influences.

Using this approach, the researchers were able to demonstrate that higher BMI plays a direct causal role in increasing the risk of dementia.

Blood pressure emerges as a key driver

Further analysis suggested that much of the increased dementia risk associated with higher body weight was driven by elevated blood pressure. This finding points to a potential pathway through which obesity may contribute to cognitive decline.

By implication, preventing or effectively treating obesity and high blood pressure could help reduce the risk of dementia, particularly forms linked to vascular damage in the brain.

“This study shows that high body weight and high blood pressure are not just warning signs, but direct causes of dementia. That makes them highly actionable targets for prevention,” said Frikke-Schmidt.

Implications for prevention and future research

The findings also raise important questions about the timing of weight management interventions. While weight-loss medications have recently been tested in people with early-stage Alzheimer’s disease, these trials have not shown clear benefits for halting cognitive decline once symptoms are established.

“Weight-loss medication has recently been tested for halting cognitive decline in early phases of Alzheimer’s disease, but with no beneficial effect,” Frikke-Schmidt said. “An open question that remains to be tested is if weight-loss medication initiated before the appearance of cognitive symptoms may be protective against dementia. Our present data would suggest that early weight-loss interventions would prevent dementia, and especially vascular-related dementia.”

Together, the results reinforce the importance of addressing obesity and high blood pressure not only to protect cardiovascular health, but also as part of a broader strategy to reduce the long-term risk of dementia.

Read More

Heart Disease Now Affects Nearly Half of US Adults, as Obesity and Diabetes Continue to Rise

Key Takeaways: 

• Nearly half of adults in the United States are now living with cardiovascular disease, with prevalence projected to rise further as obesity, diabetes, and hypertension increase.
  
• New data highlight worsening cardiometabolic risk factors, including declining blood pressure and glycaemic control, alongside rising concerns around sleep health, physical inactivity, and nicotine exposure.
  
• The report underscores the urgent need for prevention-focused, equitable approaches to cardiovascular, kidney, and metabolic health across the life course.
  
  
  

A comprehensive annual snapshot of cardiovascular health

The 2026 Heart Disease and Stroke Statistics Report from the American Heart Association, published in the journal Circulation, provides an updated and wide-ranging overview of heart disease, stroke, and cardiovascular risk factors. Updated annually, the report integrates the most recent data, adds new thematic chapters, and removes outdated material to reflect the evolving cardiovascular health landscape.

The latest edition draws on a year-long collaborative effort involving volunteers, scientists, clinicians, government representatives, and AHA staff. It includes an expanded chapter on nicotine and tobacco use and exposure, alongside a new chapter focused on cardiovascular, kidney, and metabolic (CKM) syndrome. Together, these additions reflect growing recognition of the interconnected nature of cardiometabolic risk factors and their cumulative impact on population health.

Cardiovascular health trajectories and nicotine exposure

According to the report, several major cardiometabolic conditions are projected to rise substantially by 2050 among adults in the United States. Hypertension prevalence is expected to reach 61 percent, diabetes 26.8 percent, and obesity 60.6 percent. In contrast, hypercholesterolaemia is the only major risk factor projected to decline, falling from 45 percent to 24 percent.

Most core health behaviours are projected to worsen over time. An important exception is sleep, where inadequate sleep duration is expected to increase. Evidence from a 2010 to 2022 meta-analysis showed that people with ideal cardiovascular health experienced a 74 percent lower risk of cardiovascular disease events compared with those with poor cardiovascular health.

Nicotine exposure remains a major concern. People who smoke have a mortality risk three times higher than those who have never smoked. While smoking prevalence among adults in the United States has declined, the use of e-cigarettes has increased sharply. National Health Interview Survey data from 2017 to 2023 indicate that e-cigarette use has quadrupled over this period.

Physical activity and sleep health

Levels of physical activity remain suboptimal across age groups and regions. Only one in five children and adolescents aged 6 to 17 years achieved at least 60 minutes of daily physical activity. Globally, around one-third of adults across 163 countries did not meet recommended activity levels.

Sleep health has emerged as a significant cardiovascular risk factor. Data from the National Health and Nutrition Examination Survey covering 2017 to 2020 showed that 30 percent of adults experienced at least one hour of sleep debt, defined as the difference between sleep duration on workdays and free days. Observational analyses linked poor sleep with higher odds of type 2 diabetes, hypercholesterolaemia, and hypertension.

Obesity, lipids, blood pressure, and diabetes

Obesity prevalence continues to rise among both children and adults in the United States. Estimates from the Global Burden of Diseases, Injuries, and Risk Factors study indicated that in 2021 more than 15 million children aged 5 to 14 years, 21 million young people aged 15 to 24 years, and 172 million adults aged 25 years or older were living with overweight or obesity.

While the prevalence of high total cholesterol has decreased, low-density lipoprotein cholesterol remains a major driver of cardiovascular mortality. Global data from 2021 attributed a cardiovascular disease mortality rate of 43.7 per 100,000 people to elevated low-density lipoprotein cholesterol.

Hypertension prevalence remained broadly stable between 2013 and 2023. However, blood pressure control worsened, declining from 54.1 percent in 2013 to 2014 to 48.3 percent in 2017 to 2020. Some improvement was observed among non-Hispanic Black adults between 2017 to 2020 and 2021 to 2023.

Diabetes prevalence also remains high. Between 2021 and 2023, an estimated 29.5 million adults had diagnosed diabetes, 96 million had prediabetes, and 9.6 million were living with undiagnosed diabetes. Among people with diagnosed diabetes, glycated haemoglobin levels increased significantly from 2017 to 2020 and again from 2021 to 2023, while overall glycaemic control rates declined.

Kidney disease, CKM syndrome, and pregnancy outcomes

The burden of kidney disease has risen markedly over the past two decades. The prevalence of end-stage kidney disease nearly doubled between 2002 and 2019, before stabilising in subsequent years. Across 114 cohort studies, both albuminuria and reduced kidney function were consistently associated with increased risk of kidney failure and mortality.

Data from NHANES between 2011 and 2020 suggest that approximately 90 percent of adults in the United States were in stage 1 or higher of CKM syndrome. People from underrepresented ethnic and racial groups experienced a disproportionately higher burden of advanced CKM stages. More advanced stages were strongly associated with increased cardiovascular disease mortality.

The report also highlights links between cardiometabolic health and pregnancy outcomes. In Japan, pregnant individuals with higher healthy lifestyle scores before pregnancy had around a one-third lower risk of adverse pregnancy outcomes compared with those with the lowest scores. Although maternal mortality rates declined across all ethnic and racial groups between 2021 and 2022, persistent disparities remain.

Cardiovascular disease, stroke, dementia, and congenital conditions

Overall cardiovascular disease prevalence reached nearly 49 percent among adults aged 20 years or older, based on NHANES data from 2021 to 2023. Prevalence increased with age in both women and men. At the population level, stronger adherence to healthy dietary patterns was associated with lower cardiovascular disease risk.

Stroke incidence declined between 1993 and 2015 among both Black and White adults, although rates remained consistently higher in Black populations. Dementia prevalence among older adults decreased between 2011 and 2021, though findings varied depending on study design and population. Evidence from selected intervention studies suggested that high-intensity training may help slow cognitive decline.

Congenital cardiovascular defects were estimated to affect around 1 in 80 babies in high-income regions of North America. Globally, survival into adulthood among people born with congenital heart disease improved substantially between 1990 and 2019. Population-based analyses linked limited prenatal care, neighbourhood deprivation, and air pollution to increased risk of heart defects, poorer outcomes, and delayed diagnosis.

Heart rhythm disorders, cardiac arrest, and heart failure

Heart rhythm disorders and heart failure continue to contribute significantly to cardiovascular morbidity. Atrial fibrillation affected an estimated 10.55 million adults in the United States, representing 4.48 percent of the adult population.

Patterns of cardiac arrest have also shifted. Opioid-related out-of-hospital cardiac arrests accounted for less than 1 percent of cases in 2000 but rose to between 7 percent and 14 percent by 2023. Coronary heart disease prevalence was estimated at 5.2 percent among adults aged 20 years or older between 2021 and 2023. Over the same period, heart failure prevalence increased from 6.7 million people in 2017 to 2020 to 7.7 million in 2021 to 2023.

A growing burden with global implications

Taken together, the 2026 Heart Disease and Stroke Statistics Report paints a picture of a growing cardiovascular disease burden affecting around half of the adult population. Despite major advances in diagnostics, prevention strategies, and treatment options, ageing populations, widening health inequalities, and rising cardiometabolic risk factors continue to place increasing pressure on healthcare systems.

The report emphasises the need for coordinated, prevention-led approaches that prioritise early intervention and equitable access to care. Without sustained action across policy, healthcare, and community settings, current trends are likely to continue, with profound long-term health and economic consequences.

Read More

Study Highlights Benefits and Limits of Generative AI in Weight Management

Key Takeaways: 

• A short field experiment suggests that generative AI can support modest reductions in weight and body mass index through personalised dietary feedback.
  
• Private use of AI tools appears more effective than public sharing, with public analysis associated with higher dropout rates.
  
• People with lower levels of nutritional knowledge benefited most, indicating potential for AI to help reduce health inequalities, although it does not replicate the value of human community support.
  
  
  

Introduction

Nearly three-quarters of adults in the United States are living with overweight or obesity, and prevalence continues to rise globally. As a result, demand for high-cost interventions such as bariatric surgery and glucagon-like peptide-1 medications has increased, placing significant financial pressure on health care systems.

A new working paper suggests that generative artificial intelligence may offer a low-cost way to support people with weight loss by helping them make more informed dietary choices. However, the research also indicates that AI tools do not replicate the benefits of community-based programmes where people can share experiences and openly discuss the physical and psychological challenges associated with obesity.

The study was conducted by Catherine Tucker, Professor of Marketing at MIT Sloan School of Management, and Linyi Li of Singapore Management University. They followed 416 adult participants of varying ages over a three-week period in late 2024.

Study design and intervention

The researchers partnered with an Asia-based Fortune 500 company that runs an online weight loss boot camp combining guidance on healthy eating and physical activity. The programme included a group chat function using WeChat, enabling participants to interact, share experiences and support one another.

Participants were divided into three groups to assess the impact of a generative AI tool designed to analyse meals. The tool evaluated the nutritional content of food based on photographs and provided real-time, personalised suggestions such as adding more vegetables or choosing leaner protein sources.

The three groups were structured as follows:

• Group 1 – control group: Participants received general healthy-diet tips and access to the group chat but did not use the AI food-analysis tool.
  
• Group 2 – private analysis group: Participants sent photos of their meals privately to an administrator and received personalised AI-generated nutrition reports.
  
• Group 3 – public analysis group: Participants shared meal photos within the group chat, where both the images and the AI-generated nutrition reports were visible to all group members.
  
  
  

Finding 1 – Generative AI supported weight loss

Compared with the control group, both groups that used the AI food-analysis tool showed higher engagement with the programme, greater weight loss and larger reductions in body mass index.

On average, participants in Group 1 lost 0.966 kg over the three-week period. Those in Group 2 lost 1.426 kg, while participants in Group 3 lost 1.358 kg.

Although the absolute numbers were modest, Tucker emphasised their significance given the short duration of the intervention.

“Weight loss is such a big challenge. If it were easy for us all to lose weight, we’d just lose weight,” Tucker said. “The fact that a digital tool such as AI can have any effect is wonderful because interventions such as surgery or injectables are expensive. This is evidence of the cost efficacy of a very small intervention in terms of changing behavior.”

According to Tucker, the results highlight the value of generative AI in personalising individual experiences by offering tailored feedback, practical knowledge and guidance on day-to-day dietary decisions.

Finding 2 – Public analysis reduced participation

The way in which the AI tool was used had a clear impact on engagement. Participants with private access to the food-analysis tool were significantly more likely to remain in the programme for the full three weeks.

In contrast, Group 3, where meal photos and AI feedback were shared publicly, had the highest dropout rate. Tucker suggested that some participants may have felt discouraged by seeing highly engaged or high-performing peers, leading to disengagement.

“Dropout is the big enemy of weight loss,” Tucker said. “A likely explanation [for dropouts in Group 3] is that staying in the group introduced pressure [when] consistently reporting less-favorable statistics compared to others.”

The findings suggest that making AI-generated feedback public may alienate some individuals and reduce sustained participation. Community-based programmes such as Weight Watchers have historically succeeded by fostering mutual support during both successful and challenging periods.

As Tucker noted,

“There’s a set of people there to support you through good or bad weeks. I think what we are demonstrating is that if you make it too easy to post success stories, then you lose some of that [shared] vulnerability within the community.”

Finding 3 – Potential to reduce health inequalities

The researchers also found that the greatest benefits from the AI tool were seen among participants with lower levels of education and less prior nutritional knowledge. These individuals often struggle to interpret standard weight loss advice and appeared to gain particular value from detailed, personalised recommendations generated by the AI system.

The authors suggest that this capability could help reduce health inequalities by improving access to understandable, tailored dietary guidance for people who may otherwise be disadvantaged by traditional educational approaches.

Implications for the use of AI in health behaviour change

Although the study focused specifically on weight loss, the authors argue that the findings have broader relevance for how people interact with AI systems. Generative AI appears well suited to supporting individual behaviour change through personalisation, prompts and reminders. However, it does not replicate the social connection and emotional support provided by human communities.

For organisations and programme designers, the research suggests that AI should be used to enhance individual-level support rather than as a replacement for community-building or large-scale digital ecosystems.

Although the research was conducted in China, Tucker stated that the findings are likely to be applicable in other settings.

“I think what our research shows is that in the generative AI age, technology can certainly assist with information retrieval, reminders, prompts, all those good things, but we can’t really use it to replace that sense of community,” Tucker said.

Read More

Genetic Links Between Obesity and Autoimmune Diseases Identified in Large European Study

Key Takeaways:

• Large-scale genetic analyses have identified a substantial shared genetic basis between obesity and several autoimmune disorders in people of European ancestry.
  
• Dozens of shared genetic loci and genes appear to influence both body weight regulation and immune system function, particularly pathways involved in immune homeostasis.
  
• The findings suggest potential causal links between obesity and certain autoimmune conditions, with implications for future therapeutic strategies.
  
  
  

Overview of the study

A recent study published in the Journal of Translational Medicine has identified important genetic links between obesity and autoimmune disorders, shedding new light on why these conditions often co-occur. The research, led by Jiang and colleagues, focused on individuals of European ancestry and used large-scale genomic datasets to explore how shared genetic factors may influence both excess body weight and immune-mediated disease.

Obesity and autoimmune disorders represent a significant comorbidity burden, yet until now their shared genetic architecture has remained poorly understood. By applying advanced cross-trait genome-wide association study (GWAS) methods, the researchers aimed to uncover pleiotropic genetic variants – genes or loci that influence more than one trait – that may contribute to both conditions.

Study methods and analytical approach

The researchers conducted a comprehensive cross-trait analysis using GWAS summary data for obesity and 17 autoimmune diseases. Genetic correlations between traits were assessed using LD score regression and high-definition likelihood methods, allowing the team to quantify the extent to which obesity and autoimmune conditions share inherited risk.

To identify specific shared genetic loci, the team employed Stratified Pleiotropic Locus Mapping (PLACO), followed by Bayesian colocalization analyses to confirm whether obesity and autoimmune diseases truly shared the same causal genetic variants. Further analyses examined gene-level effects and tissue-specific heritability, while potential drug targets were prioritised using summary-based Mendelian randomisation (SMR).

In addition, immune co-localization techniques and bidirectional Mendelian randomisation were used to explore immunological mechanisms and to clarify potential causal relationships between obesity and autoimmune diseases.

Key genetic findings

The analysis identified eight autoimmune diseases with significant genetic correlations to obesity. In total, researchers discovered 10,324 pleiotropic single-nucleotide polymorphisms (SNPs), which mapped to 52 independent risk loci. Of these, nine loci were confirmed as shared causal variants through colocalization analysis.

Gene-level investigations revealed 133 unique pleiotropic genes. Notably, genes such as CLN3, SH2B1, and MMEL1 were highlighted and found to be enriched in biological pathways related to hematopoietic cell differentiation and immune homeostasis. These pathways are central to both metabolic regulation and immune function, reinforcing the biological plausibility of a shared genetic basis.

Tissue and immune cell involvement

Tissue-specific heritability analyses showed that shared genetic effects were most prominent in immune-related tissues, particularly the spleen, whole blood, and Epstein–Barr virus (EBV)-transformed lymphocytes. This finding further supports the role of immune system regulation in the overlap between obesity and autoimmune disease risk.

Immune co-localization analyses implicated six traits related to IgD+ CD38− B cell subsets as key pathological conduits. These immune cells may represent an important link between metabolic dysfunction and autoimmune processes.

Evidence of causal relationships

Using bidirectional Mendelian randomisation, the study provided evidence that obesity may play a causal role in the development of certain autoimmune conditions, including hypothyroidism, psoriasis, and multiple sclerosis. Conversely, an inverse causal association was observed between type 1 diabetes and obesity risk, suggesting a more complex and condition-specific relationship.

Implications and conclusions

In their conclusions, the authors state:

“This study demonstrates a robust shared genetic foundation between obesity and multiple autoimmune diseases, pinpointing specific pleiotropic loci, genes, and immune cell subsets.”

By identifying shared genetic mechanisms, the research provides a clearer mechanistic framework for understanding why obesity and autoimmune disorders frequently coexist. Importantly, these findings also highlight potential molecular and immunological targets for future therapeutic intervention, with the potential to address both metabolic and autoimmune disease pathways simultaneously.

Overall, the study represents a significant step forward in understanding the complex interplay between body weight regulation and immune system dysfunction, and it opens new avenues for research into integrated prevention and treatment strategies.

Read More

Obesity Independently Associated With Higher Rates of Tinnitus in US Adults, Large Population Study Suggests

Key Takeaways: 

• Adults living with obesity were significantly more likely to report tinnitus than those without obesity, even after accounting for demographic, behavioural and psychological factors.
  
• Around one in five adults with obesity reported tinnitus, compared with approximately one in seven adults without obesity.
  
• The findings highlight metabolic health and body weight as potentially relevant, modifiable factors in the broader management of tinnitus.
  
  
  

A growing public health question

Obesity appears to be independently associated with a higher prevalence of tinnitus, according to a large, nationally representative study of adults in the United States published online on 2 November in Cureus. 

The research was led by Ashir Ahtsham of Lahore General Hospital in Pakistan and examined whether obesity contributes to tinnitus prevalence beyond the influence of age, sex, mental health and other known risk factors. The analysis drew on data from the National Health and Nutrition Examination Survey (NHANES), a long-running survey designed to reflect the health of the US population.

Tinnitus, commonly described as ringing, buzzing or other sounds perceived in the absence of an external auditory stimulus, affects a substantial proportion of adults worldwide. While its causes are multifactorial and not fully understood, increasing attention has been given to the role of systemic and metabolic health in its development and persistence.

How the study was conducted

The researchers performed a cross-sectional analysis using de-identified data from the NHANES 2015–2016 and 2017–2018 survey cycles. These two cycles were combined in line with established analytic guidance to improve statistical power.

After excluding individuals under the age of 20 and those with missing data on body mass index or tinnitus, the final analytic sample included 5,452 adults aged 20 years and older. Obesity was defined using standard criteria, with a body mass index of 30 kg/m² or higher.

Tinnitus was assessed through self-report. Participants were classified as having tinnitus if they reported experiencing ringing, buzzing or other noises in their ears lasting five minutes or more in the absence of an external sound.

To isolate the association between obesity and tinnitus, the researchers adjusted their analyses for a range of potential confounders, including age, sex, race and ethnicity, smoking status, sleep duration and symptoms of depression, assessed using the Patient Health Questionnaire-9. Hearing loss data were not included, as this would have substantially reduced the available sample across both survey cycles. Readers interested in the detailed methodology can refer directly to the journal article.

Tinnitus was common, particularly among people with obesity

Across the full sample, 863 participants reported tinnitus, corresponding to a weighted prevalence of 17.2 percent. Tinnitus was more frequently reported by older adults, men and individuals living with obesity or depression.

Notably, the prevalence of tinnitus differed markedly by obesity status. Around 20.3 percent of adults with obesity reported tinnitus, compared with 15.0 percent of adults without obesity. This difference remained statistically significant at the population level.

Age was also a strong factor. Tinnitus prevalence increased steadily with age, rising from just over 10 percent in adults aged 20–39 years to nearly one quarter of those aged 60 years and older. Differences were also observed across racial and ethnic groups, with non-Hispanic White adults reporting the highest prevalence.

Obesity remained a significant predictor after adjustment

In unadjusted analyses, obesity was associated with a 44 percent higher likelihood of reporting tinnitus. Importantly, this association persisted even after accounting for demographic characteristics, lifestyle factors and depression.

After full adjustment, adults living with obesity still had approximately 41 percent higher odds of reporting tinnitus than adults without obesity. The strength and consistency of this association suggest that obesity may contribute to tinnitus prevalence independently, rather than simply reflecting shared risk factors such as age or mental health.

As the authors note, “These findings underscore the potential role of body weight and metabolic health in the development or progression of tinnitus.” They add that, “The substantial burden of obesity in recent years and its association with tinnitus highlight the importance of considering modifiable metabolic risk factors as part of comprehensive tinnitus management.”

Why might obesity and tinnitus be linked?

Although the study was not designed to explore biological mechanisms directly, the authors outline several plausible pathways supported by existing research.

Obesity is characterised by chronic low-grade inflammation, metabolic dysregulation and vascular dysfunction. These processes may impair microcirculation within the cochlea and disrupt normal auditory signalling. Excess adipose tissue is also known to produce pro-inflammatory cytokines, which may contribute to oxidative stress and neural inflammation affecting auditory pathways.

In addition, obesity is frequently associated with metabolic syndrome, insulin resistance and sleep disorders, all of which have been independently linked to tinnitus severity and distress. Together, these factors may help explain why people living with obesity experience tinnitus more frequently, even in the absence of measured hearing loss.

Strengths and limitations

A key strength of this study is its use of a large, nationally representative dataset with appropriate weighting to reflect the US population. The analysis also accounted for a wide range of demographic, behavioural and psychological variables.

However, the authors emphasise that the cross-sectional design means causality cannot be inferred. Tinnitus was self-reported, which may introduce recall or reporting bias. Important factors such as occupational noise exposure, medication use and audiometric hearing thresholds were not included, and these may partially mediate the observed association.

For readers seeking detailed statistical outputs or subgroup analyses, the original journal article provides comprehensive tables and supplementary information.

Implications for clinical practice and future research

The findings suggest that obesity is independently associated with tinnitus among US adults, reinforcing the view that tinnitus should be considered within a broader framework of systemic and metabolic health.

While weight reduction cannot currently be recommended as a specific treatment for tinnitus, the results support the inclusion of metabolic risk assessment as part of holistic tinnitus care. Further longitudinal studies, particularly those incorporating objective hearing measures, are needed to clarify causal pathways and to determine whether improvements in metabolic health could reduce tinnitus risk or severity.

As the burden of both obesity and tinnitus continues to rise globally, understanding how these conditions intersect may help inform more comprehensive and person-centred approaches to prevention and management.

Read More

More Than One in Four Adults Worldwide May Be Eligible for GLP-1 Weight-Loss Medicines, Global Analysis Suggests

Key Takeaways: 

• More than 27 percent of adults globally may be eligible for GLP-1 receptor agonists for weight management, based on pooled data from 99 countries.
  
• Eligibility is highest among women, older adults, and people living in low- and middle-income countries, raising significant questions around access and health equity.
  
• Researchers emphasise that medicines alone are not sufficient, and sustained investment in prevention and non-pharmacological obesity care remains essential.
  
  
  

A growing global obesity challenge

The worldwide prevalence of obesity has more than doubled over the past three decades, accompanied by sharp rises in weight-related conditions such as type 2 diabetes, cardiovascular disease, and several cancers. This escalating public health challenge places increasing strain on healthcare systems and national economies across the globe.

Against this backdrop, a new international study suggests that glucagon-like peptide-1 receptor agonists, commonly referred to as GLP-1 medications, could play a substantial role in addressing obesity and its related complications at scale. The analysis was co-led by investigators from Mass General Brigham and aimed to estimate how many adults worldwide might benefit from these medicines.

Large-scale global data analysis

Researchers from Mass General Brigham collaborated with colleagues at Washington University School of Medicine in St. Louis and Emory University’s Rollins School of Public Health to pool household health survey data from 99 countries, collected between 2008 and 2021.

The final dataset included 810,635 adults aged 25 to 64 years, selected based on the availability of key clinical measures, including:

• Body mass index
• Blood pressure
• Diabetes biomarkers
• Diagnostic history of hypertension and diabetes
  

Eligibility for GLP-1 treatment was defined using established clinical thresholds. Adults were considered eligible if they had:

• A BMI greater than 30, or
• A BMI greater than 27 in the presence of hypertension, diabetes, or both
  
  
  

One in four adults eligible worldwide

Using these criteria, the researchers found that 27 percent of adults globally would be eligible for GLP-1 medications for weight management. Notably, around four-fifths of eligible individuals lived in low- and middle-income countries, highlighting a potential mismatch between need and access.

Eligibility varied substantially by region:

• Europe and North America showed the highest rates at 42.8 percent
• The Pacific Islands followed closely at 41.0 percent
  

Differences were also observed across demographic groups:

• Women were more likely to be eligible than men, at 28.5 percent versus lower rates among men
• Older adults showed markedly higher eligibility at 38.3 percent, compared with 17.9 percent among younger adults
  

The findings were published as a research letter in The Lancet Diabetes & Endocrinology.

Rethinking obesity through biology

Commenting on the findings, co-senior author Jennifer Manne-Goehler, MD, ScD, a physician at Brigham and Women’s Hospital and Mass General Brigham, highlighted the paradigm shift represented by GLP-1 therapies.

“There has never been such a potentially transformational and scalable tool for obesity, type 2 diabetes, and other health-related complications of obesity.”

She also reflected on the historical framing of obesity as a personal failing rather than a biologically driven disease.

“For so many decades, we told everyone the problem was you – you need to move more and eat less, then you will not struggle with this problem. GLP-1 receptor agonists have allowed us to really understand that biology is much more powerful than that, and ‘eat less, move more’ is just an oversimplified way to think about things.”

Global interest meets practical constraints

The potential of GLP-1 medicines has already been recognised by the World Health Organization, which is actively exploring ways to make these treatments more widely available as standard therapies. However, translating this promise into real-world impact depends on understanding the scale of need and addressing significant barriers to access.

Corresponding author Sang Gune K. Yoo, MD, who conducted the work while a research fellow in cardiology at Washington University School of Medicine, noted that the findings were consistent with global obesity trends.

“Given the steadily increasing prevalence of obesity, it is not surprising that our analysis found that more than one quarter of adults around the world may be eligible for this medication.”

He cautioned, however, that important questions remain unanswered.

“This medication has the potential to help many individuals, although further research is needed to better understand its long-term safety and sustainability. Access remains a major challenge as these medications are difficult to obtain in many settings. Most importantly, we must continue to invest in and develop effective non-pharmacological strategies for the prevention and treatment of obesity, an area where substantial gaps remain.”

Equity at the centre of global implementation

The study also underscores profound equity considerations. Eligibility was disproportionately high among women and people living in regions with limited healthcare resources.

Manne-Goehler highlighted the urgency of addressing these disparities.

“These socioeconomic and gender eligibility percentiles are especially staggering. As of last year, type 2 diabetes was the top cause of death for women in South Africa. There are parts of the world where women can really benefit from these medicines, and it is our job to see through their implementation.”

Co-lead author Felix Teufel, MD, from Emory University’s Rollins School of Public Health, framed access to GLP-1 therapies as a broader ethical issue.

“Global access to GLP-1s is a question of health equity. The goal is to ensure large-scale access for people who would benefit most – not just those easiest to reach.”

Beyond medicines alone

While the findings point to a potentially transformative role for GLP-1 medications in global obesity care, the authors stress that pharmacological approaches cannot replace comprehensive prevention and treatment strategies. Addressing obesity at scale will continue to require sustained investment in public health, supportive environments, and evidence-based, non-pharmacological interventions alongside new medical therapies.

CCH insight:

This study reminds us of the scale of the obesity pandemic. There are more than 1 billion people estimated to be living with obesity, according to the World Health Organisation – most of whom could in theory benefit from GLP-1 medications. The priority should be to provide access for those who are in greatest need, rather than those who can afford to pay for them. The development of oral GLP-1s is a big step, as this will increase access and bring prices down, but there is a very long way to go.

Read More

Abdominal Obesity Identified as a Key Risk Factor for Migraine in Young Adults, Large South Korean Study Finds

Key Takeaways:

• A nationwide cohort study of more than six million young adults found that obesity is associated with an increased risk of developing migraine over time
  
• Abdominal obesity, measured by waist circumference, was a stronger and more consistent predictor of migraine risk than overall body mass index
  
• The association was particularly pronounced in younger adults and appeared to be influenced by lifestyle factors such as alcohol consumption
  
  
  

A large longitudinal study conducted in South Korea has found that obesity, particularly abdominal obesity, is associated with a higher risk of developing migraine in young adulthood. The research suggests that fat distribution around the abdomen is a more important predictor of migraine onset than overall body weight as measured by body mass index. The findings were published in the medical journal Neurology.

Migraine is a disabling neurological disorder that places a substantial burden on individuals, healthcare systems, and society. While genetic predisposition plays a significant role in determining who develops migraine, environmental and lifestyle factors are also recognised contributors. In clinical practice, managing coexisting conditions is widely regarded as an important component of migraine care.

Obesity is already known to increase the severity and frequency of migraine attacks in people who live with the condition, a process often described as chronification. However, whether obesity contributes to the initial development of migraine in people without a prior history has remained less certain. Much of the existing evidence has been based on cross-sectional studies, which capture data at a single point in time and cannot establish the direction of cause and effect.

Moving beyond cross-sectional evidence

To address this limitation, the authors of the new study designed a large prospective cohort analysis to examine whether obesity precedes and increases the risk of migraine onset. Their primary objective was to assess the association between obesity and incident migraine, and to determine whether migraine risk increased in line with the severity of obesity. A further aim was to compare the predictive value of general obesity with that of abdominal obesity.

The researchers drew on data from the Korean National Health Insurance Service, which provides healthcare coverage for approximately 99 percent of the South Korean population. The analysis focused on adults aged 20 to 39 who underwent routine health examinations between 2009 and 2012.

The initial dataset comprised more than six million individuals. To ensure that only new cases of migraine were captured, the researchers applied rigorous exclusion criteria. Individuals with a prior diagnosis of migraine were removed, as were those with missing information on body measurements or lifestyle factors. To reduce the risk of including people with undiagnosed migraine at baseline, anyone diagnosed within the first year of follow-up was also excluded.

After these exclusions, the final study population included 6,106,560 participants. The average age was approximately 30 years, and around 39 percent of participants were female.

Long-term follow-up and detailed health data

Participants were followed from the date of their health examination until the end of 2018. New cases of migraine were identified using medical claims data, specifically the International Classification of Diseases code G43. The average follow-up period was seven years, allowing for robust assessment of long-term risk.

During health examinations, trained medical staff measured height, weight, and waist circumference while participants wore light clothing. Body mass index was calculated as weight in kilograms divided by height in metres squared. Body mass index was categorised into five groups, ranging from underweight to stage 2 obesity. Waist circumference was divided into six categories using 5 centimetre increments, enabling a detailed assessment of abdominal obesity.

The dataset also included extensive information on potential confounding factors. Participants completed questionnaires covering smoking status, alcohol consumption, physical activity, and income level. Blood tests provided measurements of cholesterol, glucose, and other metabolic markers, allowing for comprehensive statistical adjustment.

Abdominal fat emerges as a stronger predictor than body mass index

The analysis showed a clear association between obesity and the risk of developing migraine. In models that adjusted for age and sex, migraine risk increased progressively with higher body mass index, with individuals living with stage 2 obesity showing a higher likelihood of receiving a migraine diagnosis compared with those in the normal weight range.

However, the association was even more pronounced when abdominal obesity was examined. Waist circumference demonstrated a dose-dependent relationship with migraine risk, meaning that each incremental increase in waist size was associated with a stepwise rise in risk. This pattern persisted even after adjustment for a wide range of demographic, lifestyle, and metabolic factors.

When the researchers adjusted their models to account for waist circumference, the association between body mass index and migraine weakened. In contrast, the relationship between waist circumference and migraine remained strong even after body mass index was taken into account. This indicates that abdominal obesity functions as an independent risk factor for migraine, more influential than overall body weight.

Participants with the largest waist measurements had significantly higher hazard ratios for migraine, while those with the smallest waist circumferences showed a reduced risk.

Underweight status and the role of muscle mass

The study also explored the relationship between being underweight and migraine risk. Initial analyses suggested that underweight individuals might have an increased risk of migraine. However, this association disappeared after full statistical adjustment, indicating that low body weight alone is unlikely to be a direct cause of migraine.

More nuanced findings emerged when waist circumference was controlled for. Extremely low body mass index was associated with higher migraine risk, which the authors suggest may reflect low skeletal muscle mass rather than low fat mass. Skeletal muscle plays a role in modulating inflammatory processes, and reduced muscle mass may contribute to a pro-inflammatory state.

Inflammation as a plausible biological mechanism

Inflammation is widely considered a key biological link between obesity and migraine. Adipose tissue, particularly visceral fat stored deep within the abdominal cavity, is metabolically active and releases a range of pro-inflammatory cytokines and adipokines.

Visceral fat is known to produce higher levels of inflammatory mediators than subcutaneous fat. This distinction may explain why waist circumference was a more reliable predictor of migraine risk than body mass index. Chronic low-grade inflammation associated with excess abdominal fat could lower the threshold for migraine development and increase susceptibility to neurological sensitisation.

Differences by age and lifestyle factors

Subgroup analyses revealed that age modified the observed associations. The link between abdominal obesity and migraine was stronger in adults under 30 years of age than in those in their thirties. This suggests that younger adults may be particularly vulnerable to the neurological effects of excess abdominal fat.

Lifestyle factors also influenced the strength of the association. The relationship between abdominal obesity and migraine was more pronounced in non-smokers than in smokers, and stronger in people who consumed alcohol heavily. Alcohol is known to have vasodilatory effects and is a recognised migraine trigger.

The researchers proposed that alcohol use and obesity may have synergistic effects, with alcohol-related vascular changes interacting with obesity-driven inflammation to further increase migraine risk.

Study limitations and future directions

Several limitations should be considered when interpreting the findings. Because migraine cases were identified using health insurance claims, only individuals who sought medical care were included. Many people live with migraine without receiving a formal diagnosis, which may have led to an underestimation of true incidence.

The study population was limited to South Korea, and patterns of body composition and fat distribution vary across ethnic groups. As a result, the waist circumference and body mass index thresholds used in this study may not be directly applicable to other populations. The gender distribution was also uneven, reflecting the characteristics of the national screening programme.

As an observational study, the analysis cannot definitively establish causation. Although the temporal relationship between obesity and migraine onset was clear, unmeasured factors may still have influenced the results despite extensive statistical adjustment.

Future research is needed to confirm these findings in other populations and to explore the underlying biological pathways in greater detail. Studies examining specific inflammatory mediators and adipokines may help clarify how abdominal obesity contributes to migraine development.

Implications for migraine prevention

Despite its limitations, this large-scale study provides compelling evidence that maintaining a healthy body composition may play a role in preventing migraine, particularly in young adults. The findings emphasise that fat distribution, not just overall weight, is clinically relevant. For clinicians, assessing abdominal obesity may offer additional insight when evaluating migraine risk and discussing preventive strategies with patients.

The study, Association Between Obesity and the Risk of Migraine: A Nationwide Cohort Study in South Korea, was authored by Soo-Im Jang, Namoh Kim, Kyungdo Han, and Mi Ji Lee.

CCH insight:

Yet another inflammatory condition linked to obesity! It is interesting to note that this study found waist circumference to be a much better predictor of migraine risk than BMI. This is because waist circumference is a better indicator of excess visceral fat, which produces high levels of pro-inflammatory mediators. So this is a reminder of the limitations of BMI and the importance of considering waist circumference or waist:height ratio when assessing the extent and impact of excess body weight.

Read More

GLP-1 Weight-Loss Medications Linked to Fewer Severe Asthma Attacks in Adolescents with Excess Weight

Key Takeaways: 

• Adolescents with excess weight and asthma who were prescribed GLP-1 medications experienced around half as many asthma-related emergency room visits over one year compared with peers not taking these drugs.
  
• Use of GLP-1 therapies was also associated with reduced reliance on steroids and rescue inhalers, suggesting improved asthma control.
  
• Researchers suggest these medicines may offer a dual benefit, supporting weight management while lowering the risk of asthma exacerbations in this population.
  
  
  

Study suggests dual benefit for weight and asthma control

Severe asthma attacks among adolescents with excess weight may be significantly reduced with the use of newer weight-loss medications such as Ozempic and Zepbound, according to a new observational study.

The research found that emergency room visits for asthma were cut by more than half among teenagers who were prescribed a glucagon-like peptide-1 (GLP-1) receptor agonist. The findings were reported on 29 December in JAMA Network Open.

“Our findings suggest a potential dual benefit for this population, where a single class of medication could address both weight management and lower risk for asthma exacerbation, thereby potentially reducing the burden of two common and interconnected chronic conditions,” the researchers concluded.

The study was led by Dr Lin‑Shien Fu, chief of paediatric nephrology and immunology at Taichung Veterans General Hospital.

How the study was conducted

Researchers followed 1,070 adolescents aged 12 to 18 years who were living with excess weight and had a clinical diagnosis of asthma. Approximately half of the group had been prescribed a GLP-1 medication, while the remainder had not received a weight-loss drug.

GLP-1 receptor agonists mimic the naturally occurring GLP-1 hormone, which plays a role in regulating insulin and blood glucose levels. These medicines also reduce appetite and slow gastric emptying, contributing to weight loss.

Over a 12-month follow-up period, the researchers recorded:

• Eight asthma-related emergency department visits among adolescents taking a GLP-1 medication
  
• Nineteen asthma-related emergency visits among those not prescribed a weight-loss drug
  
  
  
  

Reduced need for asthma medications

In addition to fewer emergency visits, adolescents taking GLP-1 medications were less likely to require other treatments for asthma control.

The study found that:

• 21% of adolescents taking a GLP-1 medication required steroid treatment for asthma, compared with 31% of those not taking the drugs
  
• 32% of adolescents in the GLP-1 group needed a rescue inhaler, compared with 45% in the non-GLP-1 group
  

These differences suggest an overall reduction in asthma severity and symptom burden among those prescribed GLP-1 therapies.

Weight loss and inflammation may explain the findings

Experts not involved in the research say the observed improvements are likely linked to the degree of weight loss achieved with these newer medications.

Dr Michelle Katzow, medical director of the POWER Kids Weight Management Program and associate professor of paediatrics at Cohen Children’s Medical Center in New York City, commented on the findings in a news release.

“I think it is not surprising and not so new, except for the degree of weight loss that the drug induces is so much bigger in magnitude than we have seen before,” she said.

Dr Katzow explained that excess weight contributes to systemic inflammation, which can worsen asthma symptoms and increase the likelihood of exacerbations.

“The sort of inflammation associated with obesity predisposes somebody to having worse asthma or worse symptoms of asthma,” she said.

“If you can help people lose enough weight by whatever means, then you can improve their asthma severity.”

Implications for adolescents struggling with appetite control

Dr Katzow added that GLP-1 medications may be particularly helpful for adolescents who struggle to adopt healthy behaviours because of persistent hunger.

She noted that this is a common challenge among young people with excess weight.

“And that is true for a lot of kids,” she said. “They are just really hungry and they are thinking about food a lot. Trying to make healthier choices or eat less is really hard to do if you are hungry all the time.”

A cautious but promising signal

While the study does not establish a direct causal relationship, it adds to growing evidence that weight-loss interventions can have meaningful benefits beyond body weight alone. The findings suggest that, for some adolescents living with excess weight and asthma, GLP-1 receptor agonists may help reduce the frequency and severity of asthma exacerbations alongside supporting weight management.

Further research will be needed to confirm these findings and to better understand the long-term safety and clinical role of GLP-1 therapies in paediatric populations.

CCH insight:

The long list of benefits of GLP-1 therapy continues to grow. If obesity increases the risk of asthma, it is not surprising that GLP-1 therapy results in a reduction in hospital visits due to asthma. Further studies are needed to back up these results, and also to see if the same benefits are seen in adults, as well as adolescents.

Read More

Bottle Feeding Toddlers to Sleep Linked to Tooth Decay and Excess Weight in Early Childhood

Key Takeaways: 

• More than three in ten toddlers were still being bottle fed to sleep at two years of age
  
• Bottle feeding to sleep at age two was linked to almost double the risk of overweight in early childhood
  
• Continuing the practice at age three was associated with nearly twice as many teeth affected by decay
  
  
  

Parents and carers are being urged to avoid using bottles to help toddlers fall asleep, after new research found clear links between the practice, early childhood tooth decay, and excess weight gain.

The study, published in the Australian and New Zealand Journal of Public Health, was led by researchers at the University of Sydney and drew on data from more than 700 toddlers participating in Western Sydney University’s Healthy Smiles Healthy Kids (HSHK) cohort study. The long running study follows children from birth to examine factors influencing oral health and broader health outcomes.

Study design and data sources

Researchers analysed information collected through surveys completed by mothers, alongside clinical dental examinations and measurements of children’s height and weight. Importantly, the analysis also accounted for a range of other factors known to influence dental health and body weight, allowing the researchers to better isolate the impact of bottle feeding to sleep.

What the researchers found

The findings showed that bottle feeding to sleep remains common well beyond infancy and is associated with measurable health risks:

• More than 30 percent of children were still bottle fed to sleep at two years of age
  
• Children who were bottle fed to sleep at age two were almost twice as likely to have overweight in early childhood
  
• Children who were bottle fed to sleep at age three had nearly double the number of teeth affected by dental decay
  
  
  

Why bottle feeding to sleep matters

Lead author Heilok Cheng, a PhD candidate in the Susan Wakil School of Nursing and Midwifery at the University of Sydney, emphasised that most parents and carers are acting with good intentions but may not be fully aware of the longer term risks.

“Australian recommendations advise parents to start introducing cups at 6 months of age and stop using baby bottles at 12 months. Bottle feeding in bed is not recommended at any age. Our research now provides a much more robust evidence base for that advice.”

She explained that many commonly used drinks for toddlers can increase the risk of dental decay.

“Common toddler drinks, including cow’s milk and formula, often contain either natural or added sugars, increasing the risk of tooth decay. When a bottle is offered at bedtime it’s often being used by carers to calm an unsettled child or encourage the child to drift off to sleep. Because the bottle isn’t being offered in response to hunger, it can lead to overfeeding, putting children at risk of unhealthy weight gain.”

Cheng also highlighted the need for better support for families navigating infant and toddler feeding practices.

“We need to do more to support families and help them avoid getting into the habit of putting a child or baby to bed with a bottle, so that our future generations are set up with a healthy future from the start.”

Wider implications for policy and prevention

The authors note that the findings reinforce the importance of coordinated public health action to reduce childhood obesity and improve oral health. They also point to the potential value of universal dental care as part of a broader strategy to prevent avoidable dental disease in early life.

About the Healthy Smiles Healthy Kids study

The Healthy Smiles Healthy Kids (HSHK) cohort study is led by Associate Professor Amit Arora from Western Sydney University, in collaboration with Sydney Local Health District, South Western Sydney Local Health District, the University of Sydney, the University of Queensland, the University of Technology Sydney, and Curtin University.

The study is funded by the Australian National Health and Medical Research Council, NSW Health, the Australian Dental Research Foundation, and the Oral Health Foundation. The full paper, “Bottle feeding to sleep beyond 12 months is associated with higher risk of tooth decay and overweight in Australian children: Findings from the Healthy Smiles Healthy Kids cohort study”, was published in the Australian and New Zealand Journal of Public Health.

CCH insight:

This is an interesting study, which provides very strong evidence for avoiding bedtime bottle-feeding to help infants get to sleep. It would be interesting to know if the excess weight gain resulting from bedtime bottle-feeding is due simply to the extra calories provided by the bedtime milk, or if it also encourages increased emotional eating – it is believed that emotional eating, which is a common cause of overeating in adults, has its behavioural origin in the soothing effect we experience when suckling as a baby, so we come to associate fatty sugary food (like breast or formula milk) with bringing relief from anxiety and stress.

Read More

GLP-1 Receptor Agonists Unlikely to Meaningfully Influence Obesity-Related Cancer Risk, Review Suggests

Key Takeaways:

• Evidence from randomised trials suggests GLP-1 receptor agonists are unlikely to meaningfully increase or reduce the risk of most obesity-related cancers.
  
• For several cancer types, including colorectal, liver and endometrial cancer, the certainty of evidence remains low due to limited follow-up.
  
• Researchers emphasise the need for longer-term studies with cancer-specific outcomes to fully understand potential risks or protective effects.
  

A comprehensive systematic review published online on 8 December in Annals of Internal Medicine suggests that glucagon-like peptide-1 receptor agonists, commonly known as GLP-1 RAs, have little or no effect on the risk of developing cancers associated with obesity.

The review was led by Albert Ko, MD, of the Harvard T.H. Chan School of Public Health in Boston, and examined data from randomised, placebo-controlled trials involving people treated with GLP-1 RAs for type 2 diabetes or overweight and obesity. While these medications have transformed metabolic care in recent years, concerns have persisted about their long-term safety, including potential cancer risk.

Scope and purpose of the review

GLP-1 receptor agonists are widely prescribed for glycaemic control and weight management, yet their association with cancer has remained uncertain. To address this gap, the researchers conducted a systematic review and meta-analysis to assess whether treatment with GLP-1 RAs is associated with an increased or reduced risk of obesity-related cancers.

The review focused on cancers known to have strong links with excess adiposity, including thyroid, pancreatic, colorectal, gastric, oesophageal, liver, gallbladder, breast, ovarian, endometrial and kidney cancers. It also included multiple myeloma and meningioma.

Data sources and study selection

The authors searched PubMed, Embase, Web of Science, Scopus and the Cochrane Central Register of Controlled Trials from database inception through to August 2025. Only randomised, placebo-controlled trials reporting at least one of the specified cancer outcomes were eligible for inclusion.

In total, 48 trials met the inclusion criteria, encompassing 94,245 participants. None of the trials had been specifically designed to evaluate cancer outcomes, and follow-up durations were generally short.

Methods and quality assessment

Risk of bias across the included trials was assessed using the Cochrane Risk of Bias 2 tool. The certainty of evidence for each outcome was evaluated using the GRADE framework, which considers factors such as study limitations, consistency of results and precision of estimates.

Pooled odds ratios were calculated using random-effects meta-analysis to account for variation between studies.

Main findings by cancer type

The analysis found that GLP-1 receptor agonists probably have little or no effect on the risk of several common obesity-related cancers, based on evidence of moderate certainty.

Specifically:

• Thyroid cancer showed no clear association with GLP-1 RA use, with an odds ratio of 1.37 (95% CI, 0.82 to 2.31), corresponding to between one fewer and nine more cases per 10,000 people treated.
  
• Pancreatic cancer risk was similarly unaffected, with an odds ratio of 0.84 (95% CI, 0.53 to 1.35), equating to nine fewer to six more cases per 10,000 people.
  
• Breast cancer showed an odds ratio of 0.95 (95% CI, 0.60 to 1.49), indicating no meaningful difference in risk.
  
• Kidney cancer also demonstrated no significant association, with an odds ratio of 1.12 (95% CI, 0.78 to 1.60).
  

For other cancers, including colorectal, oesophageal, liver, gallbladder, ovarian and endometrial cancer, as well as multiple myeloma and meningioma, the evidence suggested little or no effect. However, the certainty of this evidence was rated as low.

For gastric cancer, the findings were described as very uncertain, reflecting sparse data and wide confidence intervals.

Consistency across analyses

The results remained consistent across multiple sensitivity and subgroup analyses. These included analyses restricted to trials with a low risk of bias, studies involving newer agents such as semaglutide or tirzepatide, and comparisons across different follow-up durations, populations, GLP-1 RA classes, doses, weight-loss profiles and durations of action.

This consistency strengthens confidence that the observed lack of association is not driven by a specific drug, dose or patient group.

Limitations of the evidence

The authors highlight important limitations that temper the conclusions. Most notably, the included trials were not designed to detect cancer outcomes and generally had relatively short follow-up periods. As a result, rare cancers or effects that emerge only after prolonged exposure may not have been captured.

Implications and next steps

Summarising the findings, the authors conclude that GLP-1 receptor agonists “may have little or no effect on risk for obesity-related cancers,” while emphasising the need for further research. As they write, “These findings offer important insights into the safety of GLP-1 RAs but highlight the need for longer-term studies with cancer-specific end points to clarify potential risks or protective effects.”

For clinicians and people considering or already using GLP-1 receptor agonists, the review provides a degree of reassurance regarding cancer risk in the short to medium term. However, ongoing surveillance and dedicated long-term studies will be essential as use of these medications continues to expand globally.

Read More

Metabolic Bariatric Surgery Shows Greater Two-Year Weight Loss Than GLP-1 RAs

Key Takeaways:

• Metabolic bariatric surgery was associated with substantially greater and more durable weight loss over two years than treatment with GLP-1 receptor agonists in adults living with class II or III obesity.
  
• Overall health care costs over two years were lower for people who underwent surgery, largely due to the ongoing pharmacy costs associated with GLP-1 receptor agonist therapy.
  
• The findings underline the importance of multidisciplinary care, particularly for clinicians managing obesity-related conditions where sustained weight reduction is central to disease control.
  

Overview

A large retrospective, claims-based cohort study has found that metabolic bariatric surgery delivers greater long-term weight loss benefits and lower overall health care costs over two years compared with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in adults living with severe obesity. The analysis suggests that, in real-world clinical practice, surgical approaches may offer more durable outcomes than pharmacotherapy alone for this population.

Study design and data sources

This retrospective cohort study compared outcomes following metabolic bariatric surgery with those achieved using GLP-1 receptor agonist therapy for weight management. Surgical procedures included sleeve gastrectomy and gastric bypass. Pharmacological treatments included dulaglutide, exenatide, liraglutide, lixisenatide, semaglutide, and tirzepatide.

The analysis drew on data from the Highmark Health insurance claims database linked with electronic health records from the Allegheny Health Network. In total, 30,458 adults living with class II or III obesity were included. All individuals in the weight-loss analysis had a body mass index of at least 40 at the time of enrolment.

To minimise baseline differences between groups, the researchers used propensity score weighting to balance key characteristics, including body mass index, age, sex, comorbid conditions, and patterns of health care utilisation. Adjusted analyses then compared weight-loss trajectories, obesity-related comorbidities, and total health care costs over a two-year follow-up period.

Weight loss outcomes and durability

Of the total cohort, 14,101 people underwent metabolic bariatric surgery, with a mean follow-up of 34 months. A further 16,357 people were prescribed GLP-1 receptor agonists, with a mean follow-up of 32 months.

After two years, metabolic bariatric surgery was associated with markedly greater mean total weight loss than GLP-1 receptor agonist therapy, at 28.3 per cent compared with 10.3 per cent. Weight loss following surgery was also more durable. Ninety-six per cent of people in the surgical group achieved sustained weight loss of at least 10 per cent, compared with 46 per cent of those treated with GLP-1 receptor agonists.

In addition to superior weight outcomes, people who underwent metabolic surgery experienced fewer obesity-related comorbidities and lower health care utilisation across inpatient, outpatient, and emergency care settings.

Cost analysis

Over the two-year follow-up period, metabolic bariatric surgery was associated with significantly lower mean total health care costs than GLP-1 receptor agonist therapy. Average costs were reported as $51,794 for the surgical group compared with $63,483 for those receiving GLP-1 receptor agonists.

The higher costs observed in the pharmacotherapy group were largely driven by ongoing pharmacy expenses related to long-term GLP-1 receptor agonist use. While surgery involves a higher upfront cost, the findings suggest this is offset over time by reduced medication use and lower overall health care utilisation.

Study limitations

The authors note several important limitations. Weight data were available for only a small proportion of participants, comprising 9 per cent of the surgery group and 1.6 per cent of the GLP-1 receptor agonist group. This limits the generalisability of the weight-loss findings to the full cohort.

In addition, the indication for GLP-1 receptor agonist prescriptions was not always clear, meaning some individuals may have been treated primarily for diabetes rather than obesity. However, an obesity-only subgroup analysis restricted to people without a diabetes diagnosis produced similar results, supporting the robustness of the main findings.

Follow-up duration differed slightly between groups, and adherence to GLP-1 receptor agonist therapy was likely lower in this real-world setting than would be expected in a controlled clinical trial. Finally, the cost data reflect the United States health care system and may not be directly transferable to other countries or funding models.

Clinical relevance

For clinicians managing obesity-related complications, including ophthalmologists caring for people with obesity-associated eye disease such as idiopathic intracranial hypertension, these findings highlight the broader systemic benefits of durable weight reduction. Although GLP-1 receptor agonists are increasingly recommended in the management of idiopathic intracranial hypertension, the study suggests that metabolic bariatric surgery may offer greater sustained weight loss at a lower long-term cost.

The results emphasise the value of close collaboration between ophthalmology, endocrinology, and bariatric surgery teams when supporting people whose disease burden is driven by obesity. While ongoing government discussions around medication pricing may influence future cost-effectiveness analyses, the substantial differences observed in this study indicate that metabolic surgery is likely to remain a cost-effective intervention even if GLP-1 receptor agonist costs were to decrease.

Disclosures and publication details

Financial disclosures: Dr Chantal Boisvert reports a financial relationship with Viridian Therapeutics, serving as a consultant or advisor and receiving grant support.

Read More