Obesity Care Tag

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

Key Takeaways:

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

Intermittent fasting under scrutiny

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

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

Obesity remains a global public health challenge

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

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

What the review examined

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

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

Limited evidence on safety and long-term outcomes

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

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

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

Social media enthusiasm outpaces the evidence

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

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

Generalisability remains uncertain

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

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

Implications for clinical practice

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

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

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

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

 Key Takeaways: 

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

Background and rationale

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

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

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

Study design and dietary interventions

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

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

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

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

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

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

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

Measurements and outcomes assessed

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

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

Weight loss, energy expenditure and metabolic markers

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

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

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

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

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

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

Gut microbiota composition and short-chain fatty acids

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

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

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

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

Interpretation and clinical implications

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

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

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

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

Key Takeaways: 

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

Overview of the analysis

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

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

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

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

Study design and assessment methods

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

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

Depression symptoms over time

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

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

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

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

Suicidal ideation and behaviour

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

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

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

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

Implications for mental health care in obesity

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

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

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

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

Disclosures

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

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

Key Takeaways:

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

Obesity and severe infection risk across multiple pathogens

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

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

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

Weight matters for infection outcomes

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

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

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

Possible links with immune system dysfunction

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

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

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

Obesity and global infectious disease mortality

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

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

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

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

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

Importance of vaccination and prevention

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

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

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

Key Takeaways:

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

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

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

How GLP-1 weight loss drugs work

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

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

Experts warn of risks without nutrition support

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

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

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

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

Public guidelines versus private use

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

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

Rising use outpaces nutrition guidance

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

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

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

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

Limited research leaves major questions unanswered

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

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

Lessons from bariatric nutrition care

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

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

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

Equipping healthcare professionals with the nutritional knowledge to guide patients safely through this kind of rapid 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.

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

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

Studying real-world experiences

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

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

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

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

CCH insights:

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

Explore Nutrition & Weight Management Essentials →

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

Key Takeaways: 

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

Growing concern over ultra-processed food consumption

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

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

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

What are ultra-processed foods?

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

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

Rising obesity across adults and children

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

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

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

A rapidly expanding market

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

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

Health and economic costs

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

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

Marketing practices under scrutiny

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

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

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

Existing policies and regulatory gaps

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

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

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

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

Proposed measures, including advertising restrictions

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

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

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

Call for a multi-pronged response

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

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

CCH insights:

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

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

Key Takeaways:

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

Weight management challenges after menopause

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

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

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

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

Hormone therapy and obesity treatments

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

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

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

Findings and limitations

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

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

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

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

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

Possible biological synergy

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

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

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

Next steps for research

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

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

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

CCH insight:

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

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Dietary Melatonin Intake Linked to Lower Rates of Obesity and Depression

Key Takeaways: 

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

Background and study context

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

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

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

Rationale for examining dietary melatonin

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

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

Study design and population

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

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

Dietary assessment and estimation of melatonin intake

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

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

Health outcomes and definitions

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

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

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

Cardiometabolic criteria

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

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

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

Statistical analysis

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

Participant characteristics

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

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

Melatonin content of foods and dietary sources

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

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

Associations with health outcomes

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

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

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

Conclusions and implications

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

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

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

CCH insights:

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

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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.

Building confidence in these delicate conversations is the focus of professional training such as the College of Contemporary Health’s Behaviour Change Skills: Person-Centred Communication, a CPD-accredited online short course.

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 an entire family can benefit from these interventions, not just the child with excess weight. Because so much rests on how these conversations are handled, CCH’s Behaviour Change Skills: Person-Centred Communication CPD short course (2 CPD hours, fully online, CPD-accredited) gives healthcare professionals a practical, evidence-based foundation in person-centred communication – helping them raise sensitive issues like weight with patients and families supportively and without judgement.

Explore Person-Centred Communication →

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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.

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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.

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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.

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