Dual Burden of Alcohol Use and Obesity Linked to Rising Liver Disease Risk
Key Takeaways:
- Around 1 in 10 U.S. adults report both heavy drinking and obesity, creating a compounded risk for liver disease
- This overlap is most common in younger and middle-aged adults, suggesting risk accumulates early in life
- Integrated, non-judgemental care targeting both conditions together may improve long-term outcomes and reduce progression to advanced liver disease
A growing overlap with serious implications
Heavy alcohol use and obesity are both increasing in the United States, and they are increasingly affecting the same individuals. A new study published in JAMA Internal Medicine explores how often these two major risk factors coincide among U.S. adults and why this overlap has important implications for clinical care and public health policy.
The research was led by Dr Bryant Shuey, a board-certified general internist at UPMC and a clinician-investigator at the University of Pittsburgh Center for Research on Health Care. His work focuses on substance use, chronic disease, and access to care. Drawing on national survey data, the study highlights a critical, and often overlooked, opportunity to intervene earlier in the disease trajectory before severe liver damage develops.
Why examine alcohol use and obesity together?
Dr Shuey explains that this combined risk is increasingly visible in clinical practice:
“In my clinical work, I’ve been seeing more people in their 30s and 40s coming to the hospital with advanced liver disease linked to both alcohol use and metabolic risk factors. Nationally, heavy drinking and obesity are both becoming more common and there has been greater recognition that alcohol and metabolic disease can combine to accelerate liver disease progression. Treatment of both conditions, especially alcohol use disorder, is also lagging, as evident by research by my colleague and study co-author Dr. Eden Bernstein from the University of Colorado. Together, we sought to understand how often risky alcohol use and obesity overlap and what it might mean for prevention and earlier intervention.”
This convergence of risks reflects a broader shift in how liver disease is understood. Rather than being driven by a single cause, many people now present with multiple interacting factors that amplify disease progression.
A significant and early-emerging risk
The study’s central finding is clear:
“The key finding is that about 1 in 10 U.S. adults reported both heavy drinking and a body mass index of 30 or greater in 2023. That’s a substantial share of the population, especially considering how strongly each of these factors contributes to liver disease risk on its own.”
What is particularly striking is how early this overlap appears.
“What stood out most was how early this overlap appears. Rates were highest among young and middle-aged adults, when risk factors for serious liver disease are just beginning to build. These findings suggest that many people are entering adulthood with multiple, reinforcing risk factors for liver disease long before they ever develop symptoms.”
This suggests that prevention efforts may need to begin far earlier than is currently typical, focusing on identifying and addressing risk factors before clinical disease becomes apparent.
How liver disease presents in clinical practice
People living with alcohol-related and metabolically related liver disease may present at very different stages. Some are identified early through routine primary care assessments, while others present later with advanced complications.
Dr Shuey describes this spectrum:
“Patients can show up at different points along the disease course. Some are identified early by their primary care doctor by discussing risk factors like alcohol use and metabolic health and ordering blood work and liver imaging. Others present later, sometimes to the emergency department, with symptoms of advanced liver disease, or cirrhosis, like jaundice, abdominal swelling or gastrointestinal bleeding. Liver disease can lurk for years with no symptoms, so for some, that’s the first time they’re learning they have liver disease. Whether the illness is driven mainly by metabolic disease, alcohol use or a combination of both, if unchecked, the outcome can be the same: progressive liver damage that can lead to cirrhosis and liver failure. That’s why it’s so important to address these risk factors together, not in isolation.”
The silent progression of liver disease underscores the importance of proactive screening and early intervention.
Rethinking care: addressing both risks together
For clinicians, the findings point to the need for a more integrated approach to care.
“We need to routinely screen for both conditions in an empathetic and non-judgmental way and recognize how strongly they interact when it comes to liver disease risk. Clinicians should offer standard evidence-based options to treat both conditions: dietary counseling, motivational interviewing, medications for alcohol use disorder and therapies for metabolic disease such as GLP-1s and related weight loss drugs. There’s growing interest in these medications because they help people reduce their metabolic risk through weight loss and reversing inflammation in metabolic liver disease. Additionally, a smaller trial last year found that GLP-1s may reduce alcohol use among people with alcohol use disorder. While these results should not be overstated, GLP-1s may emerge as an important dual-therapeutic for patients with risky alcohol use and obesity if these findings hold up in larger trials. Ultimately, addressing both risk factors together may be an important strategy to change long-term outcomes.”
This reflects a shift towards dual-risk management, where treatment strategies are designed to address interconnected drivers of disease rather than isolated conditions.
Supporting people without judgement
A central theme in managing these conditions is the importance of person-centred care.
“The most important thing is creating space to talk about these concerns without judgment. I would want to learn about their goals, explore their understanding of the health impacts of alcohol use and metabolic disease, counsel them on treatment options and support them in their decision. For some people, the priority is avoiding serious illness down the road. Others may want to lose weight, drink less or stop drinking altogether. While addressing both conditions simultaneously may be of interest to some patients, others may feel overwhelmed and want to focus on just one. There isn’t a single right goal.”
This highlights the need for flexibility in care plans and respect for individual priorities and readiness for change.
Barriers to care and policy implications
The study also draws attention to wider structural barriers that influence health outcomes.
“Our social conditions shape our health. Improving access to affordable, healthy foods and safe spaces for exercise and activity can go a long way in helping people attain their highest level of health. Bolstering public health messaging about the lesser-known risk of liver disease as a complication of alcohol use and metabolic disease is also critical to helping people make informed decisions. Furthermore, stigma around both weight and alcohol use can discourage people from seeking care in the first place. Fewer than 10% of people with an alcohol use disorder receive treatment, and just 5% are prescribed evidence-based medications that have been demonstrated to reduce alcohol use. Clinicians can be a part of the solution by ensuring they are offering patients standard treatments for alcohol use disorder.”
Access to care remains a major challenge, particularly for those without adequate insurance or financial resources.
“Health care affordability and access to care are major barriers to timely diagnosis and treatment of alcohol- and metabolic-related health issues, particularly for people who are uninsured. Preventing progression to advanced liver disease isn’t just better for patients, it’s far less expensive than treating cirrhosis and its complications. In the U.S., we spend an estimated $135 billion on liver disease every year. We need prevention-focused approaches and more equitable access to care for the populations at highest risk.”
These findings reinforce the importance of prevention-focused policy and equitable healthcare access.
Priorities for future research
Looking ahead, the study highlights several important areas for further investigation.
“We should figure out how to intervene earlier, when obesity and risky alcohol use first begin to overlap, long before advanced liver disease develops. We also need more data on how existing treatments work in patients with multiple, co-occurring risk factors, since many clinical trials have historically excluded these groups.”
There is also a need to better understand how health systems and policy decisions shape outcomes.
“From a policy standpoint, future research should also look at how insurance coverage and access barriers affect outcomes for people at greatest risk. Better evidence in these areas could help guide more effective and equitable prevention strategies.”
A shift towards earlier, integrated prevention
Taken together, the findings point to a clear conclusion: the intersection of heavy alcohol use and obesity represents a growing and under-recognised driver of liver disease. Identifying and addressing these risks earlier, and in combination, may offer a meaningful opportunity to improve patient outcomes and reduce the long-term burden on healthcare systems.
Source: UPMC Life Changing Medicine
Automated Weight Loss Programme Shows Promise for People Living with Cancer in Landmark Trial
Key Takeaways:
- A fully automated, web-based programme delivered clinically meaningful weight loss in people living with and beyond cancer, without any in-person support
- More than 43 percent of participants achieved at least 3 percent weight loss, with nearly one in three reaching 5 percent or more
- The intervention also improved a range of health outcomes, including diet quality, physical functioning, and cardiometabolic markers
A new model for post-cancer care
A large national randomised clinical trial has demonstrated that a fully automated, web-based weight loss intervention can deliver substantial health benefits for people living with and beyond cancer. The programme, developed by researchers at the University of Alabama at Birmingham, represents a significant shift in how post-cancer care may be delivered in the future.
Published in the Journal of the National Comprehensive Cancer Network, the study reported the highest level of weight loss ever achieved through a fully automated intervention in this population. The programme, known as the AMPLIFY Diet (AiM, PLan and act on LIFestYles), was designed to provide structured, evidence-based lifestyle support without requiring direct clinician involvement.
Addressing a major unmet need
A substantial proportion of people living with and beyond cancer are also living with overweight or obesity. In the United States, this figure is estimated to be around 70 percent. This places individuals at increased risk of cardiovascular disease, type 2 diabetes, functional decline, cancer recurrence, and the development of second primary cancers.
Despite this, access to specialist oncology dietitians remains limited. Traditional weight management programmes often rely on in-person consultations or regular coaching, which can be difficult to scale and may not be accessible to all patients.
The AMPLIFY Diet intervention was developed specifically to address these barriers by delivering personalised nutrition and behavioural support entirely online.
A fully automated intervention
The programme operates without live coaching, counselling calls, or face-to-face appointments. Instead, it uses a structured digital platform that includes weekly interactive sessions, goal-setting tools, progress monitoring, and automated personalised feedback.
Participants engage with the system independently, receiving guidance that is grounded in established behavioural and nutritional science. This approach allows for scalability while maintaining a consistent standard of care.
“This is a game changer for cancer survivorship care,” said Wendy Demark-Wahnefried, Ph.D., R.D., senior author and professor at UAB’s School of Health Professions and O’Neal Comprehensive Cancer Center. “We showed that a completely automated online program grounded in decades of behavioral and nutrition science can safely and effectively help cancer survivors lose weight and improve their health at scale.”
Study design and participant profile
Between 2020 and 2024, the study enrolled 349 participants aged between 50 and 82 years from 31 states across the United States. All participants were living with and beyond cancers associated with obesity.
The cohort included individuals with a range of cancer types, including breast, colorectal, prostate, endometrial, ovarian, thyroid, renal, and haematologic cancers. Participants were randomly assigned to either the AMPLIFY Diet programme or a control group receiving standard survivorship information.
Clinically meaningful weight loss outcomes
After six months, the results showed clear differences between the intervention and control groups.
More than 43 percent of participants in the AMPLIFY Diet group achieved weight loss of at least 3 percent of their body weight. In comparison, only 13 percent of those receiving usual care reached this threshold.
In addition, nearly one in three participants in the intervention group lost at least 5 percent of their body weight. This level of weight loss is widely associated with reductions in cardiovascular risk and improvements in cancer-related outcomes.
On average, weight loss in the intervention group was nearly five times greater than that observed in the control group.
Broader health improvements
The benefits of the programme extended beyond weight loss alone. Participants in the AMPLIFY Diet group experienced improvements across multiple domains of health and wellbeing.
These included reductions in waist circumference and overall caloric intake, as well as improvements in diet quality. Biochemical markers also shifted in a favourable direction, with lower circulating levels of leptin, a hormone associated with cancer progression and cardiometabolic disease.
Further gains were observed in blood pressure, physical functioning, and cognitive performance. Participants also reported improvements in depression and their ability to engage in social roles, suggesting a broader impact on quality of life.
Strong engagement without human support
One notable finding from the study was the level of participant engagement. Individuals completed an average of 60 percent of the weekly sessions, which is considerably higher than engagement rates typically reported in other digital lifestyle interventions.
This suggests that a well-designed automated system can maintain user engagement even in the absence of direct human interaction.
Implications for scalable care
Unlike many conventional weight management programmes, the AMPLIFY Diet intervention does not require ongoing staff involvement. This makes it particularly well suited for integration into healthcare systems, cancer centres, and community-based services.
The ability to deliver consistent, evidence-based care at scale may help address longstanding gaps in survivorship support, particularly in settings where specialist resources are limited.
The role of behavioural and nutritional care
The researchers emphasise that lifestyle-based interventions remain a cornerstone of care for people living with and beyond cancer, particularly as pharmacological approaches continue to evolve.
“Behavioral and nutritional interventions are essential,” Demark-Wahnefried said. “Diet quality, muscle preservation, cognition, and long-term sustainability of a healthful lifestyle and body weight are critical for cancer survivors, and even if weight loss medications eventually receive broadscale endorsement, they alone do not address all of these needs.”
Future directions
The research team is now focusing on expanding the reach of the AMPLIFY Diet programme across both clinical and non-clinical settings. The aim is to improve access to effective survivorship care while also contributing to broader cancer prevention efforts.
The study was funded by the National Institutes of Health and the American Cancer Society.
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Whole Milk and Childhood Obesity – New Study Challenges Long-Standing Dietary Advice
Key Takeaways:
- Children who consumed whole-fat milk in early childhood showed lower odds of living with obesity in later childhood compared with those consuming reduced-fat options
- The study found no evidence that whole milk increases adiposity, challenging decades of low-fat dietary guidance
- Researchers suggest milk fat may influence satiety and overall dietary patterns, although mechanisms remain unclear
Rethinking milk fat and childhood health
New research from the University of Toronto suggests that children who consume whole-fat milk during early childhood may have a lower likelihood of living with obesity in middle childhood than those who drink reduced-fat milk.
These findings contribute to a growing body of evidence indicating that lower-fat milk may not provide the protective effect against childhood obesity that has long been assumed. For several decades, dietary guidelines in many countries have promoted low-fat dairy products. For example, Canada’s Dietary Guidelines in 2019 continued to recommend reduced-fat options, reflecting a broader historical focus on reducing dietary fat intake.
Study overview and design
The study, published in the American Journal of Clinical Nutrition, is described as one of the most comprehensive analyses to date examining the relationship between milk consumption and childhood obesity over time.
Researchers, including former postdoctoral fellow Tara Zeitoun and doctoral student Zheng Hao Chen, analysed data from the CHILD Cohort Study. This large, prospective study tracks health data from thousands of children from before birth through to adolescence.
Caregivers reported the type of milk consumed by children, including skim, one per cent, two per cent, and whole-fat milk. Researchers then assessed a range of outcomes at ages five and eight, including:
- Body mass index (BMI)
- Waist-to-height ratio
- Fat mass
- Preclinical and clinical obesity status
Key findings
Milk consumption was common among participants, with over 90 per cent of children consuming milk before the age of five. Among these:
- 24 per cent consumed whole-fat milk
- Approximately half consumed less than one cup per day
Despite relatively modest intake, notable differences emerged. Children who consumed whole milk at age five had significantly lower BMI at age eight. They also had 69 per cent lower odds of living with obesity compared with children who consumed skim milk.
In addition, researchers identified a broader pattern in which higher milk fat content was associated with more favourable adiposity profiles.
Expert insight
Kozeta Miliku, a professor of nutritional sciences at the University of Toronto’s Temerty Faculty of Medicine and a researcher at the Joannah and Brian Lawson Centre for Child Nutrition, emphasised the implications of these findings:
“The most important learning from this study is that whole milk was not associated with higher adiposity or obesity risks risk in children, and may even be linked to healthier growth patterns,”
She also highlighted the limitations of focusing narrowly on fat reduction:
“Switching to lower-fat milk has been about cutting fat in the diet, but that may miss the bigger picture,” says Miliku. “When we think about healthy growth, it’s important to consider the overall nutritional context. Removing fat does not automatically make skim milk a healthier choice for children.”
Implications for public health guidance
The findings raise important questions about long-standing public health recommendations. Prior to 2019, Health Canada advised that children transition from whole milk to reduced-fat milk from the age of two. Similarly, the Dietary Guidelines for Americans 2020–2025 supported reduced-fat dairy intake.
However, recent policy developments suggest a shift in thinking. In the United States, the Whole Milk for Healthy Kids Act has allowed full-fat milk to be reintroduced into school lunches, aligning with updated national guidance that is more permissive of full-fat dairy.
Possible biological mechanisms
While the study did not directly investigate underlying mechanisms, the researchers proposed several hypotheses:
- Milk fat may enhance satiety, potentially reducing the consumption of energy-dense, nutrient-poor foods
- It may influence overall energy balance
- It could play a role in metabolic pathways linked to growth and nutritional status
These potential explanations highlight the complexity of dietary patterns and suggest that focusing on single nutrients may overlook broader physiological effects.
The need for further research
Miliku noted that additional research is needed to better understand how milk fat may influence obesity risk and whether any protective effects persist into adolescence and adulthood.
With Canada’s 2019 dietary recommendations offering limited specific guidance on milk consumption for children, the study’s findings may help inform future discussions among parents, clinicians, and policymakers.
A broader view of healthy diets
Miliku concluded by reinforcing the importance of overall dietary quality:
“Whole fat milk can be part of a healthy diet and does not on its own increase obesity risk,” she adds. “And it’s important to think about the overall quality of the diet – the fruits and vegetables, whole grains and protein-rich foods they consume.”
Funding and support
The research was funded by the Canadian Institutes of Health Research and the Joannah & Brian Lawson Centre for Child Nutrition at the University of Toronto, supported through a donation by President’s Choice Children’s Charity.
CCH insights:
This interesting new research will hopefully be the trigger for governments and public health bodies to review and amend their outdated advice to choose low-fat dairy options instead of full-fat. The reductionist approach to nutrition, which considers food just in terms of calories and individual nutrients, is an oversimplification which does not help our understanding of the relationship between food and health. If the best food for children early in life is whole milk, why would it be beneficial for them to suddenly switch to low-fat milk at the age of 2?
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Visual Signals, Healthier Choices – Study Shows Colour-Coded Labels Influence Consumer Decisions
Key Takeaways:
- Colour-coded nutrition labels are more effective than traditional tables in guiding healthier food choices
- Red warning signals have a stronger behavioural impact than green positive cues, reflecting a “negative bias” in decision-making
- Simple visual labelling systems may support public health efforts to address obesity and poor dietary habits
The growing use of colour-coded nutrition labels
Colour coding on food packaging is becoming increasingly common, particularly as policymakers and manufacturers seek ways to guide consumers towards healthier dietary choices. A recent study conducted by researchers from SWPS University, the University of Wisconsin, and the University of Massachusetts suggests that these visual systems are significantly more effective than traditional nutritional tables.
The findings, published in Current Psychology, indicate that the effectiveness of colour-coded labels lies in how the brain processes signals of benefit and risk. Rather than requiring effortful interpretation, colour cues allow for rapid, intuitive judgements about a product’s healthfulness.
Obesity and the need for clearer nutritional guidance
According to the World Health Organization, overweight and obesity are major contributors to the development of chronic diseases. Over the past three decades, the proportion of children and adolescents in the United States who are overweight or at risk has more than tripled, reaching 37% and 34% respectively.
This trend has been driven largely by reduced physical activity and the increased consumption of foods high in fat and sugar. In response, clearer and more accessible nutritional labelling systems are being explored as tools to help people make more informed food choices.
How traffic light labelling works
One widely adopted approach is the traffic light labelling (TLL) system, originally developed in the United Kingdom. This system uses colours to indicate the levels of key nutrients such as calories, fat, saturated fat, sugar, and salt relative to recommended intake levels.
- Green indicates low levels, typically below 15% of the reference intake
- Red signals high levels, typically exceeding 25% of the reference intake
By translating numerical data into easily recognisable visual cues, the system allows consumers to assess a product’s nutritional profile at a glance.
“A picture is worth a thousand words”
The study aimed to explore the psychological mechanisms behind how people interpret these colour-coded labels.
“We decided to investigate the psychological mechanisms behind the reading of color-coded product labels. We drew on theories about verbal and visual information processing, as well as the perception of information in positive and negative contexts. We wanted to bridge a gap. Previous studies focused exclusively on consumer purchasing behavior and analyzed the extent to which color-coded labels influenced the choice of healthy food products,” says Professor Andrzej Falkowski, a business psychologist from the Institute of Psychology at SWPS University and the author of the study.
To examine this, researchers recruited 79 participants in the United States via Amazon Mechanical Turk. Participants were asked to evaluate products such as chicken noodle soup, ranch dressing, and peanut butter. These products were presented either with colour-coded nutrient indicators or with traditional text-based information.
Participants rated each product on a scale from 0 to 10, where 0 indicated “harmful” and 10 indicated “healthy”.
Faster processing, more intuitive decisions
The findings confirmed that visual information is easier for people to process than text. Colour cues are interpreted almost instantly by the brain, requiring minimal cognitive effort.
This enables individuals to make quick, instinctive judgements about whether a product is beneficial, even in time-pressured situations such as shopping. In contrast, traditional nutritional tables require more deliberate analysis, which may reduce their practical usefulness in real-world settings.
The power of red and the role of negative bias
One of the most striking findings was the disproportionately strong influence of the colour red. While green highlights positive attributes, red signals high levels of fat or sugar and prompts caution.
“This result also aligns with existing theories suggesting that negative events exert a stronger influence on behavior than positive ones. It is this ‘negative bias’ that makes color systems so effective. Red causes us to pause and reconsider a purchase,” Professor Falkowski emphasizes.
This asymmetry – where negative signals carry more weight than positive ones – was not observed with traditional labelling formats. Without clear visual cues, participants found it more difficult to distinguish between beneficial and harmful aspects of a product.
Improved consistency in consumer judgements
The study also found that colour-coded labels led to more consistent evaluations across participants. Because the visual system clearly differentiates between risks and benefits, individuals were better able to assess products in a uniform way.
By contrast, traditional descriptors such as “low fat” can be ambiguous and open to interpretation, particularly for those with limited nutritional knowledge. Colour coding, based on universally recognised traffic signals, offers a more accessible and intuitive alternative.
Implications for public health and obesity prevention
The researchers suggest that these findings have important implications for public health policy.
“Given the ongoing global challenges of obesity and poor dietary habits, color-coded labeling represents a simple yet impactful strategy for guiding healthier consumer choices,” Falkowski says.
By enhancing the visibility and clarity of nutritional information, colour-coded systems may encourage people to select healthier options. Over time, such behavioural shifts could contribute to improvements in population health.
The authors conclude that leveraging visual attention mechanisms and simplifying complex nutritional data may be a practical and scalable approach to addressing poor dietary habits and the global rise in obesity.
CCH insights:
The results of this study supports the use colour-coded labelling system as it enables quick health-based decision-making, with minimal time or effort required. And it also revealed that we use the system more to avoid unhealthy ‘red’ foods than to actively choose healthy ‘green’ foods. These outcomes emphasise the complex range of factors that contribute to shopping behaviours and decisions about what people eat. And if we want to encourage people to eat healthily, we need to understand these factors better and consider how best to influence them.
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Children with Obesity Face Elevated Long-Term Health Risks Even with Normal Test Results, Study Finds
Key Takeaways:
- Children living with obesity can face significantly higher risks of future disease even when current clinical tests appear normal
- By early adulthood, rates of type 2 diabetes, hypertension and abnormal lipids are markedly higher compared with the general population
- Effective obesity treatment in childhood is associated with meaningful reductions in long-term health risks
Rethinking “metabolically healthy” obesity in childhood
Children living with obesity who show no immediate signs of metabolic complications may still be at substantial risk of developing serious health conditions later in life. New research from the Karolinska Institutet, published in JAMA Pediatrics, challenges the long-standing notion that some children with obesity can be considered “metabolically healthy” and therefore may not require intervention.
The findings contribute to an ongoing clinical debate about whether normal blood markers, liver function and blood pressure in childhood are sufficient indicators of long-term health.
“There has been a debate about whether children with normal blood and liver values and normal blood pressure might not need treatment for their obesity. Our study shows that this assumption is incorrect,” says Claude Marcus, professor at the Department of Clinical Science, Intervention and Technology at Karolinska Institutet.
Study design and population
The study followed just over 7,200 children aged 7–17 in Sweden who had initiated obesity treatment. Participants were tracked longitudinally up to the age of 30, allowing researchers to assess long-term health outcomes.
Children were grouped into three categories:
- Those with metabolically healthy obesity (MHO)
- Those with obesity and impaired cardiometabolic risk markers (MUO)
- A control group drawn from the general population
This design enabled a direct comparison of long-term disease risk across different metabolic profiles in childhood.
A clearly increased risk of future disease
Despite appearing clinically healthy in childhood, individuals with MHO demonstrated a substantially elevated risk of developing cardiometabolic diseases by early adulthood.
By the age of 30:
- 9 percent of individuals with MHO had developed type 2 diabetes, compared with 17 percent in the MUO group and 0.5 percent in the control group
- High blood pressure was observed in 11 percent of the MHO group, 18 percent of the MUO group and 4 percent of the general population
- Abnormal blood lipid levels were present in 5 percent of those with MHO and 13 percent of those with MUO, compared with just 1 percent among controls
These findings indicate that even in the absence of early warning signs, children living with obesity carry a significantly increased burden of future disease risk.
“Even children with obesity who show no signs of cardiometabolic impact have a clearly increased risk of future diseases. This means that normal blood pressure and the absence of abnormal blood test results are not sufficient protection against future morbidity,” says Emilia Hagman, associate professor at the same department and the study’s corresponding author.
The role of early treatment
All children included in the study received structured support aimed at improving lifestyle habits. Researchers examined whether treatment response during childhood influenced long-term outcomes.
A strong response to treatment was associated with a reduced risk of developing all studied conditions – including type 2 diabetes, hypertension and dyslipidaemia. Notably, this protective effect was observed in both MHO and MUO groups.
This suggests that early intervention has meaningful and lasting clinical benefits, regardless of a child’s initial metabolic profile.
“Our results suggest that all children with obesity need treatment, even if they appear completely healthy upon examination,” says Claude Marcus.
Data sources and funding
The study drew on data from Sweden’s national quality registry BORIS, alongside several national health data registries.
Funding was provided by multiple organisations, including the Center for Innovative Medicine, the Ollie and Elof Ericsson Foundation and the Freemason Foundation for Children’s Welfare.
Several researchers reported receiving compensation from companies unrelated to this work. A full list of potential conflicts of interest is available in the original scientific publication.
Implications for clinical practice
The findings underscore the limitations of relying solely on current metabolic markers when assessing risk in children living with obesity. Even in the absence of immediate clinical abnormalities, long-term risks remain significant.
For clinicians, this supports a more proactive and inclusive approach to obesity management in paediatric populations – one that does not defer intervention based on apparently normal test results, but instead recognises obesity itself as a key driver of future health risk.
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Genetic Risk Scores Offer Improved Prediction of Obesity, Type 2 Diabetes and Long-Term Health Outcomes
Key Takeaways:
- A new polygenic risk score integrates genetic data from over 8.5 million people to better predict obesity and type 2 diabetes risk
- The model goes beyond traditional measures such as body mass index by incorporating multiple aspects of metabolic function
- Individuals with higher genetic risk were more likely to develop complications and require interventions such as GLP-1 therapy or bariatric surgery
A more comprehensive approach to metabolic risk
Obesity and type 2 diabetes are complex metabolic conditions influenced by a combination of environmental, behavioural and genetic factors. While traditional clinical measures such as body mass index have long been used to assess risk, they do not fully capture the biological complexity underlying these conditions.
In a new study published in Cell Metabolism, researchers from Mass General Brigham have developed an advanced polygenic risk score designed to improve prediction of both obesity and type 2 diabetes, as well as their long-term health consequences. Polygenic risk scores work by aggregating the effects of many genetic variants across the genome, providing an estimate of an individual’s predisposition to developing a given condition.
“Our intention was to not only capture the risk of being diagnosed with obesity or diabetes, but also to better predict health consequences across the life course by integrating many aspects of metabolic function,” said co-first author Min Seo Kim, MD, MSc. “In the future, this genomic approach could complement established clinical risk factors to inform patient care and preventative strategies.”
Building a next-generation polygenic risk score
The research team constructed two distinct metabolic risk scores – one optimised for obesity and another for type 2 diabetes. Unlike conventional models, these scores incorporate genetic signals linked to 20 different traits associated with metabolic health. These include factors such as fat distribution, insulin regulation and glucose control.
To build these models, the investigators drew on genome-wide association studies conducted across some of the largest biobank datasets globally, encompassing more than 8.5 million individuals. This scale allowed the researchers to capture a broad and diverse range of genetic influences.
Importantly, the model moves beyond reliance on body mass index alone, reflecting a growing recognition that metabolic health cannot be fully understood through weight-based measures in isolation.
Predicting disease progression and clinical outcomes
Beyond predicting the likelihood of developing obesity or type 2 diabetes, the new polygenic risk scores demonstrated the ability to forecast downstream health outcomes.
The researchers found that individuals identified as high risk were more likely to go on to develop complications such as cardiovascular disease and stroke. Even among people who were initially healthy, those with a high genetic risk score were approximately twice as likely to require clinical interventions over time.
Specifically, individuals with higher polygenic risk scores were about twice as likely to receive GLP-1 receptor agonist medications or undergo bariatric surgery compared with those with average risk scores, over a median follow-up period of 5.5 years.
These findings suggest that genetic profiling could help identify people at risk earlier in the disease trajectory, potentially enabling more proactive and targeted care.
Improved performance across diverse populations
A notable strength of the study lies in its use of multi-ancestry genetic data. By incorporating genome-wide association studies from a wide range of populations, including African, East Asian, South Asian and Middle Eastern groups, the researchers were able to develop risk scores that performed better across diverse populations than earlier models.
Historically, many genetic prediction tools have been less accurate in non-European populations due to limited representation in genomic datasets. This study represents a step towards addressing that imbalance and improving equity in precision medicine.
Towards more personalised prevention and treatment
The research team emphasises that this work is part of a broader effort to refine understanding of the genetic subtypes of obesity and type 2 diabetes. Improved classification of these conditions could support more precise patient stratification in clinical trials and, ultimately, more tailored interventions in routine care.
“We want clinicians to be able to think about metabolic conditions in terms beyond body mass index, with a focus more broadly on underlying genetic susceptibility,” said co-senior author Akl Fahed, MD, MPH, of the Cardiovascular Research Center at Massachusetts General Hospital and an interventional cardiologist with the Mass General Brigham Heart and Vascular Institute. “Early identification of people who are likely to have a worse trajectory of poor metabolic health, before they even develop these conditions, can help us improve prevention and clinical interventions. That is how we can cure disease, and that is the bold mission that we are after.”
Implications for clinical practice
While further validation and implementation work will be required, the findings highlight the potential role of genomic tools in enhancing current approaches to metabolic disease prevention and management. By complementing existing clinical risk factors, polygenic risk scores could support earlier identification of people at risk and enable more personalised, proactive care pathways.
As healthcare systems increasingly move towards precision medicine, integrating genetic insights with clinical decision-making may become an important step in improving outcomes for people living with obesity and type 2 diabetes.
CCH insights:
This is exciting research, and a big step towards precision obesity prevention, as it gives us an individual risk score for obesity and diabetes for each patient. However, it is only half the story – ideally we’d also like to be able to determine what type of interventions will work best for each individual (in terms of diet, lifestyle and medicine) in order to optimise their chances of good metabolic health and achieving a healthy weight. Hopefully the ability to do this is not too far away.
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Green Tea Shows Significant Benefits for Glucose Metabolism and Muscle Health in Mice with Obesity
Key Takeaways:
- Green tea extract significantly improved insulin sensitivity, glucose tolerance, and muscle preservation in mice with obesity, even when they continued consuming a high-calorie diet.
- The study controlled for temperature effects, providing clearer evidence that green tea’s metabolic benefits are independent of cold-induced energy expenditure.
- Findings suggest a potential role for green tea as a safe, accessible adjunct to obesity treatment in humans, though exact dosing for people remains to be established.
Ancient beverage, modern research
Green tea, long valued for its medicinal and antioxidant properties, continues to attract scientific interest for its impact on metabolic diseases such as obesity and type 2 diabetes. A recent study led by Professor Rosemari Otton from the Interdisciplinary Graduate Programme in Health Sciences at Cruzeiro do Sul University in São Paulo, Brazil, offers new insights into how green tea affects metabolism.
Otton, who has dedicated over 15 years to the study of green tea, explained that her initial curiosity stemmed from the popular belief that green tea promotes weight loss. The findings of her latest research, published in Cell Biochemistry & Function, reinforce the potential of green tea as a therapeutic adjunct in managing obesity.
Study design and green tea administration
The research team first fed mice a high-calorie diet for four weeks, including both a fat-rich diet and a “cafeteria diet” to replicate a Western-style eating pattern. “We give them chocolate, filled cookies, dulce de leche, condensed milk… In other words, the same type of food that many people consume on a daily basis,” said Otton.
After this induction phase, the mice continued on the high-calorie diet for 12 weeks, with some receiving a standardised green tea extract at 500mg per kilogram of body weight via intragastric gavage. This method ensured precise dosing. “If we put it in water, for example, we’d have no way of knowing how much the animal actually ingested,” Otton explained.
For humans, this dose would equate to approximately 3 grams of green tea daily — roughly three cups. However, Otton cautioned that not all commercial products meet required standards:
“Ready-made tea bags do not always guarantee the quantity or quality of the compounds. The ideal for consumption would be to use standardised green tea extract, like those found in compounding pharmacies. This is a concentrated way of using the plant, with a guarantee of the presence of flavonoids, which are the health-beneficial compounds present in the green tea plant.”
Controlled conditions for reliable results
A distinctive feature of the study was the use of a thermoneutral environment at 28°C, eliminating confounding effects caused by chronic cold exposure. Mice are typically kept at around 22°C in animal facilities, a temperature that triggers energy expenditure to maintain body heat.
“Excessive cold activates compensatory regulatory mechanisms in the animals’ bodies, causing them to expend more energy to stay warm. This can mask the real effects of any substance,” Otton explained. “By maintaining thermoneutrality, we were able to see the effects of green tea in a ‘clean’ way, without environmental interference.”
A previous study published in European Journal of Nutrition (August 2022) found that obese mice treated with green tea lost up to 30% of their body weight — a reduction Otton described as highly significant:
“If a person loses 5% to 10% of their body weight, that’s already a lot. So this result in animals is very significant.”
Preservation of muscle health
One of the most striking findings of the latest study was the preservation of muscle fibre morphology. Obesity often leads to a reduction in muscle fibre diameter, but green tea helped maintain muscle structure.
“One way to assess muscle function is to look at fibre diameter. If it increases, we have more active muscle components. Green tea managed to maintain this diameter, showing that it protects muscle against the harmful effects of obesity,” Otton said.
Genetic and metabolic insights
The study also explored gene expression related to glucose metabolism. Green tea treatment enhanced the expression of genes such as Insr, Irs1, Glut4, Hk1, and Pi3k, all of which play a role in glucose uptake and utilisation in muscle tissue. Additionally, the activity of lactate dehydrogenase (LDH), an enzyme vital for glucose metabolism, was restored.
Otton noted that green tea appeared to have a selective effect:
“It makes obese animals lose weight but keeps lean animals at a balanced weight. This shows that the tea seems to need an environment with excess nutrients to act, which supports the hypothesis that it acts directly on fat cells.”
Synergy of bioactive compounds
Green tea contains dozens of bioactive compounds, and attempts to isolate them have proven less effective than using the whole extract.
“We’ve tried to separate these compounds and study their effects individually, but the whole extract is always more effective. There’s a synergy between the compounds that we can’t reproduce when they’re isolated,” Otton explained.
One mechanism under investigation involves adiponectin, a protein secreted by fat cells that regulates inflammation and metabolism. In mice genetically modified to lack adiponectin, green tea showed no effect — pointing to adiponectin as a key mediator of its benefits.
Translating findings to human health
Despite these promising findings, Otton cautioned that safe and effective doses for humans have yet to be established, owing to variability in extracts and individual responses. She stressed the importance of long-term, habitual consumption rather than expecting rapid results:
“The ideal is chronic consumption, as we see in Asian countries. In Japan, for example, people consume green tea every day, throughout their lives, and obesity rates are low. But this is different from drinking tea for five months and expecting a miraculous weight loss effect.”
Otton also emphasised the importance of accessible and safe treatment options:
“The idea is to have safe, natural, effective, and high-quality compounds. The Camellia sinensis plant offers this. We’re still studying all the compounds involved, but there’s no doubt that green tea, as a plant matrix rich in flavonoids, has important therapeutic potential.”
The road ahead
Finally, Otton underscored the need for caution when translating animal research to clinical practice:
“What we see in animals doesn’t always reproduce in humans. But if we want to make this translation to real life, we need to think about all the details, such as ambient temperature. It’s these precautions that increase the validity of our data. We’re far from having all the answers, but we’re getting closer and closer.”
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