weight loss Tag

Bariatric Surgery Delivers Greater Weight Loss and Disease Remission Than GLP-1 Drugs, Large Analysis Finds

Key Takeaways:

• A large real-world analysis involving more than 430,000 patients found that metabolic and bariatric surgery produced substantially greater weight loss than GLP-1 medications after 12 months.
  
• Surgery was associated with higher remission rates for obesity-related conditions including type 2 diabetes, hypertension and high cholesterol.
  
• Researchers and clinicians said GLP-1 medications represent an important advance in obesity care, but cautioned that they should not be viewed as a replacement for metabolic and bariatric surgery in people requiring more substantial and durable outcomes. 
  
  
  

Surgery outperformed GLP-1 drugs across key outcomes

Metabolic and bariatric surgery may provide significantly greater weight loss and higher rates of obesity-related disease remission than glucagon-like peptide-1 receptor agonist medications, according to a major new real-world comparison presented at the American Society for Metabolic and Bariatric Surgery (ASMBS) Annual Meeting 2026.

The systematic review and analysis, described as one of the largest and most comprehensive comparisons of the two treatment approaches to date, evaluated data from 30 clinical studies involving more than 430,000 patients. Researchers found that although both treatments produced meaningful clinical benefits for people living with obesity, metabolic and bariatric surgery consistently outperformed GLP-1 therapies across all major outcomes assessed.

The research was conducted by investigators from Yale School of Medicine, Coreva-Scientific, Vanderbilt University and UT Health San Antonio.

Greater weight loss after surgery

According to the findings, people who underwent metabolic and bariatric surgery experienced more than 20% greater weight loss at 12 months compared with those treated with GLP-1 receptor agonist medications.

Researchers also reported that surgery was linked to substantially higher remission rates for several obesity-related health conditions. Compared with GLP-1 therapy, metabolic and bariatric surgery was associated with:

• 42% higher remission rates for type 2 diabetes
• 12.8% higher remission rates for hypertension
• 20.8% higher remission rates for high cholesterol

The analysis focused specifically on studies that directly compared bariatric surgery with GLP-1 receptor agonists. Studies that combined surgery and medication therapies were excluded from the review.

The primary endpoint examined was weight loss at 12 months. Secondary endpoints included remission of obesity-related conditions such as type 2 diabetes, hypertension and hyperlipidaemia.

Researchers highlight durability of surgical outcomes

The study authors noted that although GLP-1 medications have transformed obesity treatment and expanded evidence-based care options, metabolic and bariatric surgery continues to deliver greater and more durable results for many patients.

“While GLP-1 medications are an important advance, they do not match the magnitude or durability of outcomes achieved with metabolic and bariatric surgery, which remains one of the most underutilized treatments in medicine. Once the medications are discontinued, whether due to side effects, cost or other factors, their benefits often diminish or disappear, whereas the benefits of surgery endure.” – John M. Morton, MD, MPH, FASMBS, Study Co-Author, Professor of Surgery and Vice-Chair, Quality, Surgery at Yale School of Medicine

The findings add to ongoing discussions within obesity care about how best to position GLP-1 therapies and surgical interventions within long-term treatment pathways.

Evidence gap in direct comparisons

Despite the rapid growth in the use of GLP-1 medications such as semaglutide and tirzepatide, researchers noted that direct comparisons between these drugs and bariatric surgery remain limited.

The review involved a comprehensive search of PubMed and EMBASE databases to identify relevant studies comparing the two treatment approaches.

Commenting on the findings, an independent obesity surgery expert said the analysis helps address a major evidence gap in the field.

“Despite the explosive growth of GLP-1 drugs, no randomized controlled trials have directly compared them to bariatric surgery. This analysis helps fill that evidence gap,” said John Scott, MD, FACS, FASMBS, clinical professor of surgery at the University of South Carolina School of Medicine Greenville and metabolic and bariatric surgery director for Prisma Health, who was not involved in the study.

“GLP-1s have expanded evidence-based treatment options, but they should not be seen as a replacement for surgery – especially for patients who require the level of outcomes that only metabolic and bariatric surgery can provide.”

Expanding treatment options in obesity care

The findings come amid growing global interest in obesity treatment strategies as the use of GLP-1 receptor agonists continues to rise rapidly. Medications in this class have demonstrated significant effectiveness for weight reduction and metabolic health improvement, but concerns remain regarding long-term adherence, cost, side effects and weight regain after discontinuation.

Metabolic and bariatric surgery, meanwhile, has long been associated with substantial and sustained weight loss as well as improvements in obesity-related conditions such as type 2 diabetes and cardiovascular risk factors. However, experts have repeatedly argued that surgery remains significantly underutilised despite its established effectiveness.

The researchers concluded that while both treatment approaches play an important role in obesity management, metabolic and bariatric surgery continues to provide the most substantial improvements in weight loss and disease remission outcomes based on current comparative evidence.

Source: American Society for Metabolic and Bariatric Surgery

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Walking 8,500 Steps a Day May Help Prevent Weight Regain, Study Finds

Key Takeaways:

• New research presented at ECO 2026 suggests that walking around 8,500 steps a day may help people maintain weight loss and reduce the risk of weight regain after dieting.
  
• Researchers found that people who increased and sustained their daily step count were more successful at keeping weight off over the long term.
  
• The study highlights walking as a simple, affordable, and accessible strategy that could support long-term obesity management.
  
  
  

Study explores the role of walking in long-term weight management

New research being presented at the European Congress on Obesity (ECO 2026) in Istanbul, Turkey, taking place from May 12–15, suggests that walking approximately 8,500 steps per day could help people avoid regaining weight after dieting.

The findings, which will also be published in the International Journal of Environmental Research and Public Health, address one of the biggest challenges in obesity care – maintaining weight loss over time.

Although many weight loss programmes encourage people to increase their daily physical activity, including walking, researchers say there has been relatively limited evidence examining whether higher step counts genuinely help people lose weight during dieting or maintain that weight loss afterwards.

The new study aimed to clarify whether walking more each day could reduce the likelihood of weight regain and identify what level of daily activity may be most beneficial.

Preventing weight regain remains a major challenge

Professor Marwan El Ghoch, from the Department of Biomedical, Metabolic and Neural Sciences at the University of Modena and Reggio Emilia in Italy, highlighted the importance of addressing weight regain in obesity treatment.

“The most important – and greatest – challenge when treating obesity is preventing weight regain,” explained Professor El Ghoch.

“Around 80% of people with overweight or obesity who initially lose weight tend to put some or all of it back on again within three to five years.

“The identification of a strategy that would solve this problem and help people maintain their new weight would be of huge clinical value.”

Long-term weight maintenance is widely recognised as one of the most difficult aspects of obesity management. While many people can initially lose weight through dietary changes, sustaining those results often proves far more challenging due to complex biological, behavioural, and environmental factors.

Researchers conducted a large systematic review and meta-analysis

To explore the relationship between walking and long-term weight management, Professor El Ghoch and colleagues from Italy and Lebanon carried out a systematic review and meta-analysis of existing research.

The researchers analysed 18 randomised controlled trials investigating walking and weight management strategies. Fourteen of those studies, involving a total of 3,758 adults, were included in the final meta-analysis.

Participants had an average age of 53 years and an average body mass index (BMI) of 31 kg/m², placing the average participant in the obesity category. The studies included participants from a range of countries, including the United Kingdom, United States, Australia, and Japan.

The trials compared two groups:

• 1,987 participants enrolled in lifestyle modification (LSM) programmes
• 1,771 participants assigned to control groups

The control groups either followed dieting programmes without additional support or received no treatment intervention.

Lifestyle programmes combined diet and increased walking

The lifestyle modification programmes combined dietary guidance with recommendations to increase walking and monitor daily step counts.

These interventions generally included two distinct phases:

1. An initial weight loss phase
2. A longer-term maintenance phase designed to help participants sustain weight loss

Researchers assessed participants’ daily step counts at multiple time points throughout the studies, including:

• At baseline
• After the weight loss phase
• After the maintenance phase

The average duration of the weight loss phase was 7.9 months, while the maintenance phase lasted an average of 10.3 months.

At the start of the studies, physical activity levels were similar in both groups. Participants in the lifestyle modification programmes averaged 7,280 steps per day, while participants in the control groups averaged 7,180 daily steps.

Higher step counts were associated with less weight regain

The researchers found that participants in the control groups did not significantly increase their daily walking levels and did not experience meaningful weight loss during the studies.

In contrast, participants enrolled in the lifestyle modification programmes increased their average daily step count to 8,454 steps by the end of the weight loss phase.

During this period, participants lost an average of 4.39% of their body weight, equivalent to approximately 4 kg.

Importantly, participants were largely able to maintain their higher levels of daily activity throughout the maintenance phase. By the end of the studies, they were still averaging 8,241 steps per day.

They also maintained most of their weight loss over the longer term, with an average sustained weight reduction of 3.28%, or roughly 3 kg.

Further analysis demonstrated a clear association between higher daily step counts and lower levels of weight regain.

Researchers found that people who increased their walking during the weight loss phase and sustained those higher activity levels afterwards were more successful at maintaining weight loss over time.

Walking appeared more important for weight maintenance than initial weight loss

Interestingly, the study found that walking more was not associated with greater weight loss during the initial dieting period itself.

Researchers suggested this may be because calorie reduction and dietary changes tend to have a stronger influence on short-term weight loss than physical activity alone.

However, physical activity appeared to play a more significant role in helping people sustain weight loss once it had been achieved.

This distinction is important because many obesity interventions focus heavily on initial weight reduction, despite evidence showing that long-term maintenance is often the more difficult challenge.

A simple and affordable intervention

Professor El Ghoch said the findings demonstrate that lifestyle modification programmes incorporating walking can support clinically meaningful long-term weight management.

He added:

“Participants should be always encouraged to increase their step count to approximately 8,500 a day during the weight loss phase and sustain this level of physical activity during the maintenance phase to help prevent them from regaining weight.

“Increasing the number of steps walked to 8,500 each day is a simple and affordable strategy to prevent weight regain.”

The researchers suggest that walking may represent a practical and accessible intervention that could be incorporated into obesity treatment programmes without the need for expensive equipment or specialist facilities.

As obesity rates continue to rise globally, strategies that are sustainable, low-cost, and easy to implement may become increasingly important in supporting long-term health outcomes.

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People Judge Weight Loss More Harshly When GLP-1 Drugs Are Used, Study Finds

Key Takeaways:

• People using GLP-1 and other anti-obesity medications were consistently judged more negatively than those losing weight through diet and exercise alone.
  
• Researchers found that anti-obesity medication users were perceived as putting in less effort and were therefore viewed as less moral, competent, warm, and deserving of their success.
  
• The findings suggest that stigma surrounding obesity treatment may discourage people from seeking effective medical care and reinforce harmful misconceptions about obesity and weight loss.
  
  
  

Study explores social attitudes toward weight loss medication

A recent study published in Scientific Reports has found that people who lose weight using anti-obesity medications (AOMs), including glucagon-like peptide-1 (GLP-1) receptor agonists, are often judged more harshly than those who lose weight through diet and exercise alone.

The research examined how the use of anti-obesity medication influences perceptions of effort, morality, competence, warmth, and deservingness. The findings suggest that social attitudes toward obesity treatment remain strongly shaped by beliefs about personal effort and self-control.

With more than one billion people worldwide living with obesity, the researchers noted that how a person loses weight can significantly influence how others perceive them. Although GLP-1 receptor agonists and other anti-obesity medications have demonstrated substantial effectiveness in treating obesity, they are frequently criticised as an “easy way out.”

According to the researchers, this perception reflects a broader psychological phenomenon known as effort moralization – the tendency to associate greater effort with greater moral worth.

The authors explained that such beliefs may reinforce obesity stigma, discourage people from seeking treatment, and negatively affect both physical and mental health outcomes.

While anti-obesity medications can provide important medical support for people living with persistent obesity, the researchers stressed that understanding the social impact of these perceptions is necessary if the full potential of these treatments is to be realised.

Four studies conducted across three countries

The research involved four pre-registered experimental studies conducted between November 2024 and February 2025 in Belgium, the United States, and the United Kingdom.

In total, 1,205 participants took part in the research. Participants were recruited online through university participant pools and the Prolific platform. Researchers applied several quality-control measures, excluding incomplete responses, failed attention checks, overly rapid responses, and participants with insufficient language proficiency.

Across the studies, participants were presented with descriptions of two individuals who shared identical weight-loss goals and similar experiences with diet and exercise. The only difference between the individuals was that one used an anti-obesity medication while the other did not.

Participants then rated both individuals using Likert-type scales assessing:

• Perceived effort
• Moral character
• Warmth
• Competence
• Deservingness of weight-loss success
• Willingness to cooperate with them in future scenarios

The researchers also explored several additional variables across the studies, including:

• General attitudes toward anti-obesity medication
• Personal or social experience with weight-loss medication
• Beliefs that anti-obesity medication represents a “shortcut”
• Personality traits measured using the Big Five Inventory (BFI)

To analyse the data, the researchers used t-tests, correlations, multilevel modelling, and evidence synthesis techniques.

Anti-obesity medication users viewed more negatively

Across all four studies, the findings revealed a consistent pattern of negative social judgement toward individuals using anti-obesity medication.

Compared with people relying solely on diet and exercise, anti-obesity medication users were perceived as putting in less effort into achieving their weight-loss goals.

This perception of lower effort was strongly linked to harsher moral evaluations. Participants consistently rated anti-obesity medication users as less moral than non-users.

In Study 1, for example, significantly lower perceived effort ratings for anti-obesity medication users were accompanied by similarly large reductions in moral character ratings.

The bias extended beyond morality alone.

Participants also viewed anti-obesity medication users as:

• Less competent
• Less warm
• Less deserving of their success

In addition, participants reported lower anticipated satisfaction with future cooperation involving anti-obesity medication users in a hypothetical training-partner scenario.

According to the paper’s evidence synthesis, most of these effects were large, although the effect relating to warmth was more moderate.

Perceived effort was closely tied to moral judgement

One of the most significant findings was the strong relationship between perceived effort and moral judgement.

Across all four studies, larger differences in perceived effort between medication users and non-users were associated with larger differences in moral evaluations.

The researchers concluded that perceptions of effort appear to play a major role in shaping broader social judgement.

The findings support the idea that many people continue to associate moral worth with visible personal struggle and self-discipline, particularly in relation to body weight and weight loss.

“Shortcut” beliefs intensified negative bias

The study also examined factors that influenced the strength of these perceptions.

Participants who held more positive views toward anti-obesity medications, or who had prior personal or social experience with such treatments, tended to judge medication users less harshly.

In contrast, stronger beliefs that anti-obesity medication represents a “shortcut” to weight loss were associated with more negative moral judgements.

In some analyses, these shortcut beliefs also amplified the relationship between perceived effort and bias.

The researchers found that personality traits such as conscientiousness and extraversion had little overall effect on participants’ judgements. This suggests that the bias is driven more by beliefs about effort and treatment legitimacy than by broader personality characteristics.

One exploratory analysis identified a small association with neuroticism, although this effect was limited.

Meta-analytic evidence synthesis across the studies confirmed that most effects were large, particularly for:

• Perceived effort
• Moral judgement
• Competence
• Cooperation satisfaction
• Deservingness

Effects relating to warmth were moderate by comparison.

Findings highlight social challenges surrounding obesity treatment

The researchers concluded that using anti-obesity medication is not simply a medical decision, but also a social one that may expose individuals to stigma and negative judgement.

According to the findings, people using anti-obesity medications are frequently perceived as putting in less effort and are therefore judged as less moral, less competent, and less deserving of success.

Although the studies were based on vignette scenarios rather than real-world interactions, the researchers stated that the findings point toward a widespread bias rooted in effort moralization.

They suggested that these attitudes could influence interpersonal relationships, healthcare experiences, and broader public perceptions of obesity treatment.

The authors argued that addressing these misconceptions is important for improving healthcare quality and reducing obesity-related stigma.

They also suggested that public education and changes in the way weight loss is discussed may help shift attention away from perceived effort and toward health outcomes and overall well-being.

CCH insights:

Unfortunately, this shows that there is still a very poor understanding of obesity amongst the general public, which means that biased, negative attitudes towards people with excess weight persist. Instead of being seen as medical tools to treat a complex chronic condition, GLP-1 medications are seen by many as short-cut for weight loss cheats. Current evidence suggests these attitudes are common even within the health professions. To improve the quality of obesity care, and to encourage those who need help to seek it, these misconceptions must be addressed.

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Adding Weekly GLP-1 to CBT Further Reduces Heavy Drinking

Key Takeaways:

• A new randomised controlled trial found that weekly semaglutide injections combined with cognitive behavioural therapy significantly reduced heavy drinking days in people living with obesity and alcohol use disorder.
  
• Participants receiving semaglutide experienced a 41.1% reduction in heavy drinking days, which was notably greater than the reduction seen in the placebo group.
  
• Researchers say the findings add to growing evidence that GLP-1 receptor agonists may have therapeutic potential beyond weight management, including in the treatment of substance use disorders.
  
  
  

Study suggests GLP-1 therapy may help address alcohol use disorder

A team of researchers from the National Institutes of Health (NIH), Copenhagen University Hospital, and international collaborators has reported the first evidence from a randomised controlled clinical trial showing that a GLP-1 receptor agonist may help reduce heavy drinking in people living with both obesity and alcohol use disorder.

The findings, led by researchers at Copenhagen University Hospital, contribute to a growing body of research suggesting that GLP-1 receptor agonists such as semaglutide may have applications beyond obesity and type 2 diabetes treatment, including potential use in substance use disorders.

Alcohol use disorder remains significantly undertreated worldwide, despite its substantial impact on physical health, mental health, and mortality. Current pharmacological treatment options are limited and often underused in clinical practice.

“Very few medications are currently approved for alcohol use disorder, and these are vastly underutilized. A new option that is more accessible and more effective could be a gamechanger for closing the treatment gap,” said Director of NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA) George Koob, Ph.D., a study co-author.

Increasing interest in GLP-1s for addiction and substance use disorders

In recent years, researchers have become increasingly interested in the possible role of GLP-1 receptor agonists in addiction medicine.

GLP-1 drugs were originally developed for type 2 diabetes and later became widely used for obesity management due to their effects on appetite regulation, satiety, and weight reduction. However, emerging research has suggested these medications may also influence the brain’s reward pathways and reduce cravings or compulsive behaviours associated with substance use disorders.

Previous studies examining GLP-1 therapies in alcohol use disorder have produced mixed findings. One recent clinical trial found that a GLP-1 receptor agonist did not significantly reduce heavy drinking across the entire study population. However, researchers observed that participants living with obesity appeared to respond particularly well.

The latest study was designed specifically to investigate this subgroup.

Trial focused on people living with both obesity and alcohol use disorder

The research team enrolled 108 treatment-seeking adults living with alcohol use disorder and comorbid obesity.

All participants received standard cognitive behavioural therapy (CBT), which is a commonly used psychological treatment for alcohol use disorder that aims to help people identify and modify harmful thought patterns and behaviours associated with drinking.

Participants were then randomly assigned to receive either:

• Weekly semaglutide injections
• A placebo injection

The intervention lasted for 26 weeks.

Throughout the study period, researchers collected self-reported alcohol consumption data and monitored several quantitative biomarkers associated with alcohol use. These biological measurements were used to support and validate the participants’ reported drinking behaviour.

Semaglutide group experienced larger reduction in heavy drinking

At the end of the study, the researchers found that participants receiving semaglutide experienced a substantial decline in heavy drinking days.

According to the findings:

• The semaglutide group showed a 41.1% reduction in heavy drinking days
• This represented a 13.7% greater reduction compared with the placebo group

Importantly, biomarker data measuring alcohol exposure supported the self-reported reductions in drinking behaviour, strengthening confidence in the results.

Researchers also observed improvements in several cardiometabolic measures among participants receiving semaglutide. As expected based on previous obesity trials, reductions in body weight and blood pressure were more pronounced in the GLP-1 treatment group.

Researchers note mild and temporary side effects

The study authors reported that semaglutide was generally well tolerated.

Some participants experienced adverse effects, primarily gastrointestinal symptoms, which are commonly associated with GLP-1 receptor agonists. However, the researchers noted that these symptoms were generally mild and transient.

No unexpected safety concerns were highlighted in the report.

Potential clinical impact compared with existing medications

The investigators also evaluated the treatment’s number needed to treat (NNT), a standard clinical metric used to estimate how many people need to receive a treatment for one person to benefit.

In this study, semaglutide achieved an NNT of 4.3.

The researchers noted that currently approved medications for alcohol use disorder typically have an NNT of 7 or higher, suggesting semaglutide may potentially produce clinically meaningful benefits more frequently than existing therapies.

While the authors stressed that further research is needed before definitive conclusions can be drawn, the findings are likely to increase interest in GLP-1 therapies as a possible future treatment option for alcohol use disorder.

“We’re beginning to see some of that potential for GLP-1s to treat drug addiction turn into reality. Questions remain but this is nonetheless very encouraging,” said Director of NIH’s National Institute on Drug Abuse (NIDA) and study co-author Nora Volkow, M.D.

Larger and longer studies still needed

Despite the encouraging findings, the researchers emphasised that additional studies will be necessary to confirm the results.

Future research will need to assess:

• Whether the effects persist over longer periods
• How GLP-1 therapies perform in larger and more diverse populations
• Which patient groups are most likely to benefit
• Whether similar effects are seen in people without obesity

The authors stated that they hope to examine the effects of GLP-1 receptor agonists over a longer duration and in larger study populations in future investigations.

The scientific team was led by first author Mette Kruse Klausen, M.D., and corresponding author Anders Fink-Jensen, D.M.Sc., at Copenhagen University Hospital.

CCH insights:

These results are very promising, suggesting GLP-1 medications offer an effective treatment option for some people with obesity and alcohol use disorder (AUD). However, these patients would need careful monitoring in terms of diet and nutrition. People with AUD are susceptible to nutrient deficiencies because they get most of their calories from alcoholic drinks. If they eat less than usual due to appetite suppression induced by GLP-1 therapy, there is a risk of exacerbating these deficiencies. 

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Remote Culinary Coaching Shows Sustained Weight Loss Benefits in Adults with Overweight and Obesity

Key Takeaways:

• A fully remote culinary medicine programme combining cooking and health coaching led to sustained weight loss over 12 months
  
• Participants experienced significant fat mass reduction without loss of lean body mass
  
• Improvements in diet quality, calorie intake, and cooking confidence were observed alongside weight changes
  
  
  

Study overview

A recent randomised controlled trial has found that a fully remote culinary medicine intervention can support meaningful and sustained weight loss in people living with overweight and stage I obesity. The programme combined practical cooking education with health coaching, offering a patient-centred approach to improving dietary behaviours and long-term health outcomes.

Conducted across two hospitals between May 2019 and September 2022, the study examined the one-year impact of this combined intervention on weight, body composition, and dietary habits.

Methodology

Participant characteristics

The study included 50 adults with overweight or stage I obesity. Participants had a mean age of 47.5 years, and 70% were female. The average body mass index was 30.7, with a mean total fat mass of 40.37%. All participants reported cooking fewer than five meals at home per week at baseline.

Intervention design

All participants initially received two nutrition education sessions focused on the Mediterranean diet. Following this, they were randomly assigned to one of two groups:

• Intervention group: Participants took part in a structured culinary coaching programme consisting of 12 weekly one-to-one tele-sessions, each lasting 30 minutes. These sessions integrated culinary skills training with health coaching principles and provided access to culinary medicine resources.
• Control group: Participants were given access to the same culinary medicine resources but did not receive coaching sessions
  
  
  

Outcome measures

Researchers assessed a range of clinical and behavioural outcomes at baseline, and again at 3, 6, and 12 months within a hospital clinical research setting:

• Body weight and height were measured by a registered dietitian
• Body composition was analysed using dual-energy X-ray absorptiometry (DEXA)
• Dietary intake was calculated using 4-day food records reviewed by a registered dietitian
• Diet quality was evaluated using a 14-item Mediterranean diet assessment tool
• Culinary attitudes and self-efficacy were measured using a validated questionnaire

The primary outcome was change in body weight at 6 months, with secondary outcomes including dietary intake, body composition, and behavioural measures.

Weight loss outcomes

Participants in the culinary coaching group achieved significantly greater weight loss compared with the control group at all measured time points:

• 3 months: -3.23% vs -0.71% (between-group difference -2.52; P = .016)
• 6 months: -4.2% vs -1.22% (between-group difference -2.98; P = .027)
• 12 months: -4.02% vs a weight gain of 0.28% (between-group difference -4.30; P = .021)

These findings indicate that the intervention not only supported early weight loss but also helped sustain these changes over a full year.

Changes in body composition

At 6 months, participants receiving culinary coaching demonstrated favourable changes in body composition:

• Average fat mass decreased by 1.86% in the intervention group
• In contrast, the control group experienced a slight increase in fat mass of 0.11%
• The between-group difference was 1.96 (P = .039)

Importantly, these reductions in fat mass occurred without any significant changes in lean body mass, suggesting that weight loss was primarily driven by fat reduction rather than muscle loss.

Dietary improvements

The intervention also led to measurable improvements in diet quality and energy intake:

• At 3 months, Mediterranean diet scores increased by 2 points in the intervention group compared with 0.38 points in the control group (net difference 1.62; P = .020)
• At 6 months, daily calorie intake decreased by 452 calories in the intervention group compared with 62.4 calories in the control group (net difference 390 calories; P = .015)

These findings suggest that the programme successfully influenced both food choices and overall energy consumption.

Behavioural and skill-based outcomes

Participants who received culinary coaching reported significant improvements in their confidence and ability to prepare meals:

• Self-efficacy in cooking techniques and meal preparation improved significantly at 12 months in the intervention group compared with the control group (P = .040)

No serious adverse events were reported during the study, indicating that the intervention was safe and well tolerated.

Interpretation and clinical relevance

The study authors highlighted the broader significance of these findings, stating:

“This study is an important step in considering CM [culinary medicine] interventions as an effective patient-centered nutrition strategy for weight loss.”

This suggests that combining practical cooking skills with behavioural coaching may offer a scalable and effective approach to supporting people living with overweight and obesity, particularly in remote or resource-limited settings.

Limitations

The study has several limitations, many of which were influenced by the COVID pandemic:

• High dropout rates after the first visit may have introduced attrition bias
• Some follow-up visits were conducted remotely, requiring participants to self-measure body weight
• Remote assessments limited the ability to collect body composition and other clinical data at certain time points
• Pandemic-related restrictions may have affected participants’ ability to cook at home

These factors should be considered when interpreting the findings.

Funding and disclosures

The study was led by Rani Polak at Harvard Medical School and Spaulding Rehabilitation Hospital in Boston and was published in Obesity.

Funding was provided by the US-Israel Binational Science Foundation and the National Institutes of Health Clinical Center. One author reported receiving royalties from a home cooking book and an honorarium from Wellcoaches.

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GLP-1 Weight Loss Is Mostly Driven by Fat Loss, Not Muscle

Key Takeaways:

• GLP-1 receptor agonists and dual GLP-1/GIP therapies lead to significant weight loss, primarily through reductions in fat mass rather than muscle.
  
• Improvements in body composition, including reductions in visceral fat, occur as early as three months into treatment.
  
• Although some lean body mass loss is observed, it is relatively modest compared with overall weight loss, suggesting a favourable pattern of change.
  
  
  

GLP-1 therapies in the context of obesity care

A recent study published in the International Journal of Obesity examined how glucagon-like peptide 1 receptor agonists and dual GLP-1/glucose-dependent insulinotropic polypeptide agonists affect body weight and composition in adults living with overweight or obesity.

The global prevalence of obesity has risen substantially in recent decades. This condition is closely linked to a range of cardiometabolic complications that can reduce both quality of life and life expectancy. As a result, effective obesity management typically requires a personalised, multidisciplinary approach. This may include behavioural support, dietary changes, physical activity, pharmacological treatments, and, in some cases, surgical intervention.

GLP-1 receptor agonists and related incretin-based therapies have emerged as an important pharmacological option. These treatments are known to support sustained weight loss and improve obesity-related comorbidities. They have also demonstrated cardioprotective effects. However, while these therapies predominantly reduce fat body mass, they may also lead to some loss of lean body mass, which has raised concerns, particularly for older adults and people at risk of frailty.

Study design and methods

To better understand these effects, researchers conducted a comprehensive evaluation of clinical studies assessing GLP-1-based therapies and their impact on body composition.

Databases including Web of Science, PubMed, and Scopus were systematically searched for relevant studies involving adults with overweight or obesity, with or without type 2 diabetes. Following removal of duplicate records, studies were screened based on titles, abstracts, and full texts to determine eligibility.

The methodological quality of the included studies was assessed using established tools. Meta-analyses were then performed on studies that provided numerical data on changes in body composition and anthropometric measures. Statistical analyses used random-effects models, with subgroup analyses based on drug type and treatment duration. Publication bias was evaluated using Egger’s test.

In total, 36 studies were included in the qualitative review, with 24 contributing to the meta-analyses. Most studies were conducted in Europe and Asia, and many reported outcomes at six months. Twenty-four studies included people living with type 2 diabetes. The most frequently studied medications were liraglutide and semaglutide. Body composition was commonly assessed using bioelectrical impedance analysis and dual-energy X-ray absorptiometry.

Changes in weight and body composition

Early effects at three months

After three months of treatment, participants experienced a significant reduction in body mass of approximately 9 percent. This effect was particularly notable among those receiving beinaglutide.

Substantial improvements in body composition were also observed. Visceral adipose tissue area decreased by 29.25 cm², while fat body mass was reduced by 17 percent. Lean body mass showed a smaller but statistically significant reduction of 2 percent.

In addition, body mass index decreased by 2.96 kg/m² and waist circumference by 9.6 cm.

Outcomes at six months

At six months, body mass remained significantly reduced, with an average decrease of 5 percent.

Both fat body mass and lean body mass declined further, by 6 percent and 1 percent respectively. Skeletal muscle mass showed a modest reduction of 3 percent. Visceral adipose tissue continued to decrease, with a reduction of 32.31 cm².

Body mass index fell by 2.40 kg/m², while waist circumference decreased by 2.3 cm.

Longer-term results at twelve months

At twelve months, body mass was reduced by 4 percent, with continued decreases in body mass index of 1.74 kg/m² and waist circumference of 3.2 cm.

Both fat body mass and lean body mass were reduced by 4 percent. The most pronounced reductions were reported in a study involving liraglutide, although the authors noted considerable variability between studies and advised caution when comparing specific agents.

Egger’s test indicated some publication bias in outcomes reported at three months, but no significant bias was observed at later time points.

Interpreting fat loss and muscle preservation

Overall, the findings demonstrate that GLP-1-based therapies produce meaningful improvements in key measures associated with obesity, including body mass, body mass index, and waist circumference, across multiple time points.

The most rapid and substantial changes occurred within the first three months of treatment. Across all timeframes, reductions in fat mass, particularly visceral fat, were more pronounced than reductions in lean mass.

The authors described this pattern as “quality” weight loss, characterised by a predominance of fat mass reduction with relative preservation of lean tissue. Importantly, no single GLP-1 receptor agonist was found to be superior in preserving lean mass.

Implications for clinical practice and future research

These findings have important implications for clinical care. While some degree of lean mass loss occurs with GLP-1-based therapies, the overall pattern of weight loss appears favourable, particularly given the substantial reductions in fat mass and visceral adiposity.

Future research should focus on optimising treatment strategies that combine pharmacotherapy with lifestyle interventions. In particular, there is a need to explore approaches that support the preservation of lean mass, such as targeted nutritional strategies and resistance training programmes.

Such considerations are especially important for people at higher risk of sarcopenia, including older adults and those with existing muscle loss.

CCH insights:

These results are encouraging, but it is important not to become complacent about lean mass loss during weight loss. The studies analysed here involved average weight losses of less than 10% of body weight, but some people can lose 15-20% of body weight on GLP-1 therapy – do they lose similar proportions of body fat and lean tissue? All patients on GLP-1 therapy should receive advice on lifestyle measures to help minimise lean tissue loss.

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Automated Weight Loss Programme Shows Promise for People Living with Cancer in Landmark Trial

Key Takeaways: 

• A fully automated, web-based programme delivered clinically meaningful weight loss in people living with and beyond cancer, without any in-person support
  
• More than 43 percent of participants achieved at least 3 percent weight loss, with nearly one in three reaching 5 percent or more
  
• The intervention also improved a range of health outcomes, including diet quality, physical functioning, and cardiometabolic markers
  
  
  

A new model for post-cancer care

A large national randomised clinical trial has demonstrated that a fully automated, web-based weight loss intervention can deliver substantial health benefits for people living with and beyond cancer. The programme, developed by researchers at the University of Alabama at Birmingham, represents a significant shift in how post-cancer care may be delivered in the future.

Published in the Journal of the National Comprehensive Cancer Network, the study reported the highest level of weight loss ever achieved through a fully automated intervention in this population. The programme, known as the AMPLIFY Diet (AiM, PLan and act on LIFestYles), was designed to provide structured, evidence-based lifestyle support without requiring direct clinician involvement.

Addressing a major unmet need

A substantial proportion of people living with and beyond cancer are also living with overweight or obesity. In the United States, this figure is estimated to be around 70 percent. This places individuals at increased risk of cardiovascular disease, type 2 diabetes, functional decline, cancer recurrence, and the development of second primary cancers.

Despite this, access to specialist oncology dietitians remains limited. Traditional weight management programmes often rely on in-person consultations or regular coaching, which can be difficult to scale and may not be accessible to all patients.

The AMPLIFY Diet intervention was developed specifically to address these barriers by delivering personalised nutrition and behavioural support entirely online.

A fully automated intervention

The programme operates without live coaching, counselling calls, or face-to-face appointments. Instead, it uses a structured digital platform that includes weekly interactive sessions, goal-setting tools, progress monitoring, and automated personalised feedback.

Participants engage with the system independently, receiving guidance that is grounded in established behavioural and nutritional science. This approach allows for scalability while maintaining a consistent standard of care.

“This is a game changer for cancer survivorship care,” said Wendy Demark-Wahnefried, Ph.D., R.D., senior author and professor at UAB’s School of Health Professions and O’Neal Comprehensive Cancer Center. “We showed that a completely automated online program grounded in decades of behavioral and nutrition science can safely and effectively help cancer survivors lose weight and improve their health at scale.”

Study design and participant profile

Between 2020 and 2024, the study enrolled 349 participants aged between 50 and 82 years from 31 states across the United States. All participants were living with and beyond cancers associated with obesity.

The cohort included individuals with a range of cancer types, including breast, colorectal, prostate, endometrial, ovarian, thyroid, renal, and haematologic cancers. Participants were randomly assigned to either the AMPLIFY Diet programme or a control group receiving standard survivorship information.

Clinically meaningful weight loss outcomes

After six months, the results showed clear differences between the intervention and control groups.

More than 43 percent of participants in the AMPLIFY Diet group achieved weight loss of at least 3 percent of their body weight. In comparison, only 13 percent of those receiving usual care reached this threshold.

In addition, nearly one in three participants in the intervention group lost at least 5 percent of their body weight. This level of weight loss is widely associated with reductions in cardiovascular risk and improvements in cancer-related outcomes.

On average, weight loss in the intervention group was nearly five times greater than that observed in the control group.

Broader health improvements

The benefits of the programme extended beyond weight loss alone. Participants in the AMPLIFY Diet group experienced improvements across multiple domains of health and wellbeing.

These included reductions in waist circumference and overall caloric intake, as well as improvements in diet quality. Biochemical markers also shifted in a favourable direction, with lower circulating levels of leptin, a hormone associated with cancer progression and cardiometabolic disease.

Further gains were observed in blood pressure, physical functioning, and cognitive performance. Participants also reported improvements in depression and their ability to engage in social roles, suggesting a broader impact on quality of life.

Strong engagement without human support

One notable finding from the study was the level of participant engagement. Individuals completed an average of 60 percent of the weekly sessions, which is considerably higher than engagement rates typically reported in other digital lifestyle interventions.

This suggests that a well-designed automated system can maintain user engagement even in the absence of direct human interaction.

Implications for scalable care

Unlike many conventional weight management programmes, the AMPLIFY Diet intervention does not require ongoing staff involvement. This makes it particularly well suited for integration into healthcare systems, cancer centres, and community-based services.

The ability to deliver consistent, evidence-based care at scale may help address longstanding gaps in survivorship support, particularly in settings where specialist resources are limited.

The role of behavioural and nutritional care

The researchers emphasise that lifestyle-based interventions remain a cornerstone of care for people living with and beyond cancer, particularly as pharmacological approaches continue to evolve.

“Behavioral and nutritional interventions are essential,” Demark-Wahnefried said. “Diet quality, muscle preservation, cognition, and long-term sustainability of a healthful lifestyle and body weight are critical for cancer survivors, and even if weight loss medications eventually receive broadscale endorsement, they alone do not address all of these needs.”

Future directions

The research team is now focusing on expanding the reach of the AMPLIFY Diet programme across both clinical and non-clinical settings. The aim is to improve access to effective survivorship care while also contributing to broader cancer prevention efforts.

The study was funded by the National Institutes of Health and the American Cancer Society.

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Can Less Be More? Reduced GLP-1 Dosing May Sustain – and Even Enhance – Weight Loss

Key Takeaways: 

• Structured reduction in GLP-1 receptor agonist dosing frequency may allow continued weight loss while lowering treatment burden
  
• Cardiometabolic improvements achieved during weekly dosing appear to be maintained with less frequent dosing
  
• Early evidence suggests some individuals may not require high or frequent dosing to sustain weight loss, although larger trials are needed
  
  
  

A new approach to GLP-1 treatment

Emerging evidence suggests that reducing the frequency of glucagon-like peptide-1 receptor agonist (GLP-1 RA) dosing may still deliver sustained benefits for people living with obesity. Data presented at the Obesity Medicine Association’s annual conference indicate that a structured, gradual de-escalation strategy could maintain, and in some cases enhance, weight loss outcomes while reducing the burden of ongoing treatment.

This finding challenges the prevailing assumption that continuous, high-frequency dosing is required to preserve the benefits of these therapies.

Continued weight loss despite reduced dosing

The research, led by Mitch Biermann, MD, PhD, examined outcomes in individuals who transitioned from weekly GLP-1 RA dosing to less frequent schedules. Reflecting on the results, Biermann noted:

“What I found was actually surprising, where in addition to losing weight initially on the weekly regimen, people actually lost further weight on the every-other-week regimen,” Mitch Biermann, MD, PhD, an obesity medicine physician and scientist at Scripps Health, told Healio. “I was just hoping people would break even, not get an additional 2% weight loss.”

This observation suggests that, for some individuals, reduced dosing frequency does not simply preserve prior weight loss but may contribute to further reductions.

Addressing a common patient concern

The study was partly motivated by a frequent question from patients considering GLP-1 therapy. As Biermann explained:

“The No. 1 question patients have when they’re deciding to start one of these medicines is, ‘Do I have to be on this every week for the rest of my life? Do I have to take this forever?’” he said. “Patients ask that about certain medicines and not others. It usually correlates with the stigma around the disease. They always ask about it for weight loss medicine.”

This highlights an important dimension of obesity care – long-term treatment expectations and the role of stigma in shaping patient concerns.

Study design and patient cohort

The analysis was based on a retrospective case series involving 30 adults who had been prescribed either semaglutide (Wegovy or Ozempic) or tirzepatide (Mounjaro). All participants had experienced a plateau in weight loss during standard weekly treatment.

Participants agreed to reduce their dosing frequency while maintaining their effective dose. The adjusted schedules included:

• Every 10 to 14 days (n = 6)
• Every two weeks (n = 17)
• Longer than every two weeks (n = 7)

The mean follow-up period was 36 weeks.

Body composition and weight outcomes

Following the transition to reduced dosing, participants continued to lose weight, with reported reductions of 72.4 ± 2.2 kg (P < .01). In addition to overall weight loss, improvements were observed in body composition:

• Reductions in body fat mass
• Decreases in average percentage body fat
• Lower truncal fat mass

At the same time, skeletal muscle mass increased slightly from 30.33 ± 1.27 to 30.63 ± 1.25, suggesting that weight loss was not associated with disproportionate muscle loss.

Sustained cardiometabolic benefits

Importantly, key metabolic improvements achieved during weekly dosing were maintained after reducing treatment frequency:

• Glycaemic control: HbA1c improved from 5.6% ± 0.13% before treatment to 5.1% ± 0.1% during weekly dosing (P < .001), with no change during reduced dosing
• Triglycerides: Levels decreased from 121 ± 11.3 mg/dL to 84.3 ± 9.6 mg/dL during weekly dosing (P < .001) and remained stable at 74.8 ± 4.1 mg/dL
• Mean arterial pressure: Reduced from 90.5 ± 2 mm Hg to 84.8 ± 2.1 mm Hg (P < .05), remaining stable at 85.1 ± 1.5 mm Hg during maintenance

The proportion of participants meeting criteria for metabolic syndrome also declined, from nearly 83% before treatment to 68% during weekly dosing and 58.6% following dose reduction.

Interpreting the findings

The study authors suggest that lower levels of GLP-1 receptor stimulation may be sufficient to maintain weight loss once it has been achieved. Biermann offered the following interpretation:

“that you don’t need much of these hormones to maintain weight loss, even though you need a lot of them to reduce weight.”

He also drew a parallel with physical activity:

“Exercise doesn’t cause people to lose a ton of weight. It causes people to maintain their weight if they lose it by another method for the most part,” he said. “And that matches this hormone data, because that 30% increase [in hormone levels] you get on GLP-1s from exercise is probably enough to maintain your weight loss.”

Limitations and considerations

The findings should be interpreted cautiously. The study was small, non-randomised, and based on a retrospective case series. In addition, the cohort lacked diversity, with only four participants not identified as white and just two individuals living with class II or III obesity.

These limitations mean that the results may not be generalisable to broader populations.

Implications for clinical practice

Despite its limitations, the study offers a potentially important insight into long-term obesity management. Gradual dose reduction may represent a viable strategy for some individuals seeking to balance efficacy with treatment burden.

As Biermann concluded:

“I think it’s an option that works for many people, [particularly] when we don’t study how to stop medicine in general,” Biermann told Healio.

“I think it’s nice to have some published data on the average effectiveness of this strategy, even though it’s not a randomized controlled trial,” he said.

Looking ahead

Further research, particularly large-scale randomised controlled trials, will be essential to determine whether reduced dosing strategies can be safely and effectively implemented in routine care. For now, these findings provide an early signal that long-term GLP-1 therapy may not need to follow a one-size-fits-all model.

Source: Healio

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Semaglutide and Bimagrumab Combination Shows Greater Weight Loss While Preserving Muscle Mass

Key Takeaways: 

• A phase 2 clinical trial found that combining semaglutide with the antibody bimagrumab produced greater overall weight loss while largely preserving lean body mass.
  
• Participants receiving the two-drug combination lost 22.1% of body weight on average, with over 90% of the reduction coming from fat mass.
  
• The findings highlight the importance of focusing on body composition rather than weight alone when evaluating treatments for people living with obesity.
  
  
  

Combining two mechanisms to improve obesity treatment

A recent clinical trial has found that combining the GLP-1 receptor agonist semaglutide with bimagrumab, an antibody that blocks activin signalling pathways, may produce greater weight loss while preserving lean body mass.

The findings were reported in the paper “Bimagrumab and semaglutide alone or in combination for the treatment of obesity: a phase 2 randomized clinical trial”, published in the journal Nature Medicine. The study describes the results of the BELIEVE trial, led by Dr Steven Heymsfield of the Pennington Biomedical Research Center.

GLP-1–based therapies have become highly effective tools for reducing body weight in people living with obesity. However, a recognised limitation of these therapies is that up to 40% of the weight lost may come from lean mass, which includes skeletal muscle and connective tissue.

The BELIEVE trial explored whether combining semaglutide with bimagrumab could address this issue by enhancing fat loss while protecting lean body mass.

Why lean mass preservation matters

Historically, obesity treatment has often focused on reductions in body weight as the primary outcome. However, researchers increasingly emphasise the importance of preserving muscle mass, which plays a vital role in both physical function and metabolic health.

Dr Heymsfield explained that maintaining lean mass could be particularly important for people living with obesity who may already be at risk of low muscle mass.

“Obesity treatment has traditionally focused on the number on a scale. Patients with obesity who are at risk for low muscle mass, affecting both physical and metabolic function, may benefit from treatments that maximize fat mass reduction while preserving skeletal muscle,” said Heymsfield, who is an LSU Boyd Professor and director of the Metabolism and Body Composition Laboratory.

He also highlighted the complementary biological mechanisms of the two drugs.

“Bimagrumab and semaglutide work through distinct biological pathways, and when combined, we observed not only a preservation of lean mass but also an additive reduction in fat mass that exceeded what either therapy achieved alone.”

Design of the BELIEVE phase 2 trial

The BELIEVE study was designed as a double-blind, placebo-controlled clinical trial evaluating the effects of semaglutide and bimagrumab used either alone or in combination.

Participants were randomly assigned to several treatment groups:

• Bimagrumab only
  
• Semaglutide only
  
• Combination therapy
  

Each medication was also administered at two different dosing levels:

• Bimagrumab: 10 mg/kg or 30 mg/kg
  
• Semaglutide: 1.0 mg or 2.4 mg
  

Because of these dosing combinations, the trial ultimately included nine randomised groups.

Bimagrumab was administered every 12 weeks, while semaglutide was given once weekly. Participants were followed over a 72-week treatment period.

Weight loss and body composition outcomes

The results showed clear differences between the treatment groups in terms of both total weight loss and the composition of that weight loss.

Participants receiving bimagrumab alone experienced an average weight reduction of 10.8%. Notably, all of this reduction was attributable to fat mass, while lean mass increased by 2.5%.

Those treated with semaglutide alone lost an average of 15.7% of body weight, with 71.8% of the weight loss coming from fat mass.

The most striking results were seen in participants receiving the combination therapy. These individuals experienced an average weight loss of 22.1%, with 92.8% of the weight reduction attributable to fat mass, while lean mass was largely preserved.

These findings suggest that the combination therapy may offer a way to achieve substantial reductions in body weight while maintaining the muscle mass that supports metabolic health and physical function.

Improvements in metabolic and inflammatory markers

Beyond weight loss and body composition, the study also identified several favourable metabolic changes.

Participants experienced up to an 83% reduction in high-sensitivity C-reactive protein (hsCRP), an inflammatory marker that is associated with increased cardiovascular risk.

The study also reported a substantial increase in adiponectin, a hormone that plays an important role in:

• Improving insulin sensitivity
  
• Supporting fat metabolism
  
• Promoting anti-inflammatory processes
  

Among participants who had indicators of prediabetes at baseline, some of the groups receiving the two-drug combination experienced complete reversion to normoglycaemia, meaning all participants in those groups moved from a prediabetic state to normal blood glucose levels.

Safety and tolerability

Overall, the drug combination was generally well tolerated by participants. Reported side effects were broadly consistent with the known safety profiles of the individual drugs.

However, researchers noted that participants receiving bimagrumab experienced some common adverse events, including:

• Mild-to-moderate acne
  
• Muscle spasms
  

The study authors emphasised the need for continued clinical development and further investigation to better understand these effects.

Moving beyond the number on the scale

The BELIEVE trial also underscores a broader shift in how obesity treatments may be evaluated in the future.

Rather than focusing solely on weight or body mass index, researchers increasingly argue that body composition measures, such as the proportion of fat mass and lean mass, provide more meaningful insight into treatment effectiveness and overall health outcomes for people living with obesity.

Funding and study oversight

The study was funded by Eli Lilly and Company. The trial was originally designed by Versanis Bio, a wholly owned subsidiary of Eli Lilly.

Versanis Bio oversaw the clinical trial and provided partial funding before its acquisition by Lilly.

CCH insight:

The results for bimagrumab are very exciting. Although overall weight loss was less for bimagrumab than semaglutide, the amount of fat lost was very similar, but with retention or even increase of muscle mass. As muscle is an important metabolic tissue, you can argue that in this case the lesser weight loss is a better outcome than the higher weight loss, because the weight that is retained is muscle, not fat.

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

Key Takeaways: 

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

A closer look at tirzepatide’s metabolic effects

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

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

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

A dual-action therapy

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

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

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

Investigating effects on adipose tissue

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

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

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

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

Metabolic benefits beyond appetite suppression

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

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

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

Implications for obesity treatment strategies

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

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

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

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

Towards more personalised prescribing

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

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

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

The need for caution and further research

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

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

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

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

Key Takeaways:

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

New financial incentives added to GP contract

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

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

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

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

Focus on Mounjaro within primary care

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

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

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

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

Government position: access based on need

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

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

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

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

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

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

Strict eligibility criteria remain in place

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

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

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

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

Support from obesity advocates – with caveats

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

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

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

She also stressed the importance of prevention alongside treatment:

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

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

Concerns about equity and workload

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

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

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

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

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

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

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

A cautious step in a tightly controlled rollout

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

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

CCH insight:

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

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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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