Tirzepatide May Activate Calorie-Burning Brown Fat in Obesity, Trial Suggests
Key Takeaways:
- Findings from the TABFAT trial, presented at ENDO 2026, indicate that tirzepatide does more than curb appetite – it also appears to activate brown adipose tissue, a heat-producing fat that burns calories.
- Among premenopausal women with obesity, the proportion with PET/CT-detectable brown fat activity rose from 41.2% to 64.7% after 24 weeks of treatment, with no comparable change in the placebo group.
- Researchers also saw potential signs of white fat taking on more metabolically active “beige” characteristics, pointing towards future therapies that pair appetite control with increased energy expenditure.
Beyond appetite: a different question
For people taking tirzepatide, weight loss has so far been explained mainly by a reduced appetite and the smaller portions that follow. New research suggests the picture may be more complex. The medication appears to do more than dampen hunger – it also seems to switch on brown adipose tissue, a metabolically active fat that generates heat and consumes calories. The findings, described by the research team as a notable milestone in obesity research, were due to be presented on Monday at ENDO 2026, the Endocrine Society’s annual meeting in Chicago, Illinois.
The study set out to look past the appetite-suppressing effect that has dominated explanations of how these medications work. As lead investigator Rok Herman, M.D., of the Department of Endocrinology, Diabetes and Metabolic Diseases at University Medical Centre Ljubljana in Ljubljana, Slovenia, put it: “In the TABFAT trial, we asked a different question: beyond eating less, does tirzepatide also change how the body burns energy – specifically through brown adipose tissue, a metabolically active type of fat that produces heat and consumes calories?”
What is brown adipose tissue?
Brown adipose tissue, often referred to as brown fat, was for many years thought to disappear after infancy. Its presence in adults was only confirmed through imaging studies in the late 2000s. Unlike ordinary white fat, which mainly stores energy, brown fat burns it to produce heat. In people living with obesity this tissue is markedly suppressed, and until now moderate cold exposure has been its strongest recognised activator.
How the TABFAT trial was designed
The team led by Herman ran a randomised, placebo-controlled clinical trial in premenopausal women with obesity. To assess what was happening within the tissue itself, the researchers used cold-stimulated PET/CT imaging alongside MRI scans, measuring brown adipose tissue activity both before treatment and after 24 weeks. Using more than one imaging method allowed the team to capture different aspects of brown fat biology rather than relying on a single measure.
What the scans revealed
The results pointed to a measurable change in how the body handled energy, not simply how much participants ate. “We found that tirzepatide significantly increased brown adipose tissue activity and volume, and it also showed potential signs of converting white subcutaneous fat into more metabolically active ‘beige’ fat,” Herman said.
The shift was clear in the imaging data. Tirzepatide increased PET/CT-detectable brown adipose tissue activity from 41.2% to 64.7% of participants, while no comparable change was seen in the placebo group. The researchers were reassured that the effect showed up across the different scanning techniques used. “We were also encouraged by the consistency of the signal across other imaging modalities employed in the study that may capture different component of brown fat biology,” Herman added.
Why this matters for obesity care
The findings suggest a fuller account of how the latest anti-obesity medications work. Rather than acting on appetite alone, tirzepatide also appears to influence how much energy the body burns at the level of the tissue. “This adds a new layer to how we understand the new generation of anti-obesity medications,” Herman said. “They are not only appetite suppressants – tirzepatide also appears to modulate energy expenditure at the tissue level, opening a plausible path toward future therapies that combine appetite regulation with thermogenic activation.”
Keeping pace with this fast-evolving mechanistic understanding of anti-obesity medications is the focus of professional training such as the College of Contemporary Health’s GLP-1RAs in Focus, a CPD-accredited online short course that grounds clinicians in how these drugs work.
Looking ahead
Herman suggests that future research should measure, study and potentially enhance brown and beige fat activity, treating it as a specific target within a more tailored approach to obesity care. If brown fat activation can be reliably encouraged and built upon, it may complement the appetite-related effects already well documented, broadening the options available to people living with obesity.
CCH insights:
This is a fascinating study. For many years researchers have been looking at ways to stimulate brown adipose tissue (BAT) activity, or enhance beige adipose tissue production, without much success, except for asking people to spend hours in the cold every day. Now it seems we may have stumbled across an answer by accident. The question now is, how does tirzepatide have this effect, and could we develop other agents which act in a similar way to activate BAT and beige adipose tissue without affecting gastro-intestinal function and/or appetite? This would enable us to widen the range of tools for obesity care.
Following where questions like this lead – how a dual GIP/GLP-1 agent acts on energy expenditure and not just appetite – starts with a solid grounding in the underlying physiology, which is exactly what our two-hour CPD course GLP-1RAs in Focus – Why Drugs Like Ozempic Work is built to give any clinician wanting to understand these medications at the mechanistic level wanting to understand these medications at the mechanistic level.
Explore GLP-1RAs in Focus →
This article summarises findings presented at ENDO 2026, the Endocrine Society’s annual meeting. Research presented at conferences may not yet have completed full peer review.
Source: Endocrine Society
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People with Obesity Tend to Move Less After Starting GLP-1 Medications, Study Finds
Key Takeaways:
- Daily step counts and moderate-to-vigorous activity both dropped after adults with obesity started a GLP-1 receptor agonist, with no sign that weight loss prompted people to move more.
- Because these medications strip away lean muscle as well as fat, staying active matters for protecting strength and long-term health rather than being an optional extra.
- This is the first large study to draw on data from wearable fitness trackers in adults taking GLP-1 medications, and its authors argue for targeted support that builds activity in alongside treatment.
A counterintuitive picture of how people move
It is tempting to assume that as the weight comes off, people naturally become more active. New findings suggest the opposite may be closer to the truth. Adults with obesity who were losing weight on glucagon-like peptide-1 (GLP-1) receptor agonist medications significantly reduced their physical activity, according to a study being presented on Saturday at ENDO 2026, the Endocrine Society’s annual meeting in Chicago, Illinois.
That matters because activity is one of the main safeguards against an unwanted side effect of these treatments. GLP-1 receptor agonists such as semaglutide, liraglutide, dulaglutide and tirzepatide reduce not only fat but also lean muscle mass. This makes physical activity essential for preserving strength and long-term health, according to study lead Sajana Maharjan, M.D., of HSHS St. John’s Hospital in Springfield, Illinois.
How the study was carried out
The work was a retrospective pre–post cohort study, meaning researchers compared the same individuals before and after they started treatment. It drew on data from the National Institutes of Health’s All of Us Research Program, which links participants’ electronic health records with their Fitbit activity data, allowing the team to track real-world movement rather than relying on self-reported habits.
Among the 1,950 adults with obesity who started a GLP-1 medication, researchers studied 753 people who had enough wearable-device data for analysis. The cohort was predominantly female, at 78.6 per cent, with a mean age of 52.7 years.
For each person, the researchers compared physical activity before and after treatment began, focusing on two measures: daily step counts and minutes of moderate-to-vigorous physical activity (MVPA).
Steps and active minutes both fell
The direction of travel was clear. On average, daily steps decreased from 5,047 to 4,487 per day, while MVPA minutes fell from 28 to 22 per day after people began a GLP-1 receptor agonist medication.
Crucially, the study found no evidence that weight loss from these medications led to increased physical activity. The expected rebound in movement simply did not appear in the data.
Who saw the biggest changes
The decline was not evenly spread. The largest drops were seen in men and in people living with joint or muscle pain. By contrast, factors such as age, heart failure or a prior stroke did not change the results, suggesting the pattern held across a fairly broad range of circumstances.
Why activity cannot be an afterthought
For Dr Maharjan, the practical message is that exercise needs to be designed into treatment rather than left to chance:
“While many assume that weight loss leads naturally to increased physical activity, our study suggests otherwise. The findings in our study reinforce that exercise cannot be optional for people taking these medications. People need targeted interventions that encourage physical activity alongside medication for obesity.”
Given that GLP-1 receptor agonists reduce lean muscle alongside fat, a fall in activity could compound the loss of strength, making structured support for movement an important part of care rather than a nice-to-have.
A first for wearable-data research
The study stands out for its method as much as its findings. It is the first large study analysing data from wearable fitness trackers among adults taking GLP-1 receptor agonists, offering a more objective window into everyday behaviour than questionnaires alone can provide. As these medications become more widely used, that kind of real-world evidence is likely to shape how clinicians and patients approach physical activity during treatment.
CCH insights:
This is a very interesting study, but it throws up more questions than answers. Firstly, were any of the participants receiving diet and lifestyle advice as they are supposed to? GLP-1 medications are designed as an adjunct to such advice, but these results suggest it was probably lacking from these patients’ treatment. Another question, of course, is why did physical activity drop? Further research is needed to understand what is the underlying reason for these results. But most importantly, this study is a reminder that GLP-1 therapy is not just about taking the medication, it requires diet and lifestyle advice and ongoing support and monitoring.
Source: Endocrine Society
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New Triple-Hormone Injection Shows Major Weight Loss in People with Type 2 Diabetes and Obesity
Key Takeaways:
- In a phase 3 trial, retatrutide cut body weight more than four times as much as placebo and roughly doubled the reduction in long-term blood sugar.
- The once-weekly jab works through three hormone pathways at once – GLP-1, GIP and glucagon – the last of which may help raise energy expenditure.
- Experts called the results encouraging but stressed that head-to-head trials against existing drugs are still needed.
A new approach to managing type 2 diabetes
A once-weekly injection that works through three hormone pathways at the same time could deliver substantial reductions in both blood sugar and body weight for people with type 2 diabetes, according to phase 3 trial results.
People taking part in the trial who received weekly retatrutide injections over 40 weeks lost more than four times as much weight as those given a placebo, while their average reduction in long-term blood sugar (HbA1c) was more than twice that seen in the placebo group.
How retatrutide works
Retatrutide is described as a triple-hormone drug because it mimics three gut hormones that help regulate appetite, blood sugar and metabolism: GLP-1, GIP and glucagon.
This sets it apart from several medications already in use. Drugs such as Ozempic and Wegovy primarily target the GLP-1 pathway to suppress appetite, while Mounjaro combines GLP-1 with GIP to help control blood-sugar levels. Retatrutide goes a step further by also engaging the glucagon receptor, which is thought to help increase energy expenditure.
Inside the phase 3 trial
The trial, published in the Lancet, randomly assigned 930 adults with type 2 diabetes to receive either 4mg, 9mg or 12mg of retatrutide, or a placebo.
None of the participants were already taking diabetes medicines. All had inadequately controlled blood-sugar levels and a body mass index (BMI) of at least 23.
Throughout the trial, researchers monitored a range of health markers, including HbA1c, weight, cholesterol levels and other indicators, and recorded any side-effects that arose.
What the results showed
After 40 weeks, participants receiving retatrutide saw their HbA1c fall by an average of about 1.7–1.9 percentage points, compared with 0.8 in the placebo group.
The weight loss results were similarly marked. On average, participants taking retatrutide lost about 11.5%–15.3% of their body weight, against 2.6% for those on placebo. Cholesterol and blood pressure also improved among people taking the drug.
Safety and side-effects
Fourteen participants experienced serious adverse events during the trial, including two in the placebo group. For most people, however, side-effects were mild to moderate and eased over time, with gastrointestinal symptoms the most commonly reported.
What the findings could mean
The study authors say this triple-action medication has the potential to improve health outcomes for some people, including greater weight loss, particularly for those who may need more intensive treatment regimens to manage their type 2 diabetes. Further clinical trials are continuing.
The results follow earlier findings from the manufacturer, Eli Lilly, which suggested that retatrutide was highly effective at reducing weight among people with obesity.
What the experts say
Dr Kath McCullough, special adviser on obesity at the Royal College of Physicians, said the findings were very encouraging.
“For many people living with diabetes and obesity, treatments like this could be genuinely life-changing,” she said.
“However, medications are not a silver bullet. While they are proving to be effective, the long-term goal must be to prevent people from needing them in the first place.”
Dr Marie Spreckley, a specialist in prevention of diabetes and related metabolic disorders at IMS Epidemiology, University of Cambridge, said the results were striking: “The magnitude of weight loss observed is particularly notable. However, because this study compared retatrutide with placebo rather than semaglutide or tirzepatide, it is not possible to determine from this data whether retatrutide is superior, equivalent or inferior to currently available therapies. Direct head-to-head trials will be required before firm conclusions can be drawn regarding comparative effectiveness.”
She added that weight loss alone did not necessarily equate to optimal health outcomes, and that people needed support to maintain adequate nutritional intake, preserve muscle mass and maximise long-term health during treatment.
Dr Lucy Chambers, the head of research impact and communications at Diabetes UK, said: “These encouraging findings show that this new class of drug for type 2 diabetes could deliver dual benefits for both weight loss and blood-sugar management. We look forward to further research to understand its long-term effects and how it compares to treatments already available on the NHS.”
Source: The Guardian
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Beyond the Scales: Why Physical Activity Remains Central to Obesity Care
Key Takeaways:
- Exercise earns its place in obesity care through benefits the scales never show – lower blood pressure, better insulin sensitivity and improved fitness – so it remains worthwhile even when weight changes little.
- On its own, activity shifts the scales only modestly, but paired with diet, obesity medications or surgery it protects lean muscle, drives fat loss and makes the results last.
- Tools such as the 5A consultation model, wearables and app-based coaching can lift adherence, though their value depends on access, accuracy and how well they fit each person’s life.
How much weight someone loses has long been the headline measure of whether obesity treatment is working. A new scientific statement from the American Heart Association, published in Circulation, makes the case that this measure misses much of what physical activity actually does. Movement, the statement argues, reshapes cardiovascular and metabolic health in ways that a set of weighing scales will never register.
What activity does that the scales cannot capture
Obesity sits at the centre of cardiovascular risk because of the company it keeps: raised blood pressure, disordered blood fats and insulin resistance. With roughly 42% of adults in the United States affected, the stakes are considerable, and treatment has traditionally pursued two linked aims, shedding weight and lowering heart disease risk.
Physical activity contributes to both, but the more interesting finding is how much it achieves on its own terms. Regular exercise lowers blood pressure, sharpens the body’s response to insulin and nudges cholesterol and other lipids in a healthier direction, and it does so whether or not the number on the scales falls. Aerobic and resistance training each deliver. As a rough rule, doing more tends to help weight-related outcomes most, while working harder pays off most for cardiorespiratory fitness.
Why exercise alone is a poor weight-loss strategy
If the goal is purely to lose weight, activity by itself is an inefficient route. Unless someone trains at high volumes, the losses are usually small, and fewer than one person in seven manages a clinically meaningful reduction through exercise alone. The body, in effect, fights back: appetite climbs and metabolism slows, eroding the deficit that training creates.
This is why exercise works best in combination. Adding it to a calorie-reduced diet produces more weight loss and better metabolic results than either approach in isolation. And the composition of that loss matters as much as the total. Eating enough protein and including resistance work helps ensure the weight that goes is fat rather than muscle, preserving the lean tissue that keeps metabolism and strength intact.
Keeping weight off is the harder battle
Losing weight is difficult; not regaining it is harder still, and regain tends to undo the health gains that came with it. Here the evidence points firmly towards higher activity levels, somewhere between 200 and 300 minutes a week, as a marker of people who keep weight off successfully. The catch is that few people sustain that volume.
A more realistic path is to build gradually towards at least 150 minutes a week of moderate-to-vigorous activity, then add more where possible. Even when some weight creeps back, staying active keeps the cardiometabolic benefits in play, which is reason enough to maintain the habit rather than abandon it after a setback.
Where medication and surgery enter the picture
For people whose body mass index is high and for whom lifestyle change has not been enough, obesity medications and bariatric surgery are central options. Both are effective, and both come with real-world limits around cost, availability and side effects. Neither replaces an active lifestyle; the statement frames physical activity as the strategy that should run alongside them.
The newer GLP-1 receptor agonists, including liraglutide, semaglutide and tirzepatide, have transformed what medication can achieve, with some trials approaching the results once seen only after surgery. They work mainly by curbing appetite and slowing the stomach’s emptying, and although side effects are common, they are usually manageable. Beyond weight, liraglutide and semaglutide have been shown to cut major cardiovascular events in certain high-risk groups.
What remains poorly understood is how exercise fits into this newer landscape. Most medication trials simply have not isolated what activity adds, or how the two interact, leaving the ideal exercise prescription for people on these drugs an open question. The issue is sharpened by the fact that a notable share of the weight lost on GLP-1 receptor agonists is lean tissue rather than fat, even if the long-term consequences of that are not yet clear. The handful of studies that do compare medication with and without exercise suggest that adding activity means more fat loss and better fitness, but the field is still waiting for the large, controlled trials that would settle the matter.
Surgery raises related questions. People approaching bariatric procedures tend to be less active to begin with, and there is no agreed playbook for the period beforehand; insurer-mandated pre-surgical activity programmes exist, but the evidence that they change outcomes is thin and inconsistent. Afterwards, the picture is clearer: people who move more lose more weight and fat, hold onto those losses, and gain in fitness and strength, though effects on metabolic risk markers vary and access to structured programmes is frequently lacking.
Turning good intentions into sustained habits
Clinicians are not bystanders in any of this. A widely used framework, the 5A model, gives consultations a useful spine: assess where the person is, advise on the options, agree on goals, assist in pursuing them and arrange follow-up. Worked through properly, each step tends to deepen engagement with both dietary change and activity, making healthy behaviours easier to stick to.
Doing this well means looking past activity levels alone to the psychological, social and medical factors that can stall progress, and gauging how ready and confident someone feels about changing. Counselling tailored to that profile builds motivation and trust, which in turn supports the activity itself. Equipping clinicians to weave physical activity, dietary change and behaviour change into everyday obesity consultations is the focus of practical training such as the College of Contemporary Health’s Obesity Toolbox, a CPD-accredited online short course. Because a short appointment can only do so much, part of the clinician’s job is helping people spot the obstacles in their way, solve them together, and connect with wider support, whether behavioural counselling or a digital programme that keeps them accountable between visits.
Technology is increasingly part of that support. Wearables, apps, text reminders, personalised feedback and self-monitoring all show promise for keeping people moving. The statement is careful, though, to flag the caveats: not everyone has equal access to these tools, the devices vary in how accurately they measure activity, and none of it substitutes for regular reassessment and structured follow-up.
The bottom line for treatment
Physical activity belongs at the heart of comprehensive obesity care, supporting weight loss, helping maintain it and improving health more broadly. Medications and surgery are genuine advances, but exercise adds something they do not fully provide: gains in cardiovascular risk, body composition, fitness and quality of life, many of which arrive independently of any change on the scales.
Delivering that well takes teamwork across clinicians and allied health professionals, and programmes that are not only effective but also affordable and within reach, especially for under-resourced communities where obesity is more common and activity levels lower. Making the wider case for movement, rather than treating it as a weight-loss tool alone, is likely to be what makes obesity treatment hold up over the long run and eases the cardiovascular toll that obesity exacts.
CCH insights:
This study strikes right at the heart of how our understanding of obesity is starting to change – it is not all about body weight and body fat, but about health. Although reducing harmful body fat is an important part of obesity treatment, so is improving cardiometabolic health and other health issues that arise as a result of obesity. And physical activity is a vital tool in delivering these health improvements – helping to reduce blood pressure, regulate blood glucose, reduce cholesterol and improve
muscle mass and function – whether or not it results in weight loss whether or not it results in weight loss. For clinicians looking to put this into practice, CCH’s Obesity Toolbox (1.5 hours, fully online, CPD-accredited) is a quick, practical primer on the essentials of physical activity, dietary change and behaviour change in obesity care – a fast starting point for busy practitioners.
Explore the Obesity Toolbox →
Semaglutide Shows Benefit in Severe, Long-Standing Treatment-Resistant Obesity, Trial Finds
Key Takeaways:
- Weekly semaglutide (2.4 mg) cut BMI by an average of 19 per cent – around 22.3 kg – over 68 weeks in young adults with treatment-resistant severe obesity.
- Benefits went beyond weight, with large falls in total, abdominal and liver fat and in metabolic syndrome severity, lowering cardiovascular and type 2 diabetes risk.
- The drug was safe and well tolerated, with only mild, short-lived side effects and no related dropouts.
A promising option for hard-to-treat obesity
A weekly dose of semaglutide (2.4 mg) leads to a clinically significant reduction in body mass index (BMI) and related health outcomes in young adults living with severe obesity who are resistant to treatment following hospital-based, non-pharmacological obesity care during childhood. That is the finding of a randomised controlled trial being presented at this year’s European Congress on Obesity (ECO).
The study, led by researchers from the University of Copenhagen and Holbæk Hospital in Denmark, highlights the importance of identifying as early as possible the children who are resistant to hospital-based obesity care and who may benefit from the timely addition of semaglutide or other glucagon-like peptide-1 receptor agonists (GLP-1 RAs).
Semaglutide and other GLP-1 RAs work by mimicking naturally produced incretin hormones. These hormones help to lower blood sugar levels after a meal and reduce appetite, prompting people to eat less.
Why new strategies are urgently needed
Children living with obesity are five times as likely to be living with obesity in adulthood as their healthy-weight counterparts [1]. Obesity that begins in early childhood carries significant health risks in early adulthood, including early-onset type 2 diabetes, cancer, cardiovascular disease and a reduced quality of life.
Hospital-based, non-pharmacological obesity care – which involves supporting children living with obesity and their families to improve health and thriving during growth and development – has been shown to reduce childhood obesity. However, around one in four children are more difficult to treat, and any reduction in the degree of obesity is hard to maintain. New, effective and safe treatment strategies are therefore urgently needed.
Inside the RESETTLE trial
In the new RESETTLE trial – a randomised, placebo-controlled, double-blind study – the researchers investigated the effect of semaglutide treatment in young adults (aged 18 to 28 years) who were still living with severe obesity despite at least one year of treatment at the Children’s Obesity Clinic, European Centre for Obesity Management, at Holbæk Hospital in Denmark.
The study involved 246 young adults (average age 23 years, 59 per cent female) who had been included in the HOLBAEK Study [2]. Participants were randomised into four different groups, based on how they had previously responded to the paediatric hospital-based treatment programme and on their current BMI:
- 82 participants with a low response to childhood obesity care (a change in BMI that was not enough to improve their health) and who were currently living with obesity as young adults (BMI of 30 kg/m² or above).
- 80 participants with a medium response to childhood obesity care and living with obesity as young adults (BMI of 30 kg/m² or above).
- 34 participants with a high response to childhood obesity care who were not living with obesity as young adults (BMI below 30 kg/m²).
- 50 participants from a population-based reference group who had a normal weight development in childhood.
What the assessments measured
All participants, regardless of their response group, underwent examinations of cardiometabolic biomarkers (waist circumference; lipids in the blood, including cholesterol; blood glucose; and blood pressure), full-body dual-energy x-ray absorptiometry (DXA) imaging of body composition, and magnetic resonance imaging (MRI) of liver and visceral (abdominal) fat.
The 162 participants in the low- and medium-response groups – who had poorer health outcomes than the high-response and normal-BMI-development groups – were randomly assigned to either weekly injections of semaglutide (2.4 mg; 54 in the low-response group and 55 in the medium-response group) or placebo (28 and 25 respectively) over 68 weeks. In total, 152 participants (94 per cent) attended the final visit.
Results: large reductions in BMI and weight
After 68 weeks, semaglutide led to an average decrease in BMI of 19 per cent (average weight loss of 22.3 kg) in both the low- and medium-response groups, compared with placebo.
In the low-response group, average BMI among those taking semaglutide fell by 7.3 kg/m² (from 40.5 kg/m²), compared with a minor increase of 0.5 kg/m² in the placebo group. Similarly, in the medium-response group, average BMI decreased by 6.7 kg/m² (from 38.0 kg/m²) among those taking semaglutide, but rose by 0.6 kg/m² among those given placebo (see figure 1 in the full abstract).
Beyond weight: fat and metabolic health
Participants in the low- and medium-response groups who received semaglutide also saw substantial improvements in total fat mass (-17 kg and -15 kg respectively), abdominal fat (-48 per cent and -41 per cent) and liver fat (-39 per cent and -34 per cent) compared with placebo – all key factors in reducing obesity-related health risks.
In addition, these participants experienced substantial improvements in their metabolic syndrome severity score (-0.80 and -0.58), a measure that integrates lipids, blood pressure, fasting glucose and waist circumference into a single value. This reflects a substantial reduction in the risk of developing cardiovascular disease and type 2 diabetes.
Safety and tolerability
Semaglutide was safe and generally well tolerated. Gastrointestinal side effects, such as nausea and abdominal pain, were the most common. However, most side effects were manageable, resolved over time, and did not lead to participants dropping out of the trial.
What the researchers say
“By reducing the degree of obesity and improving cardiometabolic health irrespective of prior response to childhood obesity care, GLP-1 based treatment could help more young people with severe obesity to reduce their burden of obesity-related complications in early adulthood,” said author Joachim Holt from the University of Copenhagen.
According to study lead Professor Signe Sørensen Torekov at the University of Copenhagen, “Severe obesity in young people is a complex, chronic disease with serious health consequences. GLP-1 based treatment offers a promising option for managing severe obesity in young people who are resistant to prior hospital-based non-pharmacological care. Importantly, supporting families to implement increased physical activity and health behaviours should remain the foundation of all treatments for childhood obesity and prevention of obesity across generations.”
Head consultant Jens-Christian Holm, of the Children’s Obesity Clinic, European Centre for Obesity Management, Holbæk University Hospital, adds that, “Childhood obesity is a chronic disease resulting in numerous complications reducing physical, mental and social thriving during growth and development. Being able to optimise obesity treatment with the addition of drugs in selected patients to improve health is a worldwide imperative.”
CCH insights:
Once again, GLP-1 therapy delivers excellent results, providing the necessary change in appetite that allowed these young people to make the behavioural changes needed to lose weight and improve health, when previously they had been unable to do so. And it is not just about losing weight, with significant improvements in metabolic and cardiovascular disease risk factors.
References:
[1] Predicting adult obesity from childhood obesity: a systematic review and meta‐analysis – Simmonds – 2016 – Obesity Reviews – Wiley Online Library
[2] The HOLBAEK Study includes more than 4,000 Danish children and adolescents with and without obesity (Study Details | NCT02852694 | Reduce Risk for Crohn’s Disease Patients | ClinicalTrials.gov).
Year-Long Trial Finds Rapid Weight Loss Outperforms a Gradual Approach, Overturning a Long-Held Assumption
Key Takeaways:
- In a 52-week randomised trial, adults living with obesity who followed a rapid weight loss programme lost significantly more weight at one year than those on a gradual programme (14.4% versus 10.5% of total body weight), and the gap held throughout the study.
- Rapid weight loss was not associated with greater weight regain, directly contradicting the widespread belief that losing weight slowly is necessary to keep it off.
- A larger share of people in the rapid weight loss group reached clinically meaningful BMI and waist-to-height targets linked to a lower 10-year risk of obesity-related conditions.
A long-held belief comes under scrutiny
New research presented at the European Congress on Obesity (ECO 2026) in Istanbul, Turkey, indicates that rapid weight loss (RWL) is considerably more effective than gradual weight loss (GWL), both in the amount of weight people lose and in how well that loss is sustained at one year.
For years, conventional thinking has held that rapid weight loss is unhealthy and that shedding weight very quickly raises the chance of regaining it. Yet these concerns rest largely on observational data, historical assumptions, or small studies with methodological limitations. The scientific evidence directly supporting them is limited and inconsistent, and high-quality randomised controlled trial evidence remains relatively sparse.
The study was led by Dr Line Kristin Johnson of the Department of Endocrinology, Obesity and Nutrition at Vestfold Hospital Trust in Tønsberg, Norway, together with colleagues. The centre is a collaborating centre with the European Association for the Study of Obesity (EASO-COM-Centre); EASO leads obesity advocacy and education across Europe and organises ECO.
Setting the treatment targets
A recent large, population-based cohort study concluded that, after weight loss, a body-mass index (BMI) of 27 kg/m² or below and a waist-to-height ratio (WHtR) of 0.53 or below may represent clinically meaningful treatment targets for lowering the 10-year risk of obesity-related complications, namely type 2 diabetes, hypertension, atherosclerotic cardiovascular disease, and hip and knee osteoarthritis.
In this new study, the researchers set out to compare how effectively a rapid weight loss programme and a gradual weight loss programme helped people reach those targets.
How the trial was designed
The 52-week, investigator-initiated, randomised clinical trial was run as a collaboration between the Department of Endocrinology, Obesity and Nutrition at Vestfold Hospital Trust and Roede AS, one of Norway’s leading and most established providers of commercial weight loss programmes.
In total, 284 adults living with obesity (BMI of 30 or above), of whom 257 (90%) were women, were randomised on a one-to-one basis to one of two 16-week, food-based programmes. The rapid weight loss programme reduced energy intake in stages: under 1,000 kcal per day in weeks 1 to 8, under 1,300 kcal per day in weeks 9 to 12, and under 1,500 kcal per day in weeks 13 to 16. The gradual weight loss programme set intake at 800 to 1,000 kcal per day below each participant’s estimated total energy expenditure, with a mean self-reported intake in this group of roughly 1,400 kcal per day.
Estimated energy expenditure was calculated from each participant’s estimated resting energy expenditure and then adjusted according to whether they had low, medium, or high physical activity.
The food composition in both programmes followed current Norwegian dietary recommendations from the Norwegian Directorate of Health. Core advice included eating healthy foods such as vegetables, fruits, whole grains, low-fat dairy products, fish, eggs, lean meat, and other protein-rich foods, while limiting saturated fats and added sugars.
Maintaining the results
After the initial weight loss phase, participants in both groups moved into an identical 36-week weight-regain prevention programme.
Throughout the study, the interventions included weekly in-person group sessions from week 1 to week 16. After that, in-person group meetings took place every 14 days for the first three months, followed by monthly meetings or individual contact via webinars, video, or telephone for the remaining five months.
In these sessions, participants were advised to raise their daily energy intake by 100 to 300 kcal during the first month, until their weight stabilised. From then on, daily intake was adjusted as needed in response to any weight changes across the eight-month maintenance phase. Participants could decide for themselves whether to maintain their weight or aim for further loss, and the majority chose to keep losing weight after the initial 16-week period.
What the trial found
Of the 284 participants, 142 were randomised to the rapid weight loss programme and 142 to the gradual weight loss programme. At baseline, the rapid weight loss group had a mean age of 48.5 years, body weight of 102.4 kg, height of 169 cm, BMI of 35.8 kg/m², waist circumference of 112.5 cm, and WHtR of 0.67. The corresponding figures in the gradual weight loss group were 47.7 years, 103.0 kg, 168 cm, 36.5 kg/m², 112.8 cm, and 0.67.
The primary outcome was one-year percentage total body weight loss (%TBWL). The proportion of participants reaching a BMI of 27 kg/m² or below, or a WHtR of 0.53 or below, after one year were exploratory outcomes.
During the first 16 weeks, the rapid weight loss group lost significantly more weight than the gradual weight loss group, with a mean %TBWL of -12.9% compared with -8.1%, a between-group difference of -4.8%.
At one year, that significant difference was maintained: the mean %TBWL was -14.4% in the rapid weight loss group and -10.5% in the gradual weight loss group, a between-group difference of -3.9 percentage points.
The share of participants achieving a BMI of 27 kg/m² or below was significantly higher in the rapid weight loss group than in the gradual weight loss group at both 16 weeks (13.8% versus 0.8%) and one year (28.3% versus 9.7%). A higher proportion also reached a WHtR of 0.53 or below in the rapid weight loss group, both at 16 weeks (24.2% versus 8.9%) and at one year (33.0% versus 18.4%).
What the researchers say
The authors conclude, “Among adults with obesity, participation in a structured rapid weight loss program resulted in significantly greater weight loss at one year, and higher rates of achieving clinically meaningful BMI and WHtR targets compared with a gradual weight loss approach.
“These findings indicate that, when provided within a controlled and professionally supervised setting, rapid weight loss may represent a more effective method than gradual weight loss for reaching key body weight targets associated with reduced obesity-related health risks.”
Dr Johnson adds, “Our results clearly challenge the prevailing belief that slow and steady gradual weight loss is necessary to prevent weight regain and reduce obesity-related complications.
“By contrast, we show that rapid weight loss is not associated with weight regain, and, more importantly, that a larger proportion of participants undergoing rapid weight loss – compared with gradual weight loss – achieved clinically meaningful treatment targets for reducing the 10-year risk of type 2 diabetes, hypertension, atherosclerotic cardiovascular disease, and hip/knee osteoarthritis.
“These findings are particularly relevant given the urgent need for effective weight-loss and weight-maintenance strategies. As many individuals with obesity cannot access or afford medical or surgical treatments, our results support the potential of effective, commercially available weight-reduction programs to help reduce the growing burden on public health care systems.”
Why it matters
With obesity placing a rising strain on health systems, and with medical and surgical treatments out of reach for many, the trial points to professionally supervised commercial programmes as a potential route to meaningful, lasting results. Its central message reframes a long-standing assumption: under proper supervision, losing weight quickly did not undermine maintenance, and it helped more people reach the targets tied to lower long-term health risks.
CCH insights:
These are impressive results for a diet and lifestyle intervention, with both groups achieving greater than 10% total body weight loss over a period of a year. However, participants received fairly intensive support throughout the entire year of the trial. The important thing is what happens in the next 12 months, after the intervention has stopped – are they able to sustain behavioural changes and weight loss without the support from the programme?
Source: Medical Xpress
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AI Model Improves Early Detection of Serious Lung Disease in Newborns
Key Takeaways:
- Researchers at the University of Rochester have developed a time-series AI machine learning model that predicts bronchopulmonary dysplasia (BPD) in premature newborns more accurately than existing prediction tools.
- The model uses detailed electronic health record data rather than the limited datasets used in many current online BPD calculators.
- Researchers hope the technology could eventually support real-time clinical decision-making in neonatal intensive care units and help reduce the severity of lung disease in vulnerable infants.
AI and neonatal care
A research team from the University of Rochester has developed a new artificial intelligence and machine learning model designed to improve the prediction of bronchopulmonary dysplasia (BPD), a serious lung disease that affects premature newborns. Their findings were published in The Journal of Pediatrics in a study titled “Time-Series Machine Learning for Prediction of Bronchopulmonary Dysplasia.”
The project centres on the use of time-series machine learning, an approach that analyses patterns in data collected over time, allowing researchers to build more dynamic and potentially more accurate disease prediction models.
Understanding bronchopulmonary dysplasia
Bronchopulmonary dysplasia is a chronic lung condition that primarily affects babies born prematurely and with low birth weight. Because their lungs are still underdeveloped, many premature infants require oxygen therapy and mechanical ventilation shortly after birth to survive. However, this early exposure to oxygen and ventilatory support can contribute to lung injury and long-term respiratory complications.
Children who develop BPD may experience ongoing breathing difficulties and other long-term health challenges linked to impaired lung development.
“We take great effort in the neonatal intensive care unit to prevent lung damage,” said Associate Professor Andrew Dylag, MD, from the Department of Pediatrics, Neonatology. “Despite this, premature infants still develop BPD. There are BPD ‘calculators’ on the internet that can predict the severity of lung disease while the baby is still in the hospital, but they use a very limited set of data.”
According to the research team, recently updated versions of these existing calculators demonstrated lower accuracy than earlier models, prompting the group to explore a different strategy.
“We thought that using more detailed data from the University’s electronic health record would improve disease predictions and allow us to pinpoint vulnerable times when we might be able to intervene to prevent lung disease in newborns,” Dylag said.
Funding supports new collaboration
To support the project, the researchers secured a 2023 Digital Health Seedling award from the Clinical and Translational Science Institute (CTSI).
“We hoped that CTSI could help us test the hypothesis that machine learning could improve disease predictions in hospitalized premature newborns,” Dylag said. “The 2023 Digital Health Seedling award was exactly the type of funding we needed to develop new collaborations across the University community and kickstart our team’s academic interactions.”
The funding enabled the formation of a multidisciplinary research team combining expertise from neonatology, engineering, computer science, biostatistics and health informatics.
The collaboration included Jiebo Luo, PhD, Albert Arendt Hopeman Professor of Engineering in the Department of Computer Science, who connected graduate students to the project, as well as Professor Xing Qiu, PhD, from the Department of Biostatistics and Computational Biology.
“The neonatology team brought content and clinical expertise to the work, the computer science team developed and tested the models, and the biostatisticians ensured the rigor and testing of the models and algorithms,” Dylag said.
The project also expanded on an existing partnership with the University of Rochester Clinical and Translational Science Institute’s Informatics and Analytics group, particularly in relation to electronic health record research.
Building a secure AI research environment
Because the project relied on a very large dataset containing sensitive patient information, the research required substantial data security and privacy protections.
“We initially got involved by helping the study team pull clinical data from eRecord,” said Jack Chang, PhD, associate director of Research Informatics. “Recognizing the project involved a very large patient population and massive data including Protected Health Information, we identified a need for a more secure analytical workspace.”
To address these concerns, the Informatics team transitioned the data into the Secure Environment for Research Data Analytics (SERDA), a protected platform designed for high-risk clinical research and advanced analytics.
High-risk healthcare data projects typically involve extensive administrative oversight and cybersecurity requirements to ensure patient privacy and regulatory compliance.
“SERDA removes that obstacle by providing a secure, scalable, and ‘ready-to-go’ environment tailored for advanced analytics and machine learning,” Chang said. “It allows researchers to focus on their science while knowing their data is protected and compliant with all privacy regulations.”
Chang said the Informatics team worked closely with institutional partners to build the infrastructure required for the study.
“Our team—working with our ISD partners—handled the technical heavy lifting: setting up virtual machines, configuring project shares, ensuring secure access with the security team, and customizing the environment with specialized analytical software,” Chang said. “We also provided training and facilitated the numerous exports of analytical outcomes from SERDA for their publication.”
Towards real-time clinical decision support
Researchers believe the improved AI model may help clinicians identify which infants are most likely to benefit from early intervention and more precise treatment strategies.
The long-term goal is to integrate the model into clinical decision support systems capable of updating disease risk predictions in real time as patient conditions evolve.
“We want to build clinical decision support tools to identify how disease predictions change in real time,” Dylag said. “If we validate our algorithm and can present the disease prediction to the clinical team, we can test guideline implementation for how to manage or treat infants that may reduce BPD severity.”
The research team said that continued collaboration between departments, alongside infrastructure support from CTSI and ISD, will be essential as the project progresses into its next phase of development and validation.
Source: University of Rochester Medicine
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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:
- An initial weight loss phase
- 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.
CCH insight
The evidence increasingly points to sustained behaviour change – not just the initial loss – as the real challenge in obesity care. CCH’s Obesity Essentials CPD short course (8–10 hours, fully online, CPD-accredited) gives healthcare professionals the practical skills to assess, support and manage patients with overweight and obesity, including how to help them build and maintain the everyday habits, such as regular walking, that keep weight off for good.
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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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