Clinical obesity and Himan-sho (obesity disease): Lessons from Japan's 25 years of experience toward a new era of obesity care.

Obesity is a chronic, relapsing disease associated with significant morbidity, mortality, and rising healthcare costs. It represents one of the most urgent global health challenges of the 21st century. With the continued surge of obesity among children and adolescents, the burden in adulthood is projected to escalate further, fueling an epidemic of non-communicable diseases (NCDs) such as type 2 diabetes, cardiovascular disease, and cancer. Once regarded as a problem confined to Western nations, obesity is now rising sharply across the globe, including in South Asia and Bangladesh, where it threatens to derail public health progress. Advances in our understanding of weight regulation and the gut–brain axis have paved the way for a new generation of safe and effective pharmacotherapies. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide 2.4 mg once weekly, approved in 2021, deliver unprecedented results, achieving an average weight reduction of 15–17% by targeting appetite and satiety pathways. The dual incretin agent tirzepatide (GLP-1/GIP RA) has further expanded therapeutic possibilities, initially approved for type 2 diabetes and now established as an option for obesity care. Additional entero-pancreatic and non-entero-pancreatic hormone-based agents are under active investigation. This emerging therapeutic landscape signals a paradigm shift: obesity management is shifting toward individualized treatment strategies, similar to those used in diabetes or dyslipidemia care. Treatment selection could be tailored not only to weight reduction goals but also to obesity-related complications. Ectopic fat accumulation drives organ-specific dysfunctions—including type 2 diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD)/ metabolic dysfunction-associated steatohepatitis (MASH), and heart failure with preserved ejection fraction (HFpEF). Some agents, such as GLP-1/glucagon combinations, demonstrate weight-independent effects on liver fat reduction, suggesting opportunities for tailored therapy. Moreover, robust cardiovascular and renal outcome data are already available for several newer anti-obesity agents, reinforcing their potential to improve survival as well as quality of life. The new era of obesity care is therefore defined not merely by greater weight loss, but by improved, patient-centered outcomes across metabolic, cardiovascular, hepatic, and renal domains. The challenge for clinicians is to translate this evidence into practice—ensuring equitable access, long-term adherence, and individualized therapeutic decisions to reduce the global burden of obesity and its complications. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S30]

ObjectiveThis study identified the journals with the highest yield of clinical obesity research articles and surveyed the scatter of such studies across journals. The study exemplifies an approach to establishing a journal collection that is likely to contain most new knowledge about a field.Design and methodsAll original studies that were cited in 40 systematic reviews about obesity topics (“included studies”) were compiled and journal titles of where they were published were extracted. The journals were ranked by the number of included studies. The highest yielding journals for clinical obesity and the scatter across journal titles were determined. A subset of these journals was created in MEDLINE (PubMed) to test search recall and precision for high quality studies of obesity treatment (i.e., articles that pass predetermined methodology criteria, including random allocation of participants to comparison groups, assessment of clinical outcomes, and at least 80% follow-up).ResultsArticles in 252 journals were cited in the systematic reviews. The three highest yielding journals specialized in obesity but they published only 19.2% of the research, leaving 80.8% scattered across 249 non-obesity journals. The MEDLINE journal subset comprised 241 journals (11 journals were not indexed in MEDLINE) and included 82% of the clinical obesity research articles retrieved by a search for high quality treatment studies (“recall” of 82%) and 11% of the articles retrieved were about clinical obesity care (“precision” of 11%), compared with precision of 6% for obesity treatment studies in the full MEDLINE database.ConclusionObesity journals captured only a small proportion of the literature on clinical obesity care. Those wishing to keep up in this field will need to develop more inclusive strategies than reading these specialty journals. A journal subset based on these findings may be useful when searching large electronic databases to increase search precision.

Although the obesity epidemic is progressing in European children too, there is no consensus on the population-specific prevalence of comorbidities or efficient diagnostic strategies. Therefore, weight-related risk factors, their interrelationship, and association with biological parameters were assessed in a large group of overweight (OW) children, documented by an electronic database. Data of 26,008 children (age 12.6+/-2.9 years, 56% females) presented for OW (BMI >90th percentile) or obesity (>97th percentile) in 98 specialized centers were evaluated using a simple software (Adipositas Patienten Verlaufsbeobachtung (APV)) for standardized longitudinal documentation. After local anonymization, data were transmitted for central analysis including multiple logistic regression. A total of 5.9% of the children were normal weight, 41% obese (OB), and 37% extremely OB (>99.5th percentile, XXL; 41% of the girls). In 50%, at least one risk factor and in 11% a cluster of two were found, comprising increased blood pressure (BP): 35.4%, dyslipidemia: 32% (total cholesterol: 14.1%, low-density lipoprotein (LDL)-cholesterol: 15.8%, high-density lipoprotein (HDL)-cholesterol: 11.1%, triglycerides: 14.3%), impaired glucose tolerance (IGtT): 6.5% and suspicion of diabetes: 0.7%. The degree of OW was inversely associated with HDL-cholesterol and directly with clustered risk factors, impaired glucose metabolism, increased BP and triglycerides (odds ratios (ORs) XXL vs. normal=6.15, >10, 4.3, 3.0 and 2.5, respectively), but not with LDL-cholesterol. In a very large cohort of young Europeans risk factors for cardiovascular (CV) diseases are frequently found, related to the degree of OW and tend to cluster, thus a comprehensive screening is justified in all OW or OB children. Electronic patient documentation is feasible in a large obesity care network.

This paper aims to analyze and consolidate the existing evidence on models of care and clinical obesity services for adults living with obesity 1) to identify the key components of clinical obesity services, and 2) to propose recommendations for future directions of promoting the international development of clinical obesity care. The key components of clinical obesity services include 1) a contextualized composition of multi-disciplinary teams and mechanisms to empower the healthcare professionals, 2) clear stepwise pathways matching patient needs with appropriate clinical and community resources in a timely manner, 3) comprehensive assessment and individualized treatment plan informed by the evidence-based clinical practice guidelines. Furthermore, clinical information systems and financing resources are instrumental to the effective and sustainable functioning of a comprehensive clinical service with strong connections across primary, secondary and tertiary levels of care. We synthesized these findings to make recommendations for healthcare practitioners, hospital administrations and policymakers in developing and improving comprehensive clinical services to address the needs of adults living with obesity.

PurposeThe focus of measuring success in obesity treatment is shifting from weight loss to patients’ health and quality of life. The objective of this study was to select a core set of patient-reported outcomes and patient-reported outcome measures to be used in clinical obesity care.Materials and MethodsThe Standardizing Quality of Life in Obesity Treatment III, face-to-face hybrid consensus meeting, including people living with obesity as well as healthcare providers, was held in Maastricht, the Netherlands, in 2022. It was preceded by two prior multinational consensus meetings and a systematic review.ResultsThe meeting was attended by 27 participants, representing twelve countries from five continents. The participants included healthcare providers, such as surgeons, endocrinologists, dietitians, psychologists, researchers, and people living with obesity, most of whom were involved in patient representative networks. Three patient-reported outcome measures (patient-reported outcomes) were selected: the Impact of Weight on Quality of Life-Lite (self-esteem) measure, the BODY-Q (physical function, physical symptoms, psychological function, social function, eating behavior, and body image), and the Quality of Life for Obesity Surgery questionnaire (excess skin). No patient-reported outcome measure was selected for stigma.ConclusionA core set of patient-reported outcomes and patient-reported outcome measures for measuring quality of life in clinical obesity care is established incorporating patients’ and experts’ opinions. This set should be used as a minimum for measuring quality of life in routine clinical practice. It is essential that individual patient-reported outcome measure scores are shared with people living with obesity in order to enhance patient engagement and shared decision-making.Graphical

eHealth in obesity care

Childhood obesity should be addressed in multiple sectors, including the health services/clinical setting. While many physicians believe it is their responsibility to help adult patients lose weight, the majority feels they are not equipped to manage weight problems of their patients. Healthy Clinics, Healthy Kids (HCHK) was designed to test the impact of addressing obesity, using a lifestyle approach, among pediatric patients and families in a variety of primary care clinical settings. HCHK interventions took place over a 2-year period (2010-2012) in three states (MI, MS and NM). Lifestyle interventions (nutrition, healthy living, physical activity education/technical assistance), targeted children and caregivers in low-income clinical settings that care for children. The goal was to help clinical staff address obesity issues and concerns of patients and families. Impact of interventions was assessed using pre and post surveys. 21 sites completed pre and post surveys (MI (9), MS (9), and NM (3)). Respondents included nurses (14), managers (2), physicians (2), coordinators (1), and a registered dietitian. Prevalence of obesity among children was higher than the national average (respondents reported that only 56% were “normal”, as compared to approximately 66% nationally). 32% indicated private insurance pays for some obesity care, and 42% indicated public insurance. 44% indicated they discuss weight with parents of “normal” weight children, and about 73% indicated they discuss this with parents of “overweight” children. Statistically significantly (at the p<.05 level) more respondents indicated, at the end of the project than at the beginning, that they discuss “the impact of childhood obesity on their future risk for chronic diseases in adulthood” (70% versus 57%). Statistically significantly more indicated that they discuss this topic with parents at the end (76% versus 57%). There was an increase in discussing obesity with patients, topics including exercise and physical activity (+8.5%) and limiting sedentary behaviors (+5.0%). There was an increase in conversations with parents, topics including healthy food and beverage choices (+4.8%), physical activity (+9.4%), limiting sedentary behaviors (+4.7%), “creating a healthy home environment” (+19.1%), and “removing the TV from the bedroom” (+14.3%) Although at baseline it was not discussed much (22.2%), at follow-up, there was an increase in “encouraging breastfeeding for childhood obesity prevention, if pregnant” (38.1%). Regarding parents, although already a topic with high comfort level at baseline, statistically significantly more respondents indicated at the end of the project that they felt comfortable discussing exercise and physical activity (76.2% versus 90.5% respectively). Overall, HCHK showed that implementation of a nutrition and healthy living program for clinics is feasible and effective.

Obesity is a highly prevalent disease and providers are expected to offer or refer patients for weight management yet increasingly fewer clinical visits address obesity. Challenges to offering care are known but less is known about referrals and how specialists who treat obesity-related comorbidities address care and referrals. This study explored perceptions of primary care providers (PCPs) and specialty providers regarding care and referrals for weight management, specifically referrals to programs in the community setting. A qualitative design was used to interview 33 PCPs (mean age 54 years) and 31 specialists (cardiology, gynecology, endocrinology, and orthopedics [mean age 62 years]) in the USA during 2019. Each interview was conducted by telephone, audio-recorded, and transcribed verbatim. Inductive analysis was used and followed the constant comparative method. Four themes emerged from the data including (a) Clinical guidelines and provider discretion influence obesity care; (b) Facilitators and barriers to discussing weight and small step strategies; (c) Informal referrals are made for weight management in community settings; and (d) Opportunities and challenges for integrating clinical and community services for weight management. Facilitating referrals to effective programs, ideally with a feedback loop could coordinate care and enhance accountability, but education, compliance, and cost issues need addressed. Care may be offered but not be well-aligned with clinical guidelines. Knowledge gaps regarding community programs’ offerings and efficacy were evident. Referrals could be systematically promoted, facilitated, and tracked to advance weight management objectives.

Semaglutide and tirzepatide constitute powerful tools for the medical treatment of clinical obesity, a chronic disease that results from altered organ function or physical functioning owing to excess adiposity.1 For the 90% of patients with type 2 diabetes who have overweight or obesity,2 these drugs offer simultaneous treatment of the two diseases. The diverse metabolic and physical manifestations and complications of obesity respond differentially to treatment, and algorithms to guide individualized treatment intensity are needed, similar to those developed for the treatment of other chronic diseases such as diabetes and hypertension.3 Given the varied individual efficacy and side effects of .

Studies have documented that few patients with obesity receive evidence-based care. One provider characteristic that may impact clinical obesity care, but that has been under studied to date, is political party affiliation. This study sought to evaluate how primary care physicians (PCPs) report managing patients with obesity and assess whether there are differences between Democratic and Republican PCPs. This was a secondary analysis of a cross-sectional survey of 225 PCPs registered to vote as Democrats or Republicans in 29 US States. After reading a patient vignette, the PCPs reported the following outcomes: likelihood of documenting obesity in the medical record; likelihood of discussing obesity with the patient; and likelihood of engaging in eight different obesity management options. Almost all PCPs reported they would document obesity in the medical record (Republican = 97.6%, Democrat = 94.3%) and discuss it further (Republican = 95.2%, Democrat = 92.2%). Among eight obesity management options, PCPs were least likely to say they would prescribe medication (3.9%) or refer the patient to counselling (24.0%), regardless of political affiliation. Republicans were more likely to report that they would inquire about the time course of obesity (73.4% v. 56.2%, P = 0.012) and discuss health risks of obesity (91.0% vs 78.3%, P = .018). Republican and Democratic PCPs report some differences in managing patients with obesity, suggesting that political beliefs may play a role in some clinical care.

BackgroundWeight-related stigmatization is a public health problem. It impairs the psychological well-being of obese individuals and hinders them from adopting weight-loss behaviors. We conducted an experimental study to investigate weight stigmatization in work settings using a sample of experienced human resource (HR) professionals from a real-life employment setting.MethodsIn a cross-sectional, computer-based experimental study, a volunteer sample of 127 HR professionals (age: 41.1 ± 10.9 yrs., 56% female), who regularly make career decisions about other people, evaluated individuals shown in standardized photographs regarding work-related prestige and achievements. The photographed individuals differed with respect to gender, ethnicity, and Body Mass Index (BMI).ResultsParticipants underestimated the occupational prestige of obese individuals and overestimated it for normal-weight individuals. Obese people were more often disqualified from being hired and less often nominated for a supervisory position, while non-ethnic normal-weight individuals were favored. Stigmatization was most pronounced in obese females.ConclusionsThe data suggest that HR professionals are prone to pronounced weight stigmatization, especially in women. This highlights the need for interventions targeting this stigmatization as well as stigma-management strategies for obese individuals. Weight stigmatization and its consequences needs to be a topic that is more strongly addressed in clinical obesity care.

Intensive health behavior and lifestyle treatment (IHBLT) is recommended for children aged 6-18years with obesity. The objective was to evaluate the effectiveness of Fit Together, a health care and parks and recreation partnership to deliver IHBLT. A randomized controlled trial was conducted from 2018 to 2021. Youths (aged 5-17years) with obesity were recruited from primary care clinics and randomized to a waitlist control or Fit Together (ie, clinical obesity care plus group-based lifestyle sessions at a local recreation center). Primary outcomes, child body mass index relative to the 95th percentile (BMIp95) and submaximal heart rate, were collected at baseline and 6 months. Generalized estimating equation models were used to assess changes in primary outcomes for those affected and not affected by COVID-19 study disruptions. Participants (n = 255) had a mean (SD) age of 10.0 (3.0) years, were 39% Hispanic, and were 38% non-Hispanic Black. Intervention youths not affected by COVID-19 disruptions experienced a significant decrease in BMIp95 (β = -3.05; 95% confidence interval [CI], -5.08 to -1.01) compared with controls. There was no difference in BMIp95 between intervention and control youths affected by COVID-19 disruptions (β = -3.25; 95% CI, -7.98 to 1.48). For the entire cohort, intervention youths had a significant decrease in BMIp95 compared with control youths (β = -3.32; 95% CI, -5.69 to -0.96). Submaximal heart rate was only available for the nondisrupted group, but there was no difference between intervention and control youths (β = -7.18; 95% CI, -16.12 to 1.76). Effective child obesity treatment can be implemented in local communities through a partnership between clinical practices and parks and recreation providers. Future research will explore this model in combination with newer, more effective obesity treatments.