ABSTRACTObjectiveCandidates for metabolic bariatric surgery (MBS) often exhibit a higher prevalence of depressive symptoms compared with the general population. Studies have shown improvements in depressive symptoms and a reduction in depression prevalence during the initial years following MBS. However, reports on the long‐term maintenance of these improvements are conflicting, and factors such as preoperative predictors and gender differences remain poorly understood.MethodsData were collected from 210 subjects pre‐MBS and at 1‐ and 5‐years post‐MBS. Health care providers measured Body Mass Index (BMI). All other data were collected via self‐report (questionnaires). Pre‐MBS factors assumed associated with depressive symptoms at 5 years included BMI, body dissatisfaction, appearance orientation, resilience, and outcome expectancies.ResultsThe sample comprised 77.6% women. Pre‐MBS there were no significant gender differences in depressive symptomatology or the likelihood of being depressed. At both one and 5 years post‐MBS, a higher proportion of men were categorized as probably depressed. From baseline to 5 years post‐MBS, depressive symptoms declined among women, whereas there was no change among men. Regardless of gender, preoperative depressive symptoms and resilience predicted postoperative depression. Among women, preoperative body dissatisfaction and expectations regarding weight change and appearance were initially associated with postoperative levels of depression.ConclusionsContrasting common findings, this study identified higher rates of post‐surgery depression in men than in women. Furthermore, the results indicate that post‐surgery depression may be bivariately associated with different factors depending on gender, although resilience predicted depressive symptoms irrespective of gender.

Obesity impairs health-related quality-of-life (HRQoL). Substantial weight loss following metabolic and bariatric surgery improves HRQoL, but there is a need for larger long-term studies. This study aimed to examine changes in HRQoL at 2 and 5years, comparing outcomes between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), and to evaluate associations with pre-operative patient characteristics. HRQoL was assessed using the Short Form-36 (SF-36) questionnaire before surgery and at 2- and 5-year follow-up. Physical and Mental Component Scores (PCS and MCS) were calculated, and associations between baseline characteristics and changes in HRQoL were analyzed. Of 2031 patients, 1285 completed at least one postoperative SF-36. PCS improved significantly at 2years (mean 9.4, 95% CI 8.7-10.0) and was maintained at 5years. MCS showed an improvement at 2years (1.5, 95% CI 0.8-2.2) but not at 5years. No major differences were found between RYGB and SG, except for lower MCS at 5years in SG patients (5.2, p=0.009). Preoperative type 2 diabetes and osteoarthritis were associated with improved HRQoL, whereas psychiatric and gastrointestinal disorders predicted poorer results. Metabolic and bariatric surgery leads to sustained improvements in physical HRQoL, but the response is influenced by preoperative comorbidity.

Obesity-related mortality in the United States has increased substantially over recent decades, yet long-term national trends and demographic disparities remain incompletely characterized. To evaluate nationwide trends in obesity-related mortality among U.S. adults and identify disparities by age, sex, race, and geographic region from 1968 to 2025. We performed a retrospective analysis using CDC WONDER mortality data from 1968 to 2025 (nearly sixdecades). Adults aged ≥25years with obesity identified using International Classification of Diseases (ICD) codes listed as an underlying or contributing cause of death were included. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated using the 2000 U.S. standard population, and temporal trends were evaluated using Joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC). From 1968 to 2025, a total of 211,479 obesity-related deaths were recorded among U.S. adults aged ≥25years. AAMRs increased from 1.15 to 3.32 per 100,000, peaking in 2021 (4.54 per 100,000). Mortality rates were consistently higher among males, older adults, Black populations, and residents of the Southern United States, while younger adults (25-44years) experienced the most rapid rise in mortality. Obesity-related mortality in the United States has more than tripled over nearly sixdecades, with substantial demographic and geographic disparities. These findings highlight the urgent need for targeted, culturally tailored, and age-specific public health interventions to address the growing burden of obesity.

The transition from high school to college involves lifestyle changes that can lead to increased body weight, a phenomenon commonly referred to as the Freshman 15. Although educational settings may differ across countries, this period could also present a risk of weight gain. To determine the weight gain in Mexican students during the transition from high school to a public university and identify the primary associated modifiable factors. Two hundred twenty-six students of both sexes, aged 17-21years, were evaluated at the beginning and end of the first semester. Anthropometric characteristics, lifestyle habits, and self-perceived stress were analyzed. Intra-subject differences were assessed using the general linear model with repeated measures, and categorical variables were evaluated using non-parametric tests. A significant weight increase of 0.8kg was observed regardless of sex. Adolescents who ate under 20min or lived in a rooming house without appliances exhibited the highest weight gain. Regression analyses revealed that female sex (β=-0.929, p=0.008) and eating time of 21min or more (β=0.756, p=0.050) were significantly associated with body weight change. In the multiple regression model, only sex remained a significant factor (p=0.018). Weight gain in university students, especially in men, highlights this stage as a vulnerable period. It is essential to study habits and behaviors according to gender to design interventions that promote healthy eating. Further research is needed to identify modifiable factors associated with weight gain.

Metabolic and bariatric surgery is the most effective long-term treatment for patients with obesity; however, access to publicly funded surgery in Australia has been limited despite strong evidence of clinical benefit. The Bariatric Surgery Initiative (BSI) was established to improve equitable access for people with obesity and type 2 diabetes, but its long-term economic value has not been evaluated. This study assessed the cost-effectiveness of metabolic and bariatric surgery compared with usual medical care to inform health-system decision-making. A Markov model was developed to simulate health outcomes and costs over the rest of life for patients with BSI. The model had five health states representing BMI classes. Costs obtained from the BSI for the surgical procedure were used and long-term costs for BMI classes were drawn from the literature. Quality of life (utility) weights were obtained from the BSI as were outcomes at 12months following surgery. A Usual Care comparison group was developed from the literature and long-term costs were applied to both groups depending on the BMI class. Incremental cost-effectiveness ratios were estimated and sensitivity analyses were undertaken from the perspective of the Australian public health system. The base-case analysis demonstrated that MBS was the preferred strategy that is, better health outcomes (2.5 QALYs gained) and lower costs (cost-savings of $67,000). Scenario analyses identified that younger age groups have greater health benefits and higher BMI classes have greater cost-savings. MBS is a cost-effective intervention for patients with obesity class 2 and diabetes. The BSI was an efficient service that provided the necessary information to develop the local evidence.

ABSTRACTBackgroundGLP‐1 RAs are effective in treating obesity; however, they typically result in significant loss of skeletal muscle mass. Real‐world evidence to inform systematic guidelines and clinical implementation for preserving skeletal muscle mass and reducing cardiometabolic risk with lifestyle modifications on GLP‐1 RAs remains limited.ObjectiveThis study evaluated the effectiveness of the TouchCare Method, a lifestyle intervention incorporating nutrition and exercise with GLP‐1 RAs, for improving body composition and cardiometabolic risk.MethodsA retrospective chart review included patients enrolled in Bucks Health and Wellness between February 2024 and September 2025, for at least 12 month (n = 187). The TouchCare Method incorporates registered dietitian counseling, progressive exercise programming, mobile self monitoring, and body composition analysis during visits. Primary outcomes included: clinically significant weight loss (> 10% of body weight), proportion of weight loss from skeletal muscle mass, and changes in total‐C, LDL‐C, Apolipoprotein B, Triglycerides, HbA1c, and blood pressure at 12 months.ResultsPatients adherent to the TouchCare Method for 12 months were included in the final analysis (n = 171). Clinically significant weight loss (≥ 10%) was achieved by 69.56% (n = 139) of patients. Skeletal muscle mass accounted for 12.22% ± 8.73% of total weight loss. Among prediabetic patients (n = 95), 74.7% (n = 71) reached euglycemia by 12 months. Patients with Stage II hypertension or higher (77% of the cohort) demonstrated improved blood pressure control, with most reaching < 140/90 mmHg. Patients with HLD experienced significant reductions in Total‐C (24.71 ± 23.31 mg/dL), LDL‐C (−13.75 ± 21.51 mg/dL), and ApoB (−14.24 ± 16.19 mg/dL). All lipid and HgA1c changes were statistically significant (p < 0.001).ConclusionThe TouchCare Method may improve GLP‐1 RA treatment outcomes by providing comprehensive structured lifestyle interventions supporting clinically significant weight loss while preserving skeletal muscle mass and improving cardiometabolic risk factors.

Although clinical practice guidelines are valuable for managing obesity and should be the foundation for health system protocols for screening, diagnosis, and treatment, these guidelines need to be translated and implemented within clinical care pathways that account for organizations' processes, structures, and cultures. Variation in resources across systems is another challenge. A narrative review was undertaken to assess how obesity treatment pathways can support health systems and HCPs in informed decision-making for obesity management, and to offer practical considerations for developing and implementing health care system treatment pathways. Little publicly available information exists on developing and implementing obesity treatment pathways in clinical practice within health systems. This review discusses the key elements of obesity care, including screening, diagnosis, treatment, and monitoring, and outlines the roles and responsibilities of health care professionals within each step of the pathway. This review offers resources and considerations for developing and implementing obesity care pathways in primary care, specialty care, and various other settings to assist health systems and health care professionals in making informed, evidence-based decisions in obesity management.

GLP-1 therapies for obesity are limited by side effects and weight regain is common after treatment ends. Therefore, alternative treatments with new mechanisms are needed for sustained weight loss. Human MOGAT2 regulates triglyceride metabolism and its inhibition reduces weight in people with obesity, making MOGAT2 a promising target for obesity therapy. This study evaluated the therapeutic potential of the VB-85387 MOGAT2 inhibitor for weight loss. High throughput screening was used to identify human MOGAT2 inhibitors. Diet-induced mice with obesity were treated with VB-85387 for 7days. Body weight, food intake, blood and liver lipid and hormone levels were assessed. Glucose tolerance and insulin sensitivity were evaluated via oral glucose tolerance and hyperinsulaemic-euglycaemic clamp tests. Gene expression of PPARα and SREBP target genes was measured using qRT-PCR. High throughput screening identified VB-85387 as a highly potent and selective human MOGAT2 inhibitor. Mice with obesity treated with VB-85387 experienced weight loss, reduced food intake, improved glucose tolerance, and enhanced insulin sensitivity. Treatment decreased liver triglyceride levels and increased GLP-1 concentrations. β-hydroxybutyrate levels were elevated, PPARα-dependent fatty acid β-oxidation gene expression was increased, and SREBP-dependent gene expression was reduced. VB-85387 serves as a starting point for medicinal chemistry lead optimization. Weight loss may be attributed to PPARα activation and a sustained elevation in GLP-1 levels.

Information on therapeutic inertia (TI) in weight loss in people with type 2 diabetes (T2D) is limited. To describe the prevalence of TI in the management of overweight/obesity in people with T2D undergoing primary care program (PCP) follow-up and weight changes according to the prescribed treatment. A retrospective longitudinal study was conducted in patients with T2D with body mass index (BMI) ≥25kg/m2 followed by PCP. The following data were obtained from medical records at the first assessment, 6 and 12months: anthropometric data, HbA1c, medications added according to their effect on weight, and specialist referrals (nutrition and metabolic and bariatric surgery). A total of 128 patients were included (age 65.5±11.7years, HbA1c 7.8±1.7%, BMI 33.1±5.7kg/m2). The mean HbA1c at the end of follow-up was 7.4%±1.4%. Twenty-five percent achieved ≥5% weight loss after 12months. The proportion of patients without weight-loss interventions increased from 59% in the first assessment to 86% and 89% after 6 and 12months of follow-up. Patients who lost ≥5% of their weight were more likely to be referred to dietary counseling at program entry (37.5% vs. 23.4%) and at 6months (18.8% vs. 6.4%) compared to patients who gained weight. In addition, the prescription of SGLT2 inhibitors/GLP1-receptor agonist was higher in this group at 6months (49.3% vs. 10.7%). Although there was a reduction in HbA1c, the TI for prescribing weight-loss interventions was high. This suggests the importance of including weight loss as a therapeutic goal alongside lowering HbA1c in primary care.

Obesity in childhood is complex; structural equation modeling (SEM) offers an approach to ascertain complicated relationships between weight and proximal (health behaviors, child health) and distal (family/household, community) variables. The objective of the study was to use SEM to map the influence of different etiological clusters on obesity in childhood. Secondary analysis of baseline data from patients and parents enrolled in a multi-site study of pediatric weight management was conducted. The primary outcome was weight status (utilizing percentage above the 95th percentile BMI, %95BMI). SEM was used to evaluate the influences of variables proximal and distal to child weight within the context of the Ecological Model of obesity in childhood. Complete data on 375 child-parent dyads were imputed. Proximal factors (child stress and mobility, parent BMI) were significantly related to %95BMI; some distal factors (family level) did not have a direct effect on %95BMI, but did indirectly through proximal factors (such as child stress). Other distal factors (neighborhood deprivation represented by the Area Deprivation Index) were significantly related to %95BMI and family-level factors. Except for the distal factor of neighborhood deprivation, proximal factors were the drivers of weight status. Distal factors did have indirect effects via proximal factors. SEM provides a means to investigate the complex contributors to childhood obesity, and could identify key leverage points for intervention.