Objectives: This study evaluated the associations of the Gamitaeeumjowee-tang–based weight reduction program with body weight, body composition, and adverse events in overweight patients, stratified by baseline skeletal muscle mass.Methods: A retrospective chart review was performed on 155 women aged 20 to 59 years who were overweight (body mass index [BMI], 23 to 24.9 kg/m²) and participated in a 12-week weight reduction program with Gamitaeeumjowee-tang from 2019 to 2024. Participants were classified into a low muscle group (80% to <90% of reference skeletal muscle, n = 75) and a normal muscle group (100% to <110%, n = 80). Changes in body weight, BMI, fat mass, fat-free mass (FFM), and skeletal muscle mass were assessed before and after treatment. Adverse events were also evaluated.Results: Both groups showed significant reductions in body weight, BMI, body fat mass, and body fat percentage (p < 0.05). Skeletal muscle mass showed no significant change in the low muscle group but decreased slightly in the normal muscle group. The proportion achieving ≥5% weight loss was 84% in the low muscle group and 75% in the normal muscle group; ≥10% was achieved in 32% and 18.8%, respectively. Adverse events occurred mainly during the early phase, decreased over time, and were mostly mild.Conclusions: The Gamitaeeumjowee-tang–based weight reduction program was associated with fat-focused weight loss with relative muscle preservation in overweight women. These findings should be interpreted with caution due to the lack of control for diet and physical activity.

BackgroundPediatric obesity is a growing global health concern, and interventions aimed at increasing resting energy expenditure (REE) have gained attention as complementary strategies to dietary restriction. Whole-body vibration (WBV), an innovative exercise mimetic, may offer metabolic and functional benefits, particularly in populations with limited exercise tolerance. This study was a randomized clinical trial aimed to evaluate the effects of incorporating WBV into a 3-week in-hospital multidisciplinary body weight reduction program (BWRP) in male adolescents with obesity.MethodsTwenty-three male adolescents with obesity (mean age: 15.7 ± 1.3 years; mean body mass index (BMI): 38.5 ± 5.6 kg/m2) hospitalized for a 3-week BWRP were randomly assigned to a control group receiving the standard BWRP (subgroup A, n = 12) or an experimental group receiving BWRP plus WBV sessions (subgroup B, n = 11). Anthropometric and clinical parameters, REE, and lower limb muscle power, evaluated using the stair-climbing test, were assessed before and after the intervention.ResultsBoth subgroups demonstrated significant reductions in body weight and BMI. REE showed a significant Time × Group interaction (p < 0.01), indicating differential responses between the two intervention groups. WBV training significantly increased REE in subgroup B, from 2470.1 ± 249.6 kcal/day at baseline to 2733.0 ± 310.8 kcal/day post-intervention (Δ = +262.9 kcal, p < 0.001). In contrast, subgroup A showed no significant change in REE, with values decreasing from 2204.0 ± 307.4 kcal/day to 2020.8 ± 442.5 kcal/day (Δ = ˗183.2 kcal, p = ns). REE change was supported by significant Time × Group interaction in a two-way repeated measures ANOVA (p = 0.002). Furthermore, a significant post-intervention correlation emerged between REE and anaerobic power only in subgroup B.ConclusionThe addition of WBV to a structured BWRP significantly increased REE in obese adolescents, beyond the effects of the BWRP alone. This finding supports the use of WBV as a promising adjunct strategy to conventional interventions in pediatric obesity.

Abstract Objectives Binge eating disorder (BED) is commonly associated with obesity but underrecognized, thus leading to a more severe psychopathological impairment. The new Eating Behaviors Assessment for Obesity (EBA-O) was designed to detect pathological eating behaviors in obesity. This cross-sectional study aimed to determine the EBA-O ability to capture BED among patients with obesity. Methods Consecutive participants with obesity underwent a medical visit and filled in the EBA-O. Trained psychiatrists interviewed all participants using the Eating Disorder Examination Questionnaire (EDE-Q 6.0) and the Structured Clinical Interview for the DSM-5 (SCID-5-CV) in order to ascertain the diagnosis of BED. Multivariate Analysis of Variance (MANOVA), a logistic regression analysis, and a Receiver Operating Characteristic (ROC) curve analysis were run to determine the sensitivity and specificity of the EBA-O to identify patients with BED. Results About 67 out of 129 participants received a clinical diagnosis of BED. The EBA-O showed high accuracy (0.81) and precision (0.83) discriminating between individuals with obesity with and without BED (AUC = 0.89). The sensitivity and specificity of the EBA-O were 81% and 82%, respectively. “Food addiction” and “Binge eating” significantly predicted BED diagnosis. Conclusions Although the EBA-O scale is not a substitute for extensive diagnostics, it seems useful for not only assessing altered eating behaviors but also differentiating and easily detecting BED among patients with obesity looking for weight reduction programs.

Globally, type 2 diabetes mellitus (T2DM) is an epidemic medical problem that adversely affect the patient’s functional capacity and quality of life (QoL). This study designed to examine the effects of weight reduction program on biochemical parameters and quality of life for obese T2DM patients. Eighty obese subjects with T2DM (48 males and 32 females), the range of their body mass index (BMI) was 30 to 34 Kg/m2. Smoking, pregnancy, heart, kidney, hepatic and respiratory failure were the main exclusion criteria. Participants randomly assigned into two study groups; group (A) enrolled in weight-reducing program composed of aerobic exercise and diet regimen. However, group (B) received no clinical intervention. All participants signed the informed consent. Weight reducing program of group (A) resulted in significant increase in mean values of SF-36 subscale scores, HDL cholesterol and QUICKI. In addition to significant increase in mean values of LDL cholesterol, TC, TG, HOMA-IR and BMI. Changes of group (B) were not significant. Moreover, comparison between both groups revealed significant differences at the end of the study. Weight reducing program improves quality of life and selected biochemical parameters of obese type 2 diabetics.

Background: Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) is the accumulation of fat in the liver without excessive alcohol consumption or other known liver diseases. MASLD is the most common liver disease in adolescents with obesity. The aims of this study were as follows: (i) to determine which index (waist circumference BMI, WHtR, VAI, METS-IR, METS-VF, HSI, FLI, or MetS_zscore) best explains the prevalence of MASLD in adolescents with obesity; (ii) to determine whether there was a specific index that was most strongly associated with MASLD; (iii) to assess which liver function indexes were most strongly correlated with MASLD. Methods: A total of 758 adolescents with severe obesity (BMI z-score > 2) admitted at the Division of Auxology, Istituto Auxologico Italiano, IRCCS, Piancavallo-Verbania for a 3-week multidisciplinary body weight reduction program were selected. Anthropometric parameters (stature, body mass, BMI, and waist and hip circumference) were collected, and body composition (lean and fat mass) was determined using the tetrapolar bioimpedance analysis (BIA) technique. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (gamma GT), alkaline phosphatase (ALP), bilirubin, glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), triglycerides (TG), and C-reactive protein (CRP) were measured using standard techniques. MASLD was diagnosed based on abdominal ultrasound results. Results: WHtR (65.76%) was the most sensitive compared with other indexes. The HSI (AUC: 0.67 (0.63-0.71, 95% CI), p-value < 0.05) showed the best performance in predicting MASLD, with the threshold for having MASLD considered at 48.22. The indexes that showed the worst performance in predicting MASLD were the MetS z-score (AUC: 0.56 (0.52-0.60)) and the VAI (AUC: 0.57 (0.52-0.61)). ALT (OR: 2.92 (2.29-3.77); 95% CI) and AST (OR: 2.52 (2.03-3.20)) were the parameters with a stronger correlation with MASLD. Conclusions: The most sensitive index for diagnosing MASLD was the WHtR, based exclusively on anthropometric parameters. HSI was the index that correlated the most with MASLD, while the parameters of liver function (ALT and AST) were the most strongly correlated with the disease and its severity.

Globally, about 20% of the population are affected with asthma. However, public health is adversely affected with asthma and obesity. The target of the present study was to measure influence of weight loss on quality of life and Inflammatory cytokines of obese asthmatic patients. Eighty obese asthmatic patients; the mean of their age was 42.71 ± 6.35 year and body mass index (BMI) was 32.85 ± 3.16 Kg/m2. Participants equally assigned in group (A) received weight reducing program, where group (B) received no therapeutic intervention. The Health-related quality of life (SF-36 HRQL) subscale scores, interleukin-10 (IL-10) and Asthma Control Test (ACT) improved significantly, where, the mean values of BMI, TNF-α and IL-6 were significantly reduced in group (A). While group (B) had no significant changes in their parameters. In addition, the differences between both groups were not significant at the end of the study. Inflammatory cytokines and quality of life parameters improved with lifestyle modification among obese asthmatic patients.

BackgroundFalls are a leading cause of morbidity and mortality among the elderly, often resulting in injury, disability, and loss of independence. Obesity and physical inactivity are believed to impact the risk of falls among the elderly, yet the relationship remains poorly understood, especially in Nigeria. This study aimed to evaluate the association between obesity, physical activity, and falls among elderly patients attending the Family Medicine Clinic of Irrua Specialist Teaching Hospital (ISTH), Edo State, Nigeria.MethodsUsing a cross-sectional design, 288 elderly patients were systematically sampled. Data collection included socio-demographic information, fall history, physical examination, and anthropometric measurements of obesity using body mass index (BMI) and physical activity using World Health Organization (WHO) criteria. Chi square test and logistic regression analysis were used to determine associations between variables. Level of significance was set at P value < 0.05%.ResultAmong participants, 25.9% reported at least one fall in the previous year. Obesity prevalence was 14.4%, with a significantly higher number (77.5%) of obese participants reporting falls compared to non-obese (17.2%) participants (p < 0.0001). Physical inactivity was also associated with increased fall risk, though this was not statistically significant. Logistic regression analysis revealed that obese participants had a significantly higher risk of falling (adjusted odds ratio (aOR = 16.55; 95%CI = 7.33,37.38; p < 0.001), while physical inactivity showed no significant association with falls (aOR = 0.52; 95%CI = 0.21,1.71; p = 0.297).ConclusionObesity appears to be a strong predictor of fall risk among elderly individuals. There is need for incorporating weight reduction and physical activity programs into the elderly people’s care to mitigate fall risk. Further research, particularly interventional studies, is recommended to establish effective preventive measures tailored to the elderly populations.Clinical trial numberNot applicable.

It has recently been estimated that non-alcoholic steatohepatitis (NASH) affects 10–24% of people worldwide. Prior research shown that individuals with chronic NASH frequently have inadequate immune system response. Nonetheless, for NASH patients, obesity is strongly linked to compromised immune function. The purpose of this study was to determine how obese NASH patients’ responses to a weight-loss program were affected by specific immunological characteristics. In this study, 80 obese Saudi NASH patients with body mass indices (BMIs) ranging from 31 to 36 kg/m2 and ages ranging from 45 to 59 years were included. Every participant was divided into two equal groups: Group (A) underwent a weight-loss program consisting of aerobic workouts and food management, whereas Group (B) did not get any diet control or training. Immune system parameters and BMI were measured both before and after the three-month trial period. Immunological parameters (white blood cells, total neutrophil count, monocytes, CD3, CD4, and CD8) and BMI mean values significantly decreased as a result of group (A)’s weight reduction program. However, there were no appreciable changes in the aforementioned parameters in the control group (B). Furthermore, at the conclusion of the study, a comparison of the two groups showed notable disparities. In obese patients with nonalcoholic steatohepatitis, weight loss alters immune markers.

Background: Diabetic nephropathy is a microvascular diabetic complication affecting about 40% of diabetic patients all over the world. Objective: This study aimed to measure oxidative stress, systemic inflammation and kidney function response to exercise training in type 2 diabetes mellitus (T2DM) nephropathy patients. Material and Methods: Seventy patients T2DM (42 males and 28 females), body mass index (BMI) mean was 32.96 ± 3.25 Kg/m2and the mean of diabetes chronicity was 13.17 ± 2.18 year and enrolled two groups; group I: practiced aerobic exercise training &amp; diet regimen) and group II: practiced no training or diet regimen intervention. Results: There were significant reduction in the mean values of body mass index (BMI), glycosylated hemoglobin (HBA1c), Homeostasis Model Assessment-Insulin Resistance Index) HOMA-IR (, insulin, estimated glomerular filtration rate (eGFR) and creatinine, in the other hand there were significant increase in the mean values of the quantitative insulin-sensitivity check index (QUICKI) in patients of group (A) as a result of weight reducing program, in the other hand the results of the control group (B) were not significant (P&lt;0.05). Conclusion: Weight reducing program modulated glycemic control and renal function of patients with type 2 diabetic nephropathy.

Metabolically healthy obesity (MHO) represents a subset of obesity characterized by a lower risk of cardiometabolic syndrome than individuals with metabolically unhealthy obesity (MUO). This study aimed to (1) describe the transition of metabolic health phenotypes in adults with obesity and (2) identify the differentiating factors associated with this transition following the 12-week weight reduction program. This study recruited 91 adults with obesity (Age: 39.6±6.3 years; 74.7% women; body mass index (BMI): 31.2±4.5 kg/m2). The weight reduction intervention incorporates multiple lifestyle domains, including dietary modifications, physical activity, behavioural strategies, and chrono-nutrition, which encompasses temporal eating patterns, meal timing and sleep. At pre-intervention, 55% of participants (n=50) were classified as MHO: BMI≥25kg/m2 with fewer than three metabolic abnormalities, while 45% (n=41) were classified as MUO: BMI≥25kg/m2 with three or more metabolic abnormalities. Post-intervention, about 24% of the participants (n=22) exhibited positive changes, transitioning from MUO to MHO or from MUO/MHO to metabolically healthy normal weight (MHN). The MUO proportion decreased to 31% (n=28), and 45% (n=41) remained as MHO. Participants who demonstrated positive changes were characterized with highest increase in energy intake from protein sources (+5.2% vs +1.1%, p=0.004), particularly during the earlier part of the day (+4.3% vs +1.1%, p=0.029), greater body weight loss (-7.0% vs -3.2%, p=0.022), body fat loss (-3.4% vs -1.3%, p=0.013) and visceral fat loss (-1.3 vs -0.5, p=0.013) as well as a higher proportion of morning chronotype (72.7% vs 35.7%, p=0.033), than the participants who showed negative changes. These results imply that, the timing of protein intake and chronotype may play significant roles in mitigating the risk of cardiometabolic syndrome among adults with obesity, in addition to weight reduction.

AimThis pre-post intervention study aimed to assess the relationship between baseline dietary quality and the efficacy of a dietitian-guided weight reduction program, which has not been thoroughly documented to date.MethodsNinety-two consecutive obese or overweight patients visiting a tertiary center clinic for weight reduction were enrolled in this study. Participants received a dietitian-guided weight reduction education program aimed at reducing daily caloric intake by 500 kcal and improving adherence to the Mediterranean diet for 3 months. Baseline dietary quality was assessed using the 14-item Taiwanese Mediterranean Diet Adherence Screener (T-MEDAS), where a higher T-MEDAS score reflects greater adherence to the Mediterranean diet. Additional covariates, including dietary behaviors, lifestyle factors, and comorbidities were also recorded. The primary outcome was the percentage of weight reduction at 3 months, analyzed using restricted cubic spline models and generalized estimating equations (GEE) to account for the correlation between weight change and the baseline T-MEDAS scores.ResultsThirty-nine participants were excluded due to major illnesses, use of anti-obesity medications, or loss to follow-up. Among the remaining 53 participants (mean age 41.2 ± 12.8 years, 56.6% female), the average weight reduction was 3.9 ± 3.3% from a baseline weight of 98.5 ± 12.8 kg. Participants who did not achieve a weight reduction of more than 5% had higher baseline T-MEDAS scores compared to those who did (5.4 ± 1.7 vs. 4.1 ± 1.8, p = 0.026). A restricted cubic spline model, adjusted for covariates including age, gender, diabetes mellitus (DM), dyslipidemia, and smoking, revealed a significant inverse relationship between higher baseline T-MEDAS scores and weight loss. After controlling for various confounders, GEE analysis demonstrated that higher baseline T-MEDAS scores were significantly associated with less weight loss (beta: -4.1, 95% CI: -5.6 to -2.6, p < 0.001).ConclusionsHigher baseline dietary quality was associated with reduced effectiveness of a dietitian-guided weight reduction program. This suggests that additional strategies may be required to improve the success of weight loss interventions in individuals with higher baseline dietary quality.

Obesity medicine provider-directed health coaching in a commercial weight loss program: Proof of concept

Background Obesity presents a significant global health challenge, increasing the risk of various health complications. Nurse-led interventions offer a promising, patient-centered approach to weight reduction. However, qualitative research on participants' experiences in nurse-led weight reduction programs is limited. Objective The objective of this study was to explore the lived experiences of participants in a nurse-led weight reduction program over a period of 12 months. Methods Following a randomized controlled trial within a sequential mixed-methods study, in-depth interviews were conducted with 13 volunteers who successfully reduced their weight by at least 5% through a nurse-led intervention (NLI). The data were analyzed using interpretative phenomenological analysis, with careful attention to ensuring both data credibility and participant confidentiality. Results Participants reported positive health improvements over 12 months, including reductions in weight, BMI, waist circumference, blood pressure, and glucose levels. Four primary themes that surfaced were nutritional choices and habits, active lifestyle, support system and motivation, insights, and strategies from health journey participants. Participants adapted to healthier eating habits, incorporating protein-rich foods, millets, and seasonal fruits and vegetables. Walking and yoga were primary physical activities, with participants emphasizing their importance and strategies to overcome barriers. Family support, healthcare guidance, and work-life balance played crucial roles in participants' weight loss journeys. Conclusion The study highlights the effectiveness of NLIs in promoting sustainable weight loss and improving metabolic health. Insights from participants' experiences underscore the importance of dietary modifications, regular physical activity, and social support in successful weight management. Further research is needed to validate these findings and develop tailored interventions.

Overweight and obesity affect 71.2% of adults in the United States, with cancer survivors not far behind at 70.3%. Subgroups such as those diagnosed with acute lymphoblastic leukemia (ALL) face even greater challenges. The Exercise and Quality Diet after Leukemia (EQUAL) trial sought to address weight management issues among ALL survivors by implementing a remotely delivered weight loss intervention, leveraging the previously proven Practice-based Opportunities for Weight Reduction (POWER) program. Despite a strong foundation and design, the EQUAL trial yielded null results. Key differences in study populations and intervention contexts between the EQUAL and POWER trials, such as the lack of primary care physician involvement in EQUAL, contributed to these outcomes. EQUAL's failure to meet its accrual target and poor adherence among participants highlighted challenges in engaging this unique population. Contrary to EQUAL's conclusions, evidence from other studies supports the efficacy of remote interventions for weight loss among cancer survivors. The lack of qualitative assessment among ALL survivors and key integration to inform intervention adaptations undermined EQUAL's impact. However, EQUAL's impressive retention rate offers valuable insights. Lessons from EQUAL underscore the need for well-fitted, remotely delivered interventions and the importance of thoughtfully adapted and tailored approaches to specific survivor populations. See related article by Fiedmann et al., p. 1158.

Background: Obesity is characterized by increased oxidative stress, which, in a vicious circle, promotes chronic low-grade inflammation. Melatonin, a well-documented antioxidant, might be useful as a supplement to enhance the cardiometabolic benefits of any body weight reduction program (BWRP). Objectives/Methods: The present study aimed to evaluate the post-exercise oxidative stress and inflammation in a group of subjects with obesity treated with melatonin (2 mg/die) or placebo, undergoing a 2-week BWRP, with the administration of a single bout of acute exercise at the start and the end of the protocol (G1–G15). Results: Eighteen adults with obesity were enrolled and distributed to the two arms of the study: the melatonin group (F/M: 7/2; age: 27.8 ± 5.6 years; body mass index [BMI]: 43.0 ± 4.9 kg/m2) and the placebo group (F/M: 6/3; age: 28.8 ± 5.0 years; BMI: 42.8 ± 4.0 kg/m2). BWRP induced a decrease in BMI and waist circumference (WC) in both groups; plasma glucose, blood glycated hemoglobin (HbA1c), and neutrophil to lymphocyte ratio (NLR) were reduced only in the placebo group. Importantly, plasma biological antioxidant potential (BAP) increased throughout BWRP. Paradoxically, melatonin enhanced post-exercise production of plasma derivatives of reactive oxygen metabolites (d-ROMs) and erythrocytic glutathionyl-Hb (HbSSG) (at G1 and G15). Finally, differently from the placebo group, melatonin-treated subjects did not exhibit the BWRP-induced decrease in plasma levels of interleukin-6 (IL-6), before and after exercise, at the end of two weeks (G15). Conclusions: Melatonin is presumably an antioxidant with “conditional” prooxidant actions. The use of melatonin as a supplement in subjects with obesity might be deleterious due to the abolishment of BWRP-induced cardiometabolic benefits.

An Intermittent Fasting Intervention for Black Adults Can Be Feasibly Implemented in Black Churches: A Cluster Randomized Controlled Pilot Study

ObjectivesWe sought to extrapolate the long-term costs and clinical impacts attributed to the rugby fans in training–New Zealand (RUFIT-NZ) trial in Aotearoa, New Zealand.DesignA modelled cost-effectiveness analysis using efficacy data...

Sarcopenic obesity (SO) is a clinical disorder characterized by increased adiposity and decreased muscle mass and function, commonly observed in older adults. However, most of the studies that investigated SO prevalence rates were not based on current standardized diagnostic methods. Thus, this study aims to estimate the prevalence rates of SO and their level of agreement using different instruments proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) Consensus, in a sample of hospitalized older adults with severe obesity. A cross-sectional study with 90 older adults (≥ 60 years) with severe obesity (body mass index ≥ 35 kg/m/²) seeking an in-hospital multidisciplinary body weight reduction program. Skeletal muscle function was assessed using the five-repetition Sit-Stand test (5-SSt) and Handgrip Strength (HGS). Body composition was evaluated by high percentages of fat mass (FM), low appendicular lean mass (ALM/W), and skeletal muscle mass (SMM/W), adjusted to body weight. The stage of SO was assessed on the presence of at least one comorbidity and specific cut-offs were adopted for each step. All analyses were performed according to gender and age range. The prevalence rates of SO in the total sample were 23.3%, 25.5%, 31.1%, and 40.0% considering altered values of 5-SSt+FM+ALM/W, HGS+FM+ALM/W, 5-SSt+FMSSM/W, and HGS+FM+SSM/W, respectively. Higher prevalence rates were observed among female and old elderly subgroups, regardless of the diagnostic combination. There were weak agreements between the muscle function tests (5-SSt versus HGS) using both muscle mass indexes in the total sample and all subgroups. Moderate agreements were observed between muscle mass indexes (SMM/W versus ALM/W) in the total sample, male and younger older adults (using 5-SSt), and strong agreements for men and younger older adults (using HGS). The discrepancies observed between the prevalence rates and their levels of agreement reinforce the need for new studies in similar populations aiming for better standardization of SO assessment.

Effects of Lacticaseibacillus rhamnosus HA-114 probiotic supplementation on circulating IGFBP-2 levels during a calorie-restricted diet in overweight humans

Abstract Introduction Pulsed field ablation (PFA) is a "single-shot" non thermal ablation modality for atrial fibrillation (AF). In general, obesity is associated with increased risk of AF recurrence after catheter ablation with thermal energy sources. Purpose We aimed to assess the impact of body mass index (BMI) on procedural characteristics, safety, acute efficacy and long-term outcomes of PFA for symptomatic AF. Methods Of 1233 subjects enrolled in the EU-PORIA registry, in our subanalysis we included 1055 patients undergoing de novo pulmonary vein isolation (PVI)-only ablation procedure for symptomatic AF using the pentaspline PFA catheter from March 2021 until May 2022 at seven high-volume European centers. Patients were divided into two groups based on BMI: normal weight (nW, &amp;lt; 25 kg/m2) and overweight (oW, ≥ 25 kg/m2). Overweight patients were further categorized into three subgroups: pre-obesity (pOb, 25-29.9 kg/m2), obesity (Ob, 30-34.9 kg/m2) and severe obesity (sOb, ≥ 35 kg/m2). Clinical and procedural characteristics, complications and follow up data were collected. Results A total of 1055 patients (39% female, mean age 65,7±10,9 years, 65% paroxysmal AF) were enrolled. 32% of patients were normal weight (nW) and 68% overweight (oW). Among oW group, 438 subjects (41%) were assigned to pOb group, 204 (19%) to Ob, and 71 (7%) to sOb. Acute PVI was achieved in 100% of cases. The median skin-to-skin procedure and the median fluoroscopy time were similar between nW and oW and in all investigational subgroups, but radiation exposure increased in line with BMI (p&amp;lt;0.001). Periprocedural complications were 5% in nW, 1.6% in pOb, 3.9% in Ob, and 2.8% in sOb (p=0.06). The Kaplan-Meier estimate of arrhythmia-free survival was 80.2% in nW and 71.9% in oW (p=0.017). Each unit increment in BMI was associated with 4.2% increase in risk of AF/AT recurrence. Severe obese patients presented the highest 1-year AT/AF recurrence rate (37.2%). In the sOb group the rate of recurrence was not influenced by the type of AF (PAF 65.7% vs. pers AF 59.4%; p=0.484). Conclusion Overweight patients seem to experience more AF recurrences even after PFA PVI, mainly driven by a higher recurrence rate for BMI ≥ 35 kg/m2. Weight reduction programs remain crucial, nevertheless, reduced procedural times, good safety profile and acceptable 1-year observed AF/AT freedom make PFA a feasible strategy for AF rhythm control in patients with BMI ≥ 25 kg/m2.Freedom from AF/AT recurrence