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Abstract Rationale Controlled trials have demonstrated successful weight loss associated with certain weight management medications (WMMs). However, there are limited real‐world data on prescribing patterns and efficacy and safety profiles of WMMs in Veterans Affairs (VA) patients. Objective To evaluate: utilization patterns of WMMs liraglutide, naltrexone/bupropion, orlistat, phentermine, phentermine/topiramate, and semaglutide; weight loss at three, six, twelve, and more than 12 months; safety; and treatment barriers. Methods A retrospective, cross‐sectional medication use evaluation (MUE) was conducted using electronic health records of outpatient Veterans newly initiated on WMMs at 37 VA Medical Centers between 1 March 2020 and 31 March 2022. Chart review was used to identify WMM utilization and capture rates of clinical response, defined as 5% and 10% or greater weight loss at the final weight, adverse drug events (ADEs), non‐adherence, and discontinuations. Site‐specific surveys evaluated local practices and barriers. Results Among 1959 eligible Veterans, semaglutide, phentermine/topiramate, and orlistat were most frequently prescribed. The clinical response was highest among phentermine/topiramate, liraglutide, and semaglutide. Naltrexone/bupropion and phentermine demonstrated the highest and lowest ADE rates, respectively. Potential barriers to WMM utilization and successful treatment by site reports were drug shortages, patient perceptions of therapeutic course, personal preferences, and VA WMM use criteria. Conclusions Smaller weight loss and higher discontinuation rates were observed relative to clinical trials. The MUE data allow for better assessment of benefits and risks for Veterans prescribed WMMs.

Abstract Introduction Effective, evidence‐based obesity treatment is needed, which often involves use of anti‐obesity medications (AOMs). Data on the breadth and quality of guideline‐directed obesity treatment implementation in primary care remain limited. This study aimed to assess primary care clinicians' agreement with and knowledge of guideline‐directed obesity treatment, as well as to assess the health status of persons with obesity and their use of AOMs. Methods This multimethod study included a prospective survey of primary care clinicians, utilizing a questionnaire that measured agreement on a 5‐point Likert scale and knowledge via multiple choice questions. A retrospective analysis was also performed of patient data collected between 30 June 2016 and 30 June 2020 from primary care clinics in the Midwest. Results Data were analyzed from 27 clinician survey responders, finding agreement toward all measured areas, however less strong for chronic AOM use and resource allocation. The survey identified multiple gaps in knowledge. Researchers assessed 5656 baseline encounters and 2941 corresponding follow‐up encounters. Analysis revealed ≥50% of the total patients experienced persistently uncontrolled obesity (mean body mass index of ≥40 kg/m2) and weight‐related complications. Low rates (≤10%) of AOM use in clinically eligible patients were shown, with phentermine monotherapy being the most commonly used. Conclusions Clinicians agree with guideline‐directed obesity treatment. Persons with obesity who are poorly controlled identify an opportunity for patient care improvement.

Abstract Background Obesity is recognized as a risk factor for various cancers, including thyroid cancer. However, the association between different metabolic obesity phenotypes and thyroid cancer risk remains unclear. This systematic review aimed to comprehensively evaluate the existing literature to elucidate the association between metabolic obesity phenotypes and thyroid cancer risk. Methods This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. PubMed, Scopus, EMBASE, Web of Science, and Google Scholar were searched for relevant studies until April 2024. Studies examining the link between metabolic obesity phenotypes and thyroid cancer risk were included. Results Five cohort studies involving 831,510 participants met the inclusion criteria. Metabolically unhealthy obesity was consistently associated with an increased risk of thyroid cancer in both men and women. Central adiposity emerged as a significant predictor of thyroid cancer risk. Mechanistically, chronic inflammation, dysregulated adipokine secretion, hormonal imbalances, and altered signaling pathways may contribute to thyroid carcinogenesis. There is an ongoing debate regarding the risk associated with metabolically healthy obesity, with some suggesting potential protective effects due to favorable metabolic profiles. Conclusion This systematic review highlights the complex relationship between metabolic obesity phenotypes and thyroid cancer risk. The findings highlighted the importance of considering metabolic status alongside obesity in thyroid cancer risk assessment and intervention strategies.

Abstract Background Identifying patient‐, facility‐, and environment‐level factors that influence the initiation and retention of comprehensive lifestyle management interventions (CLMI) for urban and rural Veterans could improve obesity treatment and reach at Veterans Affairs (VA) facilities. Aims This study identified factors at these various levels that predicted treatment engagement, retention, and weight management among urban and rural Veterans. Methods A retrospective cohort study of 631,325 Veterans was designed using VA databases to identify Veterans with class II and III obesity during 2015–2017. Primary outcomes were initiation of CLMI, bariatric surgery, or obesity pharmacotherapy within 1 year of index date. Secondary outcomes included treatment retention and successful weight loss. Generalized linear mixed models were used to evaluate the relationships between factors and obesity‐related outcomes, with rurality differences assessed through interaction terms. Results Patient characteristics associated with increased odds of initiating CLMI included female sex (p

Abstract Rationale Short‐term weight loss is possible in a variety of settings. However, long‐term, free‐living weight loss maintenance following structured weight loss interventions remains elusive. Objective The purpose was to study body weight trajectories over 2 years of intensive lifestyle intervention (ILI) and up to 4 years of follow‐up versus usual care (UC). Methods Data were obtained from electronic medical records (EMRs) from participating clinics. Baseline (Day 0) was established as the EMR data point closest but prior to the baseline date of the trial. The sample included 111 ILI and 196 UC patients. The primary statistical analysis focused on differentiating weight loss trajectories between ILI and UC. Results The ILI group experienced significantly greater weight loss compared with the UC group from Day 100 to Day 700, beyond which there were no significant differences. Intensive lifestyle intervention patients who maintained ≥5% and ≥10% weight loss at 24 months demonstrated significantly greater weight loss (p

Abstract Introduction Obesity is associated with increased morbidity in patients with advanced liver disease, but it is particularly challenging for these patients to preserve skeletal muscle mass during weight loss and accelerating sarcopenia is a concern. Alternate‐day modified fasting (ADMF) may be particularly effective for weight loss in patients with concomitant cirrhosis and obesity due to preservation of fat‐free mass (FFM). Methods A weight loss program featuring either ADMF or a continuous low‐calorie diet (LCD) was evaluated in a 24‐week randomized clinical trial in 20 adult patients with Child‐Pugh Class A cirrhosis and obesity. Participants were randomized to either ADMF (n = 11) or LCD (n = 9). Both groups received a remotely delivered exercise program. Body composition, sarcopenia measures, and functional outcomes were assessed pre‐post. Results Thirteen participants completed the intervention (Age = 57 ± 10; BMI = 37.7 ± 5.8 kg/m2). The median body weight lost in ADMF was 13.7 ± 4.8 kg (13.9% of initial body weight), while LCD lost 9.9 ± 6.9 kg (10.7% of initial body weight). Total body fat percentage decreased in both groups (ADMF: −4.1 ± 4.0%; LCD = −2.8 ± 1.4%). Fat‐free mass accounted for 34 ± 20% of total weight loss in ADMF and 38 ± 10% in LCD. Functional measures, such as timed chair stands, improved in both groups. Conclusion This pilot study demonstrates the feasibility of the ADMF and LCD interventions to produce significant weight loss while improving body composition in patients with cirrhosis and obesity. Further research is needed to validate these findings in larger cohorts and to assess changes in muscle quality and visceral fat. Trial Registration ClinicalTrials.gov Identifier: NCT05367596.

Abstract Background Weight stigma is prevalent within healthcare settings and is an aspect of the lived experience of people living with obesity. There is international evidence of weight stigma in the dental setting, where currently there is also evidence indicating limited training amongst dental professionals regarding obesity or obesity‐related stigma. There has been Australian research and none have included dental support staff. Aims This cross‐sectional survey aimed to assess stigmatizing attitudes and beliefs of dental professionals (registered general dentists, oral health therapists) and support staff (dental assistants, dental receptionists) working in private and public regional practices in New South Wales and specialists in Special Needs Dentistry across Australia toward people living with obesity. Methods An anonymous electronic validated survey was administered through REDCap™ to assess stigmatizing attitudes and beliefs held amongst respondents in relation to people living with obesity. Results Fifty‐three participants completed the survey (n = 33 clinicians, n = 20 support staff). The majority 47/53 (88.7%) held positive attitudes toward people living with obesity. Of the clinicians, 15/33 (45.5%) reported 1 hour or less and 14/33 (42.4%) reported two to 5 hours of obesity‐related education. 14/20 (70%) of the support staff reported no prior education or training about obesity. Of responses reflecting weight stigma, only three clinicians reported negative reactions toward the appearance, or discomfort during examination, of a patient with obesity, or a perception of laziness, compared with normal weight individuals. A higher proportion 4/20 (20%) of support staff reported responses indicating negative attitudes for people with obesity compared with normal weight individuals. Conclusion Survey responses reflected evidence of weight stigma in both dental professionals and support staff. Professional development targeting weight stigma reduction in the dental setting is needed for both clinicians and support staff.

Abstract Introduction There is a relationship between excess body weight and the risk of a number of infectious diseases, including urinary tract infections (UTIs). This study aimed to investigate the correlation between body mass index (BMI) and UTIs among Prospective Epidemiological Research Studies of the Iranian Adults (PERSIAN) Guilan Cohort Study (PGCS) population. Methods This cross‐sectional study was conducted on 10,520 individuals aged 35–70 years from PGCS. The demographical data and clinical characteristics of the participants were recorded. Microscopic examination of the urine samples was performed to detect the presence of bacteria or white blood cells (WBC) as indicators of infection. UTI was defined as the presence of bacteria in the urine (Few, moderate, and many) and a value of ≥10 WBC/high power field (HPF) by light microscopy. Results The prevalence of UTIs in this study was 8.8%, with a higher incidence in females compared to males (12.2% vs. 4.7%, p

Abstract Objective Prior research has found that plant‐based diets (PBDs) are rated as acceptable and have similar levels of adherence as compared to other therapeutic dietary approaches; however, previous studies were mostly among white populations. Plant‐based diets can produce clinically meaningful weight loss, but outcomes may vary by level of adherence. The goal of this study was to examine the differences in weight and lipids among participants in the Nutritious Eating with Soul study based on adherence to their diet assignment. Methods African American adults (n = 159; 79% female) with overweight or obesity (mean BMI 36.9 ± 6.9 kg/m2) were recruited to participate in a 24‐month intervention. Participants were randomized to a plant‐based vegan (n = 77) or a low‐fat omnivorous (n = 82) diet, both emphasizing soul food cuisine. Participants attended nutrition classes and had dietary intake/adherence (three 24‐h recalls; adherence score 1–5), body weight, lipids, and other secondary outcomes assessed at baseline, 6‐, 12‐, and 24 months. Participants who met at least half of the adherence criteria (≥2.5 out of 5) were categorized as adherents. Results At 24 months, adherent vegans lost 5% of their body weight, non‐adherent vegans lost −0.005%, adherent omnivores lost −0.03%, and non‐adherent omnivores lost −0.02%. Adherent vegans lost more weight (kg) than all other participants at both 6‐ (−3.32 ± 0.92 (−5.14, −1.49), p

Abstract Background Changes in gene expression related to obesity are linked to microRNAs, such as miR‐141, which play a crucial role in metabolic homeostasis. Sirtuin 1 (SIRT1), an enzyme that plays a crucial role in regulating various cellular functions and metabolism, is implicated in obesity and the ensuing non‐alcoholic fatty liver disease (NAFLD). The aim of this research was to evaluate the levels of miR‐141 and its relationship with SIRT1 and NAFLD. Methods A group of 100 adults (50 with obesity and 50 with normal‐weight) were selected and underwent complete clinical evaluation and anthropometric measurements. Biochemical parameters were assessed in blood serum, and the levels of miR‐141 in plasma were measured by real‐time PCR. The expression of the SIRT1 gene was also evaluated in the peripheral blood mononuclear cells using Real‐time PCR. The ELISA technique was used to determine insulin levels. Liver steatosis was assessed by ultrasound. Results The results showed that levels of miR‐141 were significantly increased in participants with obesity compared with the control group. Conversely, the expression of the SIRT1 gene in individuals with obesity was lower than that in control participants. A strong negative correlation was observed between miR‐141 and SIRT1 and a strong positive association was observed between miR‐141 and metabolic parameters. Furthermore, participants with fatty liver had significantly elevated levels of miR‐141 gene expression and lower expression of SIRT1 gene, compared to those without fatty liver. Conclusion elevated levels of miR‐141 in individuals with obesity might be a contributing factor in the repression of SIRT1 in obesity and its consequences, including NAFLD. Therefore, miR‐141 might serve as a suitable diagnostic and therapeutic target in obesity and NAFLD.

Abstract Objective Individuals with obesity face unique challenges when visiting healthcare providers, including inadequate equipment. These negative care experiences, often exacerbated by weight stigma, frequently lead to mistrust and reluctance to seek future care. Currently, few instruments exist to ensure that an ambulatory clinic is welcoming to patients with obesity. The following clinical environment checklist was created with an aim to identify weaknesses in accommodating individuals of size. Methods A checklist of equipment considered ideal for the care of patients with obesity was developed through a comprehensive review of the literature and feedback from office staff. Eight ambulatory clinics within an urban Midwest setting were assessed, focusing on their accommodations for patients with obesity. Feedback from clinic staff was incorporated to further refine the checklist. Results Common equipment deficiencies included extra‐large blood pressure cuffs, wheelchair‐accessible scales, 2XL gowns, and adequate seat dimensions in the waiting area. Healthcare workers reported moral distress for their patients when unable to provide proper care due to these limitations. Newly constructed clinics exhibited better‐equipped facilities for patients with obesity. Conclusions Many clinics lack proper equipment to accommodate patients with obesity, resulting in negative care experiences. This clinical environment checklist can identify problem areas and provide solutions to create more welcoming environments, encouraging future care‐seeking behaviors.

Abstract Background Mistreatment of individuals due to their body size or weight stigma has been described as a source of stress and as a deterrent for engagement in the healthcare system. Efforts to reduce weight stigma have included curricular interventions to reduce weight bias among future healthcare professionals. However, few studies have examined students’ observations of weight stigma and subsequent socialization to healthcare environmental norms. Aims The purpose of this study is to evaluate observed weight stigma among pre‐licensure nursing students and recent graduates during clinical rotations and its effect on the perceived ability to provide respectful care to people in larger bodies. Materials and Methods A cross‐sectional, descriptive study was conducted from February to March 2023. Participants answered questions related to personal weight bias (Fat Phobia Scale), observations of weight stigma, and perceived ability to provide respectful care. Results Ninety‐one participants completed the survey, of whom half (n = 48) held a high level of weight bias. A quarter of participants (n = 23) reported that they engaged in weight stigma behaviors and a quarter (n = 24) of participants observed weight stigma behaviors from two or more healthcare professional roles. Almost one‐third (n = 10) of participants who observed weight stigma behaviors perceived that it impacted their ability to provide respectful care to patients in larger bodies. Conclusions These findings describe that weight stigma enacted by multiple healthcare professional roles is observed by nursing students during clinical rotations and is perceived to impact their ability to provide respectful care. Efforts to improve healthcare professionals’ sensitivity to the effects of weight bias and weight stigma should include addressing the role of socialized norms on weight bias among future healthcare professionals.

Abstract Introduction General practitioners (GPs) have been identified as pivotal in the identification and initiation of treatment for obesity, yet effective obesity management remains challenging in general practice. Despite the growing prevalence of obesity and the central role of GPs, there is a dearth of research exploring their experiences and challenges in managing the disease. Objective This study aimed to understand these challenges by exploring GPs' experiences and to identify factors influencing their obesity management practices to inform the development of targeted intervention strategies. Method In‐depth interviews were conducted with 10 GPs. Data were analyzed using abductive thematic analysis underpinned by the theoretical domains framework (TDF). Findings were mapped to the behavior change wheel (BCW) and the behavior change taxonomy to identify potential future intervention strategies. Findings Participants described multiple barriers to effective obesity management, including knowledge gaps, lack of training, patient factors, and systemic challenges. Key themes identified were the need for increased support, improved patient engagement, and system‐level changes. Conclusion This study offers valuable insights into the challenges GPs encounter when managing obesity in general practice. Application of the TDF and BCW frameworks identified complex interactions between knowledge, beliefs, and environmental factors influencing GP behavior. These findings highlight key areas for targeted interventions to enhance obesity care and drive best practice.

Abstract Background An international panel of obesity medicine experts from multiple professional organizations examined patterns of obesity care and current obesity treatment guidelines to identify areas requiring updating in response to emerging science and clinical evidence. Aims The panel focused on multiple medical health and societal issues influencing effective treatment of obesity and identified several unmet needs in the definition, assessment, and care of obesity. Methods The panel was held in Leesburg, Virginia in September 2019. Results The panelists recommended addressing these unmet needs in obesity medicine through research, education, evaluation of delivery and payment of care, and updating clinical practice guidelines (CPG) to better reflect obesity’s pathophysiological basis and heterogeneity, as well as the disease’s health, sociocultural, and economic complications; effects on quality of life; need for standards for quantitative comparison of treatment benefits, risks, and costs; and the need to more effectively integrate obesity treatment guidelines into routine clinical practice and to facilitate more direct clinician participation to improve public understanding of obesity as a disease with a pathophysiological basis. The panel also recommended that professional organizations working to improve the care of people with obesity collaborate via a working group to develop an updated, patient‐focused, comprehensive CPG establishing standards of care, addressing identified needs, and providing for routine, periodic review and updating. Conclusions Unmet needs in the definition, assessment and treatment of obesity were identified and a blueprint to address these needs developed via a clinical practice guideline that can be utilized worldwide to respond to the increasing prevalence of obesity.

Abstract Background It is anticipated that by 2030, 20% of the world's population will live with obesity. Success in the management of obesity is predominately determined in terms of BMI or percentage weight loss, yet the limitations of these have been widely recognized. This study aimed to understand patient definitions of success in obesity treatment. Methods A series of in‐depth focus groups, carried out with n = 30 adults living with obesity, offered a qualitative insight into patient definitions of success. Results A thematic analysis of data yielded four thematic findings: Success as freedom from stigma, bias and the mental burden of obesity; success as being able to participate fully in the world; success as measured by NSVs [non‐scale victories]; and success is not a number on a scale. Conclusions What this study highlights is (1) how current measures of success do not accurately encompass the priorities of people living with obesity, (2) the importance of addressing the psychological and emotional aspects of living with obesity in any definition of success , and (3) the importance of meaningful co‐creation of goals and indicators of success between clinician and patient for the effective management of the disease of obesity.

Abstract Background Epidemiologic findings suggest that measures of body fat distribution predict health outcomes independent of the overall body fat assessed by body mass index (BMI). This study aimed to evaluate the associations of overall and regional body fat with the severity of hepatic steatosis and fibrosis in type 2 diabetic patients with non‐alcoholic fatty liver disease. Methods Bioelectric impedance analysis and two newly developed anthropometric indices, namely, A Body Shape Index (ABSI) and Body Roundness Index (BRI), were used to estimate the body fat. Based on fibroscan parameters, significant hepatic fibrosis and severe steatosis were defined as ≥F2 and >66%, respectively. Results Higher total body fat (odds ratio [OR] 1.107, 95% confidence intervals (CI) 1.038–1.182, p = 0.002), trunk fat (OR 1.136, 95% CI 1.034–1.248, p = 0.008) and leg fat (OR 1.381, 95% CI 1.139–1.674, p = 0.001) were associated with liver fibrosis. However, in contrast to the total body fat (OR 1.088, 95% CI 1.017–1.164, p = 0.014) and leg fat (OR 1.317, 95% CI 1.066–1.628, p = 0.011), the trunk fat was not associated with severe hepatic steatosis. BRI performed better than trunk, leg and total body fat in predicting hepatic steatosis (OR 2.186, 95% CI 1.370–3.487, p = 0.001) and fibrosis (OR 2.132, 95% CI 1.419–3.204, p 0.05). Conclusion BRI revealed a superior predictive ability for identifying the degree of hepatic steatosis and stiffness than other obesity indices. Additionally, higher levels of adiposity in the trunk, legs, and overall body were linked to an increased risk of developing liver fibrosis. Although trunk fat did not show an association with severe hepatic steatosis, an increase in leg and total fat was related to liver steatosis.

Abstract Objective Treatment of obesity has been transformed by the recent approval of incretin‐based therapies for weight loss (e.g., glucagon‐like peptide 1 agonist semaglutide), but little is known about patient perspectives on these medications. Methods Between December 2023 and March 2024, healthcare patients from an academic medical center in the Southeast United States with Body Mass Index ≥30 kg/m2 completed a cross‐sectional online survey on attitudes toward incretin‐based medications. Results Compared to patients with a bachelor's degree, those without a degree were less likely to be aware of incretin‐based pharmacotherapies (96% vs. 78%) and to have discussed pharmacotherapies with a doctor (43% vs. 27%) but had greater interest in using these pharmacotherapies (4.3 vs. 4.7). These pharmacotherapy‐related variables did not differ significantly according to gender, race, or financial security. Concerns about side effects, long‐term health risks, and potential for weight regain were highly endorsed and were associated with lower interest in using incretin‐based therapies and with some demographic factors. Patients reported high interest in lifestyle programs designed for individuals taking anti‐obesity medications. Conclusion Demographic considerations, notably education level, should be factored into the strategy to promote equitable utilization of incretin‐based therapies, particularly as their accessibility expands.

Abstract Objective Cross‐sectional research has demonstrated that internalized weight stigma (IWS) is associated with less engagement in weight management behaviors, including physical activity. However, limited research has explored longitudinal relationships among IWS, physical activity, and weight loss. This study examined longitudinal associations of changes in IWS, physical activity, and weight and tested whether physical activity mediated the relationship between IWS and weight change. Methods Individuals with obesity and high IWS (N = 105) participated in a 72‐week behavioral weight loss intervention, with or without a weight stigma intervention. Measures of IWS (Weight Self‐Stigma Questionnaire), physical activity (accelerometry and self‐report), and weight were collected at baseline and weeks 20, 46 and 72. Correlations examined relationships among changes in variables from baseline to all timepoints, controlling for treatment condition. Mediation, controlling for treatment condition, tested whether IWS reductions during the first 20 weeks predicted greater weight loss at weeks 46 and 72 via increased physical activity between weeks 20 and 46 or 72. Results Decreases in IWS at week 20 were associated with greater week‐20 weight loss (r = 0.265, p = 0.012). Physical activity was not a significant mediator, but greater reductions in IWS at week 20 predicted greater week‐46 weight loss with or without controlling for physical activity (WSSQ: b = 0.30, confidence interval: 0.12, 0.54). Significant associations were not found at week 72. Conclusion Initial reductions in IWS were associated with greater week‐46 weight loss. Further research should investigate whether reducing IWS early in obesity treatment enhances long‐term outcomes. Clinical trial registration ClinicalTrials.gov (NCT03704064).

Abstract Background Anti‐obesity medications (AOMs) may provide a viable option for obesity management. However, little is known about the use of AOMs in persons with SCI/D. Objective Describe health care providers' (HCPs) views about barriers to AOM use in persons living with SCI/D. Methods Descriptive qualitative design using in‐depth interviews Descriptive statistics were used to calculate demographic and employment characteristics. Interviews were audio‐recorded and transcribed verbatim. Transcripts were coded and analyzed using Braun and Clarke's (2006) six thematic analysis phases. Results HCPs (n = 12) were from 11 different nationwide facilities. Most HCPs were male (75%), a large majority were white (67%), and most were 26–49 years of age. Participants were dietitians (75%), physicians (17%), and psychologists (8%). HCPs ranged from 1.5 to 15 years of providing SCI/D care. HCPs described four main thematic barriers to AOM use in persons with SCI/D: (1) AOM side effects that are especially concerning in persons with SCI/D; (2) AOMs contribute to poor eating habits; (3) availability, accessibility, and administration; and (4) lack of evidence, clinical agreement, and knowledge about AOM use in the SCI/D population. Conclusions There are several potential barriers to AOM use in the SCI/D population. Barriers include AOM side effects which may cause or exacerbate conditions that are already concerns in persons with SCI/D, such as bowel and skin problems, and muscle loss. SCI/D HCPs reported a lack of evidence about AOM use in persons with SCI/D, but interest in obtaining more knowledge.

Abstract Background Rising obesity rates in the workforce are accompanied by a hidden cost burden to employers due to work productivity loss. Understanding the impact of obesity on work productivity is essential for employers to provide tailored weight loss interventions in the workplace. Objectives To measure work loss and associated productivity costs among employees with overweight/obesity compared with employees with normal weight. Methods This retrospective cohort study used the MerativeTM MarketScan® Health and Productivity Management Database to identify adult employees with ≥1 diagnosis code reporting a body mass index (BMI) between 1/1/2015‐12/31/2019. Based on the earliest BMI, employees were assigned to normal weight (BMI 19–24.9), overweight (BMI 25–29.9), obesity class 1 (BMI 30–34.9), obesity class 2 (BMI 35–39.9), and obesity class 3 (BMI ≥40) cohorts. Among employees with data for each work loss category (absenteeism, short‐term disability [STD], long‐term disability [LTD], worker's compensation [WC]) during the 12‐month follow‐up, the percentage of employees with work loss, number of hours/days lost, and associated productivity costs were reported. Results 719,482 employees (normal weight: 106,631, overweight: 230,637, obesity class 1: 185,850, obesity class 2: 101,909, obesity class 3: 94,455) were included. Outcomes increased with each higher BMI category for the mean number of absence hours ([in order of BMI category]: 262, 273, 285, 290, 304) and percentage of employees with a claim (STD: 6.8%, 7.6%, 9.7%, 11.7%, 17.0%; LTD: 0.4%, 0.4%, 0.5%, 0.6%, 0.8%; WC: 2.7%, 2.8%, 3.4%, 3.6%, 3.5%). Estimated costs to the employer associated with absenteeism, STD, LTD, and WC were $1,036, $611, $38, and $95 higher per year (respectively) in the obesity class 3 cohort relative to the normal weight cohort. Conclusions This real‐world analysis demonstrated that employees with overweight/obesity had higher loss of work productivity compared with employees with normal weight. Further studies are warranted to determine the long‐term impacts on work productivity loss if overweight and obesity are left untreated.

Abstract Background Engaging in physical activity (PA) and reducing sedentary behaviors among youth are linked to improved mental and physical health. This study aimed to examine demographic differences among youth adhering to PA and Screen Time (ST) recommendations. Methods The present study utilized data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES). The NHANES survey employed a cross‐sectional design and gathered information on the daily duration of moderate‐to‐vigorous PA lasting 60 min or more, as well as the maximum daily ST not exceeding 2 h. The analysis encompassed a total of 1697 youth aged between 6 and 17 years. Results Overall, 36.3% of participants adhered to PA recommendations, 20.9% adhered to ST recommendations and 10.8% of youth met both recommendations. The odds of meeting PA, ST and both recommendations were inversely associated with obesity (obese vs. normal: aOR, 0.56 [95% CI, 0.42–0.75]), (aOR, 0.67 [95% CI, 0.48–0.94]) and (aOR, 0.51 [95% CI, 0.32–0.82]) respectively, and age (14–17 years vs. 6–9 years: aOR, 0.2 [95% CI, 0.15–0.27]), (aOR, 0.33 [95% CI, 0.23–0.47]) and (aOR, 0.16 [95% CI, 0.09–0.3]) respectively. Conclusion A small portion of the youth met PA and ST recommendations. Older youth, youth with obesity, and youth with a parent or guardian who had not completed a high school education were particularly at risk.

Abstract Objective The purpose of this study was to examine the association between lifestyle factors and body weight in a nationally representative sample of US adults and to evaluate the association between a novel “Healthy Habits Composite Score (HHCS)” and risk of obesity. Methods This cross‐sectional study included data from 4870 adults who participated in the 2017–2018 National Health and Nutrition Examination Survey (NHANES). The HHCS was developed based on 4 factors: diet, physical activity, sedentary time, and sleep, all of which were measured during the NHANES. A “healthy lifestyle” was defined as meeting ≥3 of the 4 established criteria. Data analysis was conducted using SAS 9.4 and procedures to account for the complex survey design. All models were adjusted for age, sex, race, household income, and education. Results Adults with obesity had significantly lower dietary quality (48.8 ± 0.6 vs. 53.2 ± 0.9) and reported significantly more sedentary time (∼1 h more; 356.3 ± 7.0 vs. 301.4 ± 8.3 min) than lean adults, both p

Abstract Objective Existing behavioral weight management interventions produce clinically meaningful weight loss. The onset of the COVID‐19 pandemic led to the quick transition of such interventions from in‐person to virtual platforms. This provided a unique opportunity to compare engagement and outcomes for an in‐person versus virtually delivered weight management intervention. Methods A non‐randomized comparison of engagement and weight outcomes was performed between two cohorts who participated in a weight management intervention in person (N = 97) versus three who participated virtually via videoconference (N = 134). Various metrics of engagement were examined, including group class and individual phone call attendance and duration, and retention for weight assessments. Behavioral targets of daily caloric intake and step‐counts and the clinical weight outcome were explored. Results Cohorts (mean [standard deviation] age 47.3 (11.5), 67.1% women: 86.8% White) that participated virtually attended more group sessions (p

Abstract Background Metabolic and bariatric surgery (MBS) reduces glomerular hyperfiltration. The renoprotective effects of GLP‐1 analogs were derived from clinical studies in type 2 diabetes (T2D). The objective of this study was to evaluate the changes in glomerular filtration rate (GFR) over time associated with weight loss in patients with a BMI ≥ 35 kg/m2 treated with liraglutide compared with patients treated with MBS. Methods A longitudinal study derived from a retrospective cohort of patients with BMI ≥ 35 kg/m2 treated with either MBS or liraglutide 3 mg/day, with follow‐up ≥1 year. Clinical variables, baseline GFR, and 1‐year GFR were analyzed. A generalized estimating equation (GEE) model was used to compare changes in GFR between both groups while controlling for confounding variables. Results A total of 159 patients were included in the analysis. Of these, 129 patients underwent MBS (median age 60.5 years [IQR 51.8–66.6], body mass index (BMI) 40.9 kg/m2 [IQR 0.68–0.89]), and 30 patients were treated with liraglutide (median age 56 years [IQR 46–62], BMI 37.4 kg/m2 [IQR 0.69–0.93]). No difference in baseline GFR or at 12 months of follow‐up was found between the two interventions. GEE analysis revealed an increase of 0.32 mL/min/1.73 m2 per month of follow‐up. Factors associated with a greater increase in GFR were the percentage total weight loss (%TWL) (0.12 mL/min/1.73 m2, p = 0.023) and baseline GFR (0.69 mL/min/1.73 m2, p > 0.001) for both interventions, independent of a history of T2D. Conclusion In patients with BMI ≥ 35 kg/m2, changes in GFR are related to %TWL and baseline GFR, regardless of the presence of diabetes or the type of intervention used.

Abstract Background Type 2 diabetes (T2D) is a risk factor for female breast cancer (FBC). Obesity has also been associated with FBC, also depending on menopausal status. This study aimed to evaluate the impact of obesity and T2D on the development, aggressiveness, and invasiveness of FBC. Methods Demographic, clinical, and histopathological data from 335 women with FBC were collected, and analyzed according to weight category (102 normal weight, 117 overweight, and 116 living with obesity) and the presence/absence of T2D. Results Age at oncologic diagnosis was not statistically significantly different for body weight; women with overweight or obesity were more likely to have an oncologic diagnosis after menopause than normal weight (p 20%). This study highlights the importance of prevention in all women, with early screening, and adequate nutritional programs.

Abstract Background Socioecological factors are associated with key health behaviors that are critical for weight management, and major life events may disrupt engagement in these behaviors. However, the influence of socioecological factors on health behaviors in the midst of major life events is not clear and is difficult to study due to the random and sporadic nature of their occurrence. The COVID‐19 pandemic provided a unique opportunity to study a major life event and its impacts on diet, physical activity, and body weight. Objective This cross‐sectional study aimed to investigate associations between socioecological factors (environmental, interpersonal, and individual) and self‐reported weight change during a major life event using data collected during the COVID‐19 pandemic, and whether the associations were mediated through self‐reported changes in eating and physical activity behaviors. Methods Participants self‐reported socioecological factors, weight change, and changes in eating behaviors (EB) and physical activity (PA) via online questionnaires between December 2020 and October 2021. Changes in EB and PA were measured using scales with higher scores reflecting more positive changes during the COVID‐19 pandemic. Results Participants (n = 1283) were mostly female (84.9%) with age 52.1 ± 14.1 years (mean ± SD) and BMI of 32.9 ± 8.2 kg/m2. Stronger healthy eater and exercise identities (individual factors) were associated with higher EB scores (EBS) and PA scores (PAS), respectively (p's

Abstract Introduction We examined the psychological burden associated with metabolic syndrome (MetSyn). Methods We used comparable longitudinal data of older adults (≥50 years) from the UK (English Longitudinal Study of Aging) and the US (Health and Retirement Study). We defined MetSyn based on biomarker assessments (e.g., blood pressure, impaired glycemic control). Using regression models, we tested a range of individual psychological outcomes (e.g., depressive symptoms) associated with MetSyn. We also examined whether these psychological outcomes may explain or moderate the link between MetSyn and non‐communicable diseases (NCDs). Findings MetSyn was associated cross‐sectionally with a range of psychological outcomes, including depression, anxiety, loneliness, hopelessness, cynical hostility, social strain, negative affect and decreased positive affect, social support and purpose in life. There was no convincing evidence that psychological factors interacted with or explained (mediated) the relationship between MetSyn and increased risk of developing NCD over 10‐year follow‐ups. Conclusions MetSyn and the psychological burden outcomes examined may have independent effects on NCD risk.

Abstract Objectives In many countries, obesity treatments are not fully reimbursed by healthcare systems. People living with obesity (PwO) often pay out‐of‐pocket (OOP) for pharmacological and non‐pharmacological interventions, placing them in a position of financial risk to manage their condition. This study sought to understand the OOP expenditures and non‐financial costs incurred by PwO to manage weight. Methods A 25‐min cross‐sectional online survey was conducted with PwO between ages 18–60 in Italy, Japan, India, Brazil, Spain and South Korea. Respondents were recruited using proprietary vendor panels and non‐probability sampling. N = 600 participants completed the survey (n = 100 per country). Results The mean annual OOP expenditure related to weight loss/management was $7,351, accounting for nearly 17% of annual household income. Costs generally increased by BMI. Half or more of the respondents agreed that obesity affected multiple aspects of their lives (outside activities, running a household, social life, work, family life, traveling). 46% agreed that obesity limited their job prospects. Conclusion PwO spend a notable amount of their income paying OOP expenditures related to managing their weight. Quantifying the individual economic burden of living with obesity can inform the understanding of the resources required and policy changes needed to treat obesity as a disease.

Abstract Background The EXOFFIT study compared the effectiveness of three time‐matched exercise interventions in women with obesity for improving cardiorespiratory fitness. To best inform future research, evaluation of the interventions' acceptability is needed. Previous research has been inconsistent with methods and reporting of acceptability. Thus, the theoretical framework of acceptability (TFA) can be utilized to ensure that all aspects of acceptability are evaluated. No study to date in women with obesity has utilized the TFA in conjunction with quantitative data (i.e., frequencies of themes) to highlight the aspects of interventions that may be most important for participants. Objective This study aimed to examine the acceptability of the EXOFFIT program and gain insight into the participants' experience of participation, their perspective on the acceptability of trial procedures and interventions and gather their feedback on program changes. Methods A mixed‐methods approach was employed. Thirty‐eight participants who completed the exercise interventions were interviewed and completed a self‐reported exit questionnaire. Interviews were transcribed verbatim and analyzed in three phases: emergent themes were agreed upon, then mapped to the TFA constructs and the frequencies of each construct and theme were presented as counts. Data collected from the exit questionnaire were collated and reported using descriptive statistics. Results All seven TFA constructs were identified in the analysis. The EXOFFIT program was found to have a high level of acceptability, with affective attitude, perceived effectiveness and self‐efficacy being the most reported constructs. The burden and opportunity costs associated with the program were mainly related to family commitments and support needed to participate. Any negative impact of participation was noted to be outweighed by the perceived benefits. Conclusions The results of this study will inform the development of future programs with women with obesity and support the consideration of the TFA constructs from the outset of study design. Clinical Trial Registration Number: ISRCTN13517067

Abstract Objective Commonly used terms like “obese person” have been identified as stigmatizing by those with lived experience. Thus, this study sought to revise a commonly used measure of weight stigmatizing attitudes, the Attitudes Toward Obese Persons (ATOP) scale. Methods The original terminology in the 20‐item ATOP (e.g., “obese”) was compared to a modified version using neutral terms (e.g., “higher weight”). Participants (N = 832) were randomized to either receive the original or modified ATOP. Results There was a statistically significant difference, with a small effect size (d = −0.22), between the scores of participants who received the original ATOP (M = 69.25) and the modified ATOP (M = 72.85), t(414) = −2.27, p = 0.024. Through principal component analysis, the modified ATOP was best used as a brief, 8‐item unidimensional measure. In a second sample, confirmatory factor analysis verified the fit of the brief, 8‐item factor structure. Conclusions Findings suggest that a modified, brief version of the ATOP (ATOP‐Heigher Weight; ATOP‐HW) with neutral language is suitable for assessing negative attitudes about higher‐weight people. The ATOP‐HW may slightly underestimate weight stigma compared to the original ATOP, or the language in the ATOP may magnify negative attitudes. Further examination of the terminology used in weight stigma measures is needed to determine how to best assess weight stigma without reinforcing stigmatizing attitudes. The present study's findings suggest that the use of neutral terms in measures of anti‐fat bias is a promising solution that warrants further investigation.

Abstract Background and Objective The relationship between sleep duration and obesity has been the focus of numerous investigations. This systematic review and meta‐analysis of prospective cohort studies aimed to assess the relationship between sleep duration, abdominal obesity, and body composition. Methods PubMed, Scopus, and Web of Science were searched until February 2024. Cohort studies that assessed the relationship between sleep duration at night and central obesity measures or body composition indices in adults were included. The quality of studies was assessed using the Newcastle‐Ottawa scale. Random‐effects meta‐analysis was conducted on studies that reported risk ratio (RR) and 95% confidence intervals (CIs). Results Eighteen studies were eligible to be included. Eleven out of the 18 studies were not included in the analysis as 10 studies did not report RR, and in one study, the definition of short and normal sleep duration was different from others. The results of the meta‐analysis indicated that short sleep duration was significantly associated with abdominal obesity (RR = 1.08; 95% CI: 1.04–1.12; I2 = 49.1%, n = 7), but long sleep duration was not (RR = 1.02; 95% CI: 0.83–1.24; I2 = 98.2%, n = 6). Conclusions Short sleep duration was associated with a slightly higher risk of central obesity, while long sleep duration was not.

Abstract Background Anti‐obesity medications (AOMs) have historically had limited weight‐loss efficacy. However, newer glucagon‐like peptide‐1 receptor agonist (GLP‐1 RA)–based therapies seem to be more effective, including dual agonists of GLP‐1R and the glucagon receptor (GCGR) or glucose‐dependent insulinotropic polypeptide receptor. Objective To explore healthcare professionals' (HCPs) experience in obesity treatment and their understanding of agonists of GCGR, glucose‐dependent insulinotropic polypeptide (GIP) RA, and GLP‐1 RA. Methods This cross‐sectional online survey of HCPs prescribing AOMs was conducted in the United States in 2023 with a questionnaire designed to evaluate prescribing behavior and understanding of GCGR, GIP RA, and GLP‐1 RA. Results The 785 respondents (251 primary‐care physicians [PCPs], 263 endocrinologists, and 271 advanced practice providers [APPs]) reported 55% of their patients had obesity (body mass index ≥30 kg/m2 or ≥27 with weight‐related complications) and recommended AOMs to 49% overall, significantly more endocrinologists (57% of patients, p

Abstract Background Osteoarthritis (OA) is a prevalent degenerative joint disorder. While the effect of obesity on OA is well documented, less is known about the effect of semaglutide on OA. Objective To determine the impact of semaglutide on the risk of OA in patients with obesity in the United States. Methods A retrospective cohort study was conducted utilizing Kythera Medicare closed claims data from November 1, 2020 to October 31, 2023. Continuously enrolled patients with obesity diagnoses during the baseline period (November 1, 2020– October 31, 2021) were identified and grouped based on whether they had or had not used semaglutide during the identification period (November 1, 2021– October 31, 2022) and followed if they had OA during the follow‐up period. Multivariate analysis was utilized to adjust for demographic variables and comorbidities. Results We identified 1360 patients taking semaglutide and 39,891 patients not taking semaglutide. The most common comorbidities were chronic obstructive pulmonary disease, depression, and anxiety. After controlling for demographic and clinical factors, the semaglutide cohort had a significantly lower risk of OA than the non‐semaglutide cohort (HR, 0.84; p = 0.0069). Conclusions This study suggests that semaglutide may have the potential to help in preventing OA.

Abstract Objective Excess adiposity represents a risk factor for chronic kidney disease (CKD) and progression to end‐stage kidney disease. Anti‐Obesity Medications (AOMs) are vastly underutilized in patients with advanced CKD because of concerns related to safety and efficacy. This study was conducted to evaluate the real‐world approach to weight management and the efficacy and safety of AOMs in people with advanced CKD. Methods This is a retrospective analysis of individuals with Body Mass Index (BMI) ≥ 27 kg/m2 and eGFR ≤ 30 mL/min/1.73 m2 referred to an academic medical weight‐management program between 01/2015 and 09/2022. Evaluation of weight‐management approaches, body weight change, treatment‐related side effects, and reasons for treatment discontinuation were reported. Results Eighty‐nine patients met inclusion criteria, 16 were treated with intensive lifestyle modifications (ILM) alone and 73 with AOMs (all treated with glucagon‐like peptide‐1 receptor agonist [GLP1‐RA] +/− other AOMs) along with ILM. Patients treated with AOMs had a longer duration of on‐treatment follow‐up (median 924 days) compared to (93 days) the ILM group. Over 75% of patients treated with AOMs lost ≥5% body weight versus 25% of those treated with ILM. Only 15% of patients treated with AOMs discontinued therapy due to treatment‐related side effects. Conclusion In patients with obesity and advanced CKD, GLP‐1RA‐based anti‐obesity treatment was well‐tolerated, effective, and led to durable weight reduction.

Abstract Background The prevalence of excess weight and obesity is increasing in an extremely concerning manner worldwide, with highly diverse therapies for current treatment. This review evaluated the scientific evidence of the past 10 years on the use of probiotics in treating excess weight and obesity in the absence of dieting. Materials A systematic review was conducted by searching for clinical trials on humans published in English in the PubMed, Scopus and Cochrane Central databases, using the combination of keywords “Overweight”, “Probiotics” and “Obesity”, and published between 2012 and 2022. Results Six published studies met the inclusion criteria. The review showed that, although there is a lack of consensus in the literature, the use of probiotics in the absence of dieting produced a significant reduction in body weight and body mass index in 66.6% of the reviewed studies, a significant reduction in waist circumference in 80.0% of the reviewed studies, and an improvement in total body fat mass and waist circumference. Conclusions This review showed evidence of a trend in preventing body weight gain and reducing weight through the use of probiotics in individuals with excess weight or obesity. A combination of various strains of the genera Bifidobacterium and Lactobacillus was the most effective.

Abstract Aim With increasing rates of global obesity and associated health issues, there is an ever‐increasing need for weight management solutions to be more accessible. Mobile applications offer accessible support systems and have the potential to offer a viable and effective weight management solution as an alternative to traditional healthcare models. Objective To evaluate the effectiveness of the SIMPLE mobile application for time‐restricted eating in achieving weight loss (WL). Methods User data were analyzed between January 2021 and January 2023. In‐app activity was calculated as the proportion of active days over 12, 26 and 52 weeks. A day is considered active if it contains at least one in‐app action (e.g., logging weight, food, fasting, or physical activity). Users were categorized into four in‐app activity levels: inactive (in‐app activity

Abstract Background and Objective While earlier studies have focused on the relationship between stress and obesity, there was a gap in understanding the potential impact of positive psychological factors, such as resilience, on obesity. By investigating the role of psychological resilience with obesity, this study aimed to address this gap and tackle obesity through a positive psychological framework. Methods Participants consisted of 2445 community residents from Shenzhen, China, with a mean age of 41.09 ± 13.72 years, comprising 846 males and 1599 females. Psychological resilience was measured using the Brief Resilience Scale; gender, age, marital status, education level, smoking status, alcohol consumption, frequency of physical exercise, and perceived stress were considered potential confounding factors. The relationship between psychological resilience and body mass index (BMI) was examined through multiple linear regression and logistic regression analyses. Results The participants had an average psychological resilience score of 3.46 (standard deviation [SD] = 0.62) and an average BMI of 22.59 (SD = 3.35), with 104 individuals (4.3%) identified with obesity. In the fully adjusted multiple linear regression model, a higher psychological resilience score was associated with a higher BMI (β = 0.507, 95% CI:0.283, 0.731). In the logistic regression model, higher psychological resilience scores were linked to increased obesity risk, with a more significant association observed among males (odds ratio [OR] = 2.169, 95% CI:1.155, 4.073), while psychological resilience acted as a protective factor against underweight among females (OR = 0.528, 95% CI:0.376, 0.816). Conclusion The study demonstrated a significant link between higher psychological resilience and elevated BMI, emphasizing the complex relationship between psychological fortitude and weight management. Interventions targeting socioeconomic status, education, lifestyle habits, and physiological well‐being might offer a promising strategy for enhancing psychological resilience and promoting healthier weight. Emphasizing self‐efficacy and coping skills at the individual level could contribute to balanced weight and comprehensive health outcomes, addressing the global challenge of obesity.

Abstract Background Overall, there is conflicting evidence regarding the beneficial effects of optimal lifestyle modification, particularly weight loss interventions, with nonalcoholic fatty liver disease (non‐alcoholic fatty liver disease (NAFLD)). Therefore, this study investigated the effects of weight loss interventions on laboratory and clinical parameters in children and adolescents with NAFLD. Methods Original databases (PubMed/MEDLINE, Web of Science, SCOPUS, and Embase) were searched using standard keywords to identify all controlled trials investigating the effects of weight loss interventions among NAFLD children and adolescents. Pooled weighted mean difference and 95% confidence intervals were achieved by random‐effects model analysis. Results Eighteen eligible clinical trials were included in this systematic review and meta‐analysis. The pooled findings showed that especially more intense weight loss interventions significantly reduced the glucose (p = 0.007), insulin (p = 0.002), homeostatic model assessment‐insulin resistance (HOMA‐IR) (p = 0.003), weight (p = 0.025), body mass index (BMI) (p = 0.003), BMI z‐score (p 0.05) following weight loss interventions. Conclusions Weight loss interventions had significant effects on NAFLD‐related parameters including glucose, insulin, HOMA‐IR, weight, BMI, BMI z‐score, WC, TG, and AST.

Abstract Increasing evidence has reported the anti‐obesity effects of traditional Chinese medicines (TCMs) and their potential advantages in weight loss, such as fewer side effects and lower costs compared to the current recommended treatments like Western medicines. Previous review studies have examined the effects of a few commonly used TCM therapies such as acupuncture and herbal medicines on weight loss. This network meta‐analysis (NMA) study aims to review and rank the effects of currently available TCMs on weight loss and to compare the effects of TCMs with different intervention durations. Eligible Randomized controlled trials (RCTs) conducted among Chinese adults with overweight or obesity were searched on electronic databases (PubMed, Embase, CNKI, WanFang, VIP, and SinoMed) up to 1 March 2023. Pairwise meta‐analysis was performed to examine the pooled effects of TCMs on weight loss, and NMA was conducted to rank different types of TCMs. Subgroup analysis stratified by intervention duration was performed. Forty‐six RCTs were eligible for inclusion in the review. The results showed that TCMs, especially when the treatment duration was ≤6 months, were more effective in both body weight and Body Mass Index (BMI) reduction than non‐pharmacological interventions and placebo/no treatment. Acupotomy was ranked as the most effective TCM treatment in reducing both body weight and BMI. Traditional Chinese medicines have promising potential for weight loss and could be included in future clinical guidance as a standalone or supplementary treatment for obesity. Future studies need to further investigate under‐researched TCMs, examine the long‐term effects and safety of TCMs in obesity treatment, and validate the findings from this study among other ethnic populations.

Abstract Background Currently available behavioral and dietary weight‐loss programs lack magnitude and sustainability compared with bariatric surgery. A novel dietary weight‐loss program was developed to assist participants in achieving sustainable diet changes by building knowledge and skills in food self‐selection. Although the approach worked, a large variation was observed in outcome among participants. Objective Determine factors affecting weight‐loss outcomes among participants to further improve the efficacy of the program. Methods Participants attended 19 dietary educational sessions during a 1‐year intervention which included prescribed homework. Changes in weight, diet, and body composition were assessed. Results Participants (n = 22) achieved mean body weight loss of −6.49(8.37%, p 5% of initial bodyweight; two reached a Body Mass Index 25 kg/m2. A large divergence in weight loss among participants was observed; successful (n = 9) achieved −12.9(9.6)% while unsuccessful achieved −2.03(2.78)%. Dietary protein and fiber density by 24‐h records showed a significant and inverse correlation with weight loss (%) throughout the program. Weight loss at 3 months and 12 months showed a strong correlation (r = 0.84). Participants with self‐reported depression lost significantly less weight than those without depression at 12 months (p

Abstract Background Obesity is a leading cause of preventable death among individuals with serious mental illness (SMI). A prior randomized controlled trial demonstrated the efficacy of a lifestyle style intervention tailored to this population; however, such interventions need to be adapted and tested for real‐world settings. Aims This study evaluated implementation interventions to support community mental health program staff to deliver an evidence‐based lifestyle intervention to clients with obesity and SMI. Materials & Methods In this cluster‐randomized pilot trial, the standard arm combined multimodal training with organizational strategy meetings and the enhanced arm included all standard strategies plus performance coaching. Staff‐coaches delivered a 6‐month group‐based lifestyle intervention to clients with SMI. Primary outcomes were changes in staff knowledge, self‐efficacy, and fidelity scores for lifestyle intervention delivery. Linear mixed‐effects modeling was used to analyze outcomes, addressing within‐site clustering and within‐participant longitudinal correlation of outcomes. Results Three sites were in the standard arm (7 staff‐coaches); 5 sites in the enhanced arm (11 staff‐coaches). All sites delivered all 26 modules of the lifestyle intervention. Staff‐coaches highly rated the training strategy's acceptability, feasibility and appropriateness. Overall, mean knowledge score significantly increased pre‐post by 5.5 (95% CI: 3.9, 7.1) and self‐efficacy was unchanged; neither significantly differed between arms. Fidelity ratings remained stable over time and did not differ between arms. Clients with SMI achieved a mean 6‐month weight loss of 3.8 kg (95% CI: 1.6, 6.1). Conclusions Mental health staff delivering a lifestyle intervention was feasible using multicomponent implementation interventions, and preliminary results show weight reduction among clients with SMI. The addition of performance coaching did not significantly change outcomes. Future studies are needed to definitively determine the effect on client health outcomes.

Abstract Introduction Physical activity and exercise are movement behaviors that support the lifestyle management of overweight and obesity. However, home‐based exercise programs are commonly generic, and inconsistently undertake a holistic approach to program design. Methods This work applied the Behavior Change Wheel, supplemented with previously conducted interviews, to the development of a home‐based exercise program, specifically for people living with overweight and obesity. This provided an understanding of the target behavior and identified a behavioral diagnosis. These findings were mapped onto the Capability, Opportunity, Motivation‐Behavior model and Theoretical Domains Framework, identifying changes needed and corresponding intervention functions. Results Suitable Behavior Change Techniques were identified, alongside Capability Opportunity Motivation‐Behavior components needed to facilitate an increase in exercise behaviors, and five key intervention functions. This housed the delivery of 24 Behavior Change Techniques, including goal setting, feedback, monitoring and repetition. Conclusion Applying the Behavior Change Wheel has enabled detailed development of a home‐based exercise program for adults living with overweight and obesity.

Abstract Background Many of the drugs used for obesity treatment have adverse effects on the central nervous system. Therefore, novel treatments, such as peripherally acting drugs, are needed. Monoacylglycerol acyltransferase 2 (MGAT2), highly expressed in the small intestine, catalyzes the first step of triacylglycerol re‐synthesis. MGAT2 inhibition suppresses food intake in high‐fat diet (HFD)‐fed mice, but the mechanisms remain unclear. Here, the involvement of the vagus nerve in MGAT2 inhibition‐induced feeding suppression was investigated. Methods Fasted mice were administered an MGAT2 inhibitor. Food intake was measured after HFD re‐feeding, and the effect of capsaicin pretreatment on changes in food intake was evaluated. The number of c‐fos‐positive cells in the nucleus tractus solitarius and levels of appetite regulators were determined after HFD re‐feeding or lipid gavage. Results The anorectic effect of the MGAT2 inhibitor was abolished when vagus nerve function was interrupted by capsaicin. MGAT2 inhibition increased the number of c‐fos‐positive cells in the nucleus tractus solitarius and elevated intestinal oleoylethanolamide, plasma peptide tyrosine–tyrosine and plasma glucagon‐like peptide‐1 levels. Conclusion MGAT2 inhibition suppresses feeding behavior via peripheral vagus nerve signaling and may serve as a novel anti‐obesity strategy with a low risk of unexpected central nervous system‐related adverse effects.

Abstract Background Given the obesity's high prevalence among individuals with serious mental illness (SMI), translating weight‐loss interventions with demonstrated effectiveness is needed. This study describes the initial translation phase of such an intervention using the Enhanced Replicating Effective Programs (REP) Framework for delivery by mental health program staff. Methods The Achieving Healthy Lifestyles in Psychiatric Rehabilitation (Achieving Healthy Lifestyles in Psychiatric Rehabilitation) trial intervention was preliminarily adapted to create the ACHIEVE‐Dissemination (ACHIEVE‐D) curriculum. A treatment‐only study was conducted to rapidly evaluate the curriculum using a mixed‐methods approach including surveys and focus groups. A study coach delivered an abbreviated curriculum to individuals with SMI from a single psychiatric program. Among all participants with SMI (n = 17), outcomes were attendance and satisfaction; 14 participated in a focus group. The program staff observed curriculum delivery and participated in a focus group (n = 3). Results Overall, 23 group sessions were delivered. Median attendance was 78.6% across participants with SMI; 92.9% would recommend ACHIEVE‐D to others. The staff found the curriculum acceptable, particularly its structured nature, inclusion of weight management and exercise, and integrated goal setting and tracking. These improvements recommended by participants and/or staff were to assess participant readiness‐to‐change prior to enrollment, change the frequency of weigh‐ins, and train staff coaches on anticipated challenges (e.g., exercise engagement, weight fluctuations). Conclusions During this first REP phase, individuals with SMI and program staff were satisfied with ACHIEVE‐D. Additional refinements will aid future implementation and improve participant experience.

Abstract Introduction Fast food consumption is associated with excessive intake of energy‐dense foods; a major determinant of childhood obesity. The lack of data on the marketing strategies used to promote fast food to adolescents in low and middle‐income countries (LMICs) acts as a barrier to global efforts to reduce the marketing of unhealthy foods to young people around the world. Objectives This systematic review aimed to identify the adolescent‐directed marketing strategies of transnational fast food corporations in LMICs. Methods A systematic search of eight scientific databases (PubMed, CINAHL, Medline, Embase, ProQuest, PsycInfo, Scopus and Google Scholar) was conducted. Following PRISMA guidelines, primary research articles written in English were included if they were published between 1 January 2010 and 30 December 2022, and reported any adolescent‐directed marketing activity undertaken by a transnational fast food company operating in a LMIC. Articles were excluded if they were not peer reviewed. The quality of the included articles was assessed using a condensed version of the Consolidated Criteria for Reporting Qualitative Research tool. Results Twelve articles met the eligibility criteria and were included in this review. A narrative synthesis of these articles revealed that the most documented strategies used to promote fast food to adolescents in LMICs were the use of incentives or premium offers, product appeals, promotional characters and brand familiarity. These strategies were mostly observed on social media, suggesting that there are serious concerns about adolescent exposure to fast food via social media in developing settings, especially as contextual differences in the nature of such marketing were identified. Discussion The promotion of fast food to adolescents in LMICs is contextual in nature, with the nature of marketing strategies employed by transnational fast food corporations varying greatly across cultural and socio‐economic contexts. These findings are crucial for the development of guidelines and regulations restricting the marketing of fast food to adolescents in lower income settings, contributing to global efforts to reduce adolescent exposure to unhealthy food promotion.

Abstract Objective Type 1 endometrial cancer (EC) survivors who are overweight or obese are at increased risk of comorbidities and reduced quality of life. Lifestyle modification interventions (e.g., healthy eating, exercise) may help these women reduce excess weight and improve their quality of life. However, existing interventions have shown limited success. Guided by Self‐Determination Theory, the proposed study sought to identify factors associated with perceived importance of weight loss and exercise as well as interest in lifestyle modification interventions (components of extrinsic and intrinsic motivation) among EC survivors with overweight or obesity to inform future intervention development. Methods One hundred type 1 EC survivors [body mass index (BMI) ≥ 25 kg/m2] completed a cross‐sectional survey assessing sociodemographics, medical factors, exercise, risk perceptions and provider communication, quality of life, barriers to dieting and exercise, perceived importance of healthy lifestyles, and desired intervention content. Results EC survivors who were aware obesity is a risk factor for EC were significantly more likely to perceive weight loss as important and were interested in weight loss programs and receiving information about exercise (ps

Abstract Background Both obesity and sleep disorders are common among women during pregnancy. Although prior research has identified a relationship between obesity and sleep disorders, those findings are from women later in pregnancy. Objective To explore the relationships between self‐reported sleep duration, insufficient sleep and snoring with body mass index (BMI) among multiethnic women at risk of gestational diabetes mellitus (GDM)in early pregnancy. Methods Cross‐sectional study of baseline data from women at risk of GDM enrolled in the Treatment of BOoking Gestational diabetes Mellitus (TOBOGM) multicentre trial across 12 Australian/Austrian sites. Participants completed a questionnaire before 20 weeks’ gestation to evaluate sleep. BMI 5 days/month was higher in class II and class III obesity (1.38 (1.03–1.85) and 1.34 (1.01–1.80), respectively), and the risk of snoring increased as BMI increased (1.59 (1.25–2.02), 2.68 (2.07–3.48), 4.35 (3.21–5.88) to 4.96 (3.65–6.74), respectively)). Conclusions Obesity is associated with insufficient sleep among pregnant women at risk of GDM. Snoring is more prevalent with increasing BMI.

Abstract Importance The prevalence of obesity among United States adults has increased from 34.9% in 2013–2014 to 42.8% in 2017–2018. Developing methods to model the increase of obesity over‐time is a necessity to know how to accurately quantify its cost and to develop solutions to combat this national public health emergency. Methods A cross‐sectional cohort study using the publicly available National Health and Nutrition Examination Survey (NHANES 2017–2020) was conducted in individuals who completed the weight questionnaire and had accurate data for both weight at the time of survey and weight 10 years ago. To model the dynamics of obesity, a Markov transition state matrix was created, which allowed for the analysis of weight transitions over time. Bootstrap simulation was incorporated to account for uncertainty and generate multiple simulated datasets, providing a more robust estimation of the prevalence and trends in obesity within the cohort. Results Of the 6146 individuals who met the inclusion criteria, 3024 (49%) individuals were male and 3122 (51%) were female. There were 2252 (37%) White individuals, 1257 (20%) Hispanic individuals, 1636 (37%) Black individuals, and 739 (12%) Asian individuals. The average BMI was 30.16 (SD = 7.15), the average weight was 83.67 kilos (SD = 22.04), and the average weight change was a 3.27 kg (SD = 14.97) increase in body weight. A total of 2411 (39%) individuals lost weight, and 3735 (61%) individuals gained weight. 87 (1%) individuals were underweight (BMI 30). Conclusion United States adults are at risk of transitioning from normal weight to the overweight or obese category. Markov modeling combined with bootstrap simulations can accurately model long‐term weight status.

Abstract Objective Evaluations of lifestyle modification interventions (LMIs), modeled after the Diabetes Prevention Program, have repeatedly shown a dose‐response relationship between session attendance and weight loss. Despite this, not all participants had “average” weight loss experiences. Nearly one‐third of LMI participants experienced unexpected, paradoxical outcomes (i.e., high attendance with little weight loss, and low attendance with clinically significant weight loss). Paradoxical weight‐loss outcomes were characterized based on session attendance among participants in a group‐based LMI in a real‐world healthcare setting. This group‐based LMI was delivered over 1 year to participants with the possibility of attending up to 25 sessions total. Methods LMI participants identified in 2010–2017 from electronic health records were characterized as having low (

Abstract Background Previous research has established the importance of moderate‐to‐vigorous physical activity (MVPA) for weight control. One area of unexplored investigation is the relationship between individuals' perceptions of the importance of MVPA for weight control and MVPA engagement. This study examined the associations between the perceived importance of MVPA and MVPA engagement, weight loss, barriers to PA, and exercise enjoyment in adults enrolled in a long‐term behavioral weight loss (BWL) intervention. Methods Adults (N = 301) with overweight/obesity (BMI = 27–45 kg/m2) completed an 18‐month BWL intervention, followed by a no‐intervention 18‐month follow‐up. At baseline, 6 months, 18 months (i.e., post‐treatment), and 36 months (i.e., follow‐up), participants ranked the importance of six strategies for weight control: keeping a food record, MVPA, light PA, self‐weighing, small portions, and low‐calorie diet. Observed MVPA (measured by accelerometer), percent weight loss, perceived barriers to PA, and exercise enjoyment were also measured at each assessment. Results Results showed that most participants perceived MVPA as a primary weight control strategy (first, second, or third most important) throughout the intervention, regardless of the weight control goal (weight loss vs. maintenance). Individuals who ranked MVPA as a primary strategy for weight control at concurrent time points, compared to those who did not, engaged in significantly more MVPA at post‐treatment, had greater weight loss at follow‐up, endorsed fewer barriers to PA at post‐treatment and follow‐up, and reported greater exercise enjoyment at baseline and post‐treatment. Conclusion Perceived importance of MVPA was related to subjective experiences of MVPA, MVPA adherence, and weight loss in a long‐term BWL intervention.