This review frames obesity as a chronic, multifactorial disease with major clinical, social, and economic consequences, arguing that body mass index (BMI)-only definitions are increasingly inadequate. It summarizes how classification is evolving toward more holistic staging (eg, clinical vs pre-clinical obesity) that incorporates adiposity-related complications, metabolic biomarkers, and functional impact, alongside tools like waist circumference and staging systems that consider quality of life and mental health. The authors highlight BMI’s key limitations—poor discrimination of fat vs lean mass, failure to capture visceral fat risk, and reduced accuracy across ethnic groups—driving interest in diagnostics that better reflect metabolic health while remaining feasible in routine care.

Risk is shaped by genetics/epigenetics interacting with an “obesogenic” environment (ultra-processed foods, sedentary behavior, poor sleep), socioeconomic stressors and psychology, endocrine disruptors, microbiome changes, and iatrogenic causes (notably weight-promoting medications). Health impacts span insulin resistance/metabolic syndrome, non-alcoholic fatty liver disease/non-alcoholic steatohepatitis, cardiovascular and respiratory disease, chronic kidney disease, osteoarthritis, cancer risk, and neuroendocrine/mental health effects. Treatment is presented as a continuum: lifestyle and behavioral support as foundational, older drugs and bariatric surgery as established options, and newer incretin-based therapies as transformational but limited by tolerability, access, and weight regain after discontinuation. The review reinforces the need for long-term, multidisciplinary care and future research into combination regimens plus emerging approaches, including epigenetic, microbiome, and RNA-based strategies.

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Reference: Ullah MI, Tamanna S. Obesity: Clinical Impact, Pathophysiology, Complications, and Modern Innovations in Therapeutic Strategies. Medicines (Basel). 2025 Jul 28;12(3):19. doi: 10.3390/medicines12030019

Authors of this review outline how pediatric obesity is assessed in practice using body mass index (BMI) percentiles, while noting BMI’s limits as a stand-in for adiposity. They also review key drivers, including appetite regulation via the gut–brain axis, mixed evidence on microbiome contributions, and genetic influences ranging from rare monogenic/syndromic forms to common polygenic risk amplified by calorie-dense, low-activity environments. Early feeding patterns, family food practices, and increasing peer influence and autonomy during adolescence further shape eating behaviors and activity.

Clinically, the review highlights obesity’s downstream impacts across childhood and adolescence—cardiometabolic risk (hypertension, dyslipidemia, prediabetes/type 2 diabetes), non-alcoholic fatty liver disease/non-alcoholic steatohepatitis, sleep apnea, orthopedic complications, and effects on growth and puberty—along with the importance of screening for metabolic syndrome risk factors and sleep behaviors. For management, it prioritizes prevention and family-based, multicomponent behavioral treatment as the gold standard, emphasizing that stigmatizing language can reduce engagement and that motivational interviewing can support sustainable change. When lifestyle strategies aren’t enough, multidisciplinary programs may help. Bariatric surgery is reserved for carefully selected adolescents with severe obesity and significant comorbidities, supported by long-term multidisciplinary follow-up and broader environmental/policy efforts.

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Reference: Kansra AR, Lakkunarajah S, Jay MS. Childhood and Adolescent Obesity: A Review. Front Pediatr. 2021 Jan 12;8:581461. doi: 10.3389/fped.2020.581461.

Obesity is a chronic, heterogeneous disease with a complex, multifactorial etiology, and its prevalence continues to rise worldwide. GLP-1–based therapies—first used for type 2 diabetes—are now commonly prescribed for people with overweight and obesity as an adjunct to reduced-calorie eating plans and increased physical activity. Even with their weight-loss effects, many patients don’t receive structured nutrition guidance and often struggle to maintain weight reduction, creating a gap between short-term results and durable health improvements.

This narrative review synthesizes the literature on nutrition-related challenges for individuals with obesity taking GLP-1 therapies and outlines practical, clinic-ready lifestyle approaches to improve long-term outcomes. The authors highlight risks tied to weight loss and obesity itself, particularly unfavorable body-composition changes such as lean mass loss and the potential development of sarcopenic obesity, alongside broader concerns about inadequate macro- and micronutrient intake and hydration. They recommend coordinated, patient-centered care—ideally involving physicians working closely with dietitians and other clinicians—tailored to the individual’s needs, preferences, and barriers. Core strategies include ensuring adequate calories and nutrient density, prioritizing sufficient protein and fluids, pairing higher protein intake with resistance training to help preserve muscle, and addressing mental health, sleep hygiene, physical activity, and medication adherence/persistence. Overall, the review concludes that patients on GLP-1 therapies should be closely monitored and consistently supported with comprehensive nutrition and lifestyle counseling to maximize safety, function, and sustained benefits.

Reference: Fitch A, Gigliotti L, Bays HE. Application of nutrition interventions with GLP-1 based therapies: A narrative review of the challenges and solutions. Obes Pillars. 2025 Aug 28;16:100205. doi: 10.1016/j.obpill.2025.100205.