Obesity affects about 42% of US adults and is associated with higher rates of type 2 diabetes, hypertension, cardiovascular disease, sleep disorders, osteoarthritis, and premature death. Body mass index (BMI) cutoffs (≥25 overweight; ≥30 obesity, with lower thresholds for many Asian populations) are commonly used, but BMI alone isn’t recommended to gauge individual risk. Cardiovascular event rates are higher with obesity, and even 5% to 10% weight loss can yield meaningful benefits—lowering systolic blood pressure by about 3 mm Hg in people with hypertension and reducing A1c by ~0.6% to 1% in type 2 diabetes.

Evidence-based care typically combines behavioral therapy, nutrition, physical activity, pharmacotherapy, and metabolic/bariatric procedures, tailored to the patient. Multicomponent behavioral programs (often ≥14 sessions over 6 months) can produce 5% to 10% weight loss, though regain is common. Nutrition strategies focus on calorie reduction aligned to preferences, and physical activity is key for maintenance. Clinicians should also review medications that cause weight gain and consider alternatives. For eligible nonpregnant patients, long-term FDA-approved antiobesity medications can augment lifestyle changes. Endoscopic procedures can achieve about 10% to 13% loss at 6 months, and bariatric surgery typically produces about 25% to 30% loss at 12 months, with long-term meds often needed to support maintenance.

Reference: Elmaleh-Sachs A, Schwartz JL, Bramante CT, et al. Obesity Management in Adults: A Review. JAMA. 2023 Nov 28;330(20):2000-2015. doi: 10.1001/jama.2023.19897. 

An economic evaluation modeled what would happen if Medicare Part D began covering GLP-1 receptor agonists (GLP-1RAs) for obesity, a move under discussion in the context of proposals to expand coverage. Using a validated microsimulation model, the authors projected 10-year costs and offsets (2026–2035) for Medicare beneficiaries with body mass index of at least 30, or at least 27 with an obesity-related comorbidity. In the base case, they assumed a 10% one-time uptake in each new eligible cohort, 40% adherence beyond year 1, and an additional 10% price discount beyond current net prices. Then, they tested alternative uptake/adherence/discount scenarios.

Across an estimated 30 million eligible beneficiaries over the decade, the model projected about 3 million would receive treatment. Medicare drug spending for GLP-1RAs was estimated at $65.9B, with $18.2B in downstream healthcare savings from reduced obesity-related complications. This scenario yielded an estimated net increase in spending of $47.7B over 10 years. Sensitivity analyses found that higher uptake and adherence increase clinical savings, but savings still did not catch up to drug costs and net spending rose substantially. Even under a more conservative “moderate” scenario (5% uptake, 20% adherence, 30% additional discount), net spending was still projected at about $8B over a decade. The authors conclude that meaningful price reductions and complementary lower-cost strategies to sustain weight loss (and reduce low-value care) would be needed to improve the fiscal balance.

Reference: Hwang JH, Laiteerapong N, Huang ES, et al. Fiscal Impact of Expanded Medicare Coverage for GLP-1 Receptor Agonists to Treat Obesity. JAMA Health Forum. 2025 Apr 4;6(4):e250905. doi: 10.1001/jamahealthforum.2025.0905. 

Authors of this updated review examined 14 head-to-head phase 3 trials comparing GLP-1 receptor agonists (GLP-1 RAs) for type 2 diabetes, focusing on A1C reduction, weight loss, adverse effects, and patient satisfaction. Overall, all agents improved glycemic control, but meaningful differences emerged within the class. Long-acting agents generally outperformed short-acting agents for A1C lowering, with subcutaneous semaglutide showing the greatest reductions in both A1C and body weight. Oral semaglutide also performed strongly, while dulaglutide and liraglutide delivered solid efficacy with somewhat less dramatic weight loss. Short-acting agents such as exenatide twice daily and lixisenatide were less effective overall for A1C and weight outcomes. The review emphasizes that GLP-1 RAs should not be treated as interchangeable, because dosing schedule, formulation, and pharmacologic differences can meaningfully affect outcomes.

In terms of tolerability, gastrointestinal adverse effects such as nausea, vomiting, and diarrhea were the most common across the class, with higher rates generally seen with short-acting agents and semaglutide. Exenatide once weekly tended to have fewer gastrointestinal effects but more injection-site reactions. Hypoglycemia risk was low overall and mainly increased when sulfonylureas were used concurrently. Patient satisfaction often favored once-weekly options over once- or twice-daily injections, and real-world studies suggested dulaglutide may have advantages for adherence, persistence, and device ease of use. The authors conclude that while semaglutide appears to offer the strongest efficacy, treatment selection should remain patient-centered and also consider cardiovascular benefit, tolerability, administration burden, cost, and patient preference rather than formulary access alone.

Reference: Trujillo JM, Nuffer W, Smith BA. GLP-1 receptor agonists: an updated review of head-to-head clinical studies. Ther Adv Endocrinol Metab. 2021;12:2042018821997320. doi: 10.1177/2042018821997320.

This mixed-methods study examined how experiences of weight bias relate to eating behaviors among patients entering a plant-based lifestyle medicine program. It also explored how providers can deliver more weight-inclusive care. Quantitatively, more than half of patients reported experiencing weight bias. Those patients entered the program with poorer eating patterns and higher rates of emotional eating than those who did not report weight bias. Specifically, weight bias was associated with lower healthful plant-based eating scores and about fivefold higher odds of often or always engaging in emotional eating, even after adjustment for sociodemographic factors. Providers also described weight bias as widespread in patients’ lives, coming not only from the public and family members but from healthcare settings as well. They linked those experiences to anxiety, depression, shame, low self-esteem, and difficulty making sustainable lifestyle changes.

The qualitative findings highlight a model of weight-inclusive care that shifts attention away from shame and the scale and toward trust, health behaviors, and patient dignity. Providers emphasized listening seriously to patients’ concerns, focusing on healthy habits rather than weight loss alone, encouraging small achievable steps, and reinforcing self-compassion instead of blaming patients’ “willpower.” They also recommended formal screening for weight bias, greater integration of mental health support, training all care team members in weight-inclusive practice, and creating size-inclusive clinical spaces and equipment. Overall, the study argues that addressing weight bias is not just a matter of patient experience. It is also a meaningful clinical and public health priority, because reducing stigma may improve eating behaviors, mental health, engagement in care, and broader health outcomes for people in larger bodies.

Reference: Albert SL, Kwok L, Massar R, et al. The burden of bias: Patient experiences and providers' perspectives on weight bias. Obes Pillars. 2026 Feb 18;18:100251. doi: 10.1016/j.obpill.2026.100251.

Authors of this systematic review synthesized recent evidence on adult obesity prevention and management across pharmacologic, surgical, dietary, exercise, and adjunctive therapies. Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, the authors searched major databases (2015–2025) and narrowed 4,749 records to 12 interventional studies. These included mostly randomized controlled trials of GLP-1 receptor agonists, bariatric and endoscopic procedures, structured exercise programs, time-restricted eating, probiotics, and comprehensive lifestyle interventions.

Across studies, GLP-1 agents consistently produced clinically meaningful, sustained weight loss and cardiometabolic improvement. Bariatric surgery and endoscopic sleeve gastroplasty achieved the greatest and most durable weight loss and diabetes benefits, with attendant surgical and nutritional risks. Exercise interventions—especially combined aerobic and resistance programs—reduced ectopic fat, improved insulin sensitivity, and enhanced functional capacity, and time-restricted eating and probiotics offered modest additional benefits, particularly when paired with exercise. Overall, the review supports a multimodal, individualized approach to obesity management. Thoughtfully combining diet, exercise, pharmacotherapy, and, when appropriate, metabolic or bariatric procedures yields the most robust and sustained improvements in weight and metabolic health.

Reference: Shankar G, Sharma J, Soni R, Gondalia S, Kumar V. Recent Trends in the Prevention and Management of Obesity Among Adults: A Systematic Review. Cureus. 2025 Aug 1;17(8):e89207. doi: 10.7759/cureus.89207.

Authors of this narrative review synthesize current evidence linking obesity with cancer risk, outcomes, and survivorship care, including how obesity is defined and measured—from body mass index (BMI) and waist–hip ratio to more precise modalities such as dual energy X-ray absorptiometry—and global trends showing rising obesity rates and a substantial proportion of cancers attributable to excess body weight. Key biological mechanisms include increased estrogen production from adipose tissue, hyperinsulinemia and elevated IGF-1, chronic low-grade inflammation, altered adipokine profiles, and adipose-tissue remodeling that changes the tumor microenvironment. Strong evidence links obesity to higher incidence of multiple cancers and shows that higher BMI and central obesity are associated with increased all-cause and cancer-specific mortality, as well as higher risks of recurrence in several tumor types.

The review also highlights that obesity adversely affects cancer treatment and survivorship, with higher rates of surgical complications, greater radiation and chemotherapy toxicity, and underdosing due to chemotherapy “dose capping,” which guidelines now recommend against. For survivors, weight management is framed as an important adjunct to oncologic care, with structured lifestyle interventions (hypocaloric diets, regular aerobic and resistance exercise, and behavior therapy) improving weight, metabolic markers, and quality of life. Pharmacologic therapies and bariatric surgery remain less studied in this population but may benefit carefully selected patients. Ongoing trials are testing whether intentional weight loss and physical activity can improve survival, underscoring the need for more precise, mechanism-informed strategies to integrate obesity management into cancer prevention and survivorship care.

Reference: Pati S, Irfan W, Jameel A, Ahmed S, Shahid RK. Obesity and Cancer: A Current Overview of Epidemiology, Pathogenesis, Outcomes, and Management. Cancers (Basel). 2023 Jan 12;15(2):485. doi: 10.3390/cancers15020485.

This executive summary from the American Heart Association (AHA) and National Heart, Lung, and Blood Institute (NHLBI) provides updated guidance on diagnosing and managing metabolic syndrome in adults, emphasizing it as a cluster of metabolic risk factors—atherogenic dyslipidemia, elevated blood pressure, elevated fasting glucose, prothrombotic and proinflammatory states—driven largely by abdominal obesity and insulin resistance. Metabolic syndrome roughly doubles atherosclerotic cardiovascular disease (ASCVD) risk and increases the risk of type 2 diabetes about fivefold, making it a marker of high long-term cardiometabolic risk. The statement reaffirms the Adult Treatment Panel III diagnostic criteria (any 3 of 5: elevated waist circumference, triglycerides, blood pressure, fasting glucose, or reduced HDL-C) with minor updates, including lower fasting glucose cutoffs (≥100 mg/dL) and allowance for ethnicity-specific waist thresholds and counting drug-treated abnormalities as present.

Management is framed within global cardiovascular prevention, with primary goals to reduce ASCVD risk and delay or prevent type 2 diabetes. Short-term (10-year) absolute risk is estimated using Framingham scoring, which then guides the intensity of drug therapy for LDL-C, blood pressure, and glucose, especially in those with established ASCVD or diabetes. Lifestyle intervention is the foundation of care for all: weight loss (initially 7%–10% of body weight), increased moderate-intensity physical activity, and an atherogenic diet low in saturated and trans fats. Drug therapy is applied according to existing AHA/NHLBI/American Diabetes Association guidelines for individual risk factors, and low-dose aspirin is recommended in appropriately high-risk patients. The statement concludes that metabolic syndrome is a useful clinical construct signaling elevated long-term risk, best addressed through sustained lifestyle change plus targeted pharmacotherapy.

Reference: Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005 Oct 25;112(17):2735-52. doi: 10.1161/CIRCULATIONAHA.105.169404. Epub 2005 Sep 12. Erratum in: Circulation. 2005 Oct 25;112(17):e297. Erratum in: Circulation. 2005 Oct 25;112(17):e298.

Novel insights into neuroendocrine and gastrointestinal regulation of appetite and energy expenditure have driven development of new anti-obesity medications that, when paired with lifestyle change, can improve appetite control and support sustained weight loss. These same pathways help explain the superior and durable weight loss and comorbidity improvements seen after metabolic–bariatric procedures such as sleeve gastrectomy and gastric bypass. Because precise imaging tools can be impractical for routine care, clinicians rely mainly on body mass index (BMI) and waist circumference, despite their limitations and the need for lower BMI and waist cutoffs in some groups. Central fat distribution (abdominal/visceral fat) is particularly important, as increased waist circumference strongly predicts metabolic syndrome, type 2 diabetes, hypertension, and cardiovascular disease—even in people whose BMI is below the traditional obesity threshold.

Obesity is more common in midlife, in women after menopause, and disproportionately affects racial and ethnic minorities, as well as those with lower income and education. Similar trends are now seen worldwide, where rapid economic and technological change has increased sedentary work, access to ultra-processed foods, and exposure to obesogenic environments, while undernutrition persists in some regions. Overall, obesity is framed as a chronic disease and a major driver of other noncommunicable diseases (type 2 diabetes, dyslipidemia, hypertension, cardiovascular disease), creating escalating health-care utilization and costs and underscoring the need for better risk assessment tools, equitable treatment access, and large-scale prevention strategies.

Reference: Purnell JQ. Definitions, Classification, and Epidemiology of Obesity. 2023 May 4. In: Feingold KR, Ahmed SF, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, Muzumdar R, Purnell J, Rey R, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905390.

Obesity has become a global health crisis, with more than 1 billion people now living with obesity and many more with being overweight. Its prevalence has risen sharply in both adults and children across nearly all regions, including low- and middle-income countries that also face undernutrition. The consequences span cardiometabolic disease, respiratory and musculoskeletal disorders, several cancers, reproductive and mental health problems, and weight-related stigma. Together, these burdens drive major economic costs and substantial losses in quality of life and productivity.

Effective response requires coordinated, multilevel strategies rather than a narrow focus on willpower or short-term dieting. At the individual and clinical level, core management combines behavioral interventions (hypocaloric, nutrient-dense eating patterns; regular physical activity; resistance training; and psychological support) with evidence-based pharmacotherapy. Metabolic/bariatric surgery is reserved for severe obesity and requires careful patient selection and lifelong follow-up. Community, environmental, and policy interventions—such as fiscal policies on unhealthy foods, clear labeling, urban design that promotes active living, and school and workplace programs—are essential to shift obesogenic environments and support more precise and equitable obesity prevention and care worldwide.

Reference: Ahmed SK, Mohammed RA. Obesity: Prevalence, causes, consequences, management, preventive strategies and future research directions. Metabol Open. 2025 Jun ;27:100375. doi: 10.1016/j.metop.2025.100375.

Aging-related shifts in body composition make body mass index (BMI) an imperfect tool for diagnosing obesity and stratifying cardiovascular risk in older adults. Using data from over 18,000 ASPirin in Reducing Events in the Elderly participants (median age 74), researchers compared obesity defined by BMI with excess central adiposity defined by elevated waist circumference (WC). While BMI and WC agreed in most individuals classified as obese (over 96% of those with elevated WC were also obese by BMI), more than half of all older adults with excess central adiposity—especially those who were older, nonfrail, or in the BMI “normal” or “overweight” ranges—were misclassified as nonobese by BMI alone. This misclassification increased with age and was more common in nonfrail participants, reflecting age-related sarcopenia, bone loss, and central fat redistribution that BMI does not capture.

Crucially, older adults with elevated WC but “nonobese” BMI had similar risks of cardiovascular disease (CVD) events and major adverse cardiovascular events as those classified as obese by BMI, even after adjustment for traditional risk factors and treatments. In contrast, WC added little discriminatory value among those already obese by BMI. These findings suggest that relying on BMI alone in older adults can miss a substantial subgroup with high central adiposity and CVD risk. Given rising obesity prevalence and emerging weight-loss therapies that may lower CVD risk, the authors argue that routine assessment of waist circumference—alongside BMI—should be incorporated into obesity evaluation in older adults to more accurately identify those at risk for obesity-related complications.

Reference: Ernst ME, Fravel MA, Woods RL, et al. Prevalence of Obesity, Excess Central Adiposity, and Cardiovascular Risk Among Older Adults. JACC Adv. 2025;4(10 Pt 2):102150. doi: 10.1016/j.jacadv.2025.102150.

Researchers of a recent study examined how the relationship between adiposity and mortality changes across age groups in a nationally representative sample of 44,041 US adults aged 18 to 79 years from National Health and Nutrition Examination Survey (1999–2018), with mortality follow-up through 2019. Adiposity was assessed using body mass index, waist circumference, weight, and waist-to-height ratio. Cox proportional hazards models were then used to test interactions between age and these measures on all-cause and cardiovascular mortality, adjusting for demographic, behavioral, and clinical factors. Over a median follow-up of 10.1 years, there were 5,019 deaths, including 1,186 from cardiovascular causes, and significant interactions between age and all adiposity measures were observed.

The associations between adiposity and mortality were strongest in younger adults. For instance, each 1-SD increase in body mass index was associated with a cardiovascular mortality hazard ratio (HR) of 1.49 in adults aged 18 to 49 years, compared with 1.15 in those aged 70 to 79 years. Class 3 obesity in younger adults was also linked to a markedly increased cardiovascular mortality risk (HR 4.37). Underweight status was also associated with higher all-cause mortality, particularly in younger individuals (HR 2.04). These findings indicate that age substantially modifies the mortality risks associated with both obesity and underweight, highlighting the importance of early, age-tailored interventions to address unhealthy adiposity.

Reference: Lu Y, Mou Y, Liu Y, et al. Age-Specific Associations Between Adiposity and Mortality in U.S. Adults, 1999-2018. JACC Adv. 2025 Nov 7;4(12 Pt 2):102234. doi: 10.1016/j.jacadv.2025.102234. Epub ahead of print.

Researchers of this retrospective real-world study analyzed US children, adolescents, and young adults with obesity from 2019 to 2024. The goal was to understand clinical characteristics, treatment patterns, and healthcare use as newer anti-obesity medications became available. Across age groups, obesity-related complications were common, with asthma especially prevalent in children and anxiety and depression more common in adolescents and young adults. Treatment rates remained low overall: lifestyle interventions were documented in fewer than 10% of patients, bariatric surgery was rare, and obesity management medications were used by only a minority of adolescents and young adults. Still, use of these medications increased over time, especially incretin-based therapies such as semaglutide and tirzepatide between 2022 and 2024.

Researchers also found that adolescents and young adults who used obesity management medications tended to have higher body mass index and a heavier burden of obesity-related complications than non-users. The results suggest these therapies were more often used in patients with more severe disease. These patients also had higher overall healthcare costs, particularly pharmacy costs, although healthcare resource use was otherwise fairly stable across the study period. In the discussion, the authors emphasize that despite growing uptake of GLP-1–based therapies, obesity treatment remains underused in younger populations, likely due to access barriers, insurance and cost issues, safety concerns, stigma, and continued reliance on lifestyle intervention as first-line care. Overall, the paper argues that earlier and more effective obesity treatment may be needed to reduce long-term complications and improve outcomes in young people.

Reference: Gibble TH, Huang A, Higgins C, et al. Clinical characteristics, treatment patterns, and healthcare utilization among children, adolescents, and young adults with obesity in the United States. Obes Pillars. 2026 Feb 14;18:100252. doi: 10.1016/j.obpill.2026.100252.