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 narrative review examine how intentional weight loss achieved through lifestyle changes such as calorie restriction and exercise affects bone health in adults with overweight or obesity. Overall, the review finds that lifestyle-induced weight loss is commonly associated with increased bone turnover, especially greater bone resorption, along with small but meaningful reductions in bone mineral density at clinically important sites. These effects appear most consistent at the hip. Findings at the spine are more variable, partly because spinal measurements may be affected by DXA-related artifacts and age-related changes. The review also notes that fracture risk remains less clear: some data suggest no increase in fractures, but longer-term studies, including Look AHEAD, raise concern that intentional weight loss may increase fragility fracture risk in some higher-risk groups.

The authors conclude that weight loss can still be beneficial overall, but bone health should not be ignored when treating obesity. Potential mechanisms for bone loss include reduced mechanical loading from loss of body mass, hormonal and metabolic changes, and inadequate intake of bone-supporting nutrients such as calcium, vitamin D, and protein during hypocaloric diets. Current evidence suggests that regular exercise, adequate calcium intake, sufficient vitamin D, and higher protein intake may help protect bone during weight loss, though they may not fully eliminate skeletal risk. The review calls for more real-world research on repeated weight loss and regain, different dietary strategies, and which patients—such as postmenopausal women, older adults, and those with poorer musculoskeletal health—may be most vulnerable to bone loss during weight reduction.

Reference: Legrand MA, Paccou J, Lecerf JM, et al. Bone Health Following Lifestyle-Induced Weight Loss in Individuals With Overweight/Obesity: A Narrative Review. Obesity (Silver Spring). 2026 Jan;34(1):19-35. doi: 10.1002/oby.70047.

Authors of this pilot study evaluated the Primary Care Integrated Weight Management (PCIWM) program, which adapts the collaborative care management model—traditionally used for behavioral health—to obesity care in primary care settings. Implemented through an academic medical center and four rural South Carolina clinics, the program brought together registered dietitians, primary care providers, practice managers, and a weight management consultant to deliver coordinated, largely virtual weight management support. Adults with weight-related concerns, especially those with a body mass index (BMI) above 25 kg/m², received nutrition assessments, goal setting, medical nutrition therapy, and optional monthly follow-up sessions. The study aimed to describe how the model was implemented and identify ways to improve adoption and long-term sustainability.

Early findings suggest the model is feasible and potentially promising, particularly for rural populations with limited access to structured weight management services. Among 61 participants, the average age was 46.8 years, most were women, and the mean baseline BMI was 41.82. Nearly 29% remained actively engaged, averaging 3.4 dietitian visits, and more than half of those with follow-up weight data either maintained or lost weight. Survey responses also showed that many participants were adhering to their health goals, and overall mean BMI fell by 2.7%. The authors conclude that PCIWM offers a novel virtual care approach for obesity management, but broader research, policy support, and program expansion are needed to strengthen long-term impact on weight and cardiometabolic health.

Reference: Hales S, Koob C, Harvey J, et al. Implementing a Virtual, Collaborative Care Weight Management Program in Rural Primary Care: Pilot Results and Insights. Telemed Rep. 2025;6(1):341-351. doi: 10.1177/26924366251385717.

Researchers of this randomized 8-week study evaluated the effects of 10-hour time-restricted eating (TRE), resistance training (RT), and the combination of both in 54 college students with overweight or obesity. Participants were assigned to one of four groups: control, TRE, RT, or TRE+RT. TRE alone and TRE+RT both led to significant reductions in body weight and body mass index, with participants losing more than 2 kg on average. RT alone and TRE+RT also reduced fat mass, but the greatest reduction was seen with the combined approach, suggesting that pairing TRE with exercise may enhance fat loss more than either strategy alone. TRE by itself also reduced waist and hip circumference, but unlike the exercise-based groups, it decreased fat-free mass, indicating a loss of lean tissue. By contrast, RT increased fat-free mass, and the combined TRE+RT approach helped maintain muscle mass while still promoting meaningful weight and fat loss.

The interventions also affected several secondary outcomes related to cardiometabolic health and well-being. RT, with or without TRE, significantly lowered diastolic blood pressure, while TRE alone did not show the same benefit. In terms of mental health, mild anxiety levels present at baseline improved to normal levels in the TRE+RT group, though not in the RT-only group. No depression or stress was reported in any group during the study. Sleep quality, which was poor at baseline for many participants, improved significantly with RT and showed a trend toward improvement with TRE+RT. Overall, the findings suggest that a 10-hour TRE pattern can support weight loss without negatively affecting mood. Combining TRE with resistance training may offer the most balanced benefits by improving fat loss, preserving lean mass, and potentially supporting better sleep and emotional health in young adults with overweight or obesity.

Reference: Cui T, Sun Y, Ye W, Liu Y, Korivi M. Efficacy of time restricted eating and resistance training on body composition and mood profiles among young adults with overweight/obesity: a randomized controlled trial. J Int Soc Sports Nutr. 2025;22(1):2481127. doi: 10.1080/15502783.2025.2481127.

This joint perspective from the Obesity Medicine Association and the American College of Osteopathic Family Physicians frames obesity as a chronic, relapsing, treatable disease that primary care clinicians must address early and proactively. The paper argues that obesity is more than excess body weight; it is a major driver of common primary care problems such as type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, sleep apnea, osteoarthritis, and some cancers. It also highlights why obesity care often falls short in primary care, citing underdiagnosis, lack of training, limited time, poor reimbursement, inadequate access to treatment resources, and the harmful effects of bias and stigma. The authors emphasize that simply recognizing and documenting obesity as a disease can improve care, and they encourage a patient-centered, people-first approach that reduces shame and supports long-term management.

The article outlines practical primary care strategies built around the four pillars of obesity treatment: nutrition therapy, physical activity, behavior modification, and medical interventions such as anti-obesity medications and bariatric surgery. It stresses that family physicians and their care teams can play a central role in screening, counseling, setting goals, monitoring progress, prescribing or referring for treatment, and providing long-term follow up. The paper also reviews the benefits and limitations of current anti-obesity medications, the role of bariatric surgery, and the importance of post-surgical monitoring for nutritional deficiencies and weight regain. Overall, the authors conclude that primary care is often the first and best place to begin obesity treatment. Clinicians who understand the available tools can meaningfully improve cardiometabolic health, quality of life, and long-term outcomes for patients living with obesity.

Reference: Pennings N, Varney C, Hines S, et al. Obesity management in primary care: A joint clinical perspective and expert review from the Obesity Medicine Association (OMA) and the American College of Osteopathic Family Physicians (ACOFP) - 2025. Obes Pillars. 2025;14:100172. doi: 10.1016/j.obpill.2025.100172.

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. 

Weight stigma is common in both social and healthcare settings, yet it’s still not consistently addressed within obesity management. This review argues that comprehensive, stigma-reduction interventions—and especially reviews that assess them—have been lacking, and it aims to close that gap. Using a PRISMA-guided approach, the authors synthesize evidence on how interventions targeting weight stigma can improve psychological outcomes and behavioral outcomes.

To identify relevant evidence, the authors searched a variety of databases for studies published from 1975 through January 2024, using a structured MEDLINE-style keyword strategy, plus supplementary Google Scholar and reference-list searching. Studies were screened using a PICOS framework focused on adults experiencing weight stigma, with psychological/behavioral interventions compared against standard care, alternative approaches, or no treatment. Outcomes included reductions in stigma and improvements in quality of life and body image. Across studies, many interventions reduced internalized weight bias and improved related outcomes. Effects were often stronger and more durable when programs were longer, included support/coaching, and addressed related mediators (eg, shame, self-criticism, avoidance) rather than focusing on stigma alone.

Reference: Ramsamy G, Mosbah H, Faure JP, et al. How to reduce the adverse effects of weight stigma on the quality of life: a preferred reported items for systematic reviews and meta-analyses (PRISMA). Front Psychol. 2024 Dec 24;15:1421609. doi: 10.3389/fpsyg.2024.1421609.

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.

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.

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.

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.

Obesity is a growing global epidemic that significantly impairs quality of life, prompting strong interest in non-surgical strategies such as diet and exercise. Authors of systematic review screened 324 studies and ultimately included 11 trials of adults with obesity who underwent lifestyle modification using diet, exercise, or both. The included studies varied in design, duration, and intervention intensity but shared a focus on practical, real-world regimens that could be implemented in outpatient settings.

Across trials, targeted dietary changes and structured physical activity produced modest but clinically meaningful reductions in weight and fat mass. Dairy-based diets reduced body weight by about 1.2 kg and fat mass by about 1.5 kg, while alternate-day fasting and standard caloric restriction yielded comparable ranges of weight loss depending on adherence and weight-loss targets. A combination of roughly 175 minutes per week of strength plus endurance exercise with a portion-controlled, individualized hypocaloric diet achieved about 5% weight loss—often viewed as a threshold for metabolic and cardiometabolic benefit. The review emphasizes that tailoring diet to each patient’s metabolic profile, health status, and preferences, alongside a sustainable exercise plan, offers one of the most efficient and realistic lifestyle-based regimens for adult obesity management.

Reference: Olateju IV, Opaleye-Enakhimion T, Udeogu JE, et al. A systematic review on the effectiveness of diet and exercise in the management of obesity. Diabetes Metab Syndr. 2023 Apr;17(4):102759. doi: 10.1016/j.dsx.2023.102759.

Researchers of this prospective study of 163,008 UK Biobank participants with normal weight or severe obesity examined how severe obesity, inflammation, and insulin resistance (IR)—alone and in combination—relate to all-cause mortality and all-site cancers, and whether lifestyle modifies these risks. Severe obesity, high inflammation, and IR were each independently associated with higher all-cause mortality. Severe obesity and high inflammation were also linked to higher all-site cancer risk, whereas IR was not significantly associated with all-site cancers overall. Combined exposures had additive effects: participants with severe obesity plus both inflammation and IR had the highest hazards for death and cancer, with risks generally higher in women than in men.

Lifestyle strongly modified these relationships. Even among those with severe obesity, high inflammation, and IR, participants with favorable lifestyles had substantially lower risks of all-cause mortality and cancer than those with intermediate or unfavorable lifestyles. The authors conclude that while severe obesity, inflammation, and IR jointly increase the risk of death and cancer, adherence to a healthy lifestyle—avoiding smoking, limiting alcohol, maintaining a healthy weight, being physically active, and eating a diet rich in whole grains, fruits, vegetables, and legumes—can significantly mitigate these risks.

Reference: Jin Q, Liu S, Zhang Y, et al. Severe obesity, high inflammation, insulin resistance with risks of all-cause mortality and all-site cancers, and potential modification by healthy lifestyles. Sci Rep. 2025 Jan 9;15(1):1472. doi: 10.1038/s41598-025-85519-9.

Obesity and overweight are rising worldwide across all age groups, increasing the risk of type 2 diabetes, cardiovascular disease, and other non-communicable conditions. Management is multifaceted, combining dietary change, physical activity, behavioral interventions, and sometimes pharmacotherapy, with a strong emphasis on sustainable lifestyle modification and personalized support. Within this framework, plant-based diets (PBDs)—including vegan and lacto-ovo-vegetarian patterns that emphasize fruits, vegetables, whole grains, legumes, nuts, and seeds while minimizing or excluding animal products—have emerged as a promising option. PBDs tend to be lower in energy density and fat, richer in fiber and bioactive compounds, and may beneficially affect gut microbiota, insulin sensitivity, and satiety hormones. They are generally nutrient dense, though fully vegan patterns require attention to vitamin B12 (and sometimes calcium).

Evidence from randomized controlled trials and observational studies shows that PBDs can support weight loss, improve body composition, reduce blood pressure and LDL cholesterol, lower trimethylamine N-oxide, and enhance glucose metabolism in people who are overweight, with obesity, metabolic syndrome, or type 2 diabetes. Vegan diets often produce greater weight loss than lacto-ovo-vegetarian diets, but both appear helpful for cardiometabolic health and weight management, and adherence to a whole-food, plant-based lifestyle is associated with healthy body mass index and overall well-being. These results highlight PBDs as a safe, sustainable approach that can play a valuable role in treating and preventing obesity and related conditions, but more long-term, rigorously designed studies are needed.

Reference: Ahmad SR. Plant-based diet for obesity treatment. Front Nutr. 2022 Sep 8;9:952553. doi: 10.3389/fnut.2022.952553.