Obesities, Volume 5, Issue 3 (September 2025) – 10 articles

Our four-year interdisciplinary behavioral weight loss program is fully covered by public health insurance for patients with a body mass index of ≥35 kg/m². We evaluated the real-world outcomes of anthropometric, metabolic and psychologic parameters collected prior to the start (t₀, n = 381, 71% women) and after each segment of the program (t_1–4, n = 243, 126, 94, and 77). It is a prospective evaluation of clinical real-world data including all patients who started the first segment of behavioral treatment until they quit/finished the program. The mean dropout rates per treatment segment were 23%. Body weight after one year decreased from 127.3 kg to 122.2 (p < 0.001). Average hemoglobin A1c value decreased from 5.8% to 5.6% in all patients (p < 0.001) and from 6.6% to 6.2% in patients with type 2 diabetes (p < 0.001). Further metabolic and psychological parameters improved significantly as well. The average weight nadir was reached after two segments, co-occurring with the most beneficial changes in laboratory parameters. Afterwards, mean weight slightly increased accompanied by a discrete loss of benefits in laboratory parameters. Our real-world data with significant health improvements adds important value to discussions about the funding of obesity therapy and thus has the chance to improve therapy availability for obesity patients worldwide. Full article

Objective: To investigate the association between combined physical activity (PA) levels and sedentary behavior (SB) with dynapenic abdominal obesity (DAO) and dynapenic obesity (DO) in older adults. Methods: This cross-sectional, population-based epidemiological study included 207 community-dwelling older adults (58.90% women). PA and SB were assessed using the International Physical Activity Questionnaire. Participants were categorized into four groups: (G1) sufficiently active and low SB; (G2) sufficiently active and high SB; (G3) insufficiently active and low SB; and (G4) insufficiently active and high SB. DAO and DO were defined as the coexistence of dynapenia with abdominal and general obesity, respectively. Prevalence ratios (PR) and 95% confidence intervals (CI) were estimated using Poisson regression with robust variance. Results: The prevalence of DAO was 11.10% and DO was 6.80%. In the adjusted analysis, participants classified as insufficiently active with high SB (G4) had 5.54 times the prevalence of DAO (PR: 5.54, 95% CI: 1.91–16.03) and 6.54 times the prevalence of DO (PR: 6.54, 95% CI: 1.68–36.66) compared to the reference group (G1) (sufficiently active and low SB). Conclusions: Insufficient PA combined with high SB was positively associated with both DAO and DO in the studied population of older adults. Full article

Westernization of traditional diets has been implicated in the rising burden of overweight/obesity and type 2 diabetes, especially in developing countries. In recent times, diet therapy is increasingly being recognized as an essential component of diabetes care. This study assessed the effect of diet therapy on body composition, antioxidant nutrient intake, and glycemic status in individuals living with type 2 diabetes (ILWT2D). In this prospective observational cohort study, 45 ILWT2D who were receiving diet therapy (personalized dietary counseling) in addition to standard medical treatment (intervention group) were compared with 45 ILWT2D receiving only standard medical treatment (comparator group). Antioxidant micronutrient intake was assessed using a 24-h dietary recall. Body composition indices, including body mass index (BMI), percentage body fat (%BF), and visceral fat (VF), were assessed. Participants’ fasting blood glucose (FBG), glycated hemoglobin (HbA1C) levels, and blood pressure (BP) were measured. All measurements were performed before and after a three-month period. There were significant improvements in BMI (27.8 ± 6.0 kg/m² vs. 26.9 ± 5.5 kg/m², p = 0.003), %BF (37.8 ± 11.9% vs. 35.5 ± 10.5%, p < 0.001), visceral fat (9.8 ± 3.4 vs. 9.1 ± 3.2, p < 0.001), systolic BP (136.9 ± 19.9 mmHg vs. 124.6 ± 13.0 mmHg, p < 0.001), FBG (8.8 ± 2.8 mmol/L vs. 6.7 ± 1.5 mmol/L, p < 0.001), and HbA1c (7.3 ± 1.0% vs. 6.4 ± 0.8%, p < 0.001) in the intervention group from baseline to endline, but not in the comparator group. In contrast, %BF increased within the comparator group (39.9 ± 7.8 vs. 40.7 ± 7.4; p = 0.029). Vitamin A intake increased significantly (227.5 ± 184.3 µg vs. 318.8 ± 274.7 µg, p = 0.038) within the intervention group but not in the comparator group (174.9 ± 154.3 µg, 193.7 ± 101.4 µg, p = 0.54). There were no significant changes in zinc, copper, selenium, and vitamin C intakes (p > 0.05) in the intervention group from the baseline to endline, unlike those in the comparator group who showed a significant increase in the intake of these nutrients. There was a significant increase in vitamin A intake among the ILWT2D who received dietary counseling as an intervention compared to those who did not. Additionally, the ILWT2D who received dietary counseling had significant improvements in their body composition (BMI, body fat, and visceral fat) and systolic blood pressure, compared to those who did not. The ILWT2D who received the intervention had significantly better glycemic control (FBG and HbA1c) than their counterparts who did not. Thus, this study suggests the potential of diet therapy as a viable non-pharmacological treatment approach for individuals living with type 2 diabetes. Full article

Background: Worldwide, the awareness about childhood obesity as a public health concern is increasing, particularly in developing countries like Pakistan. Obesity during early childhood may persist into later ages, increasing the risk of chronic illnesses such as diabetes and hypertension. Objective: The aim of this study was to examine the relationship of different types of food groups with obesity among children with normal and stunted growth trajectories in Pakistan. Methods: This cross-sectional study conducted a secondary analysis of Pakistan Demographic and Health Surveys (PDHSs) conducted in the years 2012–2013 and 2017–2018. Data of 1230 healthy and obese children with either normal or stunted growth were analysed after excluding those who were aged below six months, wasted, underweight, or had missing anthropometric or dietary data. The relationship of different food groups with obesity among the children with normal and stunted growth was analysed by bivariate logistic regression. Results: The prevalence of paediatric obesity dropped from 7.3% in 2012–2013 to 2.4% in 2017–2018. However, the coexistence of stunting with obesity—termed the nutritional paradox—slightly increased from 2.8% in 2012–2013 to 3% in 2017–2018. Among the different food groups, the continuation of breastmilk was associated with lowering the odds of obesity by 69% (25% to 88%) among children with normal growth. Conversely, among children with stunted growth, the continuation of breastmilk was associated with an increase in the odds of obesity by 3.71 (1.08 to 12.62) times. Conclusion: Despite the 4.9% reduction in paediatric obesity, cases of the nutritional paradox are still escalating in Pakistan. This reflects an urgent need for targeted nutritional interventions to mitigate the impact of obesogenic diets and reduce the prevalence of childhood obesity in Pakistan. Full article

Body image and mental health outcomes are influenced by both sex and body weight. This study investigated how sex and BMI category (participants classified with healthy weight, overweight, or with obesity) relate to body image, disordered eating, weight bias, global self-esteem and depression. Participants (N = 642; 278 (43.3%) males; 364 females (56,7%)) provided self-report measures of appearance satisfaction, body appreciation, overweight preoccupation, disordered eating scores, weight bias, depression, and self-esteem. The results indicated that women and participants classified with overweight and obesity based on BMI categories reported lower appearance satisfaction and body appreciation and a higher preoccupation with overweight and depression. Interaction effects showed that women participants with overweight and obesity reported particularly low appearance satisfaction and body appreciation. Individuals classified with healthy BMI category reported higher disordered eating scores than those classified with overweight. No significant effects were found for global self-esteem. These findings suggest that sex and BMI contribute to the study’s variables of interest, with some effects more pronounced in women with a higher BMI. The results align with sociocultural theories of appearance pressure but indicate complexity in disordered eating patterns. The findings underscore the importance of adopting intersectional, weight-inclusive, and sex-responsive approaches in both research and clinical practice. Full article

Objective: The present study is a qualitative analysis of participant experiences and perspectives from people who received cognitive remediation therapy for adult obesity (CRT-O). Method: Post-intervention data were generated from an open-ended question requesting the participants to write, in the form of a letter to their therapist, about their experiences and reflections upon taking part in cognitive remediation therapy for adult obesity. Participants’ letters were thematically analyzed. Results: Four themes and nested subthemes emerged from participant responses, including (1) motivation and initial response to CRT-O for the adult obesity study eligibility process with the nested subthemes of initial apprehension pre-intervention and awareness and acknowledgement of one’s problematic eating behaviors; (2) perceived benefits from cognitive remediation therapy for adult obesity with the nested subthemes of the strategies and techniques that were found beneficial and the role of the cognitive remediation therapy for adult obesity therapists in facilitating positive change; (3) perceived outcomes post-intervention with the nested subthemes of changed relationship with food, self-acceptance and gaining control to effect positive lifestyle change; and (4) expectations and beliefs about the longer-term impact of cognitive remediation therapy for adult obesity with the nested subthemes of using the cognitive remediation therapy for adult obesity strategies as a lifestyle routine, apprehension about not having follow-up therapist support, and concern about potential relapse. Conclusion: Our analysis found helpful insights into the consumer perception of this novel intervention and highlighted the clinical utility of implementing cognitive remediation therapy in those living with a higher body weight. Full article

Mississippi has long been one of the most obese states in the U.S., with its obesity rates consistently exceeding the national average. The state’s severe obesity rate is also among the highest in the nation. This study utilized the 2011 to 2021 data from the Mississippi Behavioral Risk Factor Surveillance System (BRFSS) to conduct a comprehensive analysis of obesity and severe obesity trends in Mississippi by sex, age, and race and ethnicity. The data set included a BMI variable calculated by using self-reported height and weight, which the authors categorized into two obesity classification groups—obesity (BMI: 30.00 to 39.99) and severe obesity (BMI: 40.00 or greater)—and demographic characteristics such as sex, age, race and ethnicity. The data were analyzed using SAS 9.4 software to account for the complex design. Weighted prevalence estimates and associated standard errors (SEs) for obesity and severe obesity were calculated. Changes in the prevalence over time were assessed using logistic regression models. The prevalence estimates and SEs were exported to Joinpoint software to calculate the annual percentage change (APC) and associated 95% confidence intervals (CIs) and p-values for the trends. Our analysis of the data revealed a consistent increase in severe obesity, regardless of age, sex, or race. A concerning trend exists where individuals are moving from the obese category to the severely obese category, indicating a worsening trend in overall weight status. This is likely to accelerate the development of chronic disease and, hence, place additional strain on an economically disadvantaged state. Future research should explore the underlying drivers of this shift, including biological, behavioral, and socioeconomic factors, while also evaluating the effectiveness of existing obesity prevention and treatment programs. Full article

Vitamin D deficiency is highly prevalent in individuals with overweight/obesity and this can be largely attributed to the entrapment of VitD in adipose tissue due to impaired lipolytic stimulation. Considering the well-described role of exercise in stimulating lipolysis, the present study investigated the efficacy of multicomponent-type high-intensity interval training (m-HIIT) in increasing 25-hydroxyvitamin D [25(OH)D] levels in males with overweight/obesity. Twenty middle-aged males (43.5 ± 5 years, BMI: 30.7 ± 3.3 kg/m²) participated in three weekly supervised m-HIIT sessions over a 12-week period and underwent assessments at baseline, 6, and 12 weeks. Primary outcomes were total body fat mass, android fat, hepatorenal index, and serum 25(OH)D. Participants’ daily physical activity and dietary intake habits remained unaltered throughout the 12-week training period. The m-HIIT intervention reduced fat mass (by 3% at 12 weeks), android fat (by 3.7% at 6 weeks and 4.4% at 12 weeks), and hepatorenal index (by 8% at 12 weeks). Serum 25(OH)D levels increased by ~14% (+3.21 ng/mL, p = 0.002) and ~31% (+7.24 ng/mL, p < 0.001) at 6 and 12 weeks, respectively. The elevation of 25(OH)D levels at 12 weeks was inversely related to fat mass loss (R = 0.53, p = 0.016). Plasma SGPT, SGOT, ALP, γ-GT, fetuin-A, and calcium levels remained unaltered after the 12-week training period. In conclusion, m-HIIT may be useful as a non-pharmacological intervention to increase circulating VitD levels in adults with overweight/obesity. Full article

Obesity in the Rio Grande Valley (RGV) of Texas remains a critical public health concern, with rates (46.9%) significantly exceeding those of Texas (36%) and the U.S. (34%) (p < 0.001). This study used 2024 County Health Rankings data to analyze environmental and socioeconomic contributors to obesity across 240 Texas counties, with a population-weighted focus on Hidalgo, Cameron, Starr, and Willacy counties. The RGV exhibited markedly poorer access to exercise, higher rates of physical inactivity, lower Food Environment Index scores (FEI = 4.3 vs. 5.7 in Texas), higher rates of uninsurance, worse patient-to–primary care physician (PCP) ratios (2152:1 vs. Texas 1660:1), and increased preventable hospitalizations. Multiple linear regression identified physical inactivity (β = 0.6, p = 0.01) and access to exercise (β = −0.02, p = 0.02) as significant predictors of obesity. Notably, higher uninsured rates were associated with lower reported obesity, likely due to underdiagnosis in the absence of routine care. These findings emphasize the need for targeted interventions addressing food access, environmental and recreational infrastructure, along with healthcare infrastructure in the RGV, where socioeconomic disadvantage and structural barriers magnify the impact of national obesity trends on the regional level. Full article

Despite being acknowledged as a complex and multi-faceted condition, the prevailing view within society is that obesity is the result of individual choices and can be reversed simply by “eating less and moving more”. This is oversimplistic and leads to the view that obesity is the individual’s fault and is therefore their responsibility to remedy. These views are grounded in individuals’ beliefs around health and contribute to weight bias and stigma. In the present study, participants (n = 143) completed a cross-sectional survey which explored views around weight and health and whether weight bias or stigma differed based on demographic characteristics, weight status, and prior experience of weight stigma. Results indicate differences in the way individuals living with overweight and obesity are viewed in comparison with those of a healthy weight, with the former viewed in a more negative light. Interestingly, while women presented with higher weight bias scores (p = 0.036), men scored higher for externalised weight stigma (p = 0.001). Weight status was seen as an important factor contributing to overall health. These results demonstrate that weight bias and stigma are prevalent and highlight the need for further measures to reduce stigmatising views of people living with overweight and obesity. Full article