Obesities

The Mediterranean lifestyle (ML), encompassing key elements such as the Mediterranean diet (MD), regular physical activity, social engagement, sleep-enhancing habits, sustainable food practices, including reducing food waste and opting for seasonal and local products, proximity to nature, and a focus on slow living, has garnered increasing interest for its potential in obesity prevention and management. This narrative review examines how these lifestyle characteristics may influence body weight regulation, metabolic health, and obesity-related outcomes. A thorough literature search was conducted to synthesize findings from epidemiological studies, clinical trials, and mechanistic research. Evidence suggests that adherence to the MD is linked to lower obesity rates, improved metabolic markers, and reduced risk of weight gain. Key components contributing to these effects include high fiber intake, healthy fatty acids from olive oil and nuts, and a balanced macronutrient profile that promotes satiety and reduces inflammation. Furthermore, lifestyle practices such as regular physical activity, strong social connections, and sleep-enhancing habits may further support weight management. Despite consistently favorable findings in observational studies, intervention trials reveal variability in individual responses, highlighting the need for personalized approaches. Future research should explore strategies to enhance adherence to the MD and investigate the interactions between diet, physical activity, and psychosocial factors in obesity prevention. Full article

Introduction: Adequate protein intake is essential for maintaining lean body mass during weight loss, particularly for patients undergoing bariatric surgery (BS). Whey protein supplementation may help meet daily protein requirements. This study aimed to assess the effects of whey protein supplementation on weight loss and body composition in women during the medium-term postoperative phase following BS. Methods: In a double-blind, controlled study over four weeks, 24 women received 30 g of whey protein (Whey group), while 19 received 30 g of maltodextrin (Malto group). Body composition, energy expenditure, muscle thickness, muscle strength, walking performance, and dietary intake were evaluated. Results: Compared to the Malto group, the Whey group showed greater reductions in body weight (median: −0.6 kg vs. −0.2 kg, respectively) and fat mass (median: −1.1 kg vs. −0.25 kg, respectively), along with an increase in fat-free mass (−0.7 kg vs. 0.6 kg, respectively). Muscle thickness improved in the Whey compared to the Malto group in the abdominal (0.07 mm vs. −0.04 mm, respectively) and thigh (0.4 mm vs. −0.15 mm, respectively) regions. Additionally, muscle mass reduction was less pronounced in the Whey group (−3 kg vs. −0.13 kg). No significant differences were observed in handgrip strength, gait speed, or nutrient intake. Conclusions: Whey protein supplementation may be beneficial, as it enhances weight loss and preserves fat-free and muscle mass more effectively than a diet without this supplementation in women during the stabilization phase or late postoperative period of BS. Full article

Given the ubiquity of anti-fat prejudice, in this experimental study, we tested whether weight gain attributed to COVID-19 would influence evaluations of overweight male and female targets. Female participants (N = 160) were randomly assigned to read one of four mock medical forms that outlined distractor medical information (e.g., blood requisition results), the sex of the target (male vs. female) and stated reason for weight gain (unhealthy lifestyle choices vs. inactivity due to the COVID-19 lockdown). Participants evaluated the patient on a series of binary adjectives (e.g., lazy/industrious), and completed measures assessing anti-fat attitudes (i.e., fear of becoming fat and belief in the controllability of weight), internalization of ideal standards of appearance, and BMI (i.e., self-reported weight and height). Contrary to our predictions, we found that overweight male and female patients were evaluated similarly regardless of whether their weight gain was attributable to unhealthy lifestyle choices or inactivity due to the COVID-19 pandemic. Finally, believing that one’s weight is controllable and internalizing general standards of attractiveness correlated positively with fat disparagement of the medical patients. Participants’ BMI and fear of fat, however, were negligibly related to fat disparagement. Possible explanations for our findings, implications for healthcare settings, and directions for future research are explored. Full article

The feminist perspective is relevant to the understanding, prevention, and treatment of disturbances in eating and body image. However, limited empirical research has explored the relationship between feminist identity and weight stigma. The present study examined the associations between feminist beliefs, externalized weight bias, internalized weight bias, body image, and eating disturbances. Two hundred sixty-five racially and ethnically diverse young women were recruited from a university in the Pacific Rim. Participants completed questionnaires online and interrelationships were examined using a series of regressions. Externalized weight bias was significantly negatively associated with both feminist beliefs and identification as a feminist. However, stronger feminist beliefs and identity were significantly associated with higher internalized weight bias, worse body dissatisfaction, and greater incidence of eating disturbances. The results of the present study suggest that structural change driven by feminist values and principles may be effective for reducing weight bias and possibly other risk factors present in broader society but potentially less effective on an individual level. Longitudinal research is needed to confirm the direction of these relationships and to understand which components of feminist theory and feminist values can be most helpful in reducing weight bias on an individual level, while still addressing structural change. Full article

Obesity-Related Multimorbidity (ORM) is understood as the group of secondary diseases caused by metabolic alterations that arise from obesity. Nowadays there is a growing incidence of people with ORM who seek health services. Since this condition substantially impacts nutritional status and therefore in the survival prognosis during the hospital stay, ORM represents a challenge for health professionals. This forces doctors to specify nutritional recommendations according to clinical characteristics in individuals with obesity and types of comorbidities. Therefore, the objective of this narrative review is to present the current evidence-based recommendations that support the hospital nutritional care process for individuals with ORM. It concludes that nutritional treatment is complex and gaps in the research regarding this population group still exist. Because there are no specific guidelines for nutritional screening tools, calculating total energy requirements (alternatives to indirect calorimetry), determining fluid, protein, and immunonutrient requirements, the use of parenteral nutrition in ORM with kidney, liver, and heart failure and sarcopenic obesity that should be addressed in the new literature. For now, the standard practice in these cases is to prioritize the problem to be treated according to the maximum clinical benefit. Despite this, it is established that the nutritional care process must be systematic to be clear and objective. This document is addressed to all healthcare professionals who make up the multidisciplinary nutritional support team. Full article

This study examined the mediating role of prenatal cortisol on the relationship between gestational weight or adiposity and postpartum depression (PPD), while considering the moderating roles of breastfeeding (BF) or socioeconomic resources. We hypothesized that women with a higher pre-pregnancy body mass index (PPBMI) or a larger abdominal circumference would have elevated diurnal cortisol levels in late pregnancy, which would predict more PPD symptoms. Additionally, we hypothesized that BF and access to more socioeconomic resources would buffer the positive relationship between prenatal diurnal cortisol and PPD symptoms. We used longitudinal data from the Infant Development and Health Outcomes in Mothers Study, in which women self-reported PPBMI, BF frequency at 6 months, familial education, occupation, and income and completed the Edinburgh Postnatal Depression Scale. The abdominal circumference, cortisol area under the curve with respect to ground (AUC_G), and cortisol awakening response (CAR) were measured. Higher breastfeeding frequency and greater socioeconomic resources were associated with fewer PPD symptoms. There were main and interactive associations of AUC_G with BF frequency with PPD. Notably, higher cortisol levels were linked to more PPD symptoms among women with less frequent BF. Thus, BF may mitigate the relationship between prenatal stress and PPD, highlighting the importance of BF support in PPD prevention. Full article

This study examines the spatial and temporal evolution of obesity among adults in Italian regions. In Italy, regional administrative areas are responsible for providing health services. Moreover, Italian regions present different socioeconomic conditions and health and nutritional habits. As a result, a regional analysis of the spatiotemporal evolution of obesity allows the identification of key areas for prevention and control, enabling the design of more targeted and effective interventions. In this study, the geographic clustering of obesity in Italy was explored by analyzing the local spatial autocorrelation of regional-level prevalence rates of adulthood obesity between 2010 and 2022, updating and expanding the existing literature. Data from the Health For All repository are analyzed to determine distribution patterns and trends, employing choropleth maps, Moran’s Index and Welch’s t-test. Gender inequalities have been underlined both in the spatial and temporal distribution. Results show that obesity exhibits spatial clustering, with greater severity in the south. During the period under analysis, obesity prevalence rates in Italy show a tendency to grow, with a sharp increase during the COVID-19 lockdown. Full article

Excessive sugar consumption has been reported to be associated with various health issues such as obesity, diabetes, cardiovascular diseases, and dental problems. In the UK, effective strategies have been implemented to reduce sugar intake, including the Change4Life Sugar Smart campaign, product reformulation, traffic light labelling, portion control, and the Soft Drinks Industry Levy (SDIL). This review of empirical studies (n = 11) shows that product reformulation, especially in beverages and packaged foods, is effective, as consumers can prefer reduced-sugar alternatives when clearly labelled. The UK traffic light labelling scheme and portion control were also reported to help consumers make informed, healthier food choices. The SDIL, introduced in 2018, was also found to significantly lower sugary beverage consumption. While progress is evident, further nutrition education, public awareness, particularly for people with low socioeconomic status, and more comprehensive policies for long-term positive dietary behavioural shift are essential to limit diseases and conditions associated with high sugar consumption. Future research must evaluate the combined effects of these interventions and examine their long-term effectiveness across diverse population groups. Full article

Lycium barbarum (L. barbarum), commonly known as goji berry, is a functional food recognised for its diverse phytochemical composition and health benefits, particularly in metabolic health and disease prevention. This review explores its phytochemistry, focusing on polysaccharides, carotenoids, polyphenols, and alkaloids, which contribute to its extensive biological activities. L. barbarum polysaccharides, the primary bioactive components, exhibit antioxidant, immunomodulatory, and glycaemic-regulating properties, making them promising candidates for managing obesity-related metabolic disorders. Carotenoids, particularly zeaxanthin, play a key role in ocular health, while polyphenols and alkaloids enhance antioxidant, antimicrobial, and hepatoprotective effects. The biological properties of L. barbarum span metabolic health, cardiovascular function, and glycaemic control, alongside neuroprotection and cancer prevention. Its prebiotic effects on gut microbiota modulation offer additional benefits in managing obesity and associated complications. Furthermore, its antioxidant and anti-inflammatory activities support its role in alleviating oxidative stress and chronic inflammation, common in obesity and metabolic syndrome. Despite robust preclinical evidence, further studies are needed to validate its safety, efficacy, and long-term potential in human populations. This review highlights L. barbarum’s promising applications as a nutraceutical and therapeutic agent, particularly for metabolic and obesity-related health challenges. Full article

The diagnosis of obesity is conventionally determined by the Body Mass Index (BMI), with a threshold of 30 being extensively accepted. However, the validity of this cutoff point is subject to variation due to ethnic differences, and its accuracy in the Mexican population remains unvalidated. This cross-sectional, observational, and analytical study endeavored to assess the diagnostic performance of BMIs ≥ 30 in comparison to body fat determination using bioimpedance. A total of 715 Mexican adults, aged over 18 years were analyzed. Anthropometric measurements, including weight, height, and BMI, were recorded, and body fat percentage was assessed. The results showed that BMIs ≥ 30 had a sensitivity of 62.4%, a specificity of 93.9%, a positive predictive value (PPV) of 95.5%, and a negative predictive value (NPV) of 54%. In contrast, a BMI cut-off of ≥27 demonstrated superior diagnostic performance, with a sensitivity of 81.3%, specificity of 82.5%, PPV of 90.8%, and NPV of 67.3%. The chi-square test revealed a significant difference in obesity diagnosis between bioimpedance and BMIs ≥ 30 (p < 0.05). These findings suggest that the current BMI cutoff of ≥30 underestimates obesity diagnosis, while a cutoff of ≥27 may provide a more accurate diagnostic threshold, emphasizing the necessity for population-specific adjustments. Full article

(1) Background: Spatial energy expenditure patterns, driven by physical activity, particularly among females, remain underexplored in Ghana. This study, therefore, investigates spatial energy expenditure clustering or dispersion patterns using metabolic equivalents of task (METs) values among Ghanaian females across rural and urban areas. (2) Methods: Using 13,799 data from the 2022 Ghana Demographic and Health Survey, METs values were assigned to self-reported occupation categories as proxies for physical activity. Global and local spatial autocorrelation metrics (Queen contiguity and Moran’s I) were employed to assess spatial clustering or dispersion of METs values across the 16 administrative regions. (3) Results: Rural females reported higher METs (mean = 3.35 ± 1.627) and lower BMI (23.476 ± 3.888) than urban females (METs: mean = 2.42 ± 1.208, BMI: 25.313 ± 4.854). There was a significant but weak global spatial autocorrelation (Moran’s I = 0.003, p-value = 0.001), with stronger clustering observed in rural (Moran’s I = 0.004, p-value = 0.001) than in urban areas (Moran’s I = 0.002, p-value = 0.002). Also, High–High clusters were prevalent in the Northern, Savannah and Northeast regions particularly due to the lingering labour-intensive occupations as compared to Low–Low clusters in the Eastern and Greater Accra regions where jobs are often desk-based and sedentary. (4) Conclusions: Given the revealed geographic heterogeneity (High–High and Low–Low clustering) of female energy expenditure in Ghana, there is a need for regionally tailored health policies targeting physical inactivity and its associated risks. Full article

Background: Obesity adversely affects sleep quality through mechanisms such as obstructive sleep apnea (OSA) and hormonal imbalances that disrupt the circadian rhythm. High-intensity interval training (HIIT) helps reduce fat, inflammation, and stress, which in turn leads to improvements in deep and restful sleep. Method: This study aimed to examine the effects of HIIT on sleep quality in obese patients through a systematic review and meta-analysis of studies published in five databases: PubMed, Scopus, Ovid, The Cochrane Library, and Google Scholar. Randomized controlled trials (RCTs) comparing obese patients undergoing HIIT with control groups and assessing sleep quality via subjective measures such as the Pittsburgh Sleep Quality Index (PSQI) and objective assessments were included. Result: Eight eligible studies were identified, with six included in the meta-analysis, comprising a total of 191 participants. The analysis revealed that HIIT significantly improved overall sleep quality, as evidenced by a reduction in PSQI scores (mean difference, −3.51; 95% CI (−4.78, −2.25); p < 0.001). Significant improvements were also observed in PSQI subscales, including sleep duration (mean difference, −0.42; 95% CI (−0.58, −0.26); p < 0.001), habitual sleep efficiency (mean difference, −0.32; 95% CI (−0.59, −0.05); p = 0.02), and daytime dysfunction (mean difference, −0.66; 95% CI (−1.27, −0.05); p = 0.03). Moreover, HIIT led to a notable reduction in OSA severity, as reflected by lower Apnea–Hypopnea Index (AHI) scores (mean difference, −28.31, 95% CI (−34.39, −22.22); p < 0.001). Conclusion: HIIT significantly improves sleep quality in obese patients and reduces the severity of obstructive sleep apnea. Further long-term studies with improved control of confounding factors are recommended to validate and strengthen these findings. Full article

Reducing abdominal subcutaneous fat is a common concern among women, with evidence suggesting that combining aerobic exercise with external shock waves or radiofrequency may enhance fat reduction. This study aimed to assess the effects of six sessions of external shock wave therapy or radiofrequency combined with an aerobic exercise program on abdominal subcutaneous fat and lipid mobilization, compared to the effects of an aerobic exercise program alone. Thirty-one women (aged 18–60) were randomly assigned to three groups: EG1 (shockwave therapy + aerobic exercise), EG2 (radiofrequency + aerobic exercise), and CG (aerobic exercise only). Body composition measures, mean temperature, adipose tissue thickness, lipid profile, and glycerol and interleukin-6 levels were assessed before and after intervention. A significant decrease in the EG groups compared to the CG was observed in the subcutaneous abdominal thickness (p < 0.001, effect size of η²p = 0.446) and waist–hip ratio (p ≤ 0.001, effect size of η²p = 0.408). No significant changes were verified in the levels of lipolytic activity, lipid profile, and interleukine-6. Six sessions of shockwave or radiofrequency therapy combined with aerobic exercise reduced subcutaneous fat thickness and improved hip–waist ratio more effectively than aerobic exercise alone, without affecting lipid mobilization by changes in lipid profile, lipolytic activity, or interleukin-6 levels. Full article

In aging, chronic diseases such as obesity accelerate metabolic dysfunction through chronic inflammation and insulin resistance. This review compared three different dietary strategies to evaluate their mechanisms and benefits for metabolic health and longevity. A comprehensive database search was conducted, selecting studies in animal models and in humans with or without obesity which have been published since 2004. Fasting-mimicking diets reduce IGF-1, promote autophagy, and improve insulin sensitivity, although long-term adherence remains a challenge. Time-restricted feeding synchronizes food intake with circadian rhythms, benefiting inflammation, glycemic control, and body composition. Protein and amino acid restriction, particularly methionine and branched-chain amino acids, modulates mTOR and reduces oxidative stress but requires adjustments in older adults. According to the available evidence, each intervention offers a non-invasive and adaptive approach to mitigating the effects of aging, provided it is applied in a personalized manner with appropriate follow-up. Full article

Background/Objectives: Obesity is a chronic, progressive, recurrent disease associated with impaired health, affecting an increasing proportion of the population worldwide. Newer-generation incretin-based therapies (IBTs) (liraglutide, semaglutide, and tirzepatide) have shown greater efficacy than older anti-obesity medications. This systematic literature review provides an overview of the evidence on the symptomatic adverse events (AEs) and patient-reported outcomes of IBTs to facilitate clinical decision-making. Methods: A systematic search was conducted using a predefined search strategy to identify controlled trials and real-world evidence (RWE) studies assessing IBTs. Results: Among 4414 publications identified, 81 (>400,000 participants) were included. Liraglutide (n = 49), semaglutide (n = 34), and tirzepatide (n = 7) were used in 48 clinical and 33 RWE studies. Gastrointestinal (GI) AEs were most common: placebo-subtracted incidences were 5–39% for nausea, −7–39% for diarrhea, 2–31% for constipation, 0–26% for vomiting, and 2–20% for abdominal pain, with no clear difference across IBTs. Most AEs were mild or moderate and mainly occurred during dose escalation. Quality of life outcomes were reported in 27 publications and generally showed improvements with IBTs. Conclusions: This study confirms that GI AEs are common with IBTs. Clinicians should keep the AE profile of IBTs in mind and consider where additional preventative measures may be required. Full article

The rise in obesity and its associated health problems increases the need for therapeutic approaches such as bariatric surgery. Therefore, this study aims to explore the changes in the anthropometric and body composition characteristics of patients undergoing bariatric surgery. A retrospective longitudinal study was conducted in subjects ≥ 18 y who underwent bariatric surgery and attended one nutrition appointment before and after surgery. Information on their sex, age, weight, fat mass (kg and %), fat-free mass (kg and %), and skeletal muscle mass, obtained using bioelectrical impedance, and on their waist circumferences was collected. Their BMIs and skeletal muscle mass indexes were calculated. The differences in the anthropometric and body composition parameters between pre- and post-surgery were also calculated. The participants were grouped by sex, age groups (18–44 y and 45–69), and type of surgery (Roux-en-Y gastric bypass and gastric sleeve). The variables are presented as n (%) and as means (SDs) or medians (interquartile ranges). Student’s t-test and the Mann–Whitney test were employed (p < 0.05). The sample consisted of 57 subjects (aged 18–69 years; 75% women). Between the pre- and post-surgical periods (63 (42) days), their weight (mean: 103.0 (SD: 16.3) kg vs. 91.2 (14.2) kg, p < 0.001); BMIs (37.9 (4.2) kg/m² vs. 33.6 (4.1) kg/m², p < 0.001); waist circumferences (116.2 (12.4) cm vs. 105.7 (12.3) cm, p < 0.001); % fat mass (45.5 (6.0) vs. 41.0 (8.0), p < 0.001); skeletal muscle mass (32.8 (7.4) kg vs. 30.3 (6.5) kg, p < 0.001); and skeletal muscle mass indexes (12.0 (1.8) kg/m² vs. 11.1 (1.7) kg/m², p < 0.001) decreased; meanwhile, their % fat-free mass increased (54.7 (6.0) vs. 59.0 (8.0), p < 0.001). Most of these changes occurred regardless of sex, age, or type of surgery. Shortly after bariatric surgery, patients show a better nutritional status and body composition. Full article

Background/Objectives: Metabolic syndrome (MetSy) comprises a cluster of risk factors—including obesity, dyslipidaemia, hypertension, and impaired glucose metabolism—that increase the risk of cardiovascular disease, type 2 diabetes, and other conditions. There are close ties between the complications and outcomes of obesity and MetSy. The practical value of MetSy as a distinct diagnosis in primary care remains uncertain. This study aimed to explore general practitioners’ (GPs) perspectives on the utility of MetSy for diagnosing and managing patients in light of evolving concepts in the field of metabolic health. Methods: A qualitative study design was employed, with semi-structured interviews conducted among 15 GPs in rural Western Australia. Participants were recruited via GP networks with convenience and snowball sampling. Transcribed interviews were thematically analysed using Braun and Clarke’s reflexive approach, with iterative coding, theme identification, and member checking to ensure trustworthiness. Results: GPs generally recognized MetSy as a constellation of risk factors that heighten the risk of cardiovascular disease. Insulin resistance was frequently identified as a unifying pathophysiological driver. Nevertheless, most participants did not routinely diagnose MetSy in clinical practice, rather focusing on treating individual component conditions (e.g., obesity, hypertension, dyslipidaemia) due to readily available disease-specific guidelines. Only a minority of GPs actively used the MetSy concept for patient education to highlight interconnected risks and the potential benefits of holistic lifestyle interventions. Paucity of dedicated MetSy management guidelines and uncertainty around diagnostic criteria further hindered routine application of the syndrome in practice. Conclusions: While GPs are aware of MetSy and its broad implications, few use it as a distinct clinical tool. Development of tailored guidelines and expanded educational resources would empower GPs to integrate a more holistic, MetSy-focused approach to patient care. Full article

Obesity represents a global health challenge, with a critical and urgent need for long-term, sustainable management strategies. Tirzepatide is a novel dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist. At first approved for the treatment of type 2 diabetes mellitus, tirzepatide represents one of the latest clinically approved and commercially available pharmacological options for obesity management. This narrative review aimed to synthesize existing clinical evidence on the efficacy and safety of tirzepatide in non-diabetic obese individuals. A comprehensive literature search was conducted using the PubMed, Scopus, Web of Science, ClinicalTrials.gov, and Google Scholar databases to identify relevant clinical trials, meta-analyses, and original studies assessing the weight-loss impact of tirzepatide from 2022 onwards. Synthesized evidence indicated that tirzepatide achieved up to 20.9% weight loss over 72 weeks (SURMOUNT-1), 18.4% after lifestyle intervention (SURMOUNT-3), 17.5% in Chinese adults (SURMOUNT-CN), and 25.3% with continued treatment over 88 weeks (SURMOUNT-4). Meta-analyses confirmed higher odds of ≥5–20% weight loss versus semaglutide and liraglutide, significantly reducing body mass index, waist circumference, blood pressure, and atherosclerotic cardiovascular disease risk. Health-related quality of life improved with greater weight loss, and gastrointestinal side effects (nausea, diarrhea, constipation) were common but mild to moderate, with <5% treatment discontinuation. Tirzepatide achieved significant weight loss, cardiometabolic benefits, and improved quality of life in non-diabetic obese individuals, but further research is needed on long-term efficacy, safety, and clinical application. Full article

Obesity is one of the most pressing global public health challenges of the 21st century, affecting over a billion people worldwide. Poland, like many industrialized countries, is experiencing a rapid increase in obesity prevalence across all age groups. This review provides a comprehensive analysis of the obesity trends in Poland in relation to global patterns, emphasizing the complex interplay of dietary habits, physical inactivity, screen time, socioeconomic determinants, and gut microbiota composition. Special attention is given to the health and economic consequences of obesity and the inefficiencies in Poland’s public health response. The article also discusses novel research directions, including the role of hypothalamic BNC2 neurons and NK2R receptors in appetite regulation and energy expenditure, as well as the cellular heterogeneity of adipose tissue. These discoveries may open new avenues for personalized obesity therapies. The findings underscore the urgent need for coordinated, interdisciplinary strategies at the national and international levels to reduce the burden of obesity and improve long-term health outcomes. Full article