Search Results (1,854)

Obesity is a multidimensional condition characterized by autonomic imbalance, metabolic inflexibility, impaired physical resilience, and ectopic adiposity, pathophysiological alterations that arise long before overt cardiometabolic disease becomes clinically detectable. Despite this, current cardiometabolic risk scores continue to rely predominantly on biochemical and anthropometric variables, such as BMI, waist circumference, glucose, and lipid levels. While these markers are practical, inexpensive, and validated across large population cohorts, growing evidence shows that they offer limited incremental predictive value and fail to capture early functional and structural abnormalities. The recent literature highlights the prognostic importance of autonomic dysfunction, reduced metabolic flexibility, diminished cardiorespiratory fitness, impaired muscular strength, and ectopic fat depots including visceral and epicardial adiposity, independently of the traditional anthropometric indices. The domains remain absent from traditional algorithms such as the Metabolic Syndrome criteria, the Framingham Risk Score, and SCORE2. As a result, cardiometabolic risk is frequently underestimated in key subgroups, including young adults with obesity, individuals with high visceral adiposity but normal BMI, those with subclinical myocardial dysfunction, and metabolically unhealthy normal-weight phenotypes. This narrative review synthesizes current evidence on obesity-related cardiometabolic impairment, highlights major gaps in established risk scores, and supports the conceptual development of the C.O.R.E. (Cardio-Obesity Risk Evaluation) Indicator Model—a hypothesis-generating, non-validated multidomain framework integrating autonomic, metabolic, functional, and structural markers to enable earlier risk phenotyping in future studies. Full article

Background: The prevalence of being overweight and of obesity among women of childbearing age is constantly increasing. Objectives: To analyze the critical periods and goals of women’s weight management from early pregnancy to 3 years postpartum. Methods: Women’s weight was tracked from the first trimester of pregnancy to 3 years postpartum. We calculated their gestational weight gain (GWG) and postpartum weight retention (PPWR), and used linear mixed models and logistic models to estimate weight change velocities and risk factors associated with overweight/obesity at 1–3 years postpartum. Results: The medians of pre-pregnancy BMI (pre-BMI) and GWG among the 641 participants were 20.1 kg/m² and 15.0 kg. Among women with pre-BMI < 24 kg/m², those with excessive GWG remained at higher weights within 1.5 years postpartum than those with appropriate GWG (p < 0.05). Women’s weight decreased from 42 days to 1 year postpartum (β = −0.31 for low pre-BMI, β = −0.24 for normal pre-BMI, both p < 0.05), and remained unchanged from 1 to 3 years (p > 0.05). The rate of being overweight/obese at one year postpartum was mainly associated with pre-pregnancy weight (as a continuous variable, aOR = 1.58, 95%CI: 1.44–1.74) and 1-year PPWR (aOR = 1.78, 95%CI: 1.48–2.15). Compared with women who maintained normal BMI, those who shifted to being overweight/obese had higher pre-BMI and 1-year PPWR (22.6 kg/m² vs. 20.3 kg/m², 7.0 kg vs. 1.0 kg, p < 0.01). Conclusions: Normal and relatively low pre-BMI (18.5–22.0 kg/m²) and less than 2.0 kg of 1-year PPWR are goals of women’s weight management. Full article

Metabolic syndrome (MetS) is a multifactorial disorder characterized by central obesity, insulin resistance, dyslipidemia, and hypertension, all of which increase the risk of type 2 diabetes and cardiovascular diseases. This study investigates the potential complementary effects of the standardized green and black ADM ComplexTea Extract (CTE) and the heat-treated postbiotic (BPL1^® HT) on the cardiometabolic alterations associated with MetS in a murine model. C57BL/6J mice were fed a high-fat/high-sucrose (HFHS) diet and treated with CTE, BPL1^® HT, or their combination for 20 weeks. Metabolic, inflammatory, oxidative, vascular parameters, and fecal microbiota composition were assessed. Both CTE and BPL1^® HT individually attenuated weight gain, organ hypertrophy, insulin resistance, and inflammation. However, their combined administration exerted synergistic effects, fully normalizing body weight, adipocyte size, lipid profiles, HOMA-IR index, and insulin sensitivity to levels comparable to lean controls. Co-treatment also restored PI3K/Akt signaling in liver and muscle, reduced hepatic steatosis, and normalized the expression of inflammatory and oxidative stress markers across multiple tissues. Furthermore, vascular function was significantly improved, with enhanced endothelium-dependent relaxation and reduced vasoconstrictor responses, particularly to angiotensin II. CTE, BPL1^®HT, and the blend prevented bacterial richness reduction caused by HFHS; the blend achieved higher bacterial richness than mice in Chow diet. Additionally, the blend prevented the increase in Flintibacter butyricus, which is associated with MetS clinical parameters, and showed a tendency to increase the abundance of Bifidobacterium. These findings suggest that the combination of CTE and BPL1^® HT offers a potential nutritional strategy to counteract the metabolic and cardiovascular complications of MetS through complementary mechanisms involving improved insulin signaling, reduced inflammation and oxidative stress, enhanced vascular function, and modulation of gut microbiota. Full article

Background/objectives: Metabolic abnormalities, independent of excess weight, may contribute to cancer risk even among individuals of normal weight, though their role remains unclear. This study sought to ascertain if metabolically unhealthy normal-weight (MUNW) individuals, generally characterized by a normal body mass index alongside the presence of metabolic abnormalities, have higher cancer risk than metabolically healthy peers, to analyze variations in risk across obesity-related cancer types, and to examine which single specific metabolic components can predict cancer independently in normal-weight individuals. Methods: Two authors systematically searched the PubMed, EMBASE, and Web of Science databases for longitudinal studies, published from inception to July 2025, that included normal-weight adults, classified participants by metabolic health status, and reported incident cancer outcomes in metabolically unhealthy versus healthy normal-weight groups. Hazard ratio (HR) estimates were extracted from each study and were pooled using random-effects inverse-variance model with empirical Bayes variance estimator. Results: Thirty-five studies involving 18,210,858 participants (56.0% females, mean age = 53.8 years) were included. A total of 280,828 new cancer cases were diagnosed during follow-up (mean = 10.6 years). In comparison with metabolically healthy normal-weight individuals, MUNW individuals had a 20% higher risk of cancer (HR = 1.20, 95% confidence interval [CI]: 1.13–1.28). Increased risks were observed for gastric cancer (HR = 1.40, 95% CI: 1.04–1.87), pancreatic cancer (HR = 1.37, 95% CI: 1.21–1.54), and colorectal cancer (HR = 1.34, 95% CI: 1.14–1.57), which were the cancer types showing statistically significant associations in subgroup analyses. Normal-weight participants presenting specific metabolic factors like central adiposity or glucose metabolism abnormalities had a 20% (HR = 1.20, 95% CI: 1.13–1.37) and 23% (HR = 1.23, 95% CI: 1.06–1.41) increased cancer risk, respectively. Conclusions: MUNW individuals are at higher risk of cancer, with specific metabolic abnormalities, particularly central adiposity and impaired glucose regulation, emerging as the factors most strongly associated with increased risk in normal-weight individuals. Routine metabolic screening and detailed phenotyping are crucial to identify these risks. Full article

Background: Maternal overweight and obesity, which show a rising trend globally, are associated with adverse pregnancy outcomes and long-term health risks for both mother and child. Awareness and understanding of these risks among women of reproductive age are essential for effective prevention and early intervention. Methods: We conducted a cross-sectional survey among 958 women planning pregnancy, currently pregnant or breastfeeding to assess their knowledge and attitudes regarding overweight and obesity in the perinatal period. The questionnaire covered lifestyle behaviors, breastfeeding practices, and knowledge related to overweight and obesity in pregnancy. Results: Overall knowledge regarding the consequences of maternal overweight and obesity was low, with notable deficits in understanding the associated health risks and frequent misconceptions about dietary recommendations during pregnancy. Awareness gaps were particularly noticeable in domains related to fetal outcomes and recommended energy requirements across pregnancy. Excessive gestational weight gain was reported in over 75% of pregnancies, including among women with normal body mass index. Participation in antenatal classes, current breastfeeding and older age were significantly associated with higher knowledge; however, these factors together explained only 6.2% of variability. Still, several key aspects were not well recognized despite high educational attainment and frequent contact with maternity care services. Conclusions: Our study highlights a clear and urgent need for better, more targeted educational strategies to improve women’s understanding of metabolic health and nutrition before and during pregnancy. The low explained variance indicates that maternal knowledge is influenced by multifactorial and not easily captured determinants, emphasizing the need for comprehensive and individualized educational approaches. Enhancing maternal awareness could support better health outcomes for both mothers and their offspring. Full article

Lipodystrophies are rare syndromes characterized by partial or complete loss of subcutaneous adipose tissue leading to ectopic lipid deposition, insulin resistance, and the same metabolic derangements observed in obesity. Given the role of gut microbiota in metabolic disorders, we investigated whether its signature in obesity may be mirrored by that found in lipodystrophies, possibly contributing to their overlapping metabolic abnormalities. In this cross-sectional study, we included 8 individuals with lipodystrophy (LD), 16 individuals with obesity (Ob)—further categorized into 8 metabolically healthy (MHO) and 8 metabolically unhealthy (MUHO)—and 16 normal-weight controls (N). We assessed clinical and metabolic characteristics and performed 16S rRNA sequencing and bioinformatic analyses on fecal samples to characterize the gut microbiome. LD presented significantly lower body mass index (BMI) and waist circumference than Ob, but, from a metabolic perspective, LD showed similarity with MUHO and presented significantly lower levels of HDL-C and higher triglycerides compared to both N and MHO. Gut microbiota analysis revealed reduced α-diversity in LD, MHO and MUHO compared to N, whilst β-diversity and Firmicutes/Bacteroidetes ratio differences were not significant. At the phylum level, differential abundance analysis revealed that LD individuals exhibit similar microbial characteristics to MUHO and higher Verrucomicrobiota levels compared to MHO. The shared gut microbiota signature suggests another potential unexplored link between the pathogenesis of metabolic complications in lipodystrophies and obesity, providing novel insights into the complex interplay between dysbiosis and adiposopathy. Larger longitudinal studies are needed to explore the role of specific taxa and for a more precise characterization of different lipodystrophy subtypes. Full article

Obesity and metabolic disorders are an increasing concern in companion animals, creating demand for herb-derived nutraceuticals and functional feeds. This study evaluated whether a water extract of Aster pekinensis (AP) ameliorates high-fat-diet (HFD)-induced obesity and metabolic dysfunction in mice. The phytochemical profile of AP was characterized by mass spectrometry, revealing oleanane-type triterpenoid saponins and dicaffeoylquinic acids. Male C57BL/6 mice were fed an HFD and orally given AP (10–200 mg/kg/day) for 12 weeks, with normal diet and untreated HFD groups as controls. AP at 50–200 mg/kg/day reduced body-weight gain, adipose tissue mass and food efficiency without lowering food intake, and improved fasting glucose and atherogenic lipid indices. AP also enhanced glucose tolerance and insulin sensitivity, attenuated hepatic steatosis, hepatocellular ballooning, lobular inflammation and non-alcoholic fatty liver disease (NAFLD) Activity Score, and decreased serum liver enzyme activities. These effects were accompanied by modulation of hepatic genes involved in lipogenesis and inflammation. Together, these findings indicate that AP extract mitigates diet-induced obesity and NAFLD-like liver injury and supports further development as a herb-derived nutraceutical or functional feed ingredient for managing obesity-related metabolic disorders in companion animals. Full article

The increasing prevalence of obesity-related primary arterial hypertension (PAH) in the pediatric population emphasizes the need to develop new biomarkers that can aid in clinical practice for prevention or early diagnosis of the cardiovascular disease. The objective of the present study was to evaluate the relationship between selected adipokines, cytokines, and blood pressure (BP) values in children with obesity. A total of 78 children participated in the study: 60 children with obesity (study group) and 18 children with normal weight (control group). Blood pressure was measured according to guidelines. Serum levels of metabolic and inflammatory markers, including leptin, adiponectin, resistin, ghrelin, interleukin 6 (IL-6), interleukin 10 (IL-10), tumor necrosis factor α (TNF-α), vascular endothelial growth factor (VEGF), and insulin were determined using multiplex immunoassays. Statistical analysis included correlation and ROC tests to identify potential predictors of PAH. The study group had significantly higher systolic and diastolic BP compared to the control group (p < 0.0001). Serum levels of leptin, IL-6, VEGF, insulin, and resistin were increased in the study group. Leptin, IL-6 and resistin correlated positively with BP values (p < 0.05), while ghrelin and adiponectin correlated negatively. ROC analysis identified leptin, IL-6, and VEGF as the most promising biomarkers for predicting PAH. The results confirm the role of adipokines and cytokines in the pathogenesis of PAH. The assessment of adipokine and cytokine profiles complements traditional anthropometric parameters such as BMI in assessing cardiovascular risk. Leptin, IL-6, and VEGF presented the strongest correlation with hypertension, suggesting their potential in future diagnostic and preventive strategies. Full article

Background: Chinese adolescents face a dual burden of malnutrition, yet the weight-status-specific mechanisms underlying physical activity (PA) participation remain underexplored. Methods: We conducted a cross-sectional study among 1573 adolescents (aged 9–15 years) in Shangrao City, China. Validated scales measured social-ecological factors (family/peer support, physical environment), psychological factors (stage of change, self-efficacy, decisional balance), and PA participation. Data preprocessing utilized full information maximum likelihood to handle missing values. Confirmatory factor analysis was performed to validate the measurement model, followed by multi-group structural equation modeling to analyze pathway configurations across underweight (n = 187), normal-weight (n = 1070), and overweight/obese (n = 316) groups. Mediation effects were tested using bootstrapping with 5000 resamples. Results: Clear weight-specific patterns emerged. Normal-weight adolescents presented a fully functional comprehensive model where PA was predicted by the stage of change (β = 0.211, p < 0.001), friend support (β = 0.120, p < 0.001), self-efficacy (β = 0.092, p < 0.05), and perceived benefits (β = 0.095, p < 0.01). Underweight adolescents primarily relied on internal readiness driven by stage of change (β = 0.270, p < 0.001) and self-efficacy (β = 0.164, p < 0.05), with family support only indirectly influencing participation via psychological mediators. In contrast, overweight/obese adolescents showed a “socially dependent” pattern: friend support directly predicted PA levels (β = 0.136, p < 0.05), significantly enhanced self-efficacy (β = 0.370, p < 0.01), and effectively lowered perceived barriers (β = −0.165, p < 0.05). Additionally, the physical environment strongly impacted perceived benefits (β = 0.471, p < 0.01) but did not translate into action. Conclusions: These findings underscore the significant differences in PA determinants across the spectrum of malnutrition, necessitating targeted public health interventions to support the Healthy China 2030 initiative. Full article

Background: Obesity alters metabolic, inflammatory, and immune responses, and acute exercise may affect these parameters differently according to body composition. This study investigated the acute effects of Spartacus exercise on metabolic, inflammatory, and immune markers in adolescent girls with overweight/obesity and normal weight. Methods: In this non-randomized clinical study, sixteen girls with overweight/obesity (BMI: 31.17 ± 3.85 kg/m²) and fourteen normal-weight girls (BMI: 21.93 ± 0.99 kg/m²) performed an intermittent running test (15 s effort, 15 s passive recovery), starting at 7 km·h⁻¹ with 1 km·h⁻¹ increments every 3 min until exhaustion. Blood samples were collected at rest (T0), immediately post-exercise (T1), and 30 min post-exercise (T2). CRP and ESR were assessed at baseline to characterize participants’ inflammatory status, while glucose and leukocyte subpopulations were evaluated to investigate acute exercise responses. Results: Fasting glucose, lipid profile (TC, TG, HDL-C, LDL-C), inflammatory markers (CRP, ESR), and leukocyte subpopulations were assessed. Significant group effects were observed for all metabolic and inflammatory markers, reflecting higher baseline values in participants with overweight/obesity compared with normal-weight participants (p < 0.05). Significant effects of time were found for glucose and leukocytes (p < 0.001), indicating acute exercise-induced changes, along with significant time × group interactions. Participants with overweight/obesity showed greater and more prolonged increases in glucose, total leukocytes, and neutrophils, whereas normal-weight girls returned to baseline within 30 min. Conclusions: Acute high-intensity intermittent exercise induces transient metabolic and immune responses in adolescents, with amplified and prolonged effects in those with obesity. These findings highlight the importance of considering body composition when prescribing exercise programs. Full article

Problematic weight control behaviors during adolescence are associated with an increased risk of chronic obesity. Understanding how adolescents with obesity respond to body-related visual cues may offer insights into underlying motivational deficits. This experimental pilot study employed a peripherally measured startle reflex paradigm to assess the involuntary emotional responses to images of underweight, normal-weight, and overweight bodies. Twenty female adolescents with obesity and 21 normal-sized control subjects between 14 and 21 years of age were presented with photos of female bodies. Images from the International Affective Picture System served as reference material. The Self-Assessment Manikin was used as the subjective measure, while startle reflex magnitude and skin conductance response served as objective measures. A significant interaction emerged for body-related stimuli. In the normal-weight group, underweight and overweight body images elicited increased skin conductance responses (indicative of heightened attention) and potentiated startle reflexes (indicative of behavioral avoidance). In contrast, adolescents with obesity exhibited a general physiological down-regulation and a subjective vs. objective dissociation across all body image categories, suggesting a dysfunction in motivational processing. Our findings suggest diminished physiological salience of body-related cues in obese adolescents, which may undermine intrinsic motivation for weight loss. The limited sample size restricts generalizability. Full article

Background and Objectives: The obesity paradox in maintenance hemodialysis (MHD) patients (better survival of obese as compared to non-obese patients in MHD) remains controversial, with many published papers supporting the idea that higher BMI is protective. Data from Eastern Europe, in particular from the elderly population on hemodialysis, are limited. The aim of this study was to describe the distribution of body weight status and cardiometabolic comorbidities and to evaluate the association of BMI categories with all-cause mortality in a multi-center Romanian hemodialysis cohort. Materials and Methods: We conducted a retrospective cohort study of 679 patients with end-stage kidney disease (ESKD) undergoing maintenance haemodialysis in eight Romanian centers. All patients received thrice-weekly treatments (≥4 h/session) using high-flux dialysers. Baseline demographic, clinical, laboratory, and echocardiographic data were extracted from dialysis records. Survival across BMI groups was assessed using Kaplan–Meier curves and the log-rank test. Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality, with normal weight as the reference category. Multivariable models incorporated progressive adjustment for age, sex, dialysis vintage, diabetes, major cardiovascular comorbidities, and ESKD-related factors, including anemia parameters and CKD–mineral and bone disorder (CKD-MBD) markers. Results: A total of 679 haemodialysis patients were included (mean age 57.2 ± 12.9 years; 59.1% male); 52.7% were normal weight, 28.9% overweight, and 18.4% obese. During follow-up, 360 patients (53.0%) died, with similar crude mortality across BMI groups (normal weight 51.7%, overweight 55.1%, obese 53.6%; p > 0.05). In univariate Cox analyses, older age, obesity, hypoalbuminaemia, elevated CRP, hyperphosphataemia, peripheral and cerebrovascular disease, diabetes, low dialysis adequacy (eKt/V < 1.2), and lower ultrafiltration were associated with higher mortality, whereas preserved LVEF (≥50%) was protective. In multivariable analyses, independent predictors of mortality included older age (HR 1.042 per year, p < 0.001), obesity (HR 1.411, p = 0.045), elevated CRP (HR 1.781, p < 0.001), diabetes (HR 1.775, p < 0.001), inadequate dialysis dose (eKt/V < 1.2; HR 1.343, p = 0.029), and preserved LVEF remained protective (HR 0.665, p = 0.013). The Kaplan–Meier analysis showed significantly lower survival with increasing BMI: median survival was 7.56 years in normal-weight patients, 4.56 years in overweight patients, and 3.92 years in obese individuals (log-rank p < 0.05). Conclusions: In this Romanian cohort of multicenter hemodialysis patients, obesity as measured by BMI was associated with an increased incidence of all-cause mortality, while overweight did not confer a clear survival advantage over normal weight. These findings call into question the classic hemodialysis obesity paradox and support a more cautious interpretation of the increased BMI. Full article

Background: Midwives, despite their health-promoting role, face factors that may disrupt eating behaviours and weight regulation. Little is known about their body weight perception or disordered eating attitudes (DEAs). This study assessed body weight perception and eating attitudes across BMI categories among Polish midwives. Methods: A cross-sectional survey of 568 midwives was conducted. BMI was calculated from self-reported measures and classified according to WHO criteria. Body weight perception was assessed using discrepancies between actual and ideal body weight and between self-perceived ideal body weight and ideal body weight. Long-term weight variability was additionally evaluated using the difference between maximum and minimum adult body weight. Eating attitudes were examined using the Polish version of the EAT-26. Group differences were analysed with the Kruskal–Wallis and χ² tests. Results: Among the participants, 62.9% had normal weight, 23.4% were overweight, and 13.7% were obese. Perceived ideal body weight increased with BMI (p < 0.001). Midwives with overweight and obesity demonstrated higher EAT-26 scores than those with normal BMI, with EAT-26 > 20 observed in 8.3% of overweight and 14.1% of obese participants (p = 0.010). Overweight and obese midwives also showed larger discrepancies between actual and ideal body weight and greater lifetime weight variability, and these groups simultaneously presented higher levels of disturbed eating attitudes. Emotional eating, binge-type episodes, and dieting behaviours were more common among overweight and obese participants, while calorie awareness remained consistently high across groups. Conclusions: Midwives with excess body weight often misperceive their body size and show an elevated risk of DEA. Weight perception appears more strongly related to maladaptive eating patterns than BMI alone. These findings highlight the need for targeted, non-stigmatising interventions addressing weight perception, eating attitudes, and occupational stressors, which may support both midwives’ well-being and their professional effectiveness in delivering nutrition and lifestyle counselling. Full article

Objective: Pediatric overweight and obesity represent a growing public health concern with significant long-term implications. In children diagnosed with attention-deficit/hyperactivity disorder (ADHD), stimulant medications may alter appetite, potentially impacting body weight and growth patterns. However, real-world data on the effect of these treatments on body mass index (BMI) classification remains scarce. We aimed to evaluate the effect of ADHD stimulant therapy on transitions in the BMI categories among children. Study Design: We conducted a large-scale observational cohort study assessing longitudinal changes in BMI classification following the initiation of stimulant treatment, utilizing data from Clalit Health Services, Israel’s largest healthcare provider. BMI was categorized into four groups: normal weight, overweight, obesity, and severe obesity. Subgroup analysis was performed by sex and age groups: <7 years; >7 <13 years and >13 <18 years. Results: At baseline, 26,930 children met the study inclusion criteria. 12,448 (46%) were classified as overweight or obese. Most children with normal weight at baseline maintained their BMI classification (90%). 48% of children with overweight, 42% with obesity, and 29% with severe obesity transitioned to a lower BMI category. 39% of children with underweight transitioned to normal weight. Similar patterns in BMI category transitions were observed between sexes. Transition to a lower BMI category was more prevalent in the younger age group. Conclusions: Stimulant therapy for ADHD is associated with significant shifts in BMI classification among pediatric patients. While many children, especially younger with higher baseline BMI, experienced improvements in weight status, a notable minority exhibited weight gain. These findings underscore the importance of routine BMI monitoring and weight management strategies during ADHD treatment. Full article

Background/Objectives: Obesity is a common comorbidity but there remains limited understanding on how higher obesity rates in rural areas may impact physical function decline and other health domains among cancer patients. This study addresses this gap by examining the association between body mass index (BMI) and physical function among a cohort of rural advanced cancer patients. Methods: This cross-sectional analysis uses baseline data from the Nurse AMIE trial (NCT04673019). Individuals were categorized as ‘normal weight’ (BMI ≤ 25 kg/m²), ‘overweight’ (BMI > 25 to 30 kg/m²), and ‘obese’ (BMI > 30 kg/m²). Objective physical function was measured by the Short Physical Performance Battery (SPPB) and subjective physical function and health domains were measured using surveys (PROMIS; SF-36). Results: Of 348 patients included, 88 (25.3%) were classified as ‘normal weight’, 107 (30.7%) as ‘overweight’, and 153 (44.0%) as ‘obese’. Average age was 64.8 years (SD = 12.2), 46% (n = 160) were female, 95% were white (n = 331), and 52% (n = 182) were Stage 4. Total SPPB scores revealed poorer functioning with higher BMI (M ± SD: BMI ≤ 25 kg/m²: 9.1 ± 2.3; BMI > 25–30 kg/m²: 8.3 ± 3.1; BMI > 30 kg/m²: 8.1 ± 2.8; p = 0.04). Similarly, scores from the SF-36 revealed subjective physical function was lower with higher BMI (BMI ≤ 25 kg/m²: 57.9 ± 29.1; BMI > 25–30 kg/m²: 53.7 ± 28.0; BMI > 30 kg/m²: 47.6 ± 27.6; p = 0.004). Participants reported lower levels of energy and greater fatigue with higher BMI (BMI ≤ 25 kg/m²: 49.8 ± 26.1; BMI > 25–30 kg/m²: 45.1 ± 24.6; BMI > 30 kg/m²: 40.7 ± 22.6; p = 0.01). Conclusions: Higher BMI is associated with poorer physical function and increased fatigue among rural advanced cancer patients, highlighting the need for supportive care related to physical function in this at-risk group. Full article