Washington Center for Weight Management and Research

BackgroundOral semaglutide at a dose of 25 mg may provide an alternative treatment option to injectable semaglutide (2.4 mg) and higher-dose oral semaglutide (50 mg) for persons with overweight or obesity.MethodsIn a 71-week, double-blind, randomized, placebo-controlled trial conducted at 22 sites in four countries, we enrolled persons without diabetes who had a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 30 or higher or a BMI of 27 or higher with at least one obesity-related complication. The participants were randomly assigned in a 2:1 ratio to receive oral semaglutide (25 mg) or placebo once daily, plus lifestyle interventions. The coprimary end points at week 64 were the percent change in body weight and a reduction of 5% or more in body weight; confirmatory secondary end points included reductions in body weight of 10% or more, 15% or more, and 20% or more and the change in the Impact of Weight on Quality of Life–Lite Clinical Trials Version (IWQOL-Lite-CT) Physical Function score.ResultsA total of 205 participants were randomly assigned to receive oral semaglutide, and 102 to receive placebo. The estimated mean change in body weight from baseline to week 64 was −13.6% in the oral semaglutide group and −2.2% in the placebo group (estimated difference, −11.4 percentage points; 95% confidence interval, −13.9 to −9.0; P<0.001). Participants in the oral semaglutide group were significantly more likely than those in the placebo group to have body-weight reductions of 5% or more, 10% or more, 15% or more, and 20% or more (P<0.001 for all comparisons) and to have an improved IWQOL-Lite-CT Physical Function score (P<0.001). Gastrointestinal adverse events were more common with oral semaglutide than with placebo (74.0% vs. 42.2%).ConclusionsOral semaglutide at a dose of 25 mg once daily resulted in a greater mean reduction in body weight than placebo in participants with overweight or obesity. (Funded by Novo Nordisk; OASIS 4 ClinicalTrials.gov number, NCT05564117.)

Background: This study compared the acute effect of performing quarter (QS) and parallel (PS) squat with variable resistance (VR) on countermovement jump (CMJ) performance. Methods: Fifteen resistance trained athletes (age: 27.0 ± 3.7 years, bodyweight: 68.4 ± 7.7 kg, height: 169.7 ± 6.9 cm) performed either the QS or PS to induce post-activation performance enhancement on two separate occasions. During each session, participants performed three repetitions of baseline CMJ prior to performing three repetitions of either QS or PS at their three-repetition maximum load. Participants then performed the post-test CMJ after a five-minute recovery period. Results: Both conditions resulted in increased jump height (QS: p < 0.001, g = 0.19, PS: p < 0.001, g = 0.35). Countermovement depth and time to take-off were significantly decreased in QS (p < 0.001, g = 0.63 and p = 0.005, g = 0.30, respectively) but significantly increased in PS (p = 0.027, g = 0.39 and p < 0.001, g = 0.36, respectively). Mean propulsion force was significantly increased in QS (p < 0.001, g = 0.23) but significantly decreased in PS (p = 0.083, g = 0.13). PS resulted in greater change in jump height (p < 0.001, g = 1.34) and time to take-off (p = 0.005, g = 1.25), while QS resulted in greater change in countermovement depth (p < 0.001, g = 2.33) and mean propulsion force (p < 0.001, g = 1.67). Conclusions: The results showed that performing PS and QS with VR was effective in enhancing CMJ height. However, the two conditions resulted in participants adopting different jump strategies when performing the post-test CMJ.

This article offers an interpretation of the friendship between Ernst Jünger and Carl Schmitt, two of the leading thinkers of the interwar Conservative Revolution and major influences on the European New Right. Previous accounts of their relationship have usually foregrounded their intellectual exchange — including important disagreements — and focused on their growing estrangement after World War II. This article, by contrasts, reads their relationship first and foremost as a friendship, in which such disagreements were secondary to other values, including the pleasure each found in the other’s company, mutual support for their independent intellectual projects, and their common vision of a good life. I reference ideas about friendship in the works of Aristotle, Siegfried Kracauer, and Friedrich Nietzsche (among others) in order to draw out the essential grounds for the friendship between Jünger and Schmitt — grounds which continued despite complications in their friendship after 1945, and which account for the friendship’s longevity, lasting from 1930 until Schmitt’s death in 1985. I argue that their friendship was in important ways typical of the sociability of self-professed elitists and ‘outsiders’ who disdain modern liberal society, a style of friendship common among political radicals on the left and right, including among German conservative revolutionaries and their latter-day heirs in the New Right.

BackgroundSemaglutide at a dose of 2.4 mg has established weight-loss and cardiovascular benefits, and cagrilintide at a dose of 2.4 mg has shown promising results in early-phase trials; the efficacy of the combination (known as CagriSema) on weight loss in persons with either overweight and coexisting conditions or obesity is unknown.MethodsIn a phase 3a, 68-week, multicenter, double-blind, placebo-controlled and active-controlled trial, we enrolled adults without diabetes who had a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 30 or higher or a BMI of 27 or higher with at least one obesity-related complication. Participants were randomly assigned in a ratio of 21:3:3:7 to receive the combination of semaglutide at a dose of 2.4 mg and cagrilintide at a dose of 2.4 mg, semaglutide alone at a dose of 2.4 mg, cagrilintide alone at a dose of 2.4 mg, or placebo, plus lifestyle interventions for all groups. The coprimary end points were the relative change in body weight and a reduction of 5% or more in body weight from baseline to week 68 with cagrilintide–semaglutide as compared with placebo. Body-weight reductions of 20% or more, 25% or more, and 30% or more were assessed as confirmatory secondary end points. Effect estimates were assessed with the treatment-policy estimand (consistent with the intention-to-treat principle). Safety was assessed.ResultsA total of 3417 participants underwent randomization, with 2108 assigned to receive cagrilintide–semaglutide, 302 to receive semaglutide, 302 to receive cagrilintide, and 705 to receive placebo. The estimated mean percent change in body weight from baseline to week 68 was –20.4% with cagrilintide–semaglutide as compared with –3.0% with placebo (estimated difference, –17.3 percentage points; 95% confidence interval, –18.1 to –16.6; P<0.001). Participants receiving cagrilintide–semaglutide were more likely than those receiving placebo to reach weight-loss targets of 5% or more, 20% or more, 25% or more, and 30% or more (P<0.001 for all comparisons). Gastrointestinal adverse events (affecting 79.6% in the cagrilintide–semaglutide group and 39.9% in the placebo group), including nausea, vomiting, diarrhea, constipation, or abdominal pain, were mainly transient and mild-to-moderate in severity.ConclusionsCagrilintide–semaglutide provided significant and clinically relevant body-weight reductions in adults with overweight or obesity, as compared with placebo. (Funded by Novo Nordisk; REDEFINE 1 ClinicalTrials.gov number, NCT05567796.)

Obesity is a chronic, progressive, multifactorial disease with serious health implications. The most recent estimates from the US Centers for Disease Control and Prevention (CDC) indicate that more than 40% of adults have obesity (body mass index [BMI]≥30 kg/m2), while approximately 10% have severe obesity (BMI≥40 kg/m2).1 Obesity-related conditions, including dyslipidemia and type 2 diabetes, are key risk factors for the development of cardiovascular disease (CVD),2 which is the leading cause of death in the United States.3 In addition, obesity is associated with CVD independently of traditional cardiovascular (CV) risk factors,4 while abdominal obesity is an indicator of CVD risk independently of BMI.2,5 Obesity is also associated with multiple other cardiometabolic diseases, in addition to other functional and psychological comorbidities, and thus has a major impact on quality of life.6 Women experience a disproportionately high disease burden related to obesity. National Health and Nutrition Examination Survey (NHANES) data suggest that age-adjusted rates of obesity and severe obesity are higher among women than men, at 40.8% versus 36.5% and 9.8% versus 5.5%, respectively.7 Moreover, evidence indicates that women have a greater risk for developing obesity-related conditions than men.8 One study of 4,181 people found that women with class 1 (BMI 30 to <35 kg/m2) or class 2 (BMI 35 to <40 kg/m2) obesity had significantly impaired physical health functioning as measured by the Physical Component Summary scale of the Medical Outcomes Study Short Form (SF-36 PCS) after adjustment for sociodemographic factors and comorbidities, but among men this association was only seen with class 2 obesity.9 Another study of more than 10,000 people found that women lose more quality-adjusted life years (QALYs) due to obesity than men; QALYs lost with overweight versus BMI 23.0-25.0 kg/m2 were 1.8 million for women and 0.3 million for men, while QALYs lost with obesity were 3.4 million and 1.9 million, respectively.10 The increased disease burden of obesity in women has been attributed to several factors, including emotional and psychological well-being, health-related quality of life, and differences in comorbidity profiles.8 The elevated burden of obesity and its associated mortality risk in women emphasize the need to incorporate an understanding of sex differences into obesity management, including for screening, diagnosis, documentation, and treatment. Furthermore, obesity has a multisystemic impact on female physiology at different stages in life -- including during childbearing years and around the time of menopause -- and is associated with a range of health conditions specific to women.11-13 Consequently, management of obesity in women requires a considered approach that takes age and life stage into account.14 Many women in the United States consider their obstetrician/gynecologist (OB-GYN) to be their primary healthcare professional (HCP), particularly during their childbearing years.15,16 Therefore, OB-GYNs are uniquely positioned to educate women on the health risks associated with obesity and to provide compassionate, evidence-based care. This CME-certified Special Issue Supplement focuses on the impact of obesity on women’s health throughout life and how OB-GYNs can help to manage obesity and optimize women’s health outcomes. In the first article, we explore the relationship between obesity and health conditions affecting women, and the associations between obesity and female physiology at different stages of life. In the second article, we outline the importance of appropriate diagnosis and documentation of obesity in women’s health clinics, and discuss practical approaches to discussing obesity in a respectful way. In the third article, we focus on obesity management, highlighting the available options and providing guidance on treatment selection in different scenarios and at different times in life. Finally, we invite readers to put their knowledge into practice in our series of interactive videos. Each video will feature a different example of a woman living with obesity, and users will sit in the driver’s seat to make choices on the most appropriate approaches to care.

Objective: To assess the impact of psychotherapy on obesity treatment in outpatient settings. Methods: The study targets adults with a BMI of 30 or higher, comparing psychotherapeutic interventions to usual care or no treatment. Key outcomes include weight loss, adverse events, depression, quality of life, and long-term BMI changes. Extensive database searches were conducted. Results: Out of 1,334 articles reviewed, only 3 studies met the inclusion criteria, emphasizing the scarcity of relevant research. These studies primarily focused on behavioral and cognitive-behavioral strategies. Results showed that combining behavior therapy with diet/exercise led to greater weight loss than diet/exercise alone. Studies on cognitive therapy and general psychotherapy were less frequent and yielded weaker evidence. Despite varied methodologies, the findings suggest that behavioral therapy combined with dietary and exercise interventions offers improved outcomes, though more research is needed to strengthen these conclusions. Conclusions: The study found that combining behavioral therapy with diet and exercise resulted in greater weight loss than diet and exercise alone. However, research on the impact of psychotherapy on obesity is limited, as only 3 studies met the inclusion criteria. Cognitive therapies and general psychotherapy provided weaker evidence. Therefore, further research is necessary to validate these findings and investigate alternative psychotherapeutic methods for treating obesity.