We examined whether genetic risk for higher BMI, parental feeding practices (restriction, pressure to eat, and monitoring), and their interactions were associated with overweight trajectories during adolescence. Data came from 5568 participants aged 10-18 in the Twins' Early Development Study who had at least one measurement of weight. Parental feeding practices were reported at age 10 using the Child Feeding Questionnaire. A polygenic score for BMI was used as a proxy for genetic risk. We identified overweight trajectories using latent class growth analysis, and associations with genetic risk, feeding practices, and their interactions were tested using multinomial logistic regression with trajectory as the outcome. Three trajectories were identified: non-overweight, persistent overweight, and adolescent-onset overweight. Higher genetic risk and greater parental restriction and monitoring were associated with persistent overweight, whereas pressure to eat was associated with non-overweight. Associations remained after adjustment for general parenting and additional risk factors. We found no evidence for gene-environment interaction. Genetic risk and parental feeding practices were independently associated with adolescent weight development. While this suggests feeding practices may be relevant targets for prevention, the findings likely represent complex bidirectional parent-child dynamics.

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

This study aimed to assess how food-related behavioral traits, examined with the Three-Factor Eating Questionnaire (TFEQ) and the Perceived Stress Scale (PSS), influence adlibitum intake after fasting and during and after cold exposure compared to thermoneutral conditions, beyond what is explained by energy expenditure alone. Healthy participants (n = 46; 30 males; age 36.9 ± 10.5 years; BMI 32.3 ± 8.7 kg/m2) completed the TFEQ, PSS, and dual-energy x-ray absorptiometry (DXA) scan. The Hunger subscale of the TFEQ was further divided into internal and external hunger based on the methodology of Bond etal. Participants ate adlibitum from a food intake paradigm on five separate occasions, each over 24 h: (1) after a 36-h fast at thermoneutral temperature, (2) during cold exposure (19.0°C) in the chamber, (3) during thermoneutral conditions (23.5°C) in the chamber, (4) after cold exposure, and (5) after thermoneutral exposure. Total hunger score predicted intake across all five conditions (β = 0.58 MJ/day, p = 0.02). Internal and external subscales also predicted intake in separate models (β = 1.04 MJ/day, p = 0.02; β = 1.46 MJ/day, p = 0.01). Participants ate more during the cold condition than during thermoneutrality (mean = 1.69 MJ/day, or 404 kcal/day, p = 0.009). Higher external hunger scores correlated with greater intake (partial r = 0.38; p = 0.01), but internal hunger scores did not (partial r = 0.22, p = 0.16), after accounting for sex, race, fat mass, and fat-free mass. Restraint, disinhibition, and PSS were not associated with intake. Increased susceptibility to hunger cues, particularly external cues, was associated with higher food intake during cold stress. These findings suggest that behavioral approaches, such as reducing responsivity to food cues, are important targets for weight loss interventions. ClinicalTrials.gov: NCT02939404.

Broadening usage of new antiobesity medications (AOMs, e.g., GLP-1 and GLP-1/GIP agonists) has prompted access concerns. We analyzed patient and appointment factors associated with AOM prescriptions, including changing AOM coverage in state Medicaid programs (MassHealth). This was a retrospective pre-post study of medical weight management appointments at a large tertiary care center in January and April 2024, bracketing a MassHealth coverage change for AOMs. Patient and visit characteristics and AOMs prescribed were analyzed. A total of 2060 patients were analyzed. Multivariable analysis demonstrated that patients were more likely to receive Sema/Tirz compared to no or a different AOM with private insurance (aOR 2.744, p < 0.001), diabetes (aOR 2.507, p < 0.001), and established patient relationships (aOR 1.706, p < 0.001). In January 2024, Black and Hispanic patients were 49% and 47% less likely to be prescribed Sema/Tirz (p = 0.003, p = 0.025); in April 2024, after MassHealth changes, only patients of "Not Disclosed" race were less likely to receive these medications (p < 0.001). Black and Hispanic patients were less likely and patients with private insurance, diabetes, and established patient relationships were more likely to be prescribed Sema/Tirz. Racial and ethnic disparities in medication prescription were less apparent after a state Medicaid policy change to cover new GLP-1s.

This study examined the safety and effectiveness of metabolic and bariatric procedures (MBPs), including surgical and endoscopic interventions, among individuals with versus without heart failure (HF). This multicenter retrospective cohort study (2021-2023) identified persons with HF who underwent MBPs at two medical centers. Thirty-day safety events and changes in body weight and medication use were assessed. Of 1678 MBPs, 41 (2.4%) were performed in adults with HF (mean age, 51 ± 15 years; 66% female; mean BMI, 44 ± 7 kg/m2). Despite older age and more obesity-related complications, persons with HF did not appear to experience a higher risk of any safety event at 30 days versus those without HF (24% vs. 16%; adjusted OR, 1.64; 95% CI, 0.76-3.58; p = 0.21). Thirty-day change in body weight was similar between those with (-5.9%; 95% CI, -6.9%, -4.9%) and without HF (-6.2%; 95% CI, -6.4%, -6.0%; p comparison = 0.57). By 1 year, individuals with HF experienced significant reductions in body weight (mean change, -18.7%; 95% CI, -22.1%, -15.3%; p < 0.001), cardiovascular (p = 0.003) and glucose-lowering medications (p < 0.001), and loop diuretics (p = 0.003). These findings suggest that MBPs are safe and effective in well-selected adults with obesity and HF. However, larger and prospective studies are warranted to enhance understanding of MBP risk/benefit in this population.

Guidelines recommend pairing antiobesity medications (AOMs) with behavioral treatment. This 12-week, two-arm randomized controlled trial evaluated oral AOMs with versus without behavioral treatment. We recruited 101 patients eligible for bupropion and naltrexone from a telehealth weight management clinic (WeightWatchers Clinic). Participants were randomized to (i) bupropion and naltrexone (n = 50) or (ii) bupropion and naltrexone with behavioral treatment (WeightWatchers) (n = 51). Remote measurements of body weight, behavioral, and psychosocial measures were completed at baseline and week 12. The primary outcome was the 12-week change in weight (kg). ANCOVA assessed differences in changes between groups. Participants (n = 101) were mostly female (94.1%), average 43.9 years old (SD: 10.7), with a mean BMI of 37.0 kg/m2 (SD: 6.3). At 12 weeks, those receiving behavioral treatment lost significantly more absolute and percent weight than those without behavioral treatment (mean difference: -1.8 kg, p = 0.03; mean difference: -1.6%,p = 0.04). Combining oral AOMs with behavioral treatment via telemedicine resulted in significantly greater weight loss than medications alone, supporting the recommendation to pair AOMs with behavioral treatment. ClinicalTrials.gov identifier: NCT06470659.

This prespecified subpopulation analysis aimed to assess the efficacy and safety of once-weekly tirzepatide versus placebo alongside lifestyle intervention in Japanese adults with obesity or overweight. Data from 102 Japanese adults in the SURMOUNT-1 trial with BMI ≥ 30 kg/m2 or ≥ 27 kg/m2 and ≥ 1 weight-related comorbidity were analyzed. Coprimary endpoints were mean percent change in body weight and the proportion of participants who achieved ≥ 5% body weight reduction at week 72. Participants in the tirzepatide 5-, 10-, and 15-mg groups had a statistically significantly greater (all p < 0.001) least squares mean (standard error) percent change in body weight compared with those in the placebo group: -12.0% (1.7%), -22.4% (1.7%), -22.1% (1.6%), and -0.3% (1.6%), respectively. Overall, 91.7%, 100%, and 96.6% of participants in the tirzepatide 5-, 10-, and 15-mg groups, respectively, had ≥ 5% weight reduction at week 72, compared with 15.4% in the placebo group. Significant improvements in cardiometabolic measures were also observed with tirzepatide at week 72 compared to placebo. No new safety concerns were identified. Once-weekly treatment with tirzepatide demonstrated significant reductions in body weight and prespecified cardiometabolic measures compared with placebo in Japanese adults with obesity or overweight. ClinicalTrials.gov identifier: NCT04184622 https://clinicaltrials.gov/study/NCT04184622.

This post hoc analysis assessed psychiatric changes with tirzepatide in adults with obesity, without known major psychopathology, from SURMOUNT-1, SURMOUNT-2, and SURMOUNT-3. In participants (N = 4056) treated with tirzepatide (5/10/15 mg or maximum tolerated dose 10/15 mg) versus placebo, depressive symptoms and suicidal ideation and behavior (SI/SB) were measured using the Patient Health Questionnaire-9 (PHQ-9) and Columbia-Suicide Severity Rating Scale (C-SSRS), respectively. Nervous system and psychiatric disorder adverse events (AEs) were collected. Mean (SD) baseline PHQ-9 scores were 2.7 (3.0) for tirzepatide and 2.6 (3.1) for placebo, indicating no/minimal symptoms of depression. At week 72, scores were 1.9 (2.7) and 2.4 (3.3), respectively (estimated treatment difference [SE]: -0.6 [0.1]); p < 0.001. Tirzepatide-treated participants were less likely to shift to a more severe PHQ-9 category (18.2% vs. 24.3%; p < 0.001). Using the C-SSRS, 0.6% of participants in each group reported SI, most of which was considered low risk. SB (nonfatal) occurred in 0.1% of tirzepatide-treated participants versus none with placebo. AEs were generally similar across groups. In this post hoc analysis, tirzepatide versus placebo did not appear to be associated with an increased risk of depression in participants with overweight/obesity and without known major psychopathology. Rates of SI/SB observed with tirzepatide were similar to those of other incretin-based therapies. Further study of tirzepatide's safety in persons with significant psychiatric illness may be warranted. ClinicalTrials.gov identifiers: NCT04184622, NCT04657003, and NCT04657016.