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New Monthly Obesity Injection Shows Promise

Tatyana Meshcheryakova July 2, 2025 No Comments

In a significant development for obesity treatment, a new once-a-month injection has shown impressive results in a clinical trial, helping participants lose up to 16% of their body weight (and even more under ideal conditions). The drug, maridebart cafraglutide (also called MariTide or AMG133), may reshape how obesity is managed, particularly for people seeking long-term, effective solutions without the hassle of weekly injections.

This breakthrough comes from a Phase 2 randomized controlled trial published in The New England Journal of Medicine. Conducted on nearly 600 adults with obesity — with or without type 2 diabetes — the study explored both the efficacy and safety of this long-acting peptide–antibody conjugate. Here’s what the results reveal, and why experts are paying attention.

Why this matters

Obesity is more than just a number on a scale — it’s a chronic metabolic condition that raises the risk for diseases such as type 2 diabetes, heart disease, and stroke. And it’s getting worse. According to the World Health Organization, as of 2022, 890 million adults and 160 million children worldwide were living with obesity.

Despite the availability of promising medications like semaglutide (Wegovy) and tirzepatide (Zepbound), there are still major challenges: frequent dosing schedules and issues with adherence. Many people struggle to stick with weekly injection regimens, and dropout rates are high.

That’s why maridebart cafraglutide is drawing attention. With dosing just once every four to eight weeks, this new drug could improve patient compliance and produce stronger long-term results.

The science behind maridebart cafraglutide

So, what is maridebart cafraglutide, exactly? It’s a dual-action molecule: A GLP-1 receptor agonist, which promotes satiety and lowers blood sugar, and a GIP receptor antagonist, which counteracts the hormone GIP (glucose-dependent insulinotropic polypeptide) believed to contribute to weight gain in certain contexts.

This dual mechanism is key. While some drugs activate the GIP receptor (like tirzepatide), others, like maridebart, block it. Both approaches, when combined with GLP-1 agonism, appear to support weight loss. It’s a surprising paradox and an area of ongoing research.

Maridebart’s extended half-life of 21 days — nearly triple that of the longest-acting once-weekly drugs — makes monthly or even bi-monthly administration possible. The innovation lies in how the peptides are bound to a monoclonal antibody, giving the drug its staying power.

The clinical trial’s design and participants

The Phase 2 trial included 592 adults, divided into 465 participants with obesity only and 127 participants with obesity and type 2 diabetes. Participants received injections every four or eight weeks, with varying doses. Some groups used dose escalation to minimize side effects.

After 52 weeks of treatment, researchers evaluated: body weight changes, blood sugar levels, body composition (fat vs. lean mass), and adverse events and side effects.

Substantial weight loss followed

Here’s what the study found after one year:

For participants without diabetes:

3% to 16.2% weight loss in the treatment group (based on real-world conditions).
Up to 19.9% weight loss in the ideal-case (efficacy) analysis.
Placebo group lost only 2.5%.

For participants with diabetes:

4% to 12.3% weight loss in the treatment group.
Up to 17.0% in the efficacy analysis.
Placebo group lost just 1.7%.

Notably, around half of the participants reached at least 15% total weight loss, a clinical benchmark known to drastically improve health. Under ideal trial conditions, 75% achieved that milestone.

Maridebart cafraglutide didn’t just help with weight — it also improved blood sugar control, particularly in participants with type 2 diabetes, and a fat (vs. lean mass) reduction of 36.8%.

Safety and side effects

While the trial showed promising results, it also raised some safety considerations. Gastrointestinal side effects were the most common, including nausea, vomiting, constipation, retching, and diarrhea. These symptoms were more frequent in participants who skipped dose escalation or started on higher doses.

Serious adverse events were rare. Gallbladder issues were slightly more common in the treatment group than in the placebo group. Importantly, no unexpected safety signals emerged during the trial. Side effects were generally manageable and transient.

Why dose escalation matters

Gradual dose escalation and a lower starting dose greatly improved tolerability. This has influenced the design of the ongoing Phase 3 trial, where all groups are now using a more careful ramp-up strategy.

With up to 20% weight loss, improvements in metabolic markers, and a safety profile comparable to other GLP-1-based drugs, this monthly injection could change the game, especially for those who struggle with weekly dosing. As the Phase 3 trial progresses, the medical community is watching closely. If results hold, maridebart cafraglutide could soon be a powerful new tool in the global fight against obesity.

Your responses and feedback are welcome!

Source: “Once-Monthly Maridebart Cafraglutide for the Treatment of Obesity — A Phase 2 Trial,” The New England Journal of Medicine, 6/23/25
Source: “Once-monthly obesity injection shows double-digit weight loss in major clinical trial,” News Medical, 6/24/25
Image by Anna Tarazevich/Pexels

The Privilege to Give

Pat Hartman July 1, 2025 No Comments

Most of us who are not doctors or professors do not keep up with the medical journals. But we are all familiar with the previous decades’ level of obesity awareness, because it has been extensively (some would say oppressively) personified in — tah-dah! Oprah Winfrey.

Make a movie about the atomic bomb, and call it Oppenheimer. Make a movie about the never-ending struggle against body fat, and call it… Oh, never mind, let’s get serious. As Oprah has said,

I’ve been on this journey for most of my life… I don’t know if there is another public person whose weight struggle has been exploited as much as mine over the years.

Oprah has talked about a 1990 incident proving there are some human frailties from which wealth and fame cannot shield a person. It was the sort of humiliating misconception that could happen in anyone’s mind, no matter what their scale of living. On the cover of TV Guide magazine, there was a picture of her with the text, “Best and Worst-Dressed List.”

In a regular person’s life, it could have been a neighborhood news-sheet. In either case, the surprise was pleasant for only a second, until Oprah realized she had not been chosen as best-dressed. Instead, she had been picked to represent being a terrible example: “bumpy, lumpy and downright dumpy.” How many dollars would compensate for that embarrassment?

No such thing as bad publicity

The life of a star has a lot of downsides. An aspiring professional entertainer gets used to attracting disrespectful comments from segments of the public. It just comes with the territory. To be publicly recognizable is no asset to most people who value their mental health. But there is a tremendous upside.

Not everyone out there is paying attention to you for harmful reasons (especially if you are as charismatic as Oprah!). Exposure is the price of attention, and attention can be a very positive factor, because when the admiring fans hear about what you are doing, at least a percentage of them will do it too. So a wealthy, famous person is not only able to contribute financial support to a favorite cause, but is also able to inspire others. If the beloved entertainer can donate millions, even if that is only a fraction of their income, the ordinary person feels more like “What the heck, I’ll kick in one-tenth of a percent of my income, too.”

Oprah Winfrey’s influence has been vast because people believe and trust her, and sense the importance she places on retaining a genuine self, amidst the glitter and acclaim. Her rough childhood counted, too. Oprah had enough experience with the serious problems of life to want to help other people who face frightening challenges.

An Oprah-approved institution

We mentioned Shades of Hope Treatment Center, where in 2011, Oprah produced the reality TV show “Addicted to Food,” which followed eight people through the program. Oprah had been familiar with the facility for years.

Since the fall of 2003, singer Wynonna Judd had been confiding in her, in front of the cameras, about her severe food dependency. Like the ordinary citizens who were later featured on Oprah’s network show, Judd checked into the residential treatment center.

When the songstress was later interviewed by Larry King, she described her problem:

It was consuming a lot of my life… I mean food to me is what alcohol is to the alcoholic… You know the business. One minute you’re number one. The next minute you’re number zero. And I had just been using food for every emotion I had. If I was joyful, we’d go out to eat… [I]t became too much, so I did something about it.

People are not born knowing how to fix themselves, but there certainly are learnable skills that can lead strongly toward wellness. In many cases, this happens for many reasons and in many ways. This is why we need such institutions, as well as the current technology that fosters sophisticated levels of self-help.

Oprah’s charitable contributions, even when they have nothing to do with obesity, all aim to help build people better lives. We will next take a look at another of her projects which, while not directly connected to obesity, is aimed at helping young women build lives so satisfactory that they automatically preclude a lot of the self-destructive psychological pain that brings on addictive behaviors or even just carelessness, either one of which is capable of leading to medically significant obesity.

[Note: The photo is a wax figure.]

Your responses and feedback are welcome!

Source: “Oprah Reveals The Secret Behind Her Recent Weight Loss,” Essence.com, 12/08/23
Source: “Change is here. Hope is here.,” ShadesOfHope.com, undated
Image by Petr Kratochvil/License: CC0 Public Domain

Oprah’s Perennial Appeal

Pat Hartman June 26, 2025 No Comments

Oprah Winfrey is a certain kind of icon. She is absolutely not just another self-destructive doomed genius; never was and never will be a psychological basket case like Amy Winehouse, for instance. Oprah is brilliantly intelligent, and glamorous, capable of being a force of nature when necessary, and clearly a natural-born leader. But none of that could have happened without her relatability.

The reason people follow her is neither that she is so glitteringly different, nor that she is so very typical, although both are true. Her existence and accomplishments have led her to become a sort of template. At one point, during a panel discussion on “The State of Weight,” Oprah confirmed that her highest number had been 237 pounds, and added, “I’m Oprah Winfrey, and I know all that comes with that, but I get treated differently if I’m 200-plus pounds versus under 200 pounds.”

In other words, despite being wealthy and famous, she could still totally connect with the millions of women who feel that more body fat makes them “less than,” which had become the enlightened way to say “inferior.” Sitting for a magazine profile, she told a journalist,

I don’t know if there is another public person whose weight struggle has been exploited as much as mine over the years… This is a world that has shamed people for being overweight forever, and all of us who have lived it know that people treat you differently, they just do.

This talking point shone a light on the psychological double-bind that imprisons women regardless of their situations in life. The ambient culture brainwashes us every day into believing that carrying extra pounds is unacceptable and probably even immoral. That cruel mindset leads women into feeling scorn, rather than compassion — not only toward other women — but toward themselves. Just to put the icing on the cake, so to speak, we are supposed to go whole-hog with that belief, and are expected to condemn our sisters for being in the same physical condition that we fear and dread — if we are not in it already.

Through keeping an eye on Oprah, we follow every important twist and turn of the obesity issue in the fin de siècle period, and in the early years of our present century. As surely as Willie Nelson is Country & Western, Oprah Winfrey is Obesity Awareness.

History

Our take on the saga began with “Oprah Through the Years, Part 1” and so far has progressed through Part 21, and this conscientiously thorough coverage practically guarantees that there is something in it for everybody.

Then, the Childhood Obesity News blog gave Ms. Winfrey a well-earned break for a while, pausing an overview of her career about 10 years into the present century. In 2011, she produced a TV reality show called “Addicted to Food.” The venue was the Shades of Hope Treatment Center, a place to exorcise pain from the hearts of people who grew up in families characterized by dysfunction and/or abuse and/or addiction.

The program relied on numbers less than some others have done. Clients’ weights could be usefully recorded for the sake of the science, but did not have to be shared. One of the most audacious features of this program was the no-entertainment standard, which precluded both printed and televised media. You’re there to feel things, as a route to fixing yourself — so no hiding out in any media la-la land. (It does seem like this principle could usefully be emphasized, in programs everywhere, a lot more than it is currently.)

Here is a typical Shades of Hope quotation:

Your body, mind, and soul were designed to heal. Because we are holistic beings, all of these aspects of ourselves come into play when we heal — no matter what you’ve been through or are going through right now.

Next time, we pick up with Oprah again. Meanwhile, it is worth mentioning what might be called a universal truth. When it comes to kicking a habit, one factor carries over into many different therapeutic approaches: Their most outstanding and characteristic feature is the emphasis on keeping the commitment every second of every minute of every day.

Some people just are not cut out for that. Recovery is a long-term condition if ever there was one, and the better at it you are, the more chance you have of living long enough to develop real expertise. People can be quite adaptive when they want to be, which is why a tool like BrainWeighve, for an excellent example, can be surprisingly useful.

Your responses and feedback are welcome!

Source: “Oprah Reveals The Secret Behind Her Recent Weight Loss,” Essence.com, 12/08/23
Source: “Change is here. Hope is here.,” ShadesOfHope.com, undated
Image by vargas2040 cropped by Machocarioca/Attribution-Share Alike 2.0 Generic

David Kessler on the Science of Weight Loss

Tatyana Meshcheryakova June 25, 2025 No Comments

In his book Diet, Drugs, and Dopamine: The New Science of Achieving a Healthy Weight, former FDA Commissioner Dr. David A. Kessler presents an in-depth look at the science of weight loss and the forces that have fueled the obesity crisis in America. Deborah Vankin takes a look at the book for the Los Angeles Times and interviews Dr. Kessler.

“Ultraformulated” products, intentionally engineered

According to Vankin, Dr. Kessler argues that today’s food industry has deliberately crafted what he calls “ultraformulated” products — foods that are heavily processed, packed with calories, fast-digesting, and designed to be nearly impossible to resist. This strategic engineering by food manufacturers, he contends, has contributed to skyrocketing obesity rates. According to Dr. Kessler, 41.9% of U.S. adults are currently affected by obesity, and by 2030, that number could reach nearly half the population.

Dr. Kessler describes this as a “health catastrophe” that’s unfolding on a massive scale. The accumulation of visceral fat (fat that wraps around internal organs) has been linked to a wide array of serious health problems, including Type 2 diabetes, heart disease, hypertension, arthritis, dementia, stroke, and several types of cancer.

While GLP-1 medications like Wegovy and Zepbound have emerged as popular tools to reduce weight and food cravings, Dr. Kessler warns that they aren’t a silver bullet. These drugs come with their own risks, and there’s still much we don’t know about their long-term effects.

It’s personal for Dr. David Kessler

Dr. Kessler’s perspective is shaped by personal experience. Having struggled with compulsive eating since childhood, he knows firsthand how addictive certain foods can be, especially during his college and medical school years, when he relied on comfort foods as rewards. He has also faced challenges with the side effects of GLP-1 drugs. To truly address the obesity epidemic, he believes society must reframe how we understand addiction, moving away from a stigma-based model and recognizing how engineered foods help hijack the brain’s decision-making processes.

The interview takeaways

Dr. Kessler emphasizes that obesity should be treated as a long-term, chronic condition. In his conversation with the LA Times, he explores sustainable strategies for weight loss, how to approach GLP-1 use responsibly, the importance of body positivity, and ways to improve both health and longevity. Here’s a summary of the key points.

The root of the obesity crisis

Dr. Kessler identifies the “elephant in the room” as the addictive power of “ultraformulated” foods, engineered to overstimulate the brain’s reward circuits. He says,

Food is very, very powerful in changing how we feel. It’s not a question of willpower. Our bodies have experienced an insidious decline over the past half a century. And that’s been caused by this never-ending consumption of foods that can trigger the addictive circuits.

Food addiction and the role of the environment

To combat food addiction, Dr. Kessler suggests changing the cues in our surroundings that trigger cravings — like what we watch, the stores we pass, or the ads we see. Being realistic, he adds:

Many of us don’t have the opportunity to leave our environment. And the food industry isn’t prone to change their behavior any time soon. But we now have pharmaceutical aids to help tamp that down. The effect of these GLP-1 [weight loss] drugs on food noise, that’s the big discovery.

Dr. Kessler does not address the role that stress plays in driving compulsive eating, or the interplay between stress, displacement, and ultraformulated foods. Stress can definitely drive overeating, says Harvard Health Publishing, and research shows that stress shifts food preferences toward highly palatable foods.

Risks of GLP-1 drugs

While GLP-1s like Wegovy and Zepbound help reduce appetite, Dr. Kessler warns of serious health concerns such as malnutrition, gastroparesis, and hypoglycemia. Many patients are consuming dangerously low calories, and most prescribers lack training in obesity medicine. He calls for better labeling and more real-world research on long-term safety and discontinuation protocols.

Long-term weight management

Most people regain most of the lost weight after stopping GLP-1s, so the focus should be on learning sustainable habits while on them. Dr. Kessler advocates for using a full range of tools, including nutrition therapy, physical activity, and behavioral support, tailored to each individual. He says:

But the most important thing is to recognize that this is a chronic condition that needs continuous care, even after you’ve lost the weight.

Addiction vs. willpower

Dr. Kessler challenges the outdated notion that weight loss is just about “eating less and moving more,” arguing that brain chemistry plays a far more significant role. Recognizing this can reduce the shame and stigma many people experience when they struggle to lose weight.

Body positivity vs. health

Vankin asked:

There’s a delicate balance between the body positivity movement, which encourages people to accept their bodies as they are, and the health crisis that is obesity, which you say is a root cause of many diseases. How do you suggest we navigate that?

Dr. Kessler’s answer is on point:

That movement did a lot of good — it took the shame out of it, it took the stigma out. But it was at a time when we didn’t have effective tools to reduce visceral fat. You can love your body, but also do things for your health. Those things are not diametrically opposite. And I’m not comfortable with the amount of morbidity and mortality associated with visceral fat and saying we shouldn’t do something about that.

Public health concerns and institutions

Going further, Dr. Kessler is deeply concerned about the increasing burden of visceral fat-related diseases and believes the U.S. is unprepared for the long-term consequences. He also worries about the dismantling of public health institutions that were key to pandemic response efforts like Operation Warp Speed.

Even modest weight loss helps

The interview finishes on an encouraging note, that even small amounts of weight loss can meaningfully lower the risk of chronic diseases, with greater losses offering even more significant health benefits.

Your responses and feedback are welcome!

Source: “You need more than Ozempic to fight food addiction. Here’s how,” Los Angeles Times, 5/20/25
Image: Diet, Drugs, and Dopamine book cover, Amazon. Used under Fair Use: Commentary

GLP-1 and Akkermansia, the Rest of the Story

Pat Hartman June 24, 2025 No Comments

A few more things remain to be said about the bug (and tenant of our intimate innards) called Akkermansia muciniphila. As previously mentioned, its sole purpose in life is apparently to ensure that the human gut lining stays nicely knitted together and does not spring any leaks. And this is a worthy existence.

A person who wonders if they are hosting a beneficial proportion of this bug can find out from a stool test. Some of the circumstances that harm the organism are age, antibiotic use, stress, and a diet containing insufficient fiber. Unfortunately, the presence of oxygen prevents Akkermansia muciniphila from growing, so it is not available in food — with the sole exception of human breast milk, which is a great reason to breastfeed a baby for as long as possible. What a wonderful and irreplaceable gift to pass along to a newborn child!

It is possible to encourage one’s personal stock of the helpful bacterium by eating its favorite foods, like high-fiber vegetation and nondigestible carbohydrates. Note: People who suffer from, or are at risk for, inflammatory bowel disease should use caution and check with their doctors.

Now, what about the GLP-1?

Dr. Michael Ruscio informs us that, “In animal models, Akkermansia appears to stimulate the secretion of a hormone known as glucagon-like peptide-1 (GLP-1).” In other words, it’s like manufacturing gold. Imagine saying, “Farewell, Eli Lilly; au revoir, Novo Nordisk. From now on, I’ll be producing my own GLP-1 — right here in my own innards!”

This appears to be a real possibility. At the very least, it appears capable of keeping a microbiome in excellent health. If it can help us shed fat, too, so much the better!

Of course, we have to discount for “novelty bias,” and recall that the allure of the new tends to make people overlook shortcomings. The results gained so far in petri dishes and lab animals do not necessarily apply to human beings in the wild. It will take some time and a lot more study to get a handle on some of these questions.

In animals, at least, too much Akkermansia is as bad as too little. We should know a lot more about the bug before going overboard with the prescriptions, or before allowing civilians to overdose on it.

Dr. Ruscio points out that, despite strong evidence, “[W]e don’t know if low Akkermansia levels actually cause illness or not.” He also reminds us that we only have one small study to go on, so far, and consequently are a long way from knowing if this bug is our best bet for acquiring GLP-1 in aid of weight loss.

As scientists so often and so rightly repeat, more research is needed. We do not know enough about the metabolic effects and blood sugar benefits. “For now, existing probiotics (like Lactobacillus–Bifidobacterium blends) have more research and are more effective.”

And what about those claims of healing the leaky gut? “Basically, higher LPS suggests gut leakiness, and lower LPS indicates tighter intestinal wall junctions.” One study says,

After the participants took Akkermansia for 3 months, the researchers found they had lower serum LPS. This suggests that the gut wall had become less leaky, analogous to those fence boards fitting together more tightly.

While probiotics in general are useful for intestinal health and healing, Dr. Ruscio reminds us that Akkermansia has not been proven special in this area, and that above all, “[W]e should be careful not to try and micromanage the gut microbiome.” In other words, considering our vast ignorance of the whole field, we would do better to foster nourishment and balance in the whole system, rather than trying to pick a favorite based on abysmally scarce data.

The average cost of Akkermansia supplementation would be in the neighborhood of $60 to $80 per month, which is inexpensive compared to the standard GLP-1 meds — but nobody knows yet how much would be needed, for how long, or what happens when the patient quits swallowing extra bacteria? Anyway, here is Dr. Ruscio’s specific advice:

We’ll get more information on Akkermansia in time. But for now, it’s probably better and more cost-effective for your gut health to stick to the three well-studied probiotic categories. These are a Lactobacillus and Bifidobacteria blend, soil-based probiotics, and the beneficial yeast Saccharomyces boulardii.

Your responses and feedback are welcome!

Source: “Getting To Know Your Gut Bugs: Akkermansia Muciniphila,” DrHyman.com, 07/25/21
Source: “What Is Akkermansia? Here’s Everything to Know Before You Start Taking Supplements,” GoodHousekeeping.com, 05/13/25
Source: “Fact-Checking The 4 Most Popular Akkermansia Claims,” DrRuscio.com, 10/07/24
Image by vocablitz/Pixabay

GLP-1 and Akkermansia, a Glowing Prospect

Pat Hartman June 20, 2025 No Comments

We left off by mentioning Dr. Mark Hyman’s explanation of how acquaintance with the mucus-loving bacterium Akkermansia muciniphila offers a glimpse of an exciting future, featuring drug-free therapy that achieves sustainable weight loss. (Today’s post follows on from a very recent one, so get up to speed here.)

And besides, there does not seem to be a need for age limits. Imagine an affordable obesity prevention solution, for kids!

The backstory: Confronted by a serious personal health situation, Dr. Hyman discovered in himself “gut infections and really low levels of beneficial bacteria.” The mucus-loving Akkermansia, which normally accounts for between 1% and 5% of a human’s gut bacteria, was pretty much missing in him. But emerging research showed promise for this life form as “the next generation of beneficial gut microbes.” The field was on the verge of “an explosion… It’s been linked to positive health outcomes like weight loss, improved insulin resistance, lower inflammation, and more.” He wrote,

Akkermansia muciniphila feeds on mucin, a glycoprotein that regulates the thickness of our gut’s intestinal mucosal layer…. Akkermansia produces propionate and acetate, two short-chain fatty acids (SCFAs) that feed other beneficial gut bacteria…. SCFAs strengthen tight junctions (the glue that holds our intestinal cells together) and prevent unwanted materials from passing through and into circulation.

Ideally, the only substances that should pass through are “macro and micronutrients from real whole foods.” Some of the icky substances we do not want circulating at will are food particles, allergens, endotoxins, and fecal matter. The very undesirable condition that allows other stuff to circulate is known as intestinal hyperpermeability or, informally, as “leaky gut,” and is recognized as the cause of many chronic diseases.

Having a leaky gut causes the immune system to go haywire and become hypersensitive, constantly reacting to antigens (foreign proteins from food and bacteria) that enter the bloodstream unannounced.

It became increasingly obvious that Akkermansia is a good thing to have a sufficient supply of, and studies of obese adults found that high levels of this organism correlate with “healthier metabolic status and better clinical outcomes (fasting blood sugar, body fat distribution, and insulin sensitivity).” In mice, high levels of it are also associated with lower blood lipid levels, lower insulin resistance, and less adipose tissue inflammation.

One way to encourage the good bugs is to avoid highly processed foods. Another is to take it as a supplement, and a very recent article from GoodHousekeeping.com explores the possibility.

From January 2004 to February 2022, the annual number of studies published on Akkermansia grew by 33.36%, and researchers say it “is likely to remain a research hotspot in the foreseeable future.” Journalist Kaitlyn Phoenix has studied the subject in depth and quotes Madiha Saeed, M.D., on the basic mechanism of this organism’s unique talent. Akkermansia eats mucin, a protein in mucus,

[…] and produces short chain fatty acids that “strengthen the tight junctions in between our gut cells, keeping the bad stuff out of our gut…. The more mucin Akkermansia uses, the more it encourages the epithelial cells to make more mucin, which then improves gut function and overall health.

Here is an interesting detail from Dr. Michael Ruscio, DNM, DC, a doctor and clinical researcher who explores the tireless ability of Akkermansia to populate the mucosal lining of the intestines, both small and large. It appears very likely that this life form exists for the sole purpose of reinforcing the intestines to prevent their contents from seeping into other areas.

(Please return next week for the rest of this fascinating story.)

Your responses and feedback are welcome!

Obesity Guidelines Differ Between Adults and Children

Tatyana Meshcheryakova June 18, 2025 No Comments

Obesity is a growing health concern that often begins in childhood and continues into later life. Half of children with obesity stay obese into their teen years, and about 80% of those teens carry it into adulthood.

Despite the long-term nature of obesity, current clinical guidelines are usually split into rigid age categories. A recent review in Obesity Reviews analyzed existing obesity guidelines and found both overlaps and notable differences between recommendations for adults and children. The review looked at 39 guidelines issued between 2017 and 2023, containing a total of 1,248 specific recommendations.

The researchers found a lack of robust, adolescent-specific recommendations. This age group, caught between childhood and adulthood, often falls through the cracks.

Guideline differences

One major difference lies in how BMI is evaluated. Children’s BMI is measured using percentile curves that change with age and development, while adults use fixed BMI thresholds. For exercise, adults are advised to do both aerobic and strength training, while adolescents are typically only guided toward aerobic activity. Likewise, adults are given dietary options like low-calorie and low-carb diets or meal replacements, but these are largely absent — or even discouraged — for adolescents.

One reason for the limited dietary recommendations for teens is concern about how restrictive diets might impact growth. Still, a 2019 meta-analysis suggests such diets can work for adolescents, though more long-term research is needed.

When it comes to setting goals, pediatric guidelines recommend a slow and steady decrease in BMI, whereas adult guidelines often aim for a 5-10% reduction in body weight within six months. For children and teens, family involvement plays a big role in success, while adult patients are encouraged to focus on personal responsibility and education around health.

The report also highlighted a gap in guidance around metabolic and bariatric surgery (MBS) for teens. While surgery is suggested for teens with a BMI over 50, adults qualify at a BMI of 40. Few adolescent-specific recommendations exist due to a lack of research, though the authors expect more data to emerge in the coming years as obesity rates among teens rise.

The common ground

Despite these gaps, the review did identify some common ground. Both age groups are advised to have annual BMI screenings, undergo assessments for eating disorders and other obesity-linked conditions, and consider cognitive behavioral therapy. When surgery is being considered, both sets of guidelines support a team-based, multidisciplinary approach.

Your responses and feedback are welcome!

Source: “Obesity Guidelines Differ for Adult, Pediatric Patients,” AJMC, 6/13/25
Source: “Discrepancies Between Recommendations in Evidence-Based Guidelines for the Management of Obesity in Adolescents and Adults: An Evidence Map,” Obesity Reviews, 5/27/25
Image by Moe Magners/Pexels

GLP-1 and Akkermansia

Pat Hartman June 17, 2025 No Comments

One of the interesting challenges taken up by scientists in the past few years has been how to convince a body to make more GLP-1 on its own, so overweight people do not have to spend enormous sums on monthly drug buys. And clues have been found. Take, for instance, this highly technical quotation indicating progress in that direction:

The newly identified protein P9 is secreted by Akkermansia muciniphila and binds to ICAM-2 to directly trigger the secretion of GLP-1 by the L cells, while P9-stimulated IL-6 secretion by macrophages and/or intestinal epithelial cells (via an unclear mechanism) further promotes GLP-1 secretion.

A more recent and more approachable piece of reportage brings us up to date on progress in this area:

Emerging research indicates that the metabolites produced by Akkermansia […] may play a role in modulating the secretion of GLP-1… This interplay highlights the potential for Akkermansia to indirectly affect glucose metabolism and appetite regulation, offering a novel approach to addressing metabolic disorders.

Imagine us having the power to stop food cravings before they even start, right there in our own digestive tracts! Instead of swallowing or injecting medicine, why not simply manufacture it from our own innate inner resources? How do we set up the ideal conditions to facilitate that process?

Fiber is the raw material that needs to be present for metabolizing into a bunch of different stuff that all facilitates the production of GLP-1 inside a person. Then the pancreas makes insulin, which directs the brain to tell the mouth to stop eating. It also tells the stomach to hang onto the latest meal, and savor that full feeling.

What we need the body to do is to facilitate the flourishing of the prime types of gut bacteria, like Clostridium butyricum. But above all, attention is focusing on the rock-star known as Akkermansia muciniphila, which has been making quite a name for itself, and is being strenuously marketed as an over-the-counter supplement that consumers may choose at will. As we have noted here before, “Gut bacteria can significantly impact weight, independent of genes. Transplanting the microbiome from an obese twin drives obesity. Conversely, transplanting the microbiome from a healthy twin drives weight loss.”

The popularity of RYGB (roux-en-y gastric bypass surgery) has led to interesting observations and hints about what goes on inside a person after this type of surgery:

A decrease in adiposity and body weight without a change in food intake suggests that the RYGB-associated microbiota may either reduce the ability to harvest energy from the diet or produce signals regulating energy expenditure and/or lipid metabolism.

As we have seen, the gastric bypass, or Roux-en-Y procedure, used for morbidly obese people, is an irreversible combination of restrictive and malabsorptive methods. Part of the stomach is cordoned off and the very minimalist remainder of it is routed directly to the small intestine, drastically reducing the amount of food the body can absorb. This can lead to some weird results, as detailed in an article about discoveries at the Cleveland Clinic related to Type 2 diabetes:

As a treatment for obesity, Roux-en-Y is effective. As a treatment for diabetes, it is extraordinary. In 80% of cases the condition vanishes within days. Experiments conducted on mice […] show that Roux-en-Y causes the composition of the gut microbiome to change. Dr Nicholson thinks this explains the sudden disappearance of diabetes.

DiabetesJournals.org said,

[A] possibility remains that the improvement of glucose homeostasis observed following bariatric surgery is mediated by a change in gut microbiota, leading to an enhancement of nutrient-sensing mechanisms in the jejunum and an improvement in glucose tolerance…

As more surgeons investigated associations between the successful post-op maintenance of weight loss after bariatric surgery and changes in gut bacteria and functional brain activity, the gut microbiome began to be perceived as a significant regulator of obesity.

All sorts of interesting observations began to appear in the literature. From UCLA came a report by Emeran A. Mayer, M.D., about the various mechanisms by which weight-loss surgery accomplished its purpose:

We know from several studies that surgically reducing the size of the stomach is not the main mechanism for weight loss. Surprisingly, several studies have demonstrated that weight loss surgery produces changes in food preferences and appetite. Our research aims to find out what causes these unexpected changes…

What was the brain doing about weight loss, appetite reduction and changes in food preferences in response to surgery? How could this information lead to the long‐term goal of finding non-invasive treatment “capable of reproducing these brain changes and associated reductions in appetite without surgical intervention”?

Akkermansia is an enriched bacterial group that can “work independently or interdependently to influence host metabolic improvements.” Several authors from the Obesity, Metabolism & Nutrition Institute and Gastrointestinal Unit, Massachusetts General Hospital, wrote of how the probiotic Akkermansia muciniphila is a beneficial strain that is alleged to increase GLP-1 production:

[I]t is possible that Akkermansia may have a substantial role in regulating host adiposity and weight loss. Akkermansia can use mucus as a sole source of carbon and nitrogen in times of health and particularly in times of caloric restriction…

It strengthens the gut lining and improves health by reducing permeability. In this region of the body, permeable is a dirty word. We have heard the slogan, “What happens in Las Vegas, stays in Las Vegas,” and the same ought to be true of the human intestine. What belongs in there should remain in there, not go leaking all over the place.

Your responses and feedback are welcome!

Source: “A newly identified protein from Akkermansia muciniphila stimulates GLP-1 secretion,” ScienceDirect.com, 06/01/21
Source: “Akkermansia’s Impact on GLP-1 and Gut Microbiota Dynamics,” BiologyInsights.com, 04/29/25
Source: “Conserved Shifts in the Gut Microbiota Due to Gastric Bypass Reduce Host Weight and Adiposity,” NIH.gov, 05/13/13
Source: “Me, myself, us,” Economist.com, 08/18/12
Source: “Nutrient-Sensing Mechanisms in the Gut as Therapeutic Targets for Diabetes…,” DiabetesJournals.org, September 2013
Source: “From the Desk of Emeran A. Mayer, MD,” UCLA.edu, Spring 2014
Source: “Conserved Shifts in the Gut Microbiota Due to Gastric Bypass Reduce Host Weight and Adiposity,” ScienceMag.org, March 2013
Source: ‘Getting To Know Your Gut Bugs: Akkermansia Muciniphila,” DrHyman.com, 07/25/21
Image by SamuelFJohanns/Pixabay

If It’s Not the Calories, What Is It?

Pat Hartman June 12, 2025 No Comments

In relation to the food our kids eat every day of their lives, we do not like to associate such a phrase as “dirty little secret,” and yet over at Tufts School of Nutrition Science and Policy, a high official named Dariush Mozaffarian did that exact thing. As stated to journalist Dhruv Khullar, the quotation goes like this:

The dirty little secret is that no one really knows what caused the obesity epidemic. It’s the biggest change to human biology in modern history. But we still don’t have a good handle on why.

These days, any theory that embraces calories as the sole cause is likely to be rejected. But Mozaffarian offers a couple of possibilities:

Our bodies process carbs differently from fats, for instance; a calorie from corn leads your body to secrete more insulin than a calorie from cheese. Certain food additives seem to activate genes associated with weight gain, and things like weight loss and exercise can reset the body’s metabolic rate.

Dean Mozaffarian has also pointed out that with the relatively new concept of ultra-processed foods, various factions against sugary drinks, fast food, and harmful additives can join forces under one convenient banner.

A few details

If the obesity rate is falling here and there, it is likely not due to any improvement in the food or some enlightened practices, but because of the widespread use of GLP-1 drugs. Nevertheless, Americans are more overweight than their peers in other similar countries. In pursuit of knowledge, increasing numbers of researchers are looking not at what goes into the body, but what comes out. When traversing the environment of the gut, various foods leave bacterial signatures that reveal a lot.

A bug called B. theta is supposed to digest fiber, but if it doesn’t have enough fiber to work on, it will happily start digesting the mucus that forms the gut lining. Artificial sweeteners, along with a whole lot of other things, affect the microbiome. No one is quite sure of the details yet, but apparently humans have a lot fewer species of gut bugs than we used to, and this is not good.

Some experts say, maybe this is because we have changed. Others say, on an evolutionary timescale, not enough time has passed for us to have changed quite so much. So, it must be that the food itself is to blame. Foods do change our individual biology. They don’t just go in and then out in a different form. Along the way, they change our actual biology and our ability to cope with them and with other foods.

Another multifactorial field

A lot of things could be happening, and probably are. The additives that make food qualify as “highly processed” could be ruining the delicate taste receptors, which become confused and think they are encountering some nutritious substance, which turns out to actually be just fattening garbage. Feeling the lack, we struggle to make up for it by seeking (largely non-existent) nutritional value in yet more food. Dr. Chris van Tulleken describes overeating as probably “searching for that nutrition that never arrived.”

Research pioneer Kevin Hall, whose much-quoted study influenced the field tremendously, demonstrated for the first time that our metabolic health is disrupted by ultra-processed foods. He has pointed out such miscellaneous facts as, for instance, that a certain brand of vitamin water is sold as a health drink although a 20-ounce bottle of it contains almost as much sugar as a can of Coca-Cola. In regard to another point, it seems increasingly apparent that a food additive does not need to be physically addictive, but only needs to be irresistible enough to enable a behavioral addiction.

Nutritionist and molecular biologist Marion Nestle created the USA’s first academic food-studies program. She taught that during WWII, when many prospective soldiers had to be rejected because of health issues stemming from malnutrition during the Great Depression, the army became very concerned about nutrition — just as it did much more recently, when so many recruits were rejected because of obesity. That was when the Army, the National Academy of Sciences, and the National Research Council got together and published the first table of recommended amounts of various nutrients.

Your responses and feedback are welcome!

Source: “Why Is the American Diet So Deadly?,” NewYorker.com, 01/06/25
Image by Mateuszg89/Pixabay

Maximizing GLP-1 Treatment Success

Tatyana Meshcheryakova June 11, 2025 No Comments

A new joint advisory from four major clinical organizations provides a much-needed roadmap to help patients get the most out of GLP-1 medications for obesity. While GLP-1 receptor agonists like semaglutide (Ozempic, Wegovy) and tirzepatide (Zepbound) have gained popularity for their powerful effects on weight loss, this new guidance stresses that medical therapy alone isn’t enough. Nutrition and lifestyle changes are key to long-term success.

The Obesity Society, American College of Lifestyle Medicine, American Society for Nutrition, and Obesity Medicine Association came together to publish a unified advisory titled “Nutritional Priorities to Support GLP-1 Therapy for Obesity.” Drawing on a broad base of clinical and research expertise, the team reviewed current evidence and developed eight core strategies to help clinicians support patients receiving GLP-1 medications:

(1) Patient-centered initiation of therapy; (2) careful baseline nutritional assessment; (3) management of GI side effects, (4) personalized, nutrient-dense, minimally processed diets; (5) prevention of micronutrient deficiencies; (6) adequate protein intake and strength training to preserve lean mass; (7) leveraging a good diet to maximize weight reduction; and (8) promoting other lifestyle changes around activity, sleep, mental stress, substance use, and social connections to maximize long-term success.

The clinical advisory, led by Advisory Chair Dariush Mozaffarian, M.D., DrPH, of Tufts University, Boston, was published simultaneously in Obesity, American Journal of Lifestyle Medicine, The American Journal of Clinical Nutrition, and Obesity Pillars.

The guidelines in more detail

Clinical trials show that GLP-1s can reduce body weight by 5% to 18%, with multiple benefits such as improved blood sugar levels and cardiovascular risk reduction. However, real-world results tend to be more modest, and several challenges can stand in the way of long-term success. These include side effects like nausea and vomiting, nutritional deficiencies due to reduced food intake, and loss of lean muscle and bone mass. Additionally, many patients struggle with adherence over time, often regaining lost weight once treatment stops.

To address these issues, the expert panel emphasized the importance of a patient-centered approach starting from the initiation of therapy. A thorough nutritional assessment should be done at the beginning of treatment to identify any pre-existing deficiencies or health risks. Managing gastrointestinal side effects early on is essential for helping patients stick with the medication.

When it comes to diet, the group recommends moving away from restrictive eating patterns and instead focusing on nutrient-dense, minimally processed foods tailored to each patient’s preferences and needs. Ensuring adequate intake of vitamins, minerals, and protein is especially important for preserving muscle and bone health during weight loss. In addition to proper nutrition, strength training and physical activity should be prioritized to support lean mass retention.

The advisory also encourages clinicians to look beyond diet and exercise. Sleep quality, mental health, substance use, and social support all play a role in achieving and maintaining healthy weight loss. By taking a holistic view, healthcare providers can create a more sustainable and supportive plan for patients on GLP-1 therapy.

Dr. Marc-Andre Cornier, President of The Obesity Society, said:

This guidance lays a nutrition roadmap to help providers support their patients on sustainable and lasting weight reduction journeys… It underscores the importance of nutrition on quality of life and is an important contribution to the literature about incorporating lifestyle interventions into obesity care.

For patients and providers alike, the message is clear: GLP-1 medications are a powerful tool, but their true potential is only realized when paired with smart, personalized lifestyle support.

Your responses and feedback are welcome!

Source: “Advisory: Nutrition Priorities for GLP-1 Use in Obesity,” Medscape, 6/4/25
Source: “Nutritional priorities to support GLP-1 therapy for obesity…,” PubMed, 5/30/25
Image by Pavel Danilyuk/Pexels

Why this matters

The science behind maridebart cafraglutide

The clinical trial’s design and participants

Substantial weight loss followed

Safety and side effects

Why dose escalation matters

No such thing as bad publicity

An Oprah-approved institution

History

“Ultraformulated” products, intentionally engineered

It’s personal for Dr. David Kessler

The interview takeaways

The root of the obesity crisis

Food addiction and the role of the environment

Risks of GLP-1 drugs

Long-term weight management

Addiction vs. willpower

Body positivity vs. health

Public health concerns and institutions

Even modest weight loss helps

Now, what about the GLP-1?

Guideline differences

The common ground

A few details

Another multifactorial field

The guidelines in more detail

Profiles: Kids Struggling with Weight

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