U.S. Young Adults Are Eligible for GLP-1RAs, But Few Receive Them

Tatyana Meshcheryakova August 6, 2025 No Comments

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a relatively new and highly effective category of medications, making headlines for their role in weight loss. Now, new research from Yale reveals that approximately 17 million adolescents and young adults in the U.S. — about one in four in this age group — may qualify for GLP-1RAs, including well-known drugs like Ozempic and Wegovy.

The study aimed to define the demographic, clinical, and socioeconomic characteristics of eligible youth. Published in JAMA Pediatrics, the study’s lead author, medical student Ashwin Chetty, BS, noted that while GLP-1RAs are approved to treat obesity and Type 2 Diabetes (T2D) in pediatric populations, very few eligible young people are currently receiving these medications. Barriers such as limited healthcare access and inadequate insurance coverage are key contributors.

Chetty said:

Only a fraction of state Medicaid programs cover GLP-1RAs for weight management, but this research shows that broad anti-obesity medication coverage through Medicaid could substantially expand access to GLP-1RAs for adolescents and young adults. However, even with coverage expansion, high levels of uninsurance and lack of routine care are barriers to GLP-1RA access in this population.

The researchers also described this gap as “a barrier to identifying, treating, and preventing cardio-kidney-metabolic diseases.”

Chetty told Newsweek:

Assuming that all individuals who were appropriate candidates for these medications could receive them after shared-decision making with their clinician, we could see substantial progress made in treating and preventing obesity-related diseases in U.S. youth, such as dyslipidemia and hypertension.

This progress, he added, “could lead to the prevention of severe complications of obesity into adulthood, such as strokes and heart attacks.”

Chetty explained that the study used eligibility criteria aligned with FDA indications for medications such as semaglutide (Ozempic, Rybelsus, Wegovy), liraglutide (Saxenda, Victoza), exenatide (Bydureon BCise), dulaglutide (Trulicity), and tirzepatide (Zepbound, Mounjaro).

The research analyzed data from the National Health and Nutrition Examination Survey (NHANES) for individuals aged 12–17 (adolescents) and 18–25 (young adults). For adolescents, eligibility included a diagnosis of type 2 diabetes or obesity, defined as a BMI at or above the 95th percentile for age and sex, or a body weight over 60 kg (132 lbs.) with a BMI equivalent to 30 for adults. For young adults, criteria included type 2 diabetes, a BMI over 30, or a BMI of 27 or more accompanied by a weight-related condition like hypertension, dyslipidemia, cardiovascular disease, or T2D.

The final dataset included 572 adolescents and 590 young adults who met these criteria, representing an estimated 5.8 million adolescents and 11.1 million young adults nationwide.

Among eligible adolescents, 40.3% were covered by Medicaid, 40.5% by private insurance, and 7.2% were uninsured. For young adults, 20.8% had Medicaid, 49% had private insurance, and 19.4% were uninsured. While 92.2% of adolescents reported a regular source of healthcare, only 68.1% of young adults did, highlighting a key access gap.

The study also found that cardio-kidney-metabolic risk factors such as hypertension, prediabetes, impaired kidney function, and abnormal cholesterol levels were common across both age groups.

“Of note, some indications for young adults were fully encompassed by other indications and were not analyzed separately,” Chetty explained. For instance, individuals with type 2 diabetes may also have cardiovascular disease, which overlaps with other eligibility criteria.

Improving access to healthcare among young adults could help more eligible patients benefit from GLP-1RAs. In addition, expanding Medicaid and private insurance coverage for these medications across all age groups could make a significant impact.

James Nugent, MD, MPH, a co-author of the letter, told Newsweek,

Changes in lifestyle behaviors and structural factors like increased screen time, decreased physical activity, poor sleep, and consumption of ultra-processed foods and sugar-sweetened beverages are important contributors to obesity in youth.

Dr. Nugent emphasized that addressing pediatric obesity demands both individualized treatment and broad public health strategies. Medications like GLP-1RAs are one tool among many for managing obesity in children and teens, especially those facing severe obesity and related health complications.

Looking ahead, the authors urge greater national dialogue on how to expand access to GLP-1RAs and other evidence-based obesity interventions. “Given the size and clinical characteristics of the U.S. youth population eligible for GLP-1RAs, there should be greater discussion of how to improve access to GLP-1RAs and other anti-obesity interventions among this population,” they concluded.

Your responses and feedback are welcome!

Source: “New Research Letter Examines GLP-1 Access for Adolescents and Young Adults,” Yale School of Medicine, 8/4/25
Source: “Glucagon-Like Peptide-1 Receptor Agonist Eligibility Among US Adolescents and Young Adults,” JAMA Pediatrics, 8/4/25
Source: “Nearly 17 Million Young Americans Could Benefit From Ozempic-like Drugs,” Newsweek, 8/4/25
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New Study Suggests Genetics Can Predict Obesity in Childhood

Tatyana Meshcheryakova July 30, 2025 No Comments

A groundbreaking international study has revealed that our DNA may hold vital clues about our risk of developing obesity — even before we hit kindergarten. Using genetic data from more than five million people, researchers have developed a new polygenic risk score (PGS) that can accurately predict an individual’s likelihood of developing obesity starting from early childhood.

This discovery opens up exciting new possibilities for targeted early intervention, offering hope in the fight against a growing global health crisis.

Unlocking obesity risk through DNA

Led by researchers from the University of Copenhagen and the University of Bristol, the study has created the most advanced genetic tool to date for predicting obesity. The polygenic risk score, built on the world’s largest and most diverse genetic dataset, assesses thousands of genetic variations that collectively influence a person’s body mass index (BMI) and appetite regulation.

Assistant Professor Roelof Smit, lead author of the study published in Nature Medicine, explains:

What makes the score so powerful is the consistency of associations between the genetic score and BMI before the age of five and through to adulthood — timing that starts well before other risk factors begin to take shape. Intervening at this point could theoretically make a huge impact.

The PGS predicts a person’s obesity risk with twice the accuracy of previous methods and accounts for nearly 17% of the variation in BMI, an unprecedented leap in the field of genetic research.

Why this matters

According to the World Obesity Federation, more than half of the global population is expected to be overweight or obese by 2035. While traditional treatment methods like diet, medication, and surgery exist, they are not universally available or effective, and they typically come after weight problems have developed.

This new research highlights the potential of genetics as a preventive tool rather than just a diagnostic one. By identifying children with a high genetic predisposition to obesity early on, public health efforts can shift focus from treatment to prevention.

Dr. Kaitlin Wade, co-author and Associate Professor in Epidemiology at the University of Bristol, underscores this point:

Obesity is a major public health issue, with many contributing factors including genetics, environment, and behavior. Some of these likely begin in childhood. This work offers an exciting opportunity to detect at-risk individuals earlier in life and intervene proactively.

How the polygenic risk score was built

To develop the PGS, researchers used data from:

  • GIANT Consortium, a large-scale genetics initiative focused on anthropometric traits
  • 23andMe, consumer DNA testing data
  • Children of the 90s study, longitudinal BMI data tracked from birth

This allowed scientists to link specific genetic markers with patterns in BMI from early childhood through adulthood. When tested on over half a million individuals, the new score outperformed all previous models, establishing itself as a reliable early predictor of obesity risk.

Not just genetics

One of the most important takeaways from the study is this: Genetics is not destiny.

While the PGS can signal risk, lifestyle interventions, such as healthy eating, physical activity, and behavioral support, still play a critical role in outcomes. Interestingly, the study also found that individuals with a higher genetic risk for obesity were more likely to respond positively to weight-loss interventions. However, they also tended to regain weight more quickly after interventions ended.

The future of obesity prevention?

This research represents a major leap forward in understanding the complex genetic underpinnings of obesity. By identifying high-risk individuals in early childhood, there’s a real possibility to prevent obesity before it takes root, rather than trying to reverse it after the fact.

If adopted widely, polygenic risk scores could become a key tool in pediatric medicine, guiding personalized lifestyle coaching and health education that could change the trajectory of a child’s life.

Your responses and feedback are welcome!

Source: “New genetic test predicts obesity before you start kindergarten,” ScienceDaily, 7/23/25
Source: “A new genetic test may be able to predict obesity in early childhood. What to know,” USA TODAY, 7/23/25
Source: “New genetic test predicts obesity risk in early childhood,” Contemporary Pediatrics, 7/22/25
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The Link Between Sleep and Weight

Tatyana Meshcheryakova July 23, 2025 No Comments

For years, it was commonly believed that weight was determined solely by what you eat and how often you exercise. But modern research paints a more complex picture. Today, we know that weight is influenced by a combination of factors — including genetics, socioeconomic status, mental health, stress, environment, and sleep. Yes, sleep. How much (and how well) you sleep can significantly affect your ability to manage weight.

Sleep Foundation’s Senior Health Editor Alexa Fry looked at the link between sleep and weight gain, including in children and adolescents, and while some conclusions may seem obvious, studies back them up.

There’s a frustrating cycle that many people face: Sleep deprivation can lead to weight gain, and excess weight can contribute to poor sleep. Together, they can create a loop that’s difficult to break. The good news? There are ways to improve both sleep quality and weight-related health outcomes.

How sleep loss contributes to weight gain

Not getting enough sleep disrupts the body’s hormone balance. Two key hormones involved in hunger — leptin and ghrelin — are affected. Leptin helps signal fullness, while ghrelin triggers hunger. Sleep deprivation suppresses leptin and increases ghrelin, making you feel hungrier than you actually are.

Sleep loss is also linked to an increase in cortisol, the stress hormone, which is known to promote fat storage. Meanwhile, insufficient sleep can slow your metabolism and reduce levels of growth hormone, which helps regulate body composition.

On a behavioral level, lack of sleep increases cravings for high-calorie foods, especially late at night. Studies show that sleep-deprived people are more likely to choose energy-dense, nutrient-poor foods. They’re also less likely to exercise, often because they’re too fatigued. All of these factors can make it easier to gain weight — and harder to lose it.

The impact of poor sleep on children’s weight

Sleep plays a critical role in childhood development, including weight regulation. Children need more sleep than adults, and those who don’t get enough are at a greater risk for obesity.

Like adults, kids with poor sleep habits may experience hormonal shifts that affect appetite and metabolism. They may also feel more tired during the day and be less physically active.

Interestingly, bedtime matters too. Research has shown that children who go to bed later tend to eat more unhealthy foods and consume fewer fruits and vegetables. And for children who are already overweight, irregular sleep patterns and insufficient sleep can make matters worse — intensifying the long-term health risks.

Sleep disorders and health conditions linked to obesity

Being overweight doesn’t just increase the risk of chronic diseases, it also contributes to a range of sleep-related issues. Here are some of the most common sleep-disrupting conditions linked to excess weight:

  • Obstructive Sleep Apnea (OSA). OSA is a sleep disorder where the airway partially or fully collapses during sleep, causing loud snoring and interrupted breathing (including in children). People with obesity are up to seven times more likely to develop OSA. Excess weight around the neck and throat can further block the airway. In a significant medical development, the FDA recently approved Zepbound, a weight-loss medication, to treat moderate to severe OSA in patients with obesity. It’s the first drug of its kind to receive approval specifically for this purpose.
  • Gastroesophageal Reflux Disease (GERD). GERD is more common in people with excess weight. When stomach acid flows back into the esophagus, especially when lying down, it can cause sleep disturbances due to discomfort and heartburn.
  • Depression and obesity often occur together and can worsen each other. Up to 75% of people with depression experience insomnia or other sleep difficulties. And disrupted sleep can make depression symptoms more severe.
  • Obesity increases the likelihood of developing asthma and makes symptoms more difficult to manage. Many asthma patients experience nighttime flare-ups, which can significantly reduce sleep quality.
  • Excess weight puts extra stress on joints, leading to osteoarthritis. Joint pain — especially at night — can interfere with sleep. Over time, this creates a vicious cycle of pain, fatigue, and worsening health.

 

Tips for getting better sleep while overweight

Improving sleep starts with building strong sleep hygiene habits: daily behaviors and routines that promote restful sleep. Here are several strategies to consider (and this applies to children as well):

  • Stick to a regular schedule. Go to bed and wake up at the same time each day, even on weekends.
  • Create a calming bedtime routine. Wind down with quiet, screen-free activities before bed.
  • Be mindful of food and drink. Avoid heavy meals, caffeine, and alcohol close to bedtime.
  • Invest in the right mattress. Your bed should support your body comfortably, especially if you experience joint pain.
  • Exercise regularly. Physical activity helps regulate sleep and supports weight loss, but avoid intense workouts right before bed.
  • Watch late-night snacking. Try to avoid eating after dinner, especially foods high in sugar or fat.

 

Breaking the sleep–weight cycle

The relationship between sleep and weight is deeply intertwined, and breaking the cycle can feel overwhelming. But it’s not impossible. Through a combination of healthy sleep habits, medical support, and tailored lifestyle changes, you can improve both your sleep quality and your children’s.

Your responses and feedback are welcome!

Source: “Obesity and Sleep,” Sleep Foundation, 7/16/25
Source: “Mastering Sleep Hygiene: Your Path to Quality Sleep,” Sleep Foundation, 7/7/25
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Why Early-Life Factors Matter in Childhood Obesity

Tatyana Meshcheryakova July 16, 2025 No Comments

Childhood obesity doesn’t start in elementary school — it often begins much earlier, sometimes even before a child is born. A new study published in JAMA Network Open reinforces what health experts have long suspected: Prenatal and early-life conditions significantly shape a child’s risk for obesity later in life. These findings emphasize the importance of early intervention to encourage healthy growth patterns from the very start.

Early clues to a long-term problem

The study analyzed data from nearly 9,500 children between the ages of 1 and 9, tracking more than 53,000 BMI (body mass index) measurements. Researchers used a sophisticated modeling approach to uncover how BMI changes over time, not just whether a child is overweight at a certain age, but how and when those changes occur.

Children were categorized into two groups: those with a “typical” BMI pattern and those with an “atypical” trajectory — a group at higher risk for long-term obesity.

In a typical pattern (89% of children), BMI rose in infancy, dropped to its lowest point around age 6, then steadily increased through age 9 — a process known as adiposity rebound. In an atypical pattern (11% of children), these kids had stable BMIs from ages 1 to 3.5, followed by a steep increase through age 9. By age 9, their average BMI reached 26.2 — well above the 99th percentile.

The researchers noted that the timing of adiposity rebound is crucial. When this rebound happens earlier than normal, it’s considered a red flag for accelerated growth and increased risk of obesity and cardiometabolic conditions later in life.

Risk factors start before birth

The study also explored what environmental and biological factors were most predictive of a child following an atypical BMI trajectory. Several key prenatal and birth-related factors stood out:

  • High maternal BMI before or during pregnancy
  • Excessive weight gain during pregnancy
  • Smoking during pregnancy
  • High birth weight
  • Preterm birth

 

Each of these increased the odds of a child ending up in the high-risk BMI group.

What’s happening inside the womb can also influence a child’s long-term health in less obvious ways. For example, maternal obesity and weight gain have been linked to disturbances in the development of the infant’s gut microbiome — the ecosystem of bacteria that affects digestion, metabolism, and immune response. A separate study in Clinical and Experimental Pediatrics found that children born to mothers with high BMIs were more likely to have microbiota profiles associated with obesity by the time they turned one, especially if delivered via cesarean section.

Why this study stands out

Most past research could only offer snapshots — a child’s weight at one age, compared with a benchmark. What makes this new study different is the ability to chart the shape of growth over time and detect deviations from normal development earlier than ever.

The researchers used a novel modeling technique called multiphase latent growth mixture modeling, which captures not just the amount of weight gain, but its timing and rate of change. While the method is more complex and computationally demanding, it provides a clearer, more personalized picture of how and when a child might be veering off a healthy growth path.

A call for early action

The key takeaway? Obesity prevention may need to start far earlier than preschool. By understanding the early-life factors that shape growth trajectories, parents and healthcare providers have an opportunity to intervene during critical windows, even before birth.

Whether it’s supporting maternal nutrition and prenatal care, encouraging breastfeeding, promoting gut health, or simply monitoring weight gain more closely during early childhood, the message is clear: The earlier we address the risk factors, the better the long-term outcomes for children.

As the authors concluded:

We identified modifiable early-life factors that may place children at risk for or protect children from childhood obesity.

What can parents do?

Here are some actionable steps to reduce the risk of early-onset obesity:

  • Maintain a healthy weight during pregnancy. Work with a healthcare provider to stay within recommended gestational weight gain guidelines.
  • Avoid smoking during pregnancy. It’s a known risk factor for various childhood health problems, including obesity.
  • Encourage breastfeeding. It can support a healthy gut microbiome and reduce obesity risk.
  • Watch for early signs of rapid weight gain. Regular pediatric visits with growth monitoring are essential.
  • Support a healthy diet and active lifestyle from the start. Good habits formed early are more likely to stick.

 

While genetics and lifestyle are part of the equation, this study reminds us that environmental and prenatal factors play a powerful role. The good news? Many of those factors are modifiable. With greater awareness and proactive care (starting before birth), families and communities can help change the trajectory for the next generation.

Your responses and feedback are welcome!

Source: “Prenatal and Early-Life Contributors to Childhood and Adolescent Obesity,” The American Journal of Managed Care, 7/10/25
Source: “Early-Life Factors and Body Mass Index Trajectories Among Children in the ECHO Cohort,” JAMA Network Open, 5/22/25
Image by Leah Newhouse/Pexels

The Psychological and Social Complexities of GLP-1 Drugs

Tatyana Meshcheryakova July 9, 2025 No Comments

The last couple of weeks have been eventful in the realm of the ever popular GLP-1 meds, from positive news of yet another benefit to taking them (like lowering heart-related risks) to the sobering warning of a new, negative side effect on health, plus some substantial insurance coverage changes. Let’s take a look.

As has been established, GLP-1 receptor agonists (like semaglutide and liraglutide) and GLP-1/GIP combinations (like tirzepatide) help with weight loss by mimicking hormones that suppress appetite, slow digestion, and promote satiety. When paired with lifestyle changes, they can reduce body weight by 10%–20% over 9–15 months and improve cardiometabolic health. However, side effects like nausea, constipation, and loss of lean muscle mass are common and can prompt many to stop using the medication.

Psychological benefits and challenges

These medications can quiet obsessive food thoughts (“food noise”), reduce shame around eating, and give users a sense of mastery. However, they may also cause emotional side effects. Some users report a flattening of emotions or loss of pleasure in everyday experiences — possibly due to changes in the brain’s dopamine system. Studies show mixed results on whether GLP-1s increase depression or suicidal thoughts, with some linking them to mood issues and others finding mild improvements in depressive symptoms.

Psychologists are becoming essential in supporting GLP-1 patients by helping them adjust emotionally, manage disordered eating, and handle social stigma. Patients often face conflicting societal pressures — praised for losing weight, yet judged for using medication to do so. Therapy helps them navigate shifting body image, relationship dynamics, and grief over old habits or coping mechanisms (like using food for comfort).

Social and cultural complexities

The widespread use of GLP-1s brings up deeper issues around weight stigma, societal bias, and access. Some experts worry these drugs reinforce the idea that larger bodies are a problem to fix, potentially marginalizing people who are fat-positive or not interested in weight loss. Access is another concern: those with lower income or from marginalized communities may be less likely to afford or continue treatment.

Meanwhile, doctors may prescribe these drugs based on appearance, not medical need, and patients with eating disorders can misuse them. The rise of telehealth and loosely regulated medical spas also makes GLP-1s more accessible, sometimes in unsafe ways.

Role of psychology in GLP-1 use

Psychologists support patients by helping them:

• Develop sustainable, healthy relationships with food
• Prevent muscle loss through proper nutrition and exercise
• Strengthen body image and emotional resilience
• Navigate relationship changes and shifts in identity
• Cope with past trauma that may resurface with physical transformation

Some also use trauma-informed therapies like EMDR (Eye Movement Desensitization and Reprocessing) to help patients who used food to cope with abuse or fear the attention that comes with weight loss.

GLP-1s and addiction treatment

Emerging research suggests GLP-1s may help curb addictive behaviors, such as excessive alcohol use. A 2025 trial showed semaglutide reduced heavy drinking days and cravings in people with alcohol use disorder. The effect appears similar to how GLP-1s suppress appetite — by dulling the brain’s reward signals. More research is needed before these drugs are FDA-approved for addiction, but psychologists are encouraged to stay informed as more patients may use GLP-1s for this purpose.

GLP-1 medications offer significant promise for those struggling with obesity, providing both physical and emotional relief. But they also come with complex psychological and societal implications. Experts agree: The success of these drugs isn’t just medical — it’s behavioral. Psychologists play a vital role in helping patients navigate the inner changes that accompany dramatic outer transformations.

Alleviating migraines, but it’s a pancreatic risk

It’s been reported that in a small study, a GLP-1 drug shrank the number of days people spent with a migraine by almost half in a given month. However, the GLP-1 receptor agonists are under investigation by U.K. health authorities due to reports of serious pancreatic side effects, including nearly 400 cases of acute pancreatitis and up to 10 deaths.

The U.K.’s Medicines and Healthcare products Regulatory Agency (MHRA) and Genomics England are examining whether genetic factors may predispose certain individuals to these rare but serious complications. Tirzepatide-based drugs like Mounjaro and Zepbound appear to be more frequently linked to these reports.

While no direct causal link has been established, the investigation seeks to better understand who might be at greater risk. U.K. residents over 18 who experience severe reactions are encouraged to report them through the Yellow Card system and may be invited to submit further details and a saliva sample for research.

Experts stress that GLP-1 drugs remain approved and generally safe when prescribed and monitored by a doctor, but warn against obtaining them through unofficial channels.

CVS Caremark drops Zepbound from coverage, citing cost

Starting this week, CVS Caremark, one of the largest U.S. pharmacy benefit managers, will stop covering Eli Lilly’s Zepbound, a GLP-1 drug approved for chronic weight management, on its most common formulary, affecting 25–30 million Americans. Wegovy, a competing drug from Novo Nordisk, will remain covered, alongside a few less effective alternatives.

CVS says this move is designed to drive down costs by forcing drugmakers to compete, citing the high prices of GLP-1s as a major barrier to access. However, pharmacy benefit managers (PBMs) like CVS have been criticized for their role in rising drug prices.

Doctors and patient advocates argue that GLP-1s aren’t interchangeable, and abrupt coverage changes can disrupt patient care. Side effects, tolerability, and individual response vary, and switching medications mid-treatment can stall progress or worsen health outcomes.

Critics also say this move reflects a broader misunderstanding of obesity as a chronic disease, noting that insurance policies don’t treat obesity care with the same consistency or respect as other chronic conditions.

Providers report being overwhelmed with patient concerns and spending excessive time navigating insurance rules instead of delivering care. Another upcoming policy change: BCBS Massachusetts will stop covering GLP-1s for obesity in 2026, unless prescribed for diabetes.

In response, Eli Lilly is expanding access via its LillyDirect program, offering Zepbound for $499/month out-of-pocket. Still, many worry such policies will create greater inequality and care disruption for people managing obesity.

Your responses and feedback are welcome!

Source: “A new era of weight loss: Mental health effects of GLP-1 drugs,” APA, 7/1/25
Source: “Pill form of popular weight-loss drug lowers heart risks,” Harvard Health Publishing, 7/1/25
Source: “Popular weight-loss drugs show promising new power against debilitating migraines,” Fox News, 7/2/25
Source: “New Weight-Loss Drugs Under Scrutiny Amid Pancreas Concerns,” Science Alert, 7/3/25
Source: “Major insurance changes are coming to GLP-1 drugs for weight loss. Here’s how that could affect patients,” CNN, 7/1/25
Image by Leeloo The First/Pexels

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

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

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

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

 

The MAHA Report’s Shortcomings and Mistakes

Tatyana Meshcheryakova June 4, 2025 No Comments

In a bold and sweeping move, the Trump administration released the “MAHA Report: Make Our Children Healthy Again,” a 72-page document outlining the rise of chronic illnesses among America’s youth. Spearheaded by Health Secretary Robert F. Kennedy, Jr., the report zeroes in on an urgent public health crisis — one that includes high rates of obesity, asthma, behavioral health disorders, and autoimmune conditions. Among these concerns, childhood obesity stands out as both emblematic of broader systemic issues and as a pressing problem that demands real solutions.

While the report identifies compelling drivers such as poor diet, environmental toxins, lack of physical activity, and chronic stress, experts argue that its proposed solutions fall short. The diagnosis is clear. The treatment? Frustratingly vague.

A real and rising epidemic

The numbers are hard to ignore. According to the Centers for Disease Control and Prevention (CDC), roughly one in five children in the U.S. is obese. Obesity in childhood is not just about weight; it significantly increases the risk of developing type 2 diabetes, cardiovascular disease, and mental health challenges later in life.

The MAHA report acknowledges this epidemic, pointing to dietary patterns dominated by ultra-processed foods, lack of exercise, and toxic environmental exposures as major contributors. And many experts agree. Dr. William Dietz of George Washington University noted that targeting ultra-processed foods is an important step, though it needs nuance and depth, not just broad condemnation.

Yet, while the report shines a spotlight on known issues, it seems to sidestep a critical aspect of the obesity conversation: socioeconomic inequality.

Poverty, processed foods, and missed opportunities

One of the most glaring oversights in the MAHA report is its limited engagement with poverty as a root cause. Processed foods are cheaper and more accessible than fresh, nutrient-rich alternatives, especially in underserved communities where food deserts persist. Families grappling with low incomes may rely on inexpensive, calorie-dense foods simply to feed their children.

Rather than addressing this systemic problem through programs like expanded school meal funding or subsidies for fresh produce, the report offers proposals that critics describe as “splashy,” such as removing food dyes or funding small-scale research trials — steps that may look good in headlines but lack the structural force needed to shift real-world outcomes.

Mixed messages on prevention and research

The MAHA report calls for a shift toward preventive medicine, urging NIH and FDA to support more research into the health effects of diet and chemicals. On paper, this looks promising. However, in practice, the Trump administration has simultaneously enacted cuts that directly undermine these goals.

Thousands of federal employees have been laid off, and budget cuts have hit agencies such as the CDC and NIH — organizations tasked with the very research and data collection the report claims to champion. Dr. Dietz warns that such cuts may erode our ability to monitor obesity trends, making it harder to assess progress over time.

This contradiction raises the question: Can we fight an epidemic without the tools to measure and understand it?

Overmedicalization and lifestyle solutions

Another area of focus in the report is “overmedicalization”— the idea that the healthcare system is too focused on treating disease rather than preventing it. On this point, there’s widespread agreement. Childhood obesity cannot be solved with a prescription pad alone.

Instead, a comprehensive prevention model would include:

  • Parent-infant training in emotional regulation
  • Robust nutrition education in schools
  • Community-based fitness initiatives
  • Subsidized access to whole, unprocessed foods
  • Improved urban planning to ensure walkable neighborhoods and safe parks
  • Policies addressing environmental pollutants

 

And while the report mentions lifestyle medicine and surveillance of pediatric drugs, it doesn’t go far enough in proposing how such a shift would be funded or implemented at scale.

What else is missing?

Ultimately, the MAHA report highlights an urgent problem but falls short of a strategy to fix it. Childhood obesity isn’t just a matter of bad personal choices or isolated environmental exposures. It’s the result of systemic forces: poverty, inequality, food industry lobbying, and crumbling public health infrastructure.

Lauren Wisk from UCLA points out that real progress will come from social policies that address root causes, not just from banning food dyes or launching a few more studies. For instance, universal school meal programs, expanded SNAP (food stamp) benefits, and tighter regulations on junk food marketing to kids could move the needle far more than flashy headlines.

If the administration is serious about “making our children healthy again,” it must follow up this report with policies that put science, equity, and prevention at the forefront. Otherwise, this report may end up as just another diagnosis without a cure.

AI only makes it worse

In a follow-up development, the Trump administration has issued corrections to the report after journalists discovered several flawed and nonexistent citations, casting doubt on the report’s scientific integrity. Investigations by a nonprofit NOTUS and NBC News revealed that at least four referenced studies do not exist, including one falsely attributed to epidemiologist Katherine Keyes.

Dr. Keyes commented:

I can confirm that I, and my co-authors, did not write that paper… I was surprised to see what seems to be an error in the citation of my work in the report, and it does make me concerned given that citation practices are an important part of conducting and reporting rigorous science.

The report’s credibility has come under further scrutiny due to its anonymous authorship, limited medical representation among commission members, and questionable interpretation of cited research. Out of 522 total references, seven could not be verified, and some included URLs containing “oaicite,” suggesting that generative AI may have played a role in compiling sources.

Additionally, researchers like Mariana Figueiro, a professor at the Icahn School of Medicine at Mount Sinai, have stated that their studies were misrepresented. Her work on melatonin suppression in college students was incorrectly cited as evidence about children’s sleep and screen time. She said:

The conclusions in the MAHA report are incorrect and misrepresented our finding… We looked at melatonin suppression, not sleep onset. We also used college students, not children as subjects. Finally, the journal name was incorrect.

Unsurprisingly, these errors have sparked criticism over the report’s scientific validity and its use in shaping national health policy.

Your responses and feedback are welcome!

Source: “MAHA Commission report paints a dark picture of U.S. children’s health,” NPR, 5/22/25
Source: “Trump admin corrects RFK Jr.’s MAHA report after citation errors,” NBC News, 5/30/25
Source: “The MAHA Report Cites Studies That Don’t Exist,” NOTUS.org, 5/29/25
Image by Markus Winkler/Pexels

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Profiles: Kids Struggling with Weight

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The Book

OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

Food & Health Resources