WHO Declares Semaglutide and Tirzepatide Essential Medicines

Tatyana Meshcheryakova September 10, 2025 No Comments

One of the world’s most in-demand medications has just earned a new designation: essential. The World Health Organization (WHO) has added semaglutide, the active ingredient in Ozempic and Wegovy, to its Model List of Essential Medicines, alongside tirzepatide and other GLP-1 drugs.

This move is more than symbolic. By declaring semaglutide and tirzepatide “essential,” the WHO is signaling to governments worldwide that these treatments for type 2 diabetes and obesity are not luxuries but critical tools for public health.

What does it mean to be an “essential” medicine?

The WHO’s essential medicines list has existed since 1977. It’s designed to highlight drugs that provide the greatest health benefits, with the goal of improving affordability and access globally.

Today, the list includes 523 medicines for adults and 374 for children. More than 150 countries rely on it to guide decisions about which medications to prioritize for purchase, insurance coverage, and distribution.

When a drug makes the list, it’s often a catalyst for lower prices, expanded insurance coverage, and wider availability. As Yukiko Nakatani, WHO’s assistant director-general for health systems, put it:

The new editions of essential medicines lists mark a significant step toward expanding access to new medicines with proven clinical benefits and with high potential for global public health impact.

Why GLP-1 drugs are game-changers

As we’ve discussed before, the GLP-1 receptor agonists mimic natural hormones that regulate hunger, metabolism, and insulin response. For diabetes, they reliably help patients control blood sugar, reducing complications and improving long-term outcomes. For obesity, they are far more effective for weight loss than diet and exercise alone, helping many patients lose significant, sustained weight. And for overall health, by addressing obesity and diabetes, they also lower risks for cancer, cardiovascular disease, and other chronic illnesses.

Tirzepatide goes a step further by targeting not just GLP-1 but also GIP-1, another hormone involved in hunger regulation. The impact is already measurable. In the U.S., 2023 marked the first year in a decade that adult obesity rates declined, a trend many experts attribute to GLP-1s.

The accessibility is a problem, however

Despite their promise, GLP-1s are often out of reach for the people who need them most. This is due to a number of reasons, including:

  • High cost. Even after price reductions, monthly expenses can run into the hundreds of dollars.
  • Limited insurance coverage. In the U.S., many public and private insurers do not cover these drugs for obesity, restricting access to wealthier patients.
  • Global inequity. In many countries, access is even scarcer, despite diabetes and obesity being rising global health threats.

 

Deusdedit Mubangizi, WHO’s director of policy and standards for medicines, emphasized the urgency of addressing this gap:

Achieving equitable access to essential medicines requires a coherent health system response backed by strong political will, multisectoral cooperation, and people-centered programs that leave no one behind.

What the WHO’s decision could change

By adding semaglutide, tirzepatide, dulaglutide, and liraglutide to its essential medicines list, the WHO is paving the way for broader access. Some potential outcomes include generic development, for one. Canada is expected to approve the first generic semaglutide as early as 2026. In the U.S., however, generics likely won’t arrive until 2031.

The designation could also pressure drugmakers to reduce prices and encourage governments to negotiate more aggressively. The other two potential outcomes include better insurance coverage as public and private insurers may be more willing to cover drugs considered essential, and wider distribution, where primary care doctors could play a bigger role in prescribing GLP-1s, not just specialists.

Adding GLP-1s to the WHO’s essential medicines list is about more than lowering blood sugar or reducing waistlines. It’s a recognition that obesity and diabetes are among the world’s most pressing health challenges, and that effective tools to treat them must be accessible to all, not just the privileged few. As more countries act on this designation, millions of people may finally gain access to medications that can improve — and even save — their lives.

How it will play out globally remains to be seen, but let’s choose to be optimistic.

Your responses and feedback are welcome!

Source: “Ozempic Is an ‘Essential’ Drug, WHO Says as Agency Calls for Cheaper Generics,” Gizmodo, 9/5/25
Source: “WHO Includes Popular Anti-Obesity Drugs on Essential Medicines List for Diabetes Control,” Health Policy Watch, 9/5/25
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Digital Tools in Pediatric Obesity Care

Tatyana Meshcheryakova September 3, 2025 No Comments

Childhood obesity continues to be one of the most pressing public health issues in the U.S. Beyond weight gain, the condition raises risks for type 2 diabetes, heart disease, and emotional challenges that can carry into adulthood. While traditional, in-person programs remain valuable, many families struggle with barriers such as cost, travel, scheduling, and stigma.

That’s where telehealth and digital health interventions (DHIs) come in. These tools offer clinicians new ways to support patients through approaches that are scalable, family-centered, and easier to access. Let’s take a look at a piece penned by Mollie R. Cummins, Ph.D., RN, about the benefits of DHIs backed by research, recommended strategies for clinicians and parents, and current challenges.

What the research shows

Recent systematic reviews and clinical trials suggest that digital programs can do more than just help lower body mass index (BMI). Children who participate in well-designed DHIs have shown improvements in diet quality, increased physical activity, and better emotional well-being. Some programs also document reductions in body fat percentage, especially when combined with traditional clinical care.

Importantly, these findings align with the 2023 American Academy of Pediatrics (AAP) Clinical Practice Guideline, which encourages clinicians to consider digital tools as part of comprehensive obesity treatment.

Broader benefits beyond BMI

Cummins writes:

Beyond weight, DHIs have demonstrated benefits in nutrition, physical activity, and psychosocial health. Children engaged in digital programs consumed fewer sugary beverages, ate more fruits and vegetables, and became more active. Interventions that incorporated gamification or active video gaming promoted movement and reduced sedentary time. Importantly, several studies also documented improvements in quality of life, self-efficacy, and self-esteem.

Key strategies for clinicians

When using DHIs, clinicians should think beyond the technology itself and consider how to integrate these tools effectively into care. Here are some best practices:

  • Blend digital with traditional care. Programs work best when paired with in-person visits or established clinical management.
  • Engage parents actively. Family involvement improves adherence and helps reinforce healthy habits at home.
  • Focus on behavior and psychosocial goals. Increases in activity, improved diet, and boosts in self-esteem can be as meaningful as weight-related outcomes.
  • Prioritize interactive, tailored tools. Children stay engaged when programs feel relevant and enjoyable.
  • Plan for the long term. Short-term results are promising, but sustained change requires ongoing support and structured follow-up.

Barriers and challenges

While promising, digital interventions aren’t without hurdles. Clinicians need to anticipate challenges such as:

  • Declining engagement. Many families start strong but taper off after a few months. Booster sessions or scheduled check-ins may help maintain momentum.
  • Access and equity gaps. Not all families have reliable internet, digital devices, or the literacy to use them effectively. Screening for these issues is critical.
  • Safety considerations. Too much screen time or excessive focus on weight tracking can be counterproductive. Monitoring mental health and encouraging balanced use is essential.
  • Workflow integration. Without alignment to electronic health records or clinical processes, DHIs can add strain. Programs must fit seamlessly into care delivery.
  • Evidence variability. Not all digital tools are created equal. Clinicians should prioritize those with peer-reviewed research and transparent methods.

Digital obesity care of the future

Cummins writes:

The next phase of telehealth-supported obesity care will require innovation and clinical adaptation. These priorities are consistent with the World Health Organization’s global recommendations…

Areas of growth include:

  • Personalized care pathways using artificial intelligence and data analytics to deliver real-time, adaptive feedback.
  • Wearable integration for tracking activity, sleep and nutrition, but only if clinicians can incorporate the data without overwhelming workflows.
  • Sustained models of care such as year-long hybrid programs that blend telehealth visits, digital coaching and community resources.
  • Family-centered design, ensuring interventions reflect cultural needs and practical realities.
  • Broader outcome measures, including sleep, self-esteem and social participation, not just BMI.

 

Summing it up, Cummins writes:

Telehealth and digital health interventions can be valuable tools for clinicians working with children and families affected by obesity. While weight reduction outcomes appear modest, the broader behavioral and psychosocial benefits are also important. By selecting evidence-based, interactive, and family-centered programs and by planning for long-term support, clinicians can use DHIs to expand access, increase engagement, and promote healthier futures for children.

Your responses and feedback are welcome!

Source: “Using Telehealth and Digital Health to Treat Childhood Obesity,” Telehealth.org, 8/27/25
Source: “Digital health interventions to treat overweight and obesity in children and adolescents: An umbrella review,” Obesity Reviews, 2/19/25
Source: “Digital health, technology‐driven or technology‐assisted interventions for the management of obesity in children and adolescents,” Cochrane Library, 7/10/25
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Yale Study Explores How Obesity Impacts Health

Tatyana Meshcheryakova August 27, 2025 No Comments

A new research letter published in JAMA Pediatrics is shedding light on just how much obesity contributes to serious health conditions in young people. The study, led by Yale School of Medicine medical student Ashwin Chetty, estimates the extent to which obesity-related conditions (ORCs) can be tied to obesity and overweight in adolescents and young adults across the United States.

Chetty and his team used publicly available data from the National Health and Nutrition Examination Survey (NHANES) to dig into the numbers. The goal? To better understand how much obesity directly contributes to conditions like prediabetes, hypertension, and dyslipidemia, and how preventing or treating obesity might lower those risks.

As Chetty explains,

Obesity can cause hypertension, for example, but many people have hypertension who don’t have obesity. So, we want to know how many hypertension cases are caused by obesity. And that’s important because that gives us an estimate of the impact obesity has on hypertension and diseases like it and by extension, the impact that treating or preventing obesity can have on those diseases.

Building on previous research

This wasn’t Chetty’s first time tackling the question of obesity’s role in chronic conditions. While working with Alissa Chen, MD, MPH, and Alexandra Hajduk, PhD, MPH, he had already applied similar methods to study older adults ages 65 and up.

That earlier work sparked an idea. After meeting James Nugent, MD, MPH, at a pediatrics interest group, Chetty realized the same approach could be applied to adolescents and young adults, a group that hadn’t been studied as extensively. He teamed up with Dr. Nugent and Mona Sharifi, MD, MPH, to adapt the research for a younger population.

Just weeks before this new paper, the group had already published another piece in JAMA Pediatrics titled “Glucagon-Like Peptide-1 Receptor Agonist Eligibility Among US Adolescents and Young Adults.” Using those earlier definitions and methods, Chetty was able to compile fresh data for this latest study on ORCs.

A collaborative effort across specialties

One thing that stands out about this research is the cross-disciplinary teamwork. Physicians and researchers from adult medicine, geriatrics, and pediatrics — groups that don’t often overlap — came together to ask big-picture questions.

Chetty says,

We’re asking questions that bridge a lot of different populations… One of the nice things about being a medical student is that I can pivot between research on adults and research in pediatrics. The faculty who I worked with were all really open to taking part in this research. People’s openness to work on ideas that might not be squarely in their field of interest is something I really appreciate about the faculty at Yale.

What the numbers show

The findings highlight just how significant obesity’s impact is on young people’s health. The study estimated that 20–35% of adolescent cases of prediabetes, hypertension and dyslipidemia are attributable to obesity. Also, 40% of young adult cases of these same conditions can be traced back to obesity.

Chetty breaks it down:

Our interpretation of that statistical conclusion is if you were able to eliminate obesity from this population, you would reduce the prevalence of those obesity-related conditions by that amount.

Looking ahead

The team isn’t stopping here. The next step is to model the potential long-term benefits of treating obesity earlier in life. Could early intervention lower future rates of hypertension or diabetes? And what would that mean for overall healthcare costs?

Dr. Nugent praised Chetty’s initiative, noting,

This work is a testament to Ashwin who asked interesting questions and found clever ways to answer them with publicly available data. Not many people get published in JAMA Pediatrics twice in a year, never mind twice in the same month. And he’s not working with a million-dollar grant, he’s asking good questions and finding ways to answer them with NHANES data.

Your responses and feedback are welcome!

Source: “Examining the Impact of Treating and Preventing Obesity to Prevent Obesity-Related Conditions,” Yale School of Medicine, 8/25/25
Source: “Proportion of Obesity-Related Conditions Attributable to Obesity and Overweight in US Youth,” JAMA Pediatrics, 8/25/25
Source: “What’s the Cause of Obesity-Related Conditions in Youth?,” Medscape, 8/25/25
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In the Age of GLP-1 Weight-Loss Medications, Lifestyle Changes Still Matter

Tatyana Meshcheryakova August 20, 2025 No Comments

The rise of GLP-1 receptor agonists such as semaglutide and tirzepatide has transformed obesity management. Millions of patients now use these injectable drugs in pursuit of significant weight loss, and professional guidelines increasingly emphasize pharmacologic treatment. Yet, despite the promise of double-digit weight loss, many physicians still start with lifestyle interventions — nutrition, physical activity, and behavioral support — as the foundation of care.

At first glance, this may seem like resistance to innovation. In reality, it reflects a deeper philosophy shaped by evidence, clinical experience, and a long-term view of health outcomes.

Guidelines emphasize combination, not replacement

Current clinical guidance supports the use of weight-loss medications for adults with a BMI ≥ 30, or ≥ 27 with obesity-related conditions, provided that lifestyle changes alone haven’t been sufficient. Importantly, guidelines recommend combining pharmacotherapy with behavioral strategies rather than using medication as a standalone solution.

This shift from “last-resort” use of medication to a more proactive tool marks progress in obesity care. Still, the emphasis on adjunctive therapy reassures physicians who keep lifestyle-first approaches at the center of their practice. They aren’t ignoring guidance — they’re interpreting it through the lens of long-term sustainability.

Real-world data underscore the challenge

Clinical trials show dramatic results with GLP-1s, but real-world adherence is a major hurdle. A Cleveland Clinic study of 7,881 patients highlighted this gap:

  • 50% stopped GLP-1 treatment within one year.
  • 20% discontinued within three months.
  • More than 80% remained on subtherapeutic doses.

 

Weight-loss outcomes reflected these patterns:

  • Early discontinuers lost only 3.6% of body weight.
  • Patients who stayed on treatment lost 11.9% on average.
  • Those who reached full therapeutic doses achieved up to 18% loss, approaching clinical trial results.

 

For physicians like Dexter Shurney, MD, MPH, MBA, these findings validate a lifestyle-first model:

The majority of common chronic conditions — hypertension, CHF, hyperlipidemia, diabetes, depression, and obesity — are fundamentally lifestyle issues. Therefore, a lifestyle-first approach to care makes perfect sense because it addresses root cause.

Why lifestyle remains the foundation

Many clinicians see firsthand that without lifestyle changes, even the most effective drugs or surgeries can fail. Kenji Kaye, MD, an internist in Denver, explains:

Without foundational lifestyle changes, medications and surgery are destined to fail. We have seen many patients not lose weight or even gain weight despite max dosages of these pharmaceuticals.

Physicians stress that obesity is a multifactorial condition, shaped by diet, activity, genetics, hormones, and comorbidities. Addressing only one piece of the puzzle rarely yields durable results.

Dr. Shurney highlights another benefit: Lifestyle medicine reduces polypharmacy risk. Unlike single-condition drugs, lifestyle interventions improve multiple markers simultaneously — cholesterol, blood pressure, insulin resistance, and mental health.

In fact, intensive programs can yield rapid systemic improvements: Insulin doses cut in half within days for type 2 diabetes patients, plus 20–50% cholesterol reductions within two months.

Medications as strategic tools

Even physicians who prioritize behavior change often incorporate GLP-1s selectively. Elizabeth Slauter, MD, an obesity medicine physician in Texas, says:

Studies consistently show that the best outcomes with obesity medications occur when they are combined with lifestyle changes. So, it makes sense to start with lifestyle interventions as a foundational approach.

Barriers like high costs, inconsistent insurance coverage, and frequent shortages make long-term GLP-1 use impractical for many patients. For this reason, physicians frame medications as tools within a broader treatment plan, not as standalone solutions. As Dr. Kaye explains:

My usual practice is to discuss these medications as an option but only after a careful review of their food choices, activity level, health history, and current medications.

Navigating patient expectations

The popularity of GLP-1s in the media has created new dynamics in the exam room. Patients often request them directly, influenced by celebrity endorsements and online testimonials. Dr. Kaye sees this as an opportunity for education:

Medications like GLP-1s are mentioned almost everywhere including the media, pharmaceutical ads, and celebrity gossip. When a patient presents asking for a prescription, it is a perfect opportunity to really delve into the details of what these medications can offer and also the risks involved.

Expectation-setting is critical. Many patients assume they’ll only need medication short-term, but research shows discontinuation usually leads to weight regain. Helping patients understand the realities of long-term therapy protects both outcomes and trust.

System pressures and practice choices

Healthcare systems often incentivize quick, measurable results. Writing a prescription is more easily rewarded than time-intensive counseling sessions. Dr. Shurney explains:

The lack of reimbursement parity for lifestyle interventions is a disincentive to practice this way. It’s much easier to prescribe a medication and receive the “quality prize” for checking the drug adherence box than to prescribe lifestyle and not receive a similar financial reward.

To counter this, some physicians have shifted to direct primary care models, which allow longer appointments and more patient-centered counseling.

The long-term view

Ultimately, physicians who remain committed to lifestyle-first approaches are guided by long-term outcomes and healthcare sustainability. Dr. Kaye reflects:

After seeing many patients start down the pathway of pharmaceuticals and ultimately not reaching their goals reaffirmed my commitment to a more holistic approach. In my experience, without a strong foundation of lifestyle changes, the long-term success rate is low even with antiobesity medications.

Dr. Shurney adds a cautionary note:

What we risk are ever-higher healthcare costs, since these medications are very expensive and need to be taken for years, if not forever, to sustain the weight loss. Additionally, we still do not know the long-term effects of these medications.

Your responses and feedback are welcome!

Source: “Why Some Physicians Still Lead With Lifestyle-First Obesity Care Despite the GLP-1 Revolution,” Medscape, 8/12/25
Source: “Pharmacologic Treatment of Overweight and Obesity in Adults,” NIH.com, 8/20/24
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Weight Loss Without the Nausea?

Tatyana Meshcheryakova August 13, 2025 No Comments

Weight loss and diabetes drugs currently available, such as Ozempic and Zepbound, often fail to provide lasting results. While GLP-1 drugs work by targeting brain neurons that regulate appetite, they frequently cause unpleasant side effects. According to researchers, nausea and vomiting force 70% of patients to stop treatment within a year.

Now, a Syracuse University-led research team believes they’ve found a new approach that could offer weight loss without the gastrointestinal distress that derails so many patients.

Dr. Robert Doyle, a medicinal chemist and the Jack and Laura H. Milton Professor of Chemistry in the College of Arts and Sciences at Syracuse University, is leading the effort. Dr. Doyle is also a professor of pharmacology and medicine at SUNY Upstate Medical University. He and his colleagues have identified a different brain target — one that focuses on cells supporting neurons rather than the neurons themselves. This breakthrough could help treat both obesity and diabetes in a safer, more tolerable way.

Looking beyond neurons

For decades, neurons have been the most obvious and well-studied targets for brain-related drug development. GLP-1 medications, for example, zero in on neurons in the hindbrain that control appetite. But Dr. Doyle’s team is taking a different route, exploring the role of “support” cells, including glia and astrocytes, which may also influence hunger and metabolism.

A recent collaborative research effort has found that these support cells play a role in reducing feelings of hunger, although this process has received far less attention in the scientific literature. Dr. Doyle explains:

We wanted to know whether support cells might produce new peptides or new signaling molecules that might be critical in body weight reduction.

How it works

To visualize the difference between neurons and their support cells, Dr. Doyle offers a simple analogy:

Think of each brain neuron as a light bulb and support cells as the components that allow the light bulb to brighten, including the wiring, switch and filament. All of those supporting parts beyond the light bulb play a role in making the light shine.

In their research, the team discovered that certain support cells in the hindbrain naturally produce a molecule called octadecaneuropeptide (ODN), which can suppress appetite. In lab experiments, when ODN was injected directly into the brains of rats, the animals lost weight and improved their glucose processing, an important factor for managing diabetes.

However, injecting substances directly into the brain isn’t a realistic option for human treatment. To solve this, the researchers engineered a new version of the molecule, tridecaneuropeptide (TDN), that could be administered via regular subcutaneous injections, much like existing GLP-1 treatments.

When tested in obese mice and musk shrews, TDN led to weight loss and improved insulin sensitivity without triggering the nausea and vomiting commonly seen with GLP-1 drugs.

A shortcut to appetite control

One of the team’s key objectives is to develop weight loss therapies that avoid stimulating neurons directly. TDN accomplishes this by bypassing neurons and targeting the downstream support cells responsible for appetite suppression.

Dr. Doyle likens the process to starting a race partway through rather than at the very beginning. He says:

Instead of running a marathon from the very beginning like current drugs do, our targeting downstream pathways in support cells is like starting the race halfway through, reducing the unpleasant side effects many people experience… If we could hit that downstream process directly, then potentially we wouldn’t have to use GLP-1 drugs with their side effects.

Or we could reduce their dose, improving the toleration of these drugs. We could trigger weight loss signals that happen later in the pathway more directly.

This “shortcut” approach could have major implications for the millions struggling with obesity or type 2 diabetes, particularly those who cannot tolerate current treatments.

From lab to clinic

To turn this scientific discovery into a practical therapy, a new company called CoronationBio has been launched. The company has licensed intellectual property related to ODN derivatives for treating obesity and cardio-metabolic disease from both Syracuse University and the University of Pennsylvania.

CoronationBio’s mission is to move promising candidates like TDN from the lab into clinical trials. They are collaborating with other companies in the biotech and pharmaceutical sectors to accelerate development, with hopes of starting human trials as early as 2026 or 2027.

If successful, the new treatment could address one of the biggest barriers in obesity care: Keeping patients on their medication long enough to see lasting benefits.

The future of appetite control

While the research is still in early stages, Dr. Doyle’s team is optimistic about the potential impact. By shifting the focus from neurons to their support cells, they hope to change how scientists and clinicians approach weight management and metabolic disease.

The concept isn’t just about creating a new drug; it’s about rethinking the biology behind appetite regulation. Support cells, once considered secondary players in brain function, may hold the key to more tolerable and effective treatments for chronic conditions that affect millions worldwide.

As Dr. Doyle and his colleagues continue refining TDN and preparing for clinical testing, the hope is that this line of research will not only expand treatment options but also offer relief to patients who have long struggled with both their weight and the side effects of current medications.

If their theory holds true in human trials, this could mark the beginning of a new era in weight loss medicine — one where the body’s own support systems are harnessed to promote health, without the misery that forces so many to give up on treatment.

Your responses and feedback are welcome!

Source: “Scientists uncover hidden brain shortcut to weight loss without the nausea,” ScienceDaily, 8/10/25
Source: “Shortcut to Weight Loss: No Nausea Required,” Syracuse University, 7/30/25
Source: “Hindbrain octadecaneuropeptide gliotransmission as a therapeutic target for energy balance control without nausea or emesis,” Science Translational Medicine, 7/23/25
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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
Image by Artem Podrez/Pexels

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

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Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

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