Diabetic nephropathy (DN) is a common microvascular complication of diabetes. Mitochondrial dysfunction in the kidney caused by diabetes has previously been linked to the pathogenesis of DN. By mass spectrometry, we identified characteristic proteins of DN from the renal mitochondria in mouse model. To identify the core proteins among them, Mendelian randomization (MR) analysis, microarray data validation, and drug-target interaction analysis were employed. MR analysis found that 189 candidate targets had a causal link with DN risk factors (estimated glomerular filtration rate (eGFR), urinary albumin excretion, and serum creatinine). After systematic analysis, we validated that SLC25A16, CTNND1, C2CD2L, ALDH3A2, NEU1, APEH, CORO1A, NUDT19, and NDUFA4L2 are the core proteins with promising druggability in DN. This study suggests the feasibility of using MR analysis for DN drug target screening, and provides potential insights into mitochondrial dysfunction research, which may contribute to further DN pathogenesis exploration.

Obesity and type 2 diabetes mellitus (T2DM) are significant global health challenges, closely linked to metabolic dysfunction-associated steatotic liver disease (MASLD). Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown promise in treating T2DM and obesity, but their potential for managing MASLD is still being explored. This review aims to examine the current progress in using GLP-1RAs for MASLD treatment and evaluate emerging dual and triple hormonal agonists as future therapeutic options.

GLP-1RAs have been effective in controlling blood sugar levels, promoting weight loss, and improving cardiovascular and kidney function. Furthermore, they have shown potential benefits for liver function in patients with MASLD. GLP-1, a key incretin hormone, influences glucose metabolism, appetite, and insulin sensitivity while affecting gastric emptying and potentially reducing fat deposition in the liver. Recent developments in GLP-1RAs include various formulations with different administration and dosing options, expanding their therapeutic use.

GLP-1RAs have become central to the management of T2DM, obesity, and possibly MASLD due to their ability to lower HbA1c, aid in weight reduction, and provide cardiovascular protection. As research continues, dual and triple hormonal agonists are emerging as the next evolution of incretin-based therapies, offering promising new strategies for addressing MASLD in the future.

Introduction: Hypoglycemia is prevalent among patients postbariatric surgery, but its clinical implications remain unclear. The purpose of this study was to examine the longitudinal associations of hypoglycemia (i.e., occurrence in the past 3 months, frequency in the past 7 days, number of severe episodes in the past 3 months, and symptoms) with depressive symptoms, quality of life (QoL), work productivity, and weight loss over an 84-month follow-up period after bariatric surgery. Methods: This secondary analysis used data from the Longitudinal Assessment of Bariatric Surgery-2 study. Hypoglycemia, depressive symptoms, QoL, and work productivity were self-reported. Weight was primarily based on objective measures. Linear mixed modeling with time-lagged techniques was used for analysis, adjusting for potential covariates such as age and gender. Results: Across the 84-month follow-up, 20%-30% of participants (N = 552) reported experiencing hypoglycemia in the past 3 months. Hypoglycemia occurrence was positively associated with depressive symptoms [β = 2.4; 95% confidence interval (CI): 1.7, 3.0] and negatively associated with physical (β = -4.2; 95% CI: -5.1, -3.3) and mental QoL (β = -3.4; 95% CI: -4.4, -2.4). These associations became stronger with increased frequency of hypoglycemia, a higher number of severe episodes, and the presence of symptoms. Additionally, hypoglycemia occurrence was associated with several domains of work productivity, including presenteeism (β = 5.8; 95% CI: 3.4, 8.2), work productivity loss (β = 5.6; 95% CI: 2.6, 8.6), and activity impairment (β = 8.8; 95% CI: 6.0, 11.6), with the strength of these associations increasing with greater hypoglycemic frequency. Conclusions: This study highlights the critical role of hypoglycemia in patients' physical and psychosocial well-being postbariatric surgery. Future studies employing more rigorous measures of hypoglycemia and expanded outcomes (e.g. cognitive function) are needed to fully understand its clinical relevance.

Obesity is a chronic disease causing a major public health challenge, particularly in Algeria, yet in patient referrals for metabolic/bariatric surgery (MBS), the most effective treatment remain low. This study aims to analyze the factors influencing referrals for MBS, focusing on the impact of obesity bias and stigma among primary care physicians. A survey questionnaire was sent electronically to 250 physicians across four regions in Algeria. The questionnaire evaluated their knowledge, attitudes, perceptions, and practices regarding MBS including questions on indications for MBS, operative techniques, physicians' attitudes toward patients with obesity, and factors influencing patient referrals for MBS. Survey response rate was 37.2% (93/250 physicians), most physicians (89%) recognized obesity as a chronic disease, and majority (60%) of physicians were aware that hunger regulation centers are involuntary and located in the hypothalamus; 34.4% believed that lifestyle changes were sufficient to treat severe obesity. Significant knowledge gaps were observed regarding MBS indications, 83% expressed a willingness to help their patients achieve ideal weight, but only 10% of physicians referred patients for MBS. Many physicians showed negative attitudes toward patients with obesity, and 68% held stereotypes about obesity, attributing it to a lack of personal willpower. These stigmas may have contributed to the low referral rates for MBS. Additional barriers were economic barriers, such as the high cost of MBS and limited or absent insurance coverage. A lack of knowledge about metabolic/bariatric surgery, coupled with stigmatizing attitudes and economic constraints, hinders patient referrals for MBS, which is the most effective treatment for severe obesity. The study highlights the need for more education of primary care physicians, promoting an empathetic and interprofessional approach and implementing health policies that improve financial accessibility to MBS in Algeria.

Global childhood obesity continues to rise, particularly in adolescent females. The underlying cause of this change in prevalence is multifactorial with a complex interplay of genetic, socioeconomic and environmental influences. In this review, we aim to emphasize the multiple options available for assisting an adolescent female to improve their overall health and longevity.

Experts from each of their respective fields reviewed the current literature regarding the management of obesity in female adolescents.

Lifestyle changes, including decreases in overall calorie consumption and simple carbohydrates as well as increases in activity/exercise have been the mainstay of obesity therapy due to their effects on decreasing insulin resistance and associated metabolic disease, as well as weight loss. However, the combination of provider encouraged weight loss and societal obesity stigma leads to an increased risk for disordered eating. The high prevalence of mental health and sleep disorders in female youth with obesity are recent findings, as is the importance in treating these conditions for improved quality of life as well as success with lifestyle changes. The American Academy of Pediatrics' 2023 obesity guidelines are the first across the globe to recommend early adjunctive use of weight loss medications for obesity. These recommendations correspond with the development and increasing availability of new combinations of existing mediations as well as the glucagon like peptide-1 receptor agonist class of medications. Youth with a body mass index in excess of 35-40 kg/m2, can now undergo bariatric surgery in many countries, with very encouraging short- and medium-term success.

There are now many approaches to consider when treating an adolescent female for obesity or associated metabolic disease, and customized approaches may be needed for optimal success at the individual patient level.

Untreated obesity in pregnancy is associated with adverse fetal and neonatal outcomes that influence the long-term offspring health trajectory, propagating obesity and cardiometabolic disease from one generation to the next. The current efforts to reduce the risk of these negative outcomes through preconception weight loss remain largely ineffective. Anti-obesity medications (AOMs) are an understudied option for this indication, likely due to the potential for teratogenicity with accidental exposure during pregnancy. However, the current recommendation to discontinue all AOMs prior to conception fails to frame obesity within the chronic disease paradigm typically used for preconception counseling. Evolving evidence suggests that glucagon-like peptide 1 receptor agonists (GLP-1 RAs), the newest and most effective AOM class, may be safe in early pregnancy. Although further research is needed, counseling about GLP-1 RAs during pregnancy should include the potential for both risk and benefit. This review summarizes the known risks that obesity in pregnancy poses to the offspring and discusses the benefits and limitations of current treatment strategies. While there remain several barriers to optimal preconception and prenatal care for people with obesity, this review aims to arm providers with the knowledge needed for patient-centered counseling prior to and during pregnancy.

There is a pressing requirement to formulate innovative approaches for addressing inadequate weight loss or recurrence in individuals following metabolic bariatric surgery (MBS). Glucagon-like peptide- 1 (GLP- 1) analogues such as liraglutide and semaglutide have been formulated for treating type 2 diabetes or managing obesity. In this systematic review and meta-analysis, we aimed to pool the results from all available studies on GLP- 1 agonists to assess the efficacy of these drugs in weight recurrence or suboptimal clinical response of patients who underwent MBS.

We searched PubMed, Scopus, and Web of Science from inception till October 2024 for articles that fulfil our eligibility to be included in the systematic review and meta-analysis investigating the use of GLP- 1 agonists in the management of weight recurrence or suboptimal clinical response in patients who underwent MBS. The search strategy was as follows: "Liraglutide" OR "Semaglutide" OR "Tirzepatide" OR "GLP- 1" OR "Glucagon like peptide" AND "Weight" AND "Bariatric" OR "Sleeve" OR "Banding" OR "Roux-en-Y bypass. We used the mean difference (MD) to compare between continuous variables at a confidence interval (CI) of 95%, and p-value of 0.05.

The use of GLP- 1 agonists (liraglutide, semaglutide, and tirzepatide) was associated with a statistically significant decrease in the weight of the included patients showing an overall MD = 8.07 kg (95%CI: 5.5, 10.64, p < 0.00001) and I2 = 44%, p = 0.04. Moreover, these drugs (liraglutide, and semaglutide) showed significantly reduced body mass index (BMI) after treatment with overall MD = 4.42 kg/m2 (95%CI: 3.42, 5.42, p < 0.00001), and I2 = 67%, p = 0.0005. Compared with control group, the use of GLP- 1 agonists was associated with reduced weight with MD = - 9.19% (95%CI: - 10.81, - 7.58, p < 0.00001) and I2 = 0%. However, no difference was observed between both groups regarding BMI change with MD = - 1.97% (95%CI: - 4.65, 0.71, p = 0.15).

GLP- 1 agonists such as liraglutide and semaglutide effectively lower body weight and BMI in patients who suffer from weight recurrence or suboptimal clinical response after undergoing MBS. However, future studies are still warranted to investigate the most appropriate protocols for management.

Gastroesophageal reflux disease (GERD) symptoms and the use of proton pump inhibitors (PPIs) remain prevalent after Roux-en-Y Gastric Bypass (RYGB), despite it being known to alleviate reflux. The physiological changes behind long-term GERD and hiatal hernia (HH) prevalence post-RYGB are not commonly investigated.

In this consecutive cohort study, we examined patients who underwent RYGB and subsequent upper endoscopy, conducted by an expert bariatric endoscopist. The primary focus was on pouch endoscopic retrosflexion to evaluate the antireflux barrier (ARB). We gathered data encompassing patient demographics, anthropometrics, comorbidities, and findings from esophagogastroduodenoscopy (EGD) at the time of surgery and during follow-up EGD.

Our study included a total of 42 patients, predominantly female (97.5%) and White (100%), with an average age of 53.6±10.6 years and a body mass index (BMI) of 32.9±9.4 kg/m2. In our findings, all EGDs revealed the presence of a HH of varying sizes. The average HH size was 2.07±0.87 cm. The esophagogastric junction (EGJ) flap was also effaced in all patients with the majority (90.4%, 38 patients) classified as Hill grade IV and a smaller proportion (9.6%, 4 patients) as Hill grade III. Notably, PPI usage increased from the time of surgery to the time of EGD (69.0% vs. 42.9%, P=0.06).

This research highlights the high incidence of HH and EGJ flap effacement in patients after RYGB, potentially elucidating the persistence of reflux symptoms, including weakly acidic or alkaline reflux, post-RYGB.

Obesity has become major public health problem around the world. Lifestyle interventions, Pharmacotherapy and bariatric surgery are the common intervention to reduce weight in clinical practice. This study aims to conduct an economic evaluation of Duodenal-Jejunal Bypass Sleeve (DJBS) plus Intensive Lifestyle Intervention (ILI) compared with ILI only in people with obesity in China.

A hybrid model using a Decision Tree and Markov model was used to compare 9-month and lifetime horizon cost-effectiveness between DJBS plus ILI and ILI only. The data on clinical effectiveness were based on a prospective, open-label, and randomized trial (NCT05938231). This study employed 1-3 times the Gross Domestic Product (GDP) per capita (¥85,498, exchange rate: $1 US dollar = ¥6.73, 2022) and disposable income per capita (¥36,883, 2022) as the Willingness-To-Pay (WTP) thresholds. One-way, probabilistic sensitivity and scenario analysis were performed to test the robustness of the results.

The results of the 9-month decision tree model showed that compared to ILI only, DJBS plus ILI decreased body mass index (BMI) by 1.69 kg/m2 (1.41 vs. 3.10), with an increasing cost of ¥28,963.98 yuan (¥29,111.06 vs.¥147.08). The incremental cost-effectiveness ratio (ICER) was ¥17,138.45 per unit decrease of BMI. The lifetime horizon model showed that compared to ILI only, DJBS plus ILI had a higher cost of ¥13261.94 yuan (¥31,688.98 vs. ¥18,427.04), while with a life-year increase of 0.02 (9.43 vs. 9.41) and quality-adjusted life years (QALYs) increase of 0.15 (7.82 vs. 7.67) per people with obesity. The ICER was ¥88,412.93 per QALY gained. Probability sensitivity analysis showed the robustness of the economic evaluation results.

The findings suggested that DJBS plus ILI was not a cost-effective strategy over a lifetime horizon when the WTP threshold was set at GDP per capita and disposable income per capita. However, it was considered cost-effective when the threshold was set at 1.03 times GDP per capita.

Bariatric surgery, such as sleeve gastrectomy (SG) and gastric bypass, is a common option for weight loss in patients with obesity and metabolically ill individuals. However, complications like bleeding and leaks can occur. Surgeons often use intraoperative drains to detect these issues, but their effectiveness is debated due to conflicting evidence. Our study aims to evaluate the benefits of intra-abdominal drains in detecting postoperative bleeding and leaks.

This is a retrospective cross-sectional study, with data from 494 patients who underwent bariatric surgery at the primary bariatric center in Palestine, between 2017 and 2021. Patient demographics, comorbidities, surgical complications, and drain usage were collected, managed, and analyzed using SPSS.

The study included 494 patients, predominantly females (69.0%) with a median age of 39.5 years. Sleeve gastrectomy was the most common procedure (78.1%). Postoperative complications occurred in 3.0% of patients, with bleeding being the most prevalent (1.4%). Drain placement was routine (82.0%), but no significant correlation was found between drain output volume and signs of bleeding, such as heart rate and blood pressure. However, a weak inverse correlation was observed between volume for bloody drain character and hemoglobin levels on the first postoperative day.

Drains are commonly used in bariatric surgery; however, their effectiveness in detecting complications like bleeding and leaks remains uncertain. There was no association between drain output volume and signs of bleeding and leak complications, and the clinical assessment, especially the vital signs, is the most effective method in identifying postoperative issues.

Not applicable.

The Behavioral Susceptibility Theory posits that food approach/avoidance traits are key genetic contributors to obesity and disordered eating. The genetic tendency to approach/avoid food may manifest with emotional eating (i.e., over or under eating in response to emotional cues). Research indicates that emotional eating (EE) affects long-term success after bariatric surgery, but findings focus mainly on the tendency to overeat in response to negative emotions. The current study examined the role of both emotional over- and under-eating within a pre-bariatric sample, and their association with psychosocial outcomes. Using Latent Class Analysis, responses from 446 participants (74.3% female; 71.5% White, 12.1% African American, 10.3% Hispanic, 4.1% multiracial, 1.1% Other/Unreported; MAge = 42.38, MBMI = 49.15 kg/m2) on the emotional eating subscales of the Adult Eating Behavior Questionnaire were analyzed to identify EE patterns. Participants also responded to measures of emotional distress, quality of life, and disordered eating (e.g., night eating, binge eating, and avoidant/restrictive food intake disorder). A four-class solution emerged: (a) emotional over- and undereating (EOE-EUE; 14.4%), (b) emotional overeating (EOE; 25.3%), (c) emotional undereating (EUE; 26.0%), and (d) non-emotional eating (non-EE; 34.3%). Consistent with previous research, the EOE-EUE class exhibited high levels of psychosocial impairment, and emotional eating classes exhibited higher levels of disordered eating compared to the non-emotional eating class. These findings provide a more nuanced understanding of EE within a pre-bariatric population by identifying patterns of both over- and under-eating within individuals and differentially identifying risk factors associated with such patterns. Limitations include the lack of a non-surgery seeking comparison group, potential for response biases, and the reliance on cross-sectional data.

Robotic-assisted bariatric surgery is growing rapidly. The optimal approach to minimize complications remains unclear.

Assess robot utilization and compare 30-day outcomes for laparoscopic and robotic primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.

United States.

A retrospective analysis of the MBSAQIP database identified primary SG and RYGB cases from 2015 to 2022. Revisions/conversions, cases converted to another approach, and combined cases other than esophagogastroduodenoscopy were excluded. Outcomes were compared with logistic regression following 1:1 propensity-score matching to adjust for differences in patient demographics/comorbidities and operative variables.

A total of 823,902 cases (591,118 SG; 232,784 RYGB) were included. From 2015 to 2022, the percentage of SG and RYGB performed robotically increased from 6.7% and 6.9% to 29.5% and 31.8%, respectively. Compared to laparoscopic, robotic SG had significantly higher overall morbidity (odds ratio 1.14 [1.07-1.21], P < .001), leak (1.24 [1.05-1.46], P = .03), and bleeding rates (1.34 [1.13-1.58], P < .001). Robotic RYGB had significantly lower overall morbidity (.75 [.70-.81], P < .001) and bleeding (.80 [.68-.94], P < .01) with similar leak rates (.87 [.71-1.07], P = .18). Combined robotic SG and RYGB outcomes were similar to laparoscopic for 2020-2022 cases, except for higher rates of organ/space infection, readmission, and septic shock in the robotic group.

Robotic SG has higher complication rates compared to laparoscopic, while robotic RYGB is protective against bleeding complications. Short-term outcomes for robotic surgery have become more similar to laparoscopic, but remain inferior. Further studies are warranted to elucidate the factors driving these findings.

The prevalence of obesity and related co-morbidities has reached epidemic proportions. Effective evidence-based treatment approaches are therefore important. Lifestyle intervention remains the mainstay of the treatment strategy to manage obesity. Increased evidence has also emerged regarding the efficacy of metabolic bariatric surgery (MBS) to induce significant and sustained weight loss while also reducing the progression of obesity-related co-morbidities for people living with obesity.

This article aims to bring together current evidence, guidance and best practice for the prevention and management of people living with overweight or obesity by means of lifestyle and behavioural intervention, as well as by MBS.

Lifestyle intervention encompasses dietary strategies, physical activity and behavioural intervention. Discussion on MBS will focus on current indications, comparison between different MBS procedures, novel endoscopic techniques, potential complications and pre-operative management.

The number of people living with excess weight and complications associated with being overweight is alarmingly quite high. Effective treatment approaches that are supported by clinical studies are therefore important. Lifestyle changes remain very important to manage excess weight. Increased evidence has also shown the benefits of weight loss surgery to produce significant weight loss which could be sustained, while also reducing the risk of developing medical conditions associated with excess weight. This article aims to bring together current evidence, guidance and best practice for the prevention and management of people living with excess weight by means of lifestyle and behavioural changes, as well as by weight loss surgery. Lifestyle intervention encompasses dietary strategies, physical activity and behavioural intervention. Discussion on weight loss surgery will focus on current criteria for suitability, comparison between different weight loss surgery procedures, new techniques, possible complications and appropriate management prior to weight loss surgery.

Metabolic dysfunction-associated fatty liver disease (MAFLD) affects over one-fourth of the global adult population and is the leading cause of liver disease worldwide. To address this, the Asian Pacific Association for the Study of the Liver (APASL) has created clinical practice guidelines focused on MAFLD. The guidelines cover various aspects of the disease, such as its epidemiology, diagnosis, screening, assessment, and treatment. The guidelines aim to advance clinical practice, knowledge, and research on MAFLD, particularly in special groups. The guidelines are designed to advance clinical practice, to provide evidence-based recommendations to assist healthcare stakeholders in decision-making and to improve patient care and disease awareness. The guidelines take into account the burden of clinical management for the healthcare sector.

The objective of this study was to estimate the 10-year clinical benefits and economic value of weight loss in a Swedish population with obesity using a value of weight-loss simulation model.

Data on the prevalence of and costs associated with obesity and obesity-related complications (ORCs) were applied within an adapted simulation model to evaluate weight-loss benefits for a 2023 Swedish population over 10 years. The 10-year incidence of 10 ORCs and treatment costs in a random cohort of 10,000 individuals were estimated for a stable weight scenario and four weight-loss (5%-20%) scenarios.

The model included 887,272 individuals with obesity aged 20 to 60 years. Hypertension (24.1%), asthma (20.9%), dyslipidemia (18.3%), and type 2 diabetes (10.6%) were highly prevalent. For 10,000 individuals, a 5% to 20% weight loss was estimated to prevent ORCs over 10 years, leading to annual savings between 9.0 million Swedish krona (SEK)/€0.8 million (5% weight loss) and 30.0 million SEK/€2.6 million (20%) by 2033.

Annual treatment costs of ORCs in Sweden will double over 10 years, and weight loss would be associated with significant savings because of the reductions in the incidence of ORCs. Therefore, there is an urgent need to effectively treat obesity to prevent morbidity.

Obesity and heart failure are interlaced global epidemics, each contributing to significant morbidity and mortality. Obesity is not only a risk-factor for heart failure, but also complicates its management, by distinctive pathophysiological mechanisms and cumulative comorbidities, requiring tailored treatment plan. To present current treatment options for heart failure in individuals with overweight/obesity, emphasizing available pharmacological therapies, non-pharmacological strategies, and the management of related comorbidities. We conducted a comprehensive literature review regarding the results of heart failure treatments in individuals with overweight/obesity, including cornerstone interventions as well as emerging therapeutic options. Specific drug classes, including angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors, have demonstrated consistent efficacy in heart failure irrespective of body mass index, while diuretics remain a key for fluid management. Glucagon-like peptide-1 receptor agonists have shown promising results in improving relevant outcomes and warrant further research. Non-pharmacological approaches, including weight-loss strategies and lifestyle modifications, have shown to improve symptoms, exercise tolerance and quality of life. Managing heart failure in individuals with overweight/obesity requires a multidisciplinary, individualized approach integrating pharmacological and non-pharmacological options. Emerging therapies and preventive strategies arise to address the unique challenges in this population and provide improved outcomes.

The rate of pregnancy following bariatric surgery is rising globally and is associated with health benefits but also increased risk of micronutrient deficiency, preterm birth and small for gestational age offspring. Bariatric surgery may limit women's ability to meet the nutrient demands of pregnancy, necessitating individualised nutrition therapy. However, little is known about women's experiences of, and preferences for nutrition-related care during pregnancy after bariatric surgery.

To describe women's experiences of pregnancy after bariatric surgery, focussing on nutrition-related care.

This qualitative study interviewed women across Australia with a history of any bariatric surgery. Semi-structured telephone interviews were conducted after 36-weeks gestation and before childbirth. Data were analysed using reflexive thematic analysis.

Thirteen women aged 26-37 participated. Three themes were generated: navigating healthcare, the personal toll of pregnancy after bariatric surgery, and women's agency. Despite a strong desire for specialised nutrition care, women encountered several barriers to accessing this. When care was available, it often did not meet women's needs due to healthcare professionals' limited understanding of the nutrition challenges faced in pregnancies following bariatric surgery. This compelled women to seek information outside their maternity care team and advocate for themselves during care.

These findings highlight the need to address barriers to accessing nutrition care for pregnant women following bariatric surgery. Improved understanding of pregnancy and post-operative symptoms may enable enhanced woman-centred care.

Greater awareness of bariatric surgery among all maternity care professionals is needed to improve opportunities for informed, shared decision-making with pregnant women.

Postoperative nausea and vomiting (PONV) is the most common side effect after laparoscopic sleeve gastrectomy (LSG), affecting patients' postoperative recovery and increasing the medical and economic burden. This study aimed to analyze the relationship between serum pepsinogen and PONV.

Patients with obesity who underwent LSG in our center between January 2021 and December 2022 were divided into PONV and NoPONV groups and analyzed retrospectively. Binary logistic regression analysis was used to determine the independent risk factors for PONV.

219 female patients were enrolled, with an average BMI of 36.74 ± 8.34 kg/m2 and aged 32.61 ± 6.18 years. PONV occurred in 157 patients (71.7%). The influencing factors of PONV with different severity were analyzed, and the results showed that the severity of postoperative pain (χ2 = 13.169, p-values = 0.004), PGI (χ2 = 14.625, p-values = 0.002), PGII (χ2 = 25.916, p-values = 0.000), and PGR (χ2 = 17.697, p-values = 0.001) had statistical significance. Binary logistic regression showed that PGI was a risk factor for PONV with a OR (ng/mL) value of 1.013 (95% CI: 1.001-1.024, p-values = 0.037), while PGR was a protective factor for PONV with an OR(ng/mL) value of 0.952 (95% CI: 0.925-0.979, p-values = 0.001).

The incidence of PONV after LSG is high. Higher PGI may be a risk factor for promoting PONV after LSG. The higher the preoperative PGI, the later the onset of PONV; the longer the duration, the more serious the degree.

Bariatric surgery is highly effective for the management of severe obesity, but its safety profile is not completely understood. This review aimed to synthesise evidence linking demographic factors to postoperative complications and mortality following primary bariatric surgery.

We searched Medline for observational studies of adult patients linking demographic factors to postoperative complications of primary bariatric surgery published from 2017 to 2022. Risk ratios (RR) with 95% confidence intervals (95% CI) were calculated and pooled using random effect meta-analysis. Heterogeneity was quantified using the I2 statistic and tested for statistical significance using the Q-statistic. Sensitivity analyses were used to explore potential sources of heterogeneity.

A total of 71 observational studies (69 cohort, 2 case-control) were reviewed and appraised. Older age was consistently associated with increased risks of postoperative mortality (RR = 2.62, 95% CI 1.63-4.23, I2 = 42.04%), serious complications (RR = 1.76, 95% CI 1.09-2.82, I2 = 93.24%), anastomotic leak (RR = 1.64, 95% CI 1.04-2.58, I2 = 61.09%), and haemorrhage (RR = 1.44, 95% CI 1.07-1.94, I2 = 45.25%). Male sex was associated with increased anastomotic leak (RR = 1.39, 95% CI 1.04-1.87, I2 = 72.36%). Sensitivity analyses did not identify sources of bias. Socioeconomic factors, including Black/African American race, low financial status, and marital status (mixed results), were linked to higher complication risks in some studies.

Older age and certain demographic factors (male sex, Black/African American race, low financial status, marital status) were associated with increased risks of postoperative complications following primary bariatric surgery.

This study aimed to determine the preoperative surgical fear levels, postoperative pain intensity, and sleep quality of metabolic and bariatric surgery patients and to examine the relationship between them.

This study was a single-center descriptive and correlational design and was completed with 115 patients. The data of the study were collected by using the Personal Information Form, Surgical Fear Questionnaire, Richards-Campbell Sleep Questionnaire, and Visual Analog Scale. Descriptive statistics, Pearson correlation, and multiple linear regression analysis were used for data analysis.

In the study, the mean total score of the preoperative Surgical Fear Questionnaire was 24.73 ± 16.32, and the mean total score of the Richards-Campbell Sleep Questionnaire on the 1st postoperative day was 53.85 ± 20.53. The mean postoperative pain intensity scores were 7.44 ± 1.74 at the 1st hour, 5.19 ± 1.61 at the 12th hour, and 3.24 ± 1.85 at the 24th hour. In addition, it was determined that surgical fear and postoperative pain significantly predicted sleep quality (p < 0.05).

It was determined in the study that sleep quality decreased as the level of surgical fear and pain intensity of the patients increased. Considering the relationship between fear of surgery, postoperative pain, and sleep quality, it may be beneficial to develop support and counseling services for patients according to current guidelines.

To investigate the effect of preadmission education given to laparoscopic sleeve gastrectomy patients on preoperative and postoperative anxiety, postoperative pain, and patient vital signs.

The study was designed as randomized, controlled, experimental, and single-blind. This study was conducted with 68 patients who met the inclusion criteria and underwent laparoscopic sleeve gastrectomy in the general surgery clinic of a university hospital between December 2022 and October 2023. Data were collected using the 'Perioperative Form,' 'Visual Analog Scale,' and 'State Anxiety Scale I-II.' Intervention group patients were informed and educated about the surgical process in the outpatient clinic. The anxiety levels of all patients were determined with the State Anxiety Scale the day before surgery. In the postoperative period, vital signs (once), anxiety (on the first day after surgery), and pain levels (eight times during 48 h) were measured.

In the analysis between the groups, the difference between the duration of postoperative hospital stay (p = 0.007), pain (p = 0.000 for all measured), and anxiety levels (p = 0.000) was statistically significant. There were also significant differences in the diastolic blood pressure (p = 0.007), body temperature (p = 0.000), and saturation values (p = 0.000). Patients' readiness level for surgery was the most influential factor in postoperative pain levels (p = 0.000).

The education given to the patients before hospitalization decreased preoperative and postoperative anxiety levels, postoperative hospital stay and pain levels, and positively affected diastolic blood pressure, body temperature and saturation levels. One-to-one education given to patients in the outpatient clinic also contributes positively to their readiness for surgery. This study provides valuable evidence to the wider global clinical community by demonstrating the important benefits of preadmission education for patients undergoing bariatric surgery. Implementation of similar educational interventions in diverse healthcare settings worldwide may lead to increased postoperative recovery and improved overall patient well-being after bariatric surgery.

Youth with Down syndrome (DS) experience high rates of overweight and obesity; therefore, weight-loss interventions are warranted. We aimed to systematically review weight-loss interventions for adolescents with DS to better understand the most effective strategies and identify the current gaps in the literature.

This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (International Prospective Register of Systematic Reviews [PROSPERO] #CRD42022303781). Databases were searched through July 28, 2023, and screening, evaluation, and data extraction were performed by two independent reviewers. Change scores for weight or BMI were presented by study design and intervention components.

The 26 included papers describing 24 unique studies included a total of n = 1171 participants, of whom n = 393 were participants with DS. Eleven studies focused on physical activity, one on diet, and two on physical activity and diet; seven studies used multicomponent interventions; and three studies investigated laparoscopic sleeve gastrectomy. Thirteen studies using either a multicomponent intervention, a physical activity intervention, or surgery resulted in weight loss or a decrease in BMI in adolescents with DS.

Weight-loss interventions can be effective for adolescents with DS and could benefit from increasing duration/intensity to meet the existing weight-loss intervention recommendations. More research on surgery and weight-loss medications is needed.

Background: Tirzepatide (TZP), a unimolecular dual agonist targeting glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors, is a promising weight loss agent in obesity. The preservation of metabolically active fat-free mass (FFM), muscle strength (MS), and resting metabolic rate (RMR) is essential for optimizing fat mass (FM) reduction. Although TZP is typically combined with a low-calorie diet (LCD), its impact on FFM is uncertain, and studies on MS and RMR are lacking. Evidence suggests that Low-Energy Ketogenic Therapy (LEKT) may reduce FM while preserving FFM, MS, and RMR. Therefore, this study aimed to compare the effects of an LEKT and an LCD, both combined with TZP, on body weight (BW), FM, FFM, MS, and RMR in patients with obesity. Methods: We prospectively compared the effects of TZP combined with either an LCD or LEKT in 60 patients with obesity (n = 30 per group) over 12 weeks. BW, FM, FFM, MS, and RMR were measured at baseline and after 12 weeks. Clinical parameters, an assessment of dietary compliance, and side effects were also evaluated. Results: At 12-week follow-up, both groups showed a significant BW reduction from baseline (TZP+LEKT, p = 0.0289; TZP+LCD, p = 0.0278), with no significant intergroup difference (p = 0.665). Similarly, FM decreased significantly in both cohorts (TZP+LEKT, p < 0.001; TZP+LCD, p = 0.0185), with the TZP+LEKT group achieving a greater FM loss (p = 0.042). However, the TZP+LCD group exhibited significant declines from baseline in FFM (p = 0.0284), MS (p = 0.0341), and RMR (p < 0.001), whereas we did not observe any significant changes in FFM (p = 0.487), MS (p = 0.691), and RMR (p = 0.263) in the TZP+LEKT group. Intergroup direct comparisons confirmed that the TZP+LCD group experienced significantly greater reductions in FFM (p = 0.0388), MS (p = 0.046), and RMR (p = 0.019). Conclusions: Based on the findings of these preliminary data, we are able to support the hypothesis that TZP+LEKT seems to be superior to TZP+LCD in promoting FM reduction while preserving FFM, MS, and RMR in patients with obesity.

Amid hesitancy to pursue interventions, such as metabolic and bariatric surgery for obesity within some age groups, the impact of age on the relationship between body mass index (BMI) and perceived bodily function is fundamental to understand. Our objective was thus to determine whether this relationship was affected by older age such that it might alter how we consider interventions in different age groups.

Patient data (N = 1921) were obtained prospectively and assessed to determine if age decile influenced the association between BMI and BODY-Q Physical Function scores; BODY-Q PF is a validated instrument which assesses perceived physical function in patients who are being managed for weight loss. Normative BODY-Q PF scores were defined according to the previously published threshold. Stratified analyses, receiver operator characteristic curves, and logistic regression were utilized to assess for effect modification by age.

Among 1921 adults (80% female) seeking weight management interventions at an academic hospital consortium, the strongest association between normal BODY-Q PF and lower BMI was seen in patients 61-70 years of age, whether assessed through receiver operator characteristic curves, bivariable odds ratios, or multivariable logistic regression. Age was an effect modifier of the association between BODY-Q PF and BMI. When both age 61-70 years and BMI < 30 occurred concurrently, the odds of normal BODY-Q PF scores increased (OR 3.275, 95% CI 1.994-5.379). In contrast, age 61-70 years alone was associated with lower odds of a normal BODY-Q PF score (OR 0.434, 95% CI 0.298-0.603).

When BMI is improved in older patients, it is more closely associated with better physical function. Age is thus an effect modifier of the association between BMI and BODY-Q PF scores. Older patients may then experience at least as many physical function benefits from weight loss interventions as their younger counterparts.

Heart failure (HF) is a significant global health issue, categorized by left ventricular ejection fraction, being either reduced (HFrEF < 0.40) or preserved (HFpEF > 0.50), or in the middle of this range. Although the overall incidence of HF remains stable, HFpEF cases are increasing, representing about 50% of all HF cases. Outcomes for HFpEF are similar to those for HFrEF, leading to substantial health-care resource use. Despite extensive research over the past 2 decades, the prognosis and mortality rates for HFpEF remain high. A key feature of HFpEF is exercise intolerance, characterized by severe exertional dyspnea and fatigue, which significantly impacts quality of life. The underlying mechanisms of exercise intolerance are not fully understood due to the complex pathophysiology and multisystem involvement. Obesity is a common comorbidity in HFpEF, especially in North America, leading to worsening symptoms, hemodynamics, and mortality rates. Increased adiposity leads to inflammation, hypertension, dyslipidemia, and insulin resistance, and impairing cardiac, vascular, pulmonary, and skeletal muscle function. Therefore, managing obesity is crucial in treating HFpEF. In this review we explore the pathophysiologic mechanisms of HFpEF, emphasizing obesity's role, and we discuss current management strategies while identifying areas needing further research.

Obesity is recognised as a chronic, relapsing and progressive disease, and long-term weight maintenance remains one of the greatest challenges in obesity management. When treatment gets interrupted, recurrent weight gain might be expected. Funding structures for MBS in numerous health systems globally do not currently permit metabolic and bariatric surgery (MBS) to prevent recurrent weight gain in patients who are normal weight or overweight. Gastric band removal is frequently required due to long-term complications such as slippage, which raises an important question: should revisional MBS be considered for weight maintenance in patients who have successfully lost weight after gastric banding? With the increasing use of obesity management medications and the associated successful weight loss, we anticipate that more patients will discontinue pharmacological treatment after reaching a normal weight or overweight range. However, many of these patients may still seek MBS for long-term weight maintenance. We question whether weight maintenance should be considered an indication for MBS in patients who are currently normal weight or overweight but have a history of severe obesity and must discontinue their current obesity treatment.

Despite excellent weight-loss outcomes in clinical trials, Glucagon-Like Peptide 1 receptor agonists (GLP1RA) face challenges with accessibility and compliance in clinical use. We seek to quantify how these barriers impact the long-term weight-loss efficacy of GLP1RAs in the real world.

In this retrospective cohort study, we analysed weight loss outcomes of patients who were prescribed GLP1RA for class 2-3 obesity treatment between January 2020 and November 2022 in a large non-profit healthcare system in the Midwest. The primary outcome is the two-year total weight loss percentage (TWL%).

During the study period, there was a six-fold growth in GLP1RA prescription numbers. In total, 853 patients were prescribed GLP1RA for obesity treatment. Of these, 211 (24.7%) patients never received the drug and 304 (35.6%) patients had to discontinue treatment within 2 years. The most common reasons for discontinuation included loss to follow-up with the original prescriber (n = 81, 26.6%), side effects (n = 72, 23.7%) and cessation of insurance coverage (n = 65, 21.4%). Two years later, patients who stayed on GLP1RA experienced significantly more weight loss than those who never started it (difference 3.98%, 95% CI 1.57% to 6.41%, p = 0.001) and those who had stopped taking it (difference 5.82%, 95% CI 3.56% to 8.09%, p < 0.001). Patients who stopped GLP1RA within 2 years had similar weight loss to those who never started it (difference 1.83%, 95% CI -1.30% to 4.97%, p = 0.251). The average TWL% for patients who stayed on GLP1RA for 2 years is 9.22% (standard deviation 9.73%).

Nearly half of the patients who were started on GLP1RA, a treatment intended for indefinite use, stopped taking GLP1RA within 2 years. Patients who stopped treatment experienced similar weight loss to those who never started treatment. For real-world patients who stayed on treatment for 2 years, a lower TWL% was observed than previously reported in clinical trials.

Gallstones represent a common yet often underappreciated complication following bariatric surgery, with reported incidence rates ranging widely from 10.4% to 52.8% within the first postoperative year. Multiple factors contribute to gallstone formation in this setting, including intraoperative injury to the hepatic branch of the vagus nerve, alterations in bile composition, reduced food intake, shifts in gastrointestinal hormone levels, and dysbiosis of the gut microbiota. Notably, the risk of cholelithiasis varies by surgical procedure, with sleeve gastrectomy (SG) generally associated with a lower incidence compared to Roux-en-Y gastric bypass (RYGB). Prophylactic cholecystectomy during bariatric surgery may benefit patients with preexisting gallstones, whereas preserving the hepatic branch of the vagus is an important technical consideration, particularly in RYGB, to mitigate postoperative gallstone risk. Pharmacological interventions, such as ursodeoxycholic acid (UDCA), have demonstrated efficacy in preventing gallstones and reducing subsequent cholecystectomy rates. However, consensus is lacking on the optimal dosing, duration, and administration frequency of UDCA across different bariatric procedures. Additionally, dietary measures, such as moderate fat intake or fish oil supplementation, have shown promise in alleviating lithogenic processes. Emerging evidence supports the use of probiotics as a safe and patient-friendly adjunct or alternative to UDCA, given their ability to improve gut dysbiosis and reduce gallstone formation. Further high-quality studies are needed to define standardized prophylactic strategies that balance efficacy with patient adherence, offering personalized gallstone prevention protocols in the era of widespread bariatric surgery.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the umbrella term that comprises metabolic dysfunction-associated steatotic liver, or isolated hepatic steatosis, through to metabolic dysfunction-associated steatohepatitis, the progressive necroinflammatory disease form that can progress to fibrosis, cirrhosis and hepatocellular carcinoma. MASLD is estimated to affect more than one-third of adults worldwide. MASLD is closely associated with insulin resistance, obesity, gut microbial dysbiosis and genetic risk factors. The obesity epidemic and the growing prevalence of type 2 diabetes mellitus greatly contribute to the increasing burden of MASLD. The treatment and prevention of major metabolic comorbidities such as type 2 diabetes mellitus and obesity will probably slow the growth of MASLD. In 2023, the field decided on a new nomenclature and agreed on a set of research and action priorities, and in 2024, the US FDA approved the first drug, resmetirom, for the treatment of non-cirrhotic metabolic dysfunction-associated steatohepatitis with moderate to advanced fibrosis. Reliable, validated biomarkers that can replace histology for patient selection and primary end points in MASH trials will greatly accelerate the drug development process. Additionally, noninvasive tests that can reliably determine treatment response or predict response to therapy are warranted. Sustained efforts are required to combat the burden of MASLD by tackling metabolic risk factors, improving risk stratification and linkage to care, and increasing access to therapeutic agents and non-pharmaceutical interventions.

To promote use of lifestyle, pharmacologic, and surgical weight management options for adults with body mass index (BMI) ≥35 kg/m2 and type 2 diabetes (T2D), this project implements and evaluates a weight loss clinical decision support (WL-CDS) intervention that provides patient-specific estimates of the risks and benefits of evidence-based obesity management options to primary care clinicians (PCCs) and patients at primary care clinical encounters.

We randomize 38 primary care clinics to either (a) usual care (UC), or (b) the WL- CDS intervention that provides patients and PCCs recommendations for lifestyle changes and patient-specific obesity management options and estimates of benefits and risks of weight loss medications, or metabolic bariatric surgery (MBS) when indicated.

Outcomes assessed at 18-months after a patient-specific index date are (a) referral of eligible patients for MBS evaluation; (b) initiation or active management of FDA-approved medications for weight loss; and (c) weight trajectory. Outcomes measured within 1 month of index date are patient-reported (d) shared decision making about weight loss options, and (e) intention to engage in weight loss.

This study will deepen our understanding of how patients and PCCs use WL-CDS generated information to inform selection of obesity care options for adults with T2D and BMI ≥35 kg/m2.

Unhealthy weight with high body mass index is recognized as markers for chronic disease. Despite the array of multiple weight loss medications, bariatric surgery (BS) remains as a recognized efficient pathway to achieve rather quick and sustainable weight loss. Despite its effectiveness, BS comes with its own plethora of complications. This article further delves into the efficacy of BS, its associated complexities with emphasis on micro and macro nutrition management of individuals, both prior to and post operation plays a pivotal role in reducing the risk of malnutrition and its associated complications.

In 2022, the Obesity Medicine Association (OMA) published a Clinical Practice Statement (CPS) which provided an overview of bariatric surgery and related procedures, a discussion on gastrointestinal hormones and a review of the microbiome as it relates to patients with obesity. This update to the 2022 OMA CPS provides a focus on nutrition as it relates to the adult bariatric surgery patient, incorporating a detailed discussion on how to conduct a bariatric nutrition assessment and manage patients seeking metabolic and bariatric surgery (MBS) and postoperative nutrition care. In particular, the section on macronutrients, micronutrients, and bariatric surgery has been updated, highlighting practical approaches to nutrient deficiencies typically encountered in the bariatric surgery patient. Also included is a section on how to envision and develop an interdisciplinary team of medical providers with evidence-based nutrition knowledge and consistent information that improves the quality of nutrition care provided to MBS patients. This CPS adds to the series of OMA CPSs meant to provide guidance to clinicians in their care of patients with obesity.

The foundation of this paper is supported by scientific evidence in the medical literature and expert opinion derived from several bariatric nutrition resources, as well as from the 2022 OMA CPS focused on bariatric surgery.

This OMA Clinical Practice Statement provides an overview of the current bariatric nutrition clinical guidelines and nutrition tools adapted for clinicians who may not have access to an MBS team or a registered dietitian knowledgeable about bariatric nutrition.

This evidence-based review of the literature includes an overview of current bariatric nutrition recommendations. It is intended to provide clinicians with more advanced knowledge and skills in nutrition assessment and management of the preoperative and post-surgical MBS patients. This CPS also addresses macronutrient and micronutrient deficiencies common in MBS patients, and treatment recommendations designed to help the clinician with clinical decision making.

The body mass index was first described almost 200 years ago and has since been used as a measure of obesity. This review describes the history, advantages, disadvantages, and alternatives to the body mass index in the care of the metabolic and bariatric surgical patient.

International and national guidelines recommend metabolic and bariatric surgery (MBS) as a treatment option for adolescents with severe obesity, but few countries offer MBS to adolescents in routine clinical care. This narrative review summarizes existing adolescent MBS guidelines and the available underpinning evidence. Two randomized trials and additional prospective studies have demonstrated efficacy and safety in adolescent MBS, and the health benefits appear to be similar or superior to outcomes in adults. However, there are specific challenges regarding the intervention during adolescence related to decision-making capacity and a peak in risk-taking behavior. Adolescents with severe obesity have-as a group-a mental health vulnerability, and specific nutritional concerns need to be addressed in relation to MBS. This review also describes how study findings can be translated into clinical care. We use Sweden as an example, where the National Board of Health and Welfare recommends MBS for selected adolescents with severe obesity aged 15 years or older. We present practical advice for implementing and integrating MBS in adolescents in the framework of multidisciplinary pediatric and adolescent care for obesity.

We have incidentally observed a finding not yet described in the literature, on both cross-sectional imaging and fluoroscopy, to correlate with increased obstructive symptoms in our post sleeve gastrectomy patients. This case series aims to show postsurgical imaging cases with the common underlying finding of a pseudotumor associated with hiatal herniae and obstructive symptoms. Because this clinical presentation may, in some cases, warrant postsurgical revision, knowledge of the imaging findings and their potential clinical significance is useful to radiologists who interpret routine cross-sectional imaging examinations as well as fluoroscopic evaluations of these post sleeve gastrectomy patients.

Obesity is a systemic condition that is increasingly common. Obesity negatively affects sexual function and menstrual regularity. Therefore, losing excess weight is important for women's sexual and menstrual health.

The change in body mass index (BMI) and and excess weight loss (EWL) of sexually active female patients who underwent laparoscopic sleeve gastrectomy (LSG) were evaluated by a general surgeon. The preoperative and postoperative periods were compared by a gynecologist using the survey method menstrual patterns, dysmenorrhea complaints, if any, and sexual function with the Female Sexual Function Scale (FSFI).

The study included 55 patients with a mean ± standard deviation BMI on the day of the operation of 45.32 ± 5.82 kg/m2. In the first postoperative year, the mean BMI significantly reduced to 27.88 ± 1.99 (p < 0.001). The mean percentage of EWL at the end of 1 year was 73.09 ± 19.74 after LSG. The median (range) preoperative FSFI score of the patients was 26.30 (22.70-27.70). One year after LSG, the median FSFI score significantly improved to 34.50 (30.20-35.30) (p < 0.001). Compared to the period before surgery, the frequency of sexual intercourse increased from two-to-three times a week (p < 0.001).

Women's sexual desires are a fundamental human right and contribute to female well-being. Thus, it is important to treat sexual dysfunction. The results of the present study demonstrate a significant improvement in sexual dysfunctions after LSG. LSG was an effective procedure that may be recommended to obese women with sexual dysfunction and menstrual problems.

Transoral outlet reduction endoscopy (TORe) and glucagon-like peptide-1 agonist, liraglutide, have individually shown promise in managing weight regain after Roux-en-Y gastric bypass. However, combined effects of adjunctive liraglutide to TORe remain unexplored. A cross-over design was utilized to evaluate the efficacy of liraglutide treatment when initiated immediately post-TORe or 1 year post-TORe.

Data was analyzed from a double-blinded randomized controlled trial conducted at three outpatient clinics in São Paulo, Brazil, from January 2019 to December 2021. Two cohorts were established: group placebo then liraglutide (group PL) received subcutaneous saline dosed daily for 12 months after TORe then liraglutide for the subsequent 12 months, while group liraglutide then placebo (group LP) started subcutaneous liraglutide followed by subcutaneous saline in a similar fashion. Each participant received placebo and liraglutide for equal duration over the 24-month treatment phase. The primary outcomes were percent total body weight loss (%TBWL) at 12 and 24 months.

The study comprised 58 participants in group PL and 51 participants in group LP, with no significant difference in mean baseline BMI between groups. Group LP showed significantly higher %TBWL than group PL at 6, 9, and 12 months. Surprisingly, at 21 and 24 months, group LP continued to exhibit greater %TBWL than group PL, even after discontinuing liraglutide.

Immediate post-procedure administration of liraglutide appears to be more effective than placebo in reversing weight regain in patients undergoing TORe. Results indicate that the timing of post-TORe liraglutide initiation may enhance the therapeutic benefits of the procedure.

The emergence of incretin-based therapies, specifically glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and glucose-dependent insulinotropic polypeptide (GIP), as a new class of obesity medications, is dramatically changing obesity care. Use of these medications, known categorically as anti-obesity medications, as part of comprehensive obesity management is associated with significantly greater weight loss and health benefits than found with earlier-generation obesity medications. The outcomes reported from medication trials were often achieved in conjunction with lifestyle counseling sessions by a registered dietitian nutritionist (RDN) or other qualified health care professional. Research demonstrates that evidence-based obesity care should incorporate lifestyle interventions. Counseling by an RDN, paired with incretin-based therapies, can play a critical role in supporting adherence to the medication regimen, preventing and managing adverse effects, supporting adequate nutrient intake, and establishing lifestyle behaviors for long-term weight and health management. To date, minimal research has been reported on the impact of incretin-based therapies on food and nutrient intake. Until that research is conducted, RDNs and other health care professionals can apply knowledge and experience from clients who have undergone other intensive treatments. This article provides considerations for lifestyle interventions, with a focus on medical nutrition therapy provided by RDNs for adults prescribed incretin-based therapies. RDNs have the education and training to provide medical nutrition therapy for people with overweight or obesity, as well as lifestyle counseling on physical activity, stress management, sleep hygiene, goal setting, and other behaviors associated with positive health outcomes. RDNs have a critical role in the integration of incretin-based therapies into obesity management.