The Best of ObesityWeek 2025
The Best of ObesityWeek 2025 was sponsored by Lilly USA, LLC.
What are the key takeaways regarding lung injury as a complication of obesity?
By Michaela Restivo Anderson, MD, MS
Obesity is a major risk factor for acute lung injury, respiratory failure, and poorer outcomes in conditions such as COVID-19, asthma, and COPD. The speaker highlights that treating obesity—through medications such as GLP-1 therapies or bariatric surgery—can improve respiratory health and reduce exacerbations and mortality. A key message is that obesity should be recognized as a chronic biological disease, not a personal failing, and addressing it may help prevent serious lung complications. This aligns with broader discussions that view obesity as a complex disease driven by biological factors rather than simply willpower.
COR Trials
By Caroline M. Apovian, MD
The COR Phase III trials found that bupropion/naltrexone (Contrave) produced meaningful weight loss in adults with obesity, with greater results seen when combined with intensive behavioral support. Higher medication adherence was associated with greater weight loss, whereas increasing the dose in non-responders provided no additional benefit. The findings also suggest the treatment may be particularly useful for patients with food cravings, depression, or smoking cessation goals.
Lifestyle modifications in the current era of obesity medication
By Ariana M. Chao, PhD, CRNP
Obesity medications represent powerful tools that help patients achieve an energy deficit, lose weight, and improve longevity and quality of life. However, pharmacotherapy is not a standalone solution, and lifestyle modification remains essential. Behavioral support helps patients implement dietary and activity changes, manage common gastrointestinal side effects, and preserve lean muscle mass through adequate high-quality protein intake and resistance training. Robust trials are still needed to establish how physical activity, resistance training, and nutrition should be optimized alongside medication. Because obesity is heterogeneous, care must be personalized, tailoring interventions to individual drivers and matching the right patient to the right medication.
Pharmacotherapy for obesity in the real world
By Jessica L. Schwartz, MD, MHS
Translating obesity pharmacotherapy from clinical trials into real-world practice presents challenges. Although GLP-1 receptor agonists and other agents are effective, trial participants receive substantial support that everyday patients often lack, and care has shifted from specialists to primary providers who frequently lack training in obesity management. Effective treatment requires initiating non-stigmatizing conversations, addressing access and affordability, and recognizing that medication demand often centers on a single popular drug despite multiple effective alternatives. Optimal care extends beyond prescriptions to incorporate behavioral support, nutrition, and individual context. Because discontinuation commonly causes substantial weight regain, obesity pharmacotherapy should be framed as lifelong management.
Undernutrition with obesity pharmacotherapy
By Amanda Velazquez, MD, DABOM, FTOS
Undernutrition is an underrecognized risk of obesity pharmacotherapy, particularly with GLP-1 receptor agonists, and certain patients carry elevated vulnerability. Routine screening within clinics and electronic medical records is essential, yet addressing malnutrition is hindered by the absence of a consensus definition, complicating diagnosis. Populations at heightened risk include those with disordered eating and food insecurity, the latter intensified by rising food costs. Effective management demands a comprehensive, team-based approach incorporating a registered dietitian and person-centered, sustainable nutrition planning. Practical tools such as 24-hour dietary recall help quantify protein deficits and motivate change, ensuring patients’ long-term safety and health.
Why is generative AI a threat to continuing obesity knowledge?
By Stuart W. Flint, PhD
Generative AI is increasingly used to produce obesity-related content for patients, the public, and professional communication, yet it draws on sources lacking expertise and can yield inaccurate guidance on causes, prevention, and treatment. A concern is stigma: AI may reproduce harmful framing and stereotyped imagery, depicting people with obesity through clichéd, isolating tropes, including children, potentially reversing a decade of progress in obesity language and framing. The technology also offers opportunity. Collaborating with AI developers could improve accuracy, reduce bias, and expand education for clinicians who receive little obesity training. Harnessed responsibly, generative AI could advance obesity knowledge rather than undermine it.
Lean mass loss with obesity treatment
By Steven B. Heymsfield, MD
As obesity treatments have advanced from producing modest weight loss to the 15–20% achievable with GLP-1 receptor agonists, the accompanying loss of lean mass has become a major concern. Muscle is functional, metabolically active tissue essential for mobility, strength, and metabolic regulation, and weight loss can also reduce bone density, raising long-term fracture and disability risk. Preservation strategies include adequate nutrition (protein, vitamins, minerals, and micronutrients often neglected when appetite is suppressed) alongside continued or initiated exercise. Pharmacologic agents designed to prevent muscle loss are emerging, advancing into early-phase trials, though their long-term safety and functional benefits remain to be fully established.
Turning down the volume on food noise
By Corby K. Martin, PhD, FTOS
Food noise is a newly defined construct that emerged from clinical observation rather than laboratory science, after patients taking GLP-1 medications spontaneously reported dramatic reductions in intrusive, ruminative thoughts about food. Because no validated measure existed, a brief five-item questionnaire was developed to quantify food noise for clinical and research use. Key uncertainties remain: how prevalent food noise is, whether it reflects biological or cognitive processes, and the degree to which it genuinely impedes lifestyle change. Distinguishing food noise from related constructs such as food cravings and appetite is essential to determine whether it warrants specific targeting during weight-loss treatment.
Relationship between obesity and cancer risk or progression
By Arianne L. Theiss, PhD
Adipose tissue is not inert but an active, secretory organ that communicates with distant tissues, and during obesity this signaling may help drive cancer initiation and progression, particularly colorectal cancer. Rather than studying established tumors alone, this work examines how adipose tissue sets a pro-cancerous stage. It releases increased numbers of extracellular vesicles whose molecular cargo, including proteins, nucleic acids, and organelles, is altered in patients with obesity; colonic epithelial cells take up these vesicles and adopt a pre-cancerous, two-hit susceptibility. Encouragingly, these effects appear reversible in animal models following weight loss. Incorporating obesity status into cancer care could enable more personalized, targeted treatment strategies.
How close are we to getting personalized treatment?
By Kevin Williams, PhD
Precision, personalized treatment is a goal in obesity management, yet a substantial gap persists between preclinical research, which can identify cell populations and predict treatment response, and clinical application in humans. Patient responses vary widely: some lose 20–30% of body weight while taking obesity medications while others lose much less, and the reasons remain poorly understood. Identifying nonresponders could guide selection between pharmacotherapy and bariatric surgery. Better understanding of the neural circuits underlying response may enable combination therapies that maximize weight loss while minimizing gastrointestinal side effects. The field is evolving rapidly, with major advances over the past decade and future promise.
