The U.S. Preventive Services Task Force has recommended that primary care clinicians screen all adults for obesity and provide those affected intensive multicomponent behavioral interventions. Approximately 95 million U.S. adults qualify for such care, also referred to as lifestyle modification. Using the Guidelines (2013) for Managing Overweight and Obesity in Adults (hereafter, Obesity Guidelines) as a framework, this article reviews the principal components of comprehensive lifestyle modification, which include diet, physical activity, and behavior therapy. To lose weight, the Obesity Guidelines recommend participation for 6 months in high-intensity programs that provide 14 or more counseling sessions with a trained interventionist. When provided face-to-face individual or group treatment, participants lose up to 8 kg (8% of weight) in 6 months and experience improvements in cardiovascular disease risk factors and quality of life. To prevent weight regain, the Obesity Guidelines recommend participation for 1 year in weight-loss-maintenance programs that provide at least monthly counseling. High levels of physical activity, frequent monitoring of body weight, and consumption of a reduced-calorie diet are associated with long-term weight loss. Investigators currently are seeking to increase the availability of lifestyle modification by delivering it in community-based programs, as well as on digital platforms (e.g., Internet and Smartphone). Digitally delivered programs lower costs and expand treatment reach; their efficacy is likely to improve further with the addition of new technologies for monitoring food intake, activity, and weight. Ultimately, to improve long-term weight management, individual lifestyle counseling must be joined with collective and institutional efforts to improve the nation’s eating and activity environments.

Objective: The Centers for Medicare and Medicaid Services (CMS) covers intensive behavioral therapy (IBT) for obesity. The efficacy, however, of the specific approach has never been evaluated in a randomized trial, as described here. The 1-year trial also assessed whether the addition to IBT of liraglutide 3.0 mg would significantly increase weight loss and whether the provision of meal replacements would add further benefit. Methods: A total of 150 adults with obesity were randomly assigned to: IBT (IBT-alone), providing 21 counseling visits; IBT combined with liraglutide (IBT-liraglutide); or IBT-liraglutide combined for 12 weeks with a 1,000-to 1,200-kcal/d meal-replacement diet (Multicomponent). All participants received weekly IBT visits in month 1, every-other-week visits in months 2 to 6, and monthly sessions thereafter.Results: Ninety-one percent of participants completed 1 year, at which time mean (± SEM) losses for IBTalone, IBT-liraglutide, and Muticomponent participants were 6.1 ± 1.3%, 11.5 ± 1.3%, and 11.8 ± 1.3% of baseline weight, respectively. Fully 44.0%, 70.0%, and 74.0% of these participants lost ≥ 5% of weight, respectively. The liraglutide-treated groups were superior to IBT-alone on both outcomes. Weight loss in all three groups was associated with clinically meaningful improvements in cardiometabolic risk factors. Conclusions: The findings demonstrate the efficacy of IBT for obesity and the potential benefit of adding pharmacotherapy to this approach.

Objective Previous studies have shown additive weight loss when intensive behavioral therapy (IBT) was combined with weight‐loss medication. The present multisite study provides the first evaluation, in primary care, of the effect of the Centers for Medicare and Medicaid Services–based IBT benefit, delivered alone (with placebo) or in combination with liraglutide 3.0 mg. Methods The Satiety and Clinical Adiposity—Liraglutide Evidence in individuals with and without diabetes (SCALE) IBT was a 56‐week, randomized, double‐blind, placebo‐controlled, multicenter trial in individuals with obesity who received liraglutide 3.0 mg (n = 142) or placebo (n = 140) as an adjunct to IBT. Results At week 56, mean weight loss with liraglutide 3.0 mg plus IBT was 7.5% and 4.0% with placebo combined with IBT (estimated treatment difference [95% CI]–3.4% [–5.3% to –1.6%], P = 0.0003). Significantly more individuals on liraglutide 3.0 mg than placebo achieved ≥ 5% weight loss (61.5% vs. 38.8%; odds ratio [OR] 2.5% [1.5% to 4.1%], P = 0.0003), > 10% weight loss (30.5% vs. 19.8%; OR 1.8% [1.0% to 3.1%], P = 0.0469), and > 15% weight loss (18.1% vs. 8.9%; OR 2.3% [1.1% to 4.7%], P = 0.0311). Liraglutide 3.0 mg in combination with IBT was well tolerated, with no new safety signals identified. Conclusions In a primary care setting, Centers for Medicare and Medicaid Services–based IBT produced clinically meaningful weight loss at 56 weeks, enhanced by the addition of liraglutide 3.0 mg.

ImportanceSARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.ObjectiveTo develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections.Design, Setting, and ParticipantsProspective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling.ExposureSARS-CoV-2 infection.Main Outcomes and MeasuresPASC and 44 participant-reported symptoms (with severity thresholds).ResultsA total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months.Conclusions and RelevanceA definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.

Purpose of review: This review describes the results of randomized controlled trials that have evaluated the efficacy of behavioral interventions for obesity in primary care settings. Recent findings:Most studies have found that high-intensity behavioral counseling (providing 12 or more sessions per year, as defined by the US Preventative Services Task Force), when delivered in-person, by phone, or electronically, produced clinically meaningful weight loss (4 to 7 kg). Low-to moderate-intensity behavioral counseling and counseling that did not include behavioral strategies (e.g., motivational interviewing) produced modest losses of 1 to 2 kg. The addition of weight loss medication increased mean losses relative to behavioral treatment alone. Summary: Consistent with national guidelines, the largest weight losses were achieved with high-intensity counseling, either alone or in combination with obesity pharmacotherapy. Primary care providers can support their patients by inviting them to discuss their weight concerns and referring interested individuals to appropriate interventions.

Research on sex differences in the relationship between obesity and psychiatric disorders is more abundant in some areas, such as depression and eating disorders, than others, such as anxiety, trauma, and substance use. However, for most of the disorders, their relationships with obesity and sex are complex and are usually moderated by additional variables. Thus, studies that find stronger relationships for women between depression and obesity cross-sectionally do not tell the whole story, as longitudinal studies suggest that this relationship may also be present among men, particularly when confounders are considered. For those with eating disorders, men and women with obesity are fairly equally affected, and weight and shape concerns may play a role in maintaining these behaviors for both sexes. Weight stigma, though, seems to have worse consequences for women than men with obesity. Sex differences exist in relation to the associations between mental health and obesity. However, these differences vary by disorder, with disorder-specific moderators playing a role, such as age for depressive disorders, comorbid depression for anxiety disorders, and weight and shape concerns for eating disorders. More work is needed to understand if sex differences play a role in the relationship between obesity and anxiety, trauma, and substance use disorders.

Objective: To test the effects of a cognitive-behavioral intervention for weight bias internalization (WBI; i.e., self-stigma) combined with behavioral weight loss (BWL). Method: Adults with obesity and elevated WBI were randomly assigned to BWL alone or combined with the Weight Bias Internalization and Stigma Program (BWL ϩ BIAS). Participants attended weekly group meetings for 12 weeks, followed by 2 biweekly and 2 monthly meetings (26 weeks total). Changes at Week 12 on the Weight Bias Internalization Scale (WBIS) and Weight Self-Stigma Questionnaire (WSSQ) were the principal outcomes, with changes at Week 26 assessed as secondary outcomes. Other outcomes included changes in mood, body image, eating behaviors, self-monitoring, and weight. Results: Seventy-two participants were randomized (84.7% female, 66.7% Black, mean age ϭ 47.1 Ϯ 11.5 years) Linear mixed models showed no significant differences between the BWL ϩ BIAS and BWL groups in WBIS changes at Week 12 (Ϫ1.3 Ϯ 0.2 vs. Ϫ1.0 Ϯ 0.2) or week 26 (Ϫ1.5 Ϯ 0.2 vs. Ϫ1.3 Ϯ 0.2). BWL ϩ BIAS participants had greater reductions in WSSQ total scores at Week 12 (p ϭ .03), with greater changes on the self-devaluation subscale at Weeks 12 and 26 (p Յ .03). BWL ϩ BIAS participants reported significantly greater benefits on measures of eating and self-monitoring. Percent weight loss at Week 26 did not differ significantly between groups (BWL ϩ BIAS ϭ Ϫ4.5 Ϯ 1.0%, BWL ϭ Ϫ5.9 Ϯ 1.0%, p ϭ .28). Conclusion: A psychological intervention for WBI produced short-term reductions in some aspects of weight self-stigma in persons with obesity. What is the public health significance of this article?This study demonstrates the efficacy of a cognitive-behavioral weight stigma-reduction intervention, combined with behavioral weight loss.

Background:Some weight loss medications, including liraglutide 3.0 mg, are thought to facilitate weight loss by improving appetite control. However, no studies have evaluated their long-term appetitive effects.Subjects/Methods:This study examined changes in appetite in a subsample of 113 adults with obesity (76.1% female, 55.8% white, BMI = 38.8±4.8 kg/m2) who participated in a 52-week trial. Participants were randomized to intensive behavioral therapy alone (IBT-alone), IBT with liraglutide 3.0 mg/day (IBT-liraglutide), or IBT-liraglutide combined with a 12-week meal replacement diet (Multi-component). Participants rated their hunger, fullness after meals, liking of meals, and food preoccupation (all as experienced over the past week) using visual analogue scales (0-100 mm). Ratings were completed at baseline and 8 subsequent visits over the year.Results:At week 52, participants treated by IBT-alone lost 6.2±1.6% of baseline weight, compared with 11.8±1.6% and 12.1±1.5% in the IBT-liraglutide and Multi-component groups, respectively. Compared to IBT-alone, IBT-liraglutide participants reported larger reductions at week 6 in hunger (−0.3±4.2 vs −16.8±4.0 mm, p=.005) and food preoccupation (+0.2±3.7 vs −16.3±3.6 mm, p=.002) and larger increases in fullness (−5.1±3.2 vs +9.8±3.0 mm, p=.001). These significant differences persisted at all assessments through week 24. There were no differences between IBT-alone and IBT-liraglutide in meal liking. IBT-alone and Multi-component participants differed in hunger at week 6, and in food preoccupation at all assessments through week 24. Multi-component participants reported reduced liking of meals relative to the IBT-alone and IBT-liraglutide groups through weeks 40 and 52, respectively. There were no other differences among any groups at week 52.Conclusions:Consistent with short-term studies, IBT-liraglutide participants reported greater improvements in hunger, fullness, and food preoccupation than those assigned to IBT-alone. Differences in appetite persisted for 24 weeks but were not maintained at week 52, despite the relatively greater weight losses in the liraglutide-treated participants at the trial’s end.