Tag: obesity

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Stress May be Fuelling SA’s Metabolic Disease Risk

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Photo by Samson Balogun on Unsplash

Chronic stress may be doing far more than affecting South Africans’ mental health – it could be contributing to the country’s growing burden of obesity, diabetes and other metabolic disorders, many of which are also major risk factors for cardiovascular disease (CVD).

While stress is often viewed as an unavoidable part of modern life, mounting scientific evidence suggests that prolonged psychological stress can trigger biological changes that increase the likelihood of developing obesity, type 2 diabetes (T2D) and CVD.

Prof Naidoo, CEO of the Heart and Stroke Foundation SA reminds us that day-to-day stressors has a cumulative effect affecting not just ones’ immune system, but also impacts eating, exercise and other vegetative signs, such as poor sleeping patterns. Ultimately, she says, the cardiovascular system has reduced capacity in the face of cumulative stressors.

This makes the stress-metabolism connection particularly relevant during Heart Awareness Month this September, when attention turns to the factors that can influence long-term heart-health.

The warning comes at a time when many South Africans are battling significant workplace and financial pressures. According to Gallup’s recent 2026 State of the Global Workplace report1, 36% of South African employees reported experiencing stress, while the 2025 Profmed Stress Index found that financial uncertainty and workplace pressure remain among the leading causes of stress among South African professionals.

The two-way relationship between stress and metabolic health (1)

“Most people understand that stress can affect their mood and sleep, but few realise that chronic stress can also disrupt the body’s metabolism,” says Nicole Jennings, spokesperson for Pharma Dynamics.

“When stress becomes chronic, the body remains in a prolonged state of alertness and continues producing elevated levels of cortisol, often referred to as the stress hormone. Over time, this can contribute to increased blood glucose levels, insulin resistance and the accumulation of harmful visceral fat around the abdominal organs in certain individuals.”

Research shows that prolonged activation of the body’s stress-response system may disrupt glucose metabolism, reduce insulin sensitivity and encourage fat storage, all of which are strongly associated with metabolic disease.

“But the relationship goes both ways. Long-term emotional or work-related stress can increase the likelihood of developing these conditions, while metabolic disorders can, in turn, alter the body’s stress-response systems, potentially increasing vulnerability to the effects of stress.

“Because metabolic disorders can disrupt the immune system and affect the brain’s chemical balance, they may intensify how the body reacts to pressure. The result is a vicious cycle where chronic stress contributes to metabolic dysfunction, and metabolic dysfunction may further impair the body’s ability to cope with stress. Prof Naidoo states that chronic stress has a negative effect on our health outcomes in ways that are not often obvious. An example of this is excessive eating during stressful episodes resulting in weight gain which is a potential driver for type 2 diabetes. Overweight and obesity is also, in turn, a driver for raised blood pressure and hypertension.

A growing metabolic health crisis

The concern is particularly relevant for South Africa, where metabolic disorders are becoming increasingly common.

According to the International Diabetes Federation (IDF), approximately 2.3 million South African adults are currently living with diabetes, representing a prevalence rate of 7.2% among adults. The country has the fourth-highest number of adults living with diabetes in Africa.

Obesity, another major risk factor for metabolic disease, remains a significant public health challenge. Approximately one in two South African adults is living with excess weight or obesity, placing millions at increased risk of diabetes, heart disease and other metabolic conditions (2).

“Many people focus on diet and exercise when discussing metabolic health, and rightly so,” says Jennings. “However, stress management is often the missing piece of the puzzle. You can be eating relatively well, but if you’re living in a constant state of stress, your body may still be experiencing metabolic consequences.” There is increasing evidence of the gut-brain connection where research is producing results that show that the type of diet you consume also plays a role in mental health and well-being says Prof Naidoo.

Why workplaces should pay attention

This highlights the important role employers can play in supporting both mental and physical health.

Studies have found that workplace stress is associated with a higher risk of developing metabolic syndrome, a cluster of conditions that includes elevated blood pressure, high blood sugar, excess abdominal fat and abnormal cholesterol levels. Together, these factors can significantly increase the risk of heart disease and stroke.

In South Africa, where economic uncertainty, job insecurity, rising living costs and demanding workloads contribute to stress levels, workplace wellness programmes could provide an important opportunity for prevention.

Small changes can make a big difference

Fortunately, Jennings says the stress-metabolism connection is not inevitable. Regular physical activity, sufficient sleep, a balanced diet, avoiding smoking, moderating alcohol intake and incorporating mindfulness practices – along with strong social support networks – have all been shown to help regulate the body’s stress response and support better metabolic health.

She encourages South Africans to view stress management not only as an essential component of mental health, but as part of a broader approach to protecting metabolic and heart health too.

“Managing stress isn’t a luxury – it’s an important part of preventing chronic disease. By recognising the impact stress has on the body and taking proactive steps to address it, individuals can improve both their mental well-being and long-term metabolic health.”

Prof Naidoo encourages those facing unmanageable stress to seek access to healthcare as there are specialist health care practitioners that are trained for stress management and mental health conditions.

Categories : Metabolic Disorders PaediatricsTags :

Scientists Are Discovering Something Surprising About Obesity in Teenagers

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Adolescent metabolism may remain flexible enough for early weight loss interventions to prevent lasting health damage

Photo by Andres Ayrton on Pexels

Obesity doesn’t look the same at age 15 as it does at age 45 and Duke University School of Medicine researchers are learning why.

A study published in the Journal of Clinical Investigation showed teenagers retain a degree of metabolic flexibility that’s largely lost in adulthood. The study suggests that the way teenage bodies respond to excess weight is fundamentally different and potentially more reversible.

By showing that obesity’s biology changes with age, the discovery points to a potential window when the metabolic damage linked to obesity can be halted, or even reversed, before it becomes a lasting health burden.

“For a long time, medicine has tended to treat adolescents as little adults,” said John Rawls, PhD, a professor of molecular genetics and microbiology and member of the Duke Microbiome Center. “But teenagers are still growing, building muscle and bone, and using energy in ways that are very different from adults. We wanted to understand how those differences shape obesity.”

Nearly 1 in 5 U.S. children has obesity, a condition associated with higher risk for heart disease, diabetes, asthma, and some cancers later in life.

Without intervention, most children with obesity will continue to have obesity into adulthood, said study co-author Sarah Armstrong, MD, a pediatrician and medical weight management specialist at Duke Health.

The change from adolescence to adults happens in late teens to early 20s for women and early-to-mid 20s for men.

But researchers are increasingly asking when those risks become biologically embedded and whether adolescence offers a chance to change course.

The microbiome tells a different story in teens

The Duke team focused on two systems often linked to obesity: the gut microbiome which is the community of microbes living in the digestive tract, and the metabolome, the collection of chemicals produced as the body and microbiome process food and energy.

First, using gut microbes collected from 287 teenagers in the Pediatric Obesity Microbiome and Metabolism Study, they confirmed that teens with obesity have microbiomes that differ compositionally from those of teens at a healthy weight.

Next, Jessica McCann, PhD, a senior research associate in molecular genetics and microbiology, transplanted microbiome samples from adolescents with and without obesity into germ-free mice.

Unlike what researchers often see in adult obesity studies, the mice did not gain extra weight after receiving microbiota from adolescents with obesity.

The findings indicate that while obesity-related differences in the microbiome are beginning to emerge during adolescence, those microbes may not be driving disease the waythey do in adults.

“This suggests there’s a developmental window in which the microbiome becomes involved in obesity,” McCann said. “The relationship between the host and the microbiome may still be developing during adolescence, which means there may be an opportunity to change its trajectory.”

Warning signs appear, but so does resilience

Working in collaboration with the Duke Molecular Physiology Institute, the research team also found differences in how adolescents process nutrients. Adults with obesity often have elevated levels of branched-chain amino acids, as well as related compounds called branched-chain keto acids (BCKA), which are linked with insulin resistance and Type 2 diabetes.

The adolescents showed a different pattern. While branched-chain amino acids were elevated, BCKA levels remained relatively low.

The warning signs are there, McCann said, but teens’ bodies still appear capable of adapting to the metabolic strain of excess weight. “The metabolome is showing early signs of disease progression, but it’s also showing evidence of adaptive plasticity.”

At this stage they may be more responsive to weight management through diet, medication or microbiome-based therapies.

“The evidence increasingly supports intervening as early as possible,” said Armstrong, a professor of pediatrics at Duke.

Researchers hope the work would eventually lead to more personalised obesity treatments, using a child’s microbiome or metabolic profile, to help determine which weight loss therapies are most likely to succeed.

The study was supported by the American Heart Association and the National Institute of Diabetes and Digestive and Kidney Diseases.  

Source: Duke University School of Medicine

Categories : Metabolic DisordersTags :

New Obesity Definitions Better than BMI in Revealing Ill Health

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Sleeve gastrectomy. Credit: Scientific Animations CC4.0

An international study led by King’s College London has found that proposed new obesity definitions give greater insight into the ill health of metabolic bariatric surgery candidates compared with Body Mass Index (BMI).

The study, published in Jama Open Network, found that people considered for metabolic bariatric surgery had marked variation in disease burden – the number and severity of diseases – and operation-related risks, despite having similar BMI.

However, by reviewing clinical data from thousands of bariatric surgery candidates and applying new obesity definitions, the researchers were able to better understand their underlying health – which could have important implications for patient treatment and surgery prioritisation in the future.

Led by Professor Francesco Rubino, Chair of Metabolic and Bariatric Surgery at King’s College London, the researchers reviewed retrospective clinical data from 2,316 surgical candidates across four specialist centres – King’s College Hospital in the UK, and centres in France, Spain and Brazil.

They applied the new obesity definitions: clinical obesity, where there is clear evidence that excess fat, or adiposity, is causing organ damage, and preclinical obesity, where organ function is preserved despite excess adiposity.

From the surgical candidates, 73.8% had clinical obesity and 26.2% had preclinical obesity. Despite both groups of patients having similar BMI, patients with clinical obesity had far greater surgery-related and cardiovascular risks. They also had an overall high chance of death.

These findings suggest that distinguishing between clinical and preclinical obesity reveals key information about the health status and risks to surgery candidates that BMI alone cannot capture.

This study shows that the distinction between clinical and pre-clinical obesity is clinically meaningful even among surgical candidates with very high BMI levels, because BMI alone cannot tell us who has active disease.”Professor Francesco Rubino, senior author and Chair of Metabolic and Bariatric Surgery at King’s College London

He continued: “It is now essential that future surgical studies and registries systematically report patients’ clinical or pre-clinical obesity status, so that surgical safety, effectiveness and cost-effectiveness can be interpreted in the appropriate clinical context.”

Traditionally, obesity has been classified primarily using BMI, a measure of weight relative to height that provides limited information about whether excess fat is actually affecting a person’s health. BMI levels have historically played a central role in determining eligibility and priority for metabolic bariatric surgery – operations of the stomach that help people lose weight and fix health issues, such as type 2 diabetes.

In 2025, the Lancet Diabetes & Endocrinology Commission on Clinical Obesity proposed a new diagnostic framework. This distinguished between clinical obesity, where there is clear evidence that excess fat, or adiposity, is leading to organ dysfunction, from preclinical obesity, where organ function is preserved but future health risk is increased.

In the latest study, the researchers found that these differences in disease status were not reflected in BMI. In the UK centre, for example, BMI was roughly 47.5 among patients with clinical obesity and 48.5 among those with preclinical obesity. Yet those with clinical obesity were approximately 10 years older and had substantially higher risk of death, cardiovascular risk and operation-related risk.

The researchers argue that for patients with clinical obesity, surgery primarily represents treatment of established disease. On the other hand, for those with preclinical obesity, its key goal may instead be to reduce future health risk. Recognising this distinction could help clinicians plan surgery, as well as select and prioritise surgical candidates.

Read the full study here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2852615

Source: King’s College London

Categories : Cardiovascular DiseaseTags :

BP and Cholesterol in Over-40s with Obesity Are Trending to Normal Levels

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Credit: Pixabay CC0

Over the last three decades, differences in unhealthy cholesterol levels and blood pressure between older adults with obesity and those with a normal Body Mass Index (BMI) have narrowed or disappeared in several high-income countries, suggests a study published in The Lancet. The authors propose that this trend is due to the greater, and possibly more intensive, use of cholesterol-lowering medication (such as statins) and blood pressure medication in people aged over 40 living with obesity in high-income countries. 

Obesity is known to increase blood pressure and unhealthy cholesterol levels, which can impact cardiovascular health and increase the risk of heart attack, heart failure, and stroke. However, prior to this study, there was little information on blood pressure and cholesterol levels, and how they have changed, for people with obesity compared with people with normal BMI.

Author Prof Majid Ezzati, from the School of Public Health at Imperial College London (UK), says: “Our study suggests that, in high-income countries, taking medication to lower blood pressure and cholesterol has helped middle-age and older adults lower their cardiovascular risk to levels that are similar to people with normal BMI.”

He continues, “At a time that weight-loss medications are becoming more widely used, our results give a picture of the cardiovascular health of people likely to be prescribed them, which allows the healthcare system to understand how blood pressure and cholesterol treatments benefit the population alongside weight-loss medications.”

The study analysed data on blood pressure and cholesterol in people with obesity, overweight, and normal BMI from 110 health datasets including almost one million participants from 1990 to 2024 in seven high-income countries: England, the USA, Japan, South Korea, Taiwan, Thailand and Finland. 

Converging cardiovascular risk markers

The study finds that in the 1990s adults with obesity generally had higher blood pressure and high-density lipoprotein (non-HDL) cholesterol levels [1] than people with a normal BMI.
 
Since 1990, in the majority of the seven countries studied including England and the USA, blood pressure and unhealthy cholesterol fell more steeply among middle-aged and older adults (40–79 years old) with obesity and overweight than among those with normal BMI, narrowing the gap over time. The exceptions were Taiwan and Thailand, which did not see this convergence as universally as other countries.
 
The findings were most striking in older adults (60–79 years old). In England and the USA, older adults with obesity, and especially with severe obesity, had similar or even lower blood pressure and unhealthy cholesterol levels at the end of the study period than older adults with normal BMI.

Heart medication likely driving the convergence

Over the past three decades, people with obesity were more likely to be prescribed cholesterol-lowering medication (such as a statin) and blood pressure medication than those with a normal BMI. 
 
This gap was especially pronounced in older adults. For example, in England and the USA, around 70–72% of older men with severe obesity (BMI ≥35) were taking cholesterol-lowering medication by the early 2020s, compared with 40–48% of older men with a normal BMI.
 
Author Lakshya Jain, from the School of Public Health at Imperial College London (UK), says “This latest analysis suggests that the observed convergence in cholesterol and blood pressure levels between people aged over 40 with obesity and those with a normal BMI is largely due to statins and other widely accessible medications to reduce cardiovascular risk. That is a significant public health success story, and one we should not lose sight of as new weight-loss medications enter the picture.” 

Cardiovascular risks remain for younger adults with obesity

In younger adults (under 40 years old), the study findings suggest little or no narrowing of the gap in blood pressure or cholesterol between those with obesity and those with a normal BMI. The data also suggests that use of cholesterol-lowering and blood pressure medication is low for this age group, adding further evidence that medication is the driver of the gap reduction in older adults. 

Author Ysé d’Ailhaud de Brisis, from the School of Public Health at Imperial College London (UK), says “While good news for older adults with obesity, our results suggest that cardiovascular health risks remain higher for adults under 40 than for their counterparts with a normal BMI. Early lifestyle interventions, screening and, when appropriate, medication in this younger group should be considered to prevent long-term cardiovascular complications linked to obesity.”

The researchers note some limitations of the study, including that their analysis was limited to seven countries which were all high-income, therefore the finding may not be applicable elsewhere, especially for low- and middle-income countries where the use of unhealthy cholesterol and blood pressure lowering medicines is likely to be lower. Additionally, it was not possible to look at the impact of different medication doses, which require data on prescriptions. 

Writing in a linked Comment, Dr Yuan Lu, Yale School of Medicine (USA), who was not involved in the study, says, “This study reframes obesity-related cardiovascular risk as reflecting not only excess adiposity, but also treatment access, health-system engagement, and timing of intervention. Convergence of risk factors should not be equated with elimination of obesity-related risk. Although treatment of high blood pressure and cholesterol might mitigate part of the cardiovascular harm associated with obesity, the persistent burden among younger adults and the broader multisystem consequences of obesity highlight the need for integrated prevention strategies that move beyond isolated risk factor treatment.”

Source: EurekAlert!

Categories : Diet and NutritionTags :

Young UP Researchers Develop Citrus-based Supplement to Fight Diabetes and Obesity

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Dr Kadima Tshiyoyo, Marni Oberholzer and Ryan Bosch

A team of young researchers at the University of Pretoria (UP) is developing an innovative health supplement that transforms citrus peel waste into a potentially powerful tool against lifestyle diseases such as diabetes, obesity and high cholesterol, while also improving the affordability and accessibility of preventative health products for low-income communities.

The NutraPectin project is led by postdoctoral research fellow Dr Kadima Tshiyoyo, alongside recent Master of Science in Biochemistry graduates Ryan Bosch and Marni Oberholzer. Together, the team from UP’s Faculty of Natural and Agricultural Sciences (NAS) is converting citrus processing waste into a pectin-rich nutraceutical using green extraction technology. When consumed with food, pectin can help slow sugar absorption, reduce cholesterol levels and support gut health.

“South Africa’s growing burden of lifestyle diseases and abundance of agricultural waste inspired our work,” Dr Tshiyoyo said. “NutraPectin uses sustainable green methods to extract bioactive compounds from waste, which are valuable and essential in the management of lifestyle diseases such as diabetes and obesity.”

Turning science into solutions

The development of NutraPectin addresses two growing challenges: the rising prevalence of lifestyle-related diseases and the environmental cost of agricultural and food processing waste. Citrus peel, which is typically discarded in large volumes by the citrus industry, is rich in pectin and other bioactive compounds that can be recovered and repurposed.

Bosch says the NutraPectin research was his honours-degree project under Prof Samkelo Malgas of UP’s Department of Biochemistry, Genetics and Microbiology. “I was drawn to the project as I am passionate about maintaining the environment, and I was excited to investigate how food waste could be converted into useful healing products.”

For Bosch and Oberholzer, the project represents more than laboratory research. It is an opportunity to demonstrate how student-led science can be translated into solutions with tangible social and economic impact, particularly in a country where both healthcare access and food system sustainability remain pressing concerns.

“Sustainability should both underlie and overarch most research if we want to see true economic and social growth,” Oberholzer said. “South Africa has so much potential to sustainably improve and empower our agricultural industry by targeting circularity through waste valorisation. UP was foundational in this development, most markedly through our excellent supervisor’s guidance. We were allowed to explore beyond the strict boundaries of our degrees.”

The project is rooted in the Biocatalysis and Processing Research Group in the Department of Biochemistry, Genetics and Microbiology within the NAS Faculty, under the supervision of Prof Malgas. He says the work highlights the importance of university-based research in advancing both innovation and entrepreneurship, while also addressing societal challenges through science-driven solutions.

“This pectin extraction from citrus waste represents a remarkable advancement in enzyme biotechnology. The student-led innovation model effectively merges hands-on research with mentorship, equipping students with essential skills in biotechnological methods,” Prof Malgas said. “It demonstrates that active student involvement is crucial in driving innovation and developing talent. The technology promises significant environmental benefits by promoting sustainable waste use and reinforcing the circular economy. Additionally, it has the potential to drive economic growth for South Africa’s citrus industry through the production of high-value pectin.”

Catalyst competition winner

A major milestone for the project came in 2024 when NutraPectin was named the winner of the Catalyst competition, an early-stage biotech start-up pitch event organised by Immobazyme in partnership with UVU Bio. The competition brought together seven finalist teams developing biotech solutions aimed at real-world challenges.

NutraPectin stood out to judges for its dual impact: addressing lifestyle diseases while simultaneously offering a scalable approach to waste valorisation in the agricultural sector. The win signalled growing confidence in the commercial viability of the technology, moving it beyond academic research into the early stages of commercialisation.

Indeed, the Catalyst win also unlocked a structured support package designed to accelerate start-up development. This includes access to laboratory space, a reagent and consumables credit facility, mentorship from industry executives, business development training, and specialised technical support to help refine and scale production processes.

The team has also secured a Technology Innovation Agency Seed Grant, which will further support the optimisation of production methods and the transition from prototype to scalable manufacturing.

However, NutraPectin remains in the early stages of development. The current focus is on developing a production pathway that can support larger-scale manufacturing, enabling the product to be brought to market.

Looking ahead, the team envisions NutraPectin as a locally produced, widely accessible nutraceutical that supports preventative health while creating value from South Africa’s agricultural resources.

To move from a laboratory success to a market-ready product, the team is now seeking additional funding and industry partnerships to support pilot-scale production and regulatory development.

“It is envisioned that NutraPectin can move from optimisation and scale-up to a market-ready prototype supported by partnerships and collaboration to expand within South Africa,” Dr Tshiyoyo said. “Our long-term goal is to make the product affordable and accessible while creating sustainable health and commercial impact. We see NutraPectin growing into a versatile innovation with potential in the supplement, health additive, cosmetic, and pharmaceutical industries.”

As South Africa’s Youth Month draws to a close, the NutraPectin team’s work reflects the growing role of young researchers in developing solutions that integrate health, sustainability and innovation. Dr Tshiyoyo advises other young researchers to stay focused and work steadily towards their goals. “My message to the youth is think long term but act today; many consistent steps over the years can lead to your breakthrough,” he said.

Provided by University of Pretoria

Categories : Substance Use Surgeries & ProceduresTags :

Bariatric Surgery Increases the Risk of Alcohol Problems

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Sleeve gastrectomy. Credit: Scientific Animations CC4.0

The body absorbs alcohol much more rapidly after bariatric surgery, researchers from Norway have found. Patients need to know this when they choose the kind of surgery they will have.

“Bariatric surgery can come with a price. Patients have a significantly higher risk of developing alcohol problems than if they did not undergo surgery,” said Magnus Strømmen, a researcher at the Centre for Obesity Research at St. Olavs Hospital and a PhD research fellow at the Norwegian University of Science and Technology (NTNU).

Between one and two per cent of the population in Norway has undergone bariatric surgery. The most commonly used surgical methods are gastric bypass and gastric sleeve.

Both methods make patients eat less and feel full faster. This is partly due to reduced volume on the stomach, and partly due to hormonal changes. But a person’s changed anatomy also has consequences for what happens when they drink alcohol.

“In a normal stomach, a significant part of the alcohol will be broken down and thus not pass into the bloodstream. This is due to an enzyme that is secreted in the lining of the stomach. It is this protective mechanism that we deprive the patient of when we operate on the stomach. In addition, what you drink passes much faster into the intestine,” says Strømmen.

The small intestine’s big job is absorption. Since the stomach’s ability to break down alcohol more or less stops, significantly more alcohol passes directly into the bloodstream. That’s true even if the patient drinks the same as before the operation.

You get drunk faster

In a new study, Strømmen and his colleagues have had 33 adult patients undergo stress tests with alcohol. The participants consumed measured amounts of vodka mixed with orange juice both before bariatric surgery, and 3, 12 and 36 months after the operation, after which they had their blood alcohol levels measured after they had consumed the alcohol.

“Our findings show that alcohol uptake almost doubles, both after gastric bypass and gastric sleeve. Perhaps an even more dangerous finding, from a substance-abuse perspective, is that patients reach the maximum blood concentration in only half the time. These effects are lasting, probably lifelong,” Strømmen said.

In other words: The patients were intoxicated faster, and to a much greater extent, by the same amount of alcohol, and it took longer to get sober.

“The effects were more pronounced for people who had gastric bypass surgery. But that does not mean that the sleeve operation is harmless in terms of subsequent alcohol abuse,” Strømmen said.

Gastric bypass (left) and gastric sleeve are the most common forms of bariatric surgery today. In gastric bypass, a corner of the stomach is connected directly to the small intestine, so that both the stomach and one meter of the small intestine are disconnected. In gastric sleeve surgery, part of the stomach is removed so that the volume is reduced, without reconnecting the intestines. Illustration: Kari C Toverud, CMI

Bypass had a 69 per cent higher risk than sleeve

In another study, the researchers compared the risk of getting an alcohol abuse diagnosis after the two bariatric surgeries. The researchers analysed data from the Norwegian Patient Registry linked to the Norwegian Prescription Database for 17,800 patients operated on in the period from 2008 to 2018.

They found that patients who had gastric bypass surgery had a 69 per cent higher risk of being diagnosed with an alcohol-related problem than patients with a gastric sleeve. Bariatric patients who were given an alcohol-related diagnosis also had a higher mortality rate and used specialist health services more than patients who underwent bariatric surgery and who did not receive an alcohol diagnosis.

“It is important that patients, their relatives and health personnel, especially in general medicine, substance abuse and gastro medicine, share this knowledge. These Norwegian studies, based on different data sources and different methodologies, indicate that some of our patients struggle with alcohol problems as a complication from the surgery. Alcohol problems can cost the patient, their relatives, and society a great deal,” Strømmen said.

He likes to tell patients that they need to practice saying no.

“They will suddenly be in social contexts where friends and surroundings expect you to drink as much as before the operation. But your physiology has changed. That means you need to be more careful than before,” he said.

Risk factors for bariatric surgery must be investigated

“We can’t just tell people what to do or not to do,” says Associate Professor Magnus Strømmen. “I believe more that patients need to be educated about the mechanisms behind it. Knowledge can motivate people to be more careful with alcohol. They need to know how altered alcohol absorption can affect their actions while under the influence and that all alcohol intake doubles the stress on their organs. Photo: Aleksander Mjøen

He himself has been involved in building up the obesity outpatient clinic at St. Olavs Hospital in Trondheim. Now he wants to be sure that clinics incorporate this new information into their daily practice. Patients must be assessed individually in relation to the risk of alcohol problems.

“We find that many patients have a clear idea of what type of surgery they want when they are referred. And for a long time, this was given very great importance in the decisionmaking. But obesity is not just a single phenotype. Despite having a large body, patients are very different, also in terms of health,” he said.

Some patients may have type 2 diabetes, others struggle with heartburn. Some may have more extensive obesity and thus desire greater weight loss.

“For a patient like this, gastric bypass may be best. Other conditions may make you want to recommend gastric sleeve. Now we know that the operations result in different risks of alcohol problems. This means we must also investigate the patient’s risk factors for substance abuse before we decide which operation the patient should have. Where patients have several risk factors, gastric sleeve may be a better alternative, but we must also ask whether high-risk patients should be operated on at all,” Strømmen said.

Patients need to know

He wants patients to receive more specific information before the operation.

“It is important that patients make their decision to undergo surgery on a genuinely informed basis. It is not enough to say that their alcohol uptake will change. Patients should be educated about the mechanisms behind increased risk after surgery, and not least how to react differently to alcohol intoxication after surgery as a result of the sudden increase. This information can at best prevent patients from developing alcohol-related problems,” he said.

The patient’s risk factors for substance abuse should be considered before the type of surgery is chosen.

“I think most obesity clinics can get much better at their alcohol history, ie, a thorough conversation about the patient’s alcohol habits and any risk factors. We need to get better at asking the right questions, and make a more precise assessment. But this also requires transparency from the patients. I believe that good patient education can make patients understand why it is important to be honest about these things,” says Strømmen.

Drugs can replace bariatric surgery

In recent years, more effective drugs have been developed against obesity. Strømmen believes these should be considered for everyone before surgery, but especially for those at increased risk of alcohol abuse.

“The current guidelines state that we should not operate on patients with an active substance abuse problem, and that high-risk patients should abstain from alcohol after surgery. However, the guidelines do not provide any guidelines for how patients should be screened.  The lack of specification is a problem because this is information that many clinicians are reluctant to ask for, and which patients may be afraid to share,” he said.

By Ingebjørg Hestvik – Published 25.06.2026

References:

Strømmen, M., Dale, O., Klöckner, C. et al. Ethanol pharmacokinetics before and after sleeve gastrectomy and Roux-en-Y gastric bypass: a 3-year prospective study (the BAR-TRIAL). Int J Obes (2026).https://doi.org/10.1038/s41366-026-02113-3

Strømmen, M., Bakken, I.J., Sandvik, J. et al. Alcohol use disorders and related morbidity and mortality after sleeve gastrectomy and Roux-en-Y gastric bypass: a nation-wide registry study (the BAR-REGISTER). Int J Obes (2026). https://doi.org/10.1038/s41366-026-02123-1

Source: Norwegian SciTech News

Categories : Metabolic DisordersTags :

Genetics Likely Made Some People Extra Susceptible to Obesity as Society Changed

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Study finds the link between genetics and BMI has become stronger since the rise in obesity rates 

Association (+ 95% CIs) between PGI and BMI (kg/m2) by cohort, age, and PGI (adulthood or childhood). Derived from separate linear mixed effects models with the association between PGI and BMI allowed to vary by age (two natural splines). Adjustment was made for age (two natural splines), sex, first 10 genetic principal components, and a person-specific random intercept. Estimates were weighted using recruitment weights.  
Image Credit: Wright et al., 2026, PLOS Genetics, CC-BY 4.0

People who carry genetic variations linked to obesity are more likely to be heavier now than individuals with the same variants who were born before the recent obesity epidemic. Liam Wright of University College London, and colleagues, report these findings June 19 in the journal PLOS Genetics.

Over the past five decades, obesity rates have risen sharply for both children and adults. But strangely, rates of extreme obesity have increased faster than the overall increase in body mass index (BMI), an estimate of body fat based on a person’s height and weight. This trend suggests that some individuals are especially susceptible to environmental factors that encourage weight gain, such as the increasing availability of processed foods and decreasing amounts of physical activity. One cause of this susceptibility may be genetics.

To investigate this trend, researchers compared the BMIs and the presence or absence of multiple genetic variations previously linked to obesity in people from four British birth cohorts, born before or during the rise in obesity rates. The study included BMI data from early adolescence to adulthood for individuals born in 1946, 1958, 1970 and 2001 in Great Britain. Their analyses showed that these genetic variations were more strongly linked with having a high BMI in the two more recent cohorts, and were even more pronounced as people became older and among individuals with a higher BMI. These findings suggest that people with a genetic predisposition to having a higher BMI are likely more susceptible than others to changes in their environment that encourage obesity.

The researchers point out that the reason for the stronger association between genetics and BMI in the younger cohorts is unclear. However, they suspect that as the environment changed – with a rise in fast food restaurants and processed food – it may have enabled greater expression of genetic variants that encourage higher calorie consumption and, thus, higher BMI. They conclude that further work will be required to identify the specific environmental factors responsible for strengthening the link between genetics and BMI.  

The authors add: “The obesity epidemic has increased BMI regardless of genotype, but it’s those most genetically predisposed to high BMI that have been most affected.”

Provided by PLOS

Categories : Metabolic DisordersTags :

One Molecule, Two Effects: A New Drug Concept to Treat Obesity and Type 2 Diabetes

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Photo by Nataliya Vaitkevich on Pexels

A team led by metabolism researcher Prof Timo D. Müller at Helmholtz Munich has developed a new approach for treating obesity and type 2 diabetes: a hybrid molecule uses the well-known GLP-1/GIP signalling pathway as a “door opener” and delivers an additional metabolic modulator specifically into the target cells. In laboratory experiments, mice subsequently ate less, lost more weight and showed improved blood glucose values compared with reference treatments. The researchers published their preclinical results in the journal Nature.

Modern incretin therapies – drugs that mimic the body’s own satiety and blood-glucose signals (GLP-1/GIP) – have markedly improved the treatment of obesity and type 2 diabetes. Yet a key challenge remains: physicians would like to use further metabolic “levers”, for example drugs that make cells more responsive to insulin, so that glucose moves more easily from the blood into tissues. However, such additional drugs often act system-wide rather than in a targeted manner, increasing the risk of side effects.

“Our guiding question was: how can we enhance incretin activity without creating a second, systemically active source of side effects?” says the study lead Timo D. Müller, Director of the Institute for Diabetes and Obesity (IDO) at Helmholtz Munich, Professor at the Ludwig Maximilian University of Munich (LMU) and researcher at the German Center for Diabetes Research (DZD). 

Müller’s team therefore pursued the idea of an “address label with cargo”: the researchers chemically linked a well-established incretin active component to a second pharmacological component – the drug lanifibranor, a so-called pan-PPAR agonist. The incretin part binds to GLP-1 or GIP receptors on the cell surface and ensures that the hybrid molecule is taken up into the cell. Inside the cell, the second component binds to PPARs – “switches” in the cell nucleus that regulate genes involved in fat and sugar metabolism. The aim is for this additional metabolic effect to arise specifically in GLP-1R/GIPR- expressing cells, rather than throughout the body.

Low Dose via a “Trojan Horse”

Functionally, the hybrid molecule combines five drug targets in one: it activates two receptors on the cell surface (GLP-1R and GIPR) and additionally engages three PPAR “switches” inside the cell. Müller describes the principle as a “Trojan horse”: the incretin part opens the door; the “cargo” acts only once it is inside the target cell. “A major advantage is the amount,” says Müller. “Because the second component is not administered separately and systemically, but ‘travels along’ with the incretin part, it can be used at a dose that is orders of magnitude lower.” In this way, the drug gains efficacy without amplifying side effects through broad distribution across the body.

In laboratory mice with diet-induced obesity, the approach showed clear effects: “The animals ate less and lost more weight than under a GLP-1/GIP co-agonist without cargo,” says Dr Daniela Liskiewicz, group leader at IDO and co-first author together with Dr Aaron Novikoff. “In the head-to-head comparisons shown, the effect was in part even stronger than with a GLP-1-only drug.” The study therefore suggests that the coupling is not merely “more of the same”, but measurably strengthens incretin activity – at least in mice.

Additional Metabolic Readouts Improve

It was not only body weight that changed: in the experiments, blood-glucose values improved and there were indications of better insulin action in the body. Put simply, insulin was better able to “channel” glucose from the blood into tissues, and the liver released less glucose into the bloodstream. At the same time, the researchers report that typical gastrointestinal side effects were comparable in their assessment to those of existing incretin therapies – and that, in the parameters examined, they found no indications of two feared issues associated with the coupled component, namely fluid retention and anaemia.

Beyond glucose metabolism, the mouse data also provided indications of additional, potentially favourable effects on the heart and liver. It is important to note that this is a preclinical study: whether the results will translate to humans remains open – also because the GIP receptor differs between mice and humans. “We see a principle with strong effects in the animal model – now the task is to optimise the approach for humans and move it towards the clinic,” says Müller. For that development, strong industry partners will be needed, he adds.

Source: Helmholtz Association of German Research Centres

Categories : Diet and Nutrition Metabolic DisordersTags :

New Report Highlights Fructose as a Key Driver of Metabolic Disease

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Researchers emphasise fructose’s unique role in obesity, metabolic syndrome and other chronic diseases

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A new report, published in Nature Metabolism, is shedding light on the distinct and underappreciated role of fructose in driving disease, separate from its role as a simple source of calories.

Researchers examine how common dietary sweeteners, including table sugar (sucrose) and high-fructose corn syrup, impact human health. While both contain glucose and fructose, fructose has unique metabolic effects that may more directly contribute to obesity and related conditions.

“Fructose is not just another calorie,” said Richard Johnson, MD, professor at the University of Colorado Anschutz and study lead author. “It acts as a metabolic signal that promotes fat production and storage in ways that differ fundamentally from glucose.”

The report outlines how fructose metabolism bypasses key regulatory steps in the body’s energy-processing pathways. This can lead to increased fat synthesis, depletion of cellular energy (ATP) and the production of compounds linked to metabolic dysfunction. Over time, these effects may contribute to metabolic syndrome, a cluster of conditions that includes obesity, insulin resistance and cardiovascular risk.

Importantly, the authors emphasise that fructose’s impact extends beyond dietary intake alone. The body can also produce fructose internally from glucose, suggesting that its role in disease may be broader than previously recognised.

The findings come amid ongoing concern about rising rates of obesity and diabetes worldwide. Although some countries have seen declines in sugary beverage consumption, overall intake of “free sugars” remains above recommended levels in many regions and continues to increase in others.

While fructose may have once served an evolutionary purpose, helping the body store energy that can aid survival during times of food scarcity, the researchers argue that in today’s environment of constant food availability, these same mechanisms now contribute to chronic disease.

“This review highlights fructose as a central player in metabolic health,” said Johnson. “Understanding its unique biological effects is critical for developing more effective strategies to prevent and treat metabolic disease.”

By Kelsea Pieters

Source: Colorado University Anschutz

Categories : Diet and Nutrition Metabolic DisordersTags :

Ultra-processed Foods Linked with Greater Risk of Overweight or Obesity in Adolescents

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The conclusion comes from a systematic review and meta-analysis of 23 studies and 155 000 adolescents across multiple countries and regions.

Photo by Erik Mclean

Adolescents who consume more ultra-processed foods (UPFs) have significantly higher odds of being overweight or obese, according to a new systematic review and meta-analysis published in the open-access journal PLOS One by Mekuriaw Nibret Aweke of the University of Gondar, Ethiopia, and colleagues. In the most recent of the analysed studies, higher UPF consumption was linked with more than twice the odds of overweight or obesity compared to lower UPF consumption.

Being overweight or obese during adolescence raises a person’s likelihood of developing type 2 diabetes, high cholesterol, hypertension, and metabolic syndrome. The increasing consumption of UPFs – defined as industrial products made largely from extracted, modified, or synthetic ingredients, and typically high in added sugars, salt, unhealthy fats, and chemical additives – represents one of the fastest-growing unhealthy eating patterns among young people worldwide.

In the new study, researchers systematically searched multiple databases for observational studies reporting on UPF consumption and weight outcomes in adolescents aged 10 through 19. They identified 23 eligible studies involving a total of 155 000 adolescents, conducted across 16 countries between 2008 and 2025.

In a meta-analysis of all 23 studies, the researchers found that adolescents with higher UPF consumption had 63% greater odds of overweight or obesity compared with those with lower intake (OR = 1.63; 95% CI: 1.36–1.95). The positive association was consistent across all geographic regions studied, including Africa, Asia, Europe, North America, and South America. Subgroup analysis by year of publication showed that the most recent studies, published in 2024 and 2025, reported the highest odds ratio (OR = 2.09), suggesting the association may be growing stronger as UPF consumption rises globally.

Among other aspects, the study is limited by its reliance on observational designs, which cannot establish causation, and by variation across studies in how UPF consumption and obesity were measured.

The authors conclude that public health strategies should prioritize reducing UPF consumption among adolescents through education, policy interventions, and promotion of minimally processed, nutrient-dense foods.

The authors add: “Higher consumption of ultra-processed foods is linked to a substantially increased risk of overweight and obesity among adolescents, emphasising the need for early dietary interventions.”

“Improving adolescent nutrition today is essential to protecting long-term population health and reducing healthcare costs associated with obesity-related conditions.”

Provided by PLOS