Category Archives: Nutrition

GLP-1 Receptor Agonists vs. Bariatric Surgery in Youth

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SE Messiah et al. JAMA Pediatr. Published online July 20, 2026. doi:10.1001/jamapediatrics.2026.2828. Open Access! GLP-1 Receptor Agonist and Bariatric Surgery Utilization Among Adolescents and Young Adults. 

Methods: This was a retrospective analysis among US adolescents and young adults (AYAs) that leveraged data from Epic Cosmos,4 a US-based electronic health record database representing more than 300 million patients. AYAs (aged 13-25 years) treated for obesity between May 2022 and January 2026 were included.

Key findings:

  • The study included 204,148 AYAs (mean [SD] age, 21.3 [3.3] years; 150,051 females [73.5%]) who were treated with GLP-1 RAs (192,013 [94.1%]), metabolic and bariatric surgery (MBS) (9,060 [4.4%]), or a combination of both therapies (3,075 [1.5%])
  • The proportion of exclusive GLP-1 RA use increased from 88.2% in May to November 2022 to 96.1% from June 2025 to January 2026 (P for trend < .001)
  • MBS completion decreased from 11.6% to 3.7% (P for trend < .001)
  • Exclusive GLP-1 RA use was observed in a larger proportion of adolescents vs young adults (97.2% vs 93.3%; P for trend < .001). In contrast, MBS completion was observed in a larger proportion of young adults vs adolescents (5.1% vs 1.7%; P for trend < .001).

My take (borrowed from authors): There has been “a rapid shift in treatment pathways, with pharmacotherapy increasingly functioning as the initial intervention for youths with obesity.”

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Portland Head Light

Nutrition Therapy for Intensive Care Patients

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JJ Patel, SA McClave. NEJM 2026; 395: 162-174. Nutrition Therapy in Critically Ill Adults

Key points: (for adults)

  • Early enteral nutrition preserves gut integrity and supports the microbiome, so it is the preferred approach, although contemporary randomized, controlled trials show that early short-term parenteral nutrition is safe when enteral nutrition is contraindicated.
  • Providing full-dose nutrition early may lead to more metabolic and gastrointestinal complications than restrictive or trophic feeding.
  • High-dose protein (>2.0 g per kilogram of body weight per day) offers no outcome benefit over standard dosing (≤1.2 g per kilogram per day) and may be harmful in patients with acute kidney injury.
  • Adverse events with enteral feeding (often called enteral feeding intolerance) are common during critical illness, and the safe delivery of nutrition requires gradual advancement, strategies for prevention of refeeding syndrome, glycemic control (glucose level, <180 mg per deciliter), and avoidance of routine gastric residual volume monitoring.

TIMING, ROUTE AND DOSE OF NUTRITION:

  • “The receipt of nothing by mouth…impairs gut health by reducing epithelial-cell proliferation, increasing apoptosis, and disrupting mucosal integrity, enteral nutrition supports gut function by enhancing tight-junction protein expression, reducing enterocyte apoptosis, preserving villous and crypt architecture, maintaining Paneth-cell function, supporting gut-associated lymphoid tissue, and helping to sustain commensal microbiota.11,12 The collective evidence from 21 randomized, controlled trials has shown that early enteral nutrition, initiated within the first 24 to 36 hours after ICU admission, leads to better outcomes than delayed delivery or no provision of enteral nutrition.13” [if no contraindications]
  • “The CALORIES and NUTRIREA-2 trials randomly assigned critically ill adults to receive early enteral nutrition or early short-term parenteral nutrition, and the results showed no between-group differences in 30-day and 28-day mortality, respectively”
  • “Thirteen randomized, controlled trials questioned the practice of providing full-dose nutrition during the acute phase of critical illness and compared restrictive strategies — such as hypocaloric feeding, permissive underfeeding, and trophic feeding (Table 2) — with full-dose regimens.18–22,36–43 Nine trials showed no significant between-group differences in mortality.18,19,21,37–41,43 Four trials showed that restrictive-dose enteral nutrition led to better outcomes, including reductions in mortality and duration of mechanical ventilation and earlier time-to-readiness for ICU discharge, than full-dose nutrition.20,22,36,42 …Early aggressive full-dose nutrition may cause net harm by increasing the risk of bowel ischemia, refeeding syndrome, overfeeding (exogenous nutrients combined with hepatic gluconeogenesis), suppression of autophagy, increased demand on dysfunctional mitochondria, delivery of excessive fluid volume, and gastrointestinal adverse effects.28“

HIGH PROTEIN NUTRITION:

Several large well-designed studies have looked at higher protein dosing, including the EFFORT Protein Trial, the PRECISE trial and the TARGET Protein trial. Even in patients with preexisting malnutrition which was assciated wiht higher mortality, provision of high protein did not modify this outcome. “These findings were supported by two meta-analyses that showed that a high dose of protein did not lead to better outcomes in critically ill adults than a lower dose.56,57 Moreover, a high dose of protein may be harmful in patients with severe illness and acute kidney injury.”

GASTRIC RESIDUALS:

” A meta-analysis of seven trials (involving 1240 patients) indicated that not monitoring gastric residual volume reduced unnecessary feeding interruptions and showed no between-group differences in the incidence of ventilator-associated pneumonia, the length of ICU stay, or mortality.67 Current evidence does not support the use of gastric residual volume monitoring to reduce the risk of aspiration or pneumonia in ICU patients. Gastric residual volume monitoring may hinder enteral nutrition delivery… Routine monitoring of gastric residual volume — as a marker of adverse events with enteral feeding — should be strongly discouraged.”

Figure 2. Conceptual model of evolution of physiological responses and nutrition strategy across phases of critical illness.

Long Term Outcomes:

“Over the past four decades, survival from critical illness has improved but is marred by substantial loss of lean body mass, which is a major long-term consequence for survivors.4 Loss of lean body mass contributes to acquired muscle weakness and functional disability, which can persist for up to 5 years after the initial ICU admission.74 In healthy persons, resistance exercise combined with protein supplementation has been shown to elicit a greater anabolic response than protein supplementation alone.75“

My take: While this article is geared towards adult patients, my expectation is that the recommendations are largely applicable to pediatric patients. However, there is much more data in adults and pediatric care needs to be adjusted based on size.

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Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician. Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition

“Businesses Race to Cash in on Peptide Craze”

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SA O’Brien. WSJ 6/23/26: Businesses Are Taking Risks to Cash In on the Peptide Gold Rush

An excerpt:

Doctors, telehealth companies, med spas and venture capitalists are racing to get in on the craze for injectable drugs…

Demand for restricted peptides has fueled an online gray market for injections promising youth, beauty and strength. American businesses are racing—and taking risks—to get in on the craze…

These drugs, which advocate a D.I.Y. approach to health and longevity, are largely unapproved by the Food and Drug Association, meaning they can’t be marketed or sold for human consumption in the U.S. But with the support of Health Secretary Robert F. Kennedy Jr., several popular peptides will soon be up for reclassification, paving the way for a multibillion-dollar wellness gold rush.

Telehealth companies are already building infrastructure for a future where compounding pharmacies can safely provide experimental peptides…

Some longevity doctors and medical clinics are selling peptides directly to patients, obtaining substances both domestically and from abroad. Alabama’s Board of Medical Examiners released a statement in May underscoring its stance against doctors “recommending, supplying, prescribing or administering these substances.”

Wilson Hunter, the board’s general counsel, said the statement was prompted by unapproved peptides popping up in audits and investigations, via consumer complaints and as physicians inquire about guidance. “We’re not anti-peptide, we’re just anti people hurting themselves because they’re getting products that aren’t vetted or verified,” Hunter said.

In late July, the FDA’s Pharmacy Compounding Advisory Committee is set to discuss whether to greenlight seven unapproved peptides… could represent a $2.2 billion telehealth market opportunity next year…

Bill Holtz, a life sciences and U.S. Food and Drug Administration regulatory and policy strategist at Foley & Lardner LLP, said the compounding pharmacies producing the previously restricted peptides are doing so without explicit permission from FDA…

My take: Some peptides, like insulin, can be life sustaining. However, peptides that are being marketed for skin care, muscle strength and wellness are unproven and carry potential risks. In addition, like many other poorly-regulated products, there may be issues with product quality and contaminants. Long-term effects and even proper dosing are unknown.

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Health Risks from Too Much Dietary Protein

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Sophie Egan, NY Times 5/28/26: 5 Health Risks From Consuming Too Much Protein

An excerpt:

“Most Americans eat more protein than they need. We asked experts what can happen if people have too much of a good thing…

If you’ve browsed the packaged-food aisle of a grocery store lately, or scanned the updated Dietary Guidelines for Americans, you might think that when it comes to protein, more is better…the new inverted food pyramid, released by the Trump administration in January, features protein prominently, with steak, chicken and cheese at the top…

Potential problems can arise when people eat much more than around 1.2 grams of protein per kilogram of body weight per day…

Heart Disease and Type 2 Diabetes

Research suggests that those who eat larger amounts of red and processed meat tend to have higher risks of heart disease and Type 2 diabetes…In one large analysis published in 2023, for instance, researchers found that eating an extra 100 grams of red meat (equivalent to about one thin, boneless pork chop) per day increased the risk of heart disease by 11 percent — and every additional 50 grams of processed red meat (equivalent to about one standard hot dog) per day increased it by 26 percent. Another study, also published in 2023, found that among the nearly 217,000 (mostly female) participants, those who ate the most red meat had a 40 percent higher risk of developing Type 2 diabetes than those who ate the least, and that those who ate the most processed red meat had a 51 percent higher risk…

Cancer

In one study published in 2024, researchers found that diets high in red meat were linked with a 30 percent increased risk of developing colorectal cancer, and that those high in processed meat were linked with a 40 percent increase in risk…People who prioritize vegetables, fruits and whole grains, along with lean or plant-based proteins, are less likely to develop certain types of cancer (as well as cardiovascular disease and Type 2 diabetes).

Constipation and Other Digestive Concerns

People who are focused on increasing their protein consumption (especially those on low-carb diets) sometimes inadvertently leave out high-fiber foods, like vegetables and whole grains [which may increase the likelihood of constipation and irritable bowel syndrome]…

Weight Gain

Excess calories, including those from protein, will be turned into fat…A half-cup of cooked vegetables, for instance, has an average of about 25 calories, whereas a half-cup of cooked chicken has about 140 calories…

Kidney Issues

If your kidneys are healthy, you probably don’t need to worry much about excess protein consumption…for the more than 1 in 7 Americans with chronic kidney disease — especially those who may be close to needing dialysis — metabolizing large amounts of protein can stress the kidneys…Kidney stones are also a potential side effect of consuming too much animal protein.”

My take: The famous line by Mae West “Too much of a good thing can be wonderful!” is not true for dietary protein.

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Analysis of the 2025-2030 Dietary Guidelines for Americans

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In a previous post, I reviewed the 2025-2030 Dietary Guidelines for Americans (Have You Read the New “Dietary Guidelines for Americans, 2025-2030”?). For more insight into this topic, the following commentary is useful:

  • DK Tobias, FB Hu. NEJM 2025; 394: 1969-1971. The 2025–2030 Dietary Guidelines for Americans — Progress, Pitfalls, and the Path Forward

Background: “The Dietary Guidelines for Americans (DGAs), updated every 5 years by the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (HHS), set nutrition standards for federally supported programs, including school, military, and institutional meals; elements of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Supplemental Nutrition Assistance Program (SNAP); and related public education and implementation efforts. The DGAs also influence federal policies and regulations, clinical practice and health professional education, food marketing, industry formulation, and individual food choices.”

Key points:

  • “In the current cycle, although the DGAC [Independent Dietary Guidelines Advisory Committee] rigorously adhered to established procedures,3 its extensive report was not adopted as the guidelines’ scientific basis, and only 14 of its 56 specific recommendations were implemented. The USDA and HHS cited the committee’s evaluation of the evidence “through a health equity lens” … as their central rationale for dismissing most of its recommendations.”
  • “The new DGAs reintroduce the 1992 food pyramid, but invert it to feature meat, poultry, and full-fat dairy products more prominently, alongside vegetables and fruits, while relegating whole grains to the bottom wedge — an arrangement suggestive of a low-carbohydrate diet.”
  • “The new DGAs increase recommended protein intake to 1.2-to-1.6 g per kilogram of body weight per day — as high as double the adult recommended dietary allowance (0.8 g per kilogram per day).4 … But most Americans already consume well above the recommended dietary allowance of protein, primarily from animal sources,3 and there is little evidence that substantially increasing population protein intake confers additional health benefits.”
  • “The protein guidance appears to place greater visual and messaging emphasis on animal sources…This shift diverges from the broader scientific consensus, including the DGAC’s conclusion that dietary patterns higher in plant-derived proteins and fats, fruits, vegetables, and whole grains are associated with lower risks of chronic diseases, whereas higher intakes of red and processed meats are associated with increased risks.”
  • “The 2025–2030 DGAs embrace concise, consumer-oriented messaging, emphasizing that Americans should “eat real food” and eat less highly processed food.1 Although this advice reflects growing concern about ultraprocessed products, its lack of specificity regarding ingredients or quantitative thresholds limits its policy relevance.”
  • “Although the new DGAs continue to recommend limiting alcohol consumption, they no longer specify the quantitative upper limits included in previous guidelines, raising questions about the recommendations’ clarity and consistency.”
  • “Restoring confidence in the DGAs will require stronger scientific grounding and greater transparency in their development.”

My take: Many of the recommendations appear to fall in line with previous viewpoints expressed by RFK Jr, regardless of what independent experts have advised. Overall, the new guidelines do not represent a significant improvement from the previous guidelines due to the problems outlined in this commentary.

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“GLP-1 Receptor Agonists and Eating Disorders — Cause for Concern”

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A Banks. N Engl J Med 2026;394:1665-1667. GLP-1 Receptor Agonists and Eating Disorders — Cause for Concern.

An excerpt:

Constraining the growth of the global obesity epidemic would have clear benefits at the individual and population levels. Use of GLP-1 drugs has been linked in some patients to improved cardiovascular outcomes, a reduced risk of kidney disease, a reduced desire to drink alcohol, and potentially protective effects against neurodegenerative diseases. It is therefore easy to understand the substantial interest in investing in the development of these products and the optimism about their public health effects.

Nonetheless, some worrisome signals have emerged…The proportion of GLP-1 receptor agonist prescriptions that were written for people without diabetes, obesity, or overweight increased from 4.5% in 2018 to 17% in 2023…1

There is also compelling preliminary evidence suggesting that the use of these drugs could exacerbate and lead to new diagnoses of restrictive eating disorders, including anorexia nervosa…3 Lifetime prevalence of anorexia nervosa is as high as 6.3% in women and 0.3% in men,4 and the risk of death from any cause among people with anorexia nervosa is more than five times as high as that in the general population…5

Nutrient deficiencies, electrolyte abnormalities, orthostatic hypotension, osteopenia, sarcopenia, thinning hair, and other signs of malnutrition have been observed [in users of GLP-1 agents], and the effects of long-term use are still largely unknown…

The cumulative incidence of new eating-disorder diagnoses (most commonly anorexia nervosa) in the full study population was 1.275%…3 this proportion translates to more than 420,000 people who could develop a related eating disorder with long-term use.

Physicians, trialists, regulators, policymakers, and drug developers are unprepared for this coming wave.

My take: GLP-1 RAs are not for everybody; they will likely contribute to eating disorders in many patients.

GLP-1 RAs also have been associated with a higher risk of Nonarteritic Anterior Ischemic Optic Neuropathy (aka ‘eye stroke’) in approximately in 1 in 10,000 recipients. One reference: JAMA Ophthalmology. 2026;144;(3):259-264. New-Onset Nonarteritic Anterior Ischemic Optic Neuropathy and Initiators of Semaglutide in US Veterans With Type 2 Diabetes

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Dr. Danielle Wendel: Management of Short Bowel Syndrome

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Two years ago, Dr. Wendel gave our group a great lecture on short bowel syndrome (SVS). One of the neonatologists in attendance invited her back to provide a state of the art update. While this 2026 lecture covered some of the same issues, there were important updates and insights.

My notes below may contain errors in transcription and in omission. In addition, the information provided is based on what is done in Seattle. However, there is not a lot of evidence for much of what is done in intestinal rehabilitation. Thus, there is variation in practice at different centers and what works for one patient might not work for another. Following my notes, I have included many of her slides.

Diet:

  • Enteral feedings promote intestinal adaptation. Pediatric patients with SBS require much higher calories with enteral nutrition and may have hyperphagia as a compensatory mechanism
  • Breastmilk and/or Standard formula likely help promote intestinal adaptation better than hydrolysates and elemental formulas. In addition, it may help reduce the development of food allergies which are increased in children with SBS
  • Oral feedings have many advantages over NG or GT feedings when feasible. The ability to consume solid foods is quite helpful in reducing diarrhea. Also, encouraging oral feedings may help reduce feeding aversions. As such, GT placement is avoided if possible in Seattle
  • Key diet advice: avoid sweet tasting food/drink, especially in the first few years of life while they are developing their palate/food preferences
  • Feed osmolarity/caloric density: Most children with SBS tolerate lower caloric density (15-20 cal/oz) and more volume orally rather than higher caloric density/lower volume feeds

Parenteral Nutrition:

  • Lipid emulsions: SMOFlipid at 2 gm/day can help prevent essential fatty acid deficiency (EFA). Omegaven may need to be dosed at 1.5 gm/day to prevent EFA. If used for short-term and low dose, standard intralipid can be useful
  • HAL (aka TPN): Typically weaning calories is done before weaning volume. Cycling HAL (delivering over fewer hours) can be started prior to discharge. Watch for tolerance of the glucose infusion rate (JH: I prefer the terms HAL = hyperalimentation or PN=parenteral nutrition. TPN =total parenteral nutrition. Most patients are receiving parenteral nutrition but not total parenteral nutrition.)

Ostomy/Stool Output:

  • Output goals: Most pediatric patients can tolerate output of 50 mL/kg/day of ostomy output  (if being supported by PN), though less than 30 mL/kg/day is more physiologic
  • Iron: Parenteral iron is typically needed. Seattle team prefers ferric carboxymaltose as it may deliver enough iron for 6-12 months in one infusion
  • Acid suppression: While acid suppression can sometimes be beneficial by lowering gastric output, if possible avoid long-term use as it may increase risk of bacterial overgrowth along with other infections
  • Excessive stool output (via stoma or per rectum) is when it is more than the patient’s baseline. This should prompt investigation for potential causes including diet/osmotic agent, bacterial overgrowth and infections
  • Pancreatic enzymes: It is unclear if pancreatic enzymes (PERT, Relizorb) will improve stool output due to lack of data
  • Teduglutide can reduce the need for HAL. It is a hormone (like insulin) and sustained effects are generally not seen when it is stopped. However, especially in patients close to coming off HAL, it may be beneficial

Monitoring:

  • Nutrient deficiencies: Close monitoring for nutrient deficiencies is needed and often even more important when no longer receiving HAL
  • Urine sodium more than 30 is a goal. Sodium depletion interferes with growth and can contribute to other electrolye disturbances (eg. hypokalemia)

CLABSI:

  • Antibiotics: Treatment starts with a broad-spectrum antibiotic and wait to add specific gram-positive coverage unless ill-appearing or gram-positive organism starts growing. Vancomycin is not used frequently in Seattle due to concerns of renal toxicity. In patients with gram-positive infection, linezolid is often used
  • Minimum of 48 Hours For All Fevers: Everyone with SBS and with fever (greater than or equal to 100.4) stays for at least 48 hrs on broad spectrum IV antibiotics
  • Locks: Sodium bicarb locks help prevent CLABSI and appear to have similar infection prevention as ethanol locks. Ethanol locks have been difficult to get coverage.

SIBO:

  • Medications: Metronidazole is generally 1st line agent and gentamicin (IV formulation given enterally) is a 2nd line agent in Seattle. Rifaximin would be potentially their 1st line agent if it were easier to get covered

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Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.

Baby-Led Weaning and Less Picky Eaters

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FDMG Layug-Dionglay et al. J Pediatr Gastroenterol Nutr. 2026;82:801–811. Open Access! The association of baby‐led weaning and picky eating in children aged 2–5 years

Background: Baby‐led weaning (BLW) has emerged over the past decade as an alternative approach to traditional spoon‐feeding. BLW encourages infants to self‐feed nutritious whole foods during family mealtimes, without any pressure. It emphasizes infant autonomy over what, how much, and how quickly to eat from the foods offered.

Methods: A retrospective cross-sectional study was conducted in Metro Manila, Philippines (n=284)

Key findings:

  • Children who underwent strict BLW had a 95.4% lower likelihood of picky eating versus traditionally spoon-fed peers (p < 0.01)

Discussion points:

  • “In this study, picky eaters demonstrated a similar profile: Higher Food Avoidance traits (slowness in eating, satiety responsiveness, emotional undereating), and lower Food Approach traits (enjoyment of food, food responsiveness).”
  • “Strict BLW showed the lowest likelihood of picky eating, suggesting that the positive outcomes of the BLW approach requires consistent self-feeding of at least 90% of the time to experience its best effects. Meanwhile, BLW 51%–90% of the time (Predominant BLW) showed 55% lower likelihood.”
  • Limitation: “This study’s cross-sectional research design limits causal inference. Reverse causation is possible.”

My take: Allowing infants to self-feed likely reduces the tendency towards picky eating.

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Have You Read the New “Dietary Guidelines for Americans, 2025-2030”?

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Here’s a link to the new 10-page guidelines: Dietary Guidelines for Americans

Here are critiques:

What’s Good About This Guidance:

  1. Short enough to read and understand
  2. The emphasis of reducing unprocessed foods and clear language
  3. Encouraging early introduction of potential allergens at 6 months of life. This lowers the risk of developing food allergies later.

Some of the questionable advice:

  1. Increasing the protein recommendation to 1.2-1.6 gm per day, up to double prior recommendations. The reason why this level of protein is not a good idea for everyone is noted in a prior blog post: Is a High Protein Diet Beneficial and Safe?. And from the AJC critique: “Pushing protein higher can also crowd out vegetables and fiber, which play a major role in heart health, digestion and overall wellness.”
  2. Backing away from previous advice about alcohol. The current guidance states to “consume less alcohol.” From NY Times: “It is the first time in decades that the government has omitted the daily caps on drinking that define moderate consumption. The guidelines no longer warn of risks like cancer.”
  3. Encouraged changes (more red meat, full-fat dairy) may increase saturated fat intake above stated goal of less than 10%.

The NY Times article on conflicts of interests notes that “Robert F. Kennedy Jr. had promised that his panel, which released new guidelines this week, would have no “conflicts of interest”….Some parts of the guidelines represent such a departure from previous versions that it seems like the administration “handpicked” scientists likely to support those conclusions, “versus undertaking a neutral review of the science,” said Lindsey Smith Taillie, a professor of nutrition at the U.N.C. Gillings School of Global Public Health.”

My take: Overall, the focus on reducing processed foods and decreasing added sugar are worthwhile. The brevity of the guidelines make them accessible. At the same time, the guidelines appear to continue a pattern of RFK Jr of selecting advisers, whether with diet recommendations or with vaccine policy, to support a desired outcome.

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75% of U.S. Adults Have Obesity When Using New Definition With Anthropometrics

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NM Al-Roub et al.  JAMA Netw Open. 2025;8(12):e2549124. doi:10.1001/jamanetworkopen.2025.49124. Open Access! Body Mass Index and Anthropometric Criteria to Assess Obesity

Background: “Obesity has historically been defined using body mass index (BMI). However, BMI does not account for adipose tissue, limiting its accuracy. The Lancet Diabetes & Endocrinology Commission created a revised obesity definition including anthropometric measures (waist circumference [WC], waist-to-hip ratio [WHR], and waist-to-height ratio [WHtR]),1 encompassing and subcategorizing preclinical obesity (excess adiposity without organ dysfunction or physical impairment) and clinical obesity (a disease).”

Methods: The authors analyzed 14,414 participants representing 237,700,000 US adults. using the 2017-2023 National Health and Nutrition Examination Survey (NHANES)

Key findings:

  • Survey-weighted obesity prevalence was 75.2%
  • Obesity was noted in 100% among adults with BMI of 30 or greater, 80.4% with BMI 25 to less than 30, and 38.5% with BMI less than 25 

Discussion Points:

“These findings demonstrate the impact of anthropometric thresholds, particularly since 80.0% of adults had waist-to-height ratio [WHtR]) above 0.5. Though this value was cited by the Lancet Commission and identifies cardiometabolic risk,1,4,5 the commission emphasized that additional research was required for this cutoff.1“

My take: This is a provocative study indicating that even more U.S. adults could be considered obese when incorporating anthropometric criteria. More data is needed to assess the outcomes of this group that is considered obese with new criteria but not by using BMI criteria.

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This is a magnificent Hindu spiritual center in Lilburn.
No photos are allowed inside though there are several online (see below).