Caroline Apovian

• Doctor of Medicine
• Attending Physician at Brigham and Women's Hospital

Background Glucagon‐like peptide 1 receptor agonists and combination medications (hereafter collectively referred to as GLP‐1s) are shifting the treatment landscape for obesity. However, real‐world challenges and limited clinician and public knowledge on nutritional and lifestyle interventions can limit GLP‐1 efficacy, equitable results, and cost‐e...

Background Glucagon-like peptide 1 receptor agonists and combination medications (hereafter collectively referred to as GLP-1s) are shifting the treatment landscape for obesity. However, real-world challenges and limited clinician and public knowledge on nutritional and lifestyle interventions can limit GLP-1 efficacy, equitable results, and cost-e...

Objective To investigate weight loss outcomes of semaglutide in a real-world setting, specifically in patients who have undergone metabolic/bariatric surgery (MBS). Summary Background Data Despite excellent weight loss for semaglutide in clinical trials, actual results may be limited due to factors such as costs, drug availability, insurance cover...

Obesity is a leading cause of morbidity and mortality with health consequences that crosscut most medical specialties. Despite the emergence of effective and promising new therapies, many impediments to comprehensive obesity care remain. As part of their commitment to improving obesity care, the American College of Physicians (ACP) and its Council...

Objectives To determine how rates of discussion of metabolic and bariatric surgery (MBS) between patients with class 2 obesity and higher and their healthcare providers as well as subsequent progression to MBS have varied by race and sex over the last 20 years. Background Obesity is a growing public health crisis. MBS remains the most effective tr...

Objective The objective of this study was to describe the prevalence of obesity, obesity‐related conditions (ORCs), and antiobesity medication (AOM) eligibility and prescribing practice among eligible patients in a large health care system. Methods In this cross‐sectional analysis of the multicenter Mass General Brigham health care system (Boston,...

Excessive body weight and adiposity contribute to many adverse health concerns. The American College of Sports Medicine (ACSM) recognizes that the condition of excess body weight and adiposity is complex, with numerous factors warranting consideration. The ACSM published a position stand on this topic in 2001 with an update in 2009, and a consensus...

Excessive body weight and adiposity contribute to many adverse health concerns. The American College of Sports Medicine (ACSM) recognizes that the condition of excess body weight and adiposity is complex, with numerous factors warranting consideration. The ACSM published a position stand on this topic in 2001 with an update in 2009, and a consensus...

Background An international panel of obesity medicine experts from multiple professional organizations examined patterns of obesity care and current obesity treatment guidelines to identify areas requiring updating in response to emerging science and clinical evidence. Aims The panel focused on multiple medical health and societal issues influenci...

The improved efficacy and generally favorable safety profile of recently approved and emerging antiobesity medications (AOMs), which result in an average weight reduction of ≥15%, represent significant advancement in the treatment of obesity. This narrative review aims to provide practical evidence‐based recommendations for nutritional assessment,...

This joint ASGE-ESGE guideline provides an evidence-based summary and recommendations regarding the role of endoscopic bariatric and metabolic therapies (EBMTs) in the management of obesity. The document was developed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. It evaluates the efficacy and safety...

Background Lifelong follow-up after metabolic/bariatric surgery (MBS) is necessary to monitor for patient outcomes and nutritional status. However, many patients do not routinely follow up with their MBS team. We studied what prompted MBS patients to seek bariatric care after being lost to follow-up and the subsequent treatments they received. Stu...

Introduction There is an urgent need for scalable strategies for treating overweight and obesity in clinical settings. PROPS 2.0 (Partnerships for Reducing Overweight and Obesity with Patient-Centered Strategies 2.0) aims to adapt and implement the combined intervention from the PROPS Study at scale, in a diverse cross-section of patients and provi...

Background: This narrative review describes foundational and emerging evidence of how dietary protein intakes may influence muscle-related attributes of older adults. Methods: PubMed was used to identify pertinent research. Results: Among medically stable older adults, protein intakes below the recommended dietary allowance (RDA) (0.8 g/kg bod...

Background Obesity is known to be a protective factor against osteoporosis. However, recent studies have shown that excessive adiposity may be detrimental for bone health. Objective To determine the association of lean mass (LM) and fat mass (FM) with bone mineral density (BMD) in Thais. Methods Bone density studies of consecutive patients of Sri...

Obesity is a chronic disease characterized by long duration, slow progression, and periods of remission and relapses. Despite the development of effective medical and surgical interventions and millions of people conducting tremendous personal efforts to manage their weight every year, recidivism remains a significant barrier to attaining long-term...

Levels of obesity and overweight are increasing globally, with affected individuals often experiencing health issues and reduced quality of life. The pathogenesis of obesity is complex and multifactorial, and effective solutions have been elusive. In this Viewpoint, experts in the fields of medical therapy, adipocyte biology, exercise and muscle, b...

Background Weight loss is crucial for disease prevention among individuals with overweight or obesity. This study aimed to examine associations of weight loss strategies (WLSs) with weight change and type 2 diabetes (T2D) risk among US health professionals. Methods and findings This study included 93,110 participants (24 to 60 years old; 11.6% mal...

Purpose of Review The COVID-19 pandemic has challenged public health to a significant extent by markedly increasing morbidity and mortality. Evidence suggests that obesity and hypovitaminosis D constitute important risk factors for SARS-CoV-2 infection, severity of disease, and poor outcomes. Due to their high prevalence globally, obesity and hypov...

Importance: Bariatric surgery is the most effective treatment for severe obesity; yet it is unclear whether the long-term safety and comparative effectiveness of these operations differ across racial and ethnic groups. Objective: To compare outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) across racial and ethnic groups in...

The obesity pandemic continues unabated despite a persistent public health campaign to decrease energy intake (“eat less”) and increase energy expenditure (“move more”). One explanation for this failure is that the current approach, based on the notion of energy balance, has not been adequately embraced by the public. Another possibility is that th...

Objective To comprehensively investigate the association between obesity/high body mass index (BMI) and risk of Clostridioides difficile infection (CDI) using systematic review and meta-analysis.Methods Potentially eligible studies were identified from Medline and EMBASE databases from inception to February 2021 using search strategy consisting of...

Objective: To examine whether depression status before metabolic and bariatric surgery (MBS) influenced 5-year weight loss, diabetes, and safety/utilization outcomes in the PCORnet Bariatric Study. Summary of background data: Research on the impact of depression on MBS outcomes is inconsistent with few large, long-term studies. Methods: Data w...

A role for fat overfeeding in metabolic dysfunction in humans is commonly implied in the literature. Comparatively less is known about acute carbohydrate overfeeding (COF). We tested the hypothesis that COF predisposes to oxidative stress by channeling electrons away from antioxidants to support energy storage. In a study of 24 healthy human subjec...

The new federal rule that mandates sharing of medical notes with patients may help to engage them in their care, but use of stigmatizing terms in medical documents can cause offense to patients. In this commentary, the authors advocate for a more sensitive and empathic approach to patients with obesity.

Purpose of Review A growing body of evidence suggests that obesity and increased visceral adiposity are strongly and independently linked to adverse outcomes and death due to COVID-19. This review summarizes current epidemiologic data, highlights pathogenetic mechanisms on the association between excess body weight and COVID-19, compares data from...

Importance Bariatric surgical weight loss is associated with reduced cardiovascular mortality; however, the mechanisms underlying this association are incompletely understood. Objectives To identify variables associated with vascular remodeling after bariatric surgery and to examine how sex, race, and metabolic status are associated with microvasc...

This study aimed to determine the relationships among hyperglycemia (HG), the presence of type 2 diabetes (T2D), and the outcomes of COVID-19. Demographic data, blood glucose levels (BG) measured on admission, and hospital outcomes of COVID-19 patients hospitalized at Boston University Medical Center from 1 March to 4 August 2020 were extracted fro...

Background Black individuals have been disproportionately affected by the coronavirus disease 2019 (COVID-19). However, it remains unclear whether there are any biological factors that predispose Black patients to COVID-19-related morbidity and mortality.Objective To compare in-hospital morbidity, mortality, and inflammatory marker levels between B...

Adherence to weight management treatments is suboptimal. The Gelesis Loss Of Weight (GLOW; NCT02307279) pivotal trial data were used to assess treatment adherence impact on weight loss. The primary objectives of the GLOW study were to assess the effects of an oral superabsorbent hydrogel (OSH) on weight loss (targeted difference of ≥ 3%) and ≥ 5% w...

There is a bidirectional association between hyperglycemia (HG) and COVID-19 severity. We conducted a retrospective cohort study in COVID-19 patients aged ≥18 years hospitalized at the Boston Medical Center during March 1 - August 4, 2020 with the aim to determine the relationships among HG, presence of type 2 diabetes (T2D) and outcomes of COVID-1...

Background: Obese and malabsorptive patients have difficulty increasing serum 25-hydroxyvitamin D [25(OH)D] after taking vitamin D supplementation. Since 25(OH)D is more hydrophilic than vitamin D, we hypothesized that oral 25(OH)D supplementation is more effective in increasing serum 25(OH)D concentrations in these patients. Objectives: We aime...

Purpose of Review A growing body of evidence suggests that obesity and increased visceral adiposity are strongly and independently linked to adverse outcomes and death due to COVID-19. This review summarizes current epidemiologic data, highlights pathogenetic mechanisms on the association between excess body weight and COVID-19, compares data from...

Introduction: Obesity is a chronic illness that requires a multifaceted personalized treatment approach. Methods & findings: Using current guidelines and recent studies in weight management, this article reviews the multiple components of weight management: lifestyle intervention (dietary intervention, physical activity, and behavioral intervent...

Objective This study aimed to determine the medical cost impact and return on investment (ROI) of a large, commercial, digital, weight‐management intensive lifestyle intervention (ILI) program (Real Appeal). Methods Participants in this program were compared with a control group matched by age, sex, geographic region, health risk, baseline medical...

Objective To determine the association between vitamin D status and morbidity and mortality in adult hospitalized COVID-19 patients Methods We performed a retrospective chart review study in COVID-19 patients aged ≥18 years old hospitalized at Boston University Medical Center between March 1 – August 4, 2020. All studied patients were tested posit...

A safety-net hospital in Boston, Massachusetts, made adaptations to its Nourishing Our Community Program to accommodate restrictions brought on by the COVID-19 pandemic to continue providing food and education to patients. While participation in programs decreased overall, some of the adaptations made, including virtual classes and food pantry home...

Background It remains controversial whether high protein diets improve cardiometabolic profile. We investigated whether increasing protein intake to 1.3-g/kg/day in functionally-limited older adults with usual protein intake ≤RDA (0.8-g/kg/day) improves visceral fat accumulation and serum cardiovascular risk markers more than the RDA. Methods The...

Objectives Patients with Covid-19 and obesity have worse clinical outcomes which may be driven by increased inflammation. This study aimed to characterize the association between clinical outcomes in patients with obesity and inflammatory markers. Methods We analyzed data for patients aged ≥18 years admitted with a positive SARS-CoV-2 PCR test. We...

Context Weight regain (WR) after bariatric surgery is emerging as a common clinical problem due to the increase in the number of procedures performed. Early interventions are necessary to curtail the potential recurrence of comorbid conditions. However, it is often difficult to recognize WR early enough to introduce mitigating measures because ther...

Objective Weight regain (WR) after Roux‐en‐Y gastric bypass surgery (RYGB) starts to occur 2 years after surgery, ultimately affecting at least 25% of patients. A limited number of studies have evaluated the impact of antiobesity medications (AOMs) on this phenomenon. Methods This study reviewed the electronic medical records of 1,196 patients who...

Background: In 2016, the Patient-Centered Outcomes Research Institute funded the National Patient Centered Clinical Research Network (PCORnet) Bariatric Study (PBS). Understanding the experience of postoperative patients was a key component of this study. Methods: Nine focus groups were conducted in Southern California, Louisiana, Pennsylvania,...

Age is a non-modifiable risk factor for the inflammation that underlies age-associated diseases; thus, anti-inflammaging drugs hold promise for increasing health span. Cytokine profiling and bioinformatic analyses showed that Th17 cytokine production differentiates CD4⁺ T cells from lean, normoglycemic older and younger subjects, and mimics a diabe...

Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Direct...

People with obesity commonly face a pervasive, resilient form of social stigma. They are often subject to discrimination in the workplace as well as in educational and healthcare settings. Research indicates that weight stigma can cause physical and psychological harm, and that affected individuals are less likely to receive adequate care. For thes...

Objective Massive weight loss leads to marked knee pain reduction in individuals with knee pain, but the reason for the reduction in pain is unknown. This study was undertaken to quantify the contribution of magnetic resonance imaging (MRI)–evidenced changes in pain‐sensitive structures, bone marrow lesions (BMLs), and synovitis, and changes in pai...

Objective Medium chain triglycerides (MCT) have unique metabolic properties which may improve insulin sensitivity (Si) and beta cell function but data in humans are limited. We conducted a 6-week clinical trial of MCT oil supplementation. Methods 22 subjects without diabetes (8 males, 14 females, mean ± standard error age 39±2.9 years, baseline BM...

Objective: The development of these updated clinical practice guidelines (CPG) was commissioned by the AACE, TOS, ASMBS, OMA, and ASA Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPG, algorithms, and checklists. Methods: Each recommendation was evaluated and updated based on new evidence from 2013 to t...

Background/objectives: Prolonged-release (PR) naltrexone 32 mg/bupropion 360 mg (NB) is approved for chronic weight management as an adjunct to reduced-calorie diet and increased physical activity. Central nervous system-active medications have the potential to affect mood; therefore, post hoc analysis of clinical trial data was conducted to evalu...

Obesity causes and exacerbates many disease processes and affects every organ system. Thus it is not surprising that clinical providers are often overwhelmed with the multitude of symptomatology upon initial presentation in patients with obesity. However, despite a “complicated medical history,” a systematic, organized approach in obesity medicine...

Objective: The development of these updated clinical practice guidelines (CPG) was commissioned by the American Association of Clinical Endocrinologists, The Obesity Society, the American Society of Metabolic and Bariatric Surgery, the Obesity Medicine Association, and the American Society of Anesthesiologists boards of directors in adherence to t...

Mechanisms that regulate metabolites and downstream energy generation are key determinants of T cell cytokine production, but the processes underlying the Th17 profile that predicts the metabolic status of people with obesity are untested. Th17 function requires fatty acid uptake, and our new data show that blockade of CPT1A inhibits Th17-associate...

Hyperinsulinemia is strongly associated with type 2 diabetes. Racial and ethnic minority populations are disproportionately affected by diabetes and obesity-related complications. This mini-review provides an overview of the genetic and environmental factors associated with hyperinsulinemia with a focus on racial and ethnic differences and its meta...

Background Pathophysiological mechanisms that connect obesity to cardiovascular disease are incompletely understood. FSP27 (Fat‐specific protein 27) is a lipid droplet‐associated protein that regulates lipolysis and insulin sensitivity in adipocytes. We unexpectedly discovered extensive FSP 27 expression in human endothelial cells that is downregul...

Background Weight loss surgery (WLS) is neither risk-free nor universally effective. Few studies have examined what proportion of patients regret having undergone WLS. Methods We interviewed patients at two WLS centers before and after WLS about weight loss, quality of life/QOL (Impact of Weight on QOL-lite), and decision regret (modified Brehaut...

Background: The AspireAssist is the first Food and Drug Administration-approved endoluminal device indicated for treatment of class II and III obesity. Objectives: We earlier reported 1-year results of the PATHWAY study. Here, we report 4-year outcomes. Setting: United States-based, 10-center, randomized controlled trial involving 171 particip...

Obesity-associated Type 2 diabetes (T2D) is driven by chronic inflammation. A combinatorial Th17 cytokine profile characterizes and mathematically predicts T2D in people, but the mechanisms that generate the Th17 profile are not clear. We tested the possibility that anaerobic glycolysis, which fuels inflammatory cytokine production from multiple im...

Background: In a previous pilot weight-loss study, an association was observed between baseline fasting plasma glucose (FPG) levels and the effectiveness of the Gelesis100 treatment. The aim of this subanalysis of the Gelesis Loss Of Weight (GLOW; NCT02307279) study is to further assess the association between FPG and body weight (BW) responders in...

Background: Overweight and obesity are predisposing conditions for the development of prediabetes and type 2 diabetes. Insulin resistance caused by excess adiposity is a key factor in this process. Methods: The effect of Gelesis100, a novel hydrogel, was assessed in patients who were overweight or had obesity, without antidiabetic medications, and...

Background Obesity is a precursor to heart failure with preserved ejection fraction. Biomarkers that identify preclinical metabolic heart disease (MHD) in young obese patients would help identify high‐risk individuals for heart failure prevention strategies. We assessed the predictive value of GAL3 (galectin–3), FSTL3 (follistatin‐like 3 peptide),...

Table S1. Baseline Characteristics of Persons Removed From Stage B Metabolic Heart Disease Primary Analysis Due to Indeterminate Status Table S2. Logistic Regression Analysis of Predictors of Obese Metabolic Heart Disease Phenotype Table S3. Baseline Characteristics of Cohort With Metabolic Heart Disease Pulmonary Hypertension Phenotype Table S4...

Introduction The elderly population is projected to be the fastest growing group of individuals with obesity group in the US. As such, there is merit in examining factors that contribute to healthy aging and weight management. The effects of newer weight loss medications approved after 2013 have been studied but are not often assessed specifically...

Metabolic complications relating to complex effects of viral and immune mediated mechanisms are now a focus of clinical care among persons living with HIV (PWH) and obesity is emerging as a critical problem. To address knowledge gaps, the NIH sponsored a symposium in May 2018 entitled "Obesity and Fat Metabolism in HIV-infected Individuals." Mechan...

To the Editor The US Preventive Services Task Force (USPSTF)¹ recommended high-intensity counseling for adults with obesity, followed by regular contact for maintenance of weight loss. The task force did not issue recommendations for pharmacotherapy because of (1) perceived lack of generalizability of the clinical trial findings, owing to stringent...

A growing number of youth suffer from obesity and in particular severe obesity for which intensive lifestyle intervention does not adequately reduce excess adiposity. A treatment gap exists wherein effective treatment options for an adolescent with severe obesity include intensive lifestyle modification or metabolic and bariatric surgery while the...

In patients with type 2 diabetes, bariatric surgery can lead to significant improvements in glycemic control and diabetes remission. We present a case of a Hispanic female with type 2 diabetes phenotype who underwent bariatric surgery and post-operatively stopped her insulin therapy due to multiple reasons, including decreased oral intake and conce...

Obesity is one of the main risk factors for type 2 diabetes (T2D), representing a major worldwide health crisis. Modest weight-loss (≥ 5% but < 10%) can minimize and reduce diabetes-associated complications, and significant weight-loss can potentially resolve disease. Treatment guidelines recommend that intensive lifestyle interventions, pharmacolo...

Objective This study aims to assess the efficacy and safety of Gelesis100, a novel, nonsystemic, superabsorbent hydrogel to treat overweight or obesity. Methods The Gelesis Loss Of Weight (GLOW) study was a 24‐week, multicenter, randomized, double‐blind, placebo‐controlled study in patients with BMI ≥ 27 and ≤ 40 kg/m² and fasting plasma glucose ≥...

Objective Weight recidivism following Roux‐en‐Y gastric bypass (RYGB) is common and is associated with recurrence of comorbidities. Studies with long‐term follow‐up of recidivism quantified by weight regain (WR) are lacking. A retrospective review of all RYGB at our center from 2004 to 2015 was performed to examine the effects of race and type 2 di...

Objectives Central adiposity, in particular the accumulation of intra‐abdominal visceral fat, has been linked to adipose tissue dysfunction and obesity‐related diseases including hypertension and atherosclerosis, however regulatory mechanisms are poorly understood. We hypothesized that increased micro‐vascular tone specifically in visceral fat may...

We aimed to test the feasibility of an in-person behavioral weight-loss intervention for underserved postpartum African American women with overweight or obesity in an urban hospital setting. Participants were randomized to an intervention of a culturally tailored adaptation of the Diabetes Prevention Program or usual care. The primary outcome was...

Purpose of review: Obesity is a global health crisis with detrimental effects on all organ systems leading to worsening disease state and rising costs of care. Persons with obesity failing lifestyle therapies need to be escalated to appropriate pharmacological treatment modalities, medical devices, and/or bariatric surgery if criteria are met and...

Purpose of review: We review the underlying mechanisms and potential benefits of intermittent fasting (IF) from animal models and recent clinical trials. Recent findings: Numerous variations of IF exist, and study protocols vary greatly in their interpretations of this weight loss trend. Most human IF studies result in minimal weight loss and ma...

Objectives Disparities in obesity care exist among African-American children and adults. We sought to test the feasibility of a pilot program, a 1-year family-based intervention for African-American families with obesity [shape up and eat right (SUPER)], adopting the shared medical appointment model (SMA) at an urban safety net hospital.OutcomesPri...

Obesity is a chronic, relapsing disease that necessitates a multidisciplinary approach to management. Behavioral changes are the foundation to management, but adjunctive therapy is often warranted, including pharmacologic therapies and/or bariatric surgery. Until recently, treatment options included only short-term therapy (≤12 weeks), and paths be...