Donna H Ryan

• Pennington Biomedical Research Center

The development of drugs targeting Nutrient Stimulated Hormone receptors has ushered in a dramatic change in our approach to weight management because of their ability to achieve weight losses of 10%, 20%, even 30% in significant numbers of patients. Additionally, disease modifying properties of these medications are compelling. Indications now inc...

Objective The objective of this study was to assess safety of once‐weekly subcutaneous semaglutide 2.4 mg versus placebo, beyond reduction in major adverse cardiovascular events, in patients with established cardiovascular disease and overweight or obesity. Methods Safety data focused on serious adverse events (SAEs), all adverse events (AEs) lead...

Objective The objective of this study was to investigate the efficacy and safety of the Epitomee capsule versus placebo as an adjunct to high‐intensity lifestyle intervention in participants with overweight or obesity. Methods The Randomized Evaluation of Efficacy and Safety of the Epitomee Capsule Trial (RESET) was a prospective, double‐blind, pl...

OBJECTIVE To evaluate the cardiovascular effects of semaglutide by baseline glycated hemoglobin (HbA1c) and change in HbA1c in a prespecified analysis of Semaglutide Effects on Cardiovascular Outcomes in People With Overweight or Obesity (SELECT). RESEARCH DESIGN AND METHODS In SELECT, people with overweight or obesity and atherosclerotic cardiova...

OBJECTIVE To determine whether semaglutide slows progression of glycemia in people with cardiovascular disease and overweight or obesity but without diabetes. RESEARCH DESIGN AND METHODS In a multicenter, double-blind trial, participants aged ≥45 years, with BMI ≥27 kg/m2, and with preexisting cardiovascular disease but without diabetes (HbA1c <6....

In the SELECT cardiovascular outcomes trial, semaglutide showed a 20% reduction in major adverse cardiovascular events in 17,604 adults with preexisting cardiovascular disease, overweight or obesity, without diabetes. Here in this prespecified analysis, we examined effects of semaglutide on weight and anthropometric outcomes, safety and tolerabilit...

Background: Semaglutide, a glucagon-like peptide-1 receptor agonist, has been shown to reduce the risk of adverse cardiovascular events in patients with diabetes. Whether semaglutide can reduce cardiovascular risk associated with overweight and obesity in the absence of diabetes is unknown. Methods: In a multicenter, double-blind, randomized, pl...

Importance Age-related macular degeneration (AMD) is a leading cause of blindness with no treatment available for early stages. Retrospective studies have shown an association between metformin and reduced risk of AMD. Objective To investigate the association between metformin use and age-related macular degeneration (AMD). Design, Setting, and P...

Objective This paper describes the baseline characteristics of the Semaglutide Effects on Heart Disease and Stroke in Patients with Overweight or Obesity (SELECT) study, one of the largest cardiovascular (CV) outcome studies in the field of obesity, which evaluates the effect of semaglutide versus placebo on major CV events. Methods SELECT enrolle...

Background The 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) 3rd expert report highlights up-to-date Cancer Prevention Recommendations that may reduce burdens of many chronic diseases, including diabetes. This study examined if following a lifestyle that aligns with the recommendations – assessed via the 2018 WC...

OBJECTIVE To determine glycemic and nonglycemic risk factors that contribute to the presence of diabetic retinopathy (DR) before and after the onset of type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS During the Diabetes Prevention Program (DPP) and DPP Outcome Study (DPPOS), we performed fundus photography over time in adults at high risk for d...

New appetite‐regulating antiobesity treatments such as semaglutide and agents under investigation such as tirzepatide show promise in achieving weight loss of 15% or more. Energy expenditure, fat oxidation, and lean mass preservation are important determinants of weight loss and weight‐loss maintenance beyond appetite regulation. This review discus...

Objective: Look AHEAD, a randomized trial comparing intensive lifestyle intervention (ILI) and diabetes support and education (DSE) (control) in 5,145 individuals with overweight/obesity and type 2 diabetes, found no significant differences in all-cause or cardiovascular mortality or morbidity during 9.6 (median) years of intervention. Participant...

A recent Perspective article described the "carbohydrate-insulin model (CIM)" of obesity, asserting that it "better reflects knowledge on the biology of weight control" as compared to what was described as the "dominant energy balance model (EBM)" that fails to consider "biological mechanisms that promote weight gain". Unfortunately, the Perspectiv...

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...

IMPACT: By demonstrating the feasibility of a multimodal, interdisciplinary intervention for prediabetes, the current project aims to provide a template for the prevention of diabetes and associate comorbid conditions. OBJECTIVES/GOALS: To determine if a multi-modal, interdisciplinary intervention delivered to a group of prediabetic patients will r...

Against the backdrop of obesity as a major public health problem, we examined three questions: How much weight loss is needed to benefit patients with obesity? How well do current therapies do in producing weight loss? What strategies can be used to improve patient outcomes using evidence‐based studies. This paper reviews literature on the outcomes...

Objective This study was designed to determine whether intensive lifestyle intervention (ILI) aimed at weight loss lowers cancer incidence and mortality. Methods Data from the Look AHEAD trial were examined to investigate whether participants randomized to ILI designed for weight loss would have reduced overall cancer incidence, obesity‐related ca...

Cardiovascular disease (CVD) is a major cause of morbidity and mortality. While it has been widely appreciated that obesity is a major risk factor for CVD, treatments that produce effective, durable weight loss, and the impact of weight reduction in reducing cardiovascular risk, have been elusive. Instead, progress in CVD risk reduction has been ac...

This review details the proceedings of a Pennington Biomedical scientific symposium titled, “What Should I Eat and Why? The Environmental, Genetic, and Behavioral Determinants of Food Choice.” The symposium was designed to review the literature about energy homeostasis, particularly related to food choice and feeding behaviors, from psychology to p...

OBJECTIVES/GOALS: To determine if a multi-modal, interdisciplinary intervention delivered to a group of prediabetic patients will result in reduced rates of diabetes progression. This project is a retrospective evaluation that will exam the feasibility and possibly efficacy of this intervention. METHODS/STUDY POPULATION: We will evaluate outcomes o...

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: To examine the effects of an intensive lifestyle intervention (ILI) on cardiovascular disease (CVD), the Action for Health in Diabetes (Look AHEAD) trial randomized 5,145 participants with type 2 diabetes and overweight/obesity to a ILI or diabetes support and education. Although the primary outcome did not differ between the groups, th...

Background: The effects of dietary composition on weight loss are incompletely understood. In addition to energy intake, fiber intake, energy density, macronutrient composition, and demographic characteristics have all been suggested to contribute to weight loss. Objective: The primary aim of this analysis was to assess the role of dietary fiber...

Efforts to identify a preferable diet for weight management based on macronutrient composition have largely failed, but recent evidence suggests that satiety effects of carbohydrates may depend on the individual’s insulin-mediated cellular glucose uptake. Therefore, using data from the POUNDS LOST trial, pre-treatment fasting plasma glucose (FPG),...

Objective Given the disease burden and economic costs of obesity in the United States, scalable approaches to weight loss and weight management are needed. This study evaluated self‐reported weight‐loss outcomes associated with a commercial intensive lifestyle intervention marketed to employers and delivered electronically to employees. Methods Da...

Background: Individual variability in response to multiple modalities of obesity treatment is well documented, yet our understanding of why some individuals respond while others do not is limited. The etiology of this variability is multifactorial; however, at present, we lack a comprehensive evidence base to identify which factors or combination...

The prevalence of obesity, measured by body mass index, has risen to unacceptable levels in both men and women in the United States and worldwide with resultant hazardous health implications. Genetic, environmental, and behavioral factors influence the development of obesity, and both the general public and health professionals stigmatize those who...

It is an obligation for all health care providers to participate in obesity management. This article discusses obesity guidelines from The Obesity Society; the Endocrine Society; and the American Association of Clinical Endocrinologists. It reviews and compares findings and recommendations across these guidelines, identifies areas of controversy an...

Objective Minimal risk weight loss tools are needed. This study's objective was to confirm Food and Drug Administration submissions of the SmartByte™ System's safety and efficacy. Methods This 16‐week, prospective, single‐arm, four‐centre, observational study assessed the oral device in combination with a video‐delivered lifestyle programme in adu...

Purpose of review: One begins to see improvement in glycemic measures and triglycerides with small amounts of weight loss, but with greater levels of weight loss there is even greater improvement. In fact, the relationship between weight loss and glycemia is one that is very close. Recent findings: This is fortunate for diabetes prevention; it t...

To assess the association of markers for dietary protein intake, measures of dietary adherence and demographic variables with weight loss in the POUNDS Lost study over the first 6 months and again between 6 and 24 months using data from those who completed each period. This is a secondary analysis of pooled data on completers assigned to one of fou...

This chapter reviews the medications currently available for chronic weight management in the USA and some other countries and, for those five medications, discusses mechanism of action, efficacy data, and safety profiles. The chapter also discusses principles of prescribing and best practices for managing patients with medications indicated for we...

In the second paragraph of the print version of the article listed above, it was stated that George Bray worked at G.D. Searle, located in New York, NY. The location was Skokie, IL, a suburb of Chicago. In …

This article addresses current best practices in obesity management, primarily through the discussion of 5 documents' guidelines: those sponsored by the US National Institutes of Health and the AHA/ACCTTOS, ENDO, ASBP, AACE, and the United Kingdom's NICE. Common to all of these reports is the emphasis on addressing weight management as a pathway to...

Although improvement of physical appearance is a primary motivating factor for patients, the fundamental purpose of weight loss is to improve health. Patients should be managed in the context of a chronic disease, taking a systematic approach to treatment. Lifestyle modification is the cornerstone of weight management.

Identifying patients with overweight or obesity is key to implementing appropriate management to reduce the risk of cardiovascular and other complications of obesity.

A modern approach to obesity acknowledges the multifactorial determinants of weight gain and the health benefits to be derived from weight loss. Foundational to any weight loss effort is lifestyle change, diet, and increased physical activity. The approach should be a high quality diet to which patients will adhere accompanied by an exercise prescr...

Background: Circulating amino acids, such as branched-chain amino acids (BCAAs) and aromatic amino acids (AAAs), have been associated with diabetes risk; however, little is known about how a long-term dietary intervention for weight loss affects circulating amino acids. Objectives: We examined the effects of weight-loss diets on long-term change...

The traditional approach to management of type 2 diabetes has been targeting both glycemic control and associated risk factors that drive cardiovascular disease risk (blood pressure, dyslipidemia, pro-thrombotic tendency). The primary focus of this chapter is to explore the role of medical approaches (as opposed to surgical approaches) using lifest...

As obesity rates increase, so too do the risks of type 2 diabetes, cardiovascular disease, and numerous other detrimental conditions. The prevalence of obesity in U.S. adults more than doubled between 1980 and 2010, from 15.0 to 36.1%. Although this trend may be leveling off, obesity and its individual, societal, and economic costs remain of grave...

Objective: Adult obesity is recognized as a chronic disease. According to principles of chronic disease management, healthcare professionals should work collaboratively with patients to determine appropriate therapeutic strategies that address overweight and obesity, specifically considering a patient's disease status in addition to their individu...

Objective To determine whether there are differences in baseline psychological and behavioral characteristics between individuals with severe obesity who chose a surgical or nonsurgical intervention for weight loss. Methods The current study utilized data from a larger study funded by a state insurance company and is unique in that the insurance c...

Background: Hepatic lipase (HL) plays a pivotal role in the metabolism of HDL and LDL. Recent genome-wide association studies have identified common variants in the HL gene (LIPC) associated with HDL cholesterol. Objective: We tested the effect of a common variant in LIPC on changes in blood lipids in response to weight-loss diets in the Prevent...

Glucagon-like peptide-1 (GLP-1) receptor agonists are indicated for treatment of type 2 diabetes since they mimic the actions of native GLP-1 on pancreatic islet cells, stimulating insulin release, while inhibiting glucagon release, in a glucose-dependent manner. The observation of weight loss has led to exploration of their potential as antiobesit...

This chapter examines the use of drugs as adjuncts to lifestyle in the treatment of the patient who is overweight or obese. There are two groups of approved drugs that can be used in this setting. The first are the four drugs currently approved for long-term treatment of obesity and a few others that can be used for short-term treatment. Orlistat p...

Preventing weight gain rather than treating recognized obesity is an important economic and public health response to the growing levels of obesity nationwide. Community centers offer potential sites for community health promotion programs targeting African Americans. In this article, results from a pilot health promotion program at a community cen...

The field of obesity pharmacotherapy is in its infancy. While these drugs represent new tools to use to help patients in chronic obesity management, we need an educated and more experienced group of prescribers. Only then can we have a meaningful impact on the chronic disease risk driven by obesity. Understanding the basic principles of using obesi...

Background: Emerging evidence has related circulating amino acids to diabetes and cardiovascular risk. Little is known about how diet modifications affect circulating amino acids. The present study aimed to examine the effects of weight-loss diets on long-term changes in plasma amino acids, and their relations with weight loss and metabolic outcome...

Currently, early weight-loss predictions of long-term weight-loss success rely on fixed percent-weight-loss thresholds. The objective was to develop thresholds during the first 3 mo of intervention that include the influence of age, sex, baseline weight, percent weight loss, and deviations from expected weight to predict whether a participant is li...

Objective: To formulate clinical practice guidelines for the pharmacological management of obesity. Participants: An Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer. This guideline was co-sponsored by the European Society of Endocrinology and The Obesity Society. Evidence: This evidence-based guideline...

The National Institutes of Health, led by the National Heart, Lung, and Blood Institute, organized a working group of experts to discuss the problem of weight regain after weight loss. A number of experts in integrative physiology and behavioral psychology were convened with the goal of merging their perspectives regarding the barriers to scientifi...

Background: Several prospective studies have evaluated the association between body mass index (BMI) and death risk among patients with diabetes mellitus; however, the results have been inconsistent. Methods and results: We performed a prospective cohort study of 19 478 black and 15 354 white patients with type 2 diabetes mellitus. Cox proportio...

Objective: Treatment algorithms for type 2 diabetes recommend weight loss for disease management. The safety and efficacy of treatment with phentermine (PHEN)/topiramate (TPM) extended release (ER) plus lifestyle modification for weight loss and glycemic benefits were assessed in two randomized, double-blind, placebo-controlled 56-week studies of...

Importance Even though one-third of US adults are obese, identification and treatment rates for obesity remain low. Clinician engagement is vital to provide guidance and assistance to patients who are overweight or obese to address the underlying cause of many chronic diseases.Objectives To describe current best practices for assessment and lifes...

Objective: To assess the relative impact of an intensive lifestyle intervention (ILI) on use and costs of health care within the Look AHEAD trial. Research design and methods: A total of 5,121 overweight or obese adults with type 2 diabetes were randomly assigned to an ILI that promoted weight loss or to a comparison condition of diabetes suppor...

Purpose The financial impact of intensive medical interventions for weight loss has not been fully studied. Design A randomized pragmatic clinical trial. Setting Seven primary care clinics and one research center in Louisiana. Subjects Severely obese individuals (body mass index 40–60 kg/m²) randomized to usual care (n = 190) or intensive medica...

For patients who do not meet their target weight or weight-related treatment goals with initial lifestyle intervention, or who regain their weight, intensification of therapy is needed.

Obesity is a multifactorial disease that results from a combination of both physiological, genetic, and environmental inputs. Obesity is associated with adverse health consequences, including T2DM, cardiovascular disease, musculo-skeletal disorders, obstructive sleep apnea, and many types of cancer. The probability of developing adverse health outc...