The forced isolation due to the COVID-19 pandemic interrupted the lifestyle intervention programs for people with obesity. This study aimed to assess: (1) the behaviors of subjects with obesity towards medical care during the pandemic and (2) their interest in following a remotely delivered multidisciplinary program for weight loss. An online self-made survey addressed to subjects with obesity was linked to the official website of our institute. Four hundred and six subjects completed the questionnaire (90% females, 50.2 ± 11.6 years). Forty-six percent of the subjects cancelled any scheduled clinical assessments during the pandemic, 53% of whom had chronic disease. Half of the subjects were prone to following a remotely delivered lifestyle intervention, especially with a well-known health professional. About 45% of the respondents were favorable towards participating in remote psychological support and nutritional intervention, while 60% would practice physical activity with online tools. Male subjects and the elderly were more reluctant than those female and younger, especially for online psychological support. Our survey showed an interest on the part of the subjects with obesity to join a multidisciplinary weight loss intervention remotely delivered. Male subjects and the elderly seem less attracted to this intervention, and this result highlights that, even with telemedicine, the approach to weight management should be tailored.

Obesity is a chronic, relapsing disease influenced by environmental, lifestyle, biological, and genetic factors, affecting over 1 billion people globally. Treatment for adults typically involves multicomponent lifestyle interventions-diet, physical activity, and behavior change-for at least 6-12 months. However, adherence is often low, and in-person sessions can be time-consuming and costly. Digital therapeutics (DTx), which enhance patient engagement and support long-term outcomes, have proven effective in managing chronic and mental health conditions. DTx offer scalable, evidence-based solutions with the potential to improve obesity management. The Digital Therapy to Promote Weight Loss in Patients With Obesity by Increasing Their Adherence to Treatment (DEMETRA) study is a prospective, multicenter, pragmatic, randomized, double-arm, single-blind, placebo-controlled trial evaluating the 6-month efficacy of an innovative, multicomponent digital intervention for obesity, which combines dietary, physical activity, and behavioral strategies in people with obesity (primary objective). Secondary objectives were assessing changes in BMI, waist circumference, blood pressure, glucose metabolism, lipid profile, adherence, and factors associated with absolute 6-month weight loss. The trial was conducted at 2 obesity centers in Italy with 246 participants aged 18-65 years (BMI 30-45 kg/m2), randomly assigned to either the Digital Therapeutics for Obesity (DTxO) app or a placebo app. DTxO offered personalized diet plans, exercise routines, and psycho-behavioral support, while the placebo app only allowed users to log data without feedback. Both groups followed a Mediterranean-style low-calorie diet with an 800 kcal/day deficit. On average, participants used the DTxO app for 42 minutes/day and the placebo app for 35 minutes, primarily for physical activity tracking. Univariable and multivariable generalized linear models were used to assess associations with 6-month absolute weight change (primary end point) and percent weight change (secondary end point). Overall, 207 participants (84.1%) completed the 6-month visit. Both arms achieved a statistically significant absolute (DtxO: -3.2 kg, IQR -6.0 kg to -0.9 kg; placebo: -4.0 kg, IQR -6.9 kg to -0.5 kg; P<.001) and percent loss in body weight (DtxO: -3.0%, IQR -5.7% to -0.8%; placebo: -4.0%, IQR -8.5% to -0.5%; P<.001) after 6 months, without significant between-group differences (univariable generalized linear models: P=.34 and P=.17, respectively). Univariable regression analyses showed a significant association between adherence to app use and 6-month absolute weight loss (β=-.06, SE 0.02, P=.01) as well as percent weight loss (β=-.05, SE 0.01, P=.01). Adherent participants, defined as those with overall adherence at or above the 75th percentile of daily usage, included 35 individuals in the intervention group and 10 in the placebo group. In this subgroup, the estimated 6-month mean absolute weight change was -7.02 kg (95% CI -9.45 to -4.59) in the DTxO-adherent group and -3.50 kg (95% CI -7.01 to 0.01) in the placebo-adherent group (P=.02). The estimated 6-month mean percent change in weight was -6.31% (95% CI -8.86 to -3.76) in the DTxO-adherent group and -2.78% (95% CI -6.48 to 0.92) in the placebo-adherent group (P=.03). A significantly greater weight loss (P=.01 for study arm, either on absolute or percent change in weight from baseline) among adherent participants randomized to the DTxO app was also confirmed by analyses using mixed linear models for repeated measures. Although overall weight loss did not differ significantly between the DTxO and placebo groups, participants who used the DTxO app for at least 40% of the expected time achieved significantly greater weight loss. These results suggest that higher engagement with DTx can improve obesity outcomes. Further research should explore combining DTxO with pharmacological treatments or bariatric surgery. ClinicalTrials.gov NCT05394779; https://clinicaltrials.gov/ct2/show/NCT05394779. RR2-10.3389/fdgth.2023.1159744.

BACKGROUND Obesity is a chronic, relapsing disease resulting in global morbidity and mortality. Treatment continues to present significant challenges for healthcare providers. For adults, multicomponent lifestyle interventions—comprising diet, physical activity, and behavioral change strategies—are the mainstay of treatment for at least 6 to 12 months. However, patient adherence to lifestyle changes remains modest, and these interventions often require multiple in-person sessions, which can be time-consuming, costly, and challenging for both patients and healthcare providers. Given the evolving landscape of digital health, digital therapeutics could play a key role in improving and scaling obesity management interventions. OBJECTIVE this prospective, multicentre, randomized, double-arm, single-blind, placebo-controlled trial evaluated the 6-month efficacy of an innovative, multi-component, digital intervention for weight loss by increasing patients’ adherence to treatment in people living with obesity. METHODS two clinical centres enrolled a total of 246 participants, who were randomized to the Digital Therapeutics for Obesity (DTxO) or the Placebo App group. RESULTS Overall, 207 (84.1%) completed the 6-month visit; both arms achieved a statistically significant absolute and percent loss in body weight at the 6-month follow-up without significant between groups differences (p =0.415 and p=0.340, respectively). Univariable regression analyses showed a net impact of adherence to the app use on the 6-month absolute [β=-0.06 (standard error (SE)=0.02), p=0.005] and percent changes in body weight [β=-0.05 (SE=0.01), p=0.009]. At multivariable analysis, adjusted for clinical site, the estimated 6-month mean absolute change in weight was -7.02 kg [95% confidence interval (CI): -9.45; -4.59] in the DtxO-adherent group and -3.50 kg [95%CI: -7.01; 0.01] in the Placebo App-adherent group (p=0.019). The estimated 6-month mean %change in weight was -6.31% [95%CI: -8.86; -3.76] in the DTxO-adherent group and -2.78% [95%CI: -6.48; 0.92] in the Placebo App-adherent group (p=0.025). CONCLUSIONS This trial demonstrated the effectiveness of DTxO compared to a Placebo App on 6-month weight loss in people living with obesity, adherent to DTxO of at least 16 min/day to a dietary, physical activity, and mindfulness digital health multidimensional intervention. Further studies are needed to explore the additional benefits of DTxO associated with new drugs or bariatric surgery in obesity management. CLINICALTRIAL clinicaltrials.gov, identifier, NCT05394779. INTERNATIONAL REGISTERED REPORT RR2-10.3389/fdgth.2023.1159744

Background/Objectives: Metabolic–bariatric surgery (MBS) is a highly effective treatment for severe obesity; however, gender disparities exist in access and postoperative outcomes. Despite men presenting with higher baseline weight and comorbidity burden, they are significantly underrepresented among MBS patients. Existing evidence on gender-specific outcomes remains inconclusive, particularly within Mediterranean populations under updated clinical guidelines. To evaluate gender differences in weight loss outcomes following sleeve gastrectomy in an Italian cohort managed under current multidisciplinary protocols. Methods: A prospective observational study was conducted and a total of 131 patients (109 females, 22 males) underwent sleeve gastrectomy at a single center. Anthropometric and metabolic parameters were assessed at baseline and 12 months postoperatively. Outcomes included absolute weight loss (TWL%), percentage of initial and excess body weight lost (EWL%), and waist circumference. Group comparisons used t-tests (with Welch’s correction if variances were unequal) and regression models adjusted for baseline BMI and age. Results: At 12 months, men achieved significantly greater absolute weight loss than women (−36.6 kg vs. −31.2 kg; p = 0.028), although no significant differences were observed for TWL%, EWL%, or waist circumference reduction. Gender remained a significant predictor of absolute weight loss in multivariate analysis, but not of proportional weight loss. Both genders showed similar rates of achieving clinically significant weight loss thresholds. Conclusions: While men exhibited greater absolute weight loss, relative weight loss outcomes were comparable between sexes. Gender disparity is observed in the utilization of MBS. These findings highlight the importance of equitable surgical access and tailored postoperative care.

Background: Osteogenesis Imperfecta (OI) is a heterogeneous group of connective tissue disorders, characterized by varying degrees of skeletal fragility. Patients experience a range of comorbidities, such as obesity, cardiovascular, and gastrointestinal complications, especially in adulthood. All aspects that could benefit from dietary intervention. The aim of this study was to evaluate the effects of a 6-months restricted Mediterranean Diet (rMD) on nutritional status in adult patients affected by OI. We carried out a 6-months longitudinal pilot study. 14 adults (median age: 35 years; 7 women; 7 OI type III) where recruited in 2019 among the members of As.It.O.I., the Italian Association of Osteogenesis Imperfecta. As.It.O.I. All the evaluations were performed at the University of Milan, Italy. The rMD provided a reduction of 30% from daily total energy expenditure. 45% of calories derived from carbohydrates, 35% from fat and 0.7–1.0 g/kg of body weight from proteins. Comparisons of continuous variables after 6 months of intervention were performed by the paired t-test. All P-values were two-tailed, and p < 0.05 was considered significant. Results: Patients showed significant improvement in anthropometric measurements (BMI = 30.5 vs 28.1 kg/cm², p < 0.001; Body Fat % = 32.9 vs 29.9, p = 0.006; Waist circumferences = 83.6 vs 79.6 cm; p < 0.001; Arm Fat Area = 29.8 vs 23.07 cm²; p < 0.011) and energy expenditure (REE/kg = 27.2 vs 29.2 kcal/kg, p < 0.001). Glucose and lipid profiles improved (Δglycemia = − 8.6 ± 7.3 mg/dL, p = 0.003; ΔTC = − 14.6 ± 20.1 mg/dL, p = 0.036; ΔLDL = − 12.0 ± 12.1 mg/dL, p = 0.009). Adherence to the MD significantly increased, moving from a moderate to a strong adherence and reporting an increased consumption of white meat, legumes, fish, nuts, fruits and vegetables. Conclusion: A rMD was effective in improving nutritional status and dietary quality in adults with OI. These results underscores the need to raise awareness of nutrition as part of the multidisciplinary treatment of this disease.

Background: Incretin-based therapies, including glucagon-like peptide-1 (GLP-1) receptor agonists and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor co-agonists, advance obesity treatment by promoting weight loss and lowering the risk of type 2 diabetes and cardiovascular disease. Methods: This narrative review synthesizes clinical evidence to highlight the role of dietitians in obesity management when incretin-based therapies are used. Results: GLP-1 receptor agonists and dual GLP-1/GIP receptor co-agonists achieve 15–21% weight loss and reduce cardiometabolic risk. Their effectiveness and safety are optimized when integrated with medical nutrition therapy (MNT) and personalized nutrition strategies. In Italy’s aging population, the rising burden of sarcopenic obesity requires dietitian-led care to preserve fat-free mass while reducing fat mass. Dual GLP-1/GIP co-agonists show superior reductions in visceral adiposity, but effects on fat-free mass remain inconclusive, underscoring the need for dietitian oversight to prevent adverse body-composition changes. Sarcopenic obesity is associated with increased mortality and functional decline. Dietitians are uniquely qualified to ensure adequate protein intake and protect muscle during pharmacologic interventions. In Italy, role clarity in clinical nutrition remains limited; however, under national law (DM 744/94; Law 42/1999), dietitians are recognized as the professionals authorized to provide medical nutrition therapy (MNT). Conclusions: The dietitian’s expertise maximizes therapeutic efficacy, minimizes adverse effects, and safeguards long-term outcomes. Integrating dietitians into pharmacological treatment pathways is essential to optimize outcomes, ensure patient safety, and safeguard long-term metabolic health.