• Researchers have used real-world data to identify key factors for long-term weight loss for patients taking GLP-1 drugs like Ozempic and Wegovy.
• The study identified the type of medication, dosage, treatment indication, and medication persistence as four of the most important factors.
• GLP-1 drugs are powerful agents for weight loss, but cost and access are still barriers for many Americans.

Millions of Americans have taken Ozempic or similar GLP-1 drugs to lose weight, but sustaining that weight loss long-term has proved difficult for many of them.

However, new research suggests there are four factors that could be key to improving these outcomes.

Researchers from the Cleveland Clinic looked at electronic health records of nearly 3,400 patients prescribed one of two different GLP-1 drugs — semaglutide ( sold under the brand names Ozempic and Wegovy) and liraglutide (sold under the brand names Saxenda and Victoza) — to see how various factors like dosage, indication, and biological sex affected weight loss at one year. 

Their findings were published this month in Jama Network Open.

Researchers looked at how these factors affected weight loss in two ways: total percentage change in body weight and whether an individual lost 10% or more of their body weight. The 10% mark is clinically significant, as hitting that benchmark is known to improve other comorbidities like high blood pressure and chronic disease risk.

They identified four factors that appear to be the most significant for long-term weight loss, some of them obvious and others more complex:

• The type of medication (active ingredient) – Did the patient use semaglutide or liraglutide?
• The dosage – Was the patient using a high or low-maintenance dose?
• Treatment indication – Was the medicine prescribed for type 2 diabetes or obesity?
• Medication persistence – Did the patient have any gaps in access to their medication?

“Our findings provide timely data on longer-term weight outcomes in patients receiving treatment with injectable semaglutide or liraglutide for obesity or type 2 diabetes, as well as identify key characteristics that could inform the probability of achieving sustained weight loss of a magnitude large enough to provide clinically significant health benefits,” Hamlet Gasoyan, PhD, lead author of the study and a researcher with Cleveland Clinic’s Center for Value-Based Care Research, told Healthline.

How the four key factors impacted sustained weight loss

Gasoyan and his team used the Cleveland Clinic electronic health records for 3,389 patients who were prescribed either semaglutide or liraglutide from July 2015 through June 2022. In order to be included, patients had to have a BMI of at least 30, indicating the person had obesity.

More than half the patients were female (54%) and had an average age of 50. The cohort was predominantly white (68%) but included significant Black (20%) and Hispanic (7%) populations.

At the one-year mark, four factors appeared to have the largest influence on sustained weight loss. Here’s how they affected whether or not patients would achieve 10% or greater weight loss:

• Active agent: Patients who took semaglutide were more than twice as likely compared to those taking liraglutide.
• Indication: Those prescribed their medication for obesity were also more than twice as likely than those with type 2 diabetes.
• Dosage: Patients taking a higher maintenance dose of their medication were 1.5 times more likely than those taking a lower dose.
• Persistence: patients with persistent coverage (access to their medication) were more than three times as likely as those who had the least access. 

Patient sex was also an important factor. Females in the study were 1.5 times as likely to hit the 10% benchmark as males.

Two of the factors may seem obvious: active agent and dosage. Basically, the kind of medication prescribed and dosage affected the weight loss outcome.

Semaglutide resulted in more than double the average weight loss of liraglutide (5.1% versus 2.2%). However, that’s nothing new: prior studies have shown that semaglutide is simply more effective for weight loss than liraglutide.

Evidence has also pointed to higher maintenance doses of semaglutide being more effective for weight loss than lower doses.

Indication is complicated. The evidence is clear that patients prescribed a GLP-1 for obesity tend to lose more weight than those with type 2 diabetes, but why that’s the case isn’t so obvious.

Caroline Apovian MD, a Professor of Medicine at Harvard Medical School and the co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital, told Healthline that these findings are essentially confirmatory of prior research.

It’s the fourth factor — persistence — that has grabbed the attention of Apovian and other obesity experts.

Persistence is the biggest key

“What this study adds is really diving into that persistence question. Nowadays, the conversation tends to focus on the idea that these are really great medications, but are patients actually taking them?” Beverly Tchang, MD, an endocrinologist, Spokesperson for the Obesity Society, and Assistant Professor of clinical medicine at Weill Cornell Medicine, told Healthline.

“This creates a very clear relationship between that persistence and the degree of weight loss,” she said.

As effective as GLP-1 drugs are, access has proven to be a major roadblock for many Americans. With the soaring popularity of these drugs, patients across the United States have faced shortages, with manufacturers unable to keep up with demand.

Cost and insurance coverage have also been problematic for many patients. The monthly cost for GLP-1 drugs can easily reach $1,000 or more before any insurance coverage or rebates are applied. 

If patients can’t afford their medication or can’t access it, they won’t take it. It’s as simple as that. 

This latest research helps to illustrate that dilemma.

Gasoyan and his team found that at the one-year mark, only 40% of patients had persistent medication coverage, which they defined as a cumulative lapse in coverage of less than 90 days.

But those that did have persistent coverage demonstrated significantly more weight loss (5.5%) compared to those with the least (1.8%) — less than 90 days of coverage for the year.

The data “reinforces that persistence is key to achieving meaningful weight outcomes with these medications,” said Gasoyan.

“If we avoid therapeutic interruptions with these medications, whether that be due to shortages or insurance coverage, then we will have better persistence with these medications and more weight loss,” added Tchang.

The bottom line

GLP-1 drugs like Ozempic and Wegovy are powerful weight-loss tools. However, long-term weight loss outcomes can be affected by a variety of factors.

In a new study, researchers identified four of the most important factors for long-term weight loss in patients taking a GLP-1 drug. These include the kind of medication, the dosage, the indication, and medication persistence (how long the patient continuously took the medication).

Medication persistence is essential to long-term weight loss, however access and cost related to GLP-1 drugs continue to be roadblocks for many Americans.

• Research indicates that metformin could help reduce the viral reservoir in HIV patients.
• Metformin is currently used in the treatment of type 2 diabetes.
• It appears to reduce inflammation, which could reduce metabolic disease risk.
• It may also make it more difficult for HIV to evade the immune system.
• In the future, metformin might be used to make antiretrovirals more effective.

Canadian researchers say the type 2 diabetes drug metformin could help to reduce the viral reservoir — or even clear it out completely — in people living with human immunodeficiency virus (HIV) who also are undergoing antiretroviral therapy.

The authors of the September 2024 study, which was published in the journal iScience, state that in previous studies, when people took the drug for three months, there were improvements in immunity and reductions in inflammation.

In the current study, they found that metformin increased the number of cells with the HIV virus while preventing the virus from leaving the cells.

They note that these effects could be used to boost the effects of antiretrovirals.

This is significant because antiretroviral therapy can reduce the virus’s replication to undetectable levels, but it does not completely eradicate it.

Although these drugs can improve people’s quality of life, the remaining viral reservoir can lead to chronic inflammation and associated diseases such as cardiovascular disease, cancer, and metabolic disorders.

How metformin might work to reduce HIV viral reservoirs

The authors explain that metformin is capable of inhibiting the activity of the mechanistic target of rapamycin (mTOR) molecule.

In their study, this inhibition helped slow down HIV replication in the CD4⁺ T lymphocytes that harbored them, indicating that metformin could help to reduce a person’s viral load.

The researchers explain that metformin also causes the overexpression of the BST2 protein, which helps to tether virions (the infectious form of the virus) to the surface of infected cells.

This allows the immune system to locate them and send antibodies to attack them.

Edwin Bosa-Osorio, MD, a primary care physician and a faculty member in the Family Medicine Program at The Brodes H. Hartley, Jr. Teaching Health Center at Community Health of South Florida, Inc. (CHI), commented on the study, explaining how metformin could exert its effects.

“Metformin does this by helping boost the number of HIV-infected cells so as to help expose them to the HIV medication,” he explained. “So, metformin seems to be helping the HIV medication work more efficiently.”

However, Bosa-Osorio, who was not involved in the study, cautioned that these studies have only been done in a laboratory.

“So, in reality, the proof must be in the pudding,” he said, “which is to say that clinicians need to move to clinical trials that can tell us more about whether what they are seeing in vitro is applicable to actual patients.”

John Lowe, MD, a Physician at Restore Care who was not involved in the study, said that while metformin is primarily used to lower blood sugar in people with type 2 diabetes, it is also effective as an anti-inflammatory.

“In HIV, inflammation matters since it is instrumental in viral persistence, and metformin may help dampen this inflammation assisting the virus to escape,” he said.

Lowe added that this reduction in immune activity could make it harder for the viral reservoirs to persist.

“Apart from that, metformin may be beneficial in HIV treatment since it decreases insulin resistance, thereby decreasing the chance of adequate conditions for HIV reproduction,” he stated.

What this might mean for the future of HIV treatment

If future investigations bear fruit, this could alter the way that HIV therapy is managed, according to Lowe.

“Present-day therapies are effective in viral replication suppression, but there is no eradication of the virus. Hence, the patient requires medication for the rest of his life,” he said.

Lowe further commented that metformin has a positive safety record and could make HIV treatment cheaper.

It would also widen the range of possible treatments for the disease, he added, and it could decrease the number of drugs used in some people, for example, those with diabetes.

“If the results of antiretroviral therapy were positive, it would not be surprising if Metformin went further still,” he said.

“This study suggests the possibility of using metformin to get a faster response to the medications we currently use for controlling HIV,” added Bosa-Osorio.

He explained that it’s not going to replace those medications, however, since it doesn’t appear to directly affect the virus, although it could make antiretrovirals more efficient.

“And because metformin also has an anti-inflammatory effect, it can also help reduce cardiovascular conditions that HIV patients are prone to have because HIV is a pro-inflammatory disease,” Bosa-Osorio concluded.

Takeaway

A new study reports that the type 2 diabetes drug metformin could help people living with HIV who are using antiretroviral drugs.

In a previous study, after three months of using metformin, people had reduced inflammation and improved immunity.

This is important since the chronic inflammation associated with HIV puts patients at greater risk for cardiovascular disease, diabetes, and metabolic disorders.

Metformin also appears to create immune system changes that make antiretrovirals more efficient at reducing the viral reservoir.

While this has only been demonstrated in a lab so far, experts say metformin could someday become a valuable adjunct to antiretroviral therapy.

In this blog post, we will explore the methods used by our teams which help us to monitor the spread of mpox and determine the counter measures needed if we see cases of clade I mpox in the UK.

• A new review of more than 300 prior studies has identified the best tools to quit smoking.
• The research looked at a variety of medications and techniques, including nicotine replacement, medication, and therapy.
• Health experts say quitting smoking is one of the most important things you can do to improve your health.

There has never been a better time to quit smoking tobacco.

More products exist today to help people snuff out cigarettes for good, but with so many options available, identifying which are the most effective isn’t always easy.

However, a comprehensive new review published this month in Society for the Study of Addiction has revealed the top three most effective means to quit.

The Cochrane Tobacco Addiction Group (CTAG) conducted this research, which included more than 300 prior studies on tobacco cessation products and 157,179 participants.

“Using the strictest and most rigorous methods, the CTAG reviews represent the gold standard in medical evidence, which is why CTAG’s work is consistently used to inform guidelines and policies around the world,” Jonathan Livingstone-Banks, PhD,  a Lecturer and Senior researcher in evidence-based healthcare at the University of Oxford, and first author of the review, told Healthline.

What are the top three most effective ways to quit smoking?

Out of all the current options available, researchers identified three interventions that “emerged as the most effective treatments. They are:

• Varenicline (Chantix) – An oral prescription medication used alongside education and counseling to stop smoking.
• Cytisine – A plant-derived smoking cessation aid that has been used for decades in many European countries. Cytisine is not currently available in the USA, nor is it FDA-approved.
• E-cigarettes (with nicotine) – Evidence around e-cigarettes for smoking cessation remains somewhat controversial. The FDA has never approved an e-cigarette for this purpose. Nonetheless, the present review did find that e-cigarettes were effective at helping people quit.

Varenicline and cytisine both belong to a class of drugs known as nicotine receptor partial agonists. 

“By interacting with the part of the brain that nicotine normally affects, they help to reduce the withdrawal symptoms people experience when they stop smoking, like cravings and unpleasant mood changes,” said Livingstone-Banks.

They also make smoking less pleasurable, disincentivizing smokers from using cigarettes.

Nicotine replacement therapy (NRT), which includes products like nicotine gum, patches, lozenges, and pouches, is also effective. Researchers found that NRT was even more effective when a long-lasting product, like a patch, was paired with a fast-acting product, like gum.

The oral antidepressant bupropion is also approved for smoking cessation. The Cochrane review found that this medication was helpful to quit smoking, but the evidence was not as robust as that for varenicline and cytisine.

Behavioral support, which includes things like therapy and counseling, was also effective. As was incentivizing tobacco smokers with a financial reward.

Are E-cigarettes more helpful or harmful?

E-cigarettes have boomed in popularity over the past decade.

However, numerous questions remain about their safety, their role in smoking cessation, and their appeal to teens and adolescents. The FDA has not approved any e-cigarette device for smoking cessation. Despite this, anecdotal reports and some research have indicated that nicotine-containing e-cigarettes may help people quit.

Nevertheless, research on e-cigarettes is controversial, and other studies have found the opposite to be true.

Parents and policymakers have also sounded the alarm about the appeal of e-cigarettes, particularly flavored products, to children and teens.

The dilemma has led many to ask whether the devices do more harm than good. 

But, without delving into the broad social and public health implications of e-cigarette usage, the evidence for e-cigarettes as tobacco-cessation devices is substantial, according to the review.

“Our research has found that there is very strong evidence that e-cigarettes are an effective way to help people quit smoking tobacco… While e-cigarettes are unlikely to be completely safe, we can be confident that they are far safer than smoking tobacco,” said Livingstone-Banks.

Hilary Tindle, MD, PhD, the Founding Director of ViTAL, the Vanderbilt Center for Tobacco, Addiction, and Lifestyle at Vanderbilt University Medical Center, told Healthline, “The long-term safety of e-cigs is unknown.  Furthermore, e-cigs are aggressively marketed to entice young people to begin using nicotine-containing products, so beyond helping adults quit smoking, there are major public health considerations.”

Tindle wasn’t affiliated with the research.

The health benefits of quitting smoking

According to the American Lung Association, these are only a few of the positive health benefits you can experience when you stop smoking, and how quickly they can occur:

• Twenty minutes: heart rate and blood pressure drop.
• One day: your risk of heart attack is reduced.
• Three months: your lung function begins to improve.
• One year: your risk of coronary heart disease is half that of a person who smokes.
• Five years: your risk of mouth and throat cancer is half that of a person who smokes.
• Ten years: your risk of dying from lung cancer is about half that of a person who smokes.

To start quitting, Tindle recommends making a concrete plan:

“Set a target quit date, preferably within 2 weeks, and support your quit attempt with medication and counseling.  This combination of support — rather than relying on one or neither — is key and leads to higher success rates,” she said.

Many people in the United States can access free counseling and medication through the hotline 1-800-QUIT-NOW (1-800-784-8669) and websites, including Smoke Free or the Mayo Clinic and Truth Initiative collaboration, BecomeAnEx. 

“If someone does not succeed on the first quit attempt, keep trying. In the US, more than 50% of all people who ever smoked have now quit,” said Tindle.

The bottom line

There are many products and medications available to help you quit smoking, but it may be difficult to figure out which are the most effective.

A new review, which included more than 300 prior studies, has identified the three most effective tools to quit smoking.

The most effective smoking cessation tools include the medication varenicline (Chantix), the plant-derived cytisine (not available in the US), and nicotine-containing e-cigarettes.

Quitting smoking is one of the most important things you can do for your health.

• An alarming new report reveals racial disparities in unnecessary C-section rates in New Jersey hospitals.
• The data show that Black women are 25% more likely to undergo a C-section than white women.
• The researchers suggest that implicit racial bias among providers may play a role in this rate and that there may be a “financial incentive” in some hospitals to fill operating rooms.
• Many factors may be responsible, experts say, and more research is needed to determine whether this disproportionate rate carries over to other states.

As racism within the healthcare system persists, a large new study reveals startling disparities in unscheduled C-sections among Black women.

A National Bureau of Economic Research (NBER) report of nearly 1 million births at 68 hospitals in New Jersey found that Black women are 25% more likely to undergo unnecessary C-sections compared to white women. 

While more research is needed to determine whether these disparities are found in other states, the data point to the potential for implicit racial bias occurring in hospital delivery rooms at a provider’s discretion. 

“The findings from the new study are alarming — it is concerning that these disparities exist and are so stark,” said Mark Simon, MD, chief medical officer at Ob Hospitalist Group (OBHG).

“The CDC has released data that clearly highlights national differences in C-section rates across each state, with New Jersey ranking on the high end. But this problem is not unique to New Jersey — disparities in maternal mortality, particularly along racial and socioeconomic lines, are also well-documented,” Simon told Healthline. Simon wasn’t affiliated with the research.

Why do Black women have higher rates of C-sections?

Cesarean delivery (C-section) rates have been increasing in the United States in recent years.

Many C-sections are scheduled in advance, leaving experts concerned about whether these are medically necessary.

Planned and unplanned C-sections account for roughly 1 in 3 births in the U.S., well above the 10–15% target rate recommended by the World Health Organization (WHO).

As the new research suggests, these figures include a disproportionate number of Black women. The causes for this disparity, however, is less clear.

NBER researchers suggest that more unscheduled C-sections may be occurring in Black women due to doctors who are “exercising their discretion and are more likely to conduct unnecessary C-sections on Black mothers.” 

They cite in their report previous research showing that Black women are more likely to feel “pressure from a clinician to take medication to start or speed up labor and to have a C-section.”

“I do think this points to implicit bias,” Simon said. “It’s crucial that healthcare workers receive training on implicit bias to help recognize and reduce disparities in patient care. Additionally, we know a diverse clinical workforce leads to improved outcomes for Black patients. When health systems prioritize equitable outcomes for maternal patients, everyone benefits,” Simon said.  

What are the risks of C-sections?

Cesarean deliveries, whether planned or unplanned, carry risks for both the birthing person and their baby. In emergency situations, however, C-sections can be lifesaving.

C-section deliveries can raise the risk of bleeding, blood clots, infection, and injury to other organs, Simon noted. “Additionally, they pose increased risks for future pregnancies, including conditions like abnormal placentation,” he added.

As NBER researchers note, Black women tend to have worse health outcomes overall than white women. However, experts point out there are underlying factors to consider that may affect the health outcomes of Black women following C-sections.

“If Black women undergo more cesarean deliveries, their exposure to associated risk increases,” Simon said. “These risks are compounded by the fact that Black women already experience higher rates of pregnancy complications and are more likely to have underlying chronic health conditions.”

Kecia Gaither, MD, MPH, double board certified OB-GYN and maternal fetal medicine specialist and director of Perinatal Services/Maternal Fetal Medicine at NYC Health + Hospitals/Lincoln in the Bronx, agreed that comorbidities often influence C-section outcomes. Gaither wasn’t involved in the new report.

“Is there a high concentration of obesity,  hypertension,  diabetes, substance abuse, [or] HIV?” Gaither questioned.  “[It’s a] difficult question to answer.” 

Multifactorial issues, such as racism, bias, poor attention to the clinical status of postoperative Black women, or the quality of the health facility, could all impact health outcomes following a C-section delivery, Gaither said.

The long-term risks of C-section delivery are not fully understood, but research has shown that short-term effects of Cesarean delivery may include:

• altered immune development
• increased risk of allergy, atopy, and asthma
• reduced intestinal gut microbiome diversity

“Cesarean sections are not benign procedures — the risk of hemorrhage, damage to the internal organs, [and] infection run high for the mother,” Gaither said. 

“Babies born via cesarean may have breathing issues. Babies swim in amniotic fluid, this fluid fills the lungs. With a vaginal birth, this fluid is ‘squeezed out’ as the baby transits the birth canal. With an operative delivery, this lung fluid isn’t expressed, and it takes a while for that process to occur. As such, the baby breathes rapidly in an attempt to clear this fluid from its lungs,” she explained.

Is there a financial incentive to perform C-sections?

NBER researchers suggest there may be a financial incentive for healthcare providers to perform C-sections, thus pushing more Black women into the OR for the procedure.

“I don’t believe labor and delivery units prioritize keeping their operating rooms constantly occupied,” Simon said. “In my experience, labor and delivery staff do everything in their power to keep at least one OR open in case there is an emergency.” 

Gaither was also cautious to ascribe to this theory. “I think there are many factors to consider when looking at the picture,” she said.

“Is there a high preponderance of early prenatal care [and] pre-conceptual counseling, or are patients showing up late in gestation, effectively ‘crashing and burning’ with some disease process that might have had a better outcome if caught in earlier stages?” Gaither pointed out.

“Is there a high utilization of reproductive technologies contributing to the population served? Reproductive technologies contribute to multiples (twins, triplets, quadruplets, etc.). These higher-order pregnancies increase the Cesarean section rate,” she noted.

When looking at C-section rates within hospitals, Gaither said the following factors should be considered:

• Does the population being served have insurance?
• Is the population serviced in a rural or urban setting?
• What is the mindset of the physicians servicing the population? Are they likely to perform an operative delivery so they can make a social engagement in time?
• What is the financial status of the hospital/hospitals involved?
• What impact does the environment play in the health of the populace?
• What role do bias and racism play?

Takeaway

A concerning new report shows that unnecessary C-sections are 25% more common in Black women compared to white women.

The researchers suggest that implicit racial bias could play a role, and there may be a “financial incentive” to fill operating rooms.

Experts say the reasons for this alarming disparity are multifactorial. More research is needed to determine whether the high number of C-section rates persist in other states.

• Lemme, the supplement brand founded by Kourtney Kardashian Barker, is releasing an “all-natural” weight loss supplement called Lemme GLP-1 Daily.
• In spite of the name, the product is not a GLP-1 receptor agonist like Ozempic or Wegovy.
• The product contains natural ingredients such as Eriomin lemon fruit extract, Supresa saffron extract and Morosil red orange fruit extract.

Lemme, the supplement brand founded by Kourtney Kardashian Barker, announced that it is releasing a supplement called Lemme GLP-1 Daily aimed at providing consumers with an “all-natural” way to manage their weight.

In spite of its name, however, the product does not contain a synthetic GLP-1 hormone and is not a GLP-1 receptor agonist like Ozempic or Wegovy.

Ozempic and other GLP-1 drugs mimic the actions of the hormone GLP-1 by activating its receptor, which leads to weight loss and lower blood sugar, among other benefits.

Lemme GLP-1 Daily instead contains natural ingredients such as Eriomin lemon fruit extract, Supresa saffron extract and Morosil red orange fruit extract. 

The product is meant to “boost the body’s GLP-1 levels, reduce hunger, promote insulin sensitivity and support healthy weight management,” according to a company press release.

The daily capsules will be available for purchase on the brand’s website beginning September 16 and will be sold via a subscription model at $72 for a month’s supply or $90 as a one-time purchase.

But how effective is the product for weight loss? Here’s what to know about the potential benefits of the natural ingredients in Lemme GLP-1 Daily.

Lemon fruit extract

Small clinical trials of Eriomin lemon fruit extract found that this compound didn’t help people lose weight, but it may offer other benefits.

A small study of people with prediabetes and type 2 diabetes who took Eriomin for 12 weeks showed that there was no effect on body weight, body mass index (BMI), lean mass, fat mass or waist-to-hip ratio.

However, those who took Eriomin saw on average a 5% decrease in their blood glucose and a 17% increase in the hormone GLP-1, compared to those who took a non-acting placebo.

Another small 12-week study of people with prediabetes also found that Eriomin had no impact on weight. But there was a 22% increase in blood levels of GLP-1, and an increase in beneficial bacteria in the gut.

Bacteria in the gut can influence your weight by affecting how food is digested, how fat is stored, and whether you feel full or hungry. 

Eating a wide variety of high fiber foods such as whole grains, fruits, vegetables, nuts, and seeds — and limiting intake of added sugars and highly processed foods — can also support healthy gut bacteria.

Saffron extract

An 8-week study of 60 women with overweight found that those who took a saffron extract had decreased snacking, compared to those who took a placebo.

GLP-1 drugs work, in part, by reducing appetite and feelings of hunger, which can help people manage their weight.

However, studies of saffron extract have not shown a large effect on weight when the compound is used alone.

A meta-analysis of 25 earlier studies looking at the benefits of saffron extract found that people with obesity who took this compound saw decreases in their waist-to-hip ratio.

There were also decreases in weight, BMI, waist circumference, and hip circumference. However, these changes were not statistically significant, which means saffron extract may not offer any additional benefits compared to a placebo.

Two other studies, including a review paper of previous studies and a small clinical trial in people with type 2 diabetes, also found that saffron extract didn’t help people lose weight.

Other studies have examined the benefits of saffron extract for people with diabetes, such as improving blood glucose control and cholesterol levels. Some of these studies were done alongside other supplements like cinnamon and ginger or in conjunction with aerobic or resistance exercise.

Red orange fruit extract

The clearest weight loss benefits are seen with Morosil red orange fruit extract.

A six-month study found that people who were living with overweight lost an average of 4.2% of their body weight while taking Morosil, compared to 2.2% in people who took a placebo. The Morosil group also saw larger decreases in hip and waist circumference, fat mass, and fat distribution.

In contrast, one study found that people who took semaglutide — the active ingredient in Ozempic and Wegovy — lost 15.8% of their body weight over 68 weeks.

Are supplements useful for weight loss?

Mir Ali, MD, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, Calif., has concerns about how supplements used for weight loss are sometimes promoted. 

“GLP-1 medications stimulate hormones in the body and have the same effect as those hormones. So when people claim supplements do the same thing, I think that’s a bit deceptive,” he told Healthline.

And while “for some people, a natural, herbal supplement can be effective, there’s no convincing evidence that the supplement is going to have a significant effect on weight loss.”

Libu Varughese, MBBS, an endocrinology physician and medical advisor of Aeroflow Diabetes, told Healthline that he would like to see more scientific evidence before recommending the use of natural GLP-1 supplements.

However, if you do choose to use a dietary supplement, do so with caution, he said, and watch for any negative side effects.

The Food and Drug Administration has information for consumers on safely using dietary supplements.

Amy Lee, MD, head of nutrition for Nucific, suggests that people who want to lose weight naturally, think of supplements as just one component of a weight management program.

People also need to make “behavioral changes that result in decreased caloric intake and increased energy expenditure through movement and exercise,” she told Healthline.

Ali said certain diets have been shown in clinical trials to support weight loss, including ones that involve eating fewer carbohydrates, such as the keto diet and paleo diet.

“These diets are based on minimizing carbohydrate intake to direct the body toward burning fat,” Ali said. “That’s natural. There are no medications involved. No supplements. It’s just eating the right things to promote the burning of fat.”

These kinds of diets are even helpful for people who have had bariatric surgery or are taking a GLP-1 medication, he said, “because if you’re not eating the right things, you won’t see as much results.”

Takeaway

Lemme, the supplement brand founded by Kourtney Kardashian Barker, is releasing a supplement called Lemme GLP-1 Daily to provide consumers with an “all-natural” way to manage their weight.

In spite of its name, the product does not contain a synthetic GLP-1 hormone, and it is not a GLP-1 receptor agonist like Ozempic or Wegovy.

GLP-1 drugs mimic the actions of the GLP-1 hormone to lower blood glucose and promote weight loss.

Lemme GLP-1 Daily contains natural ingredients such as Eriomin lemon fruit extract, Supresa saffron extract and Morosil red orange fruit extract. Clinical studies show that these compounds may promote modest weight loss, decrease hunger and appetite, or boost the body’s GLP-1 levels.

• James Earl Jones, known for roles in Field of Dreams, The Lion King, and Star Wars, died at the age of 93.
• Jones was diagnosed with type 2 diabetes in his mid-60s, a condition he continued to manage in his later years.
• Although known for his deep, commanding voice, Jones overcame a severe stutter, which he had through much of his early life.

James Earl Jones — known for his roles in The Lion King and Field of Dreams, and as the voice of Darth Vader in the Star Wars franchise — has died. He was 93. A cause of death was not immediately released.

Jones, who developed type 2 diabetes later in life, overcame a severe stutter in childhood to become an award-winning actor known for his deep, commanding voice.

Jones was diagnosed with type 2 Diabetes in his 60s

In a 2016 interview on the Rachael Ray Show, Jones revealed that he was diagnosed with type 2 diabetes in the mid-1990s while attending a diet and exercise center.

At the time, he was in his 60s, an age at which many older adults are frequently diagnosed with this condition.

“Diabetes and other age-related diseases like obesity and abnormal cholesterol are more prevalent as we get older,” said Noa Tal, MD, an endocrinologist of the Pituitary Disorders Center at Pacific Neuroscience Institute in Santa Monica, Calif.

Jones told Ray in the interview that his condition was discovered by accident.

“I fell asleep on a bench in the middle of the gymnasium one day,” Jones explained. “And a doctor who was there said, ‘That’s not normal,’ and he encouraged me to go get checked out.”

A laboratory test revealed that Jones had type 2 diabetes.

This kind of delayed diagnosis is not uncommon.

“Unfortunately, [type 2 diabetes] does go under the radar sometimes,” said Tal.

In 2021, 38.1 million American adults had diabetes, according to the Centers for Disease Control and Prevention. More than one-fifth of these people had undiagnosed diabetes.

The rate of diagnosed diabetes is highest among American Indian or Alaska Native adults, followed by Black adults, Hispanic adults, and Asian adults, CDC data shows. White adults have the lowest rate of diabetes.

Regular screening, such as during routine doctor’s appointments, can catch diabetes early.

She recommends that everyone ask their primary care physician to screen them for diabetes at age 40 or age 35 if they have other health conditions such as high blood pressure.

“Depending on a person’s ethnicity or any [other health conditions] a patient has, screening can be either yearly or every three years,” Tal said.

How Jones learned to manage living with type 2 diabetes

Jones told Healthline’s Diabetes Mine in a 2016 interview that, after his diagnosis, there were “tough changes, like not having my favorite strawberry shortcake.” 

Depending on the severity of the diabetes, some people may be able to control their blood glucose level with changes in lifestyle, said Tal, such as healthy diet and regular physical exercise.

Others may need an oral or injectable medication like metformin, Ozempic or insulin, she said.

Jones had a doctor who suggested he try Invokana. This medication works by eliminating excess glucose through the urine.

“I’ve found that [Invokana] was very helpful in balancing my blood sugar,” he told Diabetes Mine.

Diabetes can sometimes be a lot for patients to manage. In addition to the treatment burden and needing to take care of yourself, there is also an increased risk of complications due to diabetes, especially when it is uncontrolled.

These complications may include heart disease, stroke, kidney disease, nerve damage and foot ulcers.

“When diabetes is not well controlled, it can impact the entire patient,” said Tal. “It affects basically any system in the body.”

How a strong support system can help a person manage type 2 diabetes

One thing that Jones learned by managing his diabetes is that “it comes down to being in tune with your body, and I’m sure the body tells us things long before we’re aware of what’s happening,” he told Diabetes Mine. “Since then, it’s become my job to be more aware of what my body is telling me.”

He also said his wife and son helped him stay “in line” with his healthy eating. “[My son] would count the cookies in the kitchen, and he could smell it on my breath if I snuck some,” he told Diabetes Mine. “They’ve both helped keep me in line.”

“I realized when I was diagnosed with diabetes, my whole family became diabetics,” he explained. “Not that they suffer the same things that I do, but they understand, and we have to work as a family in living with diabetes. They became my support group, as well as my doctors.”

Tal said a strong support system can help people with diabetes successfully manage their condition.

“If I have patients with diabetes who have some issues with memory or if their treatment regimen is complex, I always ask if there is any family support or other social support,” she said.

How Jones overcame a severe stutter

Although Jones is well-known for his voice work, he revealed in a 1986 interview that a severe stutter largely kept him from talking throughout much of his early life.

“I was mute from first grade through freshman year in high school,” he said, “Mute because I just gave up on talking.”

Jones explained to Charlie Rose in 1993 that he learned to speak clearly through reading his own poetry and the poetry of others, even before he had become an actor.

It was his high school English teacher, Donald Crouch, who helped Jones find a way to express himself verbally.

“Donald said, ‘Jim, this poem is so good I don’t believe you wrote it.’ Accused me of plagiarism. ‘And the only way you can prove it is to get up in front of the class and recite it from memory,’” Jones recalled in the interview. When he stood up and recited the poem word for word, they were both shocked, he said.

Jones went on to work in the film industry and on stage for many years.

In spite of that, his stutter “is always there,” he told Rose. “It’s there right now.”

“Stutterers often seem like they are ponderous and deep thinkers,” he went on to explain. “We’re not. We’re simply looking for the word we can say without tripping on it.”

Throughout his career, he continued to struggle with alliteration, and would go through scripts and ask screenwriters to take out any, such as multiple words in a row beginning with vowels, he told Rose.

In the 1986 interview, when asked if he minds talking about his stutter, Jones said he doesn’t. 

“It’s just another example of, you find yourself with a weak muscle and you exercise it. And sometimes that becomes your strong muscle,” he said. 

Takeaway

James Earl Jones, known for his roles in The Lion King, Field of Dreams, and as the voice of Darth Vader in Star Wars, died at the age of 93. No cause of death was immediately given.

The actor revealed in a 2016 interview that he was diagnosed with type 2 diabetes in the mid-1990s, after he fell asleep in the middle of the day at a diet and exercise center. His family and doctors helped him manage this condition throughout his later years.

As a child and teenager, Jones had a stutter severe enough to keep him from speaking from first grade through freshman year of high school. He credited a high school English teacher for helping him overcome his stutter by encouraging him to read his own poetry out loud.

• New research offers an alternative to daily insulin shots for the 8 million people in the United States with type 2 diabetes.
• Eli Lilly’s once-weekly insulin injection is just as effective as daily insulin shots for managing A1C levels in diabetes, according to the latest results from two phase 3 clinical trials.
• Experts say a weekly injection could make life easier for people who administer insulin on a daily basis.

The race between drug manufacturers Novo Nordisk and Eli Lilly to develop a once-weekly insulin shot continues.

On September 5, officials at Eli Lilly announced the latest results of two phase 3 clinical trials — QWINT-1 and QWINT-3 — involving a new insulin injection that would allow people with type 2 diabetes to take insulin once a week instead of daily. These results have not yet been published yet in a peer-reviewed journal.

Still, the new data builds on prior results released in May about the effectiveness of the company’s once-weekly shot during the QWINT-2 and QWINT-4 clinical trials. Those results were published in the New England Journal of Medicine, Lilly announced on Tuesday. They’re are also being presented at the European Association for the Study of Diabetes (EASD) Annual Meeting 2024 this week in Spain.

During the phase 3 trials, scientists studied the effectiveness of Lilly’s once-weekly insulin efsitora alfa (efsitora) in adults with type 2 diabetes taking insulin for the first time. They compared their progress with people who require daily insulin injections.

Eli Lilly officials said their product was effective in controlling A1C levels in all four clinical trials.

“Once weekly insulins, like efsitora, have the potential to transform diabetes care as we know it,” said Jeff Emmick, MD, senior vice president of product development at Eli Lilly, in statement last week.

“Many patients are reluctant to start insulin because of the burden it places on them. With a simple fixed-dose regimen, once-weekly efsitora could make it easier for people with diabetes to start and manage insulin therapy, while reducing the impact it has on their day-to-day lives,” Emmick continued.

How effective is Lilly’s once-weekly insulin shot?

The goal of both the QWINT-1 and QWINT-3 studies were to show equal efficacy to the currently approved insulin products. In the QWINT-1 phase 3 clinical trial, 796 participants were randomly selected to receive either the weekly efsitora injection or a daily injection of insulin glargine for 52 weeks.

At the end of the trial period, researchers reported that A1C levels on average were reduced by 1.31% in the efsitora cohort compared to 1.27% in the insulin glargine group. People taking efsitora ended the study with an average A1C level of 6.92% compared to an average of 6.96% for those taking insulin glargine.

In the QWINT-3 clinical trial, 986 participants have been randomly selected to receive either the weekly efsitora injection or a daily injection of insulin degludec.

At the 26-week mark of this 78-week trial, researchers reported that participants using efsitora had an average reduction of 0.86% in their A1C levels compared to 0.75% for the insulin degludec cohort.

People taking efsitora had an average A1C level of 6.93% at 26 weeks compared to 7.03% for the degludec group.

“Based on all the available information about the new once weekly insulin, the results consistently show the similar degree of reduction in hemoglobin A1C level to the currently available insulins and even in patients who were new to insulin, without increasing in risk of severe hypoglycemia, defined as blood glucose less than 54 mg/dl,” Marina Basina, MD, a clinical professor of endocrinology, gerontology, and metabolism at Stanford University, told Healthline.

Once-weekly injection could improve diabetes management

Noa Tal, MD, an endocrinologist at the Pituitary Disorders Center at the Pacific Neuroscience Institute in California, said the clinical trials offer hope for people with type 2 diabetes.

“The QWINT studies represent a significant advancement in diabetes management, particularly with the development of a weekly insulin injection,” Tal told Healthline. “This long-acting formulation could help address adherence issues associated with daily insulin regimens, offering a more convenient option for patients.”

Tal added that more than 8 million people in the United States with type 2 diabetes need insulin therapy, so a new weekly injection could make a major difference.

“A product like this weekly injection could have a profound impact,” Tal said.

“It could simplify diabetes management for those struggling with compliance or who are currently not using insulin due to the burden of daily injections. By reducing the frequency of injections, this weekly insulin might enhance patient adherence, improve overall glucose control, and potentially lead to better long-term health outcomes,” she noted.

Basina agreed with the importance of the clinical trials. “The more tools we have available in the treatment of diabetes, the better it is,” she said. 

Basina noted an important advantage of a once-weekly shot of long-acting insulin could benefit people also taking GLP-1 receptor agonists once a week, streamlining the frequency of their injections or making travel easier.

“Another important point is that in patients who have been on insulin for a prolonged period of time and developed scar tissue from long-term insulin injections, it will allow less frequent insulin injections and sparing some of the injection sites,” Basina added.

Are there disadvantages to once-weekly shots?

Lilly competitor Novo Nordisk is also in the process of developing a weekly insulin injection.

However, a Food and Drug Administration (FDA) advisory panel stated in May that it appears the benefits of the company’s insulin icodec lack sufficient clinical data and do not clearly outweigh the risks of the product, which may cause low blood sugar.

Novo Nordisk officials have said they are evaluating the FDA panel’s decision.

Basina cautioned that once-weekly insulin injections may not be convenient for everyone.

“It does not provide flexibility for patients who have variable day-to-day schedules with being more physically active on some days than other day. This insulin might increase the risk of low blood sugars on more physically active days,” she noted.

“There is also a concern for patients who may need urgent surgical procedure for which we usually recommend taking half of the long-acting insulin dose on the night before the procedure which will be not possible with weekly insulin administration,” Basina added.

Health risks of type 2 diabetes

Type 2 diabetes is a chronic medical condition that causes a build-up of glucose, also known as blood sugar, in the bloodstream. This happens because a person’s body can’t react to insulin effectively or doesn’t produce enough of it.

About 38 million people in the United States have diabetes. More than 90% of them have the type 2 variety.

About 25% of people with type 2 diabetes need to take insulin. That requires them to administer injections every day, much like people with type 1 diabetes.

Symptoms of type 2 diabetes include:

• constant hunger
• excessive thirst
• lack of energy
• frequent urination
• blurry vision

Symptoms can become more severe as the disease progresses.

Type 2 diabetes that is not properly managed can lead to serious complications, such as:

• cardiovascular disease
• nerve damage
• poor circulation
• eye damage
• hearing impairment

People who don’t need insulin for type 2 diabetes can manage and sometimes reverse their condition with a healthy diet and regular exercise. Maintaining a healthy weight is considered one of the most important ways to avoid or manage type 2 diabetes.

For people who don’t need insulin, medications such as metformin can be prescribed to help manage their condition.

Why is insulin important?

Insulin is a hormone created by the pancreas that helps move glucose from a person’s bloodstream to their cells. The body then uses the insulin in the cells for energy.

Insulin also helps store glucose in the liver and helps control how the body metabolizes carbohydrates, proteins, and fats.

Insulin helps keep blood sugars in a healthy range and ensures a person’s body is provided with sufficient energy.

The most common results of insulin insufficiency are type 1 diabetes and type 2 diabetes.

They are several different types of insulin therapy available. They are:

• rapid acting
• short acting
• intermediate acting
• long acting

Medical professionals prescribe an insulin treatment that works best for a particular individual. Sometimes a combination therapy involving insulin injections and non-insulin oral medications are used.

Tal said people with diabetes need to be vigilant in managing their condition.

“For individuals with prediabetes or type 2 diabetes, focusing on lifestyle changes is essential,” Tal said. This includes:

• maintaining a healthy diet
• exercising regularly
• monitoring blood glucose levels

“Early intervention and adherence to prescribed medications are also critical for effective management of the condition. Staying informed about new treatment options and discussing them with healthcare providers can help in making well-informed decisions regarding disease management,” Tal continued.

“Regular check-ups and personalized care plans tailored to individual needs contribute to better overall management and improved health outcomes. For patients using insulin, it is particularly important to be aware of hypoglycemic symptoms and to have strategies in place to prevent and address them,” she concluded.

Basina had similar advice: “Healthy lifestyle, diet, and exercise are all extremely important for prediabetes individuals to prevent conversion into clinical insulin,” she said. “For individuals with type 2 diabetes, take care of diabetes from the start. It is easier to prevent the complications than treat them if they develop.”

Takeaway

Eli Lilly says phase 3 clinical trials indicate that its new weekly insulin injections were as effective as daily injections in managing A1C levels in people with type 2 diabetes.

About 8 million people in the United States with type 2 diabetes need to take insulin on a regular basis.

Experts say a weekly injection could make managing the disease easier for people with the condition and improve their overall quality of life.

On the roof of a UK Health Security Agency (UKHSA) lab, at Chilton’s Harwell Science Campus in Oxfordshire, a new chapter in artificial intelligence (AI) and pollen monitoring is unfolding. In this blog post we’ll explore how our team of Toxicologists are working to better understand and monitor what we’re breathing in and how this may impact our health.

• TikTok’s viral “blackout challenge” (also known as the “choking challenge) is responsible for at least one death this year.
• The challenge encourages viewers to asphyxiate themselves until they lose consciousness.
• Asphyxiation is incredibly dangerous and can lead to permanent brain damage and death in less than five minutes.

Following the death of her son, a mom is warning others about the “blackout challenge” (also known as the “choking challenge”), a dangerous viral TikTok trend.

In an editorial for Huffpost, Joann Bogard describes the tragedy of losing her son Mason in 2019. Like other kids his age, he’d shown an interest in social media “challenges.” Challenge videos encourage social media users to copy an activity from social media and then perform it themselves, posting the video for all to see. Many can be relatively innocuous, but some are far more dangerous.

The “blackout challenge,” which encourages individuals to asphyxiate themselves to the point of losing consciousness, falls into the latter. It is extremely dangerous. Mason lost his life after attempting the challenge and accidentally choking himself to death. Now Bogard is helping other parents to become better educated about social media and online trends.

“What worries me most today is that what happened to Mason and our family can happen to anyone — and has happened to others. Families are desperately seeking answers on how to protect their children online,” she wrote for Huffpost.

What is the “blackout challenge?”

The “blackout challenge,” or “choking challenge,” is an online challenge proliferated through social media apps such as TikTok that encourages viewers to asphyxiate themselves until they lose consciousness. The loss of consciousness is believed to be associated with a “high” or feeling of euphoria. Challenge videos may be particularly appealing to teens and adolescents.

Unlike other dangerous trends that have come and gone over the years, such as the Tide pod challenge, variations of challenges related to asphyxiation tend to crop up every couple of years.

“This is a trend that seems to come of age with each progressive generation,” said Mary Beth Howard, MD, MSC, a Pediatric Emergency Medicine Physician at Johns Hopkins Children’s Center.

“It’s very dangerous to begin with, and the other issue at hand is that we have social media and these very powerful algorithms that are propagating these very dangerous behaviors,” she said.

Benjamin Morse, BA, a Visiting Lecturer in New Media and social media expert at the University of Nevada, Las Vegas, told Healthline, “These trends take off, and they accelerate at such a speed that something tragic can happen before a parent is even aware of what their kids are watching.”

The dangers of asphyxiation

Asphyxiation is extremely dangerous and can quickly lead to brain damage and death. There is also the added risk that an individual may take part in the “blackout challenge” by themself, without any form of supervision, greatly increasing the danger.

“When you deprive the brain of oxygen and you go unconscious, that’s it, you’re not able to stop the event,” said Marla Levine, MD, an Associate Professor of Clinical Pediatrics and Director of Emergency Medicine at Vanderbilt University Medical Center.

“You have a brief period of time where you can then reestablish blood supply or oxygen to your brain to prevent cerebral death,” she said.

Asphyxiation leads to a condition known as cerebral hypoxia, literally depriving the brain of oxygen.

The brain can be deprived of oxygen with as little as 4.4 pounds of pressure and can cause loss of consciousness in just ten seconds. When hypoxia begins, permanent brain damage can occur within just four minutes. Brain death can occur within five minutes of hypoxia.

“We’re not talking about a long period of time here,” said Levine.

There are also no hard rules for how asphyxiation may affect one individual to the next.

“Everyone’s response to these challenges is variable. So someone could pass out within seconds, someone may take closer to a minute,” said Howard. That variability makes the challenge even more dangerous since an individual may lose consciousness much faster than they anticipate.

Other dangers from asphyxiation include:

• Damaging the larynx, tissue, and blood vessels of the neck.
• Heart attack and cardiac arrest
• Aspiration (vomit in the airways)

If an individual is asphyxiating and has lost consciousness, immediately contact emergency services such as 911.

How to talk with adolescents about social media trends

Speaking to a child about social media and dangerous online challenges may not be easy, but prevention should be a top priority for all parents.

How parents, companies, and lawmakers monitor and regulate social media can be a thorny issue. While some advocate for greater responsibility and censorship from social media companies themselves, Morse recommends a more pragmatic approach.

“Waiting for the platforms to do the work is not going to happen,” he said.

Instead, he recommends parents actively engage with the platforms and apps that their children are using and set appropriate boundaries.

“If your kids are on TikTok, you need to be on TikTok. I know that’s not a fun answer for parents, but you need to understand what your kids are doing,” he told Healthline.

“It’s so incredibly important that parents are vigilant in having conversations with their children and vigilant about what they’re consuming in social media,” said Levine.

The bottom line

A dangerous social media trend known as the “choking challenge,” which encourages viewers to asphyxiate themselves until they lose consciousness, has resulted in at least one death.

Asphyxiation can result in brain damage and death in as little as four minutes.

Parents are encouraged to have open and informed conversations with their children about social media to help set safe boundaries.