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• Evidence from a large U.S. study indicates that multivitamin supplements do not improve mortality risk.
• Individuals taking a multivitamin supplement actually had a slightly higher mortality risk than those who did not.
• Multivitamins are taken by roughly one in three US adults, but their health benefits are not well established.

Daily multivitamins are some of the most popular supplements in the United States, but they may not actually make you healthier.

An estimated one-third of US adults take a multivitamin. Consumer spending on them amounts to about 8 billion dollars annually, roughly one-seventh of all dollars that go towards supplements. Of course, the appeal of getting all your necessary vitamins and minerals in one pill per day is alluring. Adults report taking multivitamins to maintain health and fitness and to prevent chronic disease. 

However, evidence, or, more accurately, a lack of evidence, has been mounting for some time that daily multivitamins may not provide consumers with any real protective benefit when it comes to chronic conditions like heart disease and cancer.

In fact, for healthy individuals, a multivitamin may provide no benefit at all. 

In a large study involving nearly 400,000 US adults without a history of chronic diseases over a follow-up period of more than 20 years, those taking a daily multivitamin showed no improvement in mortality risk compared to those who did not.

In fact, those who were taking the supplement demonstrated a slightly increased (4%) mortality risk. The average age of participants was 61.5.

The findings, from researchers at the National Cancer Institute, were published in JAMA Network Open.

Erikka Loftfield, PhD, a researcher in the Division of Cancer Epidemiology & Genetics at the National Cancer Institute, and first author of the study, told Healthline, “To date, there has been insufficient evidence to determine the benefits and harms of MV use…Leveraging data from three large and geographically diverse US cohorts with repeat assessments of MV use and extended follow-up for mortality outcomes, we aimed to evaluate the association of MV use with leading causes of chronic disease-related death.”

No mortality benefit from multivitamin

Loftfield and her team utilized three separate cohorts for their study, totaling 390,124 generally healthy US adults, with follow-up data of about 20 years.

The study’s size and length are two of its greatest strengths. However, it is observational in nature, meaning that, unlike a controlled trial, it does not demonstrate causality between two events — in this case, taking a multivitamin and death. Instead, it helps to form a picture of any associations between these events at a large scale in the real world.

Part of the difficulty of conducting a study of this nature is the sheer volume of data to sort through and the potential for confounding. For example, the study discusses two distinct problems they had to control for in their data: the “sick user effect” and the “healthy user effect.”

There is a concern that health outcomes related to multivitamin use are misleading because of the demographics using them. The “sick user effect” refers to the possibility that individuals who are sick may more frequently use multivitamins due to their health condition.

On the other hand, the “healthy user effect” is the opposite: individuals who already live a healthy lifestyle may be more inclined to use a multivitamin as part of their routine than those who are less health conscious. Without proper controls in place, these effects could lead a researcher to two opposing conclusions about the effects of multivitamins on mortality risk.

Loftfield told Healthline that they were able to control for these distinct effects, by adjusting for lifestyle factors like smoking, diet, and physical activity. They also excluded individuals with major chronic diseases, including cancer, at baseline to account for the “sick user effect.”

Ultimately, after controlling for all these factors, they found that those taking a multivitamin did not have a lower risk of all-cause mortality than those who did not. Nor did they observe any benefits related to specific health outcomes, including cancer, heart disease, and stroke.

The findings are in line with prior research, including recommendations made by the US Preventive Services Task Force in 2022 and 2014, which said there was little to no benefit in taking them.

Dr. Parul M. Goyal, MD, an Associate Professor of Medicine and Director of Medicine for Seniors at Vanderbilt University Medical Center who wasn’t affiliated with the study, told Healthline the results were not surprising.

“The patients that they enrolled are all patients without any chronic medical conditions. Essentially, they’re all healthy patients. Typically, if you are a healthy individual, and you are exercising, you’re eating a regular diet, you’re consuming your fruits and vegetables, you are getting your regular intake of vitamins and supplements,” she said.

Goyal notes that there are some individuals who would likely benefit from a multivitamin supplement, including those with anemia, diabetes, and postmenopausal women. She encourages patients to speak with their healthcare professional before taking a multivitamin.

Do dietitians recommend taking a multivitamin supplement?

Healthline spoke to two registered dietitians to hear their recommendations about eating a healthy diet and taking multivitamin supplements.

“My recommendations for patients are always personalized. In my practice at the Cleveland Clinic, a recommendation to take or skip a multivitamin is based on many factors, including the patient’s current health, dietary pattern, other supplements being taken, and personal health goals. An MVI is not insurance [from] an unhealthy dietary pattern,” said Kristin Kirkpatrick, MS RD, a registered dietitian at the Cleveland Clinic and co-author of Regenerative Health.

Alyssa Kwan, MS, RD, a Clinical Dietitian in Cardiology at Stanford Medicine, told Healthline, “I do not generally recommend a multivitamin for those following a healthy diet and eating well-balanced meals…I will only recommend one if patients are not nutritionally meeting their nutrient needs or have a poor diet at baseline. Maybe their appetite is really poor or they are just not able to meet everything via diet alone, then I would recommend supplementing with a multivitamin.”

Like Kirkpatrick, Kwan also cautions that a multivitamin should not be taken to cover unhealthy “choices of foods that are not nutritionally dense.”

The bottom line

In a large observational study involving nearly 400,000 US adults over 20 years, taking a daily multivitamin did not lower mortality risk overall, nor for specific chronic conditions like cardiovascular disease and cancer.

Multivitamins are among the most popular supplements on the market, taken by roughly one in three US adults. Despite their popularity, their health benefits are not well established.

Experts interviewed by Healthline say that if you eat a healthy diet, taking a multivitamin is not recommended. Always speak with your healthcare provider before starting or stopping taking a nutritional supplement.

• People who were treated with the GLP-1 drug liraglutide and did an exercise program lost weight and body fat but were able to preserve their bone health.
• Both liraglutide and exercise helped people maintain weight loss, but exercise minimized the loss of bone density.
• Other research shows that certain types of exercise can strengthen bones, even in people not trying to lose weight.

Losing weight can help people who are living with obesity or overweight and reduce their risk of type 2 diabetes, sleep apnea, heart disease, and other health issues. But weight loss can also lead to bone loss.

This is a concern as more people are taking GLP-1 receptor agonists such as Ozempic, Wegovy, and Zepbound to help them lose weight.

“Bone mineral density should be a serious consideration, given that we reach our peak bone mass by age 30 and then start to lose bone mass as we move beyond our 30s,” said Jennifer Sacheck-Ward, PhD, a professor of prevention and wellness at George Washington University’s Milken Institute School of Public Health.

“If taking GLP-1 receptor agonists accelerates this loss, then we will have more individuals who are at increased risk of serious fractures, and at younger ages,” she told Healthline.

New research, though, suggests that exercise can help preserve bone health in people being treated with a GLP-1 drug.

In the study, researchers found that people who were treated for a year with liraglutide (sold under the brand names Saxenda and Victoza) and did a program of moderate- to-vigorous-intensity exercise had similar changes in bone mineral density as those who didn’t undergo any treatment.

This was despite people in the combination liraglutide and exercise group losing more weight than people treated with liraglutide alone or exercise alone.

The study was published June 25 in JAMA Network Open.

GLP-1 drugs and bone density

The study was carried out from 2016 through 2019 in Denmark. It included 195 people ages 18 to 65 who were living with obesity but not diabetes. The average age of participants was 43, and nearly two-thirds were female.

Participants first followed a low calorie diet for 8 weeks, which provided 800 calories per day.

In general, adults not trying to lose weight need around 1,600 to 3,000 calories per day, although this varies depending on factors such as age, sex, size and activity level.

Next, researchers randomly assigned people to one of four groups for 52 weeks: a moderate- to vigorous-intensity exercise program, daily injections of liraglutide, a combination of exercise and liraglutide, or the non-treatment (placebo) group.

Participants underwent DEXA scans to measure bone mineral density in their hip, lower spine and forearm. These scans were done before people started the low-calorie diet and again at the end of the 52-week treatment period.

On average, participants lost 29 pounds while on the 8-week low calorie diet. During the 52-week treatment period, people in the placebo group regained weight and lost 15 pounds overall.

Those in the exercise and liraglutide groups maintained their weight loss (25 to 30 pounds overall), and people in the combination group lost additional weight (37 pounds overall).

The combination group also had larger amounts of fat loss compared to the other groups.

In addition, the groups saw different changes in bone mineral density. In the combination exercise and liraglutide group, bone mineral density in the hip and lower spine was similar to the placebo group — meaning this group maintained bone health.

The liraglutide group saw a greater decrease in bone mineral density in the hip and lower spine compared to the exercise group. This suggests that exercise can help prevent bone loss.

Also, both the exercise and combination groups saw an increase in bone mineral density in the forearm.

One limitation of the study is that researchers excluded people over age 65 and those with other chronic health conditions. Thus, the researchers write that the results may not apply to people with diabetes or older adults.

Exercise is recommended for better bone health

Spencer Nadolsky, DO, an obesity and lipid specialist and medical director of WeightWatchers, said loss of bone mineral density is always a concern when intentionally losing weight.

But “I wouldn’t be concerned about GLP-1 medicines causing more than expected losses in bone densities with the amount of weight lost,” he told Healthline. 

“Having said that, I always recommend resistance training for those who are trying to intentionally lose weight in order to minimize bone loss,” he said. 

This is particularly true for people using a GLP-1 drug because they are so effective at helping people lose weight, he said. He also pointed out that newer GLP-1 drugs, such as semaglutide and tirzepatide, are even more effective at promoting weight loss.

The new study’s results fit with other research showing that exercise can help preserve bone health in people who lose weight by cutting calories. In particular, heavy resistance or high impact exercise may have the largest effect on bone health.

Sacheck-Ward said the new study shows that there is a healthy way to lose weight with the use of GLP-1 drugs while preserving bone health.

However, she still has some concerns, “given the reality that the majority of Americans do not engage in the amount of physical activity recommended by the Physical Activity Guidelines for Americans,” she said.

She also pointed out that people in the exercise group lost a similar amount of weight as those in the liraglutide group — but the exercise group maintained their bone mineral density. 

“This should be a serious consideration, especially given the natural loss of bone mass as we progress past our 30s and 40s and with bone fractures posing a significant risk for mortality in older age,” she said.

“Why not choose exercise then, without the side effects [of a GLP-1 drug], and with the bigger bang for our buck on many aspects of our health?” she said.

Takeaway

In a new study, participants followed an 8-week low-calorie diet to lose weight. This was followed by 52 weeks of one of four interventions: treatment with the GLP-1 drug liraglutide, an exercise program, a combination of liraglutide and exercise, or a placebo group.

The combination group lost the most weight and body fat over the course of the study but had similar changes in bone mineral density to those who didn’t undergo treatment.

Both exercise and liraglutide alone led to similar amounts of weight loss, but the liraglutide group had larger amounts of bone loss. Other research shows that certain types of exercise can strengthen the bones.

• The FDA has granted accelerated approval to a novel drug for the treatment of a rare autoimmune disease that damages the liver.
• Primary biliary cholangitis (PBC) occurs when the immune system attacks the bile ducts, leading to liver damage and other serious health outcomes.
• Treatment options for PBC are limited and frequently not well-tolerated by patients.

The U.S. Food and Drug Administration(FDA) has just approved a first-in-class drug for the treatment of a rare autoimmune liver disease.

On June 10th, the FDA granted accelerated approval to the drug Iqirvo (elafibranor) to treat primary biliary cholangitis (PBC).

PBC is a rare autoimmune liver condition in which the small bile ducts in the liver are inflamed and damaged, causing bile and toxins to build up.

As the bile collects in the liver, it damages the surrounding tissue, which can lead to severe health problems like cirrhosis of the liver and destruction of the bile ducts.

Prior treatment options for PBC were limited and frequently not well-tolerated by patients. The definitive treatment for PBC requires a liver transplant. Experts say the approval of Iqirvo will meet a currently unmet need and help to expand options for patients.

“This is an exciting time for new therapies for the treatment of PBC. I am optimistic that the approval of elafibranor will allow more patients with PBC to have an improved prognosis as there will be additional options to provide for second line therapy to help achieve biochemical remission,” Aparna Goel, MD, a Clinical Associate Professor of Medicine, specializing in gastroenterology and hepatology at Stanford Medicine, told Healthline.

How does Iqirvo work?

Iqirvo helps to treat PBC through several pathways, including promoting bile acid transportation, modulating bile production, and decreasing inflammation.

“Iqirvo is the first treatment advance for PBC in 8 years and is the very first in a new class of medicines called PPARs. PPARs are designed with the aim of targeting the underlying PBC disease,” a representative for Ipsen Biopharmaceuticals, the developer of Iqirvo, told Healthline.

The FDA granted the drug accelerated approval following a promising phase 3 trial, the results of which were published in the New England Journal of Medicine in November, 2023.

That trial involved 161 patients who had inadequate response to or unacceptable side effects with ursodeoxycholic acid, the current primary treatment for PBC. 

“First line treatment for PBC is ursodeoxycholic acid. This has been the standard of care for many years. However, at least 60% of patients are either intolerant to or have an incomplete response to ursodeoxycholic acid,” said Goel.

About 67% of the patients in the trial received Iqirvo, while the rest received a placebo. After 52 weeks, half the individuals taking Iqirvo achieved a “statistically significant treatment benefit,” compared to only 4% of those taking the placebo.

Patients taking Iqirvo did experience some side effects during the trial. The most common side effects included abdominal pain, diarrhea, nausea, and vomiting.

Rhabdomyolysis, a serious and potentially fatal muscle-wasting disease, occurred in one individual taking Iqirvo.

“It will be important to monitor for any signs of muscle injury (rhabdomyolysis ) and kidney function as patients are started on this medication. As with any new medication, the long-term safety and efficacy will need to be carefully monitored,” said Goel.

What to know about the autoimmune disease primary biliary cholangitis

PBC is a rare autoimmune disease. According to the latest statistics from the National Institutes of Health (2014), PBC affects about 58 in every 100,000 women and 15 in every 100,000 men in the United States. However, like other rare diseases, the exact number of people who have PBC isn’t entirely clear. Like other autoimmune conditions, PBC is also far more common in women than in men.

Overall, women account for about 80% of all cases of autoimmune disease.

In individuals with PBC, the immune system mistakenly attacks the bile ducts of the liver, causing inflammation and damage. Bile is an acidic fluid formed in the liver that is used in digestion. It is transported by the bile ducts to other organs like the small intestines where it can be used to break down food material. 

Damaged bile ducts can not effectively transport bile, a condition known as cholestasis. As bile builds up in the liver, it can cause scarring (fibrosis), which can lead to irreversible, advanced cirrhosis. A patient may eventually require a liver transplant due to chronic liver damage.

PBC can be hard to diagnose as it begins with mild symptoms, including tiredness and itchy skin. As it progresses, other more severe symptoms like abdominal pain and joint pain may develop. In its final stages, highly visible symptoms may occur like darkening of skin color, the presence of fatty deposits under the skin, and jaundice. 

The cause of PBC is still not well understood, but is believed to be the result of a combination of genetic and environmental factors that lead to the development of an autoimmune condition.

“Several environmental triggers have been associated with ‘activating’ the disease including toxins, viruses and several bacteria. As knowledge of the disease increases, appropriate recognition and testing of the disease is also increasing which is likely to change the prevalence estimates,” said Goel.

The bottom line

This month, the FDA granted accelerated approval to Iqirvo (elafibranor) for the treatment of primary biliary cholangitis (PBC).

PBC is a rare autoimmune disease in which the bile ducts are damaged, leading to inflammation and scarring of the liver.

Current treatment options for PBC are limited and often not well-tolerated. Experts say the new medication is promising, but will need to be monitored for continued safety.

• Certain types of medications can make people more prone to heat-related illness.
• These include diuretics, beta-blockers, anticholinergics, and antipsychotics.
• They can cause dehydration, a lack of sweating, and problems regulating temperature.
• It’s important to keep cool and drink plenty of water during hot weather.
• If you experience symptoms of heat-related illness, seek medical assistance right away.

While the hotter summer months can represent fun in the sun for many of us, a heatwave can turn deadly for others, especially if they are using certain types of medications.

Medications that are commonly used to treat high blood pressure, heart conditions, allergies, and mental health disorders, among others, may put you at risk for being sensitive to high temperatures.

If you aren’t careful, you could develop heat exhaustion or heat stroke. Heat stroke, which is the more serious of the two, can lead to permanent disability or even be fatal. Both require immediate first aid.

Medications that can make you more sensitive to heat

Sazan Sylejmani, PharmD, an experienced Pharmacy Manager and owner of Westmont Pharmacy, told Healthline there are four important types of medications that can increase your sensitivity to heat.

The first of these is diuretics, which are medications that increase how much you urinate. You might also have heard them referred to as “water pills” since they help eliminate fluid retention in your body.

Diuretics are often used to treat high blood pressure and other cardiovascular conditions since they can reduce the amount of fluid in your blood vessels, leading to less pressure against their walls.

According to Sylejmani, some common examples of diuretics are furosemide and hydrochlorothiazide.

Another type of medication that can make you more sensitive to heat is beta-blockers.

Since they help the heart beat more slowly and with less force, these medications are most often used to treat irregular heartbeat and high blood pressure, but they have a range of other applications, including the treatment of anxiety disorders.

Some common examples, per Sylejmani, include metoprolol and propranolol.

A third type of medication he mentioned was anticholinergics.

These drugs work by blocking the action of acetylcholine, making them useful in treating conditions like overactive bladder, incontinence, and chronic obstructive pulmonary disease.

Oxybutynin and benztropine are examples of anticholinergics.

Finally, Sylejmani spoke about antipsychotics.

Antipsychotic medications are used to treat schizophrenia and other mental health conditions since they are capable of targeting certain neurotransmitters in the brain.

He listed risperidone and olanzapine as two medications belonging to this class.

How these medications can put you at increased risk

Dr. Paunel Vukasinov, who is with Medical Offices of Manhattan and is a contributor to LabFinder, explained that the ways these medications put you at risk during hot weather really comes down to three things.

“These medications can impact the body’s ability to regulate temperature, impact the body’s ability to sweat, or lead to worsening dehydration,” he said.

When it comes to diuretics, which cause you to shed excess fluid, if you are also sweating a lot, he said this “can worsen [dehydration] by further removing sodium and water from the body which can lead to complications including low blood pressure and even passing out.”

Sylejmani added that the problem with beta-blockers is they reduce the heart’s ability to pump blood. This can impair your body’s natural ability to dissipate heat and cool itself.

Regarding anticholinergics, Vukasinov said they affect your ability to sweat.

“[T]he core body temperature can rise, which can be further exacerbated by hot weather conditions,” he stated.

Sylejmani further explained that antipsychotics can interfere with our body’s ability to regulate its own temperature, putting people at risk.

How to minimize your risk during a heatwave

“By understanding the interplay between medications and hot weather, patients can better manage their health and minimize risks associated with extreme heat,” said Sylejmani.

He suggests taking the following steps in order to play it safe when temperatures soar:

• Stay hydrated. Drink plenty of fluids, especially water. If you’re taking medication, talk with a healthcare professional for an individualized fluid intake recommendation. “Avoid alcohol and caffeine as they can further dehydrate you,” said Sylejmani.
• Wear lightweight, loose-fitting clothing. This will allow air to reach your body and evaporate your sweat, allowing you to cool off.
• Stay in cool, shaded, or air-conditioned areas as much as possible. If you don’t have an air conditioner at home, the U.S. Centers for Disease Control and Prevention suggests checking with your local health department to see if there are shelters in your area. Malls or public libraries can also be safe spaces to seek refuge from the heat.
• Monitor yourself for signs of heat-related illness. These include excessive sweating, confusion, dizziness, or headaches. “[S]eek medical attention if symptoms appear,” Sylejmani advised.
• Consult with your doctor about adjusting your medication. “They might adjust dosages or advise timing the medication differently to reduce risks,” he said.

Takeaway

When temperatures rise during the summer, it can put people who use certain medications at risk.

Medications like diuretics, beta-blockers, anticholinergics, and antipsychotics, in particular, may be problematic.

These types of medications can cause dehydration, lack of sweating, or problems with regulating body temperature, which puts people at risk for heat exhaustion and heat stroke.

Experts say it’s important to keep your environment cool, drink lots of fluids, and seek medical assistance if you experience any of the warning signs of heat-related illness, including excessive sweating, confusion, dizziness, or headaches.

You may also need to speak with your physician about making adjustments to your medication during the hotter months of the year.

• People are chewing ‘Facial Fitness Gum’ in the hope it will give their jaws a more chiseled and defined appearance. 
• Chewing gum companies claim it allows them to tighten muscles. However, there’s little evidence to suggest it works. 
• Experts say excessive chewing could actually make your jaw appear more square-like and bulky 
• Aesthetic options are one way to achieve noticeable results; however, teen boys should remember that their bone structure is likely to change as they age. 

Facial fitness gum is the latest in a long line of bizarre beauty trends gaining popularity on social media platforms like TikTok, and companies are capitalizing on the craze.

Brands like Rockjaw, Jawz Gum, and Stronger Gum are claiming their products can help “build the most attractive jawline” and “tone and tighten 57+ facial and neck muscles, anytime, anywhere.”

They claim that chewing these products is akin to a facial workout, as facial fitness gum is tougher than regular gum. 

The popularity of these products, particularly among teen boys, is related to the “mewing” trend, which involves placing your tongue on the roof of your mouth to tighten the jaw muscles. 

It’s also associated with “looksmaxxing,” the process of “maximizing” your looks so they more closely align with conventional beauty standards.

However, health experts say there’s little evidence to suggest that facial fitness gum actually works.

Why chewing gum isn’t likely to change the appearance of your jawline

Dr. Kieren Bong, cosmetic doctor and founder of Essence Medical Cosmetic Clinic, isn’t surprised by these claims but isn’t sold on their effectiveness. 

“As a doctor, I find the claim that chewing gum defines the jawline oversimplified. While chewing gum can engage the jaw muscles, any resulting definition is likely minimal and varies between individuals,” he explained. 

“It’s unsurprising that this claim is trending, given the public’s fascination with easy, noninvasive beauty solutions promoted on social media,” Bong added. “However, it’s essential to rely on scientifically backed methods for significant changes in appearance rather than quick fixes with limited evidence.” 

Likewise, Dr. Joel Kopelman, a facial plastic surgeon at Kopelman Aesthetic Surgery, says these claims should be approached with skepticism. 

“Facial aesthetics are complex, and significant changes typically require more than just chewing gum,” he said. 

The reasoning behind facial fitness gum? 

“The trend is built on the concept that repetitive chewing motions can strengthen the muscles of the jaw and face, particularly the masseter muscles,” Kopelman explained. “Proponents argue that increased muscle tone in this area can create a more chiseled appearance.” 

Bong compared it to how other parts of the body become more defined with regular exercise but notes that the impact on overall jawline definition is likely minimal.

Limited research supports the effectiveness of facial fitness gum

Research on the effectiveness of chewing gum for a more defined jawline is limited and inconclusive. 

Bong said most scientific studies focus on chewing gum’s general benefits, such as improved concentration, stress relief, and oral health, rather than its impact on facial aesthetics. 

“Relying on chewing gum alone is not supported by robust scientific evidence and may lead to unrealistic expectations,” he said. 

Kopelman agreed. 

“Research in this area is sparse, and most of the claims are anecdotal rather than based on robust scientific data,” he said. “Strengthening the masseter muscles through chewing might result in some hypertrophy, but it’s unlikely to produce the dramatic changes some might expect.” 

Ultimately, Kopelman said the primary reason chewing gum is unlikely to yield a more defined jawline is that facial aesthetics are influenced by a combination of bone structure, skin quality, and fat distribution, not just muscle tone.

“While chewing gum might strengthen the masseter muscles, it won’t change the underlying bone structure or significantly reduce facial fat,” he said. 

Additionally, he warned that excessive chewing can lead to overdeveloped masseters, which might not be aesthetically desirable and can sometimes lead to a more square or bulky jaw rather than a defined one.

How to achieve a more defined jawline 

Both experts agreed that chewing gum is unlikely to give you a defined jaw, but what are there more effective ways to achieve this result? 

Kopelman said lasting and significant changes in facial aesthetics often require more than simple at-home remedies.

However, there are a few things you can do. 

You shouldn’t underestimate the importance of a healthy diet and exercise.

“Maintaining a healthy diet and regular exercise routine can reduce overall body fat, including facial fat, contributing to a more defined jawline,” Kopelman said. 

Taking good care of your skin is another way to achieve a tauter appearance. “Proper hydration and skin care routines can improve skin elasticity and firmness, contributing to a more defined look,” says Bong. 

These habits may trigger subtle changes. However, it’s difficult to achieve noticeable results without aesthetic interventions. 

Kopelman says noninvasive treatments like Ultherapy or radiofrequency can help tighten the skin around the jawline. 

Meanwhile, the strategic use of dermal fillers can enhance the jawline by adding volume and definition.

A popular choice is Botox.

“Botox injections can slim the jawline by reducing the size of the masseter muscles, especially in individuals with hypertrophic masseters,” Kopelman explains. 

While aesthetic treatments are the most effective option, they are likely not the right choice for teen boys whose features are still developing. 

It’s also important to note that the legal age for dermal fillers and Botox in the United States is 18. 

Takeaway 

Very limited research supports the claim that chewing gum gives you a more chiseled jawline.

In fact, experts say excessive chewing could have the opposite effect, making your jaw appear more square or bulky. 

Facial exercises and aesthetic treatments are effective ways to add definition to your jawline. However, it’s important for teen boys to remember that their bone structure is likely to change as they age.

• A study compared 5:2 intermittent fasting, done with meal replacements, to diabetes medications for the treatment of type 2 diabetes.
• People who did intermittent fasting lost more weight and saw greater improvement in blood glucose control.
• The 5:2 intermittent fasting diet involves eating 25% of your usual calories on two nonconsecutive days each week, and eating regularly the rest of the week.

A new study finds that intermittent fasting with low-calorie meal replacements may be an effective way for people with type 2 diabetes to lose weight and control blood sugar levels, compared to standard diabetes medication.

For people with type 2 diabetes, especially those with a recent diagnosis, losing weight may help improve their blood glucose (sugar) levels and reduce the need for diabetes drugs such as metformin.

However, maintaining weight loss with diet alone can be challenging.

In the new study, researchers found that combining these two dietary interventions may make it easier.

The study was published June 21 in JAMA Network Open.

Researchers found that people recently diagnosed with type 2 diabetes who did intermittent fasting using meal replacements lost more weight over 16 weeks compared to people who received standard diabetes medication.

Those who did intermittent fasting also saw greater improvements in their hemoglobin A1c (HbA1c or A1C) levels, a measure of blood glucose control.

Michael J. Wilkinson, MD, a cardiologist and assistant professor of medicine at UC San Diego Health, said the results seen in the study with intermittent fasting and meal replacements were impressive.

However, he pointed out that this was not simply a study of intermittent fasting. On the two fasting days per week, participants consumed a lower-calorie meal replacement, which ensured they ate fewer calories.

“The content of what was supplied in those meal replacements is important to the results,” said Wilkinson, as is the nutrition and exercise counseling that all participants received throughout the study. This combination of [approaches] may explain why people saw greater changes in weight and HbA1c compared to other studies, he said.

Intermittent fasting vs. diabetes drugs

The new study included 405 adults in China who were overweight or had obesity and were recently diagnosed with type 2 diabetes. Almost two-thirds of participants were men, the average age was 46 years old and the average HbA1c level was 7.9%. 

An HbA1c level of 6.5% or higher is in the diabetes range. Most people with diabetes aim to keep their HbA1c below 7%.

Researchers randomly assigned participants to be treated with a diabetes medication — either metformin (Glucophage) or empagliflozin (Jardiance) — or to follow an intermittent fasting plan for 16 weeks. Overall, 332 people completed the 16-week treatment.

All participants received guidance every 4 weeks from nutritionists and research staff about eating healthy and exercising regularly.

Researchers continued to monitor participants for 8 weeks after the treatment period. This included measuring HbA1c, body weight, waist and hip circumference, blood pressure and other metabolic markers.

People assigned to the intermittent fasting plan fasted for two nonconsecutive days per week, and mostly ate their usual foods and amounts on the other days — what’s known as 5:2 intermittent fasting.

To control the amount of calories and nutrients that people ate on fasting days, researchers provided participants with prepackaged meal replacements. People ate about one-quarter of their usual calories on those days — 500 calories for women and 600 calories for men.

Vicky Pavlou, RDN, a registered dietitian and doctoral student at the University of Illinois Chicago told Healthline that the approach used in the study is not a “true” 5:2 intermittent fasting diet.

Participants also ate a meal replacement for dinner on their non-fasting days and were asked to count their calories. Usually, people are allowed to eat whatever they want on non-fasting days, she said, which is simpler and easier to stick with.

“In general, the point of intermittent fasting is to give people really simple instructions,” she said, “as an alternative to counting their calories, which can be burdensome for people.”

Improvements in blood sugar and weight

Researchers found that after 16 weeks, people following the intermittent fasting diet had greater improvements in certain measures.

People who did intermittent fasting lost an average of 21 pounds over 16 weeks, versus 12 to 13 pounds for those receiving one of the diabetes medications.

The intermittent fasting group also saw significant reductions in waist and hip circumference and systolic and diastolic blood pressure.

In addition, in the intermittent fasting group, HbA1c decreased by 1.9%, compared to a decrease of 1.6% in the metformin group and a decrease of 1.5% in the empagliflozin group.

According to the American Diabetes Association, people with type 2 diabetes who maintain an HbA1c of 6.5% or lower for at least 3 months are considered to be in diabetes remission.

In the new study, 80% of people in the intermittent fasting group met this target at the end of 16 weeks, with 77% still at that level after the 8-week follow-up. A longer follow-up would be needed in order to confirm that they met the American Diabetes Association’s definition of remission.

Longer and more diverse studies needed

Wilkinson said one of the strengths of the study is its duration, although he thinks additional studies are needed with an even longer follow-up.

“With drugs like metformin and empagliflozin, the expectation is that these are long-term, maybe lifetime, therapies,” he said. “So if we’re comparing those to 5:2 intermittent fasting with meal replacement, the expectation is that it’s a long-term intervention.”

For that to work, “we need to have a better understanding of the long-term adherence and also the long-term safety [of intermittent fasting],” he said.

In particular, the meal replacements would need to provide all the necessary vitamins, minerals and other nutrients, he said. Studies might also need to monitor people’s health and body composition — such as lean muscle mass — to see if long-term use of meal replacements is safe, he added.

Pavlou said if you are only replacing one meal with a meal replacement — versus using them for every meal — it is less of a concern that someone would fall short on their nutrients.

In addition, the meal replacements she uses in the clinic are designed to provide a full range of nutrients and to be safe for regular use over several months. Still, people prescribed meal replacements long-term are regularly monitored by their doctor, she said.

Another concern that Wilkinson raised about the new study is that participants were all diagnosed with diabetes within the past year and had not used diabetes medications in the 3 months leading up to the study. So the results may not apply to other groups of patients.

Colette Knight, MD, chair of the Inserra Diabetes Institute at Hackensack University Medical Center echoed some of his concerns.

“This study focuses on the newly diagnosed patient with diabetes — a group where lifestyle intervention can be very helpful,” she told Healthline. “This [approach] is not for the 20-year diabetic patient.”

In addition, “we need to look at a more diverse population of patients with a longer duration of diabetes,” she said. 

Also, more studies are needed in order to know “what happens when you add this restrictive diet to known diabetes medications that also promote weight loss,” she said.

Intermittent fasting offers a simpler approach

Around 11% of Americans have diabetes, with type 2 diabetes accounting for 90-95% of all cases, according to the Centers for Disease Control and Prevention. 

Risk factors for type 2 diabetes include being overweight or having obesity, having a family history of type 2 diabetes, being physically inactive, and being older than age 45.

Lifestyle changes such as healthy eating and exercise are recommended for people with type 2 diabetes, even for those who are taking a diabetes medication. Diet and exercise alone, though, may not be enough to help people lower their blood glucose level.

Intermittent fasting, though, is designed to make it easier for people to cut back on calories while still getting enough nutrients in their diet.

“There is some research suggesting that intermittent fasting can be an effective strategy for managing type 2 diabetes and prediabetes,” said Knight. “Some studies have also shown that intermittent fasting can lead to improvements in glycemic control, weight loss and other metabolic parameters in individuals with these conditions.”

Similarly, research shows that including meal replacements as part of a lifestyle intervention, without intermittent fasting, can lead to greater weight loss and decreases in HbA1c, compared to other diets or to diabetes education.

In spite of the benefits seen in the new study and past research, there is not yet general agreement among doctors about which people might benefit most from intermittent fasting, Knight said. In addition, “just this one approach may not be enough,” she said.

Other types of intermittent fasting and time-restricted eating methods are also available, which gives people more options. These include:

• 16/8 time-restricted eating: This involves fasting for 16 hours each day and restricting eating to an 8-hour window.
• Eat Stop Eat: This involves fasting for 24 hours once or twice a week.

“Each has its own advantages and disadvantages,” said Knight. “The best approach for individuals with diabetes depends on their individual preferences, lifestyle and health status.”

Knight recommends that people with diabetes talk to their doctor before starting any intermittent fasting regimen, to ensure it is safe and appropriate for their specific needs.

Takeaway

Researchers randomly assigned people recently diagnosed with type 2 diabetes to 16 weeks of treatment with a diabetes medication or intermittent fasting with meal replacements.

Those in the intermittent fasting group saw greater improvements in their hemoglobin A1c, a measure of blood glucose control, and weight loss, compared to the diabetes medication groups.

Experts say additional research is needed, with longer follow-up and a more diverse population. This includes testing intermittent fasting in people who have had diabetes longer and those taking diabetes medications.

• A recent study focusing on people who recently experienced an episode of low back pain shows that walking can be hugely beneficial.
• Regular walking significantly reduced the risk of future episodes and healthcare visits.
• It also improved their quality of life, sleep, and mood.

Low back pain is incredibly common and notoriously difficult to treat. A new study, however, finds that a simple, cost-effective, highly accessible intervention can make a real difference: walking.

A new paper, which was published in The Lancet on June 19, found that people with low back pain who walked regularly were significantly less likely to experience pain that limited their activity. They also reported improved quality of life.

Participants who walked regularly were half as likely to need time off work or require medical treatment than people in the control group.

Low back pain is incredibly common

Healthline contacted Dr. Tash Pocovi, lead author of the study and a postdoctoral fellow at Macquarie University, Australia.

“​​Working in physiotherapy, it’s incredible to see just how prevalent low back pain is,” she said, “with reports that 620 million people globally reported experiencing low back pain in 2020.”

She explained that, while most scientists focus on treatment, fewer are focusing on prevention. This is important because “7 in 10 people who recover from an episode of low back pain will have a new episode in the next 12 months.”

“While it’s not considered a life-threatening disease, we can see the very serious impacts it can have on people’s lifestyle, ability to work, and overall quality of life,” Pocovi said.

For their study, the scientists recruited 701 people who had recently experienced an episode of low back pain. 

Split into two groups, one acted as the control, and the other embarked on a personalized walking program with six education sessions with a physiotherapist over 6 months. The scientists followed up the participants for 1–3 years.

They found that those in the walking group experienced pain that limited their activity less often than those in the control group. Also, there was a longer gap before they had a recurrence: an average of 208 days compared with 112 days.

Pocovi told Healthline that she was not surprised that walking benefited these people because the intervention “helped get people moving, reduced their fear, and gave them strategies and confidence to self-manage their condition — all of which we know are important.”

However, she was surprised “how much the intervention could impact people’s lives aside from improving their low back pain management.”

“While we were able to reduce the recurrence of low back pain requiring care-seeking by over 40%, we also had patients who reported improved sleep, mood, positive lifestyle changes, and improved management of other chronic health conditions,” she explained. 

“It was very pleasing to see the positive, overall health implications of this intervention,” Pocovi said.

How people with back pain can benefit from walking

We asked Pocovi how much walking might benefit people who experience low back pain.

In their study, the walking plan was individualized based on factors including age, physical ability, preferences, and available time. 

“We gave them a rough guide of gradually building up to 30 minutes, five times a week,” she told us. “After 3 months, most of the people who took part were walking 3 to 5 days each week for an average of 130 minutes per week.”

“We want to see the public walking more, even if this is done independently. However, if you are struggling to get started, you may consider reaching out to a health professional to help.”

Healthline spoke with Neel Anand, MD, an orthopedic spine surgeon and director of the Cedars-Sinai Spine Center in Los Angeles, CA, who was not involved in the study. He added a note of caution:

“While walking is a great total-body cardiovascular exercise that can be especially helpful for people experiencing back pain episodes, be sure not to go too far or for too long if you’re in moderate to severe pain, and make sure that the walking surface is even, without too much uphill or downhill variation to start.”

Why is low back pain so common?

To help make sense of the high prevalence of low back pain, Healthline spoke with Thomas Pontinen, MD. Pontinen, who was not involved in the study, is a double board-certified anesthesiologist, interventional pain management specialist, and chronic pain expert.

Our evolutionary past, he explained, is one of the reasons. “Human beings evolved from animals with horizontal spines.” As we evolved to walk on two legs, “the spine had to adapt.” 

“It is incredibly likely that a lifetime spent using a vertical spine, as we do, will eventually come with drawbacks since the spine has to support most of our weight and all the pressures of movement through life,” Pontinen said.

Other factors, Pontinen told us, include general wear and tear of the discs between the vertebrae with age, injuries, poor posture, a sedentary lifestyle, and obesity.

How to reduce the risk of back pain

Healthline asked Dr. Joel S. Beckett, a board-certified neurological spine surgeon how individuals can reduce their risk of experiencing low back pain.

Beckett, who was not involved in the recent study, practices at DISC Sports & Spine Center in Marina del Rey, CA. He provided these tips:

• Maintain a healthy weight.
• Engage in regular physical activity that includes strengthening and stretching exercises to maintain good core strength.
• Practice good posture.
• Use proper techniques when lifting heavy objects. 
• Avoid prolonged sitting.

In line with the results of the recent study, he told us that “standing and walking is the best activity for our back.”

Takeaway

According to a recent study, walking regularly can reduce the risk of low back pain returning, improve quality of life, and reduce the need to visit healthcare specialists. 

Taking regular walks also improved sleep and mood, and improved the management of other chronic health conditions.

However, as Anand told us, it’s important to wait for the “green light” from your doctor, but “contrary to what some might think, staying immobile or being on ‘bed rest’ after the acute phase of a back pain episode might do more harm than good.”

• GLP-1 drugs have gained popularity over the last few years for their remarkable ability to help people lose weight.
• Doctors are beginning to examine other benefits of this class of drugs, which may help you to live longer.
• In addition to treating diabetes and obesity, research suggests these drugs can also help reduce the risk of a number of additional health issues, such as cancer and cardiovascular disease.

You may not be familiar with GLP-1 agonists, but there’s a good chance you’ve heard of the brand names attached to this class of drugs: names like Wegovy, Ozempic, Mounjaro, and Zepbound.

GLP-1 agonists are drugs that act like your natural GLP-1 hormone, which is a hormone that your body produces when you eat. One of its many functions is to give you the feeling of satiation — or fullness — which is a message to stop eating.

While they can help manage diabetes, these drugs have skyrocketed in popularity due to their ability to help treat obesity, and with good reason. Obesity is a leading risk factor for many diseases that can lead to early death. By treating obesity early, these risks can be reduced and thus increase lifespan.

However, more recent research suggests that these drugs may also help reduce the risk of a number of other health conditions.

While this research is still in its early days, findings suggest these drugs may help people live longer, healthier lives by reducing their risk of the following health conditions.

Cardiovascular disease

“Obesity increases one’s risk of all aspects of cardiovascular diseases including developing blockages in the arteries, having heart attacks and strokes, heart failure, arrhythmias, hypertension, and even increasing the risk of diabetes, which can further contribute to cardiovascular diseases,” said Dr. Janet Wei, a cardiologist with the Barbra Streisand Women’s Heart Center in Los Angeles, CA, in an interview with Healthline.

“I think these drugs are a very big deal. We know how difficult it is to lose weight. Bariatric surgery has a very good track record, but of course, not everyone wants to get surgery,” Wei added.

In the realm of cardiovascular health, there’s enough evidence of GLP-1 agonists’ effectiveness that the FDA approved Wegovy earlier this year to help prevent cardiovascular death, although only for a select population.

“The current class of GLP-1 receptor agonists has been shown in clinical studies to be much more effective for weight loss than traditional lifestyle modifications such as diet and exercise,” Dr. Cheng-Han Chen, board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, told Healthline.

“There is no question that GLP-1 receptor agonists, as they become more popular, have the potential to decrease the tremendous burden of many chronic diseases on our society,” Chen said.

Cancer

“Obesity is a well-established risk factor for several types of cancer, including but not limited to breast cancer (particularly postmenopausal), colorectal cancer, endometrial cancer, esophageal adenocarcinoma, kidney cancer, pancreatic cancer, liver cancer, and gallbladder cancer,” Dr. Wael Harb, board certified hematologist and medical oncologist at MemorialCare Cancer Institute at Orange Coast Medical Center in Fountain Valley, CA, told Healthline.

“Treating obesity can potentially reduce the risk of these cancers. Weight loss has been associated with a decreased risk of several obesity-related cancers. By reducing excess body fat, individuals can lower chronic inflammation and insulin resistance, normalize hormone levels, and improve overall metabolic health, all of which contribute to a lower cancer risk,” Harb explained.

“Given that GLP-1 drugs like Wegovy, Ozempic, and Mounjaro are effective in promoting weight loss and improving metabolic health, it is plausible to hypothesize that these medications could reduce the risk of obesity-related cancers,” said Harb.

Beyond treating obesity to indirectly reduce the risk of cancer, researchers have found some evidence that GLP-1 drugs can help improve the functionality of your body’s natural killer (NK) cells.

“NK cells play a crucial role in the body’s immune response to tumors by recognizing and destroying malignant cells. If GLP-1 drugs can indeed restore or enhance NK cell functioning, this could theoretically enhance the body’s ability to detect and eliminate cancer cells, thereby reducing cancer risk,” said Harb, noting that more comprehensive research is still needed.

Neurological issues

Other research — some older and some newer — has been conducted to study whether GLP-1 drugs might provide benefits for people with Alzheimer’s disease and Parkinson’s disease, respectively.

However, in an interview with Healthline, Dr. Clifford Segil, a neurologist at Providence Saint John’s Health Center in Santa Monica, CA, advised caution regarding these diseases.

“Neuroprotection remains an elusive statement, and multiple different types of medications have made claims of being neuroprotective. In the year 2024 there does not remain any pharmaceutical drug, vitamin, mineral or technique that has been proven to slow down neurodegeneration and prevent neurology diseases common in aging,” said Segil.

“I would be extremely concerned decreased food intake would worsen the overall health of Alzheimer’s Dementia patients who often have weight maintenance as an issue because they forget to eat,” Segil added.

But that doesn’t mean GLP-1 agonists don’t have any potential to help in the realm of neurology.

Other research has shown that these drugs might be useful for treating alcohol use disorder.

Excessive alcohol use causes 178,000 annual deaths in the United States each year, according to the CDC.

“The use of GLP-1 medication as a treatment for alcohol use is extremely promising, and in clinical practice, I have found it has helped an immense amount of patients. The early satiety with food decreased eating, and the early satiety to drinking has also been noted,” said Segil.

Takeaway

GLP-1 medications may help reduce the risk of several major causes of death, but it’s also important to remain appropriately cautious at this early stage.

“We need longer monitoring to ensure this is a safe medication for a more general population to take, but what we know so far certainly appears game-changing for a high risk cardiovascular group,” said Wei.

“I hope that future trials looking at GLP-1 agonists do a better job of recruiting a diverse population, and certainly more women,” Wei added.

“Other medications have had unexpected adverse effects, which post-marketing surveillance has noted. As the use of GLP-1/GIP medications surge in the US, post-marketing surveillance will hopefully identify unexpected adverse effects as it is designed to,” said Segil.

• U.S. Surgeon General Dr. Vivek Murthy called on Congress to put a warning label on social media platforms.
• Social media contributes to the mental health crisis among children and teens, Murthy said.
• Other actions would also be needed, including social media legislation aimed at protecting the safety and health of young people.

U.S. Surgeon General Vivek Murthy, M.D, is calling for Congress to put a warning label on social media platforms, stating that social media poses a harm to the mental health of children and teens.

“The mental health crisis among young people is an emergency — and social media has emerged as an important contributor,” Murthy said in an op-ed in The New York Times June 17.

Murthy cited research published in JAMA Psychiatry showing that teens who spend more than three hours a day using social media have double the risk of mental health problems, including depression and anxiety.

Other research found that 46% of adolescents said social media made them feel worse about their bodies, while 32% said social media negatively affected their grades in school.

American teens spend an average of 4.8 hours a day on social media platforms like TikTok, Instagram, and YouTube, according to a 2023 Gallup poll. Over half reported using social media for at least four hours per day, the poll shows.

What a warning label can do

A warning label, which would require congressional action, “would regularly remind parents and adolescents that social media has not been proved safe,” Murthy wrote in The New York Times.

Joseph Trunzo, PhD, a professor of psychology at Bryant University, said the Surgeon General’s proposal is a good move.

“I’m in support of anything we can do to raise awareness of the potential dangers of social media, particularly for our youth,” Trunzo told Healthline. However, “it’s hard to say how much impact this is going to have.”

Similar labels appear on tobacco and alcohol products. Tobacco studies show that warning labels increase people’s awareness of the harms of smoking and change behavior, Murthy said.

In 1965, Congress voted to require that cigarette packages distributed in the United States carry a warning that said that cigarette smoking “may be hazardous to your health.”

Smoking rates have dropped since then. In 1954, 45% of Americans were smokers; by last year it had dropped to 12%, Gallup data shows.

However, the tobacco warning label was “coupled with a huge public health campaign and other significant efforts to get people to reduce or quit smoking tobacco,” said Trunzo.

“So I don’t think a warning label, by itself, is going to solve the problem,” he said, “but it’s certainly a step in the right direction.”

Concerns of how social media can affect mental health

Murthy has previously raised concerns about the potential harms of social media to the mental health of children and teens. But his recent call for warning labels is the most urgent to date.

In May 2023, he issued an advisory that said that we don’t have enough information to show that social media is safe and “there is growing evidence that social media use is associated with harm to young people’s mental health.”

The advisory called on policymakers and technology companies to take steps to protect the safety and health of children and teens. It also suggested ways for parents and young people to support healthy social media use.

While his op-ed this week took a stronger stance, Murthy acknowledged that “a warning label would not, on its own, make social media safe for young people.”

He urged schools to become phone-free environments and suggested parents create phone-free zones around meals, bedtime, and social gatherings to protect their child’s sleep and in-person social connections. 

And he recommended that parents limit their child’s social media use until after middle school.

“This is much easier said than done, which is why parents should work together with other families to establish shared rules, so no parents have to struggle alone or feel guilty when their teens say they are the only one who has to endure limits,” Murthy wrote in The New York Times.

The end of push notifications and infinite scroll ?

Murthy called on Congress to pass legislation to protect young people from online abuse, harassment, and exposure to violent or sexual content. 

These laws should also restrict social media features that encourage excessive use of the apps, he wrote — like push notifications, infinite scroll, and autoplay.

“Social media platforms are designed to keep eyes on the screen,” said Trunzo, “to make sure that people continue to use their platform.”

New York state’s legislature passed a bill earlier this month that would block social media platforms from showing suggested posts — fed by the algorithm — to people under the age of 18. Instead, feeds for minors would default to chronological order. A minor could still get posts the algorithm suggests if they have parental consent.

Platforms would also be blocked from sending suggested post notifications to minors between midnight and 6 a.m. without consent from their parents.

Gov. Kathy Hochul is expected to sign the bill into law, AP News reported.

Other states have taken different approaches. Florida Governor Ron DeSantis signed a bill in March that prohibits children under 14 years from obtaining their own social media account, and requires parental consent in order for 14- and 15-year-olds to have their own account.

In the op-ed, Murthy also called on tech companies to share their data on the health effects of the platforms with the public and researchers, as well as to allow independent audits of their platform.

“While the platforms claim they are making their products safer, Americans need more than words,” Murthy wrote. “We need proof.”

Takeaway

In an op-ed in The New York Times, Surgeon General Dr. Vivek Murthy called on Congress to put a warning label on social media platforms, warning of the dangers to the mental health of children and teens.

Research shows that teens who use social media more often have a greater risk of mental health problems, including depression, anxiety and negative body image. On average, U.S. teens spend 4.8 hours a day on social media, Gallup research shows.

Murthy said a warning label will not, by itself, protect the mental health of children and teens. Other steps are needed, including phone-free zones in schools and at home, and legislation to limit the negative impact of social media on young people.

• New research finds that using GLP-1 drugs like Ozempic before bariatric surgery can help improve the health of people with extreme obesity.
• Extreme obesity is defined as having a body mass index (BMI) of 70 or more.
• In 2022, there were nearly 280,000 metabolic and bariatric surgeries in the United States.

People with extreme obesity can reduce their risk of complications from bariatric or metabolic surgery by taking GLP-1 drugs before the procedures, according to a study presented over the weekend at the American Society for Metabolic and Bariatric Surgery (ASMBS) 2024 Annual Scientific Meeting. The results of the study haven’t yet been published in a peer-reviewed scientific journal.

Extreme obesity, which is defined as having a body mass index (BMI) of 70 or more, presents patients and doctors with complications during and after weight-loss surgery compared to patients with lower BMIs. The research presented at the ASMBS meeting suggests that GLP-1 drugs like Ozempic, Wegovy, Zepbound, or Mounjaro can be the most effective way to lose that weight before undergoing such surgeries.

Taking multiple types of weight loss drugs was most effective

The study documented 113 patients with a BMI greater than 70 who attempted to lose weight ahead of metabolic and bariatric surgery with either medically supervised diet and exercise, one GLP-1 medication (mostly semaglutide), or multimodal therapy involving more than one GLP-1.

Patients were treated for an average of 72.9 days.

People taking multiple medications had the greatest percentage of total body weight loss (13.1%), followed by single GLP-1 therapy (8.14%) and diet and exercise (5.95%). BMI reductions were greatest in people who were treated for six to 12 months with combination drug therapy.

Who should be taking GLP-1 drugs before surgery?

John Morton, MD, professor of surgery (bariatric, minimally invasive) at the Yale School of Medicine and Yale Medicine bariatric surgeon, told Healthline that people considering such surgery should ultimately consult a healthcare professional in advance to determine what those risks are and how much weight they ultimately need to lose.

Morton was not involved in the study.

“I look for two things. One, their motivation: Why do they want to lose weight? I ask them that, and I also ask them how much weight they want to lose,” Morton said. “And to the degree that they’re fairly accurate with their weight-loss goals, then that tells me how ready they are and also if their motivations are appropriate—in other words, to improve their health or to interact more with their families or be more productive at work. I think the main takeaway from this study is we have a lot of options for people who have extra weight and you should go to accredited centers to help figure out what’s the best path forward.”

What are the risks of bariatric surgery?

Around 42% of adults in the United States have obesity, according to the Centers for Disease Control and Prevention, putting them at risk for inflammation, cancer, and type 2 diabetes.

Researchers have linked obesity to many health complications, some of which can be life threatening if not treated:

• type 2 diabetes
• heart disease
• high blood pressure
• certain cancers (breast, colon, and endometrial)
• stroke
• gallbladder disease
• fatty liver disease
• high cholesterol
• sleep apnea and other breathing problems
• arthritis
• infertility

In 2022, there were nearly 280,000 metabolic and bariatric surgeries in the United States. Morton said this type of surgery has risks but is overall quite safe.

“It has one of the safest safety records in surgery,” Morton said. “The mortality rate from bariatric surgery is less than hip or knee replacement or removal of a gallbladder.”

Morton added that losing 5-10% of total body weight can help with diabetes, blood-pressure or cholesterol issues, and 15% percent can help with problems like sleep apnea or fatty liver. But people with severe obesity need to lose more to counter the potential health problems that they face.

“If you want to reduce your risk from cancer associated with obesity, then you probably have to lose 25% of your total body weight,” Morton said. “Bariatric surgery affords you the most weight loss. And again, the risk is quite low. You do need to take into account the risk of doing nothing. And the risk of doing nothing carries significant risk. People who carry extra weight who are obese reduce their lifespan on the order of 10 to 15 years.”

Mir Ali, MD, board certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA, told Healthline that patients with BMI in the 60s or 70s have high risks for surgery because anesthesia can be difficult to configure, and moving a patient with that level of BMI during surgery can be complicated.

Ali was not involved in the study.

“The higher their BMI, the higher their risk,” Ali said. “But also recovery is harder when the patient is extremely large. So there’s a lot of different factors that go into play. So these medications can be used to have somebody lower their weight and reduce their surgical risks to some extent.”

“There’s no set number, it’s very much dependent on the patient, their body habitus, their age, general health, other risk factors,” Ali said. “We can have a pre-op evaluation by different specialists; they could see the anesthesiologist ahead of time to see if they’re acceptable [as far as] risks for their airway for the anesthesia. So it just depends on the patient. If they have more heart or lung factors, we might have them lose more weight.”

Takeaway

A study presented over the weekend suggested that for people with extreme obesity taking GLP-1 agonists like Ozempic or Wegovy before bariatric or metabolic surgery was the most effective method of losing weight to reduce surgical or recovery complications.

Extreme obesity is defined as having a body mass index of more than 70; it can lead to multiple health conditions and make anesthesia difficult to assess for bariatric surgery.

Experts say meeting with a doctor to tailor the appropriate plan for pre- and post-surgical approaches is ultimately the best plan for each patient.