Expert panelists discuss the essential role of primary care in early skin cancer detection, balancing clinical judgment with emerging AI artificial intelligence tools, and more.

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US obesity rates have shown a statistically significant decline for the first time in years, coinciding with a sharp rise in the use of GLP-1 receptor agonist drugs, according to new findings from Gallup’s National Health and Well-Being Index released this month.

After peaking at 39.9% in 2022, the adult obesity rate has dropped to 37.0%, a reduction representing approximately 7.6 million fewer adults classified as obese in just 3 years. This decrease follows the doubling in use of GLP-1 medications, such as semaglutide (brands Ozempic and Wegovy), prescribed specifically for weight loss since early 2024. The poll was based on surveys of 16,946 US adults during the first 3 quarters of 2025. 

Since February 2024, the proportion of adults using GLP-1 injections for weight loss increased from 5.8% to 12.4%. Use remains higher in women (15.2%) than men (9.7%), but rates have more than doubled in both groups over the past year.

Obesity rates dropped more in women (down 3.5 percentage points to 38.8%) than in men (down 2.3 points to 35.2%) since 2022, paralleling greater uptake of GLP-1 therapy among women.

The most notable declines in obesity occurred among adults:

Ages 40–49: down 4.3 points to 43.3%; 16.2% now use GLP-1 drugs for weight loss

Ages 50–64: down 5.0 points to 42.8%; 17.0% report using these medications

Minimal change was seen in the youngest adults and seniors, despite the latter population having the third-highest usage rate (11.1%) but reporting less weight loss benefit.

The data reveal a clear correlation, report authors noted: age groups with the highest GLP-1 usage rates show the greatest reductions in obesity. However, seniors present an anomaly. While their usage rate is the highest, at 11.1%, there is no observed corresponding reduction in obesity. "Previous Gallup research indicates that older Americans report significantly lower effectiveness from these medications compared with younger age groups," according to the report.

Another paradox of the findings, the percentage of Americans diagnosed with diabetes has reached 13.8%, the highest yet recorded in the Gallup surveys. Reductions in obesity have not yet yielded measurable declines in diabetes diagnoses, the researchers note, pointing out the reflection of diabetes as a lifetime disease. "Once diagnosed, patients remain in that category regardless of subsequent weight changes." Obesity continues to correlate with increased diabetes prevalence across all age groups, but is not the sole factor, authors added.

The survey also probed respondents' attitudes on the approval of GLP-1 drugs for weight loss and found signficant shifts in public opinion: 

Awareness of weight loss injectables soared to 89% nationally in 2025, up from 80% the previous year.

More than half (53%) of Americans see these drugs as helpful for those with obesity or weight-related conditions, although 62% oppose the use of semaglutide for people without such conditions.

GLP-1 medications are now covered by 13 states under Medicaid, with ongoing legislative efforts for broader coverage.

The sustainability of the obesity decline may depend on both improved access to pharmacotherapy and parallel progress in public health behaviors, authors suggested. Former users of GLP-1s report somewhat fewer obesity-related chronic conditions than current users, suggesting modest long-term benefit but not a replacement for healthier daily routines.

While GLP-1 uptake aligns with reduced obesity rates, the impact on new diabetes incidence remains unproven. The article cautions, "While GLP-1s support weight management, they should not be considered a cure-all for overall health or other disease states." Non-pharmacologic factors such as physical activity and healthy eating habits remain crucial for sustained health gains, and recent Gallup findings indicate that U.S. adults' overall health habits have declined compared to 2019. Genetic risk and sociodemographic differences continue to shape U.S. diabetes and obesity landscapes, as well. Considerations 

Gallup’s data draws from more than 16,900 adults surveyed in 2025. Obesity rates use self-reported height and weight, a method that may slightly underestimate true obesity rates due to social desirability, but nevertheless reflects consistent trend data. Since the initiation of ongoing Gallup measurement in 2008, US obesity rose by more than 14% through the era of COVID-19 before this recent downturn.

With nearly 9 in 10 Americans now aware of GLP-1 medications, 2025 may mark a transitional period both for clinical obesity management and national health strategy. Whether these advances translate into lasting improvement will depend on continued access, surveillance, and broader changes in public health behaviors, the authors concluded. 

 Witters D, James MP. Obesity rate declining in the US. Wellbeing. Gallup. October 2028, 2025. Accessed October 31, 2025. https://news.gallup.com/poll/696599/obesity-rate-declining.aspx

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Use of GLP-1 receptor agonists for weight loss has more than doubled since early 2024 while 7.6 million fewer US adults qualify as obese in 2025. 

US Obesity Rates Decline in Tandem With Rise in Use of GLP-1 RA, New Gallup Index Shows 

Postdoctoral Research Fellow, Mayo Clinic College of Medicine and Science, Jacksonville, FL

Dr. Regina Castaneda discusses new research on menopause and obesity pharmacotherapy.

TMS 2025: Regina Castaneda, MD, on Tirzepatide, Menopause, and Hormone Therapy

At The Menopause Society’s 2025 Annual Meeting, Regina Castaneda, MD, a postdoctoral research fellow at the Mayo Clinic College of Medicine and Science in Jacksonville, FL, presented new data on how menopausal stage and hormone therapy use may influence weight loss outcomes with tirzepatide. In this interview with 

, Dr Castaneda explains what prompted the study, how the findings compare with prior research on semaglutide, and why understanding the interplay between estrogen, reproductive stage, and GLP-1–based therapies could help clinicians personalize obesity treatment for midlife women.

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Researchers at the University of Chicago have developed a comprehensive mathematical model that predicts diabetes complications up to 15 years in advance, offering clinicians a powerful new tool to understand how early treatment decisions shape patient outcomes. 

The Diabetes Outcome Model of the US (DOMUS), published in Diabetes Care, draws on data from 129,000 patients with type 2 diabetes (T2D) and tracks 17 distinct complications, from traditional cardiovascular events to increasingly recognized conditions such as depression and dementia.

The model addresses a critical gap in diabetes care planning, the authors noted. Unlike existing prediction models that rely heavily on data from the United Kingdom Prospective Diabetes Study, which included minimal representation of African American, Asian, Latino, and American Indian populations, DOMUS uses real-world data from Kaiser Permanente Northern California's multiethnic patient population. "We wanted to build a model that represented the people we actually treat in the US--a socioeconomically and racially diverse population," lead researcher Neda Laiteerapong, MD, MS, professor of medicine and chief of general internal medicine at the University of Chicago, said in a statement. The cohort reflects the demographic diversity of contemporary US practice, with 74% White, 24% Asian, 17% Hispanic, and 9% Black patients, followed quarterly over 12 years.

Laiteerapong said the project began with a patient's simple question: does early treatment really matter? "I wanted to say, 'Yes, absolutely,' but I didn't have any evidence to support that," she recalled. "The challenge with diabetes is that the benefits of treatment, like controlling blood sugar, blood pressure, cholesterol, weight, or quitting smoking, often don't show up until many years later." The DOMUS model now provides that evidence. "First-year HbA1c did, in fact, help predict long-term complications. So yes, those early months matter," Laiteerapong said. First-year hemoglobin A1c emerged as a predictor for most long-term complications, suggesting that the initial months after diagnosis carry lasting consequences--a finding with clear implications for the "wait and see" approach some clinicians take with newly diagnosed patients.

The research team built DOMUS as a microsimulation model with quarterly cycles, tracking patient trajectories through four interconnected modules: diabetes medications, seven biomarker trajectories (including HbA1c, blood pressure, cholesterol levels, and body mass index [BMI]), 17 diabetes-related health outcomes, and mortality. The model predicts not only established complications such as end-stage kidney disease, myocardial infarction, stroke, and amputation, but also conditions that have gained prominence in diabetes care: atrial fibrillation, depression, and dementia.

To ensure accuracy, the team split their data into 3 samples for development (50%), calibration (25%), and validation (25%). The validation process demonstrated that simulated and empirical data aligned closely across biomarkers, events, and mortality predictions. Cumulative failure curves for all complications and deaths fell within the 95% confidence intervals of observed data, confirming the model's predictive accuracy across diverse patient subgroups.

The model incorporates social determinants of health alongside clinical factors. Neighborhood deprivation index appeared as a predictor in heart failure, ischemic heart disease, and foot ulcer equations. English language proficiency influenced risk for myocardial infarction, angina, atrial fibrillation, and nonproliferative retinopathy. These findings underscore how structural inequities shape diabetes outcomes independent of individual clinical characteristics.

Researchers used instrumental variable analysis to account for treatment selection bias, employing primary care physician prescribing patterns as instruments. This methodologic approach helps disentangle the effects of medications from the clinical factors that drive prescribing decisions. The model tracked 15 common medication regimens that represented 99.5% of treatment choices in the cohort.

The median follow-up time reached 21 quarters, generating 748,582 person-years of data. Annual event rates varied widely, from 0.0003 for blindness to 0.0181 for nonproliferative retinopathy. At baseline, 25% of patients had depression, 8% had ischemic heart disease, and 5% each had atrial fibrillation, angina, and myocardial infarction.

Among the model’s limitations the authors noted the Kaiser Permanente population tends to be healthier than the general US population, with participants more than 10% less likely to be overweight or have hyperlipidemia and 9% less likely to have hypertension compared with national averages. The system's commitment to equitable care may underestimate how structural inequity affects diabetes progression in other settings. Additionally, the cohort's medication patterns predate widespread use of GLP-1 receptor agonists and SGLT2 inhibitors, though the model's structure allows researchers to incorporate newer agents by adjusting biomarker equations based on clinical trial data.

The limited 13-year follow-up constrains extrapolation beyond this timeframe, though the researchers used current age rather than time since diagnosis to measure time in survival models, which should improve predictions outside the sample period. External validation in other healthcare systems represents an important next step.

"Historically, when we ask policy questions about diabetes, we often can't do it using real people in real time," Laiteerapong explained. "We have to estimate or simulate the outcomes using mathematical models." DOMUS offers researchers, policymakers, and health system managers a tool to evaluate how interventions affect population health and health disparities. The model can inform cost-effectiveness analyses, guide clinical decisions about treatment intensification, and help quantify the long-term value of diabetes prevention programs. As healthcare systems work to eliminate persistent racial and ethnic disparities in diabetes outcomes, the study authors concluded that DOMUS provides a foundation for understanding how early clinical decisions and social determinants combine to shape patient trajectories. "This model can be used by scientists, policymakers, and health system managers to better understand how choices can affect population health and health disparities, including the broad diversity of U.S. races and ethnicities," they wrote.

The model predicts 14 different T2D complications that can develop over ~15 years, and models how the disease progresses by predicting change in risk factors over time. 

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Inequities in MHT Prescribing Patterns Run Deep: A Conversation With Wake Forest's Anna Christine Cochrane, MD

Despite the fact that up to 80% of women experience menopause-related symptoms, a troubling gap exists in medical education and clinical practice.

 A 2023 survey of obstetrics and gynecology residency program directors found that only 31.3% of programs had a menopause curriculum, and when present, all programs reported 5 or fewer menopause lectures throughout the year, with 71% reporting 2 or fewer lectures annually.

These data directly reflect one clinician's experience

"I realized how little training [on menopause] I got during my residency to be able to provide my patients with good answers, to provide them with good treatment," Anna Caroline Cochrane, MD, said in an interview with 

 at The Menopause Society 2025 Annual Meeting, October 21-25. Cochrane said she was not prepared in her early clinical practice for the proportion of her patients who presented with menopause-related symptoms. "It's not something that we generally see a lot of during training."

This educational deficit has real-world consequences: hormone therapy prescribing rates in the United States have remained persistently low since the 2002 Women's Health Initiative study, with only 3.8% of ambulatory care visits by midlife and older women in 2018-2019 involving hormone therapy prescriptions.

"The historical teaching is just that hormones are bad and increase the risk of breast cancer, stroke, and clot. That's what we learn, Cochrane pointed out. Young clinicians don't look for additional training, she added, "Because if you're taught this is bad, don't prescribe it," why would you look further when your patient panel is full and there is so much else to do?

Cochrane decided to do her own research to learn more about how menopause hormone therapy is managed in the real world and how characteristics of the prescribing clinicians and the menopausal patients might influence that. She spoke in more detail about her decision to look more closely and deeply at a situation that could lead to harm. 

The following transcript has been lightly edited for style and flow. 

 What was the impetus behind your studies that looked at the prescriber- and patient-level factors that influence whether women receive evidence-based pharmacologic therapy for menopausal symptoms? 

 I finished my research fellowship just about three and a half years ago. As I've started my career and developed my practice, it has ended up being a lot more patients who come to me with menopause-related symptoms than I anticipated. It's not something that we generally see a lot of during training. In practice, it's been a lot more of my patient population, a lot more of the questions that people bring to me. And I realized how little training I got during my residency to be able to provide my patients with good answers, provide them with good treatment. There's been a lot of work that I've had to do after my residency to get that education for myself, to go out on my own to figure out what are the good resources for this, what is the correct information, how can I best provide my patients that evidence. And then I realized that's really hard to do as a full-time practicing physician, to seek out additional training.

The historical teaching is just that hormones are bad and increase the risk of breast cancer and stroke and clot. That tends to be what we learn. People don't pursue extra training in this. They don't go look into it more because if you're taught this is bad, don't prescribe it, why would you then look more into it later when there are so many other things pulling at us? As I've learned in my practice, this is affecting a large part of our population. In the absence of our being able to provide our patients with good information, they go elsewhere for it. They're going to other sources that may not include those evidence-based resources that we have the opportunity to provide.

It made me wonder how many of us are comfortable prescribing these medications, how many of us do prescribe these medications, are our patients getting it from us or are they not? And it made me think that the problem is probably really big and takes up a large part of our prescribing population, but I don't know that for sure. In order to solve any problem, you have to define that problem. That's what I wanted to do with this, start to look at what is the landscape of our prescribing patterns right now so that I could figure out are there places that I could work towards improvement with future research.

Allen JT, Laks S, Zahler-Miller C. Needs assessment of menopause education in United States obstetrics and gynecology residency training programs. 

. 2023;30(10):1002‑1005. doi:10.1097/GME.0000000000002234

Sobel TH, Lisha NE, Huang AJ. Menopause hormone therapy prescribing in ambulatory care visits among midlife and older U.S. women from 2018 to 2019. 

. 2024;184:107997. doi:10.1016/j.maturitas.2024.107997

Zahn K, Pittman A, Conklin J, Knittel A, Neal-Perry G. Disparities in menopausal care in the United States: a systematic review. 

. 2024;186:108021. doi:10.1016/j.maturitas.2024.108021

TMS 2025: Cochrane explains the impetus behind 2 studies she has authored on the patient- and provider-level factors that influence MHT prescribing. 